Reasons for Travelling to Clinics
posted: 09/12/2010
Most people with HIV in England live within 5km (3 miles) of a specialist HIV clinic, according to a new study. The average distance people travel to their clinic was 2.5km (just over 1.5 miles). However, fewer than 1 in 10 people with HIV use the clinic that is nearest to their home. Why do people travel to a clinic further away?
Researchers wanted to see how far people live from a HIV clinic, and understand why some people travel further than they have to for HIV care.
Choice and advice on chosing clinics
People have the right to choose which HIV clinic to use and the British HIV Association recommends people who require routine, uncomplicated care to use their local clinic, and that people with more complex needs should use a more specialised clinic.
Not much has been studied about travelling to HIV clinics in the UK, nor about the social, demographic or clinical characteristics associated with people's choices about travelling to a HIV clinic.
Over 46,000 people studied
To get a clearer understanding of clinic travel, researchers looked at data on 46,550 HIV-positive adults who received HIV care in England in 2007. They pinpointed the closest HIV clinic for each person. All clinics within 5km of a someone’s home are considered ‘local’.
They looked at the wealth in each person’s borough of residence, and the person’s ethnicity, HIV risk category, length of HIV diagnosis, and HIV treatment status.
What they found – urban and often poor
Most (66%) of the people were men and 50% were white. The great majority (95%) live in an urban area, and 42% live in an economically deprived area. Almost three-quarters (73%) were on HIV treatments.
The median distance travelled to their clinic was 2.5km; but this ranged from less than 1km to 80km (50 miles). People in London travelled less than everyone else (2km vs. 3.7km).
Clinic access is good: 81% live within 5km of a specialist HIV clinic, and 93% live within 10km.
In London people had an average choice of three clinics within 5km, but those living outside the capital average just one local clinic.
The average distance travelled by patients to their clinic was a little under 5km. Overall, 73% use a local clinic. However, only 9% used the clinic closest to where they lived.
Reasons for travelling further
Haemophilia - People who were infected with HIV by blood products (mainly haemophiliacs infected during an old UK blood scandal) were most likely to travel further (51%). “These patients may need to attend specialist services that are not provided locally,” comment the authors.
Urban – People living in urban areas were significantly more likely to attend a non-local clinic than those who live in rural areas (44% vs. 22%) – people in major towns and cities are more likely to have a local choice. People living in rural areas and smaller towns have less or no choice nearby. Travelling to the next clinic is also less practical.
Ethnicity - Black African and black Caribbean people were statistically rather less likely to travel beyond their local service than white people.
Length of diagnosis - How long people have been diagnosed also affected travelling distance. People who had been diagnosed for at least a year were 50% more likely to use a clinic over 5km away service than those diagnosed within the last year (27% vs. 20). The investigators suggest “this may be because patients may not become aware of the choices available to them until they have adjusted to their HIV diagnosis.”
Poverty - Wealth also significantly affects the choice of clinic. People who lived in the better areas were twice as likely as those living in the poorest districts to travel further for treatment (42% vs. 21%). The investigators suggest that “financial difficulty” may prevent some people from travelling to clinics further away. Another recent study showed that almost a third of people with HIV in the UK did not have enough money to meet their needs and that 10% had difficulty meeting travel costs.
Help with paying to travel
If you have a low income or are on benefits, you may have a right to help with the costs of travelling to your clinic. Here's information on help with hospital travel costs.
“Barriers to service choice are likely to related to poverty and unfamiliarity with the options for HIV care,” conclude the authors, “consequently, provision of local services remains vital.”
Source including reference details
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