Human immunodeficiency virus diagnosis and care among adults with intellectual and developmental disabilities who are publicly insured.
Adults with IDD are almost never tested for HIV and Black clients face the worst follow-up care.
01Research in Context
What this study did
The team looked at Medicaid records for 1.3 million adults with intellectual or developmental disabilities.
They counted how many got an HIV test in 2018-19.
They also checked who was later diagnosed with HIV and who started treatment.
What they found
Only 1 in the adults got tested. That is 0.12 percent.
Black adults were twice as likely to test positive but less likely to get follow-up care.
Once diagnosed, most people waited months for their first HIV clinic visit.
How this fits with other research
Patton et al. (2020) saw the same pattern with medication harm. Adults with IDD landed in the hospital 28 % more often after drug errors.
Doughty et al. (2015) found these same adults face extra surgery risks. Together the three papers show a wide gap in everyday medical care.
McGeown et al. (2013) gives hope. Special forensic ID teams fixed criminogenic needs better than generic services. The lesson: tailored protocols can close gaps when someone chooses to use them.
Why it matters
If you serve adults with IDD, add HIV screening to your annual wellness checklist. A simple blood test can catch a silent infection early and stop further health gaps.
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02At a glance
03Original abstract
BACKGROUND: This study aimed to assess the prevalence of human immunodeficiency virus (HIV) testing, HIV diagnosis and receipt of HIV care among adults with intellectual and developmental disabilities (IDDs) who are publicly insured in the USA. DESIGN: This study is a cross-sectional analysis of Medicare-Medicaid linked data of adults with IDD who were publicly insured in 2012 (n = 878 186). METHODS: We estimated adjusted prevalence ratios of HIV testing, diagnosis and receipt of antiretroviral therapy (ART). We also identified the relationship between predisposing (age, gender, race and ethnicity), enabling (Medicare, Medicaid or both; rural status; geographical location; and county income) and need-related characteristics (IDD diagnosis and other co-occurring conditions) associated with these outcomes. RESULTS: Only 0.12% of adults with IDD who had no known HIV diagnosis had received an HIV test in the past year. The prevalence of HIV diagnosis among adults with IDD was 0.38%, although differences by type of IDD diagnosis were observed. Prevalence of HIV diagnosis differed by type of IDD. Among adults with IDD who were living with HIV, approximately 71% had received ART during 2012. The adjusted analyses indicate significant racial disparities, with Black adults with IDD making up the majority (59.11%) of the HIV-positive IDD adult population. CONCLUSIONS: Adults with IDD are a unique priority population at risk for HIV-related disparities, and the level of risk is differential among subtypes of IDD. People with IDD, like other people with disabilities, should be considered in prevention programming and treatment guidelines to address disparities across the HIV care continuum.
Journal of intellectual disability research : JIDR, 2024 · doi:10.1111/jir.13099