title: Use of mental health and substance abuse treatment services among adults with HIV in the United States.
abstract: BACKGROUND
  The need for mental health and substance abuse services is great among those with human immunodeficiency virus (HIV), but little information is available on services used by this population or on individual factors associated with access to care.
  
  
  METHODS
  Data are from the HIV Cost and Services Utilization Study, a national probability survey of 2864 HIV-infected adults receiving medical care in the United States in 1996. We estimated 6-month use of services for mental health and substance abuse problems and examined socioeconomic, HIV illness, and regional factors associated with use.
  
  
  RESULTS
  We estimated that 61.4% of 231 400 adults under care for HIV used mental health or substance abuse services: 1.8% had hospitalizations, 3.4% received residential substance abuse treatment, 26.0% made individual mental health specialty visits, 15.2% had group mental health treatment, 40.3% discussed emotional problems with medical providers, 29.6% took psychotherapeutic medications, 5.6% received outpatient substance abuse treatment, and 12.4% participated in substance abuse self-help groups. Socioeconomic factors commonly associated with poorer access to health services predicted lower likelihood of using mental health outpatient care, but greater likelihood of receiving substance abuse treatment services. Those with less severe HIV illness were less likely to access services. Persons living in the Northeast were more likely to receive services.
  
  
  CONCLUSIONS
  The magnitude of mental health and substance abuse care provided to those with known HIV infection is substantial, and challenges to providers should be recognized. Inequalities in access to care are evident, but differ among general medical, specialty mental health, and substance abuse treatment sectors.
authors.affiliation: RAND, 1700 Main St, PO Box 2138, Santa Monica, CA 90407-2138, USA. aburnam@rand.org
authors.forename: M A
authors.initials: MA
authors.lastname: Burnam
authors.forename: E G
authors.initials: EG
authors.lastname: Bing
authors.forename: S C
authors.initials: SC
authors.lastname: Morton
authors.forename: C
authors.initials: C
authors.lastname: Sherbourne
authors.forename: J A
authors.initials: JA
authors.lastname: Fleishman
authors.forename: A S
authors.initials: AS
authors.lastname: London
authors.forename: B
authors.initials: B
authors.lastname: Vitiello
authors.forename: M
authors.initials: M
authors.lastname: Stein
authors.forename: S A
authors.initials: SA
authors.lastname: Bozzette
authors.forename: M F
authors.initials: MF
authors.lastname: Shapiro
mesh_terms: D000293:Adolescent; D000328:Adult; D003156:Community Mental Health Services / Q000706:statistics & numerical data*; D015897:Comorbidity; D003695:Delivery of Health Care / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000628:therapy; D019538:Health Care Surveys / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000628:therapy; D008875:Middle Aged; D015999:Multivariate Analysis; D012494:Sampling Studies; D016320:Substance Abuse Treatment Centers / Q000706:statistics & numerical data*; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000628:therapy*; D014481:United States / Q000453:epidemiology