Among patients with HIV infection, participation in research trials and access to experimental treatment is influenced by race or ethnic group and type of health insurance.

Although Pap test rates and appropriate referral for abnormal findings were high among HIV-tested women, many women with initially abnormal Pap test results did not actually receive follow-up Pap testing or colposcopy. Providing gynecologic care at the same site as primary HIV care would likely improve delivery of needed gynecologic care for women.

OBJECTIVES: This study estimated the proportion of HIV-infected adults who have been assaulted by a partner or someone important to them since their HIV diagnosis and the extent to which they reported HIV-seropositive status as a cause of the violence. METHODS: Study participants were from a nationally representative probability sample of 2864 HIV-infected adults who were receiving medical care and were enrolled in the HIV Costs and Service Utilization Study. All interviews (91% in person, 9% by telephone) were conducted with computer-assisted personal interviewing instruments. Interviews began in January 1996 and ended 15 months later. RESULTS: Overall, 20.5% of the women, 11.5% of the men who reported having sex with men, and 7.5% of the heterosexual men reported physical harm since diagnosis, of whom nearly half reported HIV-seropositive status as a cause of violent episodes. CONCLUSIONS: HIV-related care is an appropriate setting for routine assessment of violence. Programs to cross-train staff in antiviolence agencies and HIV care facilities need to be developed for men and women with HIV infection.

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Objectives. This study sought to describe the characteristics of HIVinfected persons who delay medical care for themselves because they are caring for others.Methods. HIV-infected adults (n = 2864) enrolled in the HIV Cost and Services Utilization Study (1996)(1997) were interviewed.Results. The odds were 1.6 times greater for women than for men to put off care (95% conf idence interval [CI] = 1.2, 2.2); persons without insurance and with CD4 cell counts above 500 were also significantly more likely to put off care. Having a child in the household was associated with putting off care (odds ratio [OR] = 1.8, 95% CI= 1.4, 2.3).Conclusions. Women or individuals with a child in the household should be offered services that might allow them to avoid delays in seeking their own medical care. (Am J Public Health. 2000;90:1138-1140 A B S T R A C T Michael D. Stein, MD, Steve Crystal, PhD, William E. Cunningham, MD, MPH, Amarnath Ananthanarayanan, PhD, Ron M. Andersen, PhD, Barbara J. Turner, MD, MSEd, Sally Zierler, DrPH, MPH, Sally Morton, PhD, Mitchell H. Katz, MD, Samuel A. Bozzette, MD, PhD, Martin F. Shapiro, MD, PhD, Mark A. Schuster, MD, PhD Delays in Seeking HIV Care Due to Competing Caregiver Responsibilities In the 1990s, women constituted one of the fastest-growing groups with newly diagnosed AIDS cases, and HIV disease remains the leading cause of death among women of reproductive age.1,2 Across studies, women have been less likely to receive antiretroviral therapy than men even after control for transmission risk group and race. [3][4][5] One factor that may influence access to care is the caregiving role women often play. 6 Women with AIDS (and less often men) may have children, HIV-infected relatives, or partners who require care. In this article, we describe the characteristics of HIV-infected persons who delay medical care for themselves because they are caring for others. MethodsThe HIV Cost and Services Utilization Study, which involved a multistage design, sampled geographical areas, medical providers, and patients 18 years or older with known HIV infection who made at least one visit for regular or ongoing care to a nonmilitary, nonprison medical provider other than an emergency department. Computerassisted personal interviewing instruments were used in conducting interviews, which took place between January 1996 and April 1997. Full details of the design have been published elsewhere. 7-11The outcome in this analysis, delay in care due to caregiving, was a positive response to the following question: "In the last 6 months, have you ever put off going to the doctor for HIV care because taking care of someone else was more important to you?" Independent variables included were sex, insurance, race, transmission risk group, education, and self-reported lowest CD4 cell count.12 As a means of defining household composition, subjects were asked "Besides yourself, have any of the people in your household also been diagnosed with HIV or AIDS?" Subjects were also asked the ages of all children living...