Population Research and Policy Review 18: 183–199, 1999.
© 1999 Kluwer Academic Publishers. Printed in the Netherlands.
Accessibility of health and human services for the HIV-infected
JAMES E. RIVERS, ROBERT S. ANWYL, NORMAN WEATHERBY &
University of Miami School of Medicine and Health Services Research Center, Miami, FL,
Abstract. Most research on services for the HIV/AIDS population has focused on primary
medical care or on service brokering by advocacy groups. Little research data exist on the
extent to which services of programs that do not specialize in HIV/AIDS clients are available
to these individuals who often have multiple and multi-dimensional problems. The reported
research examines selected data from a sample of 236 medical, behavioral health and social
service programs in Miami-Dade County, Florida. A constructed measure of ‘involvement’
in services for HIV/AIDS clients, pertinent provider program and client characteristics are
examined in the context of geo-distributed data on reported AIDS cases and census data. In
logistic regression analyses, two aspects of race/ethnicity – the population in the zip code area
served by the program, and the clients or patients seen in the program – were signiﬁcant in pre-
dicting program under-response, deﬁned as level of response relative to cumulative reported
AIDS cases from the program’s zip code area. The analysis is brieﬂy discussed regarding its
relevance and methodological generalizability for HIV/AIDS and related public health policy
and applied purposes.
Keywords: Access, HIV/AIDS, Health services, Human services, Substance abusers
For an increasing segment of the HIV/AIDS population, injecting drug use
is both a potential transmission vector and complicating health factor for
those who are infected. The increasing size of this population highlights the
need for substance abuse treatment services for injecting drug users (IDUs),
methadone maintenance for those who inject heroin and other modalities for
injectors of other drugs. Indeed, drug abuse treatment capacity expansion,
especially for IDUs, has been recommended by such bodies as the Institute of
Medicine and the National Academy of Sciences for several years (Institute
of Medicine 1988; Jonsen & Stryker 1993; Miller et al. 1990; Turner et al.
1989), but without signiﬁcant impact (Sorenson & Miller 1996). Substance
abuse treatment also has become an important service for non-IDUs, par-
ticularly women, who engage multiple sexual partners in return for drugs
(typically, crack cocaine) or money to purchase crack. This sexual activity,