Use of mental health and substance abuse treatment services among adults with HIV in the United States

Background: The need for mental health and substance abuse services is grea t among those with human immunodeficiency virus (HIV), but little informati on is available on services used by this population or on individual factor s associated with access to care. Methods: Data are from the HIV Cost and Services Utilization Study, a natio nal probability survey of 2864 HIV-infected adults receiving medical care i n the United States in 1996. We estimated 6-month use of services for menta l health and substance abuse problems and examined socioeconomic, HIV illne ss, and regional factors associated with use. Results: We estimated that 61.4% of 231 400 adults under care for HIV used mental health or substance abuse services: 1.8% had hospitalizations, 3.4% received residential substance abuse treatment, 26.0% made individual menta l health specialty visits, 15.2% had group mental health treatment, 40.3% d iscussed emotional problems with medical providers, 29.6% took psychotherap eutic medications, 5.6% received outpatient substance abuse treatment, and 12.4% participated in substance abuse self-help groups. Socioeconomic facto rs commonly associated with poorer access to health services predicted lowe r likelihood of using mental health outpatient care, but greater likelihood of receiving substance abuse treatment services. Those with less severe HI V illness were less likely to access services. Persons living in the Northe ast were more likely to receive services. Conclusions: The magnitude of mental health and substance abuse care provid ed to those with known HIV infection is substantial, and challenges to prov iders should be recognized. Inequalities in access to care are evident, but differ among general medical, specialty mental health, and substance abuse treatment sectors.