title: The associations of gender, sexual identity and competing needs with healthcare utilization among people with HIV/AIDS.
abstract: Studies report gender differences in medical service utilization among persons with HIV, although most compare women to heterogeneous groups of men. Competing needs for medical care of women may contribute to those differences. We examined prospectively the role that competing social, economic and health needs, such as caring for others, play in gender differences in hospital, ambulatory and emergency room (ER) visits. We considered sexual identity to study women, gay/bisexual men and heterosexual men in the most recent wave (n = 1,385) of the HCSUS, a nationally representative sample of persons with HIV/AIDS in care in the United States. We considered gay/bisexual men and heterosexual men separately because their different resources and social networks may lead to disparate service utilization. Multivariate regression showed that women were more likely than gay/bisexual men to be hospitalized, while women and gay/bisexual men were more likely than heterosexual men to use the ER without subsequent hospitalization. Controlling for competing needs eliminated neither difference but predicted hospitalization and ER use. Findings suggest that addressing competing needs could reduce unnecessary hospitalization and ER use for both genders. Furthermore, examinations of gender differences in service use should include sexual identity.
authors: UCLA Division of General Internal Medicine and Health Services Research, 31-254 Center for Health Sciences, Los Angeles, CA 90095, USA. tpenniman@mednet.ucla.edu
authors: Typhanye V
authors: TV
authors: Penniman
authors: Stephanie L
authors: SL
authors: Taylor
authors: Chloe E
authors: CE
authors: Bird
authors: Robin
authors: R
authors: Beckman
authors: Rebecca L
authors: RL
authors: Collins
authors: William
authors: W
authors: Cunningham
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000453:epidemiology / Q000628:therapy; D000328:Adult; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D005260:Female; D005783:Gender Identity; D015658:HIV Infections / Q000453:epidemiology* / Q000628:therapy; D006301:Health Services Needs and Demand / Q000145:classification* / Q000706:statistics & numerical data; D020010:Heterosexuality / Q000706:statistics & numerical data; D018451:Homosexuality, Male / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D010865:Pilot Projects; D012307:Risk Factors; D012737:Sex Factors; D019529:Sexuality / Q000145:classification*; D014481:United States / Q000453:epidemiology; D016387:Women's Health