HIV/AIDS: Care Access for Minorities and Poor Still Lags
Racial and socioeconomic disparities in AIDS medical care have narrowed since potent antiretroviral drug therapy became widely available three years ago, but "substantial differences" in access to treatment still exist, according to a government-funded study published in today's Journal of the American Medical Association. "Clearly, there has been some improvement over time in access to care for people with HIV," said lead author Dr. Martin Shapiro of the University of California-Los Angeles. But at the same time, he said, gaps persist, with white men infected through homosexual intercourse faring the best, according to six treatment quality measures studied in the HIV Cost Services Utilization Study, the Washington Post reports. Researchers surveyed nearly 3,000 HIV-positive people randomly selected from 28 metropolitan areas and 24 rural regions three times over a period of three years. The study, which began in 1996 just as protease inhibitors were introduced, focused on whether patients went to the doctor regularly, stayed out of the hospital, took triple-therapy drugs and received preventive medicine to ward off pneumonia. The researchers found "virtually no difference in quality of care" for those HIV-infected people with private insurance or HMOs, and Medicaid patients received about the same level of care as the uninsured. Sex and education were "among the strongest predictors" of quality medical care, with men and college graduates faring better than their female or less educated peers.
Nuts and Bolts
Overall, the percentage of respondents whose medical care was rated as good by all six measures increased from 29% to 47% over the three year period. In the first year of the study, 59% of those surveyed had received triple therapy, but that figure climbed to 85% just three years later. For black respondents, the percentage climbed from 44% to 80%; for Hispanics, from 56% to 84%; and for whites, from 68% to 88%. For men, the percentage increased from 61% to 87%; for women; from 49% to 78%. Respondents' type of health insurance also played a role, with the percentage of people with private insurance who received triple therapy increasing from 72% the first year to 91% the third year. Triple therapy for Medicaid recipient jumped from 53% to 81%. One of the "more starling findings," the Washington Post reports, is that "the percentage of people with no insurance who were on triple therapy rose from 46% to 79% in three years" (Brown, Washington Post, 6/23).
Haves and Have-Nots
"It's very clear that there is a great divide in HIV care between the haves and the have-nots," Shapiro said, noting that blacks, Latinos and those with Medicaid coverage or without health insurance often get short shrift (Meckler, AP/Philadelphia Inquirer, 6/23). "While access to HIV care is good for many adults and improving for others, it is still not nearly optimal ... suggest[ing] the need for comprehensive efforts to improve patient care. Such care should include steps to ensure that lags in access to newer HIV treatments are not recapitulated with each improvement in treatment," he concluded (Shapiro et al., JAMA, 6/23 issue). Dr. Ronald Valdiserri, deputy director of the AIDS branch at the CDC, added, "What we have to do as a society both in terms of prevention and treatment is work harder to make sure that treatment advances are made available to all groups in need" (Smith, Knight Ridder/Ft. Worth Star-Telegram, 6/23). The Agency for Health Care Policy and Research applauded the recent gains in access to care, but warned against complacency. AHCPR Administrator Dr. John Eisenberg said, "This study gives policymakers and health officials evidence, on a national scale, that the quality of care from people with HIV too often falls short of what is considered adequate and can vary dramatically. ... The challenge now is to eliminate these disparities" (AHCPR release, 6/22).