Assessing the needs for HIV medical care in Hawai'i.

To assess HIV medical care needs in Hawai'i, data was collected through surveys of both providers and consumers, from insurance companies, from the Department of Health, and from key programs who serve the HIV-infected population. HIV care in Hawai'i is provided through a mix of private, public and charitable sources, with most ancillary services provided separately by AIDS Service Organizations. Private providers with a specialty in HIV care are not being replaced at the rate which they retire or depart. Heavy reliance on public assistance to pay for care and patient characteristics such as substance abuse, limit choice of providers for some patients. Institutions are playing a greater role in filling patient care needs. It was found that most patients in care are highly satisfied with their care providers. People living with HIV who are not in care are likely to have multiple challenges which affect access to care such as homelessness, poverty, low levels of education, being of Asian Pacific Islander ethnicity, and receiving public assistance. Those who adhere to their medication are most likely to be employed and to have received counseling by a pharmacist, while those who are from Hawai'i and who were infected through injection drug use are less likely to be adherent. Supporting more than one provider option and linking with ancillary services may help keep HIV patients in care.