The primary purpose of this study was to quantify sociodemographic differences in prescription-drug use among patients with HIV infection and to delineate the associated factors. The analysis of antiretroviral therapy was restricted for patients with CD4+ lymphocyte counts of 500 cells per cubic millimeter or less and the analysis of PCP prophylaxis was restricted to patients with CD4+ lymphocyte counts of 200 cells per cubic millimeter or less. The investigators also attempted to determine whether the patients’ use of antiretroviral therapy or PCP prophylaxis at the time of enrollment differed according to demographic characteristics.

The setting for this study was the John Hopkins Hospital AIDS Service, which provides long-term primary and subspecialty care for the majority of HIV-infected patients in the Baltimore metropolitan area. The cohort was predominantly male (69%) and black (79%), and injection-drug use was the primary mode of HIV transmission (47%). There were no differences among patients according to CD4+ lymphocyte count at presentation with respect to race or other characteristics, including insurance coverage, place of residence, annual income, and level of education.

The results indicated that “blacks were less likely than whites (48 vs. 63 percent) to have received any of the antiretroviral drugs (P=0.003)” as well as “significantly less likely than whites (58 vs. 82 percent) to have received prophylaxis for PCP at presentation (P<0.001).” When these results were analyzed with regard to race and other demographic characteristics, the racial disparities persisted, thus “suggesting that racial differences in drug therapy occur regardless of the patient’s other characteristics, including income, insurance status, mode of HIV transmission, and place of residence.” The logistic regression analysis found a relative odds of 0.59 (95% CI, 0.38 to 0.93) for the receipt of antiretroviral therapy by blacks versus whites and relative odds of 0.27 for the receipt of PCP prophylaxis (95% CI, 0.13 to 0.56) (P=0.02 and P<0.001, respectively). In the six-month follow-up, no racial differences in the use of antiretroviral or PCP prophylaxis were found.

The authors conclude that, in an HIV-infected urban cohort, “blacks were less likely than whites to have had either antiretroviral therapy or PCP prophylaxis prescribed before they came to our clinic for care. Because a provider may have prescribed a treatment for which the patient could not pay, it is notable that the data on insurance coverage and income did not explain this racial disparity. Nor did behavior such as injection-drug use, demographic characteristics such as sex and age, or socioeconomic factors such as the patient’s level of education and place of residence appear to explain the racial difference.”

Three potential explanations were offered by the investigators. First, there may be possible “misconceptions about HIV disease and AIDS” among blacks; second, “distrust of health authorities” may act as a barrier; and third, “another potential barrier to care for blacks relates to the prescribing habits of care providers.” The authors conclude, “there is evidence to suggest that the likelihood of a physician’s recommending a therapeutic regimen may be influenced by the patient’s race.” The data “indicate that among patients who identified a usual source of care, fewer blacks than whites received therapy. This is the case despite evidence indicating that there are probably no valid reasons for racial disparities in drug prescribing for HIV disease.”