• P Todd Korthuis, Somnath Saha, John A Fleishman, Moriah McSharry McGrath, Joshua S Josephs, Richard D Moore, Kelly A Gebo, James Hellinger, Mary Catherine Beach, and HIV Research Network.
• Department of Medicine, Oregon Health and Science University, Portland, OR 97239-3098, USA. korthuis@ohsu.edu
• J Gen Intern Med. 2008 Dec 1; 23 (12): 2046-52.

BackgroundPatient-centered care--including the domains of access and communication--is an important determinant of positive clinical outcomes.ObjectiveTo explore associations between race and HIV-infected patients' experiences of access and communication.DesignThis was a cross-sectional survey.ParticipantsNine hundred and fifteen HIV-infected adults receiving care at 14 U.S. HIV clinics.MeasurementsDependent variables included patients' reports of travel time to their HIV care site and waiting time to see their HIV provider (access) and ratings of their HIV providers on always listening, explaining, showing respect, and spending enough time with them (communication). We used multivariate logistic regression to estimate associations between patient race and dependent variables, and random effects models to estimate site-level contributions.ResultsPatients traveled a median 30 minutes (range 1-180) and waited a median 20 minutes (range 0-210) to see their provider. On average, blacks and Hispanics reported longer travel and wait times compared with whites. Adjusting for HIV care site attenuated this association. HIV care sites that provide services to a greater proportion of blacks and Hispanics may be more difficult to access for all patients. The majority of patients rated provider communication favorably. Compared to whites, blacks reported more positive experiences with provider communication.ConclusionsWe observed racial disparities in patients' experience of access to care but not in patient-provider communication. Disparities were explained by poor access at minority-serving clinics. Efforts to make care more patient-centered for minority HIV-infected patients should focus more on improving access to HIV care in minority communities than on improving cross-cultural patient-provider interactions.

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