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09.03.2016
Topographic maps contain data on the natural features of the land, such as elevations, contours, water bodies, and other features, plus they may also contain man-made features such as roads, railroads, buildings and structures, etc. Topographic Maps (Digital Rasterized Graphic) image files for download (for use in ArcView, Photoshop). In addition to topo maps in our collection, you may want digital or digitized topo maps to download. Use the Guide: Locating and downloading United States Geological Survey Topographic Maps to help you locate topo maps, in paper and digital formats. Historic or pre-1950 topographic maps (mostly 1:63,360) of New York State are available in the Map Collection. The USGS took over responsibility for mapping the country in 1879 and has been the primary civilian mapping agency of the United States ever since. The 7.5-minute map series was officially completed in 1992, and the program has recently been replaced by The National Map. Likert Scale questions are often used in Surveys where they are used to collect opinions. When using a likert scale question in a survey, the person answering the question may not feel that it is applicable to them. The main concept of topographic maps is that they show the way the landscape would appear if viewed from above. This UB Libaries page provides a gazetteer, along with the digital collection of downloadable USGS topographic maps, such as georeferenced Digital Raster Graphics (DRG's). These can be located using the Libraries' Catalog, and are available for use inside the Map Room. Though somewhat uniform throughout the cartographic world, not all maps use the same symbols. Send correspondence and reprint requests to: Marcela Arrivillaga, Investigadora, Departamento de Ciencias Sociales, Pontificia Universidad Javeriana-Cali, Calle 18 No. A brief history of the USGS topographic map program describes the creation of this valuable series. Below are numerical statistics on the number of USGS Topographic Maps in various series from the National Topographic Map Names Database. Additional descriptions here: Topographic map symbols, landforms, and map examples (California State University, Sacramento). This is the only uniform map series that covers the entire area of the United States in considerable detail. Participants completed three questionnaires: a socio-demographic and clinical characteristics survey, a treatment adherence scale, and a social position survey. In Latin America, conceptual models studying the link between macro socioeconomic structures and growing health inequities have been used in social medicine and public health since the 1970s (5). This social and gender differentiation results in institutionalized imbalances between men and women in access to and control of resources (6, 7), and produces important differences in health outcomes (8). In Latin American countries, policies based on gender norms restrict women's access to productive resources such as land, income, education, technology, and credit. Heterosexual transmission of HIV is the main mode of transmission among Colombian women, with 72% of cases detected in women attending vertical transmission prevention programs who report stable relationships with husbands or partners (13, 14).
Law 100 also established a two-tier system of national health care coverage-contributive and subsidized-provided through the General System of Social Security in Health (Sistema General de Seguridad Social en Salud, SGSSS).
Those enrolled in the Contributive Mandatory Health Plan (Plan Obligatorio de Salud Contributivo, POS-C), which includes all individuals who are formally employed or earning more than twice the minimum wage, pay monthly dues for their health care coverage. Those enrolled in the Subsidized Mandatory Health Plan (Plan Obligatorio de Salud Subsidiado, POS-S), which includes government-defined subsidy-eligible individuals (those unable to pay the total amount of the insurance premium), receive restricted benefits (about half of those provided under the POS-C) subsidized by the government. In spite of being below the poverty line, and due to the policies of the SISBEN, vinculados have not yet achieved access to the national health care system or the supply-driven resources originally targeted toward this population. Consequently, about 10 million citizens (approximately 25% of the Colombian population) do not have any type of health care coverage (15) and must rely on health care services provided by local governments (primary care interventions, high-level or emergency services, and some intermediate-level services), which often entail extremely high out-of-pocket expenses. However, activating this mechanism requires engaging in multiple bureaucratic procedures, resulting in delayed access to services, stress for patients and their families, and risk of worsening condition. Because Colombia's current health system is market-based, unemployed women and those working in the informal sector experience extremely limited access to health care services.


Because most of this population is uninsured, any health services they do receive require extensive, often unaffordable out-of-pocket payments. Barriers to health care for these women are further exacerbated in the event of widowhood, partner abandonment, marital separation, or partner unemployment (7). Therefore, the population most affected by barriers to care and treatment is largely composed of poor women, whose limited ability to pay for services, status as women, and low social position block their access to health care (17, 18).
Along with the direct effects of gender inequality on women's health care, it is important to analyze the indirect effects of gender on treatment adherence, such as women's limited access to the economic resources that determine their social position.
These objectives emerged after a review of available data revealed a lack of consistency regarding the association between socioeconomic status and treatment adherence. At the same time, the lack of existing data on this topic eliminated the possibility of formulating directional hypotheses.
Therefore, this study focused on the above-mentioned variables, taking into account specific effects of gender, to assess the treatment adherence of Colombian women. This report analyzes the quantitative data, using a cross-sectional, descriptive, correlational design.
Due to the nature of the sample pool, which comprised a hidden and hard-to-reach segment of the population (female seropositives), along with data inconsistencies and incomplete records at the participating health centers, a convenience sample was used.
The main exclusion criterion was documentation of a mental disorder diagnosis in the clinical history. Out of the 280 women initially contacted, 11 (4%) refused to participate in the study for fear their names would be revealed (despite guarantees of confidentiality).
Three questionnaires were applied to each study participant by appropriately trained personnel (except in the case of low educational level of the participant, which required administration of the surveys by the researchers, with the assistance of a support team). The research project was approved by the institutional review boards of the National University of Colombia (Universidad Nacional de Colombia, UN) and Javeriana University in Cali (Pontificia Universidad Javeriana Cali, PUJC). The treatment adherence questionnaire included 21 items evaluating practices, motivations, beliefs, affect, barriers, and living conditions. The variable was categorized on a scale of 21 to 84, and "low" and "high" levels of adherence were established respectively as 21-61 points and 62-84 points. This classification was based on the overall mean of compliance in patients classified as "high adherence" in past studies, which ranged from 37% to 88% (32, 33). For descriptive purposes, the frequencies of responses to the items on the three survey instruments were examined first.
For analytical purposes, univariate and multiple logistic regression models were estimated and odds ratios (OR) were used to characterize associations between the three groups of variables (social position, socio-demographic and clinical characteristics, and treatment adherence).
Table 3 shows the socio-demographic and clinical characteristics of the study sample. 57% who obtained high levels of adherence), and 80% were classified as members of a low social position (vs.
As shown in Table 4, the estimated risk for low adherence was five times higher for the women in a low social position compared to those in a medium or high social position. Through multiple correspondent analyses, the problem of multicollinearity was avoided, and the variable set was reduced. For example, as noted in the table, enrollment in the subsidized health care plan or being uninsured had a greater effect on the likelihood of low adherence than enrollment in the contributive plan (reliability 99%). The statistically significant associations found in the study underscore the importance of social determinants versus practices, motivations, beliefs, affect, and living conditions with regard to treatment adherence.
In general, socioeconomic aspects in these studies are measured and analyzed as independent factors. A majority of authors used the variable of income level as the indicator of social position. Although living in poverty and being female have been shown to be fundamental determinants of the dynamics of the HIV epidemic (17-20), research on adherence to treatment in this specific population is scarce. However, more research is required to confirm associations between treatment adherence and variables related to social position and gender role.
Women enrolled in the subsidized plan generally receive care through POS-S Administrator Agencies (Empresas Promotoras de Salud del Régimen Subsidiado), which provide limited benefits. According to the authors of the current study, this treatment adherence barrier is an indirect consequence of less-than-equal access to timely and continuous care by women of low social position in Colombia, stemming from the flawed structure of the current national health system.


Access to the national health system for the Colombian population depends on either the capacity to afford it or the ability to meet the eligibility criteria for SISBEN subsidies (42, 43).
In terms of insurance deficits, the continued prevalence of economic and gender discrimination leaves women more negatively affected than the majority of male enrollees (43, 44).
Most adherence problems among seropositive women enrolled in the subsidized plan stem from the restricted access to health services that characterizes this plan.
Many vinculados remain on long waiting lists for access to treatment in public hospitals and thus experience serious problems related to access and quality of care. In other words, the Colombian national health care system does not provide gender-equitable access to its services (access based on need, regardless of gender or social position). Some authors have observed that traditional models of medical care do not sufficiently address the specific needs of these women. For example, according to previous studies, when women receive help from others in the area of childcare their adherence to medical appointments improves significantly (26). According to predominant cultural norms in Colombia, women assume the main responsibility of taking care of their families. They kept medical appointments, complied with prevention practices, ensured their children received the prescribed schedule of ART, and, with the same level of diligence, pursued legal actions to try to guarantee continued access to it.
They also demonstrate associations between adherence and the socio-demographic variables "type of health care plan" and "having HIV-positive children." However, the authors conclude that the concepts of gender role and social position were not wholly integrated in their analyses of treatment adherence among seropositive women. Therefore, additional studies based on social determinants of health are needed to confirm these associations. This definition is based on a conceptual model devised by Breilh (5) that offers a theoretical, epistemological, and praxiological framework for analyzing social processes related to individual health. This, in turn, requires consideration of women's role as maternal caretakers as well as other gender-related issues directly or indirectly affecting women's health.
Another prerequisite for achieving progress in this area is a rights-based health system based on the principles of equity and universality. In the meantime, the Colombian government must at least guarantee access to timely and continuous ART. Comparative studies should be carried out between male and female samples to identify links between these variables and thus improve the characterization of gender differences. Other studies on structural barriers of health systems and their association with gender-role variables would also contribute to a more integrated approach to analysis of treatment adherence. Lastly, to address the limitations in the scope of the current study's sample population in terms of social position, explained above, the authors recommend the inclusion of a wider proportion of women with medium and high social position. While the current study experienced difficulty in locating seropositives with a high social position (because they tended to hide their condition and did not appear on health institutions' registers or attend NGO support groups), this population could be studied further through the use of a different research approach, such as the use of special quantitative research sampling methods, or qualitative data collection. The authors also acknowledge the contributions to the study's data collection and literature review by Paula Andrea Hoyos, research assistant for the Health and Quality of Life Research Group, a category A research group recognized by the Administrative Department for Science, Technology and Innovation (COLCIENCIAS), a Colombian government agency.
Health-related quality of life among men with HIV infection: effects of social support, coping, and depression. Socioeconomic status (SES) as a determinant of adherence to treatment in HIV infected patients: a systematic review of the literature. Adherence to antiretroviral therapy among HIV-infected methadone patients: effect of ongoing illicit drug use. Carballo E, Cadarso-Suárez C, Carrera I, Fraga J, de la Fuente J, Ocampo A, et al.
Correlates of self-reported nonadherence to antiretroviral therapy in HIV-infected patients: the Swiss HIV Cohort Study. HIV is not my biggest problem: the impact of HIV and chronic burden on depression in women at risk for AIDS.



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