Background:
Retention in HIV medical-care is associated with improved health outcomes and helps limit HIV transmission because patients can be educated on ways to modify risky behaviors

Objective:
To identify characteristics of South Carolina's (SC) adult HIV-infected population associated with HIV medical-care status in 2004.

Method:
Characteristics of all HIV-infected adults reported to the HIV/AIDS Reporting System (HARS) database who were alive on December 31st, 2003 was used in a cross-sectional study design. Reporting of HIV laboratory markers is mandatory by law and in HIV medical-care was defined as receipt of a viral load or CD4 cell count during calendar year 2004. Logistic regression was used to estimate relationships between care status and demographic and transmission factors.

Result:
Of the 13,042 HIV-infected adults, 7,303 (56%) were not in HIV medical-care in 2004. Individuals more likely to be in care were: African-Americans (OR 1.21, 95%CI: 1.10, 1.33) compared with Whites and females (OR 1.39, 95%CI: 1.26, 1.54) compared with males. Individuals less likely to be in care were: persons 25-34 years old (OR 0.71, 95%CI: 0.61, 0.83) compared to those 55 years or older; men who have sex with men (MSM)/intravenous drug users (IDU) (OR 0.73, 95%CI: 0.58, 0.91), IDU only (OR 0.76, 95%CI: 0.67, 0.87), and persons with no identifiable risk (OR 0.60, 95%CI: 0.54, 0.67) compared to those reporting heterosexual contact as their mode of transmission.

Conclusion:
This population-based study shows that a high percentage of SC's adult HIV-infected population is not in HIV medical-care. Both decreasing mortality and controlling the HIV epidemic will not be successful in SC unless these individuals are brought into HIV medical care.

Implications:
Future research is needed to identify reasons why HIV-infected adults remain out of HIV care and policy should focus on methods to enhance linkage and retention in care.