HIV/AIDS & Womens of Color: Roles of Drug Use, Violence & Insurance in HAART Use

描述（由申请人提供）：妇女中的艾滋病毒/艾滋病是一种流行病，对有色人种妇女的影响尤为严重。它反映了政治敏感问题（即种族、吸毒和性行为）的融合，这些问题难以理清和解决。自从1996年采用高效抗逆转录病毒疗法作为标准护理以来，艾滋病及其并发症的死亡率有所下降，但妇女的死亡率比男子低得多。先前的研究表明，艾滋病毒阳性的非裔美国妇女比白人妇女接受HAART治疗的可能性要小。几项全国性研究表明，非洲裔美国妇女在许多艾滋病护理标准方面的表现都不如白人男性。拟议的研究使用来自妇女机构间艾滋病毒研究（WIHS）机密数据集的数据，以1)评估种族和药物使用对HAART的作用是否被健康保险覆盖的影响所缓和；2)检查艾滋病毒阳性女性吸毒者中HAART使用的纵向差异，并调查个人潜在状态(由心理-社会或行为风险因素集群定义，如个人的药物使用，药物使用伙伴，在控制了其他混杂因素后，抑郁症（以及身体或性虐待）影响了种族/民族差异。许多研究已经评估了种族、性别、药物使用、保险范围以及身体或性虐待对艾滋病毒感染者使用医疗保健的独立影响，但对这些风险因素如何组合或聚集起作用知之甚少。采用了几种方法的改进，包括使用适合纵向数据和隐马尔可夫模型的分析方法来检查行为风险集群。研究结果将增进对吸毒、身体虐待或性虐待以及保险范围在观察到的艾滋病毒阳性妇女使用HAART的种族差异中所起作用的了解，并最终改进旨在减少妇女在艾滋病毒/艾滋病医疗保健方面的种族和其他差异的干预措施。研究结果还将为开发监测艾滋病毒阳性妇女护理质量的系统提供信息。

DESCRIPTION (provided by applicant): HIV/AIDS among women is an epidemic that disproportionately affects women of color. It reflects a convergence of politically sensitive issues (i.e., race, drug use, and sexual behavior) that are difficult to disentangle and address. Since the introduction of highly active antiretroviral therapy (HAART) as the standard of care in 1996, mortality rates from AIDS and its complications have declined, but at a much slower rate among women than men. Previous research indicates that HIV positive African American women are less likely than white women to receive HAART. Several national studies indicate that African American women fare worse than white men on a number of standards of HIV care. The proposed study uses data from the Women's Interagency HIV Study (WIHS) confidential data set to 1) assess whether the roles of race and drug use on HAART are moderated by the effects of health insurance coverage and 2) examine longitudinal differences in HAART use among HIV positive female drug users and investigate the extent to which individual latent states (as defined by clusters of psycho-social or behavioral risk factors such as an individual's drug use, drug using partners, depression, and physical or sexual abuse) influence racial/ethnic disparities after controlling for other confounders. Many studies have assessed the independent effects of race, gender, drug use, insurance coverage, and physical or sexual abuse on use of medical care by people with HIV, but little is known about how these risk factors operate in combination or clusters. Several methodological refinements are employed, including use of analytic methods appropriate for longitudinal data and Hidden Markov Models to examine behavioral risk clusters. Study results will improve understanding of the roles of drug use, physical or sexual abuse, and insurance coverage in observed racial disparities of HAART use among HIV positive women and ultimately, improve interventions aimed at reducing racial and other disparities in HIV/AIDS medical care among women. Findings will also inform development of systems for monitoring quality of care among HIV positive women.