The Effects of Ethnicity on Continuity of HIV Care Among Recent Jail Releasees Público
Ridgway, Emily Avant (2013)
Abstract
In the United States, Hispanic Americans are diagnosed with HIV at over three times the rate non-Hispanic Americans (25.0 per 100,000 people versus 8.2). With the cultural, linguistic, and legal barriers that exist for the Hispanic and foreign-born communities in the U.S., access to ongoing HIV care is difficult for this vulnerable population. The EnhanceLink project, a ten-site study of HIV-positive jail inmates, examined the effects of ethnicity on successfully being linked to HIV-related care, defined as having clinical monitoring of CD4 counts or viral load tests, upon release from jail. Twenty-five percent of study participants self-identified as Hispanic. Among all participants, the median age was 43 years old, 72% were male or transgender, 85% were born in the United States, and 21% self-identified as white. Overall, this population had high levels of unemployment (79%), low levels of high school completion (49%), and the median number of lifetime arrests was 15; however, approximately 75% had some form of health insurance or benefits in either the 30 days prior to incarceration or the 30 days prior to their 6 month follow-up interview. When stratifying on ethnicity, Hispanics were less likely to be born in the United States than non-Hispanics (42% versus 99%), more likely to have less than a high school diploma or GED equivalent than non-Hispanics (64% versus 47%). Hispanics were more likely to be male or transgender individuals than non-Hispanics (80% versus 69%). After adjusting for confounders and other variables of interest, successful linkage to care was not significantly associated with self-identifying as Hispanic (aOR = 0.96, 95% CI 0.63-1.45). Successful linkage to care was, however, positively associated with being male or transgender, increasing age, the needs of HIV-related medical care having been assessed, and the study site. More research needs to be done to better understand the unique challenges and advantages that the Hispanic community faces, especially among subpopulations affected by the criminal justice system.
Table of Contents
Chapter One: Literature Review 1
Introduction 2
Incarcerated Populations 2
HIV/AIDS in Incarcerated Populations Chapter One: Literature Review 1
Introduction 2
Incarcerated Populations 2
HIV/AIDS in Incarcerated Populations 3
Characteristics of the Hispanic Population 4
HIV/AIDS in the Hispanic Population 5
HIV/AIDS in Incarcerated Hispanics 9
Conclusion 9
Chapter Two: Manuscript 11
Abstract 12
Introduction 13
Methods 15Results 17
Discussion 21
References 25Figures & Tables 28
Chapter Three: Conclusion 31
Summary 32
Public Health Implications 32
Possible Future Directions 32
Appendices 34
Emory Institutional Review Board (IRB) Amendment Letter 35
Electronic Thesis and Dissertation (ETD) Repository Submission Agreement Form 36
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