The Los Angeles Times - December 13, 1999
Mitchell Landsberg, Times Staff Writer

Minorities, women, drug abusers and poor people were most likely to stint on medical care because of competing demands from their home lives, such as working or spending money on food and shelter, the study found. Conversely, 8% of those studied said they sometimes went without food, clothing or housing because they needed money for HIV care.

The message for policymakers is that "for complex diseases such as HIV, addressing social benefits and medical benefits at the same time may have the most benefit for the patients," said the study's lead author, Dr. William Cunningham, an assistant professor at the UCLA schools of public health and medicine.

The study's results came as no surprise to officials working in AIDS health care.

"It's something that I think those of us who work in the field of HIV and AIDS have been hearing for years, particularly as the epidemic has moved into communities of the poor and disenfranchised," said Vanessa Baird, acting chief of the state Office of AIDS.

She added, however, that it was not unique to HIV and AIDS patients. "I think it happens with people who are sick, period, who are sometimes living on the margins, where the choice of accessing something means giving up something else."

Cunningham said he believed the study was the first of its kind to look at the competing demands facing patients of a chronic disease nationwide. However, he said, another study had looked at diabetes patients in Minneapolis, and found a similar trade-off between social and medical needs.

"We do think these problems pertain to other diseases," he said. "We don't think they pertain only to HIV."

Even among HIV patients, he said, the study may represent only a small part of the problem. He said the researchers studied only those who had some history of obtaining medical care for HIV. But as many as half the people who have HIV do not seek medical care at all, the study noted.

The researchers conducted interviews in 1996-97 with 2,864 adult HIV patients nationwide. Based on those interviews, they concluded that one-third of the HIV patients in the nation--about 83,000 people--went without or postponed medical care at least once in a six-month period.

Cunningham said the vast majority did so for economic reasons--either they couldn't afford care, couldn't afford transportation to care, or couldn't afford to take time off work.

However, some AIDS health care officials said they thought there were other reasons that people failed to get care for HIV.

Michael Weinstein, director of the AIDS Health Care Foundation in Los Angeles, said some patients found the whole process of obtaining health care too daunting, especially if they were struggling to take care of other priorities in their lives.

"Patients very often say they don't really want care unless they're acutely ill," he said.

Susan Haikalis, director of HIV Services and Treatment Support for the San Francisco AIDS Foundation, said mentally ill or drug abusing patients may not be able to cope with the rigors of HIV treatment.

"It's such a complicated regimen that the best of us can have trouble managing," medications, she said.

Haikalis said she thought San Francisco had done a good job of offering a web of support for HIV patients, taking into account the difficulties they may have juggling health care and the other priorities of life.

Baird said she thought California was ahead of other states in offering such services.

However, she added, "I don't know that it's a problem that can ever be solved completely."
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