Perceptions of health care among persons living with HIV/AIDS who are not receiving antiretroviral medications

Antiretroviral medications are effective at improving the health and increasing the survival of people living with HIV/AIDS. However, studies have shown that a substantial number of HIV-infected people do not receive antiretroviral treatments. The current study examined the physical and mental health, substance use, and perceptions of medical care of 163 men and 78 women living with HIV/AIDS. Results of a confidential survey showed that 79 (33%) were not currently treated for HIV. These persons did not differ from those who were treated in chart-abstracted CD4 cell counts, years living with HIV infection, HIV-related symptoms, and HIV-related hospitalizations. Unlike past studies, gender was not found to be a factor in treatment status. However, untreated persons had higher chart-abstracted viral loads and were more likely to be ethnic minorities, have a lower level of education, greater level of depression, and greater pessimistic attitude. They were significantly more likely to have used alcohol, powder cocaine, and crack cocaine in the previous 3 months, were likely to know their own viral load and CD4 count, and held significantly more negative views of their health care and their health care providers. There were no differences between untreated and treated persons in their meeting the year 1999 antiretroviral treatment guidelines that were in effect at the time of data collection. These results suggest that persons who are not receiving antiretroviral medications may be in need of mental health and substance use interventions and may benefit from interventions designed to engage and retain them in medical treatment.