May 12, 2003
Canadian prevalence estimates for CAM use ranged from 15 percent to 52 percent between 1996 and 1997, an increase of approximately 20 percent since 1992 estimates. Out-of-pocket expenditures for 1996-1997 were estimated at CAD$3.8 billion (US$2.4 billion). In both Canada and the United States, increased utilization rates have been disproportionately reported by women, persons ages 25-40, people with higher socioeconomic status, income greater than US$50,000 or CAD$60,000, and those with a university education.
Reported CAM utilization rates are generally higher in special populations, including patients infected with HIV. Between 30 percent and 100 percent of patients with HIV in the United States and 18 percent to 39 percent of patients with HIV in Canada use some form of CAM. The present study was designed to determine the prevalence of CAM use by patients attending HIV clinics in Ontario, Canada, and to identify ways in which users and nonusers of CAM differed in relation to demographic and clinical characteristics, including use of conventional medications. Comparisons were also made to assess the impact of the CAM definition on reported utilization. Average monthly expenditures for CAM and the rate of CAM reporting to the physician managing HIV care were also evaluated.
The authors conducted a cross-sectional survey of a sample of 104 HIV-positive patients who were enrolled in the HIV Ontario Observational Database (HOOD) project and who attended one of nine hospital-based HIV outpatient clinics in Ontario between 1999 and 2001. The HOOD project was designed to collect observational information on the clinical profile of individuals with HIV/AIDS in Ontario. Approximately 25 percent of the Ontario HIV population was enrolled in the HOOD project between February 1995 and 2002. In-person interviews were conducted. Self-reported CAM utilization and demographic data were collected. Patients also provided reasons for use and physician awareness of use. Clinical data were obtained from the medical chart.
Depending on the definition used for CAM, the prevalence of CAM use varies from 38 percent to 89 percent in this study. Predictors of CAM use also vary with CAM definition and include female gender, higher education, unemployment, higher viral load, and HIV risk group. The use of greater number of prescription and nonprescription drugs is also associated with the use of CAM. Problems remain in the interpretation and inclusion of various health activities and practices as CAM. One may question whether exercise, diet and other health promotion strategies should be considered CAM. These and other questions must be answered before a true idea of the prevalence and predictors of CAM use can be addressed in the HIV population or the population as a whole.
AIDS Patient Care and STDs
04.03; Vol. 17, No. 4, P. 155-168; Michelle D. Furler, B.Sc.Pharm.; Thomas R. Einarson, Ph.D.; Sharon Walmsley, M.D.; Margaret Millson, M.D., M.H.Sc.; Reina Bendayan, Pharm.D.