Annotated Bib, post 9

Johnson, Erica N., Mollie P. Roediger, Michael L. Landrum, Nancy F. Crum-Cianflone, Amy C. Weintrob, Anuradha Ganesan, Jason F. Okulicz, Grace E. Macalino, and Brian K. Agan. “Race/Ethnicity and HAART Initiation in a Military HIV Infected Cohort.” AIDS Research & Therapy 11 (February 2014): 1.
Introduction

HIV has become a treatable illness in the era of highly active antiretroviral therapy (HAART), and HAART is associated with a reduction in morbidity and mortality among those with severe immunosuppression.

Certain groups still seem more vulnerable to issues, and those issues have persisted over time. In a U.S. study, 3 or more months of delay between the diagnosis and an initial specialty encounter happened more with African Americans, Latinos, and those who lacked access to diagnosis. Disparities are likely highly complex and multifactorial. They have been hypothesized from previous studies to include lack of education or health literacy (as we saw in source 8), lack of health insurance, or, as mentioned in other sources, aspects in the physician-provider relationship.

Methods
Population
The population of the study came from an ethnically diverse group of early-diagnosed HIV patients in the U.S. military. This group may offer less confounding due to the same free healthcare and medications, high school education, and a stable and similar income.
In the first analysis, participants were in the study from 1998-2009, did not have HAART before 1998, had HIV before going into service, and had a definite indication for HAART. To have a definite indication, patients had to have a CD4 cell (a type of white blood cell, to fight infection) count under 200, AIDS event, or severe symptoms.
Screening occurred at least every 6 months, as required by military policy. Those with more advanced HIV are evaluated more frequently (at least every 3-4 months).
Results
1262 participants were included, 94% being male. The average age was 33.8 years. 40% were white, 46% were black, 10% were Hispanic, and 5% was from other ethnic groups. The source says race/ethnicity and other demographics were not significantly associated with the timing of HAART. In the first group, there was no difference in the timing of HAART when one had an AIDS-defining condition, compared to those that had a low CD4 cell count.
Conclusion
The source states that a better understanding of psychosocial and systems-based factors might help with the elimination of treatment barriers and enable healthcare providers to give the best care to HIV patients. The lack of significant statistical difference is likely due to the similar factors in free healthcare and income, however, in the third group, which started HAART at higher CD4 cell counts without any indication, African Americans had a lower odds of starting. The source said that in other studies, differences in initiating HAART could be attributed to differences in healthcare access, racial discordance with the physician, feeling known by the provider, health literacy, and attitudes towards health. Previous sources I’ve reviewed discuss similar issues, especially involving the provider (in what was an extremely homophobic environment at one point) and, as described in source 8, health literacy and attitudes towards health.
Final Thoughts
This source discusses the different races and ethnicities involved in the military that are also infected with HIV. The memorialized veteran in my AIDS Quilt panel was likely a white male, and this source gives a better insight on the differences of diagnoses and health statistics between each race in the military. However, being in the military means having access to free healthcare, which, along with a similar and stable income, seemed to have removed disparities. The authors do admit their study’s limitations: a broad timeframe and research across five research sites can cause variation in practices. There is also limited data on the participants’ substance use, though, being in the military, it is assumed to be low. I chose this source to further explore healthcare in the military for those infected with HIV. This source attempted to examine differences in race/ethnicity of military members infected with HIV. This relates to other sources in acknowledging the similar factors that create delays or issues with receiving proper healthcare.

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