title: Healthcare access and utilization by patients infected with human immunodeficiency virus: does gender matter?
abstract: OBJECTIVE
  To examine access to and utilization of primary healthcare services with respect to gender. Greater family and child-rearing responsibilities are possible barriers to healthcare access and utilization for women with HIV infection.
  
  
  METHODS
  This study was part of a prospective, randomized, controlled trial evaluating primary care for HIV-infected patients at Duke University Medical Center (DUMC), a tertiary care medical center. Subjects were 214 HIV-infected, uninsured or publicly insured participants. Ambulatory care visits, emergency room utilization, hospitalization rates, length of stay, preventive and screening measures, and antiretroviral use were the outcome measures.
  
  
  RESULTS
  Women (n = 83) and men (n = 131) enrolled in the study were similar with respect to race, educational level, marital status, and employment status. Women with HIV were more likely than men to have children (80% vs. 25%, p = 0.001) and spend their time as primary caregivers for their children (22% vs. 0.8%, p = 0.001). Women had higher CD4(+) cell counts (378 +/- 287 vs. 243 +/- 252 cells/microl, p = 0.0002), and a smaller proportion of women than men had AIDS at baseline (41% vs. 62%, p = 0.002). Women and men had similar numbers of primary care visits, emergency room visits, annual admission rates, and lengths of stay for hospitalizations. Pneumocystis carinii pneumonia prophylaxis, pneumococcal vaccination, and tuberculosis screening were also similar between women and men. Women were more likely than men to have ever been prescribed an antiretroviral agent (88.0% vs. 71.8%, p = 0.005).
  
  
  CONCLUSIONS
  Women had greater familial responsibilities than men, but this was not a barrier to access or utilization of healthcare services. Despite less advanced HIV disease, women received similar care and had similar utilization of health services.
authors.affiliation: Center for Health Services Research in Primary Care, Department of Veterans Affairs Medical Center, 508 Fulton Street, Durham, NC 27705, USA.
authors.forename: Tamara L
authors.initials: TL
authors.lastname: Box
authors.forename: Maren
authors.initials: M
authors.lastname: Olsen
authors.forename: Eugene Z
authors.initials: EZ
authors.lastname: Oddone
authors.forename: Sheri A
authors.initials: SA
authors.lastname: Keitz
mesh_terms: D000328:Adult; D005260:Female; D015658:HIV Infections / Q000628:therapy*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data; D006785:Hospitals, University; D006801:Humans; D008297:Male; D009657:North Carolina; D010043:Outcome and Process Assessment, Health Care; D010044:Outpatient Clinics, Hospital / Q000592:standards / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000592:standards / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012737:Sex Factors; D013997:Time Factors