Identifying Barriers to Preventive Behaviors among People Living with HIV/AIDS in Rural and Urban Georgia Open Access

Mincey, Loree (Fall 2018)

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The development and dissemination of highly active antiretroviral therapy (HAART) have, in essence, changed HIV infection from a broadly fatal disease to a chronic condition. People living with HIV/AIDS (PLWHA) have seen a significant improvement in their morbidity, mortality, and life expectancy. As life expectancy rates among PLWHA increase, patients diagnosed with an HIV infection at an early age live into middle age with the disease, in some cases exceeding the lifespan of peers who are HIV negative. As these long-term survivors get older, they require appropriate preventative and age-appropriate early detection and cancer screenings, just as their HIV negative counterparts do. However, because of increased risk for certain conditions, PLWHA require even greater attention and interventions focused on preventing or reducing these conditions, such as cancer. The objective of this cross-sectional study was to determine this population’s awareness of perceived risks for cancer, barriers to preventative behaviors, benefits of preventive behaviors and screening if they were able to overcome the identified barriers, and current compliance with existing guidelines for cancer screenings in both rural and urban areas of Georgia A total sample of 178 participants were enrolled from two of the largest infectious disease clinics in Georgia. The mean age of participants was 48.75(±12.367) years; the majority was female (57%), African American (90%) and 65 % reported having a 12th grade or less education level. Data analysis showed that those seen at the rural site were significantly more likely to have received guideline-concordant screening for breast and cervical cancers compared to the urban site. Participants who pursued other types of preventive practices (e.g., flu immunization) were more likely to also pursue screening. Additionally, the data suggest that barriers to screening and preventive behaviors was associated with lack of knowledge concerning screening necessity, the cost of screenings, as well as lack of transportation to screening appointments. These data are critical for designing and testing the feasibility, acceptability, and efficacy of interventions to promote cancer screenings and preventive behaviors among PLWHA.

Table of Contents

Chapter I: Introduction. 1

Introduction and Rationale. 1

Problem Statement 3

Theoretical Framework. 3

Purpose Statement 5

Research Questions. 5

Significance Statement 6

Chapter II: Review of the Literature. 7

Introduction. 7

Historical Background. 7

HIV/AIDS in General 7

HIV/AIDS Malignancies. 8

AIDS Defining Cancers. 8

Non-AIDS Defining Cancers. 11

HIV/AIDS Statistics. 13

United States. 13

Urban and Rural Georgia. 13

Outcomes among HIV+ Malignancies. 14

Screening Guidelines for Non-AIDS Defining Cancers in HIV+ Individuals. 14

Review of Literature Related to the Health Belief Model Theoretical Frame work. 15

Chapter III: Methodology. 17

Introduction. 17

Study Design. 17

Sample Characteristics. 17

Data Collection Procedures. 18

Data Analysis. 18

Chapter IV: Results. 20

Introduction. 20

Key Findings. 20

Demographics. 25

Univariate comparison analysis of rural & urban sites among age appropriate eligible individuals for cancer screening types. 25

Univariate analysis for perceived barriers to preventative behaviors among PLWHA.. 26

Predictors of uptake of cancer screening behaviors. 27

Chapter V: Conclusion, Implications, Limitations, Recommendations. 30

Conclusion. 30

Results Summary. 30

Implications. 30

Relevance to Disparities. 30

Health Policy needs. 31

Educational needs. 31

Limitations. 31

Conclusions and Recommendations. 32

References. 34

Appendages. 38

List of Tables/Figures. 51

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