IS ACCESS TO MEDICAL-CARE ASSOCIATED WITH RECEIPT OF HIV TESTING AND COUNSELING

Lack of timely HIV testing leads to missed prevention opportunities an d poor prevention counselling may be related to further disease spread . We examined the association of self-reported access to medical care with receiving HIV testing and preventive counselling services among a sample of patients with HIV disease prior to hospitalization. We cond ucted a cross-sectional interview of 217 Los Angeles patients hospital ized with HIV-related illness between 1992 and 1993 and abstracted cli nical data from the medical record. Eighty-four per cent of patients r eceived HIV testing prior to hospitalization, but only 33% received pr eventive counselling services. Only 48% of all patients rated outpatie nt medical care as somewhat or very easy to obtain. Controlling for se verity of illness, better access to outpatient medical care (OR = 1.48 ; 95% CI = 1.02-2.15), having a regular source of care (OR = 3.40; 95% Cl = 1.29-8.97) and non-homosexual mode of HIV transmission (OR = 0.3 1; 0.12-0.83) were associated with receiving HIV testing services prio r to hospitalization. Having a regular source of care (OR = 3.55; 95% CI = 1.37-9.22), being VA (Veterans' Administration) insured (OR = 6.1 6; 1.46-26.05), alder age (OR = 0.95; 95% CI = 0.90-0.99) and having a CD4 count between 101-200 (OR = 0.19; 95% CI = 0.06-0.63) were associ ated with receiving HIV counselling. Limited self-reported access to m edical care is associated with fewer patients receiving HIV testing an d counselling. Improving timeliness of HIV testing may require removin g the barriers to medical care.