Access to HIV community services by vulnerable populations: evidence from an enhanced HIV/AIDS surveillance system

• Published in: AIDS care Vol. 23; no. 5; pp. 542 - 549
• Main Authors: Madden, H.C.E., Phillips-Howard, P.A., Hargreaves, S.C., Downing, J., Bellis, M.A., Vivancos, R., Morley, C., Syed, Q., Cook, P.A.
• Format: Journal Article
• Language: English
• Published: Abingdon Taylor & Francis Group 01.05.2011; Taylor & Francis; Taylor & Francis Ltd; Taylor & Francis (Routledge)
• Subjects: Access to health care; Acquired Immunodeficiency Syndrome - epidemiology; Adolescent; Adult; African Americans; AIDS/HIV; Analysis of Variance; Biological and medical sciences; Child; Child, Preschool; Community Health Services - utilization; Community organizations; Community service; Community services; Demographics; Deprivation; England - epidemiology; Ethnic groups; Female; Gays & lesbians; Health services; Health Services Accessibility - statistics & numerical data; HIV; HIV Infections - epidemiology; HIV Infections - ethnology; HIV Infections - prevention & control; Homosexuality, Male; Homosexuals; Human immunodeficiency virus; Human viral diseases; Humans; Immunodeficiencies; Immunodeficiencies. Immunoglobulinopathies; Immunopathology; Infant; Infant, Newborn; Infectious diseases; Logistic Models; Male; Medical sciences; Mental health; Middle Aged; Migrants; Minorities; Noncitizens; Organization of mental health. Health systems; Patients; Population Surveillance; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Public health; Refugees; Regression analysis; Social psychiatry. Ethnopsychiatry; Surveillance systems; third sector; Transients and Migrants - statistics & numerical data; United Kingdom; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; voluntary organisations; Voluntary organizations; Vulnerable people; Vulnerable Populations - statistics & numerical data; Young Adult; United Kingdom; Europe; England; United Kingdom > UK; British Isles, England; Social environment; Socioeconomic status; Accessibility; Mental health; third sector; Health service; Nongovernmental organization; community services; health services; Community health; Sanitary surveillance; Public health; Human; Immunopathology; Deprivation; Poverty; Retroviridae; AIDS; Vulnerability; voluntary organisations; Immune deficiency; Lentivirus; Infection; Virus; HIV; Sociodemographic factor; Viral disease; Human immunodeficiency virus; Predictive factor; Life Sciences
• ISSN: 0954-0121; 1360-0451
• DOI: 10.1080/09540121.2010.525609

HIV disproportionately affects vulnerable populations such as black and minority ethnic groups, men who have sex with men (MSM) and migrants, in many countries including those in the UK. Community organisations in the UK are charitable non-governmental organisations with a proportion of the workforce who volunteer, and provide invaluable additional support for people living with HIV (PLWHIV). Information on their contribution to HIV care in vulnerable groups is relatively sparse. Data generated from an enhanced HIV surveillance system in North West England, UK, was utilised for this study. We aimed to determine the characteristics of individuals who chose to access community services in addition to clinical services (1375 out of 4195 records of PLWHIV in clinical services). Demographic information, risk factors including residency status, uniquely gathered in this region, and deprivation scores were examined. Multivariate logistic regression modelling was conducted to predict the relative effect of patient characteristics on attendance at community services. Attendance at community services was highest in those living in the most, compared with least, deprived areas (p<0.001), and was most evident in MSM and heterosexuals. Compared to white UK nationals attendance was significantly higher in non-UK nationals of uncertain residency status (Adjusted odds ratio [AOR] = 21.91, 95% confidence interval [CI] 10.48-45.83; p<0.001), refugees (AOR = 5.75, 95% CI 3.3-10.03; p<0.001), migrant workers (AOR = 5.48, 95% CI 2.22-13.51; p<0.001) and temporary visitors (AOR = 3.44, 95% CI 1.68-7.05; p<0.001). Community services, initially established predominantly to support MSM, have responded to the changing demography of HIV and reach the most vulnerable members of society. Consequent to their support of migrant populations, community services are vital for the management of HIV in black and minority groups. Paradoxically, this coincides with increasing funding pressures on these services.