Stewart Katharine E, Phillips Martha M, Walker Jada F, Harvey Sarah A, Porter Austin
Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, USA.
AIDS Care. 2011 Mar;23(3):340-7. doi: 10.1080/09540121.2010.507743.
HIV prevalence has increased faster in the southern USA than in other areas, and persons living with HIV (PLWHIV) in the south are often rural, impoverished, or otherwise under-resourced. Studies of urban PLWHIV and those receiving medical care suggest that use of social services can enhance quality of life and some medical outcomes, but little is known about patterns of social service utilization and need among rural southern PLWHIV. The AIDS Alabama needs assessment survey, conducted in 2007, sampled a diverse community cohort of 476 adult PLWHIV representative of the HIV-positive population in Alabama (66% male, 76% Black, and 26% less than high school education). We developed service utilization/need (SUN) scores for each of 14 social services, and used regression models to determine demographic predictors of those most likely to need each service. We then conducted an exploratory factor analysis to determine whether certain services clustered together for the sample. Case management, assistance obtaining medical care, and financial assistance were most commonly used or needed by respondents. Black respondents were more likely to have higher SUN scores for alcohol treatment and for assistance with employment, housing, food, financial, and pharmacy needs; respondents without spousal or partner relationships had higher SUN scores for substance use treatment. Female respondents were more likely to have higher SUN scores for childcare assistance. Black respondents and unemployed respondents were more likely to have SUN scores in the highest quartile of the overall score distribution. Factor analysis yielded three main factors: basic needs, substance use treatment, and legal/medical needs. These data provide important information about rural southern PLWHIV and their needs for ancillary services. They also suggest clusters of service needs that often occur among PLWHIV, which may help case managers and other service providers work proactively to identify important gaps in care.
美国南部的艾滋病毒流行率增长速度比其他地区更快，而且南部的艾滋病毒感染者（PLWHIV）往往居住在农村地区，贫困或资源匮乏。对城市艾滋病毒感染者以及接受医疗护理者的研究表明，使用社会服务可以提高生活质量并改善一些医疗结果，但对于美国南部农村艾滋病毒感染者的社会服务利用模式和需求却知之甚少。2007年进行的阿拉巴马州艾滋病需求评估调查，对476名成年艾滋病毒感染者的不同社区队列进行了抽样，这些感染者代表了阿拉巴马州的艾滋病毒阳性人群（66%为男性，76%为黑人，26%受教育程度低于高中）。我们为14项社会服务中的每一项制定了服务利用/需求（SUN）得分，并使用回归模型来确定最有可能需要每项服务的人群的人口统计学预测因素。然后，我们进行了探索性因素分析，以确定某些服务对样本而言是否聚集在一起。个案管理、获得医疗护理的援助以及经济援助是受访者最常使用或需要的服务。黑人受访者在酒精治疗以及就业、住房、食品、财务和药房需求援助方面的SUN得分更高；没有配偶或伴侣关系的受访者在药物使用治疗方面的SUN得分更高。女性受访者在儿童保育援助方面的SUN得分更高。黑人受访者和失业受访者在总体得分分布的最高四分位数中的SUN得分更高。因素分析产生了三个主要因素：基本需求、药物使用治疗以及法律/医疗需求。这些数据提供了有关美国南部农村艾滋病毒感染者及其辅助服务需求的重要信息。它们还表明了艾滋病毒感染者中经常出现的服务需求集群，这可能有助于个案管理员和其他服务提供者积极主动地识别护理方面的重要差距。
