Urban U.S. hospitals and the mission to provide HIV-related services: changes and correlates

In 1988, the vast majority of urban U.S. hospitals (84 percent) exhibited some formal response to the demand for HIV-related services. Despite the fact that HIV-related care is now normative in many respects and the demand for inpatient care has decreased, nearly half of hospitals surveyed in 1997 (42 percent) report no formalized service provision, suggesting a heightened distinction between hospitals in terms of their varying commitments to providing HIV-related services. Certain organizational variables (such as ownership, size, system affiliation, and stigmatized services and post-acute care services indices) were connected to HIV-related services provision. When the sample was controlled for other variables, the study found that changes in teaching status, changes in bed size, and changes in post-acute services from 1988 to 1997 did influence the provision of HIV-related services. Despite significant changes over the study period in the treatment of persons living with HIV/AIDS, and structural changes in the delivery of U.S. healthcare, the organizational-level predictors of HIV-related service provision have remained remarkably stable among U.S. hospitals in urban settings. These data also suggest that organizational missions consistent with serving indigent and socially marginalized populations continue to influence the ways that the pluralistic U.S. hospital system organizes HIV-related care.