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Journal of the National Medical Association logoLink to Journal of the National Medical Association
. 2007 Apr;99(4):419–427.

The associations of gender, sexual identity and competing needs with healthcare utilization among people with HIV/AIDS.

Typhanye V Penniman 1, Stephanie L Taylor 1, Chloe E Bird 1, Robin Beckman 1, Rebecca L Collins 1, William Cunningham 1
PMCID: PMC2569651  PMID: 17444432

Abstract

Studies report gender differences in medical service utilization among persons with HIV, although most compare women to heterogeneous groups of men. Competing needs for medical care of women may contribute to those differences. We examined prospectively the role that competing social, economic and health needs, such as caring for others, play in gender differences in hospital, ambulatory and emergency room (ER) visits. We considered sexual identity to study women, gay/bisexual men and heterosexual men in the most recent wave (n = 1,385) of the HCSUS, a nationally representative sample of persons with HIV/AIDS in care in the United States. We considered gay/bisexual men and heterosexual men separately because their different resources and social networks may lead to disparate service utilization. Multivariate regression showed that women were more likely than gay/bisexual men to be hospitalized, while women and gay/bisexual men were more likely than heterosexual men to use the ER without subsequent hospitalization. Controlling for competing needs eliminated neither difference but predicted hospitalization and ER use. Findings suggest that addressing competing needs could reduce unnecessary hospitalization and ER use for both genders. Furthermore, examinations of gender differences in service use should include sexual identity.

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Selected References

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  1. Andersen R., Bozzette S., Shapiro M., St Clair P., Morton S., Crystal S., Goldman D., Wenger N., Gifford A., Leibowitz A. Access of vulnerable groups to antiretroviral therapy among persons in care for HIV disease in the United States. HCSUS Consortium. HIV Cost and Services Utilization Study. Health Serv Res. 2000 Jun;35(2):389–416. [PMC free article] [PubMed] [Google Scholar]
  2. Asch S. M., Gifford A. L., Bozzette S. A., Turner B., Mathews W. C., Kuromiya K., Cunningham W., Andersen R., Shapiro M., Rastegar A. Underuse of primary Mycobacterium avium complex and Pneumocystis carinii prophylaxis in the United States. J Acquir Immune Defic Syndr. 2001 Dec 1;28(4):340–344. doi: 10.1097/00126334-200112010-00006. [DOI] [PubMed] [Google Scholar]
  3. Beaton Dorcas E., Schemitsch Emil. Measures of health-related quality of life and physical function. Clin Orthop Relat Res. 2003 Aug;(413):90–105. doi: 10.1097/01.blo.0000079772.06654.c8. [DOI] [PubMed] [Google Scholar]
  4. Bogart Laura M., Collins Rebecca L., Cunningham William, Beckman Robin, Golinelli Daniela, Eisenman David, Bird Chloe E. The association of partner abuse with risky sexual behaviors among women and men with HIV/AIDS. AIDS Behav. 2005 Sep;9(3):325–333. doi: 10.1007/s10461-005-9006-1. [DOI] [PubMed] [Google Scholar]
  5. Bogart Laura M., Collins Rebecca L., Kanouse David E., Cunningham William, Beckman Robin, Golinelli Daniela, Bird Chloe E. Patterns and correlates of deliberate abstinence among men and women with HIV/AIDS. Am J Public Health. 2006 May 2;96(6):1078–1084. doi: 10.2105/AJPH.2005.070771. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Bombardier C. Outcome assessments in the evaluation of treatment of spinal disorders: summary and general recommendations. Spine (Phila Pa 1976) 2000 Dec 15;25(24):3100–3103. doi: 10.1097/00007632-200012150-00003. [DOI] [PubMed] [Google Scholar]
  7. Box Tamara L., Olsen Maren, Oddone Eugene Z., Keitz Sheri A. Healthcare access and utilization by patients infected with human immunodeficiency virus: does gender matter? J Womens Health (Larchmt) 2003 May;12(4):391–397. doi: 10.1089/154099903765448907. [DOI] [PubMed] [Google Scholar]
  8. Brick J. M., Kalton G. Handling missing data in survey research. Stat Methods Med Res. 1996 Sep;5(3):215–238. doi: 10.1177/096228029600500302. [DOI] [PubMed] [Google Scholar]
  9. Celentano D. D., Vlahov D., Cohn S., Shadle V. M., Obasanjo O., Moore R. D. Self-reported antiretroviral therapy in injection drug users. JAMA. 1998 Aug 12;280(6):544–546. doi: 10.1001/jama.280.6.544. [DOI] [PubMed] [Google Scholar]
  10. Ciccarone Daniel H., Kanouse David E., Collins Rebecca L., Miu Angela, Chen James L., Morton Sally C., Stall Ron. Sex without disclosure of positive HIV serostatus in a US probability sample of persons receiving medical care for HIV infection. Am J Public Health. 2003 Jun;93(6):949–954. doi: 10.2105/ajph.93.6.949. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Cunningham W. E., Andersen R. M., Katz M. H., Stein M. D., Turner B. J., Crystal S., Zierler S., Kuromiya K., Morton S. C., St Clair P. The impact of competing subsistence needs and barriers on access to medical care for persons with human immunodeficiency virus receiving care in the United States. Med Care. 1999 Dec;37(12):1270–1281. doi: 10.1097/00005650-199912000-00010. [DOI] [PubMed] [Google Scholar]
  12. Cunningham William E., Crystal Stephen, Bozzette Samuel, Hays Ron D. The association of health-related quality of life with survival among persons with HIV infection in the United States. J Gen Intern Med. 2005 Jan;20(1):21–27. doi: 10.1111/j.1525-1497.2005.30402.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Davidson A. J., Bertram S. L., Lezotte D. C., Marine W. M., Rietmeijer C. A., Hagglund B. B., Cohn D. L. Comparison of health status, socioeconomic characteristics, and knowledge and use of HIV-related resources between HIV-infected women and men. Med Care. 1998 Dec;36(12):1676–1684. doi: 10.1097/00005650-199812000-00005. [DOI] [PubMed] [Google Scholar]
  14. Dobalian Aram, Tsao Jennie C. I., Duncan R. Paul. Pain and the use of outpatient services among persons with HIV: results from a nationally representative survey. Med Care. 2004 Feb;42(2):129–138. doi: 10.1097/01.mlr.0000108744.45327.d4. [DOI] [PubMed] [Google Scholar]
  15. Eisenman David P., Cunningham William E., Zierler Sally, Nakazono Terry T., Shapiro Martin F., HCSUS Consortium Effect of violence on utilization of services and access to care in persons with HIV. J Gen Intern Med. 2003 Feb;18(2):125–127. doi: 10.1046/j.1525-1497.2003.20518.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Floris-Moore Michelle, Lo Yungtai, Klein Robert S., Budner Nancy, Gourevitch Marc N., Moskaleva Galina, Schoenbaum Ellie E. Gender and hospitalization patterns among HIV-infected drug users before and after the availability of highly active antiretroviral therapy. J Acquir Immune Defic Syndr. 2003 Nov 1;34(3):331–337. doi: 10.1097/00126334-200311010-00012. [DOI] [PubMed] [Google Scholar]
  17. Frankel M. R., Shapiro M. F., Duan N., Morton S. C., Berry S. H., Brown J. A., Burnam M. A., Cohn S. E., Goldman D. P., McCaffrey D. F. National probability samples in studies of low-prevalence diseases. Part II: Designing and implementing the HIV cost and services utilization study sample. Health Serv Res. 1999 Dec;34(5 Pt 1):969–992. [PMC free article] [PubMed] [Google Scholar]
  18. Galvan Frank H., Collins Rebecca, Kanouse David E., Burnam M. Audrey, Paddock Susan M., Beckman Robin, Mitchell Steve R. Abuse in the close relationships of people with HIV. AIDS Behav. 2004 Dec;8(4):441–451. doi: 10.1007/s10461-004-7328-z. [DOI] [PubMed] [Google Scholar]
  19. Gebo K. A., Diener-West M., Moore R. D. Hospitalization rates in an urban cohort after the introduction of highly active antiretroviral therapy. J Acquir Immune Defic Syndr. 2001 Jun 1;27(2):143–152. doi: 10.1097/00126334-200106010-00009. [DOI] [PubMed] [Google Scholar]
  20. Gebo Kelly A., Fleishman John A., Conviser Richard, Reilly Erin D., Korthuis P. Todd, Moore Richard D., Hellinger James, Keiser Philip, Rubin Haya R., Crane Lawrence. Racial and gender disparities in receipt of highly active antiretroviral therapy persist in a multistate sample of HIV patients in 2001. J Acquir Immune Defic Syndr. 2005 Jan 1;38(1):96–103. doi: 10.1097/00126334-200501010-00017. [DOI] [PubMed] [Google Scholar]
  21. Giordano Thomas P., White A. Clinton, Jr, Sajja Prasuna, Graviss Edward A., Arduino Roberto C., Adu-Oppong Ahmed, Lahart Christopher J., Visnegarwala Fehmida. Factors associated with the use of highly active antiretroviral therapy in patients newly entering care in an urban clinic. J Acquir Immune Defic Syndr. 2003 Apr 1;32(4):399–405. doi: 10.1097/00126334-200304010-00009. [DOI] [PubMed] [Google Scholar]
  22. Graham N. M., Jacobson L. P., Kuo V., Chmiel J. S., Morgenstern H., Zucconi S. L. Access to therapy in the Multicenter AIDS Cohort Study, 1989-1992. J Clin Epidemiol. 1994 Sep;47(9):1003–1012. doi: 10.1016/0895-4356(94)90115-5. [DOI] [PubMed] [Google Scholar]
  23. Kenagy Gretchen P., Linsk Nathan L., Bruce Douglas, Warnecke Richard, Gordon Audrey, Wagaw Fikirte, Densham Andrea. Service utilization, service barriers, and gender among HIV-positive consumers in primary care. AIDS Patient Care STDS. 2003 May;17(5):235–244. doi: 10.1089/108729103321655881. [DOI] [PubMed] [Google Scholar]
  24. Keruly Jeanne C., Conviser Richard, Moore Richard D. Association of medical insurance and other factors with receipt of antiretroviral therapy. Am J Public Health. 2002 May;92(5):852–857. doi: 10.2105/ajph.92.5.852. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Lehrman S., Gimbel R., Freedman J., Svicki K., Tackley L. Development and implementation of an HIV/AIDS case management outcomes assessment programme. AIDS Care. 2002 Dec;14(6):751–761. doi: 10.1080/0954012021000031822. [DOI] [PubMed] [Google Scholar]
  26. Mirowsky J., Ross C. E. Control or defense? Depression and the sense of control over good and bad outcomes. J Health Soc Behav. 1990 Mar;31(1):71–86. [PubMed] [Google Scholar]
  27. Mocroft A., Gill M. J., Davidson W., Phillips A. N. Are there gender differences in starting protease inhibitors, HAART, and disease progression despite equal access to care? J Acquir Immune Defic Syndr. 2000 Aug 15;24(5):475–482. doi: 10.1097/00126334-200008150-00013. [DOI] [PubMed] [Google Scholar]
  28. Moore R. D., Stanton D., Gopalan R., Chaisson R. E. Racial differences in the use of drug therapy for HIV disease in an urban community. N Engl J Med. 1994 Mar 17;330(11):763–768. doi: 10.1056/NEJM199403173301107. [DOI] [PubMed] [Google Scholar]
  29. Mor V., Fleishman J. A., Dresser M., Piette J. Variation in health service use among HIV-infected patients. Med Care. 1992 Jan;30(1):17–29. doi: 10.1097/00005650-199201000-00002. [DOI] [PubMed] [Google Scholar]
  30. Schwarcz S. K., Katz M. H., Hirozawa A., Gurley J., Lemp G. F. Prevention of Pneumocystis carinii pneumonia: who are we missing? AIDS. 1997 Aug;11(10):1263–1268. doi: 10.1097/00002030-199710000-00010. [DOI] [PubMed] [Google Scholar]
  31. Shapiro M. F., Morton S. C., McCaffrey D. F., Senterfitt J. W., Fleishman J. A., Perlman J. F., Athey L. A., Keesey J. W., Goldman D. P., Berry S. H. Variations in the care of HIV-infected adults in the United States: results from the HIV Cost and Services Utilization Study. JAMA. 1999 Jun 23;281(24):2305–2315. doi: 10.1001/jama.281.24.2305. [DOI] [PubMed] [Google Scholar]
  32. Solomon L., Frank R., Vlahov D., Astemborski J. Utilization of health services in a cohort of intravenous drug users with known HIV-1 serostatus. Am J Public Health. 1991 Oct;81(10):1285–1290. doi: 10.2105/ajph.81.10.1285. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Sowell R. L., Moneyham L., Aranda-Naranjo B. The care of women with AIDS: special needs and considerations. Nurs Clin North Am. 1999 Mar;34(1):179–199. [PubMed] [Google Scholar]
  34. Stein M. D., Piette J., Mor V., Wachtel T. J., Fleishman J., Mayer K. H., Carpenter C. C. Differences in access to zidovudine (AZT) among symptomatic HIV-infected persons. J Gen Intern Med. 1991 Jan-Feb;6(1):35–40. doi: 10.1007/BF02599388. [DOI] [PubMed] [Google Scholar]
  35. Thompson A. S., Blankenship K. M., Selwyn P. A., Khoshnood K., Lopez M., Balacos K., Altice F. L. Evaluation of an innovative program to address the health and social service needs of drug-using women with or at risk for HIV infection. J Community Health. 1998 Dec;23(6):419–440. doi: 10.1023/a:1018706107776. [DOI] [PubMed] [Google Scholar]
  36. Turner B. J., Markson L., Cocroft J., Cosler L., Hauck W. W. Clinic HIV-focused features and prevention of Pneumocystis carinii pneumonia. J Gen Intern Med. 1998 Jan;13(1):16–23. doi: 10.1046/j.1525-1497.1998.00003.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Verbrugge L. M. Gender and health: an update on hypotheses and evidence. J Health Soc Behav. 1985 Sep;26(3):156–182. [PubMed] [Google Scholar]
  38. Zingmond David S., Kilbourne Amy M., Justice Amy C., Wenger Neil S., Rodriguez-Barradas Maria, Rabeneck Linda, Taub Dennis, Weissman Sharon, Briggs Janet, Wagner Joseph. Differences in symptom expression in older HIV-positive patients: The Veterans Aging Cohort 3 Site Study and HIV Cost and Service Utilization Study experience. J Acquir Immune Defic Syndr. 2003 Jun 1;33 (Suppl 2):S84–S92. [PubMed] [Google Scholar]

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