The impact of HIV on oral health and subsequent use of dental services.
OBJECTIVE
This study examined differences in health and access to dental services among a nationally representative sample of patients with HIV using Andersen's Behavioral Model of Health Services Use.


METHODS
This investigation is a longitudinal study that used structural equation modeling to analyze data from the HIV Cost and Services Utilization Study, a probability sample of 2,864 adults under treatment for HIV infection. Key predisposing variables included sex, drug use, race/ethnicity, education, and age. Enabling factors included income, insurance, and regular source of care. Need factors included mental, physical, and oral health. Dependent variables included whether a respondent utilized dental services and number of visits.


RESULTS
More education, dental insurance, usual source of dental care, and poor oral health predicted a higher probability of having a dental visit. African Americans, Hispanics, those exposed to HIV through drug use or heterosexual contact, and those in poor physical health were less likely to have a dental visit. Of those who visited dental professionals, older persons, those with dental insurance, and those in worse oral health had more visits. African Americans and persons in poor mental health had fewer visits.


CONCLUSIONS
Persons with more HIV-related symptoms and a diagnosis of AIDS have a greater need for dental care than those with fewer symptoms and without AIDS, but more pressing needs for physical and mental health services limit their access to dental services. Providers should better attend to the oral health needs of persons with HIV who are in poor physical and mental health.
Dobalian
Aram
A
Department of Health Services Administration, University of Florida, PO Box 100195, Gainesville, FL 32610-0195, USA. adobalia@hp.ufl.edu
Andersen
Ronald M
RM
Stein
Judith A
JA
Hays
Ron D
RD
Cunningham
William E
WE
Marcus
Marvin
M
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D017742:Dental Care for Chronically Ill / Q000706:statistics & numerical data*; D004522:Educational Status; D005006:Ethnicity; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006297:Health Services Accessibility; D006304:Health Status; D006801:Humans; D007182:Income; D007347:Insurance, Dental; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D009909:Oral Health; D012737:Sex Factors; D019966:Substance-Related Disorders; D014481:United States