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Q}Pc?̐mQ}mR .3頋eY]BYyFtU %r9,1b}cEw!z-baM5Y" 8.%1')!9?2Yr~Hd5:g3G"+ᯪ?9⭴?bMȟOTl$䈿vysCgh5y}<1C¼`"G3[z4QΑgr(*΁h:hg=ZGGGmPOChQV].Kx s._pӎ36p<ۢ36tT|jއm!<}cۻC,Q,"\Cޓ\C 1qهS/gh{Gg#PFx'{SSFTDS Yˬ,FͳK1OG~eZx^]'އD~},C _nG<#oZxoM0Us%<cH >`a }A Ld  &:},abD>!K>a ,'d'>apG^60AQPs9e K03Hf03(#3a3"ϳ fȠ(n8gAyBy^jaM̼Cϩ³Ǎ3d"1ISem?ɂhj߃:_Eo{,&O<,☌S2ByY&O8O$}N< _# $,t=C^ SL}>,g*zSO9+8ê Z3t9O=C ;Oa쥸98W5CxVq O{l {ln+ x7Dr]~lz|J}ձ?pujW? -l~޹OIPab}UoMqv? 1 year > 18 years of age Case of HIV infection or AIDS diagnosed at least 6 months ago, but not more than 3 years ago Agreed to SHAS participation after contact by a MDH Disease Investigator for routine disease intervention OR Volunteered for SHAS by calling the SHAS interviewerxx6!x]#{SHAS Cases with HIV (non-AIDS) Interviewed Aug 2000- Dec 2003 Compared to HARS EMA HIV (non-AIDS) Cases Diagnosed 1999-2003|| (fSHAS Cases with AIDS Interviewed Aug 2000-Dec 2003 Compared to HARS EMA AIDS Cases Diagnosed 1999-2003gg L7;Agencies/Groups Given Formal SHAS Promotional Presentations<< Minnesota AIDS Project (an AIDS organization) Clinic 42 (an AIDS Clinic) Hennepin County Infectious Disease Clinic ( main clinic in MN for HIV care) Note: Interviewer often promotes SHAS with individuals/groups/clinics and distributes/posts flyers describing SHAS&ZuZ O:#Agencies/Groups Presented SHAS Data$$ Minnesota Department of Health STD and HIV Section (prevention/surveillance personnel) African American Health Care Worker Network Needs Assessment and Evaluation Committee of the Minnesota HIV Services Planning CouncilSHAS LimitationsBiased sample of HIV/AIDS cases SHAS cases may not be representative of entire EMA HIV/AIDS population Greater MN cases not included, so data may not be representative of that population Answers to questions are self-reported Recall bias Social Desirability Bias Limited sample sizeB}%}}% Demographic Data  SHAS Participants: Gender "SHAS Participants: Race/Ethnicity 0SHAS Participants: Category of Exposure (HARS)11(  Socioeconomic Data  1SHAS Participants: Socioeconomic Status (N=215)2*( 51% Employed Median number of hours worked per week = 39.0 hours (Average = 33.1 hours) Job change since diagnosis: 100/215 (47%) Reasons Quit / laid-off due to AIDS 60/100 (60%) Decreased hours/ changed jobs or tasks due to HIV 19/100 (19%) Other reasons not HIV-related 21/100 (21%) 11% = Sole provider for children (<18 years old) 41% Ever in Jail/Detention/Prison (1 refusal)n n n_ n !    #     'SHAS Participants: Socioeconomic Status((  'SHAS Participants: Socioeconomic Status((  Drug Use ;SHAS Participants: Drug Use (N=203) (Excludes African-Born)(<$ Ever had alcohol = 99% Possible alcohol problem = 54% Non-IDU drug use ever = 62% Non-IDU Drug use in 12 months prior to interview = 27% Injected drugs ever = 18% Injected in 12 months prior to interview = 3% jR7H }/h }GBSHAS Participants: Non-Injecting Drug Use (Excludes African-Born) C+  BSHAS Participants: Crack Use (Excludes African-Born) C+  P;>SHAS Participants: Injecting Drug Use (Excludes African-Born) ?'$,Injected drugs ever = 37/203 (18%) 51% in a shooting gallery (n=19) Of the 37 IDU S: 54% shared needles (n=20) Most often shared with: Friends 60% Strangers 25% Lovers 10% MSM 5% 2 cases may have shared needles/equipment. 2 cases who did not share needles shared equipment #Z!" Z" Z" ZZ" Z"3 ,_Sexual Behavior H3ENumber of Sexual Partners in Lifetime by Declared Sexual Orientation*FF LSHAS Participants: Sexually Transmitted Diseases (Excludes African-Born) M5 24Ever had STD = 66% (133/203) Last received treatment at: Private MD/Community/Public Clinic 35% (47/133) STD Clinic 37% (49/133) Emergency Room 14% (18/133) Other 14% (19/133/) STD after HIV diagnosis: 25 cases were treated for an STD > 6 months after learning of their HIV diagnosis. However, we do not always know the specific STD for which they were treated (list includes HSV, HPV, and syphilis that could be recurrent or old infections recently treated). We do know 8 cases had either gonorrhea, trichomonas, or chlamydia infections after HIV diagnosis.~9x k9x$3)fSHAS Participants: Prostitution (Excludes African-Born) gO  Ever Last 12 Months* Male 45/146 (31%) 13/146 (9%) Female 18/57 (32%) 6/57 (11%) * Note: Prostitution may have stopped after diagnosis if HIV diagnosis < 12 months ago.Z[U*[SHAS Participants: Men Who Had Sex With Men in the 12 Months Prior to the Interview (N=83)\\  Had at least 1 new partner = 66% (55/83) The following questions were asked about the last time sex with steady and non-steady partners. Risky* insertive anal sex by case with steady or non-steady partner = 5% (4/83) Risky receptive anal sex by case = 11% (9/83) (excludes 4 cases with risky insertive anal sex) Risky insertive oral sex by case = 20% (17/83) (excludes cases with anal insertive sex) *Risky sex means no condom used or unsure and partner s HIV status was negative or unknown per case. ~" 4" " *``e   n+SHAS Participants: Risky Sex and Alcohol/Drug Usage Last Time Sex With Steady or Non-Steady Partner  Men with Mentt 1 Of the 13 cases with risky anal sex:* 3 were drunk and on drugs 1 was drunk 2 were on drugs 6 of 13 impaired by alcohol/drugs (46%) Of the 17 cases with only risky oral sex: 1 was drunk and on drugs 2 were drunk 1 was on drugs 4 of 17 impaired by alcohol/drugs (24%) *With steady or non-steady partner 'Z^" Z*Z]" Z&" Z &^*^$U<SHAS Participants: Men Who Had Sex With Men in the 12 Months Prior to the Interview   0`{ 23/83 (28%) only had oral sex during their most recent sexual encounters with steady and non-steady partners (no anal sex),YSHAS Participants: Men Who Had Sex With Women in the 12 Months Prior to Interview (N=50)ZZ sHad at least one new partner = 40% (20/50) Risky vaginal sex 24% (12/50) Alcohol or drug involvement = 42% (5/12) TI *" H*-YSHAS Participants: Women Who Had Sex With Men in the 12 Months Prior to Interview (N=50)ZZ sHad at least one new partner = 32% (16/50) Risky vaginal sex = 16% (8/50) Alcohol or drug involvement = 38% (3/8) TJ )" I)I4PSHAS PARTICIPANTS: CASES WITH RISKY SEX IN THE 12 MONTHS PRIOR TO THE INTERVIEWQQ$3/4 of the men  who had sex with men with risky insertive anal sex did so after diagnosis of HIV infection 7/9 of the men  who had sex with men with risky receptive anal sex in the absence of insertive did so after diagnosis 11/17 of the  men who had sex with men with risky insertive oral sex without any insertive anal sex did so after diagnosis 8/12 of the  men who had sex with women with risky vaginal sex did so after diagnosis 6/8 of the  women who had sex with men with risky vaginal sex did so after diagnosis 2ZZYZ7 . HIV Testing J53MN Diagnosed SHAS Participants By Test Site (N=188)44 0 1SHAS Participants: Reason for Testing (N=215)2* 1!5SHAS Participants: Minnesota Diagnosed Cases (N=188)66 STest type when 1st tested Anonymous 8% Confidential 90% Unsure 2% Partner notification offered by MDH/MD/other Yes 76% No 20% Unsure 4% Of those offered partner notification (n=142) MDH/MD notification 45% Case notification 35% Both 10% Other (partner known+ or aware, etc) 10% > -# !.{ ! >-#  .  {    P7fe 82"Preventive Therapy 3#+SHAS Participants: Laboratory Tests (N=215),, 4$,SHAS Participants: Hepatitis History (N=215)-- 5%)SHAS Participants: Antiretroviral Therapy** 6&9SHAS Participants: Receiving Antiretroviral (ART) Therapy:: 7'^SHAS Participants: Receiving Antiretroviral (ART) Therapy But With Incomplete Adherence (N=53)*_X   8(=SHAS Participants: Source of Advice on Taking Antiretrovirals>> 9)1SHAS Participants: Skin Testing for Tuberculosis22 :* Health Care ;+%SHAS Participants: Source of HIV Care&& <,6SHAS Participants: Source of Health Insurance (N=215)77 >..SHAS Participants: Insurance Coverage (N=215)// Since HIV+ diagnosis: Lost health insurance >30 in a row 9% Kept insurance 87% Never had insurance 4% Last 12 months ever denied health care because couldn t pay for it: Yes 3% No 97% Delayed care in the last 12 months Yes 7% No 93% ZZ Z!ZDZ Z!Z#Z! Z!Z ZD   #  !    :?/DSHAS Participants: HIV Induced Health Problem or Impairment (N=215) E=  Yes = 29% No = 71% <!@0 ConclusionsAlcohol and drugs (non-IDU and IDU) appear to have a major role in acquiring HIV infections High lifetime number of sexual partners among HIV infected Risky sexual practices among some HIV + persons is responsible for them becoming infected and transmitting the disease to othersA1Conclusions cont. Level of health care for HIV-infected persons may be higher than expected, particularly for the non-transient White and Black (American born) populations (not enough data on Asian , American Indian and Hispanic populations) Public assistance for HIV care and survival is neededxZZP26ZJ6 ` ` ̙33` 333MMM` ff3333f` f` f` 3>?" dd@,|?" dd@   " @ ` n?" dd@   @@``PR    @ ` ` p>> l(    6s P  T Click to edit Master title style! !  0v   RClick to edit Master text styles Second level Third level Fourth level Fifth level!     S  0{ ``  @*  0 `   B*  0Ѕ `   B*T  <v޽h @ ? ̙33 Default Design `((    Nly˼y˼ .  l \* a00aa  NDly˼y˼ 3 . l ^* a00aa  Txy˼y˼ r  l \* a00aa  Ty˼y˼ r3  B ^* a00aaH  0ηo~ ? ̙33j 0(  r  S B`  B H  0޽h ? ̙33  bZpP(  Pr P S Хl  l @ P 0dl@  SHAS was a CDC-funded project designed to provide an in depth description of people diagnosed with HIV/AIDS in MN, including information about the care and treatment they were receiving. The purpose of this information was to provide planning groups, providers, and health agencies with data that could be used to develop strategies and interventions to prevent HIV infection and improve care. CDC provided a questionnaire for the project. See the  Minnesota Supplement to HIV Surveillance (SHAS) Project Summary on the MDH website for further detail and information about the project."RH P 0޽h ? ̙33   Z(   r  S lP  l r  S ll`  l r  S 8l0  l   0شlP = T EMA = Eligible Metropolitan Area! 2! H  0޽h ? ̙33  $(  r  S l`0  l r  S 8l0 l H  0޽h ? ̙33V  d(  dr d S l0  l  d <A ??px dA3H d 0޽h ? ̙33\   h(  hx h c $l  l  h <A ??p;x d-H h 0޽h ? ̙33  $(  r  S lP  l r  S l l H  0޽h ? ̙33   $(   r   S lP  l r   S l l H   0޽h ? ̙33  $(  r  S $l  l r  S l0 l H  0޽h ? ̙33j (  r  S p  H  0޽h ? ̙33  g (   r  S `P   ej  ( g  #""X (   Bl? ( L100% @`   Bl?` ( K215 @`   B?  ` ( MTotal @`   B? H   I30% @`   BP%?` H  H64 @`   B0-? H `  LFemale @`   B\.? H  I70% @`   BD9?`  H  I151 @`   B@? ` H  JMale @`   BA?  G% @`   BO?`   INo. @`   BV? `  LGender @`ZB   s *o ? ` ZB   s *1 ? ZB   s *Ԕ ?   `B   0o ? (` (`B   0o ?  `B   0o ?`B   0o ?` ( (`B   0o ?  (`B   0o ? ((`B !  0o ? (`B )  0o ?  H `B -  0o ?H `B /  0o ? H  `B 7  0o ?H  ZB E  s *o ?`  ZB F  s *o ? H  0޽h ? ̙33m&  &&;.%%(  $x $ c $]   $z  .% #"2&    * (% BTi?FV v  z12 (6)  @` '% Bj? V Fv  P 7 (11)   @` &% Bx?V v  N 5 (3) @` %% Bz?V v  [Black, African-Born @` R$ B?  S 151 (100)   @` N$ B̐?  O 5 (3) @` L$ B$?  R 1 (<1)   @` J$ B8?v  N12 (8) @` H$ B?6 V  P 55 (36)   @` F$ B? 6 O73 (48) @` D$ B ?  _ Males No. (%)  @` 9$ Bh¤?F6V  Q 91 (42)   @` 7$ Bɤ? 6FV  O36 (56) @` 5$ Bˤ?6V  _Black, African-American @` 2$ BdԤ?Fv   N15 (7) @` 0$ B? v F  M3 (5) @` .$ BT?v   PHispanic   @` +$ BL?F   R 1 (<1)   @` )$ B@? F  M0 (0) @` '$ B?   MAsian @` $$ BP ?F   i 9 (4) @` "$ B? F  M4 (6) @`  $ Bx?   WAmerican Indian @` $ B?F  Q 215 (100)   @` $ B-? F P64 (100)   @` $ BX4?  OTotal @`  $ B6?F6 P 87 (40)   @`  $ B@8? F6 O14 (22) @`  $ BF?6 \White (non-Hispanic) @`  $ B0O?F _ Total No. (%)  @` $ B<_? F aFemales No. (%)  @` $ BY? VRace/Ethnicity @`ZB $ s *o ?ZB $ s *1 ?`B $ 0o ?`B $ 0o ?`B $ 0o ?`B $ 0o ? F`B $ 0o ?F`B $ 0o ?6`B $ 0o ?6`B $ 0o ?6V `B $ 0o ?6V ZB $ s *o ? FZB $ s *o ?FZB !$ s *1 ?  ZB X$ s *o ? `B g$ 0o ?V  `B o$ 0o ?V  `B q$ 0o ?  `B x$ 0o ?  `B z$ 0o ?  `B $ 0o ?  `B $ 0o ? `B % 0o ? `B % 0o ? H $ 0޽h ? ̙33"  x"p" 7G("(  (x ( c $4   P!v @3 G( #"."   *@3 ( B?` @ S 151 (100)   @` ( B?` @  Q 17 (11)   @` ( BP?` v @  N11 (7) @` ( B?` V @v  O 9 (6) @` ( B䝥?` 6@V  N14 (9) @`  ( Bt?` @6 P100 (66)   @`  ( B?` @ _ Males No. (%)  @`  ( B?`63V  T  @`  ( BH?@6`V  O13 (20) @`  ( B4?@6` V  KIDU @` ( Bͥ?`V 3v  T  @` ( Bϥ?@V `v  J-- @` ( Bإ?@V ` v  OMSM/IDU @` ( Bإ?`v 3  T  @` ( B?@v `  O35 (55) @` ( Bh?@v `  T Heterosexual   @` ( B?` 3  T  @` ( B?@ `  O16 (25) @` ( Bh?@ `  ZOther/Not reported @` ( B<?` 3 T  @` ( B?@ ` R64 (100)   @` ( B'?@ `  OTotal @` ( B /?`36 T  @` ( B6?@`6 J-- @` ( B>?@` 6 KMSM @` ( BF?`3 T  @` ( BlH?@` cFemales No. (%)   @` ( BX?@`  \Category of Exposure @`ZB  ( s *o ?@` ZB !( s *1 ?@3`B "( 0o ?@` `B #( 0o ?@@`B $( 0o ?33`B %( 0o ?@``B &( 0o ?`3`B '( 0o ?@@6`B (( 0o ?336`B )( 0o ?@6@V `B *( 0o ?363V ZB +( s *o ?@`ZB ,( s *o ?`3ZB -( s *1 ?@ 3 ZB .( s *o ?` @`B /( 0o ?@V @v `B 0( 0o ?3V 3v `B 1( 0o ?@v @ `B 2( 0o ?3v 3 `B 3( 0o ?@ @ `B 4( 0o ?3 3 `B 5( 0o ?` @`B 6( 0o ?@ @`B 7( 0o ?3 3H ( 0޽h ? ̙33j 0,(  ,r , S 7p  H , 0޽h ? ̙33J  @0(  0r 0 S 8`   0 c dQ0e0e    H 0 0޽h ? ̙33D  P+o4(  4 4 c 8t0e0e @   ~ pp  n4 #"6* P*)**)**)pp l4 B? N p  H1% @` k4 <_?pN  MFriends @` 4 BXA? p  H3% @` 4 <h?p  O No Income   @` 4 B? p H3% @` 4 <䠧?p  KOther @` 4 Bx?  pN  H1% @` 4 <x?p N  MPension @` 4 B? p  H2% @` 4 <?p   MSavings @` 4 Bŧ? |p  H8% @` 4 <pͧ?p|  LSpouse @`  4 BΧ? 6p| H9% @`  4 <`֧?p6 | WPublic Assistance @`  4 B|ݧ? p6 I32% @`  4 <?p 6 USocial Security @`  4 Bp? p I40% @` 4 <?p  LSalary @``B 4 0o ?p `B $4 0o ?p  `B 44 0o ?pp6`B 54 0o ?pp`B 74 0o ?pp6`B 84 0o ?pp`B :4 0o ?p6p|`B <4 0o ?p6p|`B >4 0o ?p|p `B @4 0o ?p|p `B B4 0o ?p p `B D4 0o ?p p `B F4 0o ?p pN `B H4 0o ?p pN `B J4 0o ?pN p`B L4 0o ?pN p`B N4 0o ?pp `B P4 0o ?pp `B V4 0o ? p `B _4 0o ? p a4 <4M ^ Source of Main Financial Support"!    o4 <0` P C(N=215) H 4 0޽h ? ̙33  `(/8(  8 8 c 0e0e 0p   z ppp -8 #"2&P*)**)**fpp 8 B?  pd  I<1% @` 8 <?p d  MRefused @` 8 Bd$? d p H3% @`  8 <8-?pd  MUnknown @`  8 B3? p  H7% @`  8 <D5?p   O $50,000 +   @`  8 BlC? p  H7% @`  8 <D?p  Q $40-$49,999   @` 8 BR? Lp  I10% @` 8 <S?pL  Q $30-$39,999   @` 8 BXa? pL H8% @` 8 <Li?p L Q $20-$29,999   @` 8 BPj? p I23% @` 8 <x?p  Q $10-$19,999   @` 8 BD? pp I41% @` 8 <?pp  O < $10,000   @``B 8 0o ?pp p`B 8 0o ?p `B 8 0o ?pp`B 8 0o ?ppp`B 8 0o ?pp`B 8 0o ?ppp`B 8 0o ?ppL`B 8 0o ?ppL`B 8 0o ?pLp `B 8 0o ?pLp `B  8 0o ?p p `B !8 0o ?p p `B "8 0o ?p p `B #8 0o ?p p `B $8 0o ?p p`B %8 0o ?p p`B (8 0o ? p`B )8 0o ? ppp *8 <̍} [Household Income Before Taxes"    .8 <  SReceived or applied for public assistance, welfare, social security: 138/215 (64%)TT /8 <0 P C(N=215) H 8 0޽h ? ̙33j p<(  <r < S p  H < 0޽h ? ̙33  /'@(  @r @ S З0   @ c 0e0e Pp`   - @ <   s(excludes 35 cases that used only marijuana and 7 cases that used marijuana and nitrites) 83% used any illegal drugttH @ 0޽h ? ̙33   H+(  H H c 0e0e 0    H 08F i* In the 12 months prior to interview. ** Only non-AIDS cases diagnosed 1999-2003 (as in HARS) (85 cases)jj  H <A ??t AH H 0޽h ? ̙33  L((  L L c ȹ0e0e 0    L <A r??< @ rH L 0޽h ? ̙33P  ((  (x ( c $PĨ    ( c Lʨ0e0e    H ( 0޽h ? ̙33 }@+EP(  P  P <ZB 0p =SHAS Participants: Injecting Drug Use (Excludes African-Born),>& .~ P p EP #"6* P*)**O*F* Pp 5P BljB ? p J2% @` 4P <lB ?P  OUnknown @` P BzB ? f p  K<1% @` P <x|B ?Pf  ]Steroids/Testosterone @` P B B ? p  J2% @` P <̌B ?P  MOther @` P BB ?  pf  J4% @`  P <B ?P f  Stimulants/Amphetamines/Meth @`  P BB ? p  K<1% @`  P <B ?P   T Barbiturates   @`  P BB ? p K<1% @`  P <dB ?P  ZPCP, Hallucinogens @` P BB ? p J8% @` P <B ?P  <Heroin & Cocaine ( Speedball ) @` P BB ? pp K12% @` P <\B ?Pp  OCocaine @` P BB ? pp K10% @` P <B ?P  p _Heroin or other opiates @`fB P 6o ?P  fB P 6o ?P fB P 6o ?PpPfB P 6o ?P PpfB P 6o ?pppfB P 6o ?p ppfB P 6o ?PPfB P 6o ?ppfB P 6o ?PPfB P 6o ?ppfB P 6o ?PP fB P 6o ?pp fB  P 6o ?P Pf fB !P 6o ?p pf fB "P 6o ?Pf PfB #P 6o ?pf pfB $P 6o ? pfB %P 6o ? p  (P <lBpP 7(N=203) :P <l L <Ever Use  LB ;P c $D` AP <lP wENote: Only 6 cases injected in the 12 months prior to the interview.FFH P 0޽h ? ̙33j T(  Tr T S Ѩp  H T 0޽h ? ̙33J  0 v(  x  c $tը    \ Bxߨ? 0 | 1  99   @` [ B\A?  U 9 @` Z B٨? @`  w 44$ @` Y B?  hFemales Heterosexual"  @` X B  ?@   1  2,000    @` W B| ?@ PP  O40 20 @` U B ?@H  U Heterosexual @` T B ? P  ^ 1  3,000   @` Q B ? P  \Males Homosexual/Gay @`  B) ?i P Range @`  B+ ?  ^Median # of Partners @`  B(; ?0  T # of Cases   @`^B  6V ?dB  <V ?  <= ?@`  Q 56 37 @`  0|E 0@P ]-*Excludes persons with a prostitution history. 2.  0J J   <   0M  0  <   0O    : Bisexual    0S  ` @ 0  K 13,  0X    <   0Z    ` Male 6   0    ; Female 5   0b    \ 1-33 ,  0f    H 1-100  H  0޽h ? ̙33J  \(  \r \ S m     \ c tn 0e0e `   H \ 0޽h ? ̙33P  l(  lx l c $u     l c Dv 0e0e @`   H l 0޽h ? ̙33l  p(  p p c $d @P@   ( p c  0e0e `   H p 0޽h ? ̙33l  t(  t t c $l @   ( t c  0e0e @   H t 0޽h ? ̙33   @$(  @r @ S p P   r @ S س    H @ 0޽h ? ̙33-  0xm(  xx x c $İ     x c @ 0e0e P    x <  f i7Note: 7/50 had sex with men and women during this time88H x 0޽h ? ̙33P  @|(  |x | c $ܼ     | c  0e0e P   H | 0޽h ? ̙33  P$(  r  S @lAP  A r  S `A A H  0޽h ? ̙33p  `(  x  c $ p   H  0޽h ? ̙33   p J(  r  S       6    ^    6  Pp `  %  6   D   m  6 `^ eSTD Clinic Physician/HMO Hospital Outpatient/AIDS Clinic/ER Hospital Inpatient Community Center Blood Bank/Plasma Center Prenatal/OB Clinic Correctional Other Note: 44% tested at an active surveillance site.E0 22! 2f%P?G   6TKA q'21% 21% 15% 14% 11% 9% 4% 1% 4%.0 22$ 2(%H  0޽h ? ̙33  #3Y(    c  0e0e 0   Av P 3 #"."PPGGHGGP  BPtA?m  O 3% 6%   @`  < ?Pm  YTest required Other @`  B ?& m  I<1% @`  <?P& m  UPre-op physical @`  BX ? &  H4% @`   <4?P &  O Pregnancy   @`   B?  H9% @`   <"?P  Q Blood donor   @`   B`*?P I19% @`   <,2?PP `Routine checkup or curious @`  B9?P I19% @`  <B?PP 3Risk (m/m; IDU; partner: IDU, Bi-sexual, or HIV+)4/  @`  BI? I40% @`  <Q?P MIllness @``B  0o ?P`B  0o ?P`B  0o ?PPP`B  0o ?PP`B  0o ?P`B  0o ?`B  0o ?PPP`B  0o ?P`B  0o ?PP `B  0o ? `B  0o ?P P& `B  0o ? & `B  0o ?P& Pm `B  0o ?& m `B   0o ?Pm P`B ! 0o ?m `B " 0o ?`B # 0o ?H  0޽h ? ̙33P  (  x  c $dX    c [0e0e `   H  0޽h ? ̙33p  (  x  c $|dp  H  0޽h ? ̙33  =5*G(  x  c $Gp  B?  L  @``  <?  42% (53cases) didn t always take ART exactly (continued next slide)2E- @`  B?   H  @`  <\?   G  @`  B?   H  @`   <,?   T Always 58% @`   B?B   H  @`   <?B   U Usually 34% @`   B?B  P  @`   <?B  X Sometimes 6% @`  B ? P  @`  <? f Rarely 3% m @`  B?p P  @`  < ?p q! Past 30 days exact ART adherence"! @``B  0o ?pp`B  0o ?`B  0o ?`B  0o ?p`B  0o ?`B  0o ?p`B  0o ?B `B  0o ?B `B  0o ?B  `B  0o ?B  `B  0o ?  `B  0o ?  `B  0o ?  `B  0o ?  `B   0o ? `B ! 0o ? `B " 0o ?`B # 0o ?pp $ 6 ^& 125 cases on ART at time of interview'('H  0޽h ? ̙33  PH#>(    c 0e0e 0   v P > #".",GP  B?7  L  @`t  <+?7   Other* 15% *Other reasons, 1 each: Methadone interference, hard to swallow, social situations, vacation-refrigeration problem, ran out, can t afford, anger, record snafu &0 @`  B-? 7  H  @`j  <7? 7   Can t fit into schedule 9% Sick of pills 6%YY @`  B9?h   H  @`   <G?h   p* Alcohol/drug use 9%++ @`   BO?"h  H  @`   <pV?"h  [ Fell asleep 9% @`   B^?" P  @`   <d?" [ Side effects 15% @`  Btl? P  @`  <xm? f Forgot 36% m @`  Bo?P P  @`  <?P r" Reason for ART not taken exactly:#" @``B  0o ?PP`B  0o ?`B  0o ?`B  0o ?P`B  0o ?`B  0o ?P`B  0o ?"`B  0o ?"`B  0o ?"h `B  0o ?"h `B  0o ?h  `B  0o ?h  `B  0o ? 7 `B  0o ? 7 `B   0o ?7 `B ! 0o ?7 `B " 0o ?`B # 0o ?PPH  0޽h ? ̙33  XP#1(    c 0e0e 0   v P 1 #".",AGP  B?7  L  @`  <?7  7 Friends 5% Other 5% 88  @`  B? 7  H  @`  <? 7  Z Case manager 8% @`  B?   H  @`   <h?   ] AIDS organization 10% @`   B?e   H  @`   <?e   ` Pharmacist 11% @`   B?e  P  @`   <?e  T Nurse 13% @`  BH? P  @`  <? h Physician 48% m @`  B?P P  @`  <?P :41 % (61/148) sought advice Most useful source of advice:;: @``B  0o ?PP`B  0o ?`B  0o ?`B  0o ?P`B  0o ?`B  0o ?P`B  0o ?e `B  0o ?e `B  0o ?e  `B  0o ?e  `B  0o ?  `B  0o ?  `B  0o ? 7 `B  0o ? 7 `B   0o ?7 `B ! 0o ?7 `B " 0o ?`B # 0o ?PPH  0޽h ? ̙33  `X#H(    c 0e0e 0   v P  H #".",Z^DG P  B?p L  @`  <?Pp P  @`  B?p H  @`  <?Pp R  @`  BX(?pd  J  @`A   <>?Pd p  Skin test in year prior to or since HIV diagnosis 86% (166/193) (excludes 22 cases with no recent test but with previous + skin test) Note: 18 cases had unknown skin test dates. It is assumed these occurred more than a year ago.r3qd!> Dq3  @`   BlE?pd  H  @`   <xM?Ppd  _ Unknown = 1% (3/215)  @`   BT?p P  @`   <\?Pp Z No = 3% (9/215)  @`  Bc?pf P  @`  <hf?Pfp n Yes = 94% (203/215)  m @`  Bs?p f P  @`  <tu?P pf l Ever had a skin test for TB @``B  0o ?P p `B  0o ?Pp`B  0o ?PfP`B  0o ?P Pf`B  0o ?f`B  0o ? f`B  0o ?PP`B  0o ?`B  0o ?PPd `B  0o ?d `B  0o ?Pd P`B  0o ?d `B  0o ?PP`B  0o ?`B   0o ?PP`B ! 0o ?`B " 0o ?p`B # 0o ?p  H  0޽h ? ̙33p  (  x  c $܅p  H  0޽h ? ̙33   8-(    c 0e0e 0   4 j `p0 8 #""Zp`0   BԌ? 0 S 2% <1% <1% @`   <?`  @VA Center (VAMC, Mpls.) State Prison System AIDS Clinical TrialsAA @`   B<? 0  I43% @`   <?`   dPublic Clinic (includes HCMC)  @`  B0?@0  I53% @`  <x?`@  iPrivate MD/HMO/HIV Clinic  @`  B̾?p0@ P  @`  <?`p@ bSource of HIV Care (N=214) @``B  0o ?`pp`B  0o ?``B  0o ?`@` `B  0o ?`p`@`B  0o ?0@0 `B  0o ?0p0@`B  0o ?` ` `B  0o ?0 0 `B  0o ?` ``B  0o ?0 0`B " 0o ?0`B # 0o ?p0p $ 6 { s1Received HIV care in last year = 99.5% (214/215) &2(1H  0޽h ? ̙33_     06 (    c d0e0e  `    f  H  6 #"0   BL?_|H  P  @`  <`? |_H  ~8Private 33% VA 2% None 8%99 @`  B?_6| P  @`  <? 6_| VMedicare 8% @`  B?_6 P  @`   <? _6 TMedicaid 59% @``B   0o ? _`B   0o ? H _H `B  0o ?  6`B  0o ?6`B  0o ? 6 |`B  0o ?6|`B  0o ? | H `B  0o ?|H `B  0o ?_H H `B  0o ?_  0` & ]Note: Percentages total >100 percent since some persons have multiple Insurance coverage ^^H  0޽h ? ̙33P  @(  x  c $    c 0e0e `   H  0޽h ? ̙33P  P(  x  c $p    c (0e0e `   H  0޽h ? ̙33  `$(  r  S 4.P   r  S .  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"  . .2 Y/(SHAS)"!.-- "System0f0 !-&TNPP &_.KathyAKathyA    - On-screen ShowMDHR"4 9Times New RomanArial Arial NarrowDefault DesignMicrosoft Excel Worksheet/Supplement to HIV and AIDS Surveillance (SHAS) Introduction:The 11 Minnesota Counties in the Minneapolis-St. Paul EMA$Minnesota SHAS Eligibility Criteria|SHAS Cases with HIV (non-AIDS) Interviewed Aug 2000- Dec 2003 Compared to HARS EMA HIV (non-AIDS) Cases Diagnosed 1999-2003gSHAS Cases with AIDS Interviewed Aug 2000-Dec 2003 Compared to HARS EMA AIDS Cases Diagnosed 1999-2003<Agencies/Groups Given Formal SHAS Promotional Presentations$Agencies/Groups Presented SHAS DataSHAS LimitationsDemographic DataSHAS Participants: Gender#SHAS Participants: Race/Ethnicity1SHAS Participants: Category of Exposure (HARS)Socioeconomic Data2SHAS Participants: Socioeconomic Status (N=215)(SHAS Participants: Socioeconomic Status(SHAS Participants: Socioeconomic Status Drug Use<SHAS Participants: Drug Use (N=203) (Excludes African-Born)CSHAS Participants: Non-Injecting Drug Use (Excludes African-Born)CSHAS Participants: Crack Use (Excludes African-Born)?SHAS Participants: Injecting Drug Use (Excludes African-Born)PowerPoint PresentationSexual BehaviorFNumber of Sexual Partners in Lifetime by Declared Sexual Orientation*MSHAS Participants: Sexually Transmitted Diseases (Excludes African-Born)gSHAS Participants: Prostitution (Excludes African-Born)\SHAS Participants: Men Who Had Sex With Men in the 12 Months Prior to the Interview (N=83)tSHAS Participants: Risky Sex and Alcohol/Drug Usage Last Time Sex With Steady or Non-Steady Partner Men with MenSHAS Participants: Men Who Had Sex With Men in the 12 Months Prior to the Interview ZSHAS Participants: Men Who Had Sex With Women in the 12 Months Prior to Interview (N=50)ZSHAS Participants: Women Who Had Sex With Men in the 12 Months Prior to Interview (N=50)QSHAS PARTICIPANTS: CASES WITH RISKY SEX IN THE 12 MONTHS PRIOR TO THE INTERVIEW HIV Testing4MN Diagnosed SHAS Participants By Test Site (N=188)2SHAS Participants: Reason for Testing (N=215)6SHAS Participants: Minnesota Diagnosed Cases (N=188)Preventive Therapy,SHAS Participants: Laboratory Tests (N=215)-SHAS Participants: Hepatitis History (N=215)*SHAS Participants: Antiretroviral Therapy:SHAS Participants: Receiving Antiretroviral (ART) Therapy_SHAS Participants: Receiving Antiretroviral (ART) Therapy But With Incomplete Adherence (N=53)>SHAS Participants: Source of Advice on Taking Antiretrovirals2SHAS Participants: Skin Testing for Tuberculosis Health Care&SHAS Participants: Source of HIV Care7SHAS Participants: Source of Health Insurance (N=215)/SHAS Participants: Insurance Coverage (N=215)ESHAS Participants: HIV Induced Health Problem or Impairment (N=215) ConclusionsConclusions cont.  Fonts UsedDesign TemplateEmbedded OLE Servers Slide Titles4_hKathyAKathyA  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~      !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMnOPQRSTUVWXmopqrstuvwxyz{|}Root EntrydO)D ^5@PicturesY1Current User82SummaryInformation(NPowerPoint Document(RDocumentSummaryInformation8 Excel.Sheet.802Microsoft Excel Worksheet0$CWorksheet Excel.Sheet.802Microsoft Excel Worksheet0'EWorksheet Excel.Sheet.802Microsoft Excel Worksheet/ 0DTimes New Roman$50Wo 0DArialNew Roman$50Wo 0h" DArial Narrowan$50Wo 0h" a .  @n?" dd@  @@``  `X'/  h/Hp0  F !E%4(H)4*==,?2I 9 7 % 15!$     77_$"$PRJ,ɬ/ "$eǝ8|{[Iлl/ "$O-D;q/ע 3"$<@7%gr7W Y 'c $33@)i ʚ;Z1ʚ;g42d2d0ppp@ <4!d!d 0d6<4dddd 0d6 <4BdBd. 0d___PPT9x;T8(&&? %cC.Supplement to HIV and AIDS Surveillance (SHAS)// V= Introduction $9The 11 Minnesota Counties in the Minneapolis-St. Paul EMA::(+Anoka Carver Chisago Dakota Hennepin Isanti (Ramsey Scott Sherburne Washington Wright#Minnesota SHAS Eligibility Criteria$$$:Resident of the EMA for > 1 year > 18 years of age Case of HIV infection or AIDS diagnosed at least 6 months ago, but not more than 3 years ago Agreed to SHAS participation after contact by a MDH Disease Investigator for routine disease intervention OR Volunteered for SHAS by calling the SHAS interviewerxx6!x]#{SHAS Cases with HIV (non-AIDS) Interviewed Aug 2000- Dec 2003 Compared to HARS EMA HIV (non-AIDS) Cases Diagnosed 1999-2003|| (fSHAS Cases with AIDS Interviewed Aug 2000-Dec 2003 Compared to HARS EMA AIDS Cases Diagnosed 1999-2003gg L7;Agencies/Groups Given Formal SHAS Promotional Presentations<< Minnesota AIDS Project (an AIDS organization) Clinic 42 (an AIDS Clinic) Hennepin County Infectious Disease Clinic ( main clinic in MN for HIV care) Note: Interviewer often promotes SHAS with individuals/groups/clinics and distributes/posts flyers describing SHAS&ZuZ O:#Agencies/Groups Presented SHAS Data$$ Minnesota Department of Health STD and HIV Section (prevention/surveillance personnel) African American Health Care Worker Network Needs Assessment and Evaluation Committee of the Minnesota HIV Services Planning CouncilSHAS LimitationsBiased sample of HIV/AIDS cases SHAS cases may not be representative of entire EMA HIV/AIDS population Greater MN cases not included, so data may not be representative of that population Answers to questions are self-reported Recall bias Social Desirability Bias Limited sample sizeB}%}}% Demographic Data  SHAS Participants: Gender "SHAS Participants: Race/Ethnicity 0SHAS Participants: Category of Exposure (HARS)11(  Socioeconomic Data  1SHAS Participants: Socioeconomic Status (N=215)2*( 51% Employed Median number of hours worked per week = 39.0 hours (Average = 33.1 hours) Job change since diagnosis: 100/215 (47%) Reasons Quit / laid-off due to AIDS 60/100 (60%) Decreased hours/ changed jobs or tasks due to HIV 19/100 (19%) Other reasons not HIV-related 21/100 (21%) 11% = Sole provider for children (<18 years old) 41% Ever in Jail/Detention/Prison (1 refusal)n n n_ n !    #     'SHAS Participants: Socioeconomic Status((  'SHAS Participants: Socioeconomic Status((  Drug Use ;SHAS Participants: Drug Use (N=203) (Excludes African-Born)(<$ Ever had alcohol = 99% Possible alcohol problem = 54% Non-IDU drug use ever = 62% Non-IDU Drug use in 12 months prior to interview = 27% Injected drugs ever = 18% Injected in 12 months prior to interview = 3% jR7H }/h }GBSHAS Participants: Non-Injecting Drug Use (Excludes African-Born) C+  BSHAS Participants: Crack Use (Excludes African-Born) C+  P;>SHAS Participants: Injecting Drug Use (Excludes African-Born) ?'$,Injected drugs eYver = 37/203 (18%) 51% in a shooting gallery (n=19) Of the 37 IDU S: 54% shared needles (n=20) Most often shared with: Friends 60% Strangers 25% Lovers 10% MSM 5% 2 cases may have shared needles/equipment. 2 cases who did not share needles shared equipment #Z!" Z" Z" ZZ" Z"3 ,_Sexual Behavior H3ENumber of Sexual Partners in Lifetime by Declared Sexual Orientation*FF LSHAS Participants: Sexually Transmitted Diseases (Excludes African-Born) M5 24Ever had STD = 66% (133/203) Last received treatment at: Private MD/Community/Public Clinic 35% (47/133) STD Clinic 37% (49/133) Emergency Room 14% (18/133) Other 14% (19/133/) STD after HIV diagnosis: 25 cases were treated for an STD > 6 months after learning of their HIV diagnosis. However, we do not always know the specific STD for which they were treated (list includes HSV, HPV, and syphilis that could be recurrent or old infections recently treated). We do know 8 cases had either gonorrhea, trichomonas, or chlamydia infections after HIV diagnosis.~9x k9x$3)fSHAS Participants: Prostitution (Excludes African-Born) gO  Ever Last 12 Months* Male 45/146 (31%) 13/146 (9%) Female 18/57 (32%) 6/57 (11%) * Note: Prostitution may have stopped after diagnosis if HIV diagnosis < 12 months ago.Z[U*[SHAS Participants: Men Who Had Sex With Men in the 12 Months Prior to the Interview (N=83)\\  Had at least 1 new partner = 66% (55/83) The following questions were asked about the last time sex with steady and non-steady partners. Risky* insertive anal sex by case with steady or non-steady partner = 5% (4/83) Risky receptive anal sex by case = 11% (9/83) (excludes 4 cases with risky insertive anal sex) Risky insertive oral sex by case = 20% (17/83) (excludes cases with anal insertive sex) *Risky sex means no condom used or unsure and partner s HIV status was negative or unknown per case. ~" 4" " *``e   n+SHAS Participants: Risky Sex and Alcohol/Drug Usage Last Time Sex With Steady or Non-Steady Partner  Men with Mentt 1 Of the 13 cases with risky anal sex:* 3 were drunk and on drugs 1 was drunk 2 were on drugs 6 of 13 impaired by alcohol/drugs (46%) Of the 17 cases with only risky oral sex: 1 was drunk and on drugs 2 were drunk 1 was on drugs 4 of 17 impaired by alcohol/drugs (24%) *With steady or non-steady partner 'Z^" Z*Z]" Z&" Z &^*^$U<SHAS Participants: Men Who Had Sex With Men in the 12 Months Prior to the Interview   0`{ 23/83 (28%) only had oral sex during their most recent sexual encounters with steady and non-steady partners (no anal sex),YSHAS Participants: Men Who Had Sex With Women in the 12 Months Prior to Interview (N=50)ZZ sHad at least one new partner = 40% (20/50) Risky vaginal sex 24% (12/50) Alcohol or drug involvement = 42% (5/12) TI *" H*-YSHAS Participants: Women Who Had Sex With Men in the 12 Months Prior to Interview (N=50)ZZ sHad at least one new partner = 32% (16/50) Risky vaginal sex = 16% (8/50) Alcohol or drug involvement = 38% (3/8) TJ )" I)I4PSHAS PARTICIPANTS: CASES WITH RISKY SEX IN THE 12 MONTHS PRIOR TO THE INTERVIEWQQ$3/4 of the men  who had sex with men with risky insertive anal sex did so after diagnosis of HIV infection 7/9 of the men  who had sex with men with risky receptive anal sex in the absence of insertive did so after diagnosis 11/17 of the  men who had sex with men with risky insertive oral sex without any insertive anal sex did so after diagnosis 8/12 of the  men who had sex with women with risky vaginal sex did so after diagnosis 6/8 of the  women who had sex with men with risky vaginal sex did so after diagnosis 2ZZYZ7 . HIV Testing J53MN Diagnosed SHAS Participants By Test Site (N=188)44 0 1SHAS Participants: Reason for Testing (N=215)2* 1!5SHAS Participants: Minnesota Diagnosed Cases (N=188)66 STest type when 1st tested Anonymous 8% Confidential 90% Unsure 2% Partner notification offered by MDH/MD/other Yes 76% No 20% Unsure 4% Of those offered partner notification (n=142) MDH/MD notification 45% Case notification 35% Both 10% Other (partner known+ or aware, etc) 10% > -# !.{ ! >-#  .  {    P7fe 82"Preventive Therapy 3#+SHAS Participants: Laboratory Tests (N=215),, 4$,SHAS Participants: Hepatitis History (N=215)-- 5%)SHAS Participants: Antiretroviral Therapy** 6&9SHAS Participants: Receiving Antiretroviral (ART) Therapy:: 7'^SHAS Participants: Receiving Antiretroviral (ART) Therapy But With Incomplete Adherence (N=53)*_X   8(=SHAS Participants: Source of Advice on Taking Antiretrovirals>> 9)1SHAS Participants: Skin Testing for Tuberculosis22 :* Health Care ;+%SHAS Participants: Source of HIV Care&& <,6SHAS Participants: Source of Health Insurance (N=215)77 >..SHAS Participants: Insurance Coverage (N=215)// Since HIV+ diagnosis: Lost health insurance >30 in a row 9% Kept insurance 87% Never had insurance 4% Last 12 months ever denied health care because couldn t pay for it: Yes 3% No 97% Delayed care in the last 12 months Yes 7% No 93% ZZ Z!ZDZ Z!Z#Z! Z!ZZD  # !    :?/DSHAS Participants: HIV Induced Health Problem or Impairment (N=215) E=  Yes = 29% No = 71% <!@0 ConclusionsAlcohol and drugs (non-IDU and IDU) appear to have a major role in acquiring HIV infections High lifetime number of sexual partners among HIV infected Risky sexual practices among some HIV + persons is responsible for them becoming infected and transmitting the disease to othersA1Conclusions cont. Level of health care for HIV-infected persons may be higher than expected, particularly for the non-transient White and Black (American born) populations (not enough data on Asian , American Indian and Hispanic populations) Public assistance for HIV care and survival is neededxZZP26ZJ6  `X#H(    c ئ0e0e 0   v P  H #".",Z^DG P  BL?p L  @`  </?Pp P  @`  B1?p H  @`  <9?Pp R  @`  B@?pd  J  @`A   <Q?Pd p  Skin test in year prior to or since HIV diagnosis 79% (152/193) (excludes 22 cases with no recent test but with previous + skin test) Note: 18 cases had unknown skin test dates. It is assumed these occurred more than a year ago.r3qd!> Dq3  @`   BHX?pd  H  @`   <,`?Ppd  _ Unknown = 1% (3/215)  @`   Bg?p P  @`   <lo?Pp Z No = 3% (9/215)  @`  Bv?pf P  @`  <x?Pfp n Yes = 94% (203/215)  m @`  Bl?p f P  @`  <$?P pf l Ever had a skin test for TB @``B  0o ?P p `B  0o ?Pp`B  0o ?PfP`B  0o ?P Pf`B  0o ?f`B  0o ? f`B  0o ?PP`B  0o ?`B  0o ?PPd `B  0o ?d `B  0o ?Pd P`B  0o ?d `B  0o ?PP`B  0o ?`B   0o ?PP`B ! 0o ?`B " 0o ?p`B # 0o ?p  H  0޽h ? ̙33rh9^)hVC  !"#$%&'()*+,-./01234567՜.+,0     - On-screen ShowMDHR"4 9Times New RomanArial Arial NarrowDefault DesignMicrosoft Excel Worksheet/Supplement to HIV and AIDS Surveillance (SHAS) Introduction:The 11 Minnesota Counties in the Minneapolis-St. Paul EMA$Minnesota SHAS Eligibility Criteria|SHAS Cases with HIV (non-AIDS) Interviewed Aug 2000- Dec 2003 Compared to HARS EMA HIV (non-AIDS) Cases Diagnosed 1999-2003gSHAS Cases with AIDS Interviewed Aug 2000-Dec 2003 Compared to HARS EMA AIDS Cases Diagnosed 1999-2003<Agencies/Groups Given Formal SHAS Promotional Presentations$Agencies/Groups Presented SHAS DataSHAS LimitationsDemographic DataSHAS Participants: Gender#SHAS Participants: Race/Ethnicity1SHAS Participants: Category of Exposure (HARS)Socioeconomic Data2SHAS Participants: Socioeconomic Status (N=215)(SHAS Participants: Socioeconomic Status(SHAS Participants: Socioeconomic Status Drug Use<SHAS Participants: Drug Use (N=203) (Excludes African-Born)CSHAS Participants: Non-Injecting Drug Use (Excludes African-Born)CSHAS Participants: Crack Use (Excludes African-Born)?SHAS Participants: Injecting Drug Use (Excludes African-Born)PowerPoint PresentationSexual BehaviorFNumber of Sexual Partners in Lifetime by Declared Sexual Orientation*MSHAS Participants: Sexually Transmitted Diseases (Excludes African-Born)gSHAS Participants: Prostitution (Excludes African-Born)\SHAS Participants: Men Who Had Sex With Men in the 12 Months Prior to the Interview (N=83)tSHAS Participants: Risky Sex and Alcohol/Drug Usage Last Time Sex With Steady or Non-Steady Partner Men with MenSHAS Participants: Men Who Had Sex With Men in the 12 Months Prior to the Interview ZSHAS Participants: Men Who Had Sex With Women in the 12 Months Prior to Interview (N=50)ZSHAS Participants: Women Who Had Sex With Men in the 12 Months Prior to Interview (N=50)QSHAS PARTICIPANTS: CASES WITH RISKY SEX IN THE 12 MONTHS PRIOR TO THE INTERVIEW HIV Testing4MN Diagnosed SHAS Participants By Test Site (N=188)2SHAS Participants: Reason for Testing (N=215)6SHAS Participants: Minnesota Diagnosed Cases (N=188)Preventive Therapy,SHAS Participants: Laboratory Tests (N=215)-SHAS Participants: Hepatitis History (N=215)*SHAS Participants: Antiretroviral Therapy:SHAS Participants: Receiving Antiretroviral (ART) Therapy_SHAS Participants: Receiving Antiretroviral (ART) Therapy But With Incomplete Adherence (N=53)>SHAS Participants: Source of Advice on Taking Antiretrovirals2SHAS Participants: Skin Testing for Tuberculosis Health Care&SHAS Participants: Source of HIV Care7SHAS Participants: Source of Health Insurance (N=215)/SHAS Participants: Insurance Coverage (N=215)ESHAS Participants: HIV Induced Health Problem or Impairment (N=215) ConclusionsConclusions cont.  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