Mapping the HIV Cure with Geographic Information Systems

The National HIV/AIDS Strategy has provided the nation with a long-overdue framework for a population-based approach to HIV prevention and a more coordinated national response. But faced with funding reductions, HIV/AIDS professionals are now challenged to employ technology more effectively, including using not just the traditional HIV-surveillance data but increasingly a new technology: geographic information systems (GIS). Similar to the global positioning system, or GPS, feature in a cellphone or automobile, GIS maps a neighborhood's key characteristics, such as its businesses and transportation infrastructure, but allows users to connect them with HIV-surveillance data, such as a community's HIV prevalence, to help organizations fine-tune their battle against the epidemic.

"Because HIV surveillance does not collect data on education, income and other personal information, we cannot assess if there are disparities in HIV infection, for example, among people of different education or income levels," says Fangchao Ma, M.D., Ph.D., an HIV/AIDS-evaluation administrator with Illinois' health department. "However, the U.S. census provides detailed information on these factors at the census-tract level." GIS allows users to bring these two pieces of information together, a process called geo-mapping. "With geo-mapping, we can assess impacts of these factors on HIV infection," adds Dr. Ma, whose research clearly depicted the health disparities in Illinois' epidemic, such as the relationship between the state's concentration of poverty in Chicago and its HIV prevalence.

"Dr. Ma's study results showed the disparities . . . in such a clear way that even skeptics were moved to action--addressing social determinants of health as a central issue in the fight against AIDS," says Edwin Corbin-Gutierrez, youth-empowerment manager at the Center on Halsted, a LGBT community center in Chicago, and co-chair of the epidemiology and needs-assessment committee of Illinois' HIV-prevention community-planning group.

How Does Geo-Mapping Work? New users begin by listing their HIV-testing organization through the National Prevention Information Network (pdf). Once part of that database, the organization will be depicted in GIS services such as the Atlas of the Centers for Disease Control and Prevention (CDC) National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, which contains HIV, viral hepatitis, sexually transmitted disease and tuberculosis data; and AIDSVu, the GIS run by the Rollins School of Public Health at Emory University in conjunction with the CDC.

"Users then can visualize the data in many ways--think maps, reports and charts--that reveal relationships, patterns and trends in the area and make them easy to analyze and evaluate," says Jenevieve Opoku, a behavioral scientist with the District of Columbia Department of Health. Let's say that a Ryan White-grant-funded community-based organization (CBO) in an impoverished neighborhood is having difficulty retaining its young MSM clients in care. Geo-mapping might show that the agency is not located near public transportation, the closest pharmacy is four miles away or assaults against young MSM are prevalent along the route between public transportation and the agency--all of which could undermine the organization's efforts.

Read more on the Black AIDS Institute website.

Time to Shatter the Black Suicide Myth

In the 1970s and beyond, "Soul Train" defined cutting-edge cool. It became the longest-running syndicated show of its type on TV and, as Don Cornelius said every week, "The hippest trip in the galaxy." But the hip trip finally came to an end a few years ago on TV and for Cornelius, amid reports of failing health. Police say he died in his Los Angeles home of a self-inflicted gunshot wound.

That tragedy has special meaning in the African-American community, which has long nourished a dangerous myth that black people don't commit suicide. It is a point of mythical ethnic pride that our ancestors found ways to persevere despite centuries of slavery, struggle and hardship. Black people created the blues, it is often said, because we didn't have psychotherapists.

Although whites and Native Americans have the highest suicide rates, according to the Centers for Disease Control and Prevention, the black suicide rate has been high enough in recent years to claim one African-American every 4.5 hours. No group is immune. By gender, non-Hispanic white and Native American men have the highest suicide rates, of about 25 lives per 100,000. That's more than four times the rate of women in each racial group. It also is more than twice the rate of black and Hispanic men, whose suicide rate of about 11 per 100,000 is five times the rate of black and Hispanic women. Asian-American men have a rate of about 9 per 100,000, slightly more than twice the rate of Asian-American women.

Read more on the Chicago Tribune website.

Urban Indian Health Institute: 2011 Community Health Profiles

The Urban Indian Health Institute (UIHI) has released the Community Health Profiles for each Urban Indian Health Organization (UIHO) service area. The interactive map provides links to all cities for which data is available. The reports examine the health of American Indian/Alaska Natives (AI/AN) living in each of the 34 UIHO service areas using the most current data available from the 2010 U.S. Census, the American Community Survey (ACS), the Behavioral Risk Factor Surveillance System (BRFSS), the U.S. Center for Health Statistics and the Air Quality System Data Mart. The Community Health Profiles are intended to provide UIHO and other key stakeholders with a picture of the health of urban Indian people. The UIHI updates these reports every two years.

The UIHI has also released the Community Health Profile: National Aggregate of Urban Indian Health Organization Service Areas (December 2011), an update to the Community Health Profile (2009). This report examines the health of American Indian/Alaska Natives (AI/AN) living in all UIHO service areas combined and presents data from the 2010 U.S. Census, the American Community Survey (ACS), the Behavioral Risk Factor Surveillance System (BRFSS), the U.S. Center for Health Statistics and the Air Quality System Data Mart. The report includes data on access to care, smoking, alcohol use, and mental health and wellness.

Access the Community Health Profiles on the UIHI website. Read the national aggregate report (pdf).

Hispanic Lesbians and Bisexual Women at Heightened Risk of Health Disparities

A recent study titled Hispanic Lesbians and Bisexual Women at Heightened Risk or Health Disparities, published in the American Journal of Public Health found Hispanic lesbian and bisexual women tend to be at a greater risk of worse health outcomes than Hispanic heterosexual as well as white lesbian and bisexual women. Little background literature covers health disparities among sexual minorities of color, especially Hispanics, according to the authors. This study aims to explore how Hispanic sexual minorities fare in health care access, health outcomes, health status, and health risk behaviors.

Hispanic lesbians and bisexual women, compared with Hispanic heterosexual women, were at elevated risk for disparities in smoking, asthma, and disability. Hispanic bisexual women also showed higher odds of arthritis, acute drinking, poor general health, and frequent mental distress compared with Hispanic heterosexual women. In addition, Hispanic bisexual women were more likely to report frequent mental distress than were non-Hispanic White bisexual women. Hispanic lesbians were more likely to report asthma than were non-Hispanic White lesbians.

The study used the weighted-data from a 7- year merged file of the Washington State Behavioral Risk Factor Surveillance System (BRFSS), 2003 – 2009. The sample size for the analysis was 6,338. Only Hispanic and white women who self- identified as lesbian, bisexual, or heterosexual were included in the study. Within the sample, 1.1% were Hispanic lesbian and 1.6% were Hispanic bisexual. Data were collected for health status, health risk behaviors, health outcomes, and health care access.  

This study is one of the first studies to assess disparities among Hispanic lesbian and bisexual women according to the authors. The authors suggest that further research is needed in order to develop culturally appropriate programs that meet the needs of these subgroups. This in turn, as the authors argue, will achieve the goals laid out Healthy People 2020.

Read more on the Kaiser Family Foundation website. Read the abstract of the study.

Helping Substance-Involved Young People in Juvenile Justice be Successful

Reclaiming Futures is an innovative evidence-based model and approach to systems and community change that is designed to enable young people who have substance abuse issues and are in the criminal justice system to become successful. Developed in the context of ten different demonstration communities and amidst numerous economic, geographic, political, cultural, and philosophical diversities, the initiative embraces a six-stage integrated service model that supports coordinated individual response and community-directed engagement with care. This article, titled Helping substance-involved young people in juvenile justice be successful: Conceptual and structural foundations of the Reclaiming Futures model, describes the background, rationale, and context of the change effort itself, as well as the conceptual foundations of the Reclaiming Futures framework. The role of the National Program Office (NPO) and the structures designed to support the shared transformational leadership required to launch, implement, and sustain these practice and policy innovations at the local, state, and national levels are discussed.

Read more on the Robert Wood Johnson Foundation website. Read the full-text of the article (pdf).

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