Risk Factors for HIV Disease Progression in a Rural Southwest American Indian Population

• Published in: Public health reports (1974) Vol. 125; no. 4_suppl; pp. 43 - 50
• Main Authors: Iralu, Jonathan, Duran, Bonnie, Pearson, Cynthia R., Jiang, Yizhou, Foley, Kevin, Harrison, Melvin
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA Association of Schools of Public Health 01.07.2010; SAGE Publications; SAGE PUBLICATIONS, INC
• Subjects: Adhesion; AIDS; Alcohol; Alcohol abuse; Alcoholic beverages; Alcoholism; American Indians; Bivariate analysis; CD4 antigen; CD4 Lymphocyte Count; Collaboration; Criminal punishment; Data collection; Data processing; Disease Progression; Drug abuse; Economic factors; Family income; Female; Folk medicine; Gender; Healing; HIV; HIV Infections - economics; HIV Infections - ethnology; HIV Infections - therapy; Household income; Human immunodeficiency virus; Human immunodeficiency virus 1; Humans; Imprisonment; Income; Indians, North American; Male; Mathematical models; Medication Adherence; Medicine; Medicine, Traditional - utilization; Native Americans; Native North Americans; Prisoners; Public health; Regression analysis; Risk analysis; Risk assessment; Risk Factors; Rural areas; Rural communities; Rural Population; Social factors; Socioeconomic factors; Southwestern United States; Traditional medicine; Viral Load; Viruses; Southwestern United States
• ISSN: 0033-3549; 1468-2877
• DOI: 10.1177/00333549101250S408

Objectives. Risk factors for human immunodeficiency virus (HIV) disease progression among American Indians (Als) have been poorly characterized. We assessed the impact of socioeconomic factors and use of traditional healing on HIV disease progression in a rural Al community. Methods. From January 2004 through December 2006, we interviewed 36 HIV-positive Als regarding their socioeconomic status, incarceration, and use of traditional healing. We also collected chart-abstracted adherence and substance-abuse data. Through bivariate analysis, we compared these factors with the CD4-cell counts and log HIV-1 viral loads (VLs). Using a simple regression model, we assessed interactions between the significant associations and the outcome. Results. Participant characteristics included being male (58.3%), being transgender (13.9%), having ever been incarcerated (63.9%), having a household income of <$ 1,000/month (41.7%), being unemployed (61.1%), being diagnosed with alcohol abuse (50.0%), and using traditional medicine (27.8%) in the last 12 months. Higher VLs were associated with recent incarceration (p< 0.05), household income of <$1,000/month(p<0.05), and provider-assessed alcohol abuse (p<0.05). We found an interaction between incarceration and alcohol abuse, and alcohol abuse was the factor more strongly associated with higher VLs. A lower CD4 count was associated with recent incarceration (p<0.05) and use of traditional medicine (p<0.05). Conclusions. Alcohol abuse is an important contributor to HIV disease progression, and participants with lower CD4 counts were more likely to use traditional medicine. HIV care among this rural Al population should focus on addressing alcohol abuse and other socioeconomic risk factors and promote collaboration between Western medical and Navajo traditional practitioners.