Black Women in City Infected with HIV at Higher Rate than National Average

A recent article published in The Baltimore Sun discussed a study that found the rate of new HIV infections among black women in Baltimore, MD, is almost five times higher than the national average. According to the article, the Centers for Disease Control and Prevention (CDC) reports that roughly 25 percent of HIV infections occur among women and 67 percent of those infections occur in black women. However, the rate of new HIV infections among black women in cities considered to be “hot spots” (Atlanta, Baltimore, Newark, New York, Raleigh-Durham, and Washington) is significantly higher than the national average for black women (24 per 10,000 versus 5 per 10,000). These “hot spots” have been areas disproportionally impacted by the HIV/AIDS epidemic for decades, according to the article. However, the researchers were surprised by these rates as the field largely has focused on black and gay men. “This is why it’s important to remind people that this is going on right here in our hometown,” said Dr. Charles Flexner, principal investigator for the Baltimore section of the study and clinical pharmacologist and infectious disease expert at Johns Hopkins. Although Baltimore declared HIV a public health emergency in 2002, the number of infected people in the city continues to rise. 

The new study from Hopkins and other researchers underscores the urgency in addressing the problem, said Dr. William A. Blattner, chair of the City's Commission on HIV/AIDS Prevention and Treatment, which developed the citywide plan to reduce infections. Blattner, also associate director of the Institute of Human Virology at the University of Maryland School of Medicine, said the city now has a four-pillar strategy: reducing new infections; increasing access to care and improving health outcomes; reducing HIV-related disparities and health inequalities; and achieving a more coordinated city response. About the black women in particular, he said, "HIV continues to impact our most vulnerable and marginalized, in particular economically disadvantaged women whose risk is compounded by gender inequality and potential barriers to substance abuse interventions."

The new study, formally known as HIV Prevention Trials Network 064 Women’s Seroincidence Study, ended in February 2011 and was funded by the U.S. National Institute of Allergy and Infectious Diseases (NIAID), part of the U.S. National Institutes of Health.

Read more on the Kaiser Family Foundation website. Read more on the Baltimore Sun website. Read the press release on the Johns Hopkins website.

Top Health Issues for LGBT Populations Information & Resource Kit

The Substance Abuse and Mental Health Services Administration (SAMHSA) has released Top Health Issues for LGBT Populations Information & Resource Kit. This publication demonstrates SAMHSA's commitment to creating awareness of the needs, experiences, and health status of lesbian, gay, bisexual, and transgender (LGBT) Americans and to addressing behavioral health disparities. The information and resource kit informs health care providers and prevention specialists about the health experiences of LGBT populations. Understanding the health issues of LGBT individuals is a significant step in improving access to care and the quality of behavioral health services.

The information and resource kit contains seven fact sheets as well as PowerPoint slides that can be used individually or together. The fact sheets address the following topics:

• Helpful Terms for Prevention Specialists and Health Care Providers
• Gender Identity
• Top Health Issues for Lesbians
• Top Health Issues for Gay Men
• Top Health Issues for Bisexual Men and Women
• Top Health Issues for Transgender People
• Selected Web-based Resources

Download the Information & Resource Kit.

Relationship Between Socioeconomic Position and Depression among African Americans

A recent study published by Social Psychiatry and Psychiatric Epidemiology found that multiple measures of socioeconomic position, including income, unemployment, and marital status, can be important predictors for depression among blacks, and that those associations can vary between sexes. 

While many studies have demonstrated that the incidence of depression increases with lower socioeconomic position (SEP), researchers have not established the same inverse relationship among blacks. This study explored the relationship between SEP indicators and depression among blacks, whether gender differences exist in those relationships, and whether the diminished returns hypothesis – that blacks who reported higher SEP also are at greater risk for depression – held true. The authors used the National Survey of American Life (NSAL), the largest nationally representative survey of mental disorders among blacks, to capture cross-sectional data on SEP variables and incidence of depression. The study analyzed 2001-2003 NSAL data and sampled 579 men and 1,050 women for 12-month Major Depressive Episode (MDE) and 602 men and 1,267 women for lifetime MDE. The primary outcome variable was MDE diagnosis. The authors included several SEP measures including: household income, highest level of education, employment status, mother’s level of education (as a measure of childhood SEP), net worth, and estimated home value. Several demographic variables also were incorporated, including age, marital status, geographic region, and household size. Using multiple logistic regression models, stratified by gender, the researchers found that higher household income and unemployment increased the odds of 12-month MDE for black men, while educational attainment reduced the risk. However, higher household income reduced the risk of 12-month MDE for black women. For lifetime MDE, unemployment was associated with an increased risk of depression among men. This study was consistent with previous research indicating that higher earning black men may encounter additional stress related to structural barriers and discrimination in the workplace.

The authors indicated that factors beyond SEP also could be significantly correlated with depression. The researchers concluded that future research is needed to better understand the cultural and social factors that may lead to reduced health outcomes for blacks. 

Read more on the Kaiser Family Foundation website. Read the complete study.

Eliminating Health Care Disparities: Implementing the National Call to Action Using Lessons Learned

A new report titled Eliminating Health Care Disparities: Implementing the National Call to Action Using Lessons Learned, discusses nine case studies on how collecting patients' demographic data, expanding cultural competency training and diversifying health leadership can help reduce care disparities. For example, New York-Presbyterian Hospital started an initiative to improve care for patients in the largely Hispanic neighborhoods of Washington Heights and Inwood in New York City. The effort included a four-hour training program for health professionals to help address patients' cultural, language and literacy needs. New-York Presbyterian also employed bilingual patient navigators and helped establish seven patient-centered medical homes, centralized scheduling and test-results communications. The hospital saw a nearly 10% drop in emergency department visits related to problems better handled in the primary care setting. The achievement in New York is one of nine case studies included in the report.

"The cultural competency training provides background information in terms of the various ethnicities and religions and groups that we see predominantly," said J. Emilio Carrillo, MD, MPH, vice president for community health at New York-Presbyterian. "However, we are making it very clear that we ascribe to a patient-centered, cross-cultural approach." Whatever ethnic or racial background a patient is from, "people are trained to respond to them as an individual and to seek the knowledge on how to manage the person directly from the patient," Dr. Carrillo said.

Initiatives at Baylor Health Care System in Dallas, the University of Mississippi Medical Center in Jackson and Adventist HealthCare in Rockville, Md., are among the others profiled. The report is a follow-up study for an anti-disparities coalition launched in July 2011 by the American Hospital Assn., the Assn. of American Medical Colleges, the American College of Healthcare Executives, the National Assn. of Public Hospitals and Health Systems, and the Catholic Health Assn. of the United States.

Read more on the American Medical News website. Download the report (pdf).

Socioeconomic Disparities in Community-Based Treatment of Tobacco Dependence

A recent study published in the American Journal of Public Health found socioeconomic status (SES) to be a significant indicator for treatment outcome disparities in community-based tobacco treatment programs. 

Prior research shows that people of color and people in lower-SES groups encounter greater tobacco cessation challenges, according to the authors. They note that these groups are less likely to have access to accurate information about nicotine replacement and tobacco dependence treatment programs, receive cessation advice from health care providers, and have smoking bans in place in the home or workplace. The authors sought to determine how SES, ethnicity, nicotine dependence, stress levels, treatment use, and other factors contribute to maintaining tobacco cessation by exploring community-based tobacco dependence treatment programs in Arkansas. A total of 2,739 participants at 14 sites from 2005 to 2008 were included in the study. SES was defined using a scale combining household income and educational level. Other variables included age, gender, race and ethnicity, and insurance status. Overall, the abstinence rate at 3 months after treatment was 28.2 percent and 27.3 percent at 6 months, the authors note. Significant differences in abstinence rates were found across SES levels at the end of treatment and at 3 and 6 months, with those in the lowest SES group being the least likely to be tobacco free at the end of treatment, as well as at 3 and 6 months following treatment, according to the authors. The findings suggest future efforts to enhance treatment approaches for lower-SES groups should include increasing access to treatment content, addressing clinical and environmental factors that affect treatment outcomes, and managing clinical and environmental challenges, such as implementing smoking bans or managing stress. Though ethnicity was not a statistically significant variable in the study, people of color made up a greater proportion of lower-SES groups, suggesting the perspective of ethnic minorities be considered when evaluating the needs of lower-SES groups.

The authors note that future research is needed to explore more effective ways to innovatively treat low-SES smokers and reduce treatment disparities. 

Read more on the Kaiser Family Foundation website. Read the abstract of the study.

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