title: Once and future HIV treatment: a comparison of clinic and community groups.
abstract: The demographic, risk-taking, psychological, and social network characteristics of HIV+ patients receiving and not receiving antiretroviral therapy were compared to those characteristics in HIV+ and HIV- persons who are not in care. In this cohort study, we enrolled patients from the Grady Infectious Disease Program (IDP) Clinic in Atlanta, GA, defining group membership by their use of antiretroviral therapy at the time of ascertainment. We also enrolled HIV+ and HIV- persons from inner city neighbourhoods of Atlanta. We collected extensive survey information from both groups, as well as clinic and follow-up information from the Clinic groups. We attempted to interview each participant four times over a period of two years. We used scores for Risk, for Social Stress and for Psychological Distress to compare the groups. Persons receiving antiretroviral therapy continued to display risky behaviour and to experience a substantial degree of social stress and psychological distress. HIV+ persons in the community, however, had the most prominent profile for HIV-transmission risk, social stress, and psychological distress and display considerable cross-over in their patterns of risk-taking. Men who have sex with men appear to play a dominant role, through their risk behaviour and network affiliations, in the maintenance of HIV endemicity. Current approaches fail to give sufficient attention to the admixture of risk that occurs in inner city communities. Reaching HIV+ persons with antiretroviral therapy in such communities faces considerable social, structural, and psychological barriers that may be more important than simple adherence to medication.
authors.affiliation: Departmemnt of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, GA 30303, USA. rrothen@emory.edu
authors.forename: Richard
authors.initials: R
authors.lastname: Rothenberg
authors.forename: Peter E
authors.initials: PE
authors.lastname: Campos
authors.forename: Carlos
authors.initials: C
authors.lastname: del Rio
authors.forename: Wendell
authors.initials: W
authors.lastname: Johnson
authors.forename: Kimberly Jacob
authors.initials: KJ
authors.lastname: Arriola
authors.forename: Mark
authors.initials: M
authors.lastname: Brown
mesh_terms: D017677:Age Distribution; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D023241:Antiretroviral Therapy, Highly Active; D015331:Cohort Studies; D003151:Community Health Centers / Q000706:statistics & numerical data*; D004522:Educational Status; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D005845:Georgia / Q000453:epidemiology; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology; D006801:Humans; D007407:Interviews as Topic; D016015:Logistic Models; D008297:Male; D011329:Prisoners / Q000706:statistics & numerical data; D011569:Psychiatric Status Rating Scales; D012111:Residence Characteristics; D012309:Risk-Taking; D012725:Sexual Behavior / Q000706:statistics & numerical data; D012944:Social Support; D013315:Stress, Psychological / Q000453:epidemiology; D019966:Substance-Related Disorders / Q000453:epidemiology; D011795:Surveys and Questionnaires; D014505:Urban Population