University of California at San Francisco, UCSF Box 0874, San Francisco, CA 94143-0874, USA.
Am J Epidemiol. 2011 Sep 1;174(5):515-22. doi: 10.1093/aje/kwr209. Epub 2011 Jul 11.
Some gender differences in the progression of human immunodeficiency virus (HIV) infection have been attributed to delayed treatment among women and the social context of poverty. Recent economic difficulties have led to multiple service cuts, highlighting the need to identify factors with the most influence on health in order to prioritize scarce resources. The aim of this study was to empirically rank factors that longitudinally impact the health status of HIV-infected homeless and unstably housed women. Study participants were recruited between 2002 and 2008 from community-based venues in San Francisco, California, and followed over time; marginal structural models and targeted variable importance were used to rank factors by their influence. In adjusted analysis, the factor with the strongest effect on overall mental health was unmet subsistence needs (i.e., food, hygiene, and shelter needs), followed by poor adherence to antiretroviral therapy, not having a close friend, and the use of crack cocaine. Factors with the strongest effects on physical health and gynecologic symptoms followed similar patterns. Within this population, an inability to meet basic subsistence needs has at least as much of an effect on overall health as adherence to antiretroviral therapy, suggesting that advances in HIV medicine will not fully benefit indigent women until their subsistence needs are met.
一些与人类免疫缺陷病毒（HIV）感染进展相关的性别差异归因于女性治疗的延迟以及贫困的社会环境。最近的经济困难导致了多项服务削减，这凸显了需要确定对健康最有影响的因素，以便为稀缺资源确定优先级。本研究旨在从实证上对影响无家可归和住房不稳定的 HIV 感染女性健康状况的因素进行排名。研究参与者于 2002 年至 2008 年期间在加利福尼亚州旧金山的社区场所招募，并进行了随访；边际结构模型和目标变量重要性用于按影响对因素进行排名。在调整分析中，对整体心理健康影响最大的因素是未满足的基本生存需求（即食物、卫生和住所需求），其次是抗逆转录病毒治疗的依从性差、没有亲密的朋友以及使用可卡因。对身体健康和妇科症状影响最大的因素也遵循类似的模式。在这一人群中，无法满足基本生存需求对整体健康的影响至少与抗逆转录病毒治疗的依从性相同，这表明，在满足贫困妇女的生存需求之前，艾滋病毒药物的进步不会使贫困妇女完全受益。
