Perceptions of Health Care Among Persons Living With HIV/AIDS Who Are Not Receiving Antiretroviral Medications

Combination antiretroviral medications have revolutionized the medical management of HIV infection, improving health and extending the lives of many people living with HIV/AIDS. However, antiretrovirals are only available in some of the most developed countries, and studies show that a substantial number of people in even some of the most affluent places do not have access to HIV treatments. For example, a nationally representative sample of people living with HIV/AIDS in the United States showed that 10 percent of patients whose health status indicated their potential to benefit from HIV treatments had as of yet not received antiretroviral therapy (ART), and 30 percent had not received routine medications to treat or prevent Pneumocystis carinii pneumonia (PCP).

The current study was conducted to extend previous descriptive research of people living with HIV who are not receiving ART. The authors conducted their study in a large metropolitan area where most people living with HIV/AIDS have access to health care and ART. However, reductions in health care resources, introduction of co-payments, and other social and economic changes have made ART less than universal.

The authors investigated the demographics health status, and beliefs about health care providers and perceived quality of health care among untreated persons. Based on previous research, the authors hypothesized that persons who were not being treated for HIV would more likely be women, minorities, depressed, actively using substances, and uninsured. In addition, the authors hypothesized that untreated persons would be less likely to know their own health status, and would hold more negative views of their health care and their health care providers than persons who were receiving treatment.

Men and women were recruited from AIDS service organizations, health care providers, social service agencies, community residences for people living with HIV/AIDS, and infectious disease clinics in Atlanta in the fall of 2000. Individuals were told that they would be asked to complete a confidential survey and interview concerning their health behavior. Participants were informed that their HIV status would be verified by presenting a photo ID and proof of their HIV status. Informed consent forms were obtained and participants were compensated $30.

Participants were 68 percent (163) men and 32 percent (78) women living with HIV/AIDS. The majority of the sample was African-American (76 percent); 19 percent white, 2 percent Hispanic/Latino, and 3 percent of other ethnic backgrounds. With respect to sexual orientation, 74 percent of men and 17 percent of women self-identified as gay/lesbian or bisexual. All participants were fluent English speakers. The majority of participants (62 percent) had annual incomes less than $10,000. The mean age was 39.2 years, and the mean number of years of education was 12.7 years. Participants were aware of their HIV status for an average of 7.5 years and had been hospitalized an average of 1.3 times with an HIV-associated condition.

Among the 241 study participants, 79 (33 percent) were not taking antiretroviral medications at the time of the study. Of those persons not being treated with antiretrovirals, 23 (29 percent had never received HIV medications, whereas the remaining 56 (71 percent) had a history of HIV treatment but were not currently receiving treatments. Comparisons between persons receiving ART and persons who were untreated on demographic characteristics showed that ethnic minorities were significantly less likely to be treated for their HIV infection and persons who were untreated had significantly less education than persons who were treated. The researchers therefore included ethnicity and education as covariates in all further analyses. Differences between groups on gender, sexual orientation, income and age were all non-significant.

Although the authors could not draw causal conclusions regarding these findings, persons who are currently untreated for HIV may benefit from interventions to engage and retain them in treatment. Integrated approaches to HIV care that provide mental health care, substance abuse treatment, and quality medical care are clearly warranted for a substantial number of people living with HIV/AIDS.

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