AIDS and Behavior

, Volume 18, Issue 4, pp 776–782 | Cite as

Travel Distance to HIV Medical Care: A Geographic Analysis of Weighted Survey Data from the Medical Monitoring Project in Philadelphia, PA

  • M. G. EberhartEmail author
  • C. D. Voytek
  • A. Hillier
  • D. S. Metzger
  • M. B. Blank
  • K. A. Brady
Original Paper


Decisions regarding where patients access HIV care are not well understood. The purpose of this analysis was to examine differences in travel distance to care among persons receiving care in Philadelphia. A multi-stage sampling design was utilized to identify 400 potential participants. 65 % (260/400) agreed to be interviewed. Participants were asked questions about medical care, supportive services, and geographic location. Distances were calculated between residence and care location. 46.3 % travelled more than three miles beyond the nearest facility. Uninsured travelled further (6.9 miles, 95 % CI 3.9–9.8) than persons with public insurance (3.3 miles, 2.9–3.6). In multivariate analyses, no insurance (20/260) was associated with increased distance (p = 0.0005) and Hispanic ethnicity was associated with decreased distance (p = 0.0462). Persons without insurance travel further but insurance status alone does not explain the variability in distance travelled to care. In Philadelphia, Hispanic populations, and providers that may be most accessible to them, are spatially contained.


HIV/AIDS Travel distance Medical care Geographic information systems (GIS) Survey data 



The data collection and analysis for this manuscript was supported by the Centers for Disease Control and Prevention grant number 5U62PS001608, distributed as part of the Medical Monitoring Project (FOA PS09-937). Additional support for the collaboration between Philadelphia Department of Public Health and the University of Pennsylvania Center for AIDS Research was provided by Grant numbers AI-045008 and P30 AI 087714.


  1. 1.
    Allard SW, Tolman RM, Rosen D. Proximity to service providers and service utilization among welfare recipients: the interaction of place and race. J Policy Anal Manage. 2003;22(4):599–613.PubMedCrossRefGoogle Scholar
  2. 2.
    Billi JE, Pai CW, Spahlinger DA. The effect of distance to primary care physician on health care utilization and disease burden. Health Care Manage Rev. 2007;32(1):22–9.PubMedCrossRefGoogle Scholar
  3. 3.
    Huntington S, Chadborn T, Rice BD, Brown AE, Delpech VC. Travel for HIV care in England: a choice or a necessity? HIV Med. 2010;12:361–6.PubMedCrossRefGoogle Scholar
  4. 4.
    Korthuis PT, Saha S, Fleishman JA, et al. Impact of patient race on patient experiences of access and communication in HIV care. J Gen Int Med. 2008;23(12):2046–52.CrossRefGoogle Scholar
  5. 5.
    Leibowitz AA, Taylor SL. Distance to public test sites and HIV testing. Med Care Res Rev. 2007;64:568–84.PubMedCrossRefGoogle Scholar
  6. 6.
    Moneyham L, McLeod J, Boehme A, et al. Perceived barriers to HIV care among HIV-infected women in the deep south. J Assoc Nurses AIDS Care. 2010;21(6):467–77.PubMedCrossRefGoogle Scholar
  7. 7.
    Penniman TV, Taylor SL, Bird CE, Beckman R, Collins RL, Cunningham W. The associations of gender, sexual identity and competing needs with healthcare utilization among people with HIV/AIDS. J Nat Med Assoc. 2007;99(4):419–27.Google Scholar
  8. 8.
    Pierce SJ, Miller RL, Morales MM, Forney J. Identifying HIV prevention service needs of African American men who have sex with men: an application of spatial analysis techniques to service planning. J Public Health Manage Pract. 2007;January (Supp):S72–9.CrossRefGoogle Scholar
  9. 9.
    Higgs G. A literature review of the use of GIS-based measures of access to health care services. Health Serv Outcome Res Methodol. 2004;5:119–39.CrossRefGoogle Scholar
  10. 10.
    Bliss RL, Katz JN, Wright EA, Losina E. Estimating proximity to care: are straight line and zipcode centroid distances acceptable proxy measures? Med Care. 2012;50(1):99–106.PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Kaukinen C, Fulcher C. Mapping the social demography and location of HIV services across Toronto neighbourhoods. Health Soc Care Community. 2006;14(1):37–48.PubMedCrossRefGoogle Scholar
  12. 12.
    Caley LM. Using geographic information systems to design population-based interventions. Public Health Nurs. 2004;21(6):547–54.PubMedCrossRefGoogle Scholar
  13. 13.
    Dubowitz T, Williams M, Steiner ED, et al. Using geographic information systems to match local health needs with public health services and programs. Am J Public Health. 2011;101(9):1664–5.PubMedCentralPubMedCrossRefGoogle Scholar
  14. 14.
    Geanuracos CG, Cunningham SD, Weiss G, Forte D, Henry Reid LM, Ellen JM. Use of geographic information systems for planning HIV prevention interventions for high-risk youths. Am J Public Health. 2007;97(11):1974–81.PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    Miranda ML, Silva JM, Overstreet Galeano MA, et al. Building geographic information system capacity in local health departments: lessons from a North Carolina project. Am J Public Health. 2005;95(12):2180–5.PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    Whitman S, Silva A, Shah A, Ansel D. Diversity and disparity: GIS and small-area analysis in six Chicago neighbourhoods. J Med Syst. 2004;28(4):397–411.PubMedCrossRefGoogle Scholar
  17. 17.
    Kandwal R, Garg PK, Garg RD. Health GIS and HIV/AIDS studies: perspective and retrospective. J Biomed Inform. 2009;42:748–55.PubMedCrossRefGoogle Scholar
  18. 18.
    Law DCG, Serre ML, Christakos G, Leone PA, Miller WC. Spatial analysis and mapping of sexually transmitted diseases to optimize intervention and prevention strategies. Sex Transm Infect. 2004;80:294–9.PubMedCentralPubMedCrossRefGoogle Scholar
  19. 19.
    Ramani KV, Mavalankar D, Patel A, Mehandiratta S. A GIS approach to plan and deliver healthcare services to urban poor. Int J Pharm Healthcare Market. 2007;1(2):159–73.CrossRefGoogle Scholar
  20. 20.
    PDPH. AIDS Activities Coordinating Office (AACO) Surveillance Report (2010), HIV/AIDS in Philadelphia. 2011. Available at: Accessed 11 May 2013.
  21. 21.
    Blair JM, McNaghten AD, Frazier EL, Skarbinski J, Huang P, Heffelfinger JD. CDC Clinical and behavioral characteristics of adults receiving medical care for HIV infection—medical monitoring project, United States, 2007. MMWR Surveill Summ. 2011;60(11):1–20.PubMedGoogle Scholar
  22. 22.
    Frankel MR, McNaughton AD, Shapiro MF, et al. A probability sample for monitoring the HIV-infected population in care in the U.S. and in selected states. Open AIDS J. 2012;6:67–76.PubMedCentralPubMedCrossRefGoogle Scholar
  23. 23.
    Bamford L, Ehrenkranz P, Eberhart M, Shpaner M, Brady K. Factors associated with delayed entry into primary HIV medical care after HIV diagnosis. AIDS. 2010;24(6):928–30.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • M. G. Eberhart
    • 1
    Email author
  • C. D. Voytek
    • 2
  • A. Hillier
    • 3
  • D. S. Metzger
    • 2
  • M. B. Blank
    • 4
  • K. A. Brady
    • 1
  1. 1.AIDS Activities Coordinating OfficePhiladelphia Department of Public HealthPhiladelphiaUSA
  2. 2.Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaUSA
  3. 3.School of Social Policy and PracticeUniversity of PennsylvaniaPhiladelphiaUSA
  4. 4.Center for Mental Health Policy and Services ResearchUniversity of PennsylvaniaPhiladelphiaUSA

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