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The 130th Annual Meeting of APHA |
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The 130th Annual Meeting of APHA |
Ruth Finkelstein1, Joanne E. Mantell, PhD, MSPH2, Theresa Cassidy, MPH2, Barbara Aranda-Naranjo, PhD3, Bruce Agins, MD4, Ricardo Alvarez, MD5, Stephen Bowen, MD, MPH6, Dan Ciccarone, MD, MPH7, John Dougherty, PhD8, Barbara Hanna, MD9, Lisa R. Hirschhorn, MD, MPH10, Ilse Levin, MPHTM11, Sharon B. Mannheimer, MD12, Richard Moore, MD13, Linda M. Mundy, MD14, Victoria Sharp, MD15, Nancy L. VanDevanter, DrPH16, and Tracey E. Wilson, PhD17. (1) Office of Special Populations, The New York Academy of Medicine, 1216 Fifth Avenue, New York, New York, NY 10029, 212 822 7236, rfinkelstein@nyam.org, (2) New York Academy of Medicine, 1216 Fifth Avenue, New York City, NY 10029, (3) HIV/AIDS Bureau, Health Resources and Services Administration, US Department of Health and Human Services, 5600 Fishers, Lane, Room 7C-07, Rockville, MD 20857, (4) New York State Department of Health/AIDS Institute, New York State AIDS Institute, 5 Penn Plaza, New York, NY 10001, (5) Mission Neighbor Health Center, 240 Shotwell Street, San Francisco, CA 94110, (6) Executive Director, Epidemiology, North Broward Hospital District, Ft. Lauderdale, FL 33316, (7) Urban Health Study, Dept. of Family and Community Medicine, University of California, San Francisco, 3180 18th St. Suite 302, Campus Box 1304, San Francisco, CA 94110, (8) Multnomah County Health Department, 426 West Stark Street, Portland, OR 97204, (9) AIDS Services Center, Inc., 608 Martin Luther King Drive, Hobson City, AL 36201, (10) Dimock Community Health Center, 55 Dimock St, Roxbury, MA 02119, (11) Chase Brexton Health Services, Inc., 1001 Cathedral Street, Baltimore, MD 21201, (12) Harlem Hospital Center, Columbia University College of Physicians and Surgeons, 506 Lenox Avenue rm 3101-A, New York, NY 10037, (13) Johns Hopkins University School of Medicine, 1830 East Monument Street, Rm. 8059, Baltimore, MD 21287, (14) Washington University School of Medicine, 660 S. Euclid, Campus box 8051, St. Louis, MO 63110, (15) Center for Comprehensive Care, St. Luke's Roosevelt Hospital Center, 1000 Tenth Avenue, New York, NY 10019, (16) Center for Applied Public Health, Mailman School of Public Health, Columbia University, 722 W. 168 St, New York, NY 10032, (17) Preventive Medicine, SUNY Downstate Medical Center, 450 Clarkson Avenue, Box 1240, Brooklyn, NY 11203
Statement of Purpose: The September 11th terrorist attacks in New York City (NYC) and Washington, DC induced heightened fear and anxiety throughout the country, but especially in cities that sustained direct attacks. Responses in the general population -- disrupted sleep, increased PTSD, increased drug and alcohol use, increased anxiety and depression -- are all factors known to correlate with adherence burden in HIV. Little is known about the ways in which these attacks have affected adherence to HIV antiretroviral therapy (ART) and HIV risk behavior among people living with HIV/AIDS. We added a qualitative and quantitative component to our ongoing cross-site evaluation of HIV adherence support interventions in 14 U.S. sites funded by HRSA's Special Projects of National Significance to investigate the impact of these events on changes in participants' medication-taking practices, overall outlook on life and psychological status, quality of life, social relationships, illicit drug use and sexual behavior, as well as responses and adaptation to these events. Most participants in our intervention evaluation study are poor, marginalized, and socially disadvantaged and struggle to maintain stability in many aspects of their lives. The effects of terrorism may exacerbate the uncertainties, chaos and fears already faced by this fragile population, which in turn may impede adherence to ART or increase sexual and drug using risk-taking behaviors. Conversely, resilience may be noted in some individuals. Among those who use illicit drugs, stresses stemming from emotional and social dislocation are potential triggers for relapse in drug use. A supplement has been added to our routine quarterly client interviews assessing intensity of exposure to and impact of the events, depression and substance use in 4 sites (two in NYC; two outside NYC) twice over a six-month period. A one-time, in-depth qualitative interview with a convenience sample of 80 clients on ART for at least a month will be administered in the four sites. In addition, quantitative analyses of our ongoing quarterly client interview data (n=800) are being conducted to describe trends in adherence patterns between the three-month period preceding September 11th and at least the subsequent two three-month periods immediately following the events across all 14 sites. The geographic dispersion of participating sites in relation to the attack centers allows us to examine whether intensity of exposure (e.g., personal experience; proximity; relationship with those killed, injured, or otherwise directly involved; level of media viewing of the attacks) is a key factor in adaptation. Data collection is ongoing and will be completed in August 2002.
Learning Objectives:
Keywords: HIV Risk Behavior, Adherence
Related Web page: www.case.nyam.org
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.