Role of race, substance abuse and health insurance coverage on the use of HAART among HIV-infected women, 2002- 2005

Background: Highly active antiretroviral therapy (HAART) has been found to extend the quality and length of life of people with HIV disease. Previous studies, however, have found a disparity in use of HAART by race/ethnicity.

Methods: We examined racial/ethnic disparities in use of HAART and whether these differences are moderated by substance abuse or insurance coverage using data from the Women's Interagency HIV Study. Logistic regression examined HAART use among women for whom HAART was clinically indicated in 2002 (N=1,463) and 2005 (N=1,354).

Results: In 2002 and 2005, approximately 30% of women were not on HAART. African American women were less likely than white women to use HAART in either year; Hispanic women were less likely in 2005. After adjusting for potential confounders, higher likelihood of not using HAART persisted for African Americans, but not for Hispanics. Uninsured and privately insured women were less likely than Medicaid enrollees to use HAART. The AIDS Drug Assistance Program (ADAP) enrollment was associated with higher use of HAART. Alcohol use was related to HAART non-use in both years; crack cocaine or heroin use was not.

Conclusion: Racial/ethnic disparities in use of HAART persist among women with HIV/AIDS. These findings suggest that greater efforts are needed to treat women of color for whom HAART is indicated. In addition, these findings suggest that uninsured and privately insured patients may benefit from assistance paying for HIV medications, and provide policymakers with new insights about the association of health insurance and substance abuse with use of HAART.