Journal of urban health : bulletin of the New York Academy of Medicine
-
Needle-exchange programs (NEPs) have been politically controversial, and most studies have focused on evaluating their effectiveness on human immunodeficiency virus (HIV) transmission rates with little emphasis on the process of how they are used. This article shows that the way intravenous drug users use NEPs may influence their effectiveness. Using data from Baltimore's NEP, participants (N = 2,574) were classified as low, medium, and high users based on the volume, frequency, and duration of contact with the NEP. ⋯ We conclude that exclusive use of the NEP (no relay) provides greater HIV protection than NEP use involving syringe relay. The paradox is that public health goals will not be achieved by prohibiting syringe relay activities and promoting exclusive use. NEPs should broaden their education efforts to have participants understand the value of repeated visits to the NEP.
-
Inmate contact with the correctional health care system provides public health professionals an opportunity to offer HIV screening to a population that might prove difficult to reach otherwise. We report on publicly funded human immunodeficiency virus (HIV) voluntary counseling, testing, and referral (VCTR) services provided to incarcerated persons in the United States. Incarcerated persons seeking VCTR services received pretest counseling and gave a blood specimen for HIV antibody testing. ⋯ Among HIV+ episodes, those for IDUs dropped from 61.5% to 36.6%, while episodes for heterosexuals with no reported risk factor increased from 4.3% to 18.2%. The use of VCTR services by incarcerated persons rose steadily from 1992 to 1998, and 56% of HIV+ tests were newly identified. High numbers of tests that recorded risk behaviors for contracting HIV indicate that correctional facilities provide an important access point for prevention efforts.
-
Historical Article
The control of mosquito-borne diseases in New York City.
Mosquito control began in New York City in 1901. Large-scale efforts to drain marshlands occurred through the 1930s, and aerial application of pesticide occurred as early as 1956. Components of early mosquito-borne disease control were reimplemented in 1999-2000 in response to an outbreak of West Nile virus, and included promoting public and health professional awareness regarding disease causation and prevention, providing free government laboratory testing, case reporting, mapping of mosquito breeding sites and their elimination or application of larvicide to them, and adult mosquito control. Because a potential for various mosquito-borne diseases in New York City persists, continued efforts are warranted to limit mosquito breeding, to monitor adult mosquito populations for the presence of human pathogens, and to establish protocols and capacity for adult mosquito control.
-
The competing public health concerns of vector-borne disease and vector control strategies, particularly pesticide use, are inherently subjective and difficult to balance. Disease response decisions must frequently be made in the absence of data or clear criteria. ⋯ New York City's experience with West Nile virus has illustrated each of these issues. A framework for assessing the appropriate response to West Nile virus can serve to guide our response to likely new pathogens.
-
Review Historical Article
Universal coverage in the United States: lessons from experience of the 20th century.
Both the rising numbers of uninsured Americans and the recent presidential election have put the issue of universal health insurance coverage back on the national agenda. Lack of health insurance is a major barrier to care for 44 million Americans, and lack of high-quality, comprehensive insurance is a barrier to millions more. Universal coverage is one of the best ways to ensure that all Americans have equitable access to quality care, and it also contributes to the financial stability of health care providers, especially those in the urban safety net. ⋯ At the beginning of the 21st century, the American health care system is made up of varied elements, ranging from employer-sponsored health insurance for the majority of working-age adults to the public Medicare program for the elderly. While this patchwork system leaves many Americans without health insurance, it also creates many different ways to expand coverage, including various options in both the private and public sectors. By understanding how the current health care system developed, how the various proposals for universal health coverage gained and lost political and public support, and the pros and cons of the various alternatives available to expand coverage, we create a solid base from which to solve the problem of the uninsured in the 21st century.