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Objectives. To examine population and HIV care outcomes of people living with HIV/AIDS (PLWHA) at their first incarceration of 2014 in 2 county jails in King County, Washington. Methods. Using HIV surveillance data linked with jail booking data, we examined demographic information, viral loads, CD4 counts, and incarceration details for the period prior to jail booking, during incarceration, and year following jail release. Results. In 2014, 202PLWHAwere incarcerated, 51%ofwhomwere virally nonsuppressed at booking. This population represented approximately 3%of all HIV-diagnosed persons and 7%of virally nonsuppressed persons inKing County. Within a year of release, 62%were virally suppressed, compared with 79% of the general HIV-diagnosed population in King County. Conclusions. Incarcerated PLWHA are disproportionately virally nonsuppressed compared with nonincarcerated PLWHA up to a year after release from jail. Public Health Implications. Coordination of health information exchange between the health department and jails could enhance public health efforts to improve the HIV care continuum. [ABSTRACT FROM AUTHOR]

The purpose of this study was to measure unmet needs and changes in insurance status for persons with acquired immunodeficiency syndrome (AIDS). Thirty -six percent of the study's boson-area respondents (n=305) had a change in insurance coverage between AIDS diagnosis and interview. Medicaid coverage increased from 14% to 41%. pneumocystis cystis carinii pneumonia prophylaxis was nearly universal. Only 5% did not receive zidovudine, and intraenous drug users were at higher risk. Approximately 14% to 15% of patients reported problems in obtaining medical and dental services; Blacks, homeless persons, and those who were not high school graduates were at higher risk. Use of selected treatments for which there were clear clinical guidelines was adequate, yet disadvantaged groups were more likely than persons with AIDS to face obstacles to other services. [ABSTRACT FROM AUTHOR]

The pervasiveness of stigma in the United States related to the acquired immunodeficiency syndrome (AIDS) was assessed in telephone interviews with a general adult sample (n = 538) and an African-American sample (n = 607). Most respondents manifested at least some stigma. African Americans expressed greater support for policies separating persons with AIDS from others and a stronger desire to avoid these persons, whereas Whites expressed more negative feelings toward them and a greater willingness to blame them for their illness. Regardless of race, men were more likely than women to support policies such as quarantine and to say that they would avoid persons with AIDS. [ABSTRACT FROM AUTHOR]

The invention of AIDS activism came soon after the AIDS epidemic emerged in gay communities in the United States in the early 1980s. AIDS activism by and for people with AIDS, distinct from gay activism responding to the threat of AIDS on the behalf of the whole community, started as a way of resisting the phenomenon of social death. Social death, in which people are considered "as good as dead" and denied roles in community life, posed a unique threat to people with AIDS. An organized political response to AIDS began among gay men with AIDS in San Francisco, California, and New York, New York, formalized in a foundational document later called the Denver Principles. The ideas and language of these first people with AIDS influenced later AIDS activism movements. They also help to illustrate the importance of considering an epidemic from the point of view of people with the disease. [ABSTRACT FROM AUTHOR]

The Process and Collaboration for Empowerment and Discussion (PACED) approach redefines the goals for employing the performing arts in HIV/AIDS education. Considering the complexity of the epidemic, art can appropriately address HIV/AIDS by placing a greater emphasis on the creative process, engaging people living with HIV/AIDS, and focusing on contextual barriers to prevention and care. This approach was implemented in Ghana in 2006 in the form of the Asetena Pa Concert Party project. An evaluation of the project after its completion showed that it promoted a sense of empowerment among people with HIV and community dialogue about the structural and cultural obstacles to HIV/AIDS prevention, supporting the use of PACED as a viable tool in comprehensive education regarding HIV/AIDS. [ABSTRACT FROM AUTHOR]

Conclusions. Even within a population of individuals similar in regard to health coverage, there were substantial sociodemographic differences in use of PI/NNRTIs during the early years after their introduction. These differences narrowed as new treatments became standard. Participation in a case-managed Medicaid waiver program seems to be associated with a more appropriate pattern of use. These results suggest a need to address nonfinancial barriers to care. (Am J Public Health. 2001;91:1474-1481) [ABSTRACT FROM AUTHOR]

This commentary delineates a new paradigm for HIV care in which patients and providers collaborate on individualized plans to establish patients' readiness for treatment, ensure maintenance of treatment, and make use of the social services necessary to accomplish these goals. Providers have an ethical responsibility to do everything possible to see that patients who might benefit from new HIV treatments have a fair opportunity to do so, and health systems have a responsibility to facilitate this process. Substantial progress toward meeting these responsibilities can be made within the current health care environment. (Am J Public Health. 2001;91:690-694) [ABSTRACT FROM AUTHOR]

Objective. This study monitors trends in place of death among persons with acquired immunodeficiency syndrome (AIDS) as a measure of health circ usage patterns and terminal health care among persons infected with human immunodeficiency virus (HIV). Methods. Sixteen health departments collected death certificates fur 55 186 persons with AIDS whose deaths occurred through 1991. Place of death was categorized as hospital, residence, hospice or nursing home, and other. Results. The percentage of AIDS deaths at hospital facilities decreased from 92% in 1983 to 57% in 1991. In 1988, 23% of deaths occurred at home or in hospices and nursing homes. This trend was more evident among men. Whites, and men who had sex with men; less so among persons with other modes of exposure; and not at all among injecting drug users and children with perinatally acquired AIDS. Place of death varied by geographic location, with the greatest percentage of hospital deaths in the Northeast (91%) and the greatest percentage of at-home deaths in the West (27%). Conclusions. The percentage of AIDS deaths at home or in hospices and nursing homes has increased since 1983. These trends may reflect changes in hospital use for end-stage HIV infection. Decreasing hospitalization and increasing outpatient services and home care will decrease costs and may allow HIV-infected persons improved social support. [ABSTRACT FROM AUTHOR]

Objectives. The goal of the study was to determine survival time after diagnosis of acquired immunodeficiency syndrome (AIDS) and to identify predictors of survival. Methods. We conducted a population-based prospective survival analysis of all Massachusetts-resident adult AIDS patients diagnosed from January 1, 1979, through December 31, 1988. Results. Median survival was 406 days, with a 5-year survival rate of 3%. Age older than 40 years (P = .001), a diagnosis other than Kaposi's sarcoma (P= .001), and a history of intravenous drug use (P ≤ .01) were associated with shorter survival after confounding was controlled. Survival increased as year of diagnosis became more recent (P < .001). This temporal effect was strongest for patients with Pneumocystis carinii pneumonia. Individuals with Kaposi's sarcoma, Hispanics, homosexual men who were concurrent intravenous drug users, and residents of the greater Boston standard metropolitan statistical area, excluding the city of Boston, did not experience increases in survival over time. Conclusions. With the exception of cases initially defined by Kaposi's sarcoma, recently diagnosed AIDS case subjects survive longer than those diagnosed earlier in the epidemic. Further work is needed to determine whether this effect is due to lead-time bias or better treatment after diagnosis. [ABSTRACT FROM AUTHOR]

To assess the impact of HIV infection on mortality and the accuracy of AIDS reporting on death certificates, we analyzed data from 6704 homosexual men in the San Francisco City Clinic cohort. Identification of AIDS cases and deaths in the cohort was determined through multiple sources, including the national AIDS surveillance registry and the National Death Index. Through 1990, 1518 deaths had been reported in the cohort and 1292 death certificates obtained. Of the 1292 death certificates, 1162 were for known AIDS cases, but 9% of the AIDS cases did not have HIV infection or AIDS noted on the death certificate. Only 0.7% of the decedents had AIDS listed as a cause of death and had not been reported to AIDS surveillance. AIDS and HIV infection was the leading cause of death in the cohort, with the highest proportionate mortality ratio (85%) and standardized mortality ratio (153 in 1987), and the largest number of years of potential life lost (32 008 years). The devasting impact of HIV infection on mortality is increasing and will require continued efforts to prevent and treat HIV infection. [ABSTRACT FROM AUTHOR]

We performed a two-year cost of illness study of 240. AIDS patients (55 percent of all Massachusetts cases) diagnosed and treated at five hospitals from March 1984 through February 1986. Sociodemographic and clinical data as well as information on medical utilization were obtained from review of inpatient and outpatient hospital records. The yearly inpatient cost per patient decreased by 28 percent from $38,369 in year one to $27,714 in year two. These changes were related to shorter lengths of slay (from 20.6 days to 16.8 days per hospitalization, mean difference of 3.8 days, 95% CI of the difference -.2, 7.8), and less costly hospitalizations (from $12,463 to $9,957, mean difference of $2,506, 95% CI of the difference $135, $4,877). The probability of hospitalization, however, was similar in both years. These patterns of care were still evident after controlling for transmission category, race, site, mortality, insurance, age, gender, number and type of opportunistic diseases and time since diagnosis. Although the cost per patient per year decreased between years one and two, median survival increased by 70 percent (from 10 to 17 months). Hence overall estimated lifetime costs increased by 24 percent. [ABSTRACT FROM AUTHOR]

Survival analysis techniques were used in estimating lifetime inpatient utilization among patients diagnosed with acquired immunodeficiency syndrome (AIDS) using data on 863 members of the Kaiser Permanent Medical Care Program in the Northern California Region diagnosed with AIDS between January 1, 1981 and June 30, 1987. Using information on both deceased and living patients, we estimated means of 40.3 lifetime inpatient days and 3.3 hospitalizations among all AIDS patients. Those presenting with Kaposi's sarcoma experienced a mean of 7.6 fewer lifetime inpatient days than those presenting with Pneumocystis carinii pneumonia (95% confidence interval = .61, 14.6) and a mean of 11.0 (3.9, 18.6) fewer inpatient days than all other AIDS patients. Other patients had fewer hospital admissions than younger ones. Year of diagnosis does not appear to be related to lifetime utilization, and there is an indication that increased survival has been accompanied by decreased inpatient utilization intensity as measured on a per person-year basis. We recommend the use of survival analysis methods in the study of utilization among groups of patients with incomplete follow-up. [ABSTRACT FROM AUTHOR]

To assess the degree of house officers' concerns about acquiring AIDS (acquired immunodeficiency syndrome) from their patients, we surveyed 263 medical and pediatric interns and residents in four housestaff training programs affiliated with seven New York City hospitals with large AIDS patient populations; 258 questionnaires (98 per cent;) were returned. Thirty-six per cent; of medical and 17 per cent; of pediatric house officers reported percutaneous exposures to needles contaminated with blood of AIDS patients. Forty-eight per cent; of medical and 30 per cent; of pediatric house officers reported a moderate to major concern about acquiring AIDS from their patients. Greater concern about personal risk was noted in those house officers who were earlier in their residency training, who reported having treated a greater number of AIDS patients, and who were in medicine rather than pediatrics programs. Twenty-five per cent; of all respondents reported that they would not continue to care for AIDS patients if given a choice. The results demonstrate a substantial deg; of concern about acquiring AIDS among house officers caring for AIDS patients and suggest the need for housestaff program administrators to formally address these concerns. [ABSTRACT FROM AUTHOR]

Abstract: We have prospectively followed for 9-12 months, 246 female health cure workers (HCWs); 102 with high exposure (HE). 43 with low exposure (LE). and 101 with no exposure (NE) to AIDS (acquired immunodeficiency syndrome) patients. No Hews have clinical, serologic, or immunologic evidence of HIV (human immunodeficiency virus) infection. No HCWs in the HE group seroconverted to cytomegalovirus (CMV). One HCW in the HE group seroconverted to Hepatitis B virus (HBV). another HCW in the HE group seroconverted to herpes simplex virus type 2 (HSV-2) although all three groups were similar with respect to HBV and HSV-2 seropositivity. If hospital infection control practices are employed when HCWs care for AIDS patients or work with their biological specimens, the risk of occupationally acquiring a HIV, CMV, HBV or HSV-2 infection appears to be low. (Am J Public Health 1987: 77:1306-1309.) [ABSTRACT FROM AUTHOR]

Abstract: The prevalence and incidence of infection by the human immunodeficiency virus (HIV) has been under study in a cohort of 1,034 single men recruited by area probability sampling from a six kilometer square area of San Francisco where the epidemic of acquired immunodeficiency syndrome (AIDS) has been most severe. Prevalence of infection among homosexual/bisexual study subjects increased from an estimated 22.8 per ¢ during the last half of 1982 to 48.6 per ¢ during the period July through December 1984. During three subsequent six month periods, prevalence remained stable at approximately 50 per ¢. Annual infection rates, measured by seroconversion among seronegative study subjects, decreased from an estimated 18.4 per ¢ per year from 1982 to 1984, to 5.4 and 3.1 per ¢ during the first and second halves of 1985, and to 4.2 per ¢ during the first six months of 1986. These declines were associated with reductions of 60 per ¢ or more in the prevalence of high-risk sexual practices associated with both acquiring and disseminating infection by the human immunodeficiency virus. (Am J Public Health 1987; 77:685-689.) [ABSTRACT FROM AUTHOR]

Objectives. This study estimated the trends in mortality related to sexually transmitted diseases (STDs) and their sequelae in US women from 1973 through 1992. Methods. The total number of deaths was obtained from US national mortality data and from AIDS surveillance data, and current literature was reviewed to estimate proportions of diseases attributable to sexual transmission. Results. From 1973 through 1984. Total STD-related deaths decreased 24%. However, from 1985 through 1992. STD-related deaths increased by 31%, primarily because of increasing numbers of deaths from sexually transmitted human immunodeficiency virus (HIV) infection. The most important changes during the 20-year period were the emergence of and continued increase in the number of deaths related to heterosexually transmitted HIV. Conclusions. The leading causes of STD-related mortality in women, viral STDs and their sequelae, are generally not recognized as being sexually transmitted. Increases in STD-related mortality are primarily due to sexually transmitted HIV, which will soon surpass cervical cancer as the leading cause. [ABSTRACT FROM AUTHOR]

Objectives. This study developed a new acquired immunodeficiency syndrome (AIDS) severity system by including diagnostic, physiological, functional, and socio-demographic factors predictive of survival. Methods. Three-hundred five persons with AIDS in Boston were interviewed; their medical records were reviewed and vital status ascertained. Results. Overall median (±SD) survival for the cohort from the first interview until death was 560 ± 14.4 days. The best model for predicting survival, the Boston AIDS Survival Score, included the Justice score (stage 2 relative hazard [RH] = 1.25, 95% confidence interval [CI] = 0.80, 1.96; stage 3 RH = 1.76, 95% CI = 1.15, 2.70), a newly developed opportunistic disease score (Boston Opportunistic Disease Survival Score; stage 2 RH = 1.35, 95% CI = 0.90, 2.02; stage 3 RH = 2.10, 95% CI = 1.38, 3.18), and measures of activities of daily living (any intermediate limitations, RH = 1.84, 95% CI = 1.05, 3.21; any basic limitations, RH = 2.60, 95% CI = 1.44, 4.69). This model had substantially greater predictive power (R² = .17, C statistic = .68) than the Justice score alone (R² = .09, C statistic = .61). Conclusions. Incorporating data on clinically important events and functional status into a physiologically based system can improve the prediction of survival with AIDS. [ABSTRACT FROM AUTHOR]

Congregate facilities for homeless persons with the acquired immunodeficiency syndrome (AIDS) are often endemic for tuberculosis. We evaluated tuberculosis screening methods at single-room-occupancy hotels housing persons with AIDS. Residents were screened by cross matching the New York City Tuberculosis Registry, interviewing for tuberculosis history, skin testing, and chest radiography. Cases were classified as either previously or newly diagnosed. Among the 106 participants, 16 (15%) previously diagnosed tuberculosis cases were identified. Participants' tuberculosis histories were identified by the questionnaire (100%) or by registry match (69%). Eight participants (50%) were noncompliant with therapy. These findings prompted the establishment of a directly observed therapy program on site. [ABSTRACT FROM AUTHOR]

This study measured the migration of persons with the acquired immunodeficiency virus (AIDS) between diagnosis and death using AIDS case and death reports from 12 states for 1985 to 1992. Of 49 805 persons with AIDS, 10.6% changed their place of residence, and half of these individuals who moved changed their state of residence. Migration had relatively little impact on the numbers of persons with AIDS in the largest metropolitan areas, which accounted for approximately 90% of AIDS diagnoses. Although only 3% of deaths occurred in residents of nonmetropolitan areas, the net effect of migration was a 24% increase in the number of persons with AIDS residing in such areas. [ABSTRACT FROM AUTHOR]

In spite of the direct referral system and family-centered model of primary oral health care linking medical and dental care providers, most HIV-positive patients at the Columbia Presbyterian Medical Center received only emergency and episodic dental care between 1993 and 1998. To improve access to dental care for HIV/AIDS patients, a mobile program, called WE CARE, was developed and colocated in community-based organizations serving HIV-infected people. WE CARE provided preventive, early intervention, and comprehensive oral health services to minorities, low-income women and children, homeless youths, gays and lesbians, transgender individuals, and victims of past abuse. More efforts to colocate dental services with HIV/AIDS care at community-based organizations are urgently needed. [ABSTRACT FROM AUTHOR]

Objectives. This study sought to identify and characterize seriously mentally ill patients with HIV infection. Methods. Medicaid beneficiaries with HIV/AIDS were identified through the merging of New Jersey HIV/AIDS Registry and Medicaid eligibility files. Claims histories were used to classify individuals as having schizophrenia, major affective disorder, or to serious mental illness. Results. Of 8294 individuals 476 (5.7%) were classified as having major affective disorder. Those with serious mental illness were more likely than other groups to be injection drug users and to claims indicative of substance abuse. Conclusions. Individuals with serious mental illness are a significant but little-recognized subgroup of those with HIV infection. [ABSTRACT FROM AUTHOR]

Questionnaires were distributed to homosexual and bisexual male participants in the Multicenter AIDS Cohort Study and to homosexual and bisexual male patients with acquired immunodeficiency syndrome (AIDS) to determine whether the men believed they had been refused medical or dental treatment because of their sexual orientation or a condition related to the human immunodeficiency virus (HIV). Men with AIDS were significantly more likely (18%) to report being refused treatment by a doctor or dentist on the basis of a known or suspected HIV-related condition than were men who were seropositive (5%) or seronegative (1%). Significantly more respondents reported refusal of dental care than of medical care. [ABSTRACT FROM AUTHOR]

Using New York State Medicaid data from 1984 to 1987, we analyzed hospital length-of-stay patterns for acquired immunodeficiency syndrome (AIDS) patients. We found an overall decline in monthly average length of stay, with seasonal fluctuations producing longer stays in the fall and winter months. These findings suggest that hospital utilization for AIDS patients is changing over time and may vary by season. [ABSTRACT FROM AUTHOR]

An AIDS unit model ("cluster beds") and a general inpatient placement model ("scatter beds") in a major teaching hospital were compared to determine whether they differed on several dimensions of care. After controlling for severity of illness, (the major predictor of admission to the AIDS unit), length of stay, charges, and inpatient mortality rates did not differ between the two settings. Equal proportions of White, Hispanic, male, and privately insured patients were found in both settings. Nursing staff turnover rates were comparable to those of other sites. However, the data raise new issues regarding access to AIDS units for older, Black. and female patients. [ABSTRACT FROM AUTHOR]

Accidental exposure to the blood of hepatitis B patients produced less fear than does accidental exposure today to the human immunodeficiency virus (HIV), even though both have an approximately equal overall risk of death (∼1%). Subjects responding to hypothetical insect-exposure and disease-exposure scenarios chose to avoid the HIV-type risk of 1% chance of exposure/100% chance of death. [ABSTRACT FROM AUTHOR]

We compared average daily hours of care for patients with and without acquired immunodeficiency syndrome (AIDS) in a hospital-based skilled nursing facility. Patients with AIDS averaged over an hour more direct nursing care per patient day (6.5 vs 5.4 hours). These findings support other reports of greater nursing time and higher costs of caring for nursing home patients with AIDS. [ABSTRACT FROM AUTHOR]

Survival rates of 609 cases of acquired immunodeficiency syndrome (AIDS) in Washington State diagnosed between 1982 and 1987 according to pre-1987 AIDS surveillance definition were analyzed. People with a primary diagnosis of Kaposi's sarcoma survived longer than those with Pneymocystis carinii pneumonia. Both groups survived longer than those with other diagnoses. Median survival increased from 11.3, to 12.5, to 20.8 months for cases diagnosed in or before 1985, during 1986, and during 1987, respectively. [ABSTRACT FROM AUTHOR]

The AIDS Interfaith Council of Houston, sponsored by the Foundation for Interfaith Research and Ministry, recruits, trains, and coordinates volunteers for home-based care for adults and children with AIDS (acquired immunodeficiency syndrome). The program provides compassionate non-judgmental care for the sick and respite support for the primary care provider. Care is provided by highly motivated trained volunteers. The respite care team model also represents a support system to complement medical management and other health care services for people with AIDS. With the explaining number of cases and the growing preference for clients to remain at home, such a model will become increasingly important as people continue to live longer with AIDS. [ABSTRACT FROM AUTHOR]

Abstract: A randomly selected sample of physicians in three large cities was asked to read one of four vignettes describing a patient. They then completed a set of objective attitude measures eliciting their reactions to the patient described in the vignette. The vignettes were identical except thai the patient's illness was identified as either acquired immunodeficiency syndrome (AIDS) or leukemia and the patient's sexual preference as either heterosexual or homosexual. Harsh attitude judgments were associated with the AIDS portrayals as well as much less willingness to interact even in routine conversation when the patient's illness was identified as AIDS. Increasing numbers of AIDS patients will he seeking medical attention from physicians in all areas of the country and it will be important for health care professions to develop programs which counter unreasonable stigma and prejudicial attitudes thai may be associated with this illness. [ABSTRACT FROM AUTHOR]

The article examines the effectiveness of the Boston AIDS Survival Score for predicting survival immediately following an AIDS event or during hospitalization for AIDS. The AIDS survival scoring system was derived by the use of data from 305 patients who were interviewed an average of 16 months after they were diagnosed with AIDS in Massachusetts. In assessing the effectiveness and utility of the scoring system, the questions whether the score is easily used and the relevance of the components of the survival score are considered.

Interviews were conducted among 408 adults with acquired immunodeficiency syndrome at three local health departments to determine the proportion who owned pets, their perceived attachment to their pets, and the proportion who were informed about zoonoses. Nearly half (187, or 46%) were living with pets, most commonly dogs (64%), followed by cats (38%), fish (15%), birds (8%), reptiles (3%), and rodents (2%). Most pet owners (81%) reported an attachment to their pet. Only 10% were informed of zoonoses, albeit some incorrectly. Health care providers should recognize the high pet ownership rate among persons infected with human immunodeficiency virus and correctly inform their patients of strategies to sustain a low zoonotic disease incidence. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented about autopsy rates among patients with AIDS.

A letter to the editor is presented in response to the article "AIDS Screening: Confidentiality and the Duty to Warn," by L. Gostin and W. J. Curran in the 1987 issue.