Spatial Inequities and Health Disparities among American Indians and Alaska Natives
Tommi L. Gaines, DrPH
January 26th, 2018
UCSD HIV & Global Health Round
HIV in Emergencies: From research to strategies, policies and resultsHopkinsCFAR
This document discusses HIV in emergency settings and outlines research conducted from 2001 to present on this topic. It begins with assumptions and outlines research conducted on HIV prevalence, the magnitude of the issue, behavioral change and communication, and antiretroviral therapy adherence. It then discusses strategies, policies, and results, including increasing inclusion of refugees in national HIV plans, more refugees accessing antiretroviral therapy, and decreased high-risk sexual behavior. The document also summarizes several studies conducted on HIV prevalence in conflict-affected populations, behavioral surveillance surveys, and antiretroviral adherence.
The 2007 AIDS Epidemic Update from UNAIDS and WHO provides revised estimates of the global HIV/AIDS epidemic due to improvements in estimation methodologies. Key findings include:
- The estimated number of people living with HIV decreased 16% to 33.2 million, largely due to changes in India's estimates.
- Global HIV prevalence has stabilized at around 0.8% since 2001, though localized declines are occurring in some countries.
- Estimated new HIV infections in 2007 were 2.5 million, declining from a peak of over 3 million in the late 1990s likely due to prevention efforts.
- AIDS deaths in 2007 were estimated at 2.1 million, showing declines in recent years partly
A Post-Census Mortality Survey to Capture HIV/AIDS Deaths MEASURE Evaluation
A post-census mortality survey was conducted in Mozambique to accurately measure HIV/AIDS and other cause-specific mortality rates at the national and sub-national levels. The survey used a stratified random sample of households that reported a death in the previous year from the 2007 census. Trained doctors reviewed verbal autopsy questionnaires to assign causes of death. Results showed HIV/AIDS as a leading cause of death and varying HIV/AIDS mortality rates across provinces. The survey provides important data for health planning and measuring impact of interventions.
HIV/AIDS affects persons from Sub-Saharan Africa and men who have sex with men (MSM) in a disproportionate way. This article analyzes the evidence and the plausibility of anogenital anatomical factors which may contribute to the HIV/AIDS pandemic in the key populations for sexual transmission. The etiology of the pandemic is discussed. Direct and indirect evidence for narrow anogenital anatomy is presented. Two semi-theoretical arguments for anatomical factors are put forward. Anogenital anatomy is analyzed in view of Hill's criteria for causation. I describe how randomized controlled trials and other confirmatory studies could be designed and discuss the consequences of the hypothesis. While many contributing factors for the HIV/AIDS pandemic are well established, direct and indirect empirical evidence, as well as semi-theoretical arguments, militates for an additional role of macroscopic anogenital anatomy in HIV key populations. This factor fulfills Hill's criteria.
This presentation discusses Kenya's key populations program. It defines key populations as female sex workers, injecting drug users, and men who have sex with men. It notes that these groups account for 1/3 of new HIV infections in Kenya and have much higher HIV prevalence than the general population. The presentation outlines Kenya's combination prevention approach, which includes biomedical, behavioral, and structural interventions. It discusses challenges like stigma, violence, and political opposition faced by key populations. It also presents strategies to address challenges, considerations for replicating the program, and the need to scale up comprehensive interventions to reduce new HIV infections.
Cameroon has a HIV prevalence rate of 4.3% nationally, ranging from 1.2-7.2% by region. Women have a higher prevalence of 5.6% compared to 2.9% for men. Challenges include stigma and discrimination faced by 70% of PLWHA, stockouts leading to only 33% of eligible adults and 34% of children accessing ARVs, and underfunding with only 55% of needed resources mobilized from 2011-2013. Priority interventions include behavior change communication, condom usage, voluntary counseling and testing, PMTCT, STDs, and expanding access to ARVs. Some progress has been made with increased condom distribution, 57% coverage of PMTCT among
HIV in Emergencies: From research to strategies, policies and resultsHopkinsCFAR
This document discusses HIV in emergency settings and outlines research conducted from 2001 to present on this topic. It begins with assumptions and outlines research conducted on HIV prevalence, the magnitude of the issue, behavioral change and communication, and antiretroviral therapy adherence. It then discusses strategies, policies, and results, including increasing inclusion of refugees in national HIV plans, more refugees accessing antiretroviral therapy, and decreased high-risk sexual behavior. The document also summarizes several studies conducted on HIV prevalence in conflict-affected populations, behavioral surveillance surveys, and antiretroviral adherence.
The 2007 AIDS Epidemic Update from UNAIDS and WHO provides revised estimates of the global HIV/AIDS epidemic due to improvements in estimation methodologies. Key findings include:
- The estimated number of people living with HIV decreased 16% to 33.2 million, largely due to changes in India's estimates.
- Global HIV prevalence has stabilized at around 0.8% since 2001, though localized declines are occurring in some countries.
- Estimated new HIV infections in 2007 were 2.5 million, declining from a peak of over 3 million in the late 1990s likely due to prevention efforts.
- AIDS deaths in 2007 were estimated at 2.1 million, showing declines in recent years partly
A Post-Census Mortality Survey to Capture HIV/AIDS Deaths MEASURE Evaluation
A post-census mortality survey was conducted in Mozambique to accurately measure HIV/AIDS and other cause-specific mortality rates at the national and sub-national levels. The survey used a stratified random sample of households that reported a death in the previous year from the 2007 census. Trained doctors reviewed verbal autopsy questionnaires to assign causes of death. Results showed HIV/AIDS as a leading cause of death and varying HIV/AIDS mortality rates across provinces. The survey provides important data for health planning and measuring impact of interventions.
HIV/AIDS affects persons from Sub-Saharan Africa and men who have sex with men (MSM) in a disproportionate way. This article analyzes the evidence and the plausibility of anogenital anatomical factors which may contribute to the HIV/AIDS pandemic in the key populations for sexual transmission. The etiology of the pandemic is discussed. Direct and indirect evidence for narrow anogenital anatomy is presented. Two semi-theoretical arguments for anatomical factors are put forward. Anogenital anatomy is analyzed in view of Hill's criteria for causation. I describe how randomized controlled trials and other confirmatory studies could be designed and discuss the consequences of the hypothesis. While many contributing factors for the HIV/AIDS pandemic are well established, direct and indirect empirical evidence, as well as semi-theoretical arguments, militates for an additional role of macroscopic anogenital anatomy in HIV key populations. This factor fulfills Hill's criteria.
This presentation discusses Kenya's key populations program. It defines key populations as female sex workers, injecting drug users, and men who have sex with men. It notes that these groups account for 1/3 of new HIV infections in Kenya and have much higher HIV prevalence than the general population. The presentation outlines Kenya's combination prevention approach, which includes biomedical, behavioral, and structural interventions. It discusses challenges like stigma, violence, and political opposition faced by key populations. It also presents strategies to address challenges, considerations for replicating the program, and the need to scale up comprehensive interventions to reduce new HIV infections.
Cameroon has a HIV prevalence rate of 4.3% nationally, ranging from 1.2-7.2% by region. Women have a higher prevalence of 5.6% compared to 2.9% for men. Challenges include stigma and discrimination faced by 70% of PLWHA, stockouts leading to only 33% of eligible adults and 34% of children accessing ARVs, and underfunding with only 55% of needed resources mobilized from 2011-2013. Priority interventions include behavior change communication, condom usage, voluntary counseling and testing, PMTCT, STDs, and expanding access to ARVs. Some progress has been made with increased condom distribution, 57% coverage of PMTCT among
This document provides information from the HIV and AIDS Data Hub for Asia-Pacific on data availability and population size estimates of people who inject drugs, men who have sex with men, transgender people, and male sex workers across several countries in Asia and the Pacific region. It includes tables and charts with the countries where data is available from sentinel surveillance surveys, behavioral surveys, and population size estimates. It also provides references for the estimates and surveys.
This document summarizes emerging trends in HIV/AIDS in Kenya and globally. It provides key statistics on HIV prevalence rates over time in Kenya, showing a decline from 13.4% in 1999 to 5.6% in 2012. It also breaks down prevalence by age, region, and residence. The majority (57%) of new HIV infections in Sub-Saharan Africa are among women. Marginalized groups like men who have sex with men and sex workers have very high prevalence rates over 25% but face legal and social barriers to accessing health services. The document reviews strategies and terminology around HIV prevention, treatment, and awareness of HIV status.
This document provides guidelines for conducting population-based surveys to measure national HIV prevalence. It outlines how to plan and implement a new national survey, incorporate HIV testing into existing surveys, and calculate a national HIV prevalence estimate by combining data from surveys and sentinel surveillance. Population-based surveys can provide more representative HIV prevalence data than sentinel surveillance alone. The guidelines aim to help countries obtain accurate national estimates by adjusting prevalence measures from different data sources and accounting for biases.
This study analyzed the correlation between tuberculosis (TB) and human immunodeficiency virus (HIV) infections at the census tract level in Harris County, Texas from 2009-2010. The authors found that census tracts with higher percentages of poverty, Black residents, and foreign-born residents had above average rates of both HIV and TB. Logistic regression also showed these factors were associated with higher odds of co-infection of HIV/TB. The authors conclude targeted testing and education programs should focus on areas with these high-risk demographic characteristics.
Sex work and HIV incidence in South Africa: what do we know?SWEATSlideShare
Presentation by Tshepo Molapo, at the National Sex Work Symposium, in the session 'What we know: evidence-based peer reviewed knowledge on sex work' (Boksburg, 22 August 2012).
Dr. Kathleen Brady of Philadelphia's AIDS Activities Coordinating Office (AACO) gave this presentation at the January 9, 2013 Comprehensive Planning Committee meeting.
IRJET- Epidemiology of Parkinson’s Disease in AfricaIRJET Journal
This document summarizes a review paper on the epidemiology of Parkinson's disease in Africa. The review examined 30 publications from 13 African countries. It found that overall prevalence and incidence rates in African regions are lower than American and European populations. No significant differences in prevalence were seen between men and women. Management of Parkinson's disease in most African regions is generally lacking, with deficiencies in diagnosis, treatment, medication, and supervision.
The document identifies ten important determinants of mortality based on a review of sources. The top ten determinants are:
1. Income level and employment status, as wealthier nations have lower mortality rates.
2. Nutritional status, as malnutrition increases risk of death from infection.
3. Epidemics, as disease outbreaks can cause many deaths, like the 1918 influenza pandemic.
4. Injuries, both intentional and unintentional, account for around 9% of deaths globally.
5. Personal behaviors like diet, alcohol and tobacco use, and hygiene practices impact mortality.
6. Education levels, especially of women, influence health behaviors and outcomes.
The document discusses HIV epidemiology in Saskatchewan, highlighting that the province has seen a rapid increase in new HIV cases and now has the highest rates in Canada. It summarizes Saskatchewan's 2010-2013 HIV Strategy, which aims to reduce new infections and improve quality of life for those living with HIV through improved surveillance, clinical management, prevention, and harm reduction programs. The strategy goals include earlier detection of cases, decreasing new infections and sexually transmitted infections, and increasing access to testing, care, and prevention services.
Dr. Kathleen Brady (AACO)'s annual epidemiological update. This presentation was given to the Philadelphia EMA Ryan White Planning Council on Thursday, February 20, 2014.
Δείκτης Ποιότητας και Διαθεσιμότητας της Ιατροφαρμακευτικής Περίθαλψης (Healt...Δρ. Γιώργος K. Κασάπης
Η ποιότητα και διαθεσιμότητα της ιατροφαρμακευτικής περίθαλψης έχει βελτιωθεί στις περισσότερες χώρες του κόσμου μετά το 1990. Όμως, από την άλλη, έχουν αυξηθεί οι ανισότητες τόσο μεταξύ των χωρών, όσο και στο εσωτερικό τους. Η Ελλάδα βρίσκεται στην 20ή θέση της παγκόσμιας κατάταξης, ακριβώς πάνω από τη Γερμανία, σύμφωνα με διεθνή μελέτη που δημοσιεύθηκε στο επιστημονικό έντυπο The Lancet.
Ερευνητές, με επικεφαλής τον καθηγητή Κρίστοφερ Μάρεϊ του Ινστιτούτου Μετρήσεων και Αξιολόγησης της Υγείας του Πανεπιστημίου της Ουάσιγκτον στο Σιάτλ, δημιούργησαν ένα νέο παγκόσμιο δείκτη (Healthcare Access and Quality Index), και βαθμολόγησαν από το 0 έως το 100, 195 χώρες ανάλογα με την ποιότητα της ιατροφαρμακευτικής περίθαλψής τους και του βαθμού στον οποίο έχει ο πληθυσμός έχει πρόσβαση σε αυτήν.
Ο δείκτης έλαβε υπόψη στοιχεία της περιόδου 1990-2015 και βασίστηκε στη θνησιμότητα που υπάρχει σε κάθε χώρα για 32 παθήσεις, η οποία θα μπορούσε να είχε αποφευχθεί με την κατάλληλη ιατρική φροντίδα.
Ουσιαστικά, ο δείκτης αξιολογεί το σύστημα υγείας κάθε χώρας ανάλογα με το βαθμό που οι κάτοικοί της πεθαίνουν με ρυθμό ταχύτερο του αναμενομένου από αιτίες που θα μπορούσαν να είχαν αποφευχθεί με την κατάλληλη ιατροφαρμακευτική παρέμβαση.
Cancer and other noncommunicable diseases (NCDs) arenowwidely recognized as a threat to global development.The latest United Nations high-level meeting on NCDs reaffirmed thisc observation and also highlighted the slow progress in meeting the 2011 Political Declarationon the Prevention and Control of Noncommunicable Diseases and the third Sustainable Development Goal. Lack of situational analyses, priority setting,and budgeting have been identified as major obstacles in achieving these goals. All of these have incommon that they require information on the local cancer epidemiology.
The Global Burden of Disease (GBD) study is uniquely poised to provide these crucial data.
Aharona glatman freedman social determinants sept 4-5 2013 -Rosella Anstine
1) Non-biological factors like social, economic, and political determinants significantly impact the success of immunization programs. These include factors like parental education, access to healthcare, gender inequity, and governance.
2) When a new vaccine for tuberculosis becomes available, factors like public acceptance, financing, and sustainability will determine its adoption in immunization programs.
3) A study on factors influencing the introduction of new vaccines in African countries supported by GAVI found that better governance indicators, like political stability and control of corruption, were a stronger predictor of adoption than financial healthcare indicators. Addressing social and behavioral determinants is important for effective vaccine introduction and implementation.
Epidermiologic pattern of viral hepatitis in afghanistanIslam Saeed
Epidemiology of Viral Hepatitis in Afghanistan. The presentation is prepared by Dr. Islam Saeed, Director for Surveillance/DEWS at Afghan National Public Health Institute (ANPHI), MoPH
The document summarizes the key points from a quarterly review meeting of India's National AIDS Control Programme. It provides an overview of the program, highlights achievements in reducing HIV infections and AIDS-related deaths, and outlines the vision and targets to end AIDS by 2030. Key agenda items discussed establishing ART centers in all medical colleges, eliminating mother-to-child HIV transmission, implementing the HIV/AIDS Prevention and Control Act of 2017, and achieving the 90-90-90 fast track targets to diagnose and treat people living with HIV. Support was requested from states to help scale up HIV testing, treatment and care.
Estimation of HIV incidence in Malawi from cross-sectional population-based s...Humphrey Misiri
This document summarizes a study that estimated HIV incidence rates in Malawi using cross-sectional population data from 2004. The researchers formulated a recurrence relation to model population prevalence over time based on a piecewise-constant force of HIV infection that adjusts for natural and HIV-induced mortality. They estimated parameters by maximum likelihood and assessed model fit. Estimated HIV incidence per 100,000 person-years was 610 for men aged 15-24, 2700 for men 25-34, and 1320 for men 35-49. For women it was 2030 for 15-24, 1710 for 25-34, and 1730 for 35-49. The method provides a simple way to estimate incidence from cross-sectional prevalence data
National level survey relevant to health seminar (2)vishal soyam
This document provides an overview of important national level health surveys conducted in India, including their objectives, methodology, and key findings. It discusses the Census, National Family Health Survey (NFHS), District Level Household Survey (DLHS), Sample Registration System (SRS), and Annual Health Survey (AHS). The Census is conducted every 10 years and provides demographic and socioeconomic data. NFHS, DLHS, and SRS provide regular health indicator estimates. NFHS covers fertility, family planning, and child health. DLHS assesses health service coverage at district level. SRS monitors birth and death rates. AHS yields annual health indicators for high-focus states. The surveys use random sampling and standardized questionnaires to collect reliable
The document presents a progress report from the Fulton County Task Force on HIV/AIDS on developing a strategy to end AIDS in the county. It outlines goals to reduce new infections, increase access to care and health outcomes, reduce disparities, and coordinate the local response. Data shows high rates of HIV among Black residents and rising diagnoses among Black gay and bisexual men. Objectives are presented to increase HIV testing, linkage to and retention in care, viral suppression, housing support, and addressing social determinants. The strategy aims to eliminate perinatal transmission and decrease new diagnoses by at least 25% by 2020.
Getting to scale: How we can achieve the reach required of prevention service...HopkinsCFAR
This document discusses disparities in HIV/STI rates among Black and White MSM in Atlanta from 2009-2014. The study found significantly higher rates of new HIV infections, prevalent HIV infections, and STIs among Black MSM compared to White MSM. Factors contributing to the disparities included higher community-level HIV prevalence among Black MSM networks, increased likelihood of Black MSM encountering an HIV-positive partner, geographic clustering of Black MSM in high-poverty/high-stigma neighborhoods, and higher rates of condom failures or incomplete use among Black MSM. The document advocates for scaling up multiple prevention interventions like PrEP to achieve sufficient coverage levels to meaningfully reduce new HIV transmissions.
Strategies to strengthen Mission Indradhanushshayonisen2012
Mission Indradhanush aims to increase full immunization coverage in India from 65% to 90% by 2020 through special catch-up drives. It focuses on conducting immunization rounds in identified districts, targeting pregnant women, children up to age 2, and those up to age 5 for booster doses. Key challenges include only 65% of Indian children being fully immunized and continued disease burden. Strategies proposed to address this include defining state-specific desired outcomes, intensive training, effective communication, and involving community leaders. A patient reminder system is also suggested to identify children due for immunization.
This document provides information from the HIV and AIDS Data Hub for Asia-Pacific on data availability and population size estimates of people who inject drugs, men who have sex with men, transgender people, and male sex workers across several countries in Asia and the Pacific region. It includes tables and charts with the countries where data is available from sentinel surveillance surveys, behavioral surveys, and population size estimates. It also provides references for the estimates and surveys.
This document summarizes emerging trends in HIV/AIDS in Kenya and globally. It provides key statistics on HIV prevalence rates over time in Kenya, showing a decline from 13.4% in 1999 to 5.6% in 2012. It also breaks down prevalence by age, region, and residence. The majority (57%) of new HIV infections in Sub-Saharan Africa are among women. Marginalized groups like men who have sex with men and sex workers have very high prevalence rates over 25% but face legal and social barriers to accessing health services. The document reviews strategies and terminology around HIV prevention, treatment, and awareness of HIV status.
This document provides guidelines for conducting population-based surveys to measure national HIV prevalence. It outlines how to plan and implement a new national survey, incorporate HIV testing into existing surveys, and calculate a national HIV prevalence estimate by combining data from surveys and sentinel surveillance. Population-based surveys can provide more representative HIV prevalence data than sentinel surveillance alone. The guidelines aim to help countries obtain accurate national estimates by adjusting prevalence measures from different data sources and accounting for biases.
This study analyzed the correlation between tuberculosis (TB) and human immunodeficiency virus (HIV) infections at the census tract level in Harris County, Texas from 2009-2010. The authors found that census tracts with higher percentages of poverty, Black residents, and foreign-born residents had above average rates of both HIV and TB. Logistic regression also showed these factors were associated with higher odds of co-infection of HIV/TB. The authors conclude targeted testing and education programs should focus on areas with these high-risk demographic characteristics.
Sex work and HIV incidence in South Africa: what do we know?SWEATSlideShare
Presentation by Tshepo Molapo, at the National Sex Work Symposium, in the session 'What we know: evidence-based peer reviewed knowledge on sex work' (Boksburg, 22 August 2012).
Dr. Kathleen Brady of Philadelphia's AIDS Activities Coordinating Office (AACO) gave this presentation at the January 9, 2013 Comprehensive Planning Committee meeting.
IRJET- Epidemiology of Parkinson’s Disease in AfricaIRJET Journal
This document summarizes a review paper on the epidemiology of Parkinson's disease in Africa. The review examined 30 publications from 13 African countries. It found that overall prevalence and incidence rates in African regions are lower than American and European populations. No significant differences in prevalence were seen between men and women. Management of Parkinson's disease in most African regions is generally lacking, with deficiencies in diagnosis, treatment, medication, and supervision.
The document identifies ten important determinants of mortality based on a review of sources. The top ten determinants are:
1. Income level and employment status, as wealthier nations have lower mortality rates.
2. Nutritional status, as malnutrition increases risk of death from infection.
3. Epidemics, as disease outbreaks can cause many deaths, like the 1918 influenza pandemic.
4. Injuries, both intentional and unintentional, account for around 9% of deaths globally.
5. Personal behaviors like diet, alcohol and tobacco use, and hygiene practices impact mortality.
6. Education levels, especially of women, influence health behaviors and outcomes.
The document discusses HIV epidemiology in Saskatchewan, highlighting that the province has seen a rapid increase in new HIV cases and now has the highest rates in Canada. It summarizes Saskatchewan's 2010-2013 HIV Strategy, which aims to reduce new infections and improve quality of life for those living with HIV through improved surveillance, clinical management, prevention, and harm reduction programs. The strategy goals include earlier detection of cases, decreasing new infections and sexually transmitted infections, and increasing access to testing, care, and prevention services.
Dr. Kathleen Brady (AACO)'s annual epidemiological update. This presentation was given to the Philadelphia EMA Ryan White Planning Council on Thursday, February 20, 2014.
Δείκτης Ποιότητας και Διαθεσιμότητας της Ιατροφαρμακευτικής Περίθαλψης (Healt...Δρ. Γιώργος K. Κασάπης
Η ποιότητα και διαθεσιμότητα της ιατροφαρμακευτικής περίθαλψης έχει βελτιωθεί στις περισσότερες χώρες του κόσμου μετά το 1990. Όμως, από την άλλη, έχουν αυξηθεί οι ανισότητες τόσο μεταξύ των χωρών, όσο και στο εσωτερικό τους. Η Ελλάδα βρίσκεται στην 20ή θέση της παγκόσμιας κατάταξης, ακριβώς πάνω από τη Γερμανία, σύμφωνα με διεθνή μελέτη που δημοσιεύθηκε στο επιστημονικό έντυπο The Lancet.
Ερευνητές, με επικεφαλής τον καθηγητή Κρίστοφερ Μάρεϊ του Ινστιτούτου Μετρήσεων και Αξιολόγησης της Υγείας του Πανεπιστημίου της Ουάσιγκτον στο Σιάτλ, δημιούργησαν ένα νέο παγκόσμιο δείκτη (Healthcare Access and Quality Index), και βαθμολόγησαν από το 0 έως το 100, 195 χώρες ανάλογα με την ποιότητα της ιατροφαρμακευτικής περίθαλψής τους και του βαθμού στον οποίο έχει ο πληθυσμός έχει πρόσβαση σε αυτήν.
Ο δείκτης έλαβε υπόψη στοιχεία της περιόδου 1990-2015 και βασίστηκε στη θνησιμότητα που υπάρχει σε κάθε χώρα για 32 παθήσεις, η οποία θα μπορούσε να είχε αποφευχθεί με την κατάλληλη ιατρική φροντίδα.
Ουσιαστικά, ο δείκτης αξιολογεί το σύστημα υγείας κάθε χώρας ανάλογα με το βαθμό που οι κάτοικοί της πεθαίνουν με ρυθμό ταχύτερο του αναμενομένου από αιτίες που θα μπορούσαν να είχαν αποφευχθεί με την κατάλληλη ιατροφαρμακευτική παρέμβαση.
Cancer and other noncommunicable diseases (NCDs) arenowwidely recognized as a threat to global development.The latest United Nations high-level meeting on NCDs reaffirmed thisc observation and also highlighted the slow progress in meeting the 2011 Political Declarationon the Prevention and Control of Noncommunicable Diseases and the third Sustainable Development Goal. Lack of situational analyses, priority setting,and budgeting have been identified as major obstacles in achieving these goals. All of these have incommon that they require information on the local cancer epidemiology.
The Global Burden of Disease (GBD) study is uniquely poised to provide these crucial data.
Aharona glatman freedman social determinants sept 4-5 2013 -Rosella Anstine
1) Non-biological factors like social, economic, and political determinants significantly impact the success of immunization programs. These include factors like parental education, access to healthcare, gender inequity, and governance.
2) When a new vaccine for tuberculosis becomes available, factors like public acceptance, financing, and sustainability will determine its adoption in immunization programs.
3) A study on factors influencing the introduction of new vaccines in African countries supported by GAVI found that better governance indicators, like political stability and control of corruption, were a stronger predictor of adoption than financial healthcare indicators. Addressing social and behavioral determinants is important for effective vaccine introduction and implementation.
Epidermiologic pattern of viral hepatitis in afghanistanIslam Saeed
Epidemiology of Viral Hepatitis in Afghanistan. The presentation is prepared by Dr. Islam Saeed, Director for Surveillance/DEWS at Afghan National Public Health Institute (ANPHI), MoPH
The document summarizes the key points from a quarterly review meeting of India's National AIDS Control Programme. It provides an overview of the program, highlights achievements in reducing HIV infections and AIDS-related deaths, and outlines the vision and targets to end AIDS by 2030. Key agenda items discussed establishing ART centers in all medical colleges, eliminating mother-to-child HIV transmission, implementing the HIV/AIDS Prevention and Control Act of 2017, and achieving the 90-90-90 fast track targets to diagnose and treat people living with HIV. Support was requested from states to help scale up HIV testing, treatment and care.
Estimation of HIV incidence in Malawi from cross-sectional population-based s...Humphrey Misiri
This document summarizes a study that estimated HIV incidence rates in Malawi using cross-sectional population data from 2004. The researchers formulated a recurrence relation to model population prevalence over time based on a piecewise-constant force of HIV infection that adjusts for natural and HIV-induced mortality. They estimated parameters by maximum likelihood and assessed model fit. Estimated HIV incidence per 100,000 person-years was 610 for men aged 15-24, 2700 for men 25-34, and 1320 for men 35-49. For women it was 2030 for 15-24, 1710 for 25-34, and 1730 for 35-49. The method provides a simple way to estimate incidence from cross-sectional prevalence data
National level survey relevant to health seminar (2)vishal soyam
This document provides an overview of important national level health surveys conducted in India, including their objectives, methodology, and key findings. It discusses the Census, National Family Health Survey (NFHS), District Level Household Survey (DLHS), Sample Registration System (SRS), and Annual Health Survey (AHS). The Census is conducted every 10 years and provides demographic and socioeconomic data. NFHS, DLHS, and SRS provide regular health indicator estimates. NFHS covers fertility, family planning, and child health. DLHS assesses health service coverage at district level. SRS monitors birth and death rates. AHS yields annual health indicators for high-focus states. The surveys use random sampling and standardized questionnaires to collect reliable
The document presents a progress report from the Fulton County Task Force on HIV/AIDS on developing a strategy to end AIDS in the county. It outlines goals to reduce new infections, increase access to care and health outcomes, reduce disparities, and coordinate the local response. Data shows high rates of HIV among Black residents and rising diagnoses among Black gay and bisexual men. Objectives are presented to increase HIV testing, linkage to and retention in care, viral suppression, housing support, and addressing social determinants. The strategy aims to eliminate perinatal transmission and decrease new diagnoses by at least 25% by 2020.
Getting to scale: How we can achieve the reach required of prevention service...HopkinsCFAR
This document discusses disparities in HIV/STI rates among Black and White MSM in Atlanta from 2009-2014. The study found significantly higher rates of new HIV infections, prevalent HIV infections, and STIs among Black MSM compared to White MSM. Factors contributing to the disparities included higher community-level HIV prevalence among Black MSM networks, increased likelihood of Black MSM encountering an HIV-positive partner, geographic clustering of Black MSM in high-poverty/high-stigma neighborhoods, and higher rates of condom failures or incomplete use among Black MSM. The document advocates for scaling up multiple prevention interventions like PrEP to achieve sufficient coverage levels to meaningfully reduce new HIV transmissions.
Strategies to strengthen Mission Indradhanushshayonisen2012
Mission Indradhanush aims to increase full immunization coverage in India from 65% to 90% by 2020 through special catch-up drives. It focuses on conducting immunization rounds in identified districts, targeting pregnant women, children up to age 2, and those up to age 5 for booster doses. Key challenges include only 65% of Indian children being fully immunized and continued disease burden. Strategies proposed to address this include defining state-specific desired outcomes, intensive training, effective communication, and involving community leaders. A patient reminder system is also suggested to identify children due for immunization.
Theodoros F. Katsivas, M.D., M.A.S., of UC San Diego Owen Clinic, presents "San Diego Primary Care Providers' Attitudes to HIV and HIV Testing" at AIDS Clinical Rounds
This document provides an overview of health information systems and descriptive statistics. It defines a health information system as a mechanism for collecting, processing, analyzing, and transmitting health data required for operating health services. Key components of health information systems include demography, health status, health resources, and service utilization. Sources of health information include censuses, vital event registration, sample registration systems, disease notification, and hospital and health service records. Descriptive statistics are used to organize and present health data in tables and graphs. Measures of central tendency and dispersion are discussed for describing key characteristics of health data.
A Post-Census Mortality Survey to Capture HIV/AIDS Deaths MEASURE Evaluation
A post-census mortality survey was conducted in Mozambique to accurately measure HIV/AIDS and other cause-specific mortality rates at the national and sub-national levels. The survey used a stratified random sample of households that reported a death in the previous year from the 2007 census. Trained doctors reviewed verbal autopsy questionnaires to assign causes of death. Results showed HIV/AIDS as a leading cause and regional variations. The analysis will link deaths to census data to determine mortality rates compared by age, sex, location, and other factors.
Socio-Economic Determinants Of Hepatitis B & C In Rural Poor Of Pakistan Ka...Global Risk Forum GRFDavos
1) Hepatitis is a significant public health issue, especially in Asia where approximately 3500-400 million people are chronic carriers of Hepatitis B. Pakistan has a large burden with an estimated 7-9 million carriers of Hepatitis B and 12 million carriers of Hepatitis C.
2) A study conducted in rural communities in Sindh and KPK provinces found Hepatitis to be the third most common disease. Less income, out-of-pocket healthcare costs, illiteracy, and lack of access to care contributed to the spread.
3) Despite available hepatitis vaccines and services, their utilization remains low due to cultural beliefs and social constraints. An integrated approach with long-term health education is
This document summarizes HIV and STI surveillance data from the Chicago Department of Public Health. Some key points:
- In 2015, there were 921 new HIV diagnoses in Chicago and 23,355 people living with HIV. Non-Hispanic Blacks had the highest rates of new diagnoses.
- Rates of chlamydia, gonorrhea, and syphilis were also highest among Non-Hispanic Blacks.
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- Data are used to guide CDPH's efforts in preventing transmission and increasing access to treatment.
Planning, implementation and evaluation of education program on HIV/AIDS. .SanjayChaudhary27
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2) A needs assessment identifies risk factors like unsafe sex, lack of access to healthcare, and stigma. The program's goals are to reduce infection rates, increase access to treatment, and coordinate national response.
3) The education program will provide information on transmission, prevention, treatment services, and address stigma through activities like discussion, counseling, and role-playing with targets like key populations and the community.
This presents the trends, issues, and challenges in the Philippine Health Care Delivery System. The data were mostly taken from the Philippine Department of Health (DOH) website and DOH Region VI Office.
The report analyzes progress on 50 health-related SDG targets and indicators in the Eastern Mediterranean Region between 2015 and 2019. It finds that over half of the indicators showed some progress, including reductions in child malnutrition and increases in vaccination rates and healthcare workers. However, targets for reducing maternal, child, and neonatal mortality are still not being met. It also identifies five key challenges: weak governance, fragmented healthcare systems, limited data availability, emergencies like COVID-19, and issues of gender equality and health disparities. The way forward involves strengthening leadership, investing in health systems, expanding access to care, collaborating across sectors, and ensuring equity.
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This document discusses health inequalities and screening inequalities. It aims to refresh knowledge on health inequalities, update on the Public Health England screening division's inequalities strategy, and explore actions screening nurses can take to tackle inequalities. It provides data showing screening uptake disparities based on factors like learning disabilities, ethnicity, and socioeconomic status. It also outlines guidance and tools to help screening services increase uptake in deprived areas and make screening more accessible for groups facing inequalities.
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C.2. Risk and Risk Assessments HCA 402Risk and Community Risk .docxclairbycraft
C.2. Risk and Risk Assessments HCA 402
Risk and Community Risk Assessment: From the case below, complete the risk assessment with the information provided in the case below regarding Duval County M. tuberculosis.
CDC, Notes from the Field: Tuberculosis Cluster Associated with Homelessness — Duval County, Florida, 2004–2012. Notes from the Field: Tuberculosis Cluster Associated with Homelessness — Duval County, Florida, 2004–2012. July 20, 2012 / 61(28); 539-540
This module you begin your second skills assessment, i.e., a community risk assessment. The next two pages of this document are a case study and then the assessment survey form makes up the remaining pages of the document. You will use the Duval Case and assume you are from Duval County, FL. There is a lot of information available from the TB surveillance and epidemiological field work completed in this county on the Internet. Assume your facility is the Golden Retreat Assisted-Living Facility and you are part of the risk management team that is responsible for performing the risk assessment surveys.
Example: In November 2008, the local health department discovered an outbreak of tuberculosis in a Jacksonville assisted-living facility, Golden Retreat. The CDC was called in to assist the health department and found 18 active cases of TB (Jacksonville.com, 2012).
A suggestion regarding work flow is to print out the two pages of the case, and use it and the supplemental links below to fill in the survey form. Know that you need to fill it out to the best of your ability based on the case information available. You may not have information for every box on the survey form. However, you may make some logical assumptions when filling it out based on what you find (in other words, abstract and report as the information found will allow). The goal here is to learn what type of information is in the various risk assessment surveys.
If you need help finding Duval County, FL statistics, here are some links:
LINK:LINK:LINK:
Article on Golden Retreat Assisted-Living Facility Palm Beach County. (2012). Center of TB outbreak often cited, rarely punished.
Tuberculosis Cluster Associated with Homelessness — Duval County, Florida, 2004–2012
Despite a decrease in incidence of tuberculosis (TB) in Duval County, Florida, from 102 cases (11.2 per 100,000 population) in 2008 to 71 cases (8.2 per 100,000) in 2011,* analysis of Mycobacterium tuberculosis genotyping data revealed a substantial increase in the percentage of TB cases with the same genotype.† That percentage increased from 27% (10 of 37) of genotyped cases in 2008 to 51% (30 of 59) of genotyped cases in 2011 (Florida Department of Health, unpublished data, 2012). During this period, the percentage of patients with this genotype who were homeless or who abused substances also increased. Because of concern over potential ongoing TB transmission involving these hard-to-reach populations, the Duval County Health Department, Florida Departme.
This document discusses hepatitis prevention and the burden of hepatitis globally and in Sri Lanka. Some key points:
- Globally, 400 million people live with chronic hepatitis B or C, causing over 1.4 million deaths per year. Chronic hepatitis B prevalence is highest in East Asia and Africa, while HCV prevalence is high in Central/East Asia and North Africa.
- In Sri Lanka, over 7,000 hepatitis cases were reported from 2010-2014, with over half occurring in 4 districts. The disease affects males more than females and incidence increases with age. Overall HBV and HCV seroprevalence is low (<2% and <1%).
- Transmission occurs through blood and body fluids. At-
This document summarizes key information about HIV in the United States:
- Over 1.1 million people are living with HIV in the US, with about 56,000 new infections each year. Rates are highest among men who have sex with men, African Americans, Latinos, and intravenous drug users.
- Effective prevention strategies include promoting abstinence, fewer partners, condom use, not sharing needles, antiretroviral treatment, male circumcision, and pre-exposure prophylaxis. Widespread testing is also an important prevention approach.
- Combining multiple prevention approaches and targeting high-risk groups can maximize the impact of HIV prevention and reduce transmission rates in the US.
Putting Children First: Session 1.6.A Saleem Falowo - Mapping and analysing m...The Impact Initiative
Putting Children First: Identifying solutions and taking action to tackle poverty and inequality in Africa.
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This three-day international conference aimed to engage policy makers, practitioners and researchers in identifying solutions for fighting child poverty and inequality in Africa, and in inspiring action towards change. The conference offered a platform for bridging divides across sectors, disciplines and policy, practice and research.
Similar to Spatial Inequities and Health Disparities among American Indians and Alaska Natives (20)
Katherine Promer Flores, MD (she/her)
Staff Physician
Division of Infectious Diseases and Global Public Health
Department of Medicine
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Daniel Lee, MD
Clinical Professor of Medicine
Division of Infectious Diseases & Global Public Health
Department of Medicine
University of California, San Diego
Leandro Mena, MD, MPH
Chair and Professor of Population Health Science
Department of Population Health Science
University of Mississippi Medical Center
Maile Young Karris, MD
Associate Professor
Co-Director San Diego Center for AIDS Research Clinical Investigations Core
Divisions of Infectious Diseases & Global Public Health and Geriatrics & Gerontology
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Edward Cachay, MD, MAS
Professor of Medicine
Division of Infectious Diseases & Global Public Health
Department of Medicine
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Gabriel Wagner, MD
Associate Clinical Professor
Division of Infectious Diseases & Global Public Health
Department of Medicine
University of California, San Diego
Jocelyn Keehner, MD
Infectious Disease Fellow
Division of Infectious Diseases & Global Public Health
Department of Medicine
University of California, San Diego
This presentation summarizes research on cryptococcal antigen screening and treatment in resource-limited settings. It finds that screening individuals with CD4 counts <100 cells/uL and <200 cells/uL can reduce mortality, and point-of-care tests now enable screening in primary care clinics. Studies of simplified treatment regimens show promise, such as using high-dose liposomal amphotericin B for only 1-2 weeks. Field work in Mozambique demonstrated a 7.3% prevalence of cryptococcal antigenemia through screening at two clinics, and identified opportunities to improve care through expanded screening and ambulatory treatment models.
Richard Garfein, PhD, MPH
Professor
Herbert Wertheim School of Public Health and Human Longevity Science
Adjunct Professor
Division of Infectious Disease and Global Public Health
Department of Medicine
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Este documento fornece informações sobre uma sessão de treinamento virtual sobre HIV/AIDS para militares internacionais. A agenda inclui atualizações sobre a vacina COVID-19 e sua implementação na Nigéria, com discussões sobre implicações para pessoas vivendo com HIV. A sessão é conduzida pelo programa MIHTP-ECHO com o objetivo de melhorar o atendimento e prevenção de HIV em militares em todo o mundo.
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Associate Professor of Medicine
Medical Director, Owen Clinic
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Chief, Division of Infectious Diseases and Global Public Health
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Winston Tilghman, MD
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Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Kosmoderma Academy, a leading institution in the field of dermatology and aesthetics, offers comprehensive courses in cosmetology and trichology. Our specialized courses on PRP (Hair), DR+Growth Factor, GFC, and Qr678 are designed to equip practitioners with advanced skills and knowledge to excel in hair restoration and growth treatments.
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
Travel Clinic Cardiff offers comprehensive travel health services, including vaccinations, travel advice, and preventive care for international travelers. Our expert team ensures you are well-prepared and protected for your journey, providing personalized consultations tailored to your destination. Conveniently located in Cardiff, we help you travel with confidence and peace of mind. Visit us: www.nxhealthcare.co.uk
Travel Clinic Cardiff: Health Advice for International Travelers
Spatial Inequities and Health Disparities among American Indians and Alaska Natives
1.
2. Spatial Inequities and Health
Disparities among American Indians
and Alaska Natives
Tommi L. Gaines, DrPH
Assistant Professor
Department of Medicine
Division of Infectious Diseases and Global Public Health
Email: togaines@ucsd.ed
1
3. Objective
Identify potential disparities in the geographic
accessibility to HIV testing and HIV medical care
for American Indian and Alaska Native (AI/AN)
population in San Diego County, California
2
5. AI/AN population
• In 2010, 5.2 million people reported being
American Indian or Alaska Native alone or in
combination, representing 1.7% of the US
population
• Projected to grow to 8.6 million and comprise
2% of US population by 2050
4
6. Tribal Diversity
• Highly heterogeneous group representing 565
federally recognized tribes
• In San Diego County there are 18 different federally
recognized American Indian reservations
– Different languages, cultures, beliefs, tribal governance
structures, population sizes
– United by history of colonization, oppression, racism,
alienation from culture traditions, and trauma
5
7. Residential Distribution
• Majority of AI/AN do not live on a reservation
or tribal land
– In 1970, 38% of AI/AN lived in urban areas
– In 2010, 78% of AI/AN lived in urban areas
– Many AI/AN’s live in periphery of city centers, in
suburban and semi-rural areas but frequently
travel to reservations for family and ceremonies
6
9. Sociodemographic Composition
• Compared to overall U.S. Population :
– Younger (median age 29 vs. 37.2 years)
– Reside in a female-headed household (11.9% vs.
7.2%)
– Lower high school graduation rates (77% vs. 86% )
– Live below poverty level (28.4% vs. 15.3%)
8
10. Invisible Minority in the HIV Epidemic
< 1% of estimated 39,513 HIV diagnoses in U.S.
9
Source: cdc.gov
11. Why address HIV among AI/AN?
• AI/AN is a population at risk but have a low
national HIV burden
• AI/AN communities have called on the CDC to
improve the quality of HIV surveillance data that
can be used to inform public health action
• 2020 National HIV/AIDS Strategy
– Need to better characterize HIV among smaller
populations including AI/AN and focusing on places
with high concentrations of these populations
10
12. AI/AN are Vulnerable to HIV Infection
• Nearly 1 out of 5 AI/AN are infected with HIV
but do not know it (compared to 13% of
general population)
– Approx. 20% of newly diagnosed cases are full
blown AIDS
– 55% AI/AN receiving prenatal care had not been
tested compared to 46% of pregnant women in
general population
• During 2010-2014, rates of HIV diagnoses
increased from 7.8 to 9.5 per 100,000 (+22%)
11
13. STI Inequities among AI/AN
2nd highest rate of Chlamydia compared to other
racial/ethnicity groups in 2016
12
Source: CDC.gov
14. STI Marker of Elevated HIV risk
The rate of gonorrhea among AI/AN (242.9 cases per
100,000) was 4.4 times the rate among Whites (55.7
cases per 100,000)
13
Source: CDC.gov
15. Other Factors Linked to HIV risk
• Stigma and discrimination
• Confidentiality
• Distrust of Western medicine
• Alcohol and illicit drug use
• Lack of awareness of infection status
14
16. HIV Care among AI/AN
• 77.5% AI/AN linked to medical care within 3 months of an HIV
diagnosis compared to 86.1% among White
• Compared to all HIV infected individuals, AI/AN least likely to
receive continuous HIV medical care (41% vs. 51.5%)
• AI/AN had the lowest HIV survival rate among all single
race/ethnic individuals living with HIV during 2008-2011 in the
U.S
• Geographic access to HIV services may be limited among
AI/AN
15
17. Objective
Identify potential disparities in the geographic
accessibility to HIV testing and HIV medical care
for American Indian and Alaska Native (AI/AN)
population in San Diego County, California
16
20. Ecological Analysis
• Create a Geographic Information System (GIS)
surveillance of HIV testing and medical care in San
Diego County
• Identify travel time to reach HIV services relative to
the AI/AN resident population
• Compare non-spatial characteristics (i.e.,
sociodemographics and clinic attributes) of
neighborhoods with very large numbers of AI/AN
19
21. Unit of Analysis
• Census tracts in San Diego County (n=627)
• Population of interest:
– Census tracts with a high proportion of AI/AN
population relative to all other census tracts
– Census tracts with American Indian reservation
20
22. Outcome
• Travel time to reach HIV services including HIV
testing and HIV medical care
• Online database: HIV.gov
– Address of all facilities providing HIV testing and
care that is supported by the Health Resources &
Service Administration (HRSA)
– Contacted facilities to inquire about hours of
operation and ability to refer individuals
diagnosed with HIV to provider within network
21
23. Sociodemographic Comparison
• Insurance coverage
• Age
• Poverty
• Household vehicle ownership
• Education
• Medically underserved areas
– Areas or populations that lack access to primary
care services
22
24. Spatial Analysis
• Network-based spatial analysis
– SANDAG: street-level spatial data
– Constructed a transportation network
– From the census tract centroid we estimated the
minimum travel time to reach the nearest HIV
testing or medical care facility
• Network analysis conducted in ArcGIS 10.3.1
23
25. Statistical Analysis
• Bivariate analysis to compare
sociodemographic characteristics by AI/AN
population
– Wilcoxon rank sum test to assess statistical significance
• Logistic regression analysis
– Dichotomized travel time
• Long travel time (travel time at/above 90th percentile)
• STATA 14.1
24
27. 26
Demographics
American Indian (AI)
Reservation
Median
(overall)
(n = 627)
No
(n = 612)
Yes
(n = 15)
Population size (overall) 4,769* 2,800* 4,727
AIAN population density per 1,000 residents 10.9* 58.5* 11.2
Uninsured 14.5% 16.8% 14.5%
Age
≤ 24 years old 33.3% 30.9% 33.2%
25 to 44 years old 28.3%* 20.3%* 28.2%
≥ 45 years old 37.1%* 48.0%* 37.4%
Living below FPL 12.2% 11.6% 12.1%
No vehicle in household 4.3%* 1.9%* 4.2%
Education (at least HS diploma) 19.4%* 24.6%* 19.7%
Medically Underserved Area (MUA) 14.5%* 40%* 15.2%
Table 1: County demographics by AI/AN population and
census tracts
*p<0.05
29. 28
Clinic Characteristics
Near AI reservation
No
(n=612)
Yes
(n=15)
Free HIV test 45.1% 15.4%
Open M-F with Extended Hours 36.6% 7.7%
Open Saturday 38.0% 11.5%
HIV referral within health network 64.2% 43%
Table 2: Clinic characteristics offering HIV services stratified by
proximity to American Indian (AI) reservations
30. 29
Clinics near AI
reservations:
• Less likely to offer
free HIV testing
• Less likely to have
extended business
hours
• Less likely to offer
HIV care within the
clinics health care
network
31. 30
Census tracts
with a very high
AI/AN presence
(≥5.8%) are not
all located near
census tracts
with an AI
reservation
32. Table 3: Population size across different geographic areas with high
presence of AI/AN residents
• Compared to census tracts with lower AI/AN presence, census
tracts with a large AI/AN presence were more likely to have longer
travel time to reach
HIV testing OR= 2.8; 95% CI = 1.14, 6.68
HIV care OR = 3.61; 95% CI = 1.7, 7.5
31
95th percentile of
AIAN presence
AI/AN
Reservation
Below
5.8%
(n=596)
At/Above
5.8%
(n=31)
No
(n=607)
Yes
(n=15)
Overall population size (median) 4,753 4,624 4,769 2,800
AI/AN population density per 1,000 residents 10.1 78.5 10.9 58.5
Travel time to HIV testing in minutes (median, IQR) 5 (3-8)* 7 (3-12)* 5 (3-8)* 16 (12-24)*
Travel time to HIV care in minutes (median, IQR) 10 (6-15) * 17 (7-30)* 10 (6-15)* 40 (34-64)*
*p<0.05
33. Conclusion
• Geographic location and the potential access to
HIV services is limited in places with a large
presence of AI/AN
• Longer travel time may pose a greater burden for
AI/AN to manage their health and health care
• Clinics near areas with large AIAN populations are
less likely to offer services that would make them
more accessible, beyond geographic proximity
32
34. Limitations
• HIV.gov is not an exhaustive list of all HIV service
providers, private clinics underestimated
• Travel time may have been underestimated in
semi-rural and rural regions of county and
analysis did not account for travel time by public
transit
• Only examined aggregate associations; cannot
make inferences at individual-level
33
35. Implications
• Where you live can make you more vulnerable
to HIV infection
– For AI/AN, inadequate access to HIV services could
lead to less HIV testing or treatment adherence
among people living with HIV
– Need for public health awareness campaigns on
HIV prevention and engagement in HIV care in
areas with large AI/AN presence
34
36. Acknowledgements
• This research was supported by the UCSD
CFAR grant, P30 AI036214 and the National
Institute on Drug Abuse grant, K01DA034523
• Research Partners: Marta Jankowska and
Sanjay Mehta
35
37. We must promote expert Indians
instead of Indian experts
Beverly Pigman
Navajo Nation
Institutional Review Board Chair
Thank you and Questions?
36