provides the sociodemographic and health characteristics of the women in the WIHS that met study criteria in 2005 (N=1354). Slightly more than half of the women were African American and a little over one quarter were Hispanic. At enrollment, the vast majority (72%) of the women had incomes below twice the federal poverty level and slightly more than a third (39%) did not have a high school degree. Half of the women were 40 to 49 years of age in 2005. Although most (56%) of the women reported a history of prior use of crack, cocaine, or heroin, fewer than 10% reported use in the 6 months prior to the study visit. Most of the women were nondrinkers or light drinkers; however, about 11% reported they were either moderate or heavy users of alcohol.
Characteristics of Women Clinically Eligible for Highly Active Antiretroviral Therapy (HAART): Women’s Interagency HIV Study, 2005
Almost two thirds (63%) of the study participants were insured with Medicaid or Medi-Cal and 11% were uninsured (). The proportion covered by Medicaid or Medi-Cal varied by race/ethnicity: 69% for African American women and 59% for Hispanic women versus 41% for White women. In contrast, a larger percentage of White women (39%) than African American (13%) or Hispanic (7%) women had private insurance.
Approximately 75% of the women identified a physician or clinic as their usual source of medical care and 13% identified an emergency department in a hospital, a drug treatment clinic, a prison clinic, or other source of care. The remaining 12% were classified as “unknown” usual source of medical care because they were mostly women who had not seen a doctor since the last study visit and thus were not asked the follow-up question on place of care.
Self-Reported Use of HAART
As shown in , 29% of the women clinically eligible for HAART reported not using it in 2005. The crude estimates indicate a higher proportion of nonuse of HAART among African American and Hispanic women than among White women and generally higher rates of nonuse of HAART among uninsured women than among women with Medicaid coverage. Uninsured White women, however, reported lower rates of nonuse than did uninsured African American or Hispanic women ().
Number and Percentage of Clinically Eligible Women Not Using Highly Active Antiretroviral Therapy (HAART), by Race/Ethnicity and Insurance Status: Women’s Interagency HIV Study, 2005
Percentage of clinically eligible women not using highly active antiretroviral therapy (HAART), by race/ethnicity and insurance: Women’s Interagency HIV Study, 2005.
presents the unadjusted odds ratios (ORs) and adjusted odds ratios (AORs) of not using HAART. The unadjusted ORs for nonuse of HAART were higher for African American women (OR=2.06; 95% confidence interval [CI]=1.39, 3.07) and Hispanic women (OR=1.57; 95% CI=1.02, 2.41) than they were for White women. After adjustment for potential confounders, the likelihood of nonuse of HAART by African American women remained roughly twice that of White women (OR=2.01; 95% CI=1.22, 3.31). However, the difference in risk between Hispanic and White women was attenuated when demographic and other differences were controlled for in the adjusted regression analysis.
Results of Unadjusted and Adjusted Logistic Regression for the Likelihood of Clinically Eligible Women Not Using Highly Active Antiretroviral Therapy (HAART): Women’s Interagency HIV Study, 2005
Race, Insurance, and Substance Abuse and Use of HAART
Having insurance, as well as the type of insurance, was associated with use of HAART (, models 2 and 4). Uninsured women were twice as likely as were women with Medicaid or Medi-Cal coverage to report nonuse of HAART (OR=2.38; 95% CI=1.52, 3.73; model 2). The odds of not using HAART were also higher for women with private insurance coverage than they were for those with Medicaid or Medi-Cal coverage (OR=2.06; 95% CI=1.25, 3.40; model 2). Women enrolled in the AIDS Drug Assistance Program had the lowest odds of not using HAART (OR=0.54; 95% CI=0.34, 0.85; model 2), after adjustment for insurance coverage and other factors.
Model 3 () tested whether the combined effects of race and insurance coverage had an interactive effect on nonuse of HAART. Although there is no strong evidence to support this hypothesis, marginally statistically significant and almost certainly practically important differences (P<.10) were observed, suggesting that Hispanic women with private coverage may be at lower risk of not using HAART than White women with Medicaid coverage, the comparison group in this analysis. A larger population sample would be needed to determine with confidence whether this subgroup of Hispanic women are truly at lower risk of not using HAART.
Alcohol use was related to nonuse of HAART; however, crack, cocaine, or heroin use, regardless of whether it occurred prior to or during the study period, was not. The odds of not using HAART were higher for light drinkers (OR=1.39; 95% CI=1.03, 1.89; model 2) and moderate drinkers (OR=1.72; 95% CI=1.10, 2.70; model 2) than for non-drinkers.
Other Factors Associated With HAART Use
To probe 1 possible explanation for the higher odds of not using HAART among the privately insured, we examined whether having a usual source of medical care affected the study’s findings. Model 4 () provides evidence that women with an “unknown” usual source of care had a higher likelihood of not using HAART than the reference group of women whose usual source of care was an emergency department, drug clinic, or other-source (OR=1.70; 95% CI=1.00, 2.90; model 4). Most of the women with “unknown” usual source of care had not seen a provider in the last 6 months and thus were not asked the question about their usual source of care. There was, however, no statistically significant difference in nonuse of HAART between women who identified their usual source of care as a physician or clinic and women who identified it as an emergency department, drug clinic, or other source. Moreover, adjusting for having a usual source of care did not alter the greater odds of not taking HAART among privately insured women and African American women compared with their respective counterparts. It did, however, affect the relationship between depressive symptoms and HAART use. Adjusting for usual source of medical care resulted in women with depressive symptoms having statistically significant higher odds of not using HAART than women not reporting depressive symptoms (OR=1.36; 95% CI=1.01, 1.84; model 4).
When women who were eligible for HAART but not using it were asked their main reason for not doing so (), 33% replied that their doctor did not prescribe it. The next 2 most frequent reasons were that their CD4 count was too high or viral load too low (19%) and that it was a personal decision to wait (14%).
Reasons cited for not taking highly active antiretroviral therapy (HAART): Women’s Interagency HIV Study, 2005.