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Changes in demographics and risk factors among persons living with HIV in an academic medical center from 2003-2007.

Year: 2009

Type: article

Abstract: National epidemiological data indicate that the HIV epidemic in the United States has been continually changing since its initial recognition in 1981. There has been no decrease in the incidence of HIV infection in the US for over a decade, and over 55,400 individuals were newly infected with HIV in the US in 2007 (1). Of these new infections, 62% contracted their infection through sex with other men (MSM) compared with 44% a decade ago (2–3). Gradual annual increases in the proportion of incident infections in women in the US have been observed for the past 15 years, with the great majority acquired via heterosexual contact (2). During this period, the number of HIV infections attributable to injection drug use (IDU) for both men and women has dramatically declined, with estimates of a 42% overall reduction between 1994 and 2000 (4) and continued decreases in many areas through 2007 (5). There has been no significant improvement in the early diagnosis of HIV among newly infected individuals, either nationally or in Rhode Island, since the 1990s (6). The majority of data regarding changing trends have been available as statewide data from states with named-based reporting, with limited data from specific metropolitan areas. Such region-specific data will be essential in order to better respond to the needs of specific communities. This report utilizes the data from the Samuel and Esther Chester Immunology Center at The Miriam Hospital in Providence, RI, to track changes in demographics, risk factors, and clinical markers in order to evaluate the changing environment, and accessibility and adherence to care in the Rhode Island community. The Immunology Center is located on the campus of The Miriam Hospital (TMH), a non-profit Brown University teaching hospital. The Immunology Center is the largest HIV care provider in Rhode Island, with roughly 1,200 active HIV/AIDS patients in 2007, greater than 75% of the total known HIV/AIDS cases in the state. The proportion of Rhode Islanders known to be living with HIV who receive care at the Immunology Center has been consistently between 75 and 80% from 2003 through 2008. The Immunology Center was created in 1987. While the Center was originally designed to fill a gap in care for HIV-positive women, the composition of the clinic has gradually changed to reflect the demographics of the statewide epidemic. The Center now offers comprehensive health care for all Rhode Island residents living with HIV. Primary care and early intervention services have been largely supported through a federal Ryan White Part C (Title III) grant since 1994. In order to provide comprehensive care, the Center provides multiple supportive services onsite including free HIV counseling and testing (rapid blood and oral antibody testing), social services, appropriate laboratory testing, antiretroviral adherence training, limited psychiatric care, viral hepatitis testing and treatment, and a substance use treatment referral system. It has also served as the base site for multiple past and current controlled clinical trials through the NIH AIDS Clinical Trials Group, and the USPHS Centers for Disease Control and Prevention.

Source: PubMed