• The care continuum for people living with HIV in Georgia: How can we raise the bar?

      Kelly, Jane; Rane, Deppali; Wortley, Pascale; Drenzek, Cherie; Georgia Department of Public Health (Georgia Public Health Association, 2015)
      Background: Viral suppression (VS) improves quality of life and longevity for people living with HIV (PLWH) and reduces viral transmission, but is achieved by only a minority of PLWH in Georgia Methods: By use of the Georgia HIV/AIDS surveillance database, the HIV Care Continuum was stratified by age. Results: Retention in care and VS generally increased with increasing age, with the exception of adolescents (aged 13-18 years), who had the highest retention and VS. Differences by sex, race and transmission category persisted across age groups. Among persons retained in care, the proportion achieving VS also generally increased with age. Linkage to care within 3 months of HIV diagnosis was lower among young adults (aged 19-24 years) (54%); young Black, non-Hispanic (NH) males (49%); and young Black NH men who have sex with men (MSM) (49%) as compared to those among adolescents (66%, 58%, and 57%). Conclusions: Retention in care and VS decreases with the transition from adolescence to young adulthood, possibly reflecting loss of support systems and competing priorities. At the other end of the age spectrum, health care and social support systems will be confronted with increasing numbers of older PLWH in Georgia. Challenges in HIV treatment and prevention include (a) the need for integrated medical care for aging PLWH with co-morbid conditions, and (b) the changing social environment of young PLWH.
    • Perceptions of HIV/AIDS testing among urban and rural African American church members

      Walker, Roblena E; Walden University (Georgia Public Health Association, 2015)
      Background: The prevalence of the human immunodeficiency virus (HIV) continues to affect African Americans (AA) disproportionately. The purpose of this mixed methods study, guided by the health belief model, was to examine associations linking church and ambient social environment with knowledge and perceptions of HIV/AIDS testing amongst urban and rural AA church members. Methods: Multiple regressions and t tests were used to compare perceptions of HIV/AIDS testing and knowledge of HIV/AIDS among 236 participants selected from two AA churches located in a large city (n = 122) and in a rural town (n = 114) in the Southern U.S. Results: The quantitative findings indicated that the urban participants reported significantly higher rates of testing than the rural participants, but the groups had equally high HIV knowledge and positive perceptions of HIV/AIDS testing. In-depth, individual interviews (24 urban; 24 rural) were conducted to gain a better understanding of the factors that contribute to perceptions of HIV/AIDS testing and knowledge of HIV/AIDS. Transcripts were axially coded for a priori themes and then analyzed for emergent categories of responses. These interviews indicated that the participant’s perceptions of HIV/AIDS testing were in general, not influenced by the church and that there were no noticeable distinctions regarding why HIV/AIDS testing was sought. The combined results of this study suggested that the churches surveyed were not promoting HIV/AIDS awareness and that the participants felt that the church should do more as it relates to HIV/AIDS. Conclusions: Since the AA church plays an important role in the lives of many AAs, it potentially can, particularly in rural areas, bring forth social change by advocating HIV/AIDS testing and prevention efforts in order to reduce the rate of HIV infections.
    • Surviving HIV and dying for a smoke: Implications for tobacco use among people living with HIV

      Culbreth, Rachel; Kelly, Jane; Maggio, David; Wortley, Pascale; Drenzek, Cherie; Georgia Department of Public Health HIV/AIDS Epidemiology Section; Georgia State University; Georgia Department of Public Health (Georgia Public Health Association, 2015)
      Background: Since the advent of highly active antiretroviral therapy in the mid-nineties, deaths among persons living with HIV (PLWH) have declined nationally. Now a controllable condition, HIV has become a chronic disease, highlighting the importance of tobacco cessation in lowering morbidity and premature mortality. Current smoking is approximately twice as high among PLWH compared with the general population. PLWH who smoke experience higher rates of cardiovascular disease, AIDS-defining illnesses, and cancer than PLWH who do not smoke. Loss of life-years associated with smoking among PLWH is greater than life-years lost from HIV. Methods: Data on current smoking, derived from the 2009-12 Georgia Medical Monitoring Project (MMP) were analyzed. Smoking rates were calculated by demographic characteristics, and results were compared to those from the 2011 Georgia Behavioral Risk Factor Surveillance System (BRFSS), a population-based telephone survey. Results: The prevalence of current smoking among PLWH was 36.1%, compared with 21.2% among the general population in Georgia. Smoking prevalence for PLWH generally varied by demographic characteristics according to the same pattern as for the general population, but prevalence was consistently higher among PLWH. Conclusions: The prevalence of current smoking among PLWH in Georgia is high. Clinical and public health interventions must address smoking cessation as part of HIV care to prevent disease, improve quality of life, and reduce mortality. HIV-infected smokers have more barriers to quitting (alcohol, depression, drug dependence, and inaccurate risk perception) and a lower quit rate than non-HIV-infected smokers. Efficacy studies of behavioral and pharmacological interventions for smoking cessation specific to PLWH are needed.