This paper reports on community-based service use by persons with AIDS or disabling HIV (PWAs) who have an informal caregiver, with specific focus on four categories of service: nursing care; practical help; psychological services; and help with the management of personal affairs. Data are drawn from a large-scale community-based survey of caregivers in San Francisco and Los Angeles (n = 642). Caregivers report that PWAs make substantial use of community-based support: 85% use at least one service; half or more use psychological services (51%) and practical help (61%). Multivariate logistic regression models fit for each of the four categories of service use include bothPWA and caregiver characteristics as determinants, applying the widely recognized Andersen model. Our analytic models best fit nursing care and practical help outcomes and portray the complexity inherent in Andersen's framework. Correlates of service use vary by service type, illustrating the need to further study the fullest possible array of community-based services. Alongside traits of the PWA, caregiver characteristics are found to be important determinants of PWA service use, highlighting the relevance of informal caregiving to the larger system of AIDS care.
Allen, S. M. (1994). Gender differences in spousal caregiving and unmet need for care . Journal of Gerontology: Social Sciences, 49(4), S187–S195 .
2.
Andersen, R. M. (1995). Revisiting the behavioral model and access to medical care: Does it matter?Journal of Health and Social Behavior, 36, 1–10 .
3.
Andrews, R. M. , Keyes, M. A. , Fanning, T. R. and Kizer, K. W. (1991). Lifetime medicaid service utilization and expenditures for AIDS in New York and California . Journal of Acquired Immune Deficiency Syndrome, 4(10), 1046–1058 .
4.
Arno, P. S. (1986). The nonprofit sector's response to the AIDS epidemic: Community-based services in San Francisco . American Journal of Public Health, 76(11), 1325–1330 .
5.
Bass, D. M. and Noelker, L. S. (1987). The influence of family caregivers on elder's use of in-home services: An expanded conceptual framework . Journal of Health and Social Behavior, 28, 184–196 .
6.
Bass, D. M. , Looman, W. J. and Ehrlich, P. (1992). Predicting the volume of health and social services: Integrating cognitive impairment into the modified Andersen framework . The Gerontologist, 32, 33–43 .
7.
Benjamin, A. E. (1989). Perspectives on a continuum of care for persons with HIV illness . Medical Care Review, 46(4), 411–437 .
8.
Berk, R. A. (1995). Use of primary caretakers as proxies to measure the health care needs of patients with AIDS . Public Health Nursing, 12(2), 109–116 .
9.
Bowling, A. , Farquhar, M. and Browne, P. (1991). Use of services in old age: Data from three surveys of elderly people . Social Science and Medicine, 33(6), 689–700 .
10.
Burton, L. , Kasper, J. , Shore, A. , Cagney, K. , LaVeist, T. , Cubbin, C. and German, P. (1995). The structure of informal care: Are there differences by race?The Gerontologist, 35(6), 744–752 .
11.
Choi, Namkee G. (1994). Patterns and determinants of social service utilization: Comparison of the childless elderly and elderly parents living with or apart from their children . The Gerontologist, 34(3), 353–362 .
12.
Counte, M. A. and Glandon, G. L. (1991). A panel study of life stress, social support, and the health services utilization of older persons . Medical Care, 29, 348–361 .
13.
Derogatis, L. R. , Lipman, R. S. , Rickels, K. , Uhlenhuth, E. H. and Covi, L. (1974). The Hopkins symptom checklist (HSCL): A self-report symptom inventory . Behavioral Science, 19, 1–15 .
14.
Ettner, S. L. and Weissman, J. (1994). Utilization of formal and informal home care by AIDS patients in Boston: A comparison of intravenous drug users and homosexual males . Medical Care, 32(5), 459–470 .
15.
Fleishman, J. A. , Hsia, D. C. and Hellinger, F. J. (1994). Correlates of medical service utilization among people with HIV infection . Health Services Research, 29(5), 527–548 .
16.
Fleishman, J. A. and Mor, V. F. (1993). Insurance status among people with AIDS: Relationships with sociodemographic characteristics and service use . Inquiry, 30(2), 180–188 .
17.
Hammer, M. (1983). ‘Core’ and ‘extended’ social networks in relation to health and illness . Social Science and Medicine, 17, 405–411 .
18.
Hellinger, F. J. (1993). The use of health services by women with HIV infection . Health Services Research, 28(5), 543–561 .
19.
Horwitz, A. V. and Reinhard, S. C. (1995). Ethnic differences in caregiving duties and burdens among parents and siblings of persons with severe mental illnesses . Journal of Health and Social Behavior, 36, 138–150 .
20.
Howell, E. M. and Pine, P. (1991). Overview of the HCFA study of cost and utilization of AIDS services in California and New York . Journal of Acquired Immune Deficiency Syndromes, 4(10), 101–114 .
21.
Johnston, D. , Smith, K. and Stall, R. (1994). A comparison of public health care utilization by gay men and intravenous drug users with AIDS in San Francisco . AIDS Care, 6(3), 303–316 .
22.
Katz, S. , Ford, A. B. , Moskowitz, R. W. , Jackson, B. A. and Jaffe, M. W. (1963). Studies of illness in the aged: The index of ADL, a standardized measure of biological and psychosocial function . Journal of the American Medical Association, 185, 914–919 .
23.
Kelly, J. J. , Chu, S. Y. , Buehler, W. and the AIDS Mortality Project Group (1993). AIDS deaths shift from hospital to home . American Journal of Public Health, 83, 1433–1437 .
24.
Kelly, J. V. , Ball, J. K. and Turner, B. J. (1989). Duration and costs of AIDS hospitalizations in New York. Variations by patient severity of illness and hospital type . Medical Care, 27(12), 1085–1098 .
25.
Kiyak, H. A. , Teri, L. and Borson, S. (1994). Physical and functional health assessment in normal aging and in Alzheimer's disease: Self-reports vs family reports . The Gerontologist, 34(3), 324–330 .
26.
Lasher, A. T. and Ragsdale, D. (1989). The significant other's role in improving quality of life in persons with AIDS dementia complex . Journal of Neuroscience Nursing, 21, 250–255 .
27.
Lawton, M. P. and Brody, E. M. (1969). Assessment of older people: Selfmaintaining and instrumental activities of daily living . The Gerontologist, 9, 179–186 .
28.
LeBlanc, A. J. , Aneshensel, C. S. and Wight, R. W. (1995). Psychotherapy use and depression among AIDS caregivers . Journal of Community Psychology, 23, 127–142 .
29.
LeBlanc, A. J. , London, A. S. and Aneshensel, C. S. (1997). The physical costs of AIDS caregiving . Social Science and Medicine, 45, 915–923 .
30.
Logan, J. R. and Spitze, G. (1994). Informal support and the use of formal services by older Americans . Journal of Gerontology: Social Sciences, 49(1), S25–S34 .
31.
London, A. S. , LeBlanc, A. J. and Aneshensel, C. S. (1998). The integration of informal care, case management, and community-based services for persons with HIV/AIDS. AIDS Care(in press).
32.
Mechanic, D. (1979). Correlates of physician utilization: why do major multivariate studies of physician utilization find trivial psychosocial and organizational effects?Journal of Health and Social Behavior, 20, 387–396 .
33.
Meyer, M. H. and Pavalko, E. K. (1996). Family, work, and access to health insurance among mature women . Journal of Health and Social Behavior, 37(4), 311–325 .
34.
Miller, B. and McFall, S. (1991) The effect of caregiver's burden on change in frail older persons' use of formal helpers . Journal of Health and Social Behavior, 32, 165–179 .
35.
Moore, R. D. , Stanton, D. , Gopalan, R. and Chaisson, R. E. (1994). Racial differences in the use of drug therapy for HIV disease in an urban community . New England Journal of Medicine, 330(11), 763–768 .
36.
Mor, V. , Fleishman, J. A. , Dresser, M. and Piette, J. (1992). Variation in health service use among HIV-infected patients . Medical Care, 30(1), 17–29 .
37.
Morrison, C. (1993). Delivery systems for the care of persons with HIV infection and AIDS . Nursing Clinics of North America, 28(2), 317–333 .
38.
Mullan, J. T. (1993). Barriers to the use of formal services among Alzheimer's caregivers. In S. H. Zarit , L. I. Pearlin and K. Warner Schaie (Eds.), Caregiving systems: Informal and formal helpers, pp. 241–260. Hillsdale, NJ: Lawrence Erlbaum Associates .
39.
Pearlin, L. I. , Aneshensel, C. S. and LeBlanc, A. J. (1997). The forms and mechanisms of stress proliferation: The case of AIDS caregivers . Journal of Health and Social Behavior, 38, 223–236 .
40.
Pearlin, L. I. , Mullan, J. T. , Aneshensel, C. S. , Wardlaw, L. and Harrington, C. (1994). The structure and functions of AIDS caregiving relationships . Psychosocial Rehabilitation Journal, 17(4), 51–67 .
41.
Penning, M. J. (1995) Health, social support and the utilization of health services among older adults . Journal of Gerontology: Social Sciences, 50B(5), S330–S339 .
42.
Penrod, J. D. , Kane, R. A. , Kane, R. L. and Finch, M. D. (1995). Who cares? The size, scope and composition of the caregiver support system . The Gerontologist, 35(4), 489–497 .
43.
Piette, J. D. , Fleishman, J. A. , Stein, M. D. , Mor, V. and Mayer, K. (1993). Perceived needs and unmet needs for formal services among people with HIV disease . Journal of Community Health, 18(1), 11–23 .
44.
Raveis, V. H. and Siegel, K. (1991). The impact of caregiving on informal or familial caregivers . AIDS Patient Care, February, 39–43 .
45.
Rundall, T. G. (1981). A suggestion for improving the behavioral model of physician utilization . Journal of Health and Social Behavior, 22(1), 103–104 .
46.
Seage, G. R. , Hertz, T. , Stone, V. E. and Epstein, A. M. (1993). The effects of intravenous drug use and gender on the cost of hospitalization for patients with AIDS . Journal of Acquired Immune Deficiency Syndromes, 6(7), 831–839 .
47.
Seeman, T. E. , Bruce, M. L. and McAvay, G. J. (1996). Social network characteristics and onset of ADL disability: MacArthur studies of successful aging . Journal of Gerontology: Social Sciences, 51B, S191–S200 .
48.
Seltzer, B. and Buswell. A. (1994). Psychiatric symptoms in Alzheimer's disease: Mental status examination versus caregiver report . The Gerontologist, 34(1), 103–109 .
49.
Stein, M. D. , Piette, J. , Mor, V. , Wachtel, T. J. , Fleishman, J. , Mayer, K. H. and Carpenter, G. C. (1991). Differences in access to zidovudine (ZDV) among symptomatic HIV-infected persons . Journal of General Internal Medicine, 6, 35–40 .
50.
Stoller, E. P. and Pugliesi, K. L. (1991). Size and effectiveness of informal helping networks: A panel study of older people in the community . Journal of Health and Social Behavior, 32, 180–191 .
51.
Sussman, M. (1976). The family life of old people. In R. Binstock and E. Shanas (Eds.), Handbook of aging and the social sciences, pp. 218–243. New York: Van Nostrand Reinhold .
52.
Tennstedt, S. L. , Crawford, S. and McKinlay, J. B. (1993). Determining the pattern of care: Is co-residence more important than caregiver relationship?Journal of Gerontology: Social Sciences, 48(2), S74–S83 .
53.
Tramarin, A. , Campostrini, S. , Tolley, K. and De Lalla, F. (1997). The influence of socio-economic status on health service utilization by patients with AIDS in North Italy . Social Science and Medicine, 45(6), 859–866 .
54.
Turner, H. A. , Catania, J. A. and Gagnon, J. (1994). The prevalence of informal caregiving to persons with AIDS in the United States: Caregiver characteristics and their implications . Social Science and Medicine, 38(11), 1543–1552 .
55.
Velentgas, P. , Bynum, C. and Zierler, S. (1990). The buddy volunteer commitment in AIDS care . American Journal of Public Health, 80(11), 1378–1380 .
56.
Ward, R. A. , Sherman, S. and LaGory, M. (1984). Informal networks and knowledge of services for older persons . Journal of Gerontology, 39, 216–223 .
57.
Wardlaw, L. A. (1994). Sustaining informal caregivers for persons with AIDS . Families in Society, June, 373–384 .
58.
Wight, R. G. , LeBlanc, A. J. and Aneshensel, C. S. (1995). Support service use by persons with AIDS and their caregivers . AIDS Care, 7(4), 509–520 .
59.
Wolinsky, F. D. and Johnson, R. J. (1991). The use of health services by older adults . Journal of Gerontology: Social Sciences, 46, S345–S357 .
