title: Health and support service utilization patterns of American Indians and Alaska Natives diagnosed with HIV/AIDS.
abstract: The purpose of this analysis is twofold: to examine the types of health and support services provided by CARE Act funded providers to American Indians/Alaska Natives and to compare the characteristics and service utilization patterns for this group with those of individuals from other racial/ethnic groups. We present an analysis of the demographic characteristics, service utilization, and health outcomes of all HIV-infected clients who received services in five geographic areas at agencies that were funded through the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act. Standard chi-square tests were used to test for statistically significant differences (p <.05) between the demographic characteristics and service utilization patterns of matched pairs of HIV-positive American Indian/Native Alaskans with HIV-positive individuals of other racial and ethnic backgrounds. Individuals were matched on gender, age, insurance, AIDS diagnosis, and site. Other data examined include client characteristics (income, homelessness, HIV exposure category, and source of health care), health indicators (CDC-defined disease stage, CD4+ counts, substance abuse and psychiatric illness) and service utilization (medical care; mental health treatment/counseling; substance abuse treatment/counseling; case management; dental care; housing, food, emergency financial, and transportation assistance, and buddy/companion and client advocacy services). There were no statistically significant differences between the two groups for HIV exposure category, CD4 count, substance abuse problem, and being homeless and in their likelihood to receive medical care, mental health or substance abuse treatment/counseling, dental care, food, emergency financial, and transportation assistance, as well as buddy/companion and client advocacy services. They were more likely (55% vs. 46%) to receive case management services than the matched individuals from other racial/ethnic groups. They were also more likely to receive housing assistance (35% vs. 25%). The analysis provides evidence that when individuals are matched on key demographic and health characteristics, few differences remain between HIV-positive American Indians/Native Alaskans and other racial/ethnic groups. The two exceptions are case management and housing assistance. The significantly higher use of case management is not surprising, given the emphasis by American Indians/Alaska Natives on traditional Native American case management case management. In contrast, the significantly higher use of housing assistance by American Indians/Alaska Natives was unexpected. Exploring the potential need for housing assistance among all American Indians/Alaska Natives served by the Ryan White CARE Act needs to be considered.
authors.affiliation: HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, MD 20857, USA. JAshman@hrsa.gov
authors.forename: Jill J
authors.initials: JJ
authors.lastname: Ashman
authors.forename: David
authors.initials: D
authors.lastname: Pérez-Jiménez
authors.forename: Katherine
authors.initials: K
authors.lastname: Marconi
mesh_terms: D000328:Adult; D000413:Alaska; D019090:Case Management; D005006:Ethnicity; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000628:therapy*; D006296:Health Services / Q000145:classification / Q000706:statistics & numerical data*; D006801:Humans; D007198:Indians, North American; D019458:Insurance Coverage; D008297:Male; D008875:Middle Aged; D012111:Residence Characteristics; D014481:United States