One-third of the individuals infected with the human immunodeficiency virus (HIV) that causes AIDS say that they have either postponed or gone without medical care because they had to put other things first, such as paying the rent or going to work. They either could not get out of work, had no way of getting to the doctor, or were too sick to get medical care. As a result, many did not receive medical care such as antiretroviral therapy that could extend their lives. Also, 8 percent of these patients said they went without food, clothing, or housing because they needed to spend their money on medical care, according to the first national study to examine barriers to medical care for people with HIV.
More resources must be devoted to providing food, clothing, housing, transportation, home care, and employment support for these patients if they are to be kept healthy, suggests the study's lead author, William E. Cunningham, M.D., M.P.H., of the University of California, Los Angeles. Dr. Cunningham and colleagues surveyed a nationally representative sample of 2,864 adults receiving HIV care.
They found that people who were most likely to have gone without or postponed medical care were members of a minority group, drug users, and/or members of lower socioeconomic groups. People with at least one competing need were significantly more apt to have emergency department (ED) visits without being hospitalized (an indicator of lack of primary care to prevent ED visits), less likely to have received antiretroviral therapy, and more than twice as likely to report low overall access to care (such as office visits) in the prior 6 months.
These findings are part of the larger HIV Cost and Services Utilization Study (HCSUS), the first large-scale effort to collect information on a nationally representative sample of people in care for HIV and AIDS. It is directed by Martin F. Shapiro and Samuel A. Bozzette of RAND and supported under a cooperative agreement between RAND and the Agency for Healthcare Research and Quality (HS08578).
See "The impact of competing subsistence needs and barriers on access to medical care for persons with human immunodeficiency virus receiving care in the United States," by Dr. Cunningham, Ronald M. Andersen, Ph.D., Mitchell H. Katz, M.D., and others, in Medical Care 37(12), pp. 1270-1281, 1999.