title: Health services utilization among South African women living with HIV and reporting sexual and substance-use risk behaviors.
abstract: HIV health services are critical in sub-Saharan African where the burden of the HIV pandemic is devastating. Existing studies suggest that HIV-infected individuals from marginalized populations who know their status do not seek health services because they are unaware of available treatment and care options, may not understand how to access services, or have poor access to and utilization of health care services. This study examined factors associated with health service utilization in a sample of poor, underserved recently diagnosed HIV-positive South African women with sexual and substance use risk behaviors. The data were collected between June 2004 and May 2008. Primary outcomes included consultation with a medical professional and utilization of any health services since learning of HIV status at 3- and 6-month follow-up assessments. The study findings suggest that denial of HIV status may be a barrier to care, leading study participants to avoid utilizing health services specific to their disease and to prefer more general medical care services. In multivariate analyses, prior use of health services, financially supporting others, and sex trading were strongly associated with health service use at follow-up assessments. The study findings suggest a reduced likelihood of health services utilization among participants who met DSM-IV criteria for drug abuse as well as participants with greater numbers of poor physical health symptoms. As an important preliminary step in examining the issue of health services utilization in sub-Saharan Africa, the findings suggest an urgent need to promote HIV prevention and early testing, to strengthen long-term HIV care services, and to increase access to services.
authors.affiliation: Substance Abuse Treatment Evaluations and Interventions Research Program, RTI International, 3040 Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC 27709-2194, USA. wluseno@rti.org
authors.forename: Winnie K
authors.initials: WK
authors.lastname: Luseno
authors.forename: Wendee M
authors.initials: WM
authors.lastname: Wechsberg
authors.forename: Tracy L
authors.initials: TL
authors.lastname: Kline
authors.forename: Rachel Middlesteadt
authors.initials: RM
authors.lastname: Ellerson
mesh_terms: D000293:Adolescent; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D044383:Black People; D005260:Female; D005500:Follow-Up Studies; D006678:HIV; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy; D006296:Health Services / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D006801:Humans; D012307:Risk Factors; D012309:Risk-Taking; D012725:Sexual Behavior; D012959:Socioeconomic Factors; D016320:Substance Abuse Treatment Centers / Q000706:statistics & numerical data*; D019966:Substance-Related Disorders / Q000150:complications* / Q000523:psychology; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents