Drug use and barriers to use of health care services.

This paper examines barriers to health care utilization and the correlates associated with these barriers. As part of a larger study of health services utilization, the study sample of 1085 including injection drug users, other chronic users of heroin or cocaine, and a demographically similar group who had used neither heroin nor cocaine, was selected based on the criterion of not having received health care for at least one health problem within the previous 12 months. Both categories of chronic drug users were more likely than non-users not to want health care treatment and to put off seeking needed health care.     

Oral health-related quality of life among low-income adults living with HIV

Objectives: To explore oral health‐related quality of life and its correlates among low‐income human immunodeficiency virus (HIV)‐positive patients receiving primary HIV care. Methods: Data were from a randomized experimental trial evaluating an intervention to increase use of oral health services by low‐income HIV‐positive adults. Interviews were conducted in English or Spanish among 594 adults receiving HIV medical care but not dental care. Oral health‐related quality of life was measured with the 49‐item Oral Health Impact Profile (OHIP‐49). Primary predictor variables included measures of HIV disease: duration of HIV infection, CD4 cell count, and HIV viral load. Other predictors included sociodemographic and behavioral factors. Results: Overall, 62.6 percent of participants had experienced at least one oral health impact very often or fairly often in the 4 weeks preceding the survey, with a mean of 5.8 impacts. The mean number of impacts was significantly higher for women, the unemployed, those living in temporary housing, and current smokers. Neither the prevalence nor the mean number of impacts differed significantly by duration of HIV infection, CD4(+) T lymphocyte cell count, or HIV viral load. In bivariate analysis, women had higher mean OHIP‐49 scores than men overall (62.6 versus 50.5, P < 0.05) and for most subscales, indicating that women experienced more oral health impacts. In the final multivariate model, significant correlates of OHIP‐49 were sex, race/ethnicity, living situation, and smoking status. Conclusions: Oral health impacts are prevalent among adults in South Florida living with HIV, particularly among women, cigarette smokers, those in prison or other institutional settings, and certain racial and ethnic groups.     

A Comparison of the Efficacy of Two Interventions to Reduce HIV Risk Behaviors Among Drug Users

Numerous interventions have been developed and implemented to decrease risk behaviors which lead to HIV infection and transmission. These interventions have been differentially successful in reducing high risk behaviors in various populations. Testing and evaluation of the interventions have been subject to various degrees of rigor. The CDC recommends the use of interventions which have been rigorously tested and meet the standards for evidence based intervention rather than the continuation of the development of new interventions. Project RESPECT is an evidence based intervention that proved efficacious in increasing condom use among patients of STD clinics. We tested the efficacy of the RESPECT intervention against the NIDA standard intervention to determine if the RESPECT intervention was more effective in reducing high risk behaviors among drug users. Both interventions showed changes from baseline to follow-up; RESPECT was more effective than the NIDA standard intervention in reducing high risk sex behaviors.     

Utilization of dental care services among low-income HIV-positive persons receiving primary care in South Florida

We investigated the use of dental care services among a population of low-income persons living with HIV/AIDS who had not seen a dental care provider during the 12 months prior to study enrollment. A total of 593 participants were recruited from five HIV primary care clinics in two South Florida counties and interviewed regarding past utilization of dental care services, HIV primary care service utilization, and barriers to care. Multivariate logistic regression analysis was used to determine correlates of oral care utilization within the preceding two years. One-third of respondents reported seeing a dentist in the preceding two years. The odds of having seen a dentist were greater for respondents with stable housing, more than a high school education, and who had received help in getting dental care; black respondents (compared to Hispanics and non-Hispanic whites) were less likely to have seen a dentist in the preceding two years. Despite the availability of dental services for low-income HIV-positive persons, utilization of dental care remains low. This study reinforces the need to provide assistance to HIV-positive persons in obtaining dental care. In particular, it indicates that such assistance should be targeted toward Black Americans, persons with low income and unstable housing situations, and those with limited help to navigate the health care system.     

Factors associated with use of HIV primary care among persons recently diagnosed with HIV: examination of variables from the behavioural model of health-care utilization

The delay between testing positive for human immunodeficiency virus (HIV) and entering medical care can be better understood by identifying variables associated with use of HIV primary care among persons recently diagnosed with the virus. We report findings from 270 HIV-positive persons enrolled in the Antiretroviral Treatment Access Study (ARTAS). 74% had not seen an HIV care provider before enrollment; 26% had one prior visit only. Based on Andersen's behavioural model of health care utilization, several variables reflecting demographic, healthcare, illness, behavioural, and psychosocial dimensions were assessed and used to predict the likelihood that participants had seen an HIV care provider six months after enrollment. Overall, 69% had seen an HIV care provider by six months. In multivariate analysis, the likelihood of seeing a provider was significantly (p<.05) higher among men, Hispanics (vs. non-Hispanic Blacks), those with higher education, those who did not use injection drugs, those with three or more HIV-related symptoms, those with public health insurance (vs. no insurance), and those who received short-term case management (vs. passive referral). The findings support several conceptual categories of Andersen's behavioural model of health services utilization as applied to the use of HIV medical care among persons recently diagnosed with HIV.     

Safe Syringe Disposal is Related to Safe Syringe Access among HIV-positive Injection Drug Users

We evaluated the effect of syringe acquisition on syringe disposal among HIV-positive injection drug users (IDUs) in Baltimore, New York City, and San Francisco (N = 680; mean age 42 years, 62% male, 59% African-American, 21% Hispanic, 12% White). Independent predictors of safe disposal were acquiring syringes through a safe source and ever visiting a syringe exchange program. Weaker predictors included living in San Francisco, living in the area longer, less frequent binge drinking, injecting with an HIV+ partner, peer norms supporting safe injection, and self-empowerment. Independent predictors of safe “handling”—both acquiring and disposing of syringes safely—also included being from New York and being older. HIV-positive IDUs who obtain syringes from a safe source are more likely to safely dispose; peer norms contribute to both acquisition and disposal. Interventions to improve disposal should include expanding sites of safe syringe acquisition while enhancing disposal messages, alternatives, and convenience. The INSPIRE Study Group includes the following people. Baltimore: Carl Latkin, Amy Knowlton, Karin Tobin; Miami: Lisa Metsch, Eduardo Valverde, James Wilkinson, Martina DeVarona; New York: Mary, Latka, Dave Vlahov, Phillip Coffin, Marc Gourevitch, Julia Arnsten, Robert Gern; San Francisco: Cynthia Gomez, Kelly Knight, Carol Dawson Rose, Starley Shade, Sonja Mackenzie; Centers for Disease Control and Prevention: David Purcell, Yuko Mizuno, Scott Santibanez, Richard Garfein, Ann O’Leary; Health Resources and Services Administration: Lois Eldred, Kathleen Handley. The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.     

Barriers and facilitators to dental care among HIV‐Infected adults

Oral health problems can significantly compromise HIV‐infected individuals’ general health and well‐being, yet many of them experience an unmet need for oral care. The barriers and facilitators of obtaining dental care in a sample of HIV‐infected adults, all of whom were eligible for Ryan White Part A funding for their treatment, were investigated through qualitative interviews with HIV‐positive individuals who had not received dental services in the prior 12 months (n = 44). Identified barriers were as follows: (1) dental anxiety and fear, (2) cumbersome administrative procedures, (3) long waits at the dental office, (4) problem focused care‐seeking behavior, (5) transportation difficulties, (6) dentists’ reluctance to treat people like them, and (7) psychological issues. Identified facilitating factors were as follows: (1) coverage for dental care, (2) being treated with respect and acceptance, and (3) having an assigned case manager or social worker. Many of the barriers uncovered in this qualitative study can be addressed and overcome by case management services, but other approaches are needed to address the additional psychological and stigma‐related factors that are impeding access to oral healthcare in this population.