Drugs, gender and healthcare use among HIV+ homeless

描述（由申请人提供）：这是一项关于性别、住房状况、药物使用、精神疾病和卫生服务利用之间关系的研究，以及它们对艾滋病毒感染的边缘住房人群健康状况的影响。该研究的具体目的如下：1)检查一组感染艾滋病毒的无家可归者和边缘个体的卫生服务利用情况（即初级保健、药物治疗和精神卫生服务），并确定基线和28个月随访期间男女之间卫生服务利用模式的差异；2)检查一组感染艾滋病毒的无家可归者和边缘收容者的健康结果（身体和精神），并确定妇女在基线和28个月随访期间的健康结果与男子的差异程度；3)确定影响感染艾滋病毒的无家可归和边缘住房妇女在卫生服务利用和健康状况方面差异的易感因素、有利因素和需要因素。为了实现这些具体目标，将完成下列活动：1)在已有的队列中再征聘50名妇女，以便增加性别比较的统计能力；(2)在现有的REACH问卷中增加详细的吸毒、健康、受害、生存需求和卫生服务利用变量；(3)实施新的SCID诊断评估，全面评估心理健康状况；(4)利用电子卫生服务数据库开展新的效度研究；(5)针对这些感兴趣的新领域进行分析。只有通过增加这些新的活动才能实现所提议的具体目标，这些活动最终将产生一类新的分析。对性别、药物使用、精神疾病、保健服务使用、获得食物等相互竞争的需求和健康状况的影响和相互作用进行详细研究，将有助于更好地了解受艾滋病毒感染的边缘住房个人的持续死亡率，并为在各种环境中进行更有效的保健干预奠定基础。

DESCRIPTION (provided by applicant): This is a study of the relationships between gender, housing status, drug use, mental illness and health service utilization, as well as their impact on health status in a population of HIV-infected marginally housed individuals. The specific aims of the study are as follows: 1) To examine health service utilization (i.e., primary care, drug treatment, and mental health services) in a cohort of HIV-infected homeless and marginally individuals, and to determine differences in the patterns of health service utilization between women and men at baseline as well as over a 28 month follow-up period; 2) To examine health outcomes (physical and mental) in a cohort of HIV-infected homeless and marginally housed individuals, and to determine the extent to which women experience differences in health outcomes from men at baseline as well as over a 28 month follow-up period; and 3) To determine predisposing, enabling, and need factors influencing the differences that HIV-infected homeless and marginally housed women experience in health service utilization and health status. To achieve these specific aims, the following activities will be accomplished: 1) recruit an additional 50 women into a preexisting cohort in order to increase statistical power for gender comparisons; (2) add detailed drug use, health, victimization, subsistence needs, and health service utilization variables to the existing REACH questionnaire; (3) implement a new SCID diagnostic assessment to thoroughly assess mental health; (4) employ the use of electronic health service databases to conduct new validity studies; and (5) conduct analyses specific to these new areas of interest. Achieving the proposed specific aims will only be possible with the addition of these new activities that will ultimately yield a new class of analyses. A detailed study of the impact and interactions of gender, drug use, mental illness, health service use, competing needs like access to food, and health status will lead to a better understanding of ongoing mortality among HIV-infected marginally housed individuals and create the foundation for more effective health interventions in a variety of settings.