Barriers to getting needed services for Ryan White CARE clients

Abstract

To determine why HIV-infected persons do not access needed services, we interviewed clients of Ryan White CARE-funded agencies in San Francisco, San Mateo and Marin Counties. From July to September 1996, we interviewed 519 clients receiving services at 65 CARE-funded sites. Just over half the clients (54.5%) had at least one unmet service need in the previous four months; persons in an unstable living situation and those with lower perceived health status were significantly more likely to have an unmet need. For persons with unmet needs, agency barriers were most common (54.0%), followed by emotional issues (44.8%), lack of information (44.0%) and financial/practical barriers (19.4%). None of the client characteristics (sex, race/ethnicity, age, living situation, perceived health status and risk group) were consistently or significantly (p < 0.05) associated with specific barriers. We believe that the similarity between clients with and without unmet needs reflects the success of CARE in eliminating many barriers. However, the persistence of certain barriers and lack of sub-group-specific barriers suggests the need for individualized interventions to improve service delivery, publicize service availability and address the emotional barriers to accessing HIV-related care.

System and Patient Barriers to Appropriate HIV Care for Disadvantaged Populations: The HIV Medical Care Provider Perspective

“…To examine the perception of barriers to HIV care faced by disadvantaged HIV-positive populations in their community, the authors asked providers to "Please indicate the most important barriers in obtaining appropriate HIV medical care for disadvantaged HIV-positive persons in your community." Providers rated eight barriers that had been reported in the literature (Huba et al, 2001;Marx et al, 2001;Murphy et al, 2000;Napravnik et al, 2000) to be significant barriers by HIV-positive patients accessing HIV care. Four were system barriers related to clinic characteristics or services: childcare not available at clinics, clinic hours/location/services are not convenient, cost of HIV care/no insurance coverage, and unfriendly HIV care setting or system, and four were patient-related barriers: lack of social support systems, mental health problems, substance abuse problems, and transportation problems.…”

“…Some of the barriers to HIV medical care and treatment that have been cited by HIV-positive individuals in these studies include the inconvenient location or hours of operation of HIV medical care facilities, lack of bilingual staff, inadequate services, transportation issues, addiction, lack of social support, and communication problems with providers (Huba et al, 2001;Marx, Hirozawa, Soskolne, Liu, & Katz, 2001;Murphy, Roberts, Martin, Marelich, & Hoffman, 2000;Napravnik, Royce, Walter, & Lim, 2000). Important as these results are, they only present the patient's perspective of the problem.…”

Characteristics of Ryan White and non-Ryan White funded HIV medical care facilities across four metropolitan areas: results from the antiretroviral treatment and access studies site survey

“…Other studies have also found that females and minorities were receiving services covered by the CARE Act at a greater rate than the general AIDS population, and that the CARE Act was successful in equalizing access to care for women and racial/ethnic minorities (Marx et al ., 1997;Ashman et al ., 2000). AIDS service organizations surveyed in a study in Texas characterized the blend of health and social services provided by RW facilities as the most effective in meeting the needs of their HIV/AIDS population (Buchanan & Chakravotky, 1999), while another study in California indicated that the barriers to accessing RW services most commonly cited by patients were agency-related barriers such as inconvenient location or hours of operation, lack of bilingual staff, and inadequate services, among others (Marx et al ., 2001).…”

“…Previous research has demonstrated the demographic and need characteristics of patient populations served by RW funded facilities compared to the overall AIDS case data (Ashman et al ., 2000) and the need characteristics of CARE Act clients (Marx et al ., 1997(Marx et al ., , 2001. In contrast to reports solely concerned with CARE Act clinics, there have been no studies to date contrasting services and service gaps for RW funded and non-RW funded facilities.…”

Expanding the lens of HIV services provision in Canada: results of a national survey of HIV health professionals

“…Barriers to services may also include logistical and funding issues. Fifty-four percentage of PHA respondents to a San Francisco survey reported difficulties with eligibility requirements, inconvenient location or hours of operation, lack of bilingual staff, wait lists for services, and concerns about confidentiality (Marx, Hirozawa, Soskolne, Liu, & Katz, 2001).…”