HIV/AIDS & WOMENS OF COLOR: ROLES OF DRUG USE, VIOLENCE & INSURANCE IN HAART USE - DESCRIPTION (provided by applicant): HIV/AIDS among women is an epidemic that disproportionately affects women of color. It reflects a convergence of politically sensitive issues (i.e., race, drug use, and sexual behavior) that are difficult to disentangle and address. Since the introduction of highly active antiretroviral therapy (HAART) as the standard of care in 1996, mortality rates from AIDS and its complications have declined, but at a much slower rate among women than men. Previous research indicates that HIV positive African American women are less likely than white women to receive HAART. Several national studies indicate that African American women fare worse than white men on a number of standards of HIV care. The proposed study uses data from the Women's Interagency HIV Study (WIHS) confidential data set to 1) assess whether the roles of race and drug use on HAART are moderated by the effects of health insurance coverage and 2) examine longitudinal differences in HAART use among HIV positive female drug users and investigate the extent to which individual latent states (as defined by clusters of psycho-social or behavioral risk factors such as an individual's drug use, drug using partners, depression, and physical or sexual abuse) influence racial/ethnic disparities after controlling for other confounders. Many studies have assessed the independent effects of race, gender, drug use, insurance coverage, and physical or sexual abuse on use of medical care by people with HIV, but little is known about how these risk factors operate in combination or clusters. Several methodological refinements are employed, including use of analytic methods appropriate for longitudinal data and Hidden Markov Models to examine behavioral risk clusters. Study results will improve understanding of the roles of drug use, physical or sexual abuse, and insurance coverage in observed racial disparities of HAART use among HIV positive women and ultimately, improve interventions aimed at reducing racial and other disparities in HIV/AIDS medical care among women. Findings will also inform development of systems for monitoring quality of care among HIV positive women.
