title: HIV/AIDS profile and realities at a regional antiretroviral therapy clinic in Jerusalem: 12 years analysis.
abstract: The diagnosis of HIV, quality of follow-up, and treatment among immigrants are greatly influenced by cultural factors and access to the healthcare system. Israel, an immigrant-based society, features 3 cardinal HIV-positive patient groups, namely non-immigrant Israelis, legal immigrants (mainly from Ethiopia), and illegal African work-immigrants. While the first 2 groups are covered by a national health insurance, the latter group depends on an unstructured system of antiretroviral therapy (ART) supply. In the early 1990s, a national mentoring programme was implemented for legal immigrants. The programme involves community-based Ethiopian mentors who follow HIV-positive Ethiopians. In this retrospective cohort study we reviewed the files of HIV-positive patients diagnosed between 1995 and 2007, focusing on comparison between HIV-positive non-immigrant populations with both legal Ethiopian immigrants and the often overlooked illegal immigrants. Our results point to a substantial rate of loss to follow-up among the illegal immigrants. When comparing non-immigrants to legal immigrants, both feature similar adherence to follow-up, exposure and response to ART, despite profound cultural differences. Our results suggest that ethnic-related obstacles in HIV diagnosis and treatment may be overcome by 'cultural mediators', yet, addressing the silent mass of HIV-positive illegal work-immigrants, who are deprived of such programme benefits, poses a major challenge to Western health authorities.
authors.affiliation: AIDS Center, Department of Clinical Microbiology and Infectious Diseases, Hadassah University Medical Center, Ein-Kerem, Jerusalem, Israel. hilaelinav@gmail.com
authors.forename: Hila
authors.initials: H
authors.lastname: Elinav
authors.forename: Keren Olshtain
authors.initials: KO
authors.lastname: Pops
authors.forename: David
authors.initials: D
authors.lastname: Shasha
authors.forename: Maya
authors.initials: M
authors.lastname: Korem
authors.forename: Michele
authors.initials: M
authors.lastname: Hauzi-Bashan
authors.forename: Zehava
authors.initials: Z
authors.lastname: Grossman
authors.forename: Shlomo
authors.initials: S
authors.lastname: Maayan
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000600:supply & distribution* / Q000627:therapeutic use; D015331:Cohort Studies; D024882:Drug Resistance, Viral; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data; D005002:Ethiopia / Q000208:ethnology; D005260:Female; D015658:HIV Infections / Q000208:ethnology* / Q000628:therapy; D006297:Health Services Accessibility; D054625:Healthcare Disparities / Q000208:ethnology*; D006801:Humans; D007557:Israel; D059012:Lost to Follow-Up; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D044966:Anti-Retroviral Agents