Diego Correa

Applying an Expanded Social Determinant Approach to the Concept of Adherence to Treatment: The Case of Colombian Women Living With HIV/AIDS

BACKGROUND The purpose of this study was to explore and analyze social determinants that influence adherence among Colombian women living with HIV/AIDS in poverty conditions. METHODS A qualitative, descriptive-interpretative study was developed. Forty-seven women participated in five focus group discussions. Also, in-depth interviews with six women were conducted. FINDINGS Results showed that women with lower adherence sell their antiretroviral medication to satisfy economic needs, and prioritize the care of their HIV-positive children over their own adherence needs. In contrast, women with higher adherence were found to participate in social support groups offered by nongovernmental organizations. CONCLUSION These findings underscore the need to understand the social determinants that facilitate and/or hinder adherence among women in poverty-associated conditions. Results indicate the need to facilitate access to treatment on a timely and continual basis; provide economic resources, including support to meet basic needs as well as subsidies for transportation to health care centers; and explore mechanism for supporting the care of their offspring.

HIV testing and counselling in Colombia: evidence from a national health survey and recommendations for health-care services

The purpose of this study was to assess the prevalence of, and the factors associated with HIV testing and pre- and post-test counselling (PPTC) in Colombia. Cross-sectional data from the National Health Survey carried out during 2007 were analysed. Data were gathered from records of 29,760 individuals between the ages of 18 and 69 from the main regions of the country. Only 19.7% of the sample had taken an HIV test. Men, people with no education, those not affiliated with the health-care system, residents of rural areas and those aged older than 65 were less likely to have been tested for HIV; 42% of those tested did not receive pre-test counselling and 56.9% received no report of the results. Considering the low prevalence of HIV testing among the Colombian population, it is necessary to design and apply guidelines for HIV screening in all health-care settings and to conduct targeted testing in high-risk sub-populations. A national norm of PPTC in those who undergo HIV testing should be examined.

HIV/AIDS treatment adherence in economically better off women in Colombia

Abstract Studies on HIV/AIDS treatment adherence have been carried out in a limited number of geographic settings, but few studies have explored it in people of higher socioeconomic status in Latin America. This qualitative study explored and compared determinants of adherence behaviors among 52 HIV-positive Colombian women in medium and high socioeconomic positions (SPs). Findings indicated that the two SP groups reported high adherence behaviors related to taking medication, following a diet, and executing lifestyle changes in line with healthcare providers’ recommendations. Nevertheless, differences were observed between the two groups. While women with a medium SP disclosed their diagnosis, were empowered, and had acceptable access to economic resources that resulted in favorable adherence, their better off counterparts tended to hide their status and made a conscious effort to keep their adherence behaviors in secret due to HIV-related stigma. More studies on adherence of people living with HIV/AIDS from high SPs should be conducted to better understand how psychosocial support can be provided and to advance the knowledge of how and why adherence practices in these groups are undertaken.

Infecciones de transmisión sexual en la región Pacífica colombiana: implicaciones para población en situación de vulnerabilidad étnica, social y económica

Objective. Describe and analyze the presence of diagnosis of self-reported Sexually Transmitted Diseases (STDs) in adult population of the Colombian Pacific Region, as well as the consequences among population with ethnic, social and economical vulnerability. Method. A secondary source study, using data from the National Health Survey (2007) with a final sample of 4,622 persons, was conducted. Results. A self-reported STD diagnosis of 1.2% was found; the highest percentage occurred on the Pacific Coast, where the population is 1

Evidencia poblacional y análisis crítico de determinación social sobre el uso del condón en Colombia

Objetivos: determinar el nivel de uso del condon en poblacion general colombiana y analizar los hallazgos desde el enfoque critico de la determinacion social de la salud. Metodos: estudio transversal realizado con datos de la Encuesta Nacional de Salud, 2007. La muestra estuvo conformada por 29 760 registros de personas entre 18 y 69 anos de las principales regiones de Colombia. Resultados: entre el 75 y 94 % de los encuestados habian oido hablar del condon pero a pesar de eso, su uso arrojo porcentajes por debajo de 22,2, y fueron las mujeres quienes menos lo utilizaron. Las personas con bajos niveles de escolaridad, sin escolaridad, afiliados al regimen subsidiado para poblacion pobre y desplazados, fueron quienes usaron menos el condon, tanto en la primera como en la ultima relacion sexual. De forma complementaria, se encontro que en una submuestra de 209 personas, solo 13 (6,5 %) utilizaron el condon como medida preventiva cuando tuvieron alguna infeccion de transmision sexual. Conclusiones: El uso del condon en la poblacion colombiana es bajo, existen determinaciones sociales de tipo estructural relacionadas con este hecho, como son el acceso a la educacion y a servicios de salud, asi como patrones culturales de vulnerabilidad relacionados con el genero. La promocion del uso del condon en el pais debe pasar por decisiones de la autoridad sanitaria encabezada por el Ministerio de Salud, con participacion de otros sectores involucrados en la calidad de vida de los colombianos.