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American Public Health Association
133rd Annual Meeting & Exposition
December 10-14, 2005
Philadelphia, PA
APHA 2005
 
4136.0: Tuesday, December 13, 2005 - 1:10 PM

Abstract #115827

Racial and Gender Disparities in Antiretroviral Receipt Among Medicaid Recipients from Six States

William D. King, MD, JD1, George Rust, MD, MPH2, and Robert Levine, MD2. (1) Integrated Substance Abuse Program, University of California at Los Angeles, 11075 santa monica Blvd, los Angeles, CA 90025, (2) Director, National Center for Primary Care, Morehouse School of Medicine, 720 Westview Drive, SW, Atlanta, GA 30310, 404-756-5740, rlevine@msn.edu

Women, Blacks and Hispanics are more likely to be on Medicaid as compared to men and Whites for HIV clinical services. We analyzed 1998 State Medicaid claims files from five states with mid range HIV prevalence to assess racial and gender disparities in the receipt of highly active antiretroviral therapy (HAART). ICD-9 codes were used to identify persons, ages 13-64 with a diagnosis of HIV/AIDS or a HIV/AIDS defining illness .FDA approval dates and 1998 CDC guidelines identified available antiretrovirals and recommended HAART regimens. Descriptive statistics and multivariate analyses were conducted to determine the impact of age, gender, and race on the receipt of HAART. We identified 7,972/ 1,789,308 persons (0.44%) with a diagnosis of HIV/AIDS. The median age was 39; 56% were female; 53%, Black and 45%, Hispanic (45%). Logistic regression models demonstrated persons younger than 29 (<20 OR 2.99, 20-29 OR 1.64, both p<0.001) or Black (OR 1.26, p <0.001) were less likely to receive HAART. Separate regression models of Black and White recipients conducted because of a significant interaction between race and gender, demonstrated that the age disparity within the White model mirrored the full model; whereas within the Black model, persons from the age of 40-49 were also less likely to receive HAART (p<0.001). Black and White women were less likely to receive HAART (OR1.7, OR 1.9 both p< 0.001). Black or White female HIV positive Medicaid recipients did not have the same rate of HAART receipt despite the elimination of a financial barrier to access.

Learning Objectives:

Keywords: Antiretroviral Combination Therapy, Health Disparities

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.

Managing HIV Infection: Treatment and Adherence

The 133rd Annual Meeting & Exposition (December 10-14, 2005) of APHA