Factors Associated with Engaging Socially Marginalized HIV-Positive Persons in Primary Care

Boston University, Boston, Massachusetts, United States
AIDS PATIENT CARE and STDs (Impact Factor: 3.5). 02/2007; 21 Suppl 1(s1):S30-9. DOI: 10.1089/apc.2007.9989
Source: PubMed


This paper examines factors associated with engaging socially marginalized HIV-positive persons in primary care using interview and chart review data from 984 clients presenting for services at 10 agencies participating in a multisite demonstration project. The sample was predominantly minority, and many reported drug and mental health problems as well as housing instability. At baseline, roughly half of the participants were engaged in HIV primary care; the other participants were either not at all engaged in HIV primary care or somewhat engaged in care. Those who were somewhat engaged in care were very similar to those who were not at all engaged in care, and significantly different than those who were fully engaged in care across a number of demographic, health status/utilization, and barriers to care items and fared equally poorly with regard to engagement in care at 12-month follow-up. In 12-month longitudinal analyses, 58% of those not engaged at baseline ( n = 517) became more fully engaged in care. In the final multivariate model that controlled for disease stage, decreases in drug use, structural barriers, and unmet needs were associated with engagement in care. Interventions that focus on decreasing structural barriers and unmet support services needs, addressing negative health beliefs and attending to drug use are promising public health strategies to engage marginalized HIV-positive persons in HIV primary care.

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    • "These behaviors are inherently proactive, and directed toward fostering positive health and wellbeing . Research in the general population suggests that health behaviors are linked to the importance people place on health maintenance, the extent to which they believe that performing certain activities benefits health (Dutta-Bergman 2004; Rumptz et al. 2007) and their attitudes toward available health information (Dutta-Bergman 2004). Because we are interested in general health behaviors we sought to examine general health attitudes. "
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    • "" and " How many of these did you miss? " Participants were defined as not engaged in care if they did not have any healthcare visits, or if they reported at least 2 missed visits, in the past three months. Participants who reported attending at least one medical visit and who did not report any missed visits in the past three months were considered to be engaged in care (Rumptz et al. 2007). "
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    • "Barriers and facilitators that have been identified in the literature to date include structural aspects of care, availability of support services, and personal factors (Rumptz et al., 2007). "
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