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Medical Care:
Original Articles

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

Cunningham, William E. MD, MPH*†; Andersen, Ronald M. PhD; Katz, Mitchell H. MD; Stein, Michael D. MD§; Turner, Barbara J. MD, MSEd; Crystal, Steve PhD#; Zierler, Sally DrPH, MPH, MEd**; Kuromiya, Kiyoshi††; Morton, Sally C. PhD§§; St. Clair, Patricia BS§§; Bozzette, Samuel A. MD, PhD§§¶¶; Shapiro, Martin F. MD, PhD*§§

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Abstract

Objectives. To examine whether competing subsistence needs and other barriers are associated with poorer access to medical care among persons infected with human immunodeficiency virus (HIV), using self-reported data.

Design. Survey of a nationally representative sample of 2,864 adults receiving HIV care.

Main Independent Variables. Going without care because of needing the money for food, clothing, or housing; postponing care because of not having transportation; not being able to get out of work; and being too sick.

Main Outcome Measures. Having fewer than three physician visits in the previous 6 months, visiting an emergency room without being hospitalized; never receiving antiretroviral agents, no prophylaxis for Pneumocystis carinii pneumonia in the previous 6 months for persons at risk, and low overall reported access on a six-item scale.

Results. More than one third of persons (representing >83,000 persons nationally) went without or postponed care for one of the four reasons we studied. In multiple logistic regression analysis, having any one or more of the four competing needs independent variables was associated with significantly greater odds of visiting an emergency room without hospitalization, never receiving antiretroviral agents, and having low overall reported access.

Conclusions. Competing subsistence needs and other barriers are prevalent among persons receiving care for HIV in the United States, and they act as potent constraints to the receipt of needed medical care. For persons infected with HIV to benefit more fully from recent advances in medical therapy, policy makers may need to address nonmedical needs such as food, clothing, and housing as well as transportation, home care, and employment support.

© 1999 Lippincott Williams & Wilkins, Inc.

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