Mancini Eleanor G, Shelton Brittany A, Oakes Ellen, Neville Lillian, Budhwani Henna
Department of Public Health, University of Tennessee Knoxville, Knoxville, USA.
College of Nursing, Florida State University, Knoxville, USA.
AIDS Behav. 2025 Apr;29(4):1183-1191. doi: 10.1007/s10461-024-04593-8. Epub 2025 Jan 9.
While people with HIV (PWH) experience high rates of end-stage kidney disease (ESKD), they were historically denied kidney transplantation and prohibited from organ donation, both elements of treating ESKD. It remains unknown to what extent such HIV criminalization laws correlate with the provision of transplantation education to PWH. We conducted this study to elucidate the relationship between these structural-level policies and individual-level outcomes. State-level HIV criminalization laws were linked with the United States Renal Data System (2017-2020) to examine the association between HIV criminalization laws, HIV-status, and transplant education using logistic regression, and the association between transplant education, mortality, waitlisting, and transplantation using Cox proportional hazards regression. There were 164,223 incident ESKD patients in 2017 (PWH = 2,051). PWH had significantly higher odds of education than people without HIV in states without HIV criminalization laws (OR: 1.78, 95% confidence interval [CI]: 1.48-2.13, p-value < 0.001). Within states with HIV criminalization laws, there was no significant difference in odds of education by HIV-status (OR: 1.22, 95% CI: 0.98-1.53), suggesting that PWH residing in states with HIV criminalization laws were significantly less likely to receive transplant education than PWH residing in states without such laws (interaction OR: 0.76, CI: 0.61-0.96, p < 0.001). While many states have revised or overturned their HIV criminalization laws to permit organ donation from PWH, such laws remain in effect in others and disproportionately limit access to care for PWH. Eliminating laws limiting PWH's ability to participate in organ donation may benefit the health of PWH with ESKD residing in those states.
虽然感染艾滋病毒者(PWH)终末期肾病(ESKD)发病率很高,但在历史上他们被拒绝进行肾移植,并且被禁止器官捐献,而这两者都是治疗ESKD的要素。目前尚不清楚此类将感染艾滋病毒定为犯罪的法律在多大程度上与向PWH提供移植教育相关。我们开展这项研究以阐明这些结构性政策与个体层面结果之间的关系。将州一级的将感染艾滋病毒定为犯罪的法律与美国肾脏数据系统(2017 - 2020年)相关联,使用逻辑回归来研究将感染艾滋病毒定为犯罪的法律、艾滋病毒感染状况与移植教育之间的关联,以及使用Cox比例风险回归研究移植教育、死亡率、列入等待名单和移植之间的关联。2017年有164,223例新发ESKD患者(PWH = 2,051例)。在没有将感染艾滋病毒定为犯罪法律的州,PWH接受教育的几率显著高于未感染艾滋病毒者(比值比:1.78,95%置信区间[CI]:1.48 - 2.13,p值<0.001)。在有将感染艾滋病毒定为犯罪法律的州,按艾滋病毒感染状况划分的接受教育几率没有显著差异(比值比:1.22,95% CI:0.98 - 1.53),这表明居住在有将感染艾滋病毒定为犯罪法律州的PWH比居住在没有此类法律州的PWH接受移植教育的可能性显著更低(交互作用比值比:0.76,CI:0.61 - 0.96,p < 0.001)。虽然许多州已经修订或推翻了将感染艾滋病毒定为犯罪的法律以允许PWH进行器官捐献,但此类法律在其他一些州仍然有效,并且不成比例地限制了PWH获得医疗服务的机会。消除限制PWH参与器官捐献能力的法律可能有益于居住在这些州的患有ESKD的PWH的健康。
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