Responding to Racial and Ethnic Disparities in Use of HIV Drugs: Analysis of State Policies

• Published in: Public health reports (1974) Vol. 117; no. 3; pp. 263 - 272
• Main Authors: Morin, Stephen F., Sohini Sengupta, Myrna Cozen, T. Anne Richards, Michael D. Shriver, Herminia Palacio, Kahn, James G.
• Format: Journal Article
• Language: English
• Published: Washington, DC Oxford University Press 01.05.2002; Association of Schools of Public Health; SAGE PUBLICATIONS, INC
• Subjects: Acquired immune deficiency syndrome; Acquired Immunodeficiency Syndrome - drug therapy; Acquired Immunodeficiency Syndrome - ethnology; African Americans; African Americans - education; AIDS; Antiretroviral Therapy, Highly Active - economics; Antiretroviral Therapy, Highly Active - utilization; Biological and medical sciences; Black communities; California - epidemiology; Care and treatment; Community-Institutional Relations; Costs; Drugs; Eligibility Determination - organization & administration; Emigration and Immigration; Entitlement programs; Ethnic Groups - classification; Ethnic Groups - education; European Continental Ancestry Group - education; Florida - epidemiology; Group facilitation; Health; Health insurance; Health policy; Health services; Health Services Accessibility - organization & administration; Hispanic Americans - education; Hispanics; HIV; HIV positive persons; Human immunodeficiency virus; Human viral diseases; Humans; Infectious diseases; Interviews as Topic; Medicaid; Medicaid - organization & administration; Medical Assistance - organization & administration; Medical sciences; Minorities; Minority & ethnic groups; New York - epidemiology; Organizational Policy; Patient Acceptance of Health Care - ethnology; Pharmaceutical preparations; Pharmaceuticals; Population Surveillance; Public health; Social Marketing; State Health Plans - organization & administration; States; Texas - epidemiology; United States; United States - epidemiology; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; United States; North America; America; New York; California; Florida; Texas; Human; Immunopathology; Accessibility; AIDS; Immune deficiency; Ethnic group; Care; Infection; Chemotherapy; Treatment; Viral disease; Evolution; Public health
• ISSN: 0033-3549; 1468-2877
• DOI: 10.1016/S0033-3549(04)50160-7

Objectives: The objectives of this study were to assess racial/ethnic trends in surveillance data in four states--California, New York, Florida and Texas, identify structural barriers to and facilitators of access to HIV pharmaceuticals by individuals in Medicaid and the AIDS Drug Assistance Program (ADAP), and identify treatment education and outreach efforts responding to the needs of ethnic minority HIV patients. Methods: State surveillance and claims data were used to assess trends by race/ethnicity in AIDS cases and mortality as well as participation rates in Medicaid and ADAP. Key informant interviews with state program administrators and local clinic-based benefit eligibility workers were used to identify social and policy barriers to and facilitators of access to HIV drugs and state strategies for overcoming racial/ethnic disparities. Results: Racial/ethnic disparities in the reduction of AIDS-related mortality were identified in three of the four states studied. Policy barriers included Medicaid requirements for legal immigration status and residency, limits on Medicaid eligibility based on disability requirements, and state-imposed income and benefit limits on ADAP. Social barriers to accessing AIDS medications included lack of information, distrust of government, and HIV-related stigma. State strategies for overcoming disparities included contracting with community-based organizations for treatment education and outreach, the use of regional minority coordinators, and public information campaigns. Conclusions: State policies play a significant role in determining access to HIV drugs, and state policies can be used to reduce racial/ethnic disparities in pharmaceutical access. Overall, eliminating racial/ethnic disparities in access to HIV pharmaceuticals appears to be an achievable goal.