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 Hispanics are less likely to receive HAART than whites, according to a recent study by Dr. King and his associates. 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: They 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 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.
Dr. King suggested that more HIV services come to minority neighborhoods, and that physicians pay more attention to the quality and quantity of their communications with minority patients.
A separate study of 1,717 patients who were 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 investigators will study whether the risk for hospitalization is associated with less access to medications and other health services for blacks.