title: Self-perceived unmet health care needs of persons enrolled in HIV care.
abstract: We examined the prevalence of, and factors associated with unmet health service needs among persons with HIV disease. Data were examined from 1,851 participants in the U.S. AIDS Cost and Service Utilization Study, drawn from 26 medical care providers in 10 cities. Geographic areas with large numbers of AIDS cases, and health care providers within them were chosen as study sites. After completing a screener questionnaire, potential participants at each site were stratifed by illness stage, HIV exposure route, and insurance status; a systematic random sample within those strata were selected for the study. Participants completed a comprehensive survey of HIV-related service use and costs, which also asked them to identify unmet health service needs. Analyses identified the relationship between unmet needs and: stage of illness, type of insurance, source of care, living arrangement, and AIDS prevalence of respondents' geographic region. At least one unmet need was reported by 20% of the sample. Needs for non-institutional services, e.g, dental care, mental health, and medications were more likely to be unmet than need for emergency room and hospital care. While most factors significantly affected the odds of having an unmet need, the greatest effects were found for private insurance and HIV asymptomatic status, both of which decreased the odds of unmet needs by approximately 50%. These findings suggest that insurance coverage for services required during the chronic phase of HIV illness is inadequate and should be augmented.
authors.affiliation: Department of Epidemiology and Social Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY 10467, USA.
authors.forename: K A
authors.initials: KA
authors.lastname: Bonuck
authors.forename: P S
authors.initials: PS
authors.lastname: Arno
authors.forename: J
authors.initials: J
authors.lastname: Green
authors.forename: J
authors.initials: J
authors.lastname: Fleishman
authors.forename: C L
authors.initials: CL
authors.lastname: Bennett
authors.forename: M C
authors.initials: MC
authors.lastname: Fahs
authors.forename: C
authors.initials: C
authors.lastname: Maffeo
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000453:epidemiology / Q000523:psychology; D000328:Adult; D003266:Continuity of Patient Care / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000523:psychology*; D006291:Health Policy; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D010348:Patient Care Team / Q000706:statistics & numerical data; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology