title: Access to HIV community services by vulnerable populations: evidence from an enhanced HIV/AIDS surveillance system.
abstract: HIV disproportionately affects vulnerable populations such as black and minority ethnic groups, men who have sex with men (MSM) and migrants, in many countries including those in the UK. Community organisations in the UK are charitable non-governmental organisations with a proportion of the workforce who volunteer, and provide invaluable additional support for people living with HIV (PLWHIV). Information on their contribution to HIV care in vulnerable groups is relatively sparse. Data generated from an enhanced HIV surveillance system in North West England, UK, was utilised for this study. We aimed to determine the characteristics of individuals who chose to access community services in addition to clinical services (1375 out of 4195 records of PLWHIV in clinical services). Demographic information, risk factors including residency status, uniquely gathered in this region, and deprivation scores were examined. Multivariate logistic regression modelling was conducted to predict the relative effect of patient characteristics on attendance at community services. Attendance at community services was highest in those living in the most, compared with least, deprived areas (p<0.001), and was most evident in MSM and heterosexuals. Compared to white UK nationals attendance was significantly higher in non-UK nationals of uncertain residency status (Adjusted odds ratio [AOR] = 21.91, 95% confidence interval [CI] 10.48-45.83; p<0.001), refugees (AOR = 5.75, 95% CI 3.3-10.03; p<0.001), migrant workers (AOR = 5.48, 95% CI 2.22-13.51; p<0.001) and temporary visitors (AOR = 3.44, 95% CI 1.68-7.05; p<0.001). Community services, initially established predominantly to support MSM, have responded to the changing demography of HIV and reach the most vulnerable members of society. Consequent to their support of migrant populations, community services are vital for the management of HIV in black and minority groups. Paradoxically, this coincides with increasing funding pressures on these services.
authors.affiliation: Centre for Public Health, Faculty of Health and Applied Social Sciences, Liverpool John Moores University, Liverpool, UK. h.c.madden@ljmu.ac.uk
authors.forename: H C E
authors.initials: HC
authors.lastname: Madden
authors.forename: P A
authors.initials: PA
authors.lastname: Phillips-Howard
authors.forename: S C
authors.initials: SC
authors.lastname: Hargreaves
authors.forename: J
authors.initials: J
authors.lastname: Downing
authors.forename: M A
authors.initials: MA
authors.lastname: Bellis
authors.forename: R
authors.initials: R
authors.lastname: Vivancos
authors.forename: C
authors.initials: C
authors.lastname: Morley
authors.forename: Q
authors.initials: Q
authors.lastname: Syed
authors.forename: P A
authors.initials: PA
authors.lastname: Cook
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000453:epidemiology; D000293:Adolescent; D000328:Adult; D001741:Black or African American; D000704:Analysis of Variance; D002648:Child; D002675:Child, Preschool; D003153:Community Health Services / Q000706:statistics & numerical data*; D004739:England / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000208:ethnology / Q000517:prevention & control*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D018451:Homosexuality, Male; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D014171:Transients and Migrants / Q000706:statistics & numerical data; D035862:Vulnerable Populations / Q000706:statistics & numerical data*; D055815:Young Adult