Abstract

Exclusion to health care and HIV treatment: an exploratory approach in Dominican Republic

T. Azeredo, V.L. Luiza, I. Emmerick, E. Oliveira

National School of Public Health Sergio Arouca (ENSP/Fiocruz), Nucleus for Pharmaceutical Policies (NAF), Rio de Janeiro, Brazil

Background: Health exclusion can be defined as the lack of access to goods or services that improve or protect people's health suffered by some specific groups in a society. Methodological approaches to address access to care in excluded or vulnerable groups, particularly PWHA, could guide the definition of strategies and policies to promote equity and improve quality of life. Through documental review on LAC countries followed by country exploratory visit, the Dominican Republic (DR) presented favourable conditions for the development of such a study, because there are good information sources and organized efforts to face the epidemic, although treatment coverage is still small. The aim of this study is to identify the determinants of exclusion to Aids related healthcare services in DR.
Methods: Bi and multi-variate analyses of secondary data from a household survey. Dependent variables are related to utilization of healthcare (diagnosis of HIV; tests results); independent ones are socio-demographic, economic and other explanatory variables.
Results: Exclusion is characterized when there are greater discrepancies in dependent variables between groups. Women are more prone to undergo testing than men; married status is also a very protective variable, favouring diagnosis. Regional variation is an important result for policy decision and regional differences in chances for diagnosis are doubled between some regions. Almost 90% of people tested received results, which was considered a good outcome, in light of reported problems in DR. Asymmetric outcomes because of regional differences also occur when the issue is the delivery of results.
Conclusions: Methods employed in recognizing asymmetries in healthcare use could help explain exclusion to healthcare services for AIDS in DR. The main advantage of using secondary databases is the lower resource consumption. Challenges to be addressed comprehend the incompleteness and the inadequacy of important variables as well as the demand for specialized analytical capacity.
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