HIV Aware/Not in Care: Evaluating Access to HIV Primary Care in St. Louis, Missouri

Communities and health departments try to understand access to HIV primary care, but are often reliant on aggregate information to gain a comprehensive view of care. The HIV Aware/Not in Care project established an integrated picture of access to HIV primary care for persons who were diagnosed in Missouri and resided in the St. Louis area for the years 1998-2002. Key informant interviews were conducted during the fall of 2005 to explore the meaning of unmet need for HIV primary care and to explain some of the findings from the multi-year review of access. Project findings were released on March 2006. Findings from stage one are also published in the American Journal of Public Health (2007;97:744-749).

Findings:

Stage 1: Integrating data sources for a comprehensive picture of care access

Stage 2: Key informant interviews to explore unmet need for HIV primary care
  • About half of those with HIV show evidence of accessing HIV primary care in a given year.
  • A lot of people access HIV primary care in the first year after receiving their HIV diagnosis but subsequently access care inconsistently.
  • People are entering HIV primary care with an AIDS diagnosis.
  • Adjacent care programs and systems are associated with HIV primary care.

  • Non-RWCA funded health systems provide the majority of HIV primary care.
  • Participant and policy understandings of unmet need for HIV primary care were different.
  • Barriers to HIV primary care continued to be related to health system, personal, and social aspects.
  • People are tired of being sick and tired: Care Fatigue.
  • Both care fatigue and the gap between policy and participant view of unmet need appear to be symptoms of an incomplete cultural shift in understanding about HIV disease.

 

View Stage One Report

View Stage Two Report

View Project Recommendations