HHS News Women with AIDS receive fewer services than men with AIDS Women and adolescent girls infected with the human immunodeficiency virus (HIV) receive fewer medical services, such as medications, hospital admissions, and outpatient visits, than similarly diagnosed men, according to Fred J. Hellinger, Ph.D., author of a new study by the Agency for Health Care Policy and Research. In particular, an asymptomatic, HIV—infected female is 20 percent less likely to receive azidothymidine (AZT) than an asymptomatic, HIV infected male. Moreover, a female with acquired immunodeficiency syndrome (AIDS) is 20 percent less likely than a male injection drug user to be hospitalized for AI.DS-related conditions. This suggests that a female with AIDS incurs less costs for hospital services than a male injection drug user with AIDS. ‘According to Dr. Hellinger, it is unclear why females with AIDS receive fewer health services than males with AIDS, even after adjusting for income, race, insurance and geographic differences. To some extent, this finding may simply reflect the fact that women have more child care and other family—related responsibilities, but discrimination against women with HIV could be another factor, he notes. The data were collected during a 3-month period in 1991 from 1,949 adolescents and adults with HIV infection, of whom 66 percent had not progressed to an AIDS diagnosis. The study uses data from the AIDS Cost and Services Utilization Survey (ACSUS), which provides a comprehensive data base on the types and cost of medical care services used by persons with HIV infection. According to Dr. Hellinger, prior to ACSUS, the vast majority of research into the cost of treating persons with HIV infection related only to persons with AIDS. (For more information, see The use of health services by women with HIV infection, by Dr. Hellinger, which appears in the December, 1993 issue of Health Services Research Ph sicians find care of HIV pa Ients Rewarding, yet continue to fear contagion To determine physicians’ perceptions of caring for patients infected with the human immunodeficiency virus (HIV), Ronald M. Epstein, M.D., and his colleagues at the University of Rochester and Highland Hospital, interviewed 30 predominantly male, community-based primary care physicians in six Northeast cities who had treated at least two HIV-infected patients within the previous 2 years. The researchers report their findings in two reports, which were supported by the Agency for Health Care Policy and Research Although primary care physicians in general believe they are at low risk of contracting HIV from their patients, for some the fear of contagion takes a high emotional toll, according to Dr. Epstein and his colleagues. For many of the physicians interviewed, conflicts between HOWDEN COTTAGE ljeficgl G lfiéikfast Continental - No Smoking - By Reservation Only 32 No. Champlain St. - Burlington, VT 05401 Bruce M. Howden - Proprietor - 802 864-7198. 11 April 1994 fear of contagion, ethical responsibilities as physicians, a desire to “be there” for patients, and family concerns about their work with HIV-infected patients, create intense personal dilemmas. Although all of the physicians in this study assessed their risk of contracting HIV as very low, all but one spontaneously mentioned some fear about contracting HIV through treating patients. Most of the physicians took appropriate precautions to prevent exposure to blood and body fluids. Some, however, reported excessive handwashing, double—gloving to look inside the mouth of an HIV patient, and frequent testing for HIV antibodies, despite the lack of significant exposure to a patient‘s blood or body fluids. Still others denied the risk of contracting HIV and took inconsistent or no precautions, even though they described medicine as a high-risk profession., “This study confirms the existence of significant anxiety about HIV contagion in the clinical workplace, even among practicing physicians who do very few invasive procedures”, Epstein. V concludes Dr.