HIV disproportionately affects vulnerable populations, such as black and Hispanic communities, the poor, and substance users, who often have limited access to medical and social services. To address the gap in knowledge about hard-to-reach HIV-positive populations, this study compares sociodemographic, clinical and utilization characteristics of two HIV-positive population samples: Targeted Outreach and Intervention Initiative (Outreach), which targets hard-to-reach HIV-positive persons who were not in care, or not in consistent care, or at risk of dropping out of care, and the HIV Costs and Services Utilization Study (HCSUS), a nationally representative sample of persons in care for HIV.
The authors found that participants in the Outreach sample overwhelmingly included racial/ethnic minorities, substance abusers and the poor, many of the groups in which the HIV epidemic is spreading most rapidly. In comparison with the low utilization strata of HCSUS, their health status was less favorable and they tended to have fewer ambulatory visits and more acute care visits. These findings caution against generalizing results to hard-to-reach groups from a population identified as “in care.” Results showed that the Outreach sample requires extensive additional services to improve their care. Notably, recent heavy alcohol use was strongly associated with lower use of health care in the Outreach sample but not in HCSUS. This suggests that providing alcohol treatment services may particularly help increase ambulatory medical care use among persons reached through outreach efforts.
Recent studies have emphasized the role of heavy alcohol use in HIV risk behavior, but little study has been directed toward alcohol as a barrier to the use of HIV services in underserved populations.