Demographic and socio-economic determinants of community and hospital services costs for people with HIV/AIDS in London

We examined the influence of demographic, social and economic background of people with HIV/AIDS in London on total community and hospital services co sts. This was a retrospective study of community and hospital service use, needs and costs based on structured questionnaires administered by trained interviewers and costing information obtained from the service purchasers a nd providers, based on two Genito-urinary Medicine clinics in London: the J efferiss Wing at St, Mary's Hospital and Patric Clements at the Central Mid dlesex Hospital, London, England. The subjects were 225 HIV infected patien ts (105 asymptomatic, 59 symptomatic non-AIDS and 61 AIDS). We found that over and above well established determinants of health care c osts for HIV infected people such as disease stage and transmission categor y, social and economic factors such as employment and support of a living-i n partner significantly reduced community services costs. Private health in surance had a similar effect, though only a small proportion of HIV people had such cover. The cost of community services for HIV infected non-Europea n Union nationals, mainly of African origin, was one quarter that for the E uropean Union nationals. Community services costs were highest for heterose xually infected women and lowest for heterosexually infected men after adju sting for other factors. Hospital services costs were significantly higher for HIV infected people lacking educational qualifications and employment. We conclude that access to community care for HIV infected non-EU nationals appears to be very poor as the cost of their community services was one qu arter that for the EU nationals after adjusting for the effects of transmis sion category, disease stage, living with a partner, employment and having a private health insurance. Additional incentives for informal care for HIV infected people could be a cost-effective way to improve their community h ealth service provisions. (C) 1999 Elsevier Science Ltd. All rights reserve d.