Health care professionals should pay attention to their patients’ income and social environment as useful factors in identifying at-risk heterosexuals in the Chicago AIDS epidemic, according to a new study by the Chicago Department of Public Health.
This data is important in determining prevention planning, according to Nik Prachand, the study’s author. New efforts should address the social determinants of health as well as individual behavior change, said Prachand, a senior epidemiologist in the board of health’s STI/HIV/AIDS division.
“We need to train healthcare providers to understand that there are more factors at play in health that can’t be controlled.”
Prevention efforts should be focused on reducing unprotected sex and substance abuse, and increasing HIV testing, knowledge of status and free condom distribution.
In 2008, heterosexual transmission made up about one fourth of the overall HIV diagnoses in Chicago, and poverty levels are shown to define those heterosexuals who are at the highest risk for contracting the disease.
“When you think of the ill or sick, you think of them as little pockets that are not as visible,” Prachand said. “But heterosexuals are not a hidden population.”
Prachand ran a respondent-driven study of 514 heterosexual participants in which members answered survey questions and took an initial HIV test.
About 22 percent of Chicago residents live at or below the poverty level. Of the respondents, more than 80 percent lived in neighborhoods where more than one out of five households live at or below the national poverty level.
Lack of access and education are the biggest issues said Prachand. Many members of the at-risk community battled incarceration, lack of income, and limited access to insurance and medical care.
“If a community is isolated, it will be isolated from care. We can’t wait for the community to come to us. We have to go to them,” Prachand said.
David W. Hines, an infectious diseases consultant for the Metro Foundation, had a different view.
“I think members of the impoverished community know the risks in their behavior but they choose to forget it when the opportunity arises,” he said. “Healthcare workers are powerless to affect that.”
Creasie Finney Hairston, a member of the city’s Board of Health, found the results sobering and powerful.
“So much of this is quality of life that is affecting the most bare and intimate of relationships people have with one another,” she said.