OAKLAND, CALIF. — The gap in HIV care received by black patients compared with white patients has narrowed, but disparities remain a problem, William D. King, M.D., said at a conference sponsored by the American Foundation for AIDS Research.
A 2005 study found that 84% of HIV-infected patients overall receive highly active antiretroviral therapy (HAART), but blacks were less likely than whites to get HAART, said Dr. King, an internal medicine/HIV specialist in Los Angeles. Dr. King is a speaker for Pfizer Inc., which makes antiretroviral medication.
Blacks are more likely than whites to be uninsured or on Medicaid and thus are less likely to have access to HAART, compared with patients who have private insurance. Among Medicaid recipients, blacks and Hispanic patients are less likely to receive HAART than are whites, according to a recent study by Dr. King and his associates that has been submitted for publication.
Other data have shown that within the Veterans Affairs system, HIV-infected blacks and Hispanics have higher mortality than do HIV-infected white patients.
Physician attitudes play a role in the disparities, he added. Physicians are more reluctant to treat a patient who they think will not adhere to therapy. A 2000 study found that physicians who were given patient vignettes were more likely to rate them as unlikely to adhere to therapy if the patient was described as African American rather than white, even if the rest of the vignette was identical.
The interval between seeing a physician for HIV care and receiving a protease inhibitor to treat it averaged 409 days for black patients, significantly longer than the 311 days for white patients and 306 days for Hispanics, a 2003 study found. Patient attitudes and distrust also play a role in these disparities by making some less willing to seek care, Dr. King said at the conference, which was cosponsored by the Pacific AIDS Education and Training Center.
In a 2005 study of 500 African Americans, 75% said they believe institutions are trying to stop HIV, but 15% felt that AIDS is a form of genocide. Overall, 59% said they believe information about AIDS is being withheld from the poor, and 53% stated that a cure for AIDS exists but is being withheld from the poor. Men who had the highest level of conspiracy beliefs had more negative attitudes about condoms and were less likely to use them.
Dr. King suggested that more HIV services come to minority neighborhoods, and that more educational materials get translated into languages other than English. Physicians should pay attention to the quality and quantity of their communications with minority patients, and develop culturally relevant materials. More community education is needed to reduce the stigma associated with HIV and to reach out to stakeholders in black communities, such as religious organizations, he said.
A separate study of 8,319 records on 1,717 patients seen for HIV at two medical centers between 2000 and 2003 found that blacks were more likely than whites to be hospitalized, Linda Wotring, Ph.D., and Jonathan A. Cohn, M.D., reported in a poster at the meeting. The odds of being hospitalized were 70% higher for black men and 80% higher for black women, compared with white men, reported Dr. Wotring of the Michigan Department of Community Health, Detroit, and Dr. Cohn of Wayne State University, Detroit.
The chances of hospitalization remained significantly higher for blacks than for whites after adjustment for other factors that increased the risk of admission, including injection drug use or noninjection drug use, a history of an AIDS-defining illness, no history of a clinic visit, and having Medicare or Medicaid rather than private insurance.
The investigators will study whether the risk for hospitalization is associated with less access to medications and other health services for blacks.
Distrust and misconceptions about HIV remain widespread, Jerry T. Nessel, M.D., and Beny J. Primm, M.D., reported in a separate poster presentation. In surveys of 1,440 attendees at nine medical and health conferences, only 9% of respondents knew that HIV was not created in the laboratory, and that the virus came from chimpanzees or monkeys, said Dr. Nessel and Dr. Primm of the Addiction Research and Treatment Corp., New York.