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

Abstract

Little is known about the perception of system and patient barriers to adequate HIV care by an essential resource in the provision of HIV care, HIV medical care providers. To evaluate such perceptions, between November 2000 and June 2001 a survey was mailed to 526 HIV medical care providers who cared for HIV-infected individuals in Atlanta, Baltimore, Los Angeles, and Miami. Logistic regression analysis of survey results revealed significant differences in perceptions of system barriers between Black and Hispanic providers versus White providers and non-medical doctor providers versus medical doctor providers. Female providers differed significantly from male providers in assessing the importance of certain system and patient barriers. The authors observed that there are seeming disparities in perceptions of system and patient barriers to HIV medical care by providers of different race/ethnic groups, genders, and professions. More research needs to be conducted to determine if these disparities reflect differences in the provision of adequate HIV care for disadvantaged individuals.

Providers Caring for Adolescents with Perinatally-Acquired HIV: Current Practices and Barriers to Communication About Sexual and Reproductive Health

“…15 The significant challenges for patients' maintenance of sexual and reproductive health-such as stigma, disclosure, socioeconomic status, and lack of knowledge of risk reduction strategies-are nevertheless recognized by providers. 16,17 The challenges of providing SRH education to the general population of AYA are well-documented. Among other factors, the developmental stage of adolescence, inconsistent engagement in care, and patient or parent/guardian reticence to discuss SRH affects pediatric providers' ability to adequately address SRH needs.…”

System and Patient Barriers to Care among People Living with HIV/AIDS in Houston/Harris County, Texas

“…The sociodemographic and medical practice characteristic of providers in the current study has been previously described in detail by Mgbere et al 40 This study noted that race/ethnicity of the providers as well as profession of the care providers and years of experience in HIV care were influential factors that determined the perception of barriers experienced by patients in obtaining HIV care in Houston/Harris County. Although the racial/ethnic demographic of HIV care providers has changed little, 30 the demographic of persons living with HIV has changed from predominantly white MSM population to increasing racial/ethnic minorities patient populations. 30,40 This study reports that in general providers who were of minority races were less likely than white providers to perceive most of the identified barriers as important.…”

“…Although the racial/ethnic demographic of HIV care providers has changed little, 30 the demographic of persons living with HIV has changed from predominantly white MSM population to increasing racial/ethnic minorities patient populations. 30,40 This study reports that in general providers who were of minority races were less likely than white providers to perceive most of the identified barriers as important. However, within-gender effect of the associations between providers’ race/ethnicity and barriers perception status was not statistically significant.…”

“…Some of the barriers relate to the health care structure or system and include negative perceptions of the health care system, 16,17 longer wait time for appointments, 18 lack of flexibility in clinic hours to accommodate work schedules, 19 unmet needs for child care, 19,20 lack of access to a provider with expertise in treating HIV, 3 strained patient-provider relationship, 21,22 patient concerns about privacy, 23,24 mandatory insurance coverage, 25,26 and multiple funding sources with variable eligibility criteria, 3 which causes many individuals to shift in and out of eligibility for HIV care. At the patient level, some of the barriers that prevent persons with HIV from utilizing HIV medical care include mental health issues and drug addictions, [27][28][29][30] negative health beliefs about getting care, 31 perception about medical coverage, 25,26 HIV stigma, 3,16 limited social support, 26,32 unstable housing, 33,34 transportation, 20 incarceration, undocumented immigrant status, 2 and avoidance and denial of HIV status. 23,24,28 All of these issues influence entry, engagement, and retention in HIV care.…”

Identifying Gaps in HIV Prevention Services

“…For persons with known HIV infection, barriers to HIV treatment and care may include a lack of patient resources such as transportation and adequate housing (Heckman et al, 1998); comorbidity, including substance abuse; care system characteristics, such as clinic location and cost of services (Valverde et al, 2006); and community characteristics, including perceived stigma against people living with HIV (Reif, Golin, & Smith, 2005). For uninfected persons, barriers to services that provide primary prevention of HIV, such as STD clinics and substance abuse treatment centers, may also exist.…”