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Access to health services for HIV positive chronic drug users.


Int Conf AIDS. 1998;12:210 (abstract no. 14141). Unique Identifier :

BACKGROUND: Chronic drug users (CDUs) represent a vulnerable population that has unique health care access problems, which HIV seropositivity exacerbates. Previous studies have shown barriers to HIV services include low levels of insurance coverage and regular sources of care which vary by gender and race. The analysis was guided by Equity of Access theoretical formulations of, which assumes that actual entry into the health care system is influenced by predisposing and enabling characteristics, need for services, and resources. METHODS: Data collection was conducted from Apr. 1996 to Dec. 1997 from a street-recruited sample of 926 drug users and 553 non drug users in Miami, Florida. A one-hour interview elicited information on health status, utilization of services, and patient satisfaction. Multiple regression was used to measure the association of access to health services with gender and race as indicators of predisposing characteristics; regular source of care, insurance coverage, and income as enabling characteristics; and number of health problems experienced in the past 12 months as need for care. Access was measured as utilization (the number of times a subject saw a health care provider for health problems in the past 12 months). The model controlled for drug use and HIV status. RESULTS: The results of the regression analysis yielded a multiple R of 0.749 (p < .0001), indicating that the independent variables in the model significantly predicted the outcome. Enabling characteristics and need were more strongly associated with utilization than other factors. Specifically, the availability of a regular source of care (t = 8.02, p < .0001), a greater number of months with insurance (t = 8.28, p < .0001), greater need (t = 26.80, p < .0001), and non-drug use status (t = 5.71, p < .0001) were significant predictors of the actual utilization of health services. CONCLUSIONS: Access to health services is limited for chronic drug users. While services tend to be available, financial resources and having a regular source of care remain as barriers. Interventions are needed to improve providers' skills in working with difficult populations and to improve drug users' behavior in health care settings. Public health insurance should consider the inclusion of chronic drug user status as eligibility.

MEETING ABSTRACTS Adult Comorbidity Female Florida *Health Services Accessibility Human HIV Infections/*EPIDEMIOLOGY Male Medically Uninsured Prejudice Primary Health Care Socioeconomic Factors Substance Abuse, Intravenous/*EPIDEMIOLOGY


Information in this article was accurate in December 30, 1998. The state of the art may have changed since the publication date. This material is designed to support, not replace, the relationship that exists between you and your doctor. Always discuss treatment options with a doctor who specializes in treating HIV.