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Although antenatal HIV testing has
been a standard of care for pregnant Colombian women since 2000, a survey of
10,596 women revealed that only 35 percent of women who received antenatal care
between 2000 and 2005 had an HIV test. Of the 10,596 women surveyed, 26 percent
had insurance with their employer (contributory), 34 percent had
government-subsidized insurance, and 31 percent had no insurance. Eight percent
had other forms of insurance.
Subsidized insurance, a healthcare
reform measure, was intended to increase access to care for poor people.
However, study authors reported that the women with subsidized care were much
less likely than women with contributory health insurance or those with no
insurance to see a doctor during antenatal visits. The subsidized care group
was also 18 percent less likely to receive antenatal HIV testing.
Allison Ettenger, a study author,
attributed the lower HIV testing rates among women with subsidized insurance to
approval mechanisms and structural barriers built into the subsidized program.
For example, women with subsidized insurance were required to travel to the
health management organization that enrolled them in the program to give
in-person written consent for HIV testing, which presented financial and time
challenges. In contrast, women with no insurance did not have this requirement.
Study authors recommended additional
research to identify effects of subsidized insurance on access to preventive and
primary services and potential means to eliminate structural and approval
mechanism barriers.
The full report, “Health Insurance
for the Poor Decreases Access to HIV Testing in Antenatal Care: Evidence of an
Unintended Effect of Health Insurance Reform in Colombia,” was published online
in the journal Health Policy and Planning (2013; doi: 10.1093/heapol/czt021).
The Friends of AIDS Foundation is
dedicated to enhancing the quality of life for HIV positive individuals and
empowering people to make healthy choices to prevent the spread of the HIV
virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.
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