Distabile P, Dubler N N, Solomon L, Klein R S
Department of Epidemiology and Social Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA.
J Urban Health. 1999 Dec;76(4):435-47. doi: 10.1007/BF02351501.
Women at risk for human immunodeficiency virus (HIV) infection are often poor and members of racial or ethnic minorities. In addition to legal concerns that might be common among persons with similar sociodemographic characteristics, HIV infection adds the potential of possible stigma and discrimination, as well as the prospect of illness and increased mortality. To determine women's perceptions of need for and access to legal services and whether such perceptions are affected by HIV infection, from November 1993 through September 1995 we interviewed 509 women with or at risk for HIV infection by virtue of injection drug use or high-risk sexual behaviors in New York and Baltimore, Maryland. A majority of women, regardless of HIV serostatus, reported current or future needs for legal assistance with government benefits. More than 25% reported needing current or future legal help with housing, debts, arrangements for care of children, a will, and advance directives. Substantial minorities of women reported other legal needs. HIV-positive women were significantly more likely to report anticipated future need for help with paternal custody or visitation, current need in making a will, and anticipated future assistance with advance directives. For most items, a majority of women thought they knew where to receive help. However, among women reporting a current need, only a minority actually were receiving legal assistance. This study suggests that the extent of legal needs among women with or at risk for HIV infection is substantial, and that few receive legal assistance. With few exceptions, at least for women early in the course of illness, HIV infection does not appear to alter the pattern or extent of legal needs. There are dramatic differences, regardless of HIV status, between expectation and reality in women's access to legal services.
面临感染人类免疫缺陷病毒（HIV）风险的女性往往贫困，且属于种族或少数族裔群体。除了在具有相似社会人口学特征的人群中可能常见的法律问题外，HIV感染还增加了可能遭受耻辱和歧视的可能性，以及患病和死亡率上升的前景。为了确定女性对法律服务需求和获取情况的认知，以及这种认知是否受HIV感染的影响，我们于1993年11月至1995年9月期间，在纽约和马里兰州巴尔的摩，对509名因注射吸毒或高危性行为而感染HIV或有感染风险的女性进行了访谈。大多数女性，无论HIV血清学状态如何，都报告了当前或未来在政府福利方面需要法律援助。超过25%的女性报告当前或未来在住房、债务、子女照料安排、遗嘱和预先医疗指示方面需要法律帮助。相当一部分少数族裔女性报告了其他法律需求。HIV阳性女性更有可能报告预计未来在父亲监护权或探视权方面需要帮助、当前在立遗嘱方面需要帮助以及预计未来在预先医疗指示方面需要帮助。对于大多数项目，大多数女性认为她们知道在哪里可以获得帮助。然而，在报告当前有需求的女性中，只有少数实际获得了法律援助。这项研究表明，感染HIV或有感染风险的女性的法律需求程度很高，而获得法律援助的人很少。几乎没有例外，至少对于病程早期的女性来说，HIV感染似乎并没有改变法律需求的模式或程度。无论HIV状态如何，女性在获取法律服务方面的期望与现实之间存在巨大差异。
