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Dr Anatole S Menon-Johansson Drs Jean McGuire & Harvey Makadon Harvard School of Public Health

Developing and testing models for the investigation of barriers to effective HIV / AIDS prevention in the USA. Dr Anatole S Menon-Johansson Drs Jean McGuire & Harvey Makadon Harvard School of Public Health Harkness / Health Foundation Fellow 2006 Orlando June, 2007. Outline.

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Dr Anatole S Menon-Johansson Drs Jean McGuire & Harvey Makadon Harvard School of Public Health

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  1. Developing and testing models for the investigation of barriers to effective HIV / AIDS prevention in the USA Dr Anatole S Menon-Johansson Drs Jean McGuire & Harvey Makadon Harvard School of Public Health Harkness / Health Foundation Fellow 2006 Orlando June, 2007

  2. Outline • Measuring AIDS prevention performance • Describe how AIDS prevention differs between men & women • Highlight correlations with AIDS prevention • Predicting AIDS prevention performance • Policy implications

  3. HIV > AIDS > Death 1o P R E V E N T I O N Viral transmission 2-3 weeks Acute retroviral syndrome 2-3 weeks Recovery + seroconversion HIV+ 2-4 weeks Chronic HIV infection ~ 8 years Symptomatic HIV infection / AIDS AIDS 2/3o ~ 1.3 years HIV Rx Death

  4. HIV vs AIDS data • HIV data available from 28 states in 1995 and 36 in 2004 • ? HIV data reliability • HIV ≤ AIDS diagnoses for some states • Estimated 25% HIV+ persons do not know their ‘serostatus’ • AIDS = notifiable disease since late 1980’s and disease definition set in 1993

  5. Changes in AIDS cases over time Data: Center for Disease Control and Prevention (CDC) 1995-2004

  6. AIDS prevention by gender Data: CDC 1995-2004

  7. AIDS prevention in men (1995-2004)

  8. AIDS prevention in women (1995-2004)

  9. Relationships with known prevention strategies • How does AIDS prevention relate to: • Demographics • Economics • Prevention strategies • Primary • Secondary / Tertiary • Linear regression was used to compare AIDS prevention with the above variables

  10. Demographics Data: US Census Bureau 2004

  11. Income / Poverty & AIDS prevention Data: US Census Bureau 2004

  12. Primary prevention Data: Kaiser Family Foundation, Office of Applied Studies, CDC

  13. Women’s Health Data: American Cancer Society 2004, CDC 2004, NARAL Pro-choice America 2006

  14. The uninsured and state to state disparity in provision • KFF / NASTAD ADAP reports • 25% of HIV+ people on Rx use ADAP • ADAP formulary varies by state • Waiting lists are used for cost control • Variation in eligibility criterion • Kaiser Daily HIV / AIDS reports • August 29th, 2003 • “Three people with HIV / AIDS die while on West Virginia ADAP waiting list”

  15. Health care provision Data: US Census Bureau 2004

  16. Secondary / Tertiary prevention Data: KFF / NASTAD ADAP reports 1997-2004, AMA 2004, US Census Bureau 2004

  17. Impact of sodomy laws Data: CDC 1995-2003, US Supreme Court

  18. Impact of Syringe Exchange Program (SEP) authorization laws Data: Beasley School of Law, Temple University

  19. Summary • State AIDS prevention can be accurately evaluated using this model • Less effective state AIDS prevention is associated with : • Women (Reduced reproductive health) • Poverty (Black) • Poor STD control • History sodomy laws • No SEP authorization laws

  20. Prediction AIDS prevention success • Key variables: • Poverty • Gonorrhoea rate • Not having a SEP authorization law • Properties of predictive model: • Sensitivity 83% • Specificity 79%

  21. Policy implications AIDS prevention could be improved by: • Standardization of SEP authorization laws • Improving sexual and reproductive health • Poverty alleviation

  22. Acknowledgements • Commonwealth Fund • Health Foundation • Ellison-Cliffe Travelling Fellowship • Senta Foulkes Travelling Fellowship • Avni Patel (KFF) • Drs Sullivan and Campsmith (CDC) • Professors and students at HSPH

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