Insurance coverage, usual source of care, and receipt of clinically indicated care for comorbid conditions among adults living with human immunodeficiency virus.
OBJECTIVE
Associations of insurance coverage and source of care with use of human immunodeficiency virus (HIV)-related health, mental health, and substance abuse services are examined in a large, diverse, highly active antiretroviral therapy-era cohort.


METHODS
Adults who were infected with HIV (n = 3818) were interviewed in clinics and community agencies in Los Angeles, Milwaukee, New York, and San Francisco regarding drug use behaviors, health status, and health care utilization.


RESULTS
Most participants were insured by Medicaid. During the previous 3 months, 90% of privately insured, 87% of publicly insured, and 78% of uninsured participants had visited any provider. Publicly and privately insured participants were similar in receipt of antiretrovirals, prophylaxis against Pneumocystis carinii pneumonia, substance abuse services, and antidepressants. Uninsured participants were less likely to receive antiretrovirals but were more likely to use substance abuse services. Participants with no usual source of care were less likely to receive PCP prophylaxis.


CONCLUSIONS
A lack of insurance is associated with barriers to care, but the advantage of private over public coverage appears smaller than in previous studies. PCP prophylaxis, substance abuse treatment, and antidepressants remain markedly underutilized. Educational initiatives about these treatments targeting providers and patients are indicated.
Goldstein
Risë B
RB
Center for Community Health, UCLA Neuropsychiatric Institute, Los Angeles, California, USA. goldster@mail.nih.gov
Rotheram-Borus
Mary Jane
MJ
Johnson
Mallory O
MO
Weinhardt
Lance S
LS
Remien
Robert H
RH
Lightfoot
Marguerita
M
Catz
Sheryl L
SL
Gore-Felton
Cheryl
C
Kirshenbaum
Sheri
S
Morin
Stephen F
SF
D017088:AIDS-Related Opportunistic Infections / Q000191:economics / Q000517:prevention & control; D000328:Adult; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis / Q000706:statistics & numerical data; D000928:Antidepressive Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000706:statistics & numerical data; D003863:Depression / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000191:economics* / Q000628:therapy; D006279:Health Maintenance Organizations / Q000706:statistics & numerical data; D006296:Health Services / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health; D008297:Male; D008484:Medicaid; D011020:Pneumonia, Pneumocystis / Q000191:economics / Q000517:prevention & control; D011331:Private Practice / Q000706:statistics & numerical data; D019966:Substance-Related Disorders / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control; D014481:United States / Q000453:epidemiology
D044966:Anti-Retroviral Agents; D000928:Antidepressive Agents