Background:  Previous studies have shown that a variety of factors may serve as barriers to use of HAART, including gender, racial, and HIV risk factor disparities in access to HAART. However, HAART regimens have become less complex over time and HIV care providers have become more experienced in the use of these drugs. We wished to determine what factors continue to be potential barriers to HAART use.        

Methods:  During 2003, 951 adult patients participated in face-to-face interviews at 14 HIV primary care sites. These sites were part of the HIV Research Network, a multisite cohort of patients receiving HIV in academic and community-base HIV clinics from across the United States. We determined sociodemographic and clinical factors associated with self-reported use of HAART in patients who were diagnosed with AIDS (1993 criteria). HAART was defined as receipt of a ≥ 3 drug regimen at the time of the interview. Univariate and multivariate logistic regression analysis was done to assess the associations of these factors. Among those factors assessed were self-reported use of illicit drugs, hazardous drinking, which was defined (NIAAA guidelines) as > 14 drinks/week in men, > 7 drinks/week in women, or binge use ≥ 5 drinks/occasion.

Results:  The demographics of the sample were:  male (68%), African American (52%), Hispanic (14%), age (median 46; range 20 to 85). Illicit drug use was active in 36%, and 10% were classified as hazardous drinkers. Of the 62% who had AIDS, 78% were using HAART. Among those reporting alcohol use, factors associated with hazardous or binge drinking (compared to moderate drinking) were current drug use (adjusted odds ratio 2.53 [1.23 to 5.17]), former drug use (2.46 [1.12 to 5.40]), CD4 count 200 to 500 (2.47 [1.22 to 5.00]), or > 500 (2.51 [1.09 to 5.79]) compared with those with CD4 < 50. Factors associated with not using HAART were:  less than a high school diploma (0.48 [0.23 to 0.98]), and hospitalization for alcohol, illicit drug, or mental health treatment (0.37 [0.15 to 0.92]). Age, race, gender, HIV risk factor, and insurance were not associated with access to HAART.

Conclusions:  This study demonstrates that the former gender, ethnic, and HIV risk factor disparities in access to HAART may no longer be present. However, HIV providers should assess for hazardous drinking, use of illicit drugs, and mental illness, because these continue to be barriers to HAART use, and are likely to need appropriate intervention to increase the use of HAART.

Keywords: Disparities; HAART; Education