Substance Abuse Treatment Evaluations and Interventions Research Program, RTI International, 3040 Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC 27709-2194, USA.
AIDS Patient Care STDS. 2010 Apr;24(4):257-64. doi: 10.1089/apc.2009.0213.
HIV health services are critical in sub-Saharan African where the burden of the HIV pandemic is devastating. Existing studies suggest that HIV-infected individuals from marginalized populations who know their status do not seek health services because they are unaware of available treatment and care options, may not understand how to access services, or have poor access to and utilization of health care services. This study examined factors associated with health service utilization in a sample of poor, underserved recently diagnosed HIV-positive South African women with sexual and substance use risk behaviors. The data were collected between June 2004 and May 2008. Primary outcomes included consultation with a medical professional and utilization of any health services since learning of HIV status at 3- and 6-month follow-up assessments. The study findings suggest that denial of HIV status may be a barrier to care, leading study participants to avoid utilizing health services specific to their disease and to prefer more general medical care services. In multivariate analyses, prior use of health services, financially supporting others, and sex trading were strongly associated with health service use at follow-up assessments. The study findings suggest a reduced likelihood of health services utilization among participants who met DSM-IV criteria for drug abuse as well as participants with greater numbers of poor physical health symptoms. As an important preliminary step in examining the issue of health services utilization in sub-Saharan Africa, the findings suggest an urgent need to promote HIV prevention and early testing, to strengthen long-term HIV care services, and to increase access to services.
在撒哈拉以南非洲，艾滋病毒健康服务至关重要，因为该地区正承受着艾滋病毒流行的毁灭性影响。现有研究表明，来自弱势群体的艾滋病毒感染者，尽管知道自己的状况，但由于不了解现有治疗和护理选择，或者不懂得如何获取服务，或者获取和利用医疗保健服务的机会有限，因此他们不会寻求健康服务。本研究调查了在一个有性和物质使用风险行为的贫困、服务不足的新诊断艾滋病毒阳性南非妇女样本中，与健康服务利用相关的因素。数据收集于 2004 年 6 月至 2008 年 5 月。主要结果包括自艾滋病毒检测结果得知后的 3 个月和 6 个月随访评估时向医疗专业人员咨询以及利用任何卫生服务的情况。研究结果表明，否认艾滋病毒状况可能成为护理的障碍，导致研究参与者避免利用针对其疾病的特定健康服务，并更倾向于接受更一般的医疗保健服务。在多变量分析中，之前使用过卫生服务、经济支持他人和性交易与随访评估时的卫生服务利用呈强相关。研究结果表明，符合 DSM-IV 药物滥用标准的参与者以及身体症状较差的参与者更不可能利用卫生服务。作为审查撒哈拉以南非洲健康服务利用问题的重要初步步骤，研究结果表明迫切需要促进艾滋病毒预防和早期检测，加强长期艾滋病毒护理服务，并增加服务获取机会。
