A comparison of unmet needs for dental and medical care among persons with HIV infection receiving care in the United States.
OBJECTIVE
Oral health conditions associated with HIV disease are frequently more severe than those of the general population, making access to both dental and medical care important. Using the domains specified in the Behavioral Model of Health Services Use, this paper examines the correlates of unmet needs for dental and medical care in a nationally representative sample of patients with HIV.


METHODS
This investigation is a cross-sectional study using baseline data from the HIV Cost and Services Utilization Study (HCSUS), the first nationally representative study of persons in care for HIV. Using probability-based techniques, 4,042 people were randomly selected in January 1996, and 2,864 (71%) completed a structured interview that included questions on unmet needs for dental and medical care. Regression analysis was used to identify variables associated with having unmet needs for dental care only, medical care only, and both medical and dental care.


RESULTS
Of the estimated 230,900 people in treatment for HIV in the United States, approximately 58,000 had unmet medical or dental needs based on self-reported data. Unmet dental needs were more than twice as prevalent as unmet medical needs (32,900 vs 14,300), and 11,600 people were estimated to have both types of unmet needs. Multinomial logit regression showed that persons with low income had increased odds of reporting unmet needs for both dental and medical care. The uninsured and those insured by Medicaid without dental benefits had more than three times the odds of having unmet needs for both types of care than did the privately insured.


CONCLUSIONS
To serve both the dental and medical needs of diverse populations affected by HIV disease, greater coordination of services is needed. In addition, state insurance programs for people with HIV should consider the feasibility of expanding their benefit structure to include dental care benefits.
Heslin
K C
KC
Department of Health Services, UCLA School of Public Health, Room 31-254A, Center for Health Sciences (CHS), 10833 Le Conte Avenue, Los Angeles, CA 90095, USA. kheslin@ucla.edu
Cunningham
W E
WE
Marcus
M
M
Coulter
I
I
Freed
J
J
Der-Martirosian
C
C
Bozzette
S A
SA
Shapiro
M F
MF
Morton
S C
SC
Andersen
R M
RM
D000328:Adult; D000367:Age Factors; D018791:CD4 Lymphocyte Count; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D017742:Dental Care for Chronically Ill; D005006:Ethnicity; D005260:Female; D015658:HIV Infections / Q000628:therapy; D006296:Health Services; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D007182:Income; D007348:Insurance, Health; D007407:Interviews as Topic; D016015:Logistic Models; D008297:Male; D008484:Medicaid; D008507:Medically Underserved Area; D017057:Medically Uninsured; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012044:Regression Analysis; D019035:Rural Health Services; D012737:Sex Factors; D014481:United States; D019037:Urban Health Services