AIDS and Behavior

, Volume 13, Issue 1, pp 145–153 | Cite as

Factors Associated with HIV Viral Load in a Respondent Driven Sample in Los Angeles

  • William D. King
  • Sherry Larkins
  • Christopher Hucks-Ortiz
  • Pin-Chieh Wang
  • Pamina M. Gorbach
  • Rose Veniegas
  • Steven Shoptaw
Original Paper

Abstract

This study used a modified version of the Behavioral Model for Vulnerable Populations to examine the predisposing, enabling, and need factors associated with detectable viral load (VL). HIV status was measured using saliva and confirmed by blood. Of 797 persons enrolled, 193 were HIV positive and provided VL counts. A hierarchical multivariate logistic regression approach demonstrated that the predisposing factors of homelessness and recent substance abuse, particularly methamphetamine abuse, had a negative association with VL. The negative association of homelessness on VL was weakened with the introduction of enabling and need utilization factors. Mediation analysis indicated homelessness and HIV medication taking significantly associated with methamphetamine use as a predictor of detectable viral load. Guided policy to address substance abuse among those who are HIV positive is needed to improve biological outcomes.

Keywords

Homeless HIV Substance abuse Viral load Respondent driven sampling 

References

  1. Aidala, A., Cross, J. E., Stall, R., Harre, D., & Sumartojo, E. (2005). Housing status and HIV risk behaviors: Implications for prevention and policy. AIDS and Behavior, 9(3), 251–265.PubMedCrossRefGoogle Scholar
  2. Anderson, R., Bozzette, S., Shapiro, M., St. Clair, P., Morton, S., Crystal, S., Goldman, D., Wenger, N., Gifford, A, Leibowitz, A., Asch, S., Berry, S., Nakazono, T., Heslin, K., Cunningham, W., & the HCSUS Consortium (2000). Access of vulnerable groups to antiretroviral therapy among persons in care for HIV disease in the United States. Health Services Research, 35(2), 389–416.Google Scholar
  3. Arnsten, J., Demas, P., Grant, R., Gourevitch, M., Farzadegan, H., Howard, A., & Schoenbaum, E. (2002). Impact of active drug use on antiretroviral therapy adherence and viral suppression in HIV-infected drug users. Journal of General Internal Medicine, 17(5), 377–381.PubMedGoogle Scholar
  4. Barkin, S. L., Balkrishan, R., Manuel, J., Andersen, R. M., & Gelberg, L. (2003). Health care utilization among homeless adolescents and young adults. Journal of Adolescent Health, 32(4), 253–256.PubMedCrossRefGoogle Scholar
  5. Centers for Disease Control and Prevention, Factsheet, HIV/AIDS Among African Americans (2006). Atlanta: CDC.Google Scholar
  6. Crum, N. F., Riffenburgh, R. H., Wegner, S., Agan, B. K., Tasker, S. A., Spooner, K. M., Armstrong, A. W., Fraser, s., Wallace, M. R., & Triservice AIDS Clinical Consortium (2006). Comparisons of causes of death and mortality rates among HIV-infected persons; analysis of the pre-, early, and late HAART (highly active antiretroviral therapy) eras. Journal of Acquired Immune Deficiency Syndrome, 41(2), 194–200.Google Scholar
  7. Culhane, D. P., Gollub, E., Kuhn, R., & Shpaner, M. (2001). The co-occurrence of AIDS and homelessness: Results from the integration of administrative databases for AIDS surveillance and public shelter utilisation in Philadelphia. Journal of Epidemiology and Community Health, 55(7), 515–520.PubMedCrossRefGoogle Scholar
  8. Cunningham, W. E., Hays, R. D., Williams, K. W., Beck, K. C., Dixon, W. J., & Shapiro, M. F. (1995). Access to medical care and health-related quality of life for low-income persons with symptomatic human immunodeficiency virus. Medical Care, 33(7), 739–754.PubMedCrossRefGoogle Scholar
  9. Cunningham, W., Hays, R., Ettl, M., Dixon, W., Liu, C.-C., Beck, K., & Shapiro, M. (1998). The prospective effect of access to medical care on health-related quality-of-life outcomes in patients with symptomatic HIV disease. Medical Care, 36(3), 295–306.PubMedCrossRefGoogle Scholar
  10. Cunningham, W. E., Andersen, R. M., Katz, M. H., Stein, M. D., Turner, B. J., Crystal, S., Zierler, S., Kuromiya, K., Morton, S. C., St. Clair, P., Bozzette, S. A., & Shapiro, M. F. (1999). The impact of competing subsistence needs and barriers on access to medical care for persons with human immunodefiency virus receiving care in the United States. Medical Care, 37(12), 1270–1281.PubMedCrossRefGoogle Scholar
  11. Cunningham, W. E., Hays, R. D., Duan, N., Andersen, R., Nakazono, T. T., Bozzette, S. A., & Shapiro, M. F. (2005). The effect of socioeconomic status on the survival of people receiving care for HIV infection in the United States. Journal of Health Care for the Poor and Underserved, 16(4), 655–676.PubMedGoogle Scholar
  12. Derogatis, L. R. (2000). The brief symptom inventory 18: Administration, scoring and procedures manual. Minneapolis, MN: NCS Pearson.Google Scholar
  13. Diaz, T., Chu, S. Y., Buehler, J. W., Boyd, D., Checko, P. J., Conti, L., Davidson, A. J., Hermann, P., Herr, M., Levy, A. et al. (1994). Socioeconomic differences among people with AIDS: Results from a multistate surveillance project. American Journal of Preventive Medicine, 10(4), 217–222.PubMedGoogle Scholar
  14. Duran, S., Spire, B., Raffi, F., Walter, V., Bouhour, D., Journot, V., Cailleton, V., Leport, C., Moatti, J. P., & the APROCO Cohort Study Group (2001). Self-reported symptoms after initiation of protease inhibitor in HIV-infected patients and their impact on adherence to HAART. HIV Clinical Trials, 2(1), 38–45.Google Scholar
  15. Gavrilin, M. A., Mathes, L. E., & Podell, M. (2002). Methamphetamine enhances cell-associated feline immunodeficiency virus replication in astrocytes. Journal of Neurovirology, 8, 240–249.PubMedCrossRefGoogle Scholar
  16. Gelberg, L., Andersen, R. M., & Leake, B. D. (2000). The behavioral model for vulnerable populations: Application to medical care use and outcomes for homeless people. Health Services Research, 34(6), 1273–1302.PubMedGoogle Scholar
  17. Gordon, A. J., McGinnis, K. A., Conigliaro, J., Rodriguez-Barradas, M. C., Rabeneck, L., Justice, A. C., & VACS-3 Project Team (2006). Associations between alcohol use and homelessness with healthcare utilization among human immunodeficiency virus-infected veterans. Medical Care, 44(8 Suppl 2), S37–S43.Google Scholar
  18. Halkitis, P., Kutnick, A., & Slater, S. (2005). The social realities of adherence to protease inhibitor regimens: Substance use, health care and psychological states. Journal of Health Psychology, 10(4), 545–558.PubMedCrossRefGoogle Scholar
  19. Heckathorn, D. (2002). Respondent-driven sampling II: Deriving valid population estimates from chain-referral samples of hidden populations. Social Problems, 49, 11–34.CrossRefGoogle Scholar
  20. Heckathorn, D., Broadhead, R., Antony, D., & Weakliem, D. (1999). AIDS and social networks: Prevention through network mobilization, Social Focus, 32, 159–179.Google Scholar
  21. Heckathorn, D. D., & Volz, E. (2006). Respondent-driven sampling analysis tool (RDSAT) 5.6.0. Ithaca, NY: Department of Sociology, Cornell University.Google Scholar
  22. Herndon, B., Asch, S. M., Kilbourne, A. M., Wang, M., Lee, M., Wenzel, S. L., Andersen, R., & Gelberg, L. (2003). Prevalence and predictors of HIV testing among a probability sample of homeless women in Los Angeles County. Public Health Reports, 118(3), 261–269.PubMedGoogle Scholar
  23. Ho, D., Neuman, A., Perelson, A., Chen, W., Leonard, J., & Markowitz, M. (1995). Rapid turnover of plasma virions and CD4 lymphocytes in HIV-1 infection. Nature, 373, 123–126.PubMedCrossRefGoogle Scholar
  24. Katz, M., Cunningham, W., Flieshman, J., Anderson, R., Kellogg, T., Bozzette, S., & Shapiro, M. (2001). Effect of case management on unmet needs and utilization of medical care and medications among HIV-infected persons. Annals of Internal Medicine, 135(8), 557–565.PubMedGoogle Scholar
  25. Kim, T., Kertesz, S., Horton, N., Tibbets, N., & Samet, J. (2006). Episodic homelessness and healthcare utilization in a prospective cohort of HIV-infected persons with alcohol problems. BMC Health Services Research, 6(19), 1–10.Google Scholar
  26. King, W. D., Wong, M. D., Shapiro, M. F., Landon, B. E., & Cunningham, W. E. (2004). Does racial concordance between HIV-positive patients and their physicians affect the time to receipt of protease inhibitors? Journal of General Internal Medicine, 19(11), 1146–1153.PubMedCrossRefGoogle Scholar
  27. Knowlton, A., Hoover, D., Chung, S., Celentano, D., Vlahov, D., & Latkin, C. (2001). Access to medical care and service utilization among injection drug users with HIV/AIDS. Drug and Alcohol Dependence, 64(1), 55–62.PubMedCrossRefGoogle Scholar
  28. Krueger, L. E., Wood, R. W., Diehr, P. H., & Maxwell, C. L. (1990). Poverty and HIV seropositivity: The poor are more likely to be infected. AIDS Aug, 4(8), 811–814.Google Scholar
  29. Kushel, M., Colfax, G., Ragland, K., Heineman, A., Palacio, H., & Bangsberg, D. R. (2006). Case management is associated with improved antiretroviral adherence and CD4 cell counts in homeless and marginally housed individuals with HIV infection. Clinical Infectious Diseases, 43, 234–242.PubMedCrossRefGoogle Scholar
  30. Kushel, M., Vittinghoff, E., & Haas, J. (2001). Factors associated with the health care utilization of homeless persons. Journal of the American Medical Association, 285, 200–206.PubMedCrossRefGoogle Scholar
  31. Lewis, J. H., Andersen, R. M., & Gelberg, L. (2003). Health care for homeless women. Journal of General Internal Medicine, 18(11), 921–928.PubMedCrossRefGoogle Scholar
  32. Little, S., Holte, S., Routy, J.-P., Daar, E., Markowitz, M., Collier, A., Koup, R., Mellors, J., Connick, E., Conway, B., & Kilby, M. (2002). Antiretroviral drug resistance among patients recently infected with HIV. New England Journal of Medicine, 347, 385–394.PubMedCrossRefGoogle Scholar
  33. Low-Beer, S., Yip, B., O’Shaughnessey, M., Hogg, R., & Montaner, J. (2000). Adherence to triple therapy and viral load response. Journal of Acquired Immune Deficiency Syndrome, 23, 360–361.Google Scholar
  34. Lucas, G., Cheever, L., & Chaisson, R. (2001). Detrimental effects of continued illicit drug use on the treatment of HIV-1 infection. Journal of Acquired Immune Deficiency Syndrome, 27, 251–259.Google Scholar
  35. Markowitz, D., Mohri, H., Mehandru, S., Shet, A., Kalyanaraman, L. B. R., Kim, A., Chung, C., Jean-Pierre, P., Horowitz, A., La Mar, M., Wrin, T., Parkin, N., Poles, M., Petropoulos, C., Mullen, M., Boden, D., & Ho, D. D. (2005). Infection with multidrug resistant, dual-tropic HIV-1 and rapid progression to AIDS, a case report. The Lancet, 365, 1031–1038.Google Scholar
  36. Martens, W. (2001). A review of physical and mental health in homeless persons. Public Health Review, 29, 13–33.Google Scholar
  37. Martin, J. L., Wiley, J., & Osmond, D. (2003). Social networks and unobserved heterogeneity in risk for AIDS. Population Research and Policy Review, 22, 65–90.CrossRefGoogle Scholar
  38. Moss, A., Hahn, J., Perry, S., Charlebois, E., Guzman, D., Clark, R., & Bangsberg, D. (2004). Adherence to highly active antiretroviral therapy in the homeless population in San Francisco: A prospective study. Clinical Infectious Diseases, 39, 1190–1198.PubMedCrossRefGoogle Scholar
  39. O’Connell, J., Braitstein, P., & Hogg, R. (2003). Age, adherence and injection drug use predict virological suppression among men and women enrolled in a population-based antiretroviral drug treatment programme. Antiretroviral Therapy, 8, 569–576.Google Scholar
  40. Pastori, C., Weiser, B., Barassi, C., Uberti-Foppa, C., Ghezzi, S., Longhi, R., Calori, G., Burger, H., Kemal, K., Poli, G., Lazzarin, A., & Lopalco, L. (2006). Long-lasting CCR5 internalization by antibodies in a subset of long-term nonprogressors: A possible protective effect against disease progression. Blood, 107(12), 4825–4833.PubMedCrossRefGoogle Scholar
  41. Pulvirenti, J., Glowacki, R., & Muppiddi, U. (2003). Hospitalized HIV-infected patients in the HAART era: A view from the inner city. AIDS Patient Care STDS, 17, 565–573.PubMedCrossRefGoogle Scholar
  42. Rameriz-Valles, J., Heckethorn, D., Vazquez, R., Diaz, R., & Campbell, R. T. (2005). From networks to populations: The development and application of respondent-driven sampling among IDUs and Latino gay men. AIDS and Behavior, 9(4), 387–402.CrossRefGoogle Scholar
  43. Reback, C. J., Larkins, S., & Shoptaw, S. (2003). Methamphetamine abuse as a barrier to HIV medication adherence among gay and bisexual men. AIDS Care, 15(6), 775–785.PubMedCrossRefGoogle Scholar
  44. Riley, E. D., Bangsberg, D. R., Guzman, D., Perry, S., & Moss, A. R. (2005). Antiretroviral therapy, hepatitis C virus, and AIDS mortality among San Francisco’s homeless and marginally housed. Journal of Acquired Immune Deficiency Syndrome, 38(2), 191–195.CrossRefGoogle Scholar
  45. Strathdee, S., Palepu, A., Cornelisse, P., Yip, B., O’Shaughnessy, M., Montaner, J., Schechter, M., & Hogg, R. (1998). Barriers to use of free antiretroviral therapy in injection drug users. Journal of the American Medical Association, 280, 547–549.PubMedCrossRefGoogle Scholar
  46. Stein, J. A., Andersen, R. M., Koegel, P., & Gelberg, L. (2000). Predicting health services utilization among homeless adults: A prospective analysis. Journal of Health Care for the Poor and Underserved, 11(2), 212–230.PubMedGoogle Scholar
  47. Turner, B. J., Fleishman, J. A., Wenger, N., London, A. S., Burnam, M. A., & Shapiro, M. F. (2001). Effects of drug abuse and mental disorders on use and type of antiretroviral therapy in HIV-infected persons. Journal of General Internal Medicine, 16, 625–633.PubMedCrossRefGoogle Scholar
  48. U.S. Department of Health and Human Services, Health Resources and Services Adminsitration (DHHS/HRSA) (1999). Principles of Practice: A Clinical Resource Guide for Health Care for the Homeless Programs, Bureau of Primary Health Care, March 1, PAL 99–12.Google Scholar
  49. Waldrop-Valverde, D., & Valverde, E. (2005). Homelessness and psychological distress as contributors to antiretroviral nonadherence in HIV-positive injecting drug users. AIDS, Patient Care and STDs, 19(5), 326–334.CrossRefGoogle Scholar
  50. Yorke, J. A., Hethcote, H. W., & Nold, A. (1978). Dynamics and control of the transmission of gonorrhea. Sexually Transmitted Diseases, 5(2), 51–56.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • William D. King
    • 1
  • Sherry Larkins
    • 1
  • Christopher Hucks-Ortiz
    • 1
  • Pin-Chieh Wang
    • 1
  • Pamina M. Gorbach
    • 2
  • Rose Veniegas
    • 1
  • Steven Shoptaw
    • 1
    • 3
  1. 1.Department of Family MedicineDavid Geffen School of Medicine at University of California at Los Angeles (UCLA)Los AngelesUSA
  2. 2.Department of EpidemiologySchool of Public Health at UCLALos AngelesUSA
  3. 3.Department of Psychiatry and Biobehavioral SciencesDavid Geffen School of Medicine at UCLALos AngelesUSA

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