Gender Disparities in HIV Health Care Utilization among the Severely Disadvantaged: Can We Determine the Reasons?

Abstract

Data repeatedly demonstrate that HIV-infected people who regularly utilize primary health care services are more likely to have access to lifesaving treatments (including antiretroviral medications); have better indicators of health status; survive longer; and use acute care services far less. Women tend to have poorer HIV outcomes than men, which is likely due to gender disparities in optimal utilization of HIV primary care services. To understand the relationship between gender and the HIV health care system, we collected interview and medical record data between August 12, 2004 and June 7, 2005 from 414 severely marginalized, HIV-infected people in New York City and examined whether gender-related disparities in HIV health care utilization existed, and, if so, whether these patterns were explained by patient sociodemographic=behavioral characteristics and=or attitudes toward the health care system and providers. Women were significantly less likely to have optimal HIV health care services utilization, including lower use of HIV primary care services (odds ratio [OR] ¼ 0.56, 95% confidence interval [CI] ¼ 0.35, 0.90) and greater use of the emergency department (OR ¼ 2.13, 95% CI ¼ 1.31, 3.46). Although we identified several factors associated with suboptimal HIV health care services utilization patterns in addition to female gender (low education, insurance status, mistrust of the health care system, and poor trust in health care providers), we were unable to identify factors that explained the observed gender disparities. We conclude that gender disparities in HIV health care utilization are due to a complex array of factors, which require more qualitative and quantitative research attention. Development of intervention strategies that specifically target severely disadvantaged women's HIV health care utilization is in great need.

REACH: a mixed-methods study to investigate the measurement, prediction and improvement of retention and engagement in outpatient HIV care

“…Our findings are consistent with previous studies among UK populations in showing that disengagement from HIV care is more likely among women and less likely among MSM. 8,22 A study of gender disparities concluded that poorer engagement in HIV care by women was underpinned by a complex array of factors, 74 and findings from both our survey and analysis of UK CHIC data suggested that the association between gender and disengagement could be explained by other factors.…”

Prevalence and Patient Awareness of Medical Comorbidities in an Urban AIDS Clinic

“…A direction for such research on gender disparities is provided by a recent study of over 400 severely disadvantaged HIV-positive persons in New York City, which found that women were less likely to use HIV primary care services and more likely to have an emergency department visit than were men. 36 Our findings may reflect a tendency for women to wait until they are more ill to come to HIV primary care as compared to men.…”

Perceived Barriers to HIV Care Among HIV-Infected Women in the Deep South

“…Indeed, recent estimates suggest that as few as 31% of individuals in resource-poor settings who are medically eligible for antiretroviral therapy are actually receiving treatment (Bartlett, Hornberger, Shewade, Bhor, & Rajagopalan, 2009). HIV-infected women are particularly vulnerable; they tend to have poorer health outcomes compared with men, which may be due in part to differences in access to and utilization of HIV primary care services (Sohler, Li, & Cunningham, 2009). Despite evidence documenting HIV-infected women's poor access to and utilization of care, and the deleterious health effects associated with lack of engagement in care, the specific barriers to care for this target population have not been fully examined.…”