Bridging the Gap: Conference Record [Abstract book, International Conference on AIDS (12th: 1998: Geneva, Switzerland)]

604 Abstracts 32410-32414

12th World AIDS Conference

Results: Of the 216 subjects analyzed, 78 (36%) reported being HIV+ and
were compared to the combination of 40% who reported being tested HIV- within
the past year, 17% HIV- who were tested >1 year ago, and 7% who had never
been tested. HIV+s, compared to HIV-s, were significantly more likely to be
minority (77% vs 53%), unemployed (97% vs 80%), have poor perceived health
status (52% vs 32%), have completed high school (60% vs 41%), have seen a
health provider for pain (78% vs 50%), to have mental distress (88% vs 76%), and
to have medical insurance (94% vs 69%). There were no statistical differences
between HIV+s and HIV-s for comorbid chronic (74% vs 68%), or mental illness
(48% vs 44%) conditions, however injection-related conditions (71% vs 38%) and
pneumonia (41% vs 11%) were higher for HIV+s. There were no differences for
other medical conditions such as having been shot, stabbed, or suffered a broken
bone (36% vs 37%), a liver condition (38% vs 35%), experienced a drug overdose
(31% vs 30%), or had a sexually transmitted disease (38% vs 29%). Regarding
health services utilization, HIV+s were more likely to have been to the emergency
room (70% vs 53%), and been seen in an outpatient (91% vs 77%) and inpatient
(58% vs 30%) clinical setting within the previous year.
Conclusion: The prevalence of comorbid acute and chronic conditions and
mental illness is extremely high among this sample of IDUs, irrespective of HIV
status. Among HIV+s, bacterial infections were more common, as were all forms
of health service utilization, perhaps in part due to the higher rates of medical
coverage by HIV+ IDUs. Because of the enormous health care needs of both the
HIV+ and HIV- populations of IDUs, access to medical services is essential to
all IDUs, irrespective of HIV status.
32410 Linkage solutions between primary care, HIV/AIDS,
substance abuse and mental health services in
non-governmental health care organizations
Maria Lago1, S. Levin2, D. Pharham1. 1Health Resources & Services
Administration, 4350 East-West Highway 9th Floor, Bethesda, MD 20814;
2Access Consulting, Washington, DC, USA
Issue: It is well documented that people who abuse alcohol and other substances
are often affected by an array of medical disorders. Intravenous (IV) drug users
are at particular risk of contracting varous infectious diseases. Linkage between
primary care, mental health and substance abuse treatment has been minimal,
precluding effective and consistent intervention. This underscores the need for
active efforts to identify substance abusers among primary care clients and to
recruit them into treatment. The continuing AIDS epidemic has made this separation of treatment systems particularly apparent as approximately 31% of all AIDS
cases can be linked, either directly or indirectly to interavenous drug use.
Project: The US Department of Health and Human Services-Health Resources
Services Administration (HRSA) and Substance Abuse and Mental Health Services Administration (SAMHSA) funded 21 non-governmental health clinics to
identify barriers and solutions to linking Primary Care, Substance Abuse, Mental
Health and HIV/AIDS services. Having completed the demonstration after seven
years, five programs were used as models for highlighting common barriers to
linking and integrating services for patients/clients. Solutions to specific barriers
from one system (e.g., primary care) to another (substance abuse, mental health
or HIV/AIDS) or two or more systems were demonstrated.
Results: A coordinated system of care improves the health status and drug
treatment outcomes of clients, detects illnesses in the early stages and reduces
hospitalization. It greatly increased the system's ability to conduct successful
outreach and enabled communities to establish systems of community linkage
and agreements that ensure a continuum of care that did not previously exist. A
service delivery infrastructure was created that made possible funding and the
development of additional programs a reality.
Lessons Learned: The success of the demonstrations, continue to highlight
the efficacy of a coordinated system of care, particularly when the patient/clinet
is able to move through a "Seemless" primary care, substance abuse, mental
health and HIV/AIDS health care system. When the "case" manager ensures the
seemlessness of the different health care system with respect to appointment,
access and utilization and wrap-around services function smoothly and efficiently.
S502*/32411 i Continuity of medical care and risk of
incarcerationin HIV+ and HIV- high risk women
Timothy Flanigan1, Mary Sheu2, T.P. Flanigan2, J. Allsworth2, J. Hogan2,
M.D. Stein3, D. Vlahov4, E. Schoenbaum5. 1The Miriam Hospital 164 Summit
Avenue Providence Rhode Island 02906; 2Brown University School of Medicine
Providence RI; 3Brown University Statistical Sciences Providence RI; 4Johns
Hopkins University Baltimore MD; 5 Montefiore Hospital Bronx NY, USA
Objective: To evaluate if continuity of medical care correlates with a reduced risk
of incarceration within one year among HIV+ and high risk HIV- women enrolled
in the HERS multicenter prospective longitudinal cohort HERS study in four US
urban sites.
Methods: Baseline data from 782 HIV+ and 366 HIV- high risk women were
analyzed using univariate and multivariate logistic regression to determine factors

which correlated with incarceration in the first year of the study.
Results: Overall, 139 (12%) women were incarcerated for some time within the
first 12 months of follow-up. In univariate analysis, women at baseline who went
to the same doctor's office or medical clinic for medical care (OR = 0.47, 95% Cl
= 0.31-0.71), received medical treatment in a doctor's office/clinic as opposed to
an ER (OR = 0.49, 95% Cl = 0.25-0.98), or had the same provider for at least
two years (OR = 0.55, 95% Cl = 0.38-0.80) were significantly less likely to be

incarcerated. Women who had been incarcerated within the 12 months prior to
the baseline visit, had an education level of high school or less, or recently used
of heroin or cocaine, were significantly more likely to be incarcerated. We used a
multivariate logistic regression model to adjust for the effects of HIV serostatus,
study site, race, prior incarceration, education level, and drug use, and found that
having the same medical provider for at least two years significantly decreased
the odds of incarceration by 37% (OR = 0.63, Cl = 0.41-0.96).
Conclusion: Continuity of the medical provider among HIV+ and high risk HIVwomen was associated with a decreased likelihood of incarceration, even when
controlling for drug use and history of prior incarceration.
32412 Physician perceptions of HIV(+) IDUs as barriers to
treatment
Andrew Green1, R.W.H. Palmer1, P. Millson2, M. Doswell1, A. Rachlis3. 1HIV
Health Evaluation Unit G318 2075 Bayview Ave Toronto ON M4N3M5;
2University of Toronto; 3Sunnybrook Health Science Centre Toronto, Canada
Objective: To identify physician's perceptions of HIV(+) IDUs, how these may
pose a barrier to appropriate healthcare for these patients, and to suggest possible
strategies for overcoming these barriers.
Methods: A questionnaire was distributed to 240 physicians in Ontario. This
survey asked physicians to describe their patient population, their willingness
to treat HIV(+) IDUs, their agreement with reasons why they would be hesitant
(or opposed) to including HIV(+) IDUs in their practices, and how strongly they
were in agreement with ways of overcoming these barriers. In-depth interviews
were also conducted with selected physicians to better understand their concerns
about treating HIV(+) IDUs.
Results: In the province of Ontario there are an estimated 30,000 IDUs, of
whom 5-10% are HIV(+). Over 150 physicians currently treat HIV(+) IDUs. Results of both the survey and the physician interviews found that HIV(+) IDUs are
perceived to: have complex socio-economic, legal and psychiatric issues; be less
adherent to medications, less likely to attend scheduled clinic appointments or
follow medical advice; often be seeking unnecessary medications and to often
lack proper healthcare system identification. Furthermore, physicians felt that they
often lack expertise in treating HIV(+) IDUs, and had concerns regarding physical
abuse or disruptive behaviour from these patients in their clinics. Physicians indicated that more education, better coordination of services, physician mentoring
programs and more specialized services may improve access to healthcare for
HIV(+) IDUs.
Conclusion: Physician's perceptions of HIV(+) IDUs may pose a significant
barrier to treatment for these patients. However, a number of solutions may be
effective in overcoming problems of access to healthcare by HIV(+) IDUs.
32413 The economic impact of HIV on Aboriginal people in
Canada
Brenda L. Thomas1,2, R. Hanvelt2, D. Schnieder3, N. Meagher3, T.T. Copley3,
E. Nowgesic4, M.J. Dubois4. 1One Nicholas Street Suite 1002 Ottawa;
2Assembly of First Nation Ottawa ON; 3University of British Columbia Vancouver
BC; 4Health Canada Ottawa ON, Canada
Objectives: To look at the economic costs of HIV and AIDS among Aboriginal
people in British Columbia, Canada.
Design: Descriptive study.
Methods: A target of 150 adult male and female HIV+ Aboriginal clients were
actively recruited through a comprehensive strategy (i.e. poster campaign) involving Aboriginal and non-Aboriginal AIDS service providers. A detailed survey was
developed by the University of British Columbia and included questions on demographics, mobility patterns, economic status, health and access to care, as well
as treatment and traditional healing methods. Participants provided prior informed
consent and were paid a nominal fee for their time. They were interviewed in
a variety of settings, including Aboriginal organizations and health care centers.
The data collection design involved one assessment, an enrollment interview,
and subsequent face-to-face interviews every three months over a 15 month
period. The reference period provided the potential to describe the changes in
income and expenditures patterns, access and barriers to care, and household
composition related to disease progression and functional health status.
Results: 175 HIV+ Aboriginal people have been recruited thus far. Of these,
more than 50 are in stage 4 of HIV disease according to the WHO modified
staging model.
Conclusion: Preliminary analysis suggests that HIV disease in the Aboriginal population may be seriously underestimated in Canada, where the official
Aboriginal AIDS cases are presently at 249 nationally. The economic burden to
the Aboriginal community, often impoverished and with few resources, would be
heightened by HIV/AIDS.
32414 When community-based care is impossible: Lessons
from an AIDS hospice for ethnic minority women and

children in northern Thailand
Kimberly Brown1, Kaesai Ponsakunpaisan1, A. Chirakura2. 'Manager, House of
Love, Chaing Mai; PO. Box 29, Chaing Mai; 2Manager, Health Project for Tribal
People, Chaing Mai, Thailand
Issues: HIV infected ethnic minority women and children who cannot return to
their communities of origin due to armed conflict between ethnic groups, cul