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HIV-infected women receive worse quality of care than HIV-infected men

Critical health care for women infected with HIV continues to lag behind HIV-infected men. Researchers found that women with HIV infection were less likely than HIV-infected men to receive medications to prevent opportunistic infections and to be on highly active antiretroviral therapy (HAART). They were also more likely to have emergency room visits. Differences in care site did not underlie these gender disparities.

Researchers examined the critical care of men and women at Ryan White Comprehensive AIDS Resources Emergency (CARE) Act-funded clinics, which ensure provision of HIV primary care and support services for vulnerable populations such as women, minorities, and the uninsured or underinsured. During the study period, care was provided to 9,015 patients at 69 clinics undergoing a quality improvement initiative. After adjusting for patient characteristics, women were less likely than men to receive HAART (78 vs. 82 percent). Women were also less likely to receive Pneumocystis jiroveci pneumonia (PCP) prophylaxis when eligible (65 vs. 75 percent) or to have their hepatitis C virus status known (87 vs. 88 percent).

However, these gender disparities in HIV critical care cannot be attributed to lower quality care at clinics that serve many women or to lower access to providers. For example, women were seen at the clinic more regularly (in at least three of the four quarters studied) than men (69 vs. 66 percent). Also, clinics serving higher percentages of women provided equal or better quality of care than other clinics. They also provided more services to address needs more common in women. For example, these clinics had more support services, such as case management and onsite obstetrician-gynecologists, and provided more Pap smears than other clinics. Therefore, the disparities in critical HIV care observed may be due to other factors not measured in studies to date. The study was supported in part by the Agency for Healthcare Research and Quality (HS10227 and HS10408).

See "Gender differences in quality of HIV care in Ryan White CARE Act-funded clinics," by Lisa R. Hirschhorn, M.D., M.P.H., Keith McInnes, M.S., Bruce E. Landon, M.D., M.B.A., and others, in the May-June 2006 Women's Health Issues 16, pp. 104-112.

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