Transitions in insurance and employment among people with HIV infection

This article examines the extent to which people with HIV infection change their insurance and employment status over time and investigates the correlates of such changes. Data come from the AIDS Cost and Services Utilization Survey, which followed 1,949 HIV-infected adults over an 18-month period that began March 1, 1991. In the first interview, overall, 33% of respondents had private insurance; 40% had public coverage (i.e., Medicaid, Medicare, CHAMPUS); and 27% had no insurance. Among the subgroup with AIDS, corresponding figures were 32%, 54%, and 14%. Overall, 65% were unemployed; among those with AIDS, 82% were unemployed. Over the 18-month period, 23% of respondents reported a change in insurance status and 27% reported a change in employment status. Among those who began the study with private insurance, only 15% reported losing this coverage. Transitions from no insurance to public coverage occurred most frequently. Compared to those who began the study with AIDS, those who progressed to AIDS during the study period were more likely to experience a change in insurance (18% vs. 32%). Consistent with prior studies, public insurance plays a major role in financing care for people with HIV infection. Transitions from public coverage to no insurance may disrupt access to care.