Nadine Chen - Academia.edu (original) (raw)

Papers by Nadine Chen

Infectious disease reports, 2011

Despite recent advances in testing and treatment, the incidence of HIV/AIDS in the United States ... more Despite recent advances in testing and treatment, the incidence of HIV/AIDS in the United States has remained stagnant with an estimated 56,300 new infections every year. Women account for an increasing proportion of the epidemic. The vulnerability of women to HIV stems from both increased biologic susceptibility to heterosexual transmission and also the social, economic, and structural disadvantages they often confront. This review describes the main reasons for the increased vulnerability of U.S. women to HIV transmission with particular emphasis on specific high-risk groups including: non-Hispanic blacks, women who use drugs, women with a history of incarceration, and victims of intimate partner violence. Although behavioral approaches to HIV prevention may be effective, pragmatic implementation is often difficult, especially for women who lack sociocultural capital to negotiate condoms with their male partners. Recent advances in HIV prevention show promise in terms of female-in...

The criminal justice system bears a disproportionate burden of the HIV epidemic. Continuity of ca... more The criminal justice system bears a disproportionate burden of the HIV epidemic. Continuity of care is critical for HAART-based prevention of HIV-related morbidity and mortality. This paper describes four major challenges to successful management of HIV in the criminal justice system: relapse to substance use, homelessness, mental illness, and loss of medical and social benefits. Each of these areas constitutes a competing priority upon release that demands immediate attention and diverts time, energy, and valuable resources away from engagement in care and adherence to HAART. Numerous gaps exist in scientific knowledge about these issues and potential solutions. In illuminating these knowledge deficits, we present a contemporary research agenda for the management of HIV in correctional systems. Future empirical research should focus on these critical issues in HIV-infected prisoners and releasees while interventional research should incorporate evidence-based solutions into the criminal justice setting.

Journal of Public Health Research, 2012

Background-In a study of female sex workers (FSW) servicing truck driver clients in Mexican borde... more Background-In a study of female sex workers (FSW) servicing truck driver clients in Mexican border cities, we evaluated differences in HIV/STI risk behaviors by workplace.

Background: Female sex workers (FSW) are at increased risk for HIV and other STI due to occupatio... more Background: Female sex workers (FSW) are at increased risk for HIV and other STI due to occupation-related risks and exposures. Long-distance truck drivers have been implicated in the spread of HIV, but less is known about HIV/STI risks of FSW servicing truck drivers, especially in North America. As part of an international collaborative pilot study, we interviewed FSWs servicing truck driver clients along two major transportation corridors to explore factors associated with recent STI symptoms. Methods: A cross-sectional study of 200 FSW was conducted in Mexico: 100 from Nuevo Laredo (U.S. border); 100 from Ciudad Hidalgo (Guatemalan border). Eligibility criteria included age ≥18 years, speaking English or Spanish, and having ≥1 truck driver client in the past month. The main outcome was reporting any recent STI symptoms, defined as experiencing genital/anal warts, genital ulcers/sores, genital itching, or abnormal vaginal discharge in the past 6 months. Logistic regression was used to identify correlates of recent STI symptoms.

Journal of Immigrant and Minority Health, 2013

Disparities in incarceration rates and in prison-based TB/HIV testing may contribute to health di... more Disparities in incarceration rates and in prison-based TB/HIV testing may contribute to health disparities in the communities most affected by incarceration. We analyzed Bureau of Justice Statistics surveys of federal and state prison inmates to assess TB and HIV screening rates for US-born Hispanics, foreign-born Hispanics, non-Hispanic blacks, and non-Hispanic whites. Screening rates were high overall but foreign-born Hispanic inmates had significantly lower odds of being tested for TB in both state (AOR 0.55) and federal prisons (AOR 0.31) compared to white inmates. Foreign-born Hispanics also had lower odds of being tested for HIV in state prisons and Hispanics had lower odds of being tested for HIV in federal prisons compared to white inmates. Screening for infectious diseases in state and federal prisons is high but Hispanics have higher odds of going untested; this has important consequences for prevention of further transmission in the communities to which they return.

BMC Public Health, 2012

Academic Emergency Medicine, 2013

Objectives: The objective was to characterize the medical, social, and psychiatric correlates of ... more Objectives: The objective was to characterize the medical, social, and psychiatric correlates of frequent emergency department (ED) use among released prisoners with human immunodeficiency virus (HIV).

AIDS and Behavior, 2013

HIV-infected persons entering the criminal justice system (CJS) often experience suboptimal healt... more HIV-infected persons entering the criminal justice system (CJS) often experience suboptimal healthcare system engagement and social instability, including homelessness. We evaluated surveys from a multisite study of 743 HIV-infected jail detainees prescribed or eligible for antiretroviral therapy (ART) to understand correlates of healthcare engagement prior to incarceration, focusing on differences by housing status. Dependent variables of healthcare engagement were: 1) having an HIV provider, 2) taking ART, and 3) being adherent (>95% of prescribed doses) to ART during the week before incarceration. Homeless subjects, compared to their housed counterparts, were significantly less likely to be engaged in healthcare using any measure. Despite Ryan White funding availability, insurance coverage remains insufficient among those entering jails, and having health insurance was the most significant factor correlated with having an HIV provider and taking ART. Individuals interfacing with the CJS, especially those unstably housed, need innovative interventions to facilitate healthcare access and retention.

PLoS ONE, 2012

Background: Many people living with HIV access healthcare systems through the emergency departmen... more Background: Many people living with HIV access healthcare systems through the emergency department (ED), and increased ED use may be indicative of disenfranchisement with primary HIV care, under-managed comorbid disease, or coincide with use of other healthcare resources. The goal of this study was to investigate ED use by HIV-infected prisoners transitioning to communities.

Journal of Immigrant and Minority Health, 2010

To better understand access to HIV testing and prevention services experienced by Latinos, we eva... more To better understand access to HIV testing and prevention services experienced by Latinos, we evaluated data compiled through Baltimore City Health Department HIV outreach efforts in 2008. Of 6,443 clients served, Latinos were more likely male, young, and less-educated than non-Latinos. A greater proportion of Latinos had never been tested for HIV compared to non-Latinos (63% vs. 20%, P \ 0.001). Male gender (AOR 1.58, 95% CI 1.04, 2.44), [8th grade education (AOR 2.4, 95% CI 1.60, 3.60) were associated with accessing HIV testing in the past. Increasing age, identifying as gay or bisexual, history of sexually-transmitted disease, and injection drug use were also associated with reporting prior HIV testing. HIV prevention services for Latinos should expand to reach those who are younger, heterosexual, of lower educational level, and female.

Journal of Immigrant and Minority Health, 2012