July 10, 2003
While numerous studies have investigated complementary and alternative medicine (CAM) use among people infected with HIV, the prevalence of CAM use in this population remains somewhat uncertain. Previous estimates of CAM use (self-care and alternative therapist use combined) among people with HIV have ranged from 29 percent to 76 percent, with some researchers suggesting that people infected with HIV use CAM at substantially higher rates than people with other serious illnesses.
In the current study, the authors used data from the HIV Cost and Service Utilization Study (HCSUS), a nationally representative study of people receiving conventional medical care for HIV, to address some of the limitations and gaps in the existing literature on CAM use among people infected with HIV. Using this population-based sample, the authors focused on the use of alternative therapists (as opposed to CAM use more generally). The authors hypothesized that use of alternative therapists would be higher among whites, men, homosexuals, the better educated, and those with higher incomes. They hypothesized that use of alternative therapists would be more likely among people who have greater uncertainty about the efficacy of conventional HIV treatments, have experienced discrimination because of their HIV status, are better informed about HIV, have high interest in the personal management of their care and treatment, and have less trust in conventional medical providers.
HCSUS drew a nationally representative probability sample from a reference population that included HIV-infected adults age 18 or older who - during a predefined population definition period, from January 5, 1996, to February 29, 1996 -- in all but one metropolitan area, in which the start was delayed until March -- made at least one visit to a nonmilitary, nonprison medical provider (other than an emergency department) in the context of regular or ongoing care.
The study provided the first population-based estimates of the use of CAM provided by alternative therapists among people in care for HIV in the United States. Among people receiving regular medical care for HIV, 15.4 percent had seen an alternative therapist in the past six months. Additionally, 53.9 percent of those with at least one visit had five or fewer visits in six months. These estimates indicate that a sizeable minority of people who receive ongoing medical care for HIV also receive care from alternative providers.
The study results also indicate that several sociodemographic, clinical, and attitudinal variables are associated with the use of provider-based alternative care. Broadly consistent with the profile widely reported in the literature, multivariate logistic regression analyses indicated that the odds of using an alternative therapist were higher among whites, people who were gay/lesbian, had higher income, screened positive for depression, and wanted more information and decision involvement with their own care.
The study's results suggest a need to evaluate the extent to which care provided by medical and alternative care providers is coordinated, and whether care coordination varies across different types of providers. Additionally, further qualitative and quantitative examinations of how attitudinal factors shape the use of CAM in this population, and what sort of barriers prevent the use of particular types of alternative therapists, are needed. Thus, such information "will enable us to better understand the effects of CAM on treatment outcomes, foster the coordination of care, and enhance the potentially beneficial complementarity of mainstream and alternative care for HIV-infected people."
American Journal of Public Health
06.03; Vol. 93; No. 6: P. 980-987; Andrew S. London, Ph.D.; Carrie E. Foote-Ardah, Ph.D.; John A. Fleishman, Ph.D.; Martin F. Shapiro, M.D., Ph.D.