Utilization of health services in a cohort of intravenous drug users with known HIV-1 serostatus.

Abstract

BACKGROUND. Intravenous drug users (IVDUs) with human immunodeficiency virus (HIV) infection and AIDS often have no health insurance or rely on public programs to finance their health care. We examined the independent contributions of HIV serostatus, clinical symptoms, CD4 cell counts, and health insurance to utilization of health services among 1881 intravenous drug users in Baltimore, Maryland. METHODS. Participants in an ongoing natural history study of HIV were informed of HIV serostatus and seropositives were informed of CD4 cell counts; 6 months later, participants were administered a questionnaire concerning self-reported use of health services, insurance coverage, and HIV-related symptoms. RESULTS. Of 1881 participants, 67% had health insurance (including Medicaid), 48% had at least one outpatient visit, and 12% had at least one inpatient visit within the prior 6 months. The proportion of the study population that was HIV-1 seropositive was 32%. In multivariate analysis, the single most important predictor of health care utilization was the presence of two or more HIV-related clinical symptoms. HIV positive serostatus alone or known low CD4 counts were not significantly associated with use of health care services. CONCLUSIONS. These data suggest that HIV seropositive IVDUs are not receiving recommended preventive care. Additional efforts will be needed to ensure that HIV-seropositive drug users participate in currently recommended protocols for early treatment of asymptomatic HIV-1 infection.

Urbanization, Urbanicity, and Health

“…First, persons of lower socioeconomic status and minorities, both over-represented in urban areas, are more likely not to have health insurance 50 ; thus, they face barriers to care, receive poorer quality care, and disproportionately use emergency systems. 51 Other populations commonly present in cities who represent challenges are undocumented immigrants and transient populations. The greater prevalence of marginalized populations in cities likely results in a greater burden on available systems.…”

Self-Perceived And Unmet General Health Need Among Plwha In Nigeria

“…These factors include advanced level of illness (4,5), lower income earners and holders of government owned or no medical insurance (6), lack of a usual source of care (7), living alone (8,9), and areas with low AIDS prevalence (10,11). Empirical work on the unmet oral health needs of HIV/AIDS patients in sub-Saharan Africa has not been done, but rather much effort has been directed towards documenting the prevalence of the oral manifestations of this disease.…”

Health Care Utilization Among Drug-Using and Non-Drug-Using Women

“…In addition, the focus has shifted to drug treatment sites as a place for connecting drug users with health services. [13][14][15] Studies among out-of-treatment users are less common, 7,14 as are those comparing users to their nonusing counterparts. 5,13,16,17 Determinants of health, the need for health care, and access to care all have been shown to differ according to age, gender, racial or ethnic background, socio-economic status, geographic location, and various enabling conditions.…”