In a group of gay and bisexual men infected with the human immunodeficiency virus (HIV) who were more highly educated, better paid, and more likely to be insured than Americans on average, researchers found that factors other than race explained whether the men had health insurance and whether they used medical and dental services.

HIV-infected whites, however, were more likely to use so-called discretionary outpatient services, such as doctor visits, when they had a minimum of symptoms. Whites were also more likely to use dental services, although blacks were more likely to have dental insurance. The study, by researchers at the Johns Hopkins School of Public Health, appeared in the January 19, 1999, issue of The Journal of the Acquired Immunodeficiency Syndromes (JAIDS).

Lead author Nancy Kass, ScD, associate professor, Health Policy and Management, Johns Hopkins School of Public Health, and Bioethics Institute, said, "Since most of these men were highly educated, highly insured, and earned medium to high incomes, we must conclude that their differences in using these services can be explained by other influences, such as environmental, social, and psychological factors."

The authors speculated that black men at early stages of infection may have chosen to forego discretionary services because they wished to hide their infection from peers, did not feel the need to seek services as readily as whites, trusted less in biomedical institutions, or felt less welcomed by the health care system.

The scientists also stressed that race and class, while often correlated, do not measure the same thing, so that it is important for researchers to be precise when using race as a variable in health services and epidemiologic research, emphasizing when racial differences truly exist as opposed to when the variable "race" is a surrogate for another factor. "There are instances when race is the true predictor of differences in
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Contact: Kathi Moore
paffairs@jhsph.edu
410-955-6878
Johns Hopkins University Bloomberg School of Public Health
19-Jan-1999