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Exploring cardiovascular disease knowledge, risk perception, and associated socio-behavioral determinants among African American and Hispanic people living with HIV/AIDS
Dissertation   Open access

Exploring cardiovascular disease knowledge, risk perception, and associated socio-behavioral determinants among African American and Hispanic people living with HIV/AIDS

Niko Verdecias
Doctor of Public Health (Dr.P.H.), Drexel University
May 2019
DOI:
https://doi.org/10.17918/ntfy-aa51
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Abstract

Community health services Cardiovascular system--Diseases AIDS (Disease)--Patients Hispanic Americans Health services accessibility African Americans Comorbidity Health Promotion Public Health
The World Health Organization estimates the worldwide prevalence of HIV to be more than 36 million people. The annual incidence of HIV in the United States (US) is approximately 40,000 with a prevalence of 1.2 million people living with HIV/AIDS (PLWHA). Effective treatments have prolonged the lives of PLWHA. However, comorbidities such as cardiovascular disease (CVD) have become an increasing concern with CVD exhibiting higher rates among PLWHA than in the general population. African Americans and Hispanics in the US are disproportionately affected by CVD and HIV, as single conditions. CVD is a leading cause of death among these racial/ethnic groups. This prompts concerns over the combined impact that CVD-HIV comorbidity potentially has towards widening exisitng disparities. African Americans and Hispanics, especially in underserved communities, confront more barriers to CVD diagnosis and care, receive lower quality treatment, and experience worse health outcomes. African Americans and Hispanics living with HIV/AIDS who are at risk for CVD may have specific needs and risk factors that are not understood or considered by interventionists and healthcare professionals when attempting to prevent or reduce the impact of CVD-HIV comorbidity. The relationship between CVD and HIV has been largely examined from a biomedical and epidemiological perspective. The epidemiological research has provided evidence related to the increased prevalence and risk of CVD among PLWHA while the biomedical perspective has explored the physiological pathways of CVD among PLWHA. However, the literature is scant in terms of identifying and understanding the psychosocial, behavioral and contextual determinants that may contribute to increased risk. Further lacking are studies that explicitly focus on African Americans and Hispanics living with HIV/AIDS from underserved communities. CVD risk assessment and risk reduction require more than a clinical intervention driven by clinical indicators such as blood glucose levels and lipid profiles. It requires an understanding of the various individual and contextual/community level determinants that affect CVD risk, such as self-perceived CVD risk, CVD knowledge, mental health, social support, neighborhood safety, accessibility and availability of primary care, and community resources. As such, utilizing a mixed methods approach, the goals of my dissertation were to: (1) explore CVD knowledge, CVD risk perception, and psychosocial and behavioral determinants that affect CVD risk behaviors and risk levels among a sample of African Americans and Hispanics living with HIV/AIDS; and (2) explore the healthcare provider perception of CVD risk assessment and management among African Americans and Hispanics living with HIV/AIDS. The objectives of this study were to: (1) assess CVD risk among a sample of African American and Hispanic PLWHA; (2) identify potential determinants of CVD risk among a sample of African American and Hispanic PLWHA; and (3) explore organizational characteristics associated with providing care to PLWHA who are at risk of developing CVD.

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