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不成比例。它反映了政治敏感问题的趋同（即，种族、吸毒和性行为），这些问题很难解决。自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。以前的研究表明，艾滋病毒阳性的非洲裔美国妇女比白色妇女接受HAART的可能性更小。几项全国性研究表明，非洲裔美国妇女在一些艾滋病毒护理标准方面的表现比白色男子差。这项研究使用了来自妇女机构间艾滋病毒研究（WIHS）的机密数据集，以1）评估种族和药物使用对HAART的作用是否受到健康保险覆盖范围的影响，2）检查艾滋病毒阳性女性吸毒者HAART使用的纵向差异，并调查个体潜伏状态（如由心理社会或行为风险因素的集群定义，如个人的吸毒，吸毒伴侣，抑郁症，身体或性虐待）在控制其他混杂因素后影响种族/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服务的独立影响，但对这些风险因素如何组合或集群运作知之甚少。采用了几种方法上的改进，包括使用适合于纵向数据的分析方法和隐马尔可夫模型来研究行为风险群。研究结果将提高对药物使用、身体或性虐待以及保险覆盖率在观察到的艾滋病毒阳性妇女使用高效抗逆转录病毒疗法的种族差异中的作用的理解，并最终改善旨在减少妇女艾滋病毒/艾滋病医疗保健中种族和其他差异的干预措施。调查结果还将为制定监测艾滋病毒阳性妇女护理质量的制度提供信息。

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.