ABSTRACT
The purpose of this study is to characterize the relationship between identity and health care experiences (including antiretroviral therapy utilization) among HIV-positive sexual minority males. This qualitative study used grounded theory with data collection occurring through focus groups and interviews. A questionnaire was used to complete a demographic profile. The study included 47 HIV positive participants from three minorities: gay men, bisexual men and transgendered persons, gender identifying as female and or living as women. Sessions elicited information on: (1) general experiences with health care, (2) experiences with HIV antiretroviral therapies and issues surrounding access, and (3) adherence to these therapies and identity in relation to health care. These textual data revealed three themes: (1) the importance of sexual identity and its social and cultural context, (2) the differences in the health concerns between the sexual minorities and (3) a wide spectrum of experiences with the health care system that provide information surrounding the access to and adequacy of health care. Successful health care providers are aware of different issues that may play a role in the provision of health care to these sexual minorities. Providers awareness of sexual and social identity and the related different cultural values, beliefs and custom enhance care seeking and therapeutic adherence. For sexual minorities, primary care remains the most important entry point into the health care system. Cultural competence of care providers can foster patient's care seeking and adherence to treatment.
Subject(s)
Attitude of Health Personnel , Bisexuality/psychology , Clinical Competence/standards , Gender Identity , HIV Seropositivity/ethnology , Holistic Health , Homosexuality, Male/psychology , Minority Groups/psychology , Patient Acceptance of Health Care/ethnology , Prejudice , Self Concept , Transsexualism/psychology , Adult , British Columbia , Focus Groups , HIV Seropositivity/therapy , Humans , Male , Professional-Patient Relations , Surveys and Questionnaires , Truth DisclosureABSTRACT
In order to gain an understanding of the determinants of clinical management of HIV disease in adults just prior to the introduction of comprehensive guidelines, we undertook the present study among members of the British Columbia Persons with AIDS Society (BCPWA). The aim of this study was to examine whether the heterogeneity of care for HIV-infected individuals decreases with physician knowledge of HIV/AIDS and the stability of the physician-patient relationship. Eligible participants had to be full members (i.e. HIV positive) of the society, residents of British Columbia, and had to have previously agreed for the BCPWA society to include unsolicited material with their monthly newsletter. Our analysis demonstrates that compliance with appropriate care was associated with a more stable physician-patient relationship and with the perception on the patient's part of a greater level of knowledge on the part of their physician.
Subject(s)
Clinical Competence/standards , HIV Infections/therapy , Health Care Surveys , Physician-Patient Relations , Adult , British Columbia , CD4 Lymphocyte Count , Female , HIV Infections/immunology , Humans , Male , Middle Aged , Self-Help GroupsABSTRACT
OBJECTIVE: To determine the patterns and determinants of mobility in persons with HIV infection or AIDS on a population basis. DESIGN: Descriptive cross-sectional population health study. TARGET POPULATION: 650 full members (i.e., HIV-positive) of the Vancouver Persons with AIDS Society who were residents of British Columbia and who allow the society to include unsolicited material with their monthly newsletter. MAIN OUTCOME MEASURES: Migration history, access to HIV-related care at diagnosis, current and pre-HIV sociodemographic characteristics, and current health status. RESULTS: Two hundred and fifty-two persons living with HIV/AIDS participated in the study. At the time of the survey, the majority of subjects were male (94 percent), aged between 30 and 54 years (87 percent), and able to carry out daily activities without assistance (84 percent). The median time since the known date of HIV infection was 6 years. Access to care at diagnosis was associated in this population with being diagnosed in the largest metropolitan area in the province (OR = 2.14; 95 percent CI: 1.18, 3.87), a pre-HIV income of $30,000 or more per annum (OR = 0.49; 95 percent CI: 0.27, 0.89), a known date of diagnosis prior to 1990 (78 percent versus 64 percent; p = 0.019), and living in the same residence from the date of known HIV diagnosis to the date of the survey (63 percent versus 51 percent; p = 0.024). CONCLUSION: Although no definitive causal association can be provided by this cross-sectional analysis, our results clearly highlight several ways in which the need for treatment and care potentially affect where persons with HIV/AIDS choose to live.
Subject(s)
HIV Infections/therapy , Health Services Accessibility/statistics & numerical data , Adult , British Columbia , Catchment Area, Health/statistics & numerical data , Cross-Sectional Studies , Data Collection , Delivery of Health Care/standards , Delivery of Health Care/trends , Female , HIV Infections/diagnosis , Health Services Accessibility/standards , Health Services Accessibility/trends , Humans , Logistic Models , Male , Middle Aged , Socioeconomic Factors , Surveys and QuestionnairesABSTRACT
St. Paul's Hospital, Vancouver has the largest Canadian experience of the care of persons with HIV/AIDS. This article reviews St. Paul's experience during the period 1987-1991, with particular emphasis on issues in palliative AIDS care. These issues include the implications of prolonged palliative care at home, precipitous readmissions to hospital for terminal care, and long-stay terminal admissions. Aspects of treatment and social factors which have an impact on palliative AIDS care are also identified. The implications for program development in both community and institutional settings are discussed.
