Abstract
Improved HIV/AIDS outcomes and decreased mortality due to treatment with highly active antiretroviral therapy (HAART) in the USA have not benefited minorities to the same extent as whites.1,2 HIV/AIDS is one of the largest contributors to the gap in life expectancy between blacks and whites in the USA, because of disproportionate HIV infection rates as well as higher HIV-related death rates, which have persisted in the post-HAART era.1 Furthermore, HIV/AIDS is one of the key clinical areas in which disparities were found and documented in the Institute of Medicine report on health care disparities, “Unequal Treatment”.3
In addition, many other challenges and barriers may impede and complicate efforts to provide optimal care for minority persons living with HIV/AIDS in the USA. These include the competing life issues of patients who are living in poverty, such as joblessness and housing instability. For many women, the challenges can include domestic violence as well. Mental health issues and substance abuse also are prevalent in patients with HIV/AIDS and often serve as major barriers to effective treatment.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Centers for Disease Control and Prevention, HIV/AIDS Surveillance Report. 2006; 18: 1–56
Wong MD, Shapiro MF, Boscardin WJ, Ettner SL. Contribution of major diseases to disparities in mortality. N Engl J Med 2002; 347(20): 1585–1592
Smedley BD, Stith AY, Nelson AR. Institute of Medicine. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. National Academy Press, Washington, D.C., 2002
Centers for Disease Control and Prevention. Racial/ethnic disparities in diagnoses of HIV/AIDS – 33 states, 2001–2005. MMWR 2007; 56(09): 189–193
Moore R, Stanton D, Gopalan, R. Racial differences in the use of drug therapy for HIV disease in an urban community. N Engl J Med 1994; 330(11): 763–768
Weissman JS, Makadon HI, Seage, GR. Changes in insurance status and access to care by persons with AIDS in the Boston Health Study. Am J Public Health 1994; 84: 1997–2000
Mor V, Fleishman JA, Dresser, M. Variation in health service among HIV infected patients. Med Care 1992; 30(1): 17–29
Shapiro MF, Morton SC, McCaffrey, DF Variations in the care of HIV-infected adults in the United States. JAMA 1999; 281: 2305–2315
Turner BJ, Cunningham WE, Duan, N. Delayed medical care after diagnosis in a U.S. national probability sample of persons infected with HIV. Arch Intern Med 2000; 160: 2614–2622
King WD, Wong MD, Shapiro, MF. Does racial concordance between HIV-positive patients and their physicians affect the time to receipt of protease inhibitors? J Gen Intern Med 2004; 19: 1146–1153
Stone VE, Steger KA, Hirschhorn LR et al. Access to Treatment with Protease Inhibitor Containing Regimens: Is it Equal For All? [Abstract #42305] Paper presented at the 12th World AIDS Conference. Geneva, Switzerland: June 28–July 3, 1998
Anastos K, Schneider ME, Gange SJ, Minkoff. Association of race, sociodemographic, and behavioral characteristics with response to HAART in women. J Acquir Immune Defic Syndr 2005; 39(5): 537–544
Anderson RM, Bozzette AM, Shapiro, MF. Access of vulnerable groups to antiretroviral therapy among persons in care for HIV disease in the US. Health Serv Res 2000; 35(2): 389–416
Cohen MH, Cook JA, Grey D,. Medically eligible women who do not use HAART: The importance of abuse, drug use, and race. Am J Public Health 2004; 94(7): 1147–1151
Cunningham WE, Mardson LW, Andersen, RM. Prevalence and predictors of highly active antiretroviral therapy use in patients with HIV infection in the United States. J Acquir Immune Defic Syndr 2000; 25(2): 115–123
Gebo KA, Fleishman JA, Conviser, R. Racial and gender disparities in receipt of highly active antiretroviral therapy persist in a multistate sample of HIV patients in 2001. J Acquir Immune Defic Syndr 2005; 38(1): 96–103
Losina E, Schackman B, Sadownik S, et al. Disparities in Survival Attributable to Suboptimal HIV Care in the U.S.: Influence of Gender and Race/Ethnicity [Abstract #142]. Paper Presented at the 14th Conference on Retroviruses and Opportunistic Infections. Los Angeles: February 25–28, 2007
Pallela F, Baker R, Chmiel J, et al. Higher Adjusted Mortality Rates Among Publicly Insured Patients and Blacks in the HIV Outpatient Study [Abstract #530]. Paper Presented at the 15th Conference on Retroviruses and Opportunistic Infections. Boston: February 3–6, 2008
Lemly D, Shepherd B, Hulgan T, et al. Race and Sex Differences in HAART Use and Mortality Among HIV-Infected Persons in Care [Abstract #810]. Paper Presented at the 15th Conference on Retroviruses and Opportunistic Infections. Boston: February 3–6, 2008
Byrd WM, Clayton LA. An American health dilemma. Volume I: A Medical History of African Americans and the Problem of Race – Beginnings to 1900. Routledge, New York, 2000
Corbie-Smith G, Thomas SB, St. George DMM. Distrust, race, and research. Arch Intern Med 2002; 162: 2458–2463
Armstrong K, Ravenell KL, McMurphy S, Putt M. Racial/ethnic differences in physician distrust in the United States. Am J Public Health 2007; 97(7): 1283–1288
Guendelman SW, Denny C, Mauldon J, Chetkovich C. Perceptions of hormonal contraceptive safety and side effects among low-income Latina and non-Latina women. Matern Child Health J 2000; 4(4): 233–239
Thomas SB, Quinn SC. The Tuskegee Syphilis Study: Implications for HIV education and AIDS risk education programs in the black community. Am J Public Health 1991; 81: 1497–1504
Gant LM, Green W, Stewart PA, Wheeler DP, Wright EM. HIV/AIDS and African Americans: assumptions, myths and realities. In: Gant LM, Stewart PA, Lynch VJ, eds. Social Workers Speak out on the HIV/AIDS Crisis. Praeger, Westport, CT, 1998, pp. 1–12
Safren SA, Radomsky AS, Otto MW, and Salomon E. Predictors of psychological well-being in a diverse sample of HIV-positive patients receiving highly active antiretroviral therapy. Psychosomatics 2002; 43(6): 478–485
Carrillo JE, Green AR, Betancourt JR. Cross-cultural primary care: a patient-based approach. Ann Intern Med 1999; 130: 829–834
Henry J. Kaiser Family Foundation. African Americans and HIV/AIDS, 2001
Sayles JN, Ryan GW, Silver JS, Sarkasian CA, Cunningham WE. Experiences of social stigma and implications for healthcare among a diverse population of HIV positive adults. J Urban Health 2007; 84(6): 814–828
Washington DL, Bowles J, Saha S,. Transforming clinical practice to eliminate racial-ethnic disparities in healthcare. J Gen Intern Med 2008; 23(5): 685–691
Stone VE, Weissman JS, Cleary P. Satisfaction with ambulatory care of persons with AIDS: Predictors of patient ratings of quality. J Gen Intern Med 1995; 10: 239–245
Stein MD, Fleishman J, Mor V, Dresser M. Factors associated with patient satisfaction among symptomatic HIV-infected persons. Med Care 1993; 31: 182–188
Collins KS, Hughes DL, Doty MM. Diverse communities, common concerns: Assessing health care quality for minority Americans. The Commonwealth Fund, New York, 2002
Cooper-Patrick L, Gallo JJ, Gonzales JJ,. Race, gender and partnership in the patient-physician relationship. JAMA 1999; 282: 583–589
Warde C. Time is of the essence. J Gen Intern Med 2001; 16: 712–713
Angelino A, Willard S. The need for sociocultural awareness to maximize treatment acceptance and adherence in individuals initiating HIV therapy. J Int Assoc Physicians AIDS Care 2008; 7(Suppl 1): S17–S21
Giordana TP, Gifford AL, White AC,. Retention in care: A challenge to survival with HIV infection. Clin Infect Dis 2007; 44: 1493–1499
Lucas GM, Chaisson RE, Moore RD. Highly active antiretroviral therapy in a large urban clinic: risk factors for virologic failure and adverse drug reactions. Ann Intern Med 1999; 131: 81–87
Bakken S, Holzemer WL, Brown MA,. Relationships between perception of engagement with health care provider and demographic characteristics, health status, and adherence to therapeutic regimen in persons with HIV/AIDS. AIDS Patient Care and STDs 2000; 14: 189–197
Schneider J, Kaplan SH, Greenfield S, Li W, Wilson IB. Better physician-patient relationships are associated with higher reported adherence to antiretroviral therapy in patients with HIV infection. J Gen Intern Med 2004; 19: 1096–1103
Malcolm SE, Ng JJ, Rosen RK, Stone VE. An examination of HIV/AIDS patients who have excellent adherence to HAART. AIDS Care 2003; 15: 251–261
Dugdale DC, Epstein R, Pantilat SZ. Time and the patient-physician relationship. J Gen Intern Med 1999; 14(Suppl 1): S34–S40
Mugavera MJ, Lin H, Allison JJ,. Failure to establish HIV care: characterizing the “no show” phenomenon. Clin Infect Dis 2007; 45: 127–130
Stone VE, Clarke J, Lovell J,. HIV/AIDS patients’ perspectives on adhering to regimens containing protease inhibitors. J Gen Intern Med 1998; 13(9): 586–593
Bangsberg DR, Hecht FM, Clague H,. Provider assessment of adherence to HIV antiretroviral therapy. J Acquir Immune Defic Syndr 2001; 26(5): 435–442
Sontag S. Doctors withhold potent HIV treatments from some. New York Times. March 17, 1997, pp. 1A, 34A
Bogart LM, Catz SL, Kelly JA, Benotsch EG. Factors influencing physicians' judgements of adherence and treatment decisions for patients with HIV. Med Decis Making 2001; 21: 28–36
Bogart LM, Kelly JA,. Impact of medical and nonmedical factors on physician decision making for HIV/AIDS antiretroviral treatment. J Acquir Immune Defic Syndr 2000; 23(5): 396–404
Wong MD, Cunnigham WE, Shapiro MF,. Disparities in HIV treatment and physician attitudes about delaying protease inhibitors for non-adherent patients. J Gen Intern Med 2004; 19(4): 366–374
Golin CE, Liu H, Hays RD,. A prospective study of predictors of adherence to combination antiretroviral medication. J Gen Intern Med 2002; 17(10): 756–765
Silverberg M, Leyden W, Quesenberry C, Horberg M. Influence of Race/Ethnicity on Adherence to and Effectiveness of Antiretroviral Therapy in Patients with Access to Care [Abstract WePeB107]. Abstract Presentation at the 4th IAS Conference on HIV Pathogenesis, Treatment and Prevention. Sydney, July 25, 2007.
Kalichman SC, Ramachandran B, Catz S. Adherence to combination antiretroviral therapies in HIV patients of low literacy. J Gen Intern Med 1999; 14(5): 267–273
Turner BJ. Adherence to antiretroviral therapy by HIV infected patients. J Infect Dis 2002; 185(Suppl 2): S143–S151
Vervoot S, Borleffs, Hoepelman A, Grypdonck MHF. Adherence in antiretoviral therapy for HIV: a review of qualitative studies. AIDS 2009; 21(3): 271–281
Wong MD, Sarkisian CA, Davis C, Kinsler J, Cunningham WE. The association between life chaos, health care use, and health status among HIV-infected persons. J Gen Intern Med 2007; 22: 1286–1291
Stone VE. Strategies for optimizing adherence to highly active antiretroviral therapy (HAART). Clin Infect Dis 2001; 33(6): 855–872
Department of Health and Human Services. Guidelines on Treatment of HIV/AIDS in Adults and Adolescents. Updated January 28, 2008. Accessed online at http://www.hivatis.org
Simoni JM, Pearson CR, Pantalone DW, Marks G, Crepaz N. Efficacy of interventions in improving highly active antiretroviral therapy adherence and HIV-1 RNA viral load. J Acquir Immune Defic Syndr 2006; 43(Suppl 1): S23–S35
Willard S, Angelino, A. The need for sociocultural awareness to maximize treatment acceptance and adherence in individuals initiating HIV therapy. J Int Assoc Physicians AIDS Care 2008; 7(1): S17–S21
Enriquez M, Gore PA, O'Connor MC, McKinsey DS. Assessment of readiness for adherence by HIV positive males who had previously failed treatment. J Assoc Nurses AIDS Care 2004; 15: 42–49
Treisman GJ, Angelino AF, Hutton HE. Psychiatric issues in the management of patients with HIV infection. JAMA 2001; 286: 2857–2864
Angelino AF, Treisman GJ. Management of psychiatric disorders in patients infected with human immunodeficiency virus. Clin Infect Dis 2001; 33: 847–856
Horberg MA, Silverberg MJ, Hurley LB,. Effects of depression and selective serotonin reuptake inhibitor use on adherence to highly active antiretroviral therapy and on clinical outcomes in HIV-infected patients. J Acquir Immune Defic Syndr 2008; 47(3): 384–390
Turner BJ, Laine C, Cosler L, Hauck WW. Relationship of gender, depression, and health care delivery with antiretroviral adherence in HIV-infected drug users. J Gen Intern Med 2003; 18: 248–257
Lucas GM, Cheever LW, Chaisson RE,. Detrimental effects of continued illicit drug use on the treatment of HIV-1 infection. J Acquir Immune Defic Syndr 2001; 27: 251–259
Arnsten JH, Demas PA, Grant RW,. Impact of active drug use on antiretroviral therapy adherence and viral suppression in HIV-infected drug users. J Gen Intern Med 2002; 17: 377–381
Cook RL, Sereika SM,. Problem drinking and medication adherence among persons with HIV infection. J Gen Intern Med 2001; 16(2): 83–88
Altice FL, Maru DS, Bruce RD, Springer SA, Friedland GH. Superiority of directly administered antiretroviral therapy among HIV-infected drug users: a prospective, randomized, controlled trial. Clin Infect Dis 2007; 45(6): 770–778
Mitty JA, Stone VE, Sands M, Macalino G, Flanigan T. Directly observed therapy for the treatment of people with human immunodeficiency virus infection: a work in progress. Clin Infect Dis 2002; 34: 984–990
Flanigan TP, Mitty JA. The good, the bad and the ugly: providing highly active antiretroviral therapy when it is most difficult. Clin Infect Dis 2006; 42: 1636–1638
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2009 Springer Science+Business Media, LLC
About this chapter
Cite this chapter
Stone, V.E. (2009). Overcoming Challenges to Successful Treatment Outcomes in Minority Patients with HIV/AIDS. In: Stone, V., Ojikutu, B., Rawlings, M., Smith, K. (eds) HIV/AIDS in U.S. Communities of Color. Springer, New York, NY. https://doi.org/10.1007/978-0-387-98152-9_4
Download citation
DOI: https://doi.org/10.1007/978-0-387-98152-9_4
Published:
Publisher Name: Springer, New York, NY
Print ISBN: 978-0-387-98151-2
Online ISBN: 978-0-387-98152-9
eBook Packages: MedicineMedicine (R0)