Once and future HIV treatment: a comparison of clinic and community groups

Abstract

The demographic, risk-taking, psychological, and social network characteristics of HIV+ patients receiving and not receiving antiretroviral therapy were compared to those characteristics in HIV+ and HIV- persons who are not in care. In this cohort study, we enrolled patients from the Grady Infectious Disease Program (IDP) Clinic in Atlanta, GA, defining group membership by their use of antiretroviral therapy at the time of ascertainment. We also enrolled HIV+ and HIV- persons from inner city neighbourhoods of Atlanta. We collected extensive survey information from both groups, as well as clinic and follow-up information from the Clinic groups. We attempted to interview each participant four times over a period of two years. We used scores for Risk, for Social Stress and for Psychological Distress to compare the groups. Persons receiving antiretroviral therapy continued to display risky behaviour and to experience a substantial degree of social stress and psychological distress. HIV+ persons in the community, however, had the most prominent profile for HIV-transmission risk, social stress, and psychological distress and display considerable cross-over in their patterns of risk-taking. Men who have sex with men appear to play a dominant role, through their risk behaviour and network affiliations, in the maintenance of HIV endemicity. Current approaches fail to give sufficient attention to the admixture of risk that occurs in inner city communities. Reaching HIV+ persons with antiretroviral therapy in such communities faces considerable social, structural, and psychological barriers that may be more important than simple adherence to medication.