Suchergebnisse

Compared with other developed countries, the United States has an inefficient and expensive health care system with poor outcomes and many citizens who are denied access.

This article examines how proximity to the nearest publicly funded test site affects HIV testing. Using a sample of 5,361 Los Angeles County adults, multinomial logit models estimated simultaneously the likelihood of (1) obtaining an HIV test in the prior 2 years, and (2) testing in a private physician's office, a publicly funded medical clinic, or in a nonmedical setting, such as a bar or bathhouse. Low-income Los Angeles residents rely on publicly funded sites for HIV testing. When public sites are more distant, poor individuals are less likely to use them and less likely to get tested. Distance from public sites does not affect HIV testing among the nonpoor. To encourage HIV testing among the groups where HIV is growing fastest, public health agencies must keep the time and money costs of HIV testing low.

Historically, California supplemented federal funding of HIV prevention and testing so that Californians with HIV could become aware of their infection and obtain lifesaving treatment. However, budget deficits in 2009 led the state to eliminate its supplemental funding for HIV prevention. We analyzed the impact of California's HIV resource allocation change between state fiscal years 2009 and 2011. We found that the number of HIV tests declined 19 percent, from 66,629 to 53,760, in local health jurisdictions with high HIV burden. In low-burden jurisdictions, the number of HIV tests declined 90 percent, from 20,302 to 2,116. New diagnoses fell from 2,434 in 2009 to 2,235 in 2011 (calendar years) in high-burden jurisdictions and from 346 to 327 in low-burden ones. California's budget crunch prompted state and local programs to redirect remaining HIV funds from risk reduction education to testing activities. Thus, the impact of the budget cuts on HIV tests and new HIV diagnoses was smaller than might have been expected given the size of the cuts. As California's fiscal outlook improves, we recommend that the state restore supplemental funding for HIV prevention and testing.

Historically, California supplemented federal funding of HIV prevention and testing so that Californians with HIV could become aware of their infection and obtain lifesaving treatment. However, budget deficits in 2009 led the state to eliminate its supplemental funding for HIV prevention. We analyzed the impact of California's HIV resource allocation change between state fiscal years 2009 and 2011. We found that the number of HIV tests declined 19 percent, from 66,629 to 53,760, in local health jurisdictions with high HIV burden. In low-burden jurisdictions, the number of HIV tests declined 90 percent, from 20,302 to 2,116. New diagnoses fell from 2,434 in 2009 to 2,235 in 2011 (calendar years) in high-burden jurisdictions and from 346 to 327 in low-burden ones. California's budget crunch prompted state and local programs to redirect remaining HIV funds from risk reduction education to testing activities. Thus, the impact of the budget cuts on HIV tests and new HIV diagnoses was smaller than might have been expected given the size of the cuts. As California's fiscal outlook improves, we recommend that the state restore supplemental funding for HIV prevention and testing.