title: Living with HIV but without medical care: barriers to engagement.
abstract: This cross-sectional study examined factors associated with the receipt of HIV medical care among people who know their HIV status and are not newly diagnosed with HIV. Interviews were conducted with 1133 HIV-positive individuals between October 2003 and July 2005 who enrolled in 1 of 10 outreach programs across the country. The sample was predominantly non-white (86%), male (59%), and unstably housed (61%), with a past history of cocaine use (68%). Twelve percent had received no HIV medical care in the 6 months prior to the interview. Those with no care were similar to those who received some HIV care in sociodemographic characteristics, but in multivariate analysis were less likely to have a case manager (p < 0.001) or use mental health services (p < .001), had lower mental health status scores (p < 0.05), were more likely to be active drug users (p < 0.01), had greater unmet support service needs (p < 0.05) and reported that health beliefs were a barrier to care (p < 0.001). Interventions to engage people in HIV medical care need to address barriers to care through linkages with mental health, substance abuse treatment and support services, and address the health beliefs that deter people from seeking care.
authors.affiliation: Boston University School of Public Health, Boston, Massachusetts.
authors.forename: Carol R
authors.initials: CR
authors.lastname: Tobias
authors.forename: William
authors.initials: W
authors.lastname: Cunningham
authors.forename: Howard D
authors.initials: HD
authors.lastname: Cabral
authors.forename: Chinazo O
authors.initials: CO
authors.lastname: Cunningham
authors.forename: Lois
authors.initials: L
authors.lastname: Eldred
authors.forename: Sylvie
authors.initials: S
authors.lastname: Naar-King
authors.forename: Judith
authors.initials: J
authors.lastname: Bradford
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Sohler
authors.forename: Mitchell D
authors.initials: MD
authors.lastname: Wong
authors.forename: Mari-Lynn
authors.initials: ML
authors.lastname: Drainoni
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care; D005260:Female; D015658:HIV Infections / Q000523:psychology* / Q000628:therapy*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D001523:Mental Disorders; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D019966:Substance-Related Disorders; D011795:Surveys and Questionnaires