In This Issue:

Pathways to HIV Care

The Anniversary of the Affordable Care Act

My Little Black Book for Sexual Health - In Spanish

Ibis on Twitter!

Staff Updates

Support Maternal and Newborn Health in Japan

Dear Friend,

We are very happy to share with you a few highlights of our current research and recent publications. Our featured research on pathways to HIV care in Durban, South Africa, a partnership with Columbia University and the South African Medical Research Council, HIV Prevention Research Unit, seeks to better understand women’s and men’s choices to enroll in and continue HIV care and treatment and the socio-economic, structural, and psychological factors that influence getting into care. We are also interested in how positive women and men access reproductive health care and how sexual and reproductive health issues are addressed in current HIV care. We are conducting a prospective cohort study, and undertaking a range of community and clinic assessments to answer these questions. Ultimately, the findings will shed light on ways to improve policies, service provision, and access to HIV care and treatment in South Africa and other contexts.

We are also excited to celebrate the anniversary of the Affordable Care Act, the US health reform bill signed into law one year ago this week. In honor of the anniversary, Ibis staff and our partners have authored several blogs and articles about our research on the effects of health reform in Massachusetts. We are also pleased to let you know that My Little Black Book for Sexual Health: A guide for getting the health insurance you need to prevent pregnancy until you're ready, which was developed as part of the REaDY Initiative, is now available in Spanish. This resource helps young adults navigate health insurance under health care reform in Massachusetts.

Thank you for your continued support and interest in our work, and we look forward to sharing more news about Ibis’s activities.

Sincerely,

Kelly Blanchard, President

Ibis and Partners Begin Multifaceted Study on Pathways to HIV Care among Newly Diagnosed Women and Men in South Africa

Despite the global effort to scale up treatment programs and increase access to antiretroviral therapy (ART) for HIV-positive people living in low-resource settings, many are entering care too late to benefit from ART. National and international policies promoting expanded and routine testing are not enough to ensure access to life-saving ART; public health services must be designed with an understanding of the facilitators of and barriers to accessing HIV care once an individual is diagnosed.

The majority of care and treatment retention studies has been conducted among HIV-positive individuals already enrolled in care and has focused on a narrow set of demographic and clinical variables. Efforts to promote access to ART are particularly important in South Africa, where an estimated 5.6 million people are infected with HIV, more than in any other country.

Ibis, in collaboration with the HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University and the Medical Research Council, HIV Prevention Research Unit (MRC HPRU), is conducting the Pathways to Engagement in HIV Care for Newly Diagnosed South Africans study to analyze the impact of psychological, structural, and socio-economic factors on newly diagnosed South Africans’ choices regarding and ability to enroll and stay in HIV-related care. The study aims to determine time to enrollment in HIV care (defined as returning to the clinic to obtain the result of one’s first CD4 count), and facilitators and barriers to accessing HIV care at the individual, health systems, and social-structural levels. The study also aims to explore the process of disclosure of one’s HIV status and decision making around one’s care and to identify additional critical issues, including the need for and use of mental health, reproductive, and other HIV-related ancillary services among newly diagnosed individuals. The study team will address these aims through a prospective cohort study with newly diagnosed HIV-positive individuals, and through various community and clinic assessments, including an analysis of media messaging, policy changes, and public discourse in South Africa; an inventory of health and community services; measurement of distance from participant homes to study clinics; and a structured assessment with HIV pre- and post-test counselors in the study clinics.

The cohort study will follow approximately 650 newly diagnosed, HIV-positive individuals for eight months. These individuals will be asked to participate in three structured interviews: one at the time of diagnosis, one four months after diagnosis, and the final one eight months after diagnosis. Additionally, the research team will conduct in-depth interviews at time of diagnosis and at each follow-up visit with a subset of 30 individuals enrolled in the cohort study. The structured and in-depth interviews will address all aspects of enrollment and retention in ART, including physical and mental health, familial support, and social stigma associated with HIV. As part of the global drive to move toward combination prevention efforts, researchers hope to gain a broad perspective on individuals’ decisions and ability to enroll and stay in HIV care by piecing together social-structural factors, health system organization and policies, and individual health and behaviors.

The research team began the study in 2009, conducting formative work to inform development of study instruments for use with counselors and HIV-positive individuals. Structured assessments with HIV pre- and post-test counselors took place in late 2010. Recruitment for the cohort study began in late 2010 and early 2011 at two clinic sites in Durban, South Africa. It is expected that data collection for the study will go through early 2013.

This project is part of Ibis’s body of work addressing the comprehensive health needs of HIV-positive women and women at risk of HIV. In South Africa, 3.2 million of the 5.6 million living with HIV/AIDS are women and girls over the age of 15. Through the Pathways study, we aim to influence policy and practice related to HIV treatment services, and to contribute to long-term efforts to improve South African women’s and men’s access to HIV care.

This work is supported by a National Institute of Mental Health grant awarded to the HIV Center for Clinical and Behavioral Studies, NYS Psychiatric Institute and Columbia University (Susie Hoffman, DrPH, Principal Investigator). Ibis is a sub-grantee on this award.

Photo: The Pathways study team

Ibis Celebrates One-Year Anniversary of the Affordable Care Act

This week marks the one-year anniversary of the passage of the Affordable Care Act, the US health reform law, which promises to have a significant impact on women’s and girls’ access to health care. Ibis is celebrating by blogging about the benefits of the new law on MomsRising.org and RH Reality Check. Check out posts from Ibis staff and our partners:

• "Increasing access to health insurance for young adults: An unheralded benefit of the ACA," MomsRising
• "In Massachusetts, health reform is a lifesaver for women," MomsRising
• "'Making it feasible for people': Young adults on Massachusetts health care reform," MomsRising
• "Public funding of family planning is essential, even under health reform," RH Reality Check

Ibis and Partners Launch My Little Black Book for Sexual Health in Spanish

My Little Black Book for Sexual Health: A guide for getting the health insurance you need to prevent pregnancy until you’re ready, is a youth-friendly, interactive online guide that helps young adults navigate their health insurance options and answers questions about finding health plans that work for them and meet their contraceptive needs. My Little Black Book for Sexual Health was created by the Reproductive Empowerment and Decision Making for Young Adults (REaDY) Initiative, a statewide project to reduce unplanned pregnancy among young adults in the wake of Massachusetts health care reform. The Spanish version of the resource was launched in January 2011.

Ibis led the formative research for REaDY, including a systematic review of the young adult-targeted health plans and focus group discussions with young adults across Massachusetts. One of our key findings was that information about health insurance and contraception is often confusing and unclear. Young adults were also unaware of many of the provisions of Massachusetts’ health reform law, though they expressed overwhelming interest in getting more information about contraception and in having resources to help them navigate contraceptive coverage in the new health care environment.

In addition to aiding young adults, we hope that My Little Black Book for Sexual Health can also serve as a model for advocates and policymakers in other US states as they prepare for national health reform to roll out over the next few years.

My Little Black Book is available online in English and in Spanish.

Ibis Engaging in the Twitter-verse!

Ibis is excited to be participating in reproductive health dialogues on Twitter! Follow us @IbisRH. If you don’t have Twitter, you can still view our Twitter page.