HIV in Canada: A primer for service providers

Access to Healthcare

Key Points

  • Individual and system (or structural) level barriers impede access to healthcare.

Research suggests that some people living with HIV have problems accessing and navigating the healthcare system because of individual-level barriers due to personal circumstances (e.g., financial, mental health), as well as systems-level or structural barriers (e.g., geography, stigma, clinic hours).

These barriers can negatively impact the ability of some people to access healthcare. For example, refugees may experience systemic-level barriers in the form of lack of access to provincial healthcare coverage. People who use drugs may experience both individual- and systemic-level barriers in the form of mental illness, stigma and discrimination, and lack of providers experienced in the care of this population.

The ability to access healthcare may also depend on where you live in Canada. For example, people in rural communities may have fewer services available to them and may need more travel time or assistance to access healthcare services.

Sources

  1. Andersen R, Bozzette S, Shapiro M, et al. Access of vulnerable groups to antiretroviral therapy among persons in care for HIV disease in the United States. HCSUS Consortium. HIV Cost and Services Utilization Study. Health Services Research. 2000;35:389–416.
  2. Anderson KH, Mitchell JM. Differential access in the receipt of antiretroviral drugs for the treatment of AIDS and its implications for survival. Archives of Internal Medicine. 2000;160:3114–3120.
  3. Bayoumi A, Frescura L, Rachlis A, et al. Ethnic and Geographic Differences in Access to Free, Universally Accessible Genotypic Resistance Testing in Ontario, Canada [abstract]. International Conference on Urban Health. 2006; Amsterdam.
  4. Bindman AB, Osmond D, Hecht FM, et al. Multistate evaluation of anonymous HIV testing and access to medical care. Multistate Evaluation of Surveillance of HIV (MESH) Study Group. Journal of the American Medical Association. 1998;280:1416–1420.
  5. Carrieri MP, Moatti JP, Vlahov D, et al. Access to antiretroviral treatment among French HIV infected injection drug users: the influence of continued drug use. MANIF 2000 Study Group. Journal of Epidemiology and Community Health. 1999;53:4–8.
  6. Cronquist A, Edwards V, Galea S, et al. Health care utilization among young adult injection drug users in Harlem, New York. Journal of Substance Abuse. 2001;13:17–27.
  7. Cunningham WE, Hays RD, Ettl MK, et al. The prospective effect of access to medical care on health-related quality-of-life outcomes in patients with symptomatic HIV disease. Medical Care. 1998;36:295–306.
  8. Cunningham WE, Hays RD, Williams KW, et al. Access to medical care and health-related quality of life for low-income persons with symptomatic human immunodeficiency virus. Medical Care. 1995;33:739–754.
  9. Ebrahim SH, Anderson JE, Weidle P, et al. Race/ethnic disparities in HIV testing and knowledge about treatment for HIV/AIDS: United States, 2001. AIDS Patient Care & STDS. 2004;18:27–33.
  10. Knowlton AR, Hua W, Latkin C. Social support networks and medical service use among HIV-positive injection drug users: implications to intervention. AIDS Care. 2005;17:479–492.
  11. McKinney MM, Marconi KM, Cleary PD, et al. Delivering HIV services to vulnerable populations: an evaluation and research agenda. Public Health Reports. 2002;117:114–22.
  12. McKinney MM, Marconi KM. Delivering HIV services to vulnerable populations: a review of CARE Act-funded research. Public Health Reports. 2002;117:99–113.
  13. Montgomery JP, Gillespie BW, Gentry AC, et al. Does access to health care impact survival time after diagnosis of AIDS? AIDS Patient Care & STDS. 2002;16:223–231.
  14. Raboud JM, Abdurrahman ZB, Major C, et al. Nonfinancial factors associated with decreased plasma viral load testing in Ontario, Canada. Journal of Acquired Immune Deficiency Syndrome. 2005;39:327–332.
  15. Strathdee SA, Palepu A, Cornelisse PG, et al. Barriers to use of free antiretroviral therapy in injection drug users. Journal of the American Medical Association. 1998;280:547–549.