Dissertation Abstract

RESEARCH HYPOTHESES:

1. The length of time from HIV infection to AIDS presentation varies among populations within Hillsborough County
2. Some populations utilize more or less medical resources for HIV/AIDS treatment due to social stigma in their culture and community.
3. The incidence of acquired comorbidities (e.g. PCP and CMV) and the level of risk behaviors after diagnosis (e.g. IV drug use, unsafe sex, etc) varies in these groups.

ABSTRACT

The Healthy People 2010 initiative focuses on eliminating health disparities between populations. The incidence and prevalence of HIV infection between ethnic groups and socioeconomic levels within the state of Florida varies greatly. This variation may be due to differential access to care, treatment and medication, as well as cultural and community support of HIV+ patients, neighborhood resources, and risk behaviors after HIV acquisition.

Previous studies have demonstrated variation in health outcomes among HIV+ individuals (Arno et al., 2004). Some populations experience higher incidence of comorbidity, such as PCP, and some populations may experience higher mortality rates both from AIDS and HIV-related illnesses. Furthermore, past work has shown that there are differences in health outcomes between populations, even after controlling for socioeconomic status and level of insurance. For example, black women are more likely to die of an acute MI than white women even after controlling for age, SES, and insurance (2003).

Diez-Roux et al., (2002) has also demonstrated that neighborhood resources are directly predictive of disease risk and play a significant role in changing health outcomes. The authors examined a number of neighborhood indicators and found it is possible to index neighborhoods into risk of acquiring chronic diseases and suffering from acute events such as myocardial infarction.

In this study, I will examine the health disparities present within the HIV+ community of the state of Florida in order to suggest ways to focus resources appropriately. More specifically, I will test the hypothesis that the length of time from HIV infection to AIDS presentation varies among populations and, furthermore, that some populations utilize more or less medical resources for HIV/AIDS treatment due to social stigma associated with HIV+ status in their community. In addition, I will examine the incidence of acquired comorbidities (e.g. PCP and CMV) and the level of risk behaviors after diagnosis (e.g. IV drug use, unsafe sex, etc) in these groups.

Zip-codes will be used to define a population and census data will be used to characterize that population. Using the HARS data set, HIV information will be explored in order to examine the relationship between HIV outcomes and populations.

Arno, P.S. (2002). Analysis of a Population-Based Pneumocystis carinii Pneumonia Index as an Outcome Measure of Access and Quality of Care for the Treatment of HIV Disease. American Journal of Public Health. 92: 395-398.

Diez-Roux, A.V. (2002). Investigating area and neighborhood effects on health. American Journal of Public Health. 91: 1783-89.

Institute of Medicine (2003). Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare.