of private physicians are seeing the vast majority of persons with HIV disease. The public sector is similarly constrained.
A related issue is the availability of dental care for persons with HIV disease in many communities across the country. The topic of access to dental care has been hotly debated for several years. Thus, it is difficult to separate access barriers due to fear of spreading the disease from the low levels of access to dental care in this population (Capilouto et al., 1991; Neidle, 1989; Vercusio et al., 1989).
Despite these concerns for the future, the gap in availability of medical and nursing care was not given the highest priority among health and social service providers in RWJF-funded communities. More important, they felt, was the absence of housing and inadequate funding for home nursing, attendant services, and subacute long-term care facilities. Future demand for health services, and its potential for compromising access by outstripping the existing supply of physicians and clinic slots, will have to be carefully monitored and probably will vary considerably from community to community and by risk group.
This category of barriers includes those factors traditionally associated with differential access, regardless of disease or age—for example, education, ethnicity, or income. Historically, these factors have been shown to influence the behavior of providers in treating patients and the ability of patients to adhere to a prescribed treatment regimen. These personal characteristics tend to be correlated with socioeconomic status, making it difficult to disentangle the effects of personal characteristics from the effects of living in a particular neighborhood, the lack of insurance coverage, and reliance on public medical resources for medical care.
One clear indicator of access to care is whether infected individuals who should be receiving a given therapy are actually receiving it. Holmberg and colleagues (1990) found that as many as half of all AIDS patients were not receiving aerosolized pentamidine when it was the therapy of choice. In the RWJF AHSP evaluation sample, among those eligible to receive aerosolized pentamidine, men were four times as likely as women to have received it. This finding held true after controlling for disease duration, drug use, and insurance status, all of which were also significantly related to treatment (Piette et al., in press). Hidalgo and colleagues (1990) also found a surprisingly small number in the Maryland Medical or Pharmacy Assistance program on pentamidine. Findings on who received the drug were similar to those in the RWJF study: those more likely to have received the drug were gay, white men.
Another drug known to be of benefit to persons with HIV disease is