Effect of Race on Insurance Coverage and Health Service Use for HIV-Infected Gay Men

Abstract

Further research must be conducted to examine cultural, social, and psychological factors that help explain why white gay men use more outpatient and dental services, when other service use is unrelated to race. Investigators should be precise when using race as a variable in health services and epidemiologic research, emphasizing when racial differences truly exist versus when the variable race is a surrogate for another factor.

Effect of race and/or ethnicity in use of antiretrovirals and prophylaxis for opportunistic infection: a review of the literature

“…38 In contrast, analysis of data for 1991-1996 found that among 307 men at the Baltimore MACS site, only 43% reported at their most recent study visit having used antiretroviral medications in the prior six months. 43 Another study in Baltimore found among 838 people who presented to the Johns Hopkins AIDS Service in 1990-1992 that 58% of African Americans and 63% of whites reported current antiretroviral use. 39 Somewhat later, in 1993-1995, 70% of 863 HIVpositive women enrolled in the HIV Epidemiology Research Study (HERS) reported ever having used antiretrovirals, but only 43% reported current use.…”

“…(See Table 1.) Overall, 15 studies had data collection periods that included 1996 or later, [43][44][45][46][47][48][49][50][51][52][53][54][55][56][57] i.e., after FDA approval for use of the first protease inhibitor in late 1995. Ten of the these reports specifically measured the use of either protease inhibitors, NNRTIs, or HAART.…”

“…37,45,48,[52][53][54] Three studies found a positive association with at least one antiretroviral use measure, 40,44,48 two of which found either no association 44 or a negative association 48 across a different measure of antiretroviral use. Sixteen studies found no association between race/ethnicity and at least one measure of antiretroviral use; [33][34][35]37,[41][42][43][44][45][49][50][51][52][53][54]57 however, five of these also found a negative association on at least one antiretroviral use measure, 37,45,52-54 and one also found a positive association. 44 In four of these studies an association between race/ethnicity and antiretroviral use explicitly noted in bivariate analyses lost statistical significance after adjustment for other covariates.…”

“…Overall, 16 studies did not find an association between race/ ethnicity and at least one measure of antiretroviral use. [33][34][35]37,[41][42][43][44][45][49][50][51][52][53][54]57 Among them, seven found a statistically significant association between race/ethnicity and one of the study's measures of antiretroviral use, 37,44,45,[52][53][54] and therefore were discussed in above sections.…”

“…[33][34][35][41][42][43][44][49][50][51]57 Among these ten, five reported on sample sizes of Ͻ350. 30,31,40,47,54 Specifically, Weissman et al measured AZT use among 249 patients with AIDS from the Boston Health Study; 33 Katz et al evaluated use of AZT among 142 HIV-infected homosexual men with a CD4 cell count Ͻ500 cells/mm 3 in San Francisco; 34 Kass et al evaluated use of any antiretrovirals among 307 men enrolled in the Baltimore site of the MACS; 44 Sorvillo et al evaluated protease inhibitor use among 339 people with AIDS in Los Angeles County; 50 and Schwarz et al evaluated subsequent HAART use among 219 HIV-infected adolescents who were HAART-naive at study enrollment.…”