Hepatitis and HIV risk among drug-using men who have sex with men: Demonstration of Hart's law of inverse access and application to HIV

David G. Ostrow, Peter A Vanable, David J. McKirnan, Lauren Brown

Research output: Contribution to journalArticle

6 Scopus citations


Objectives: The first 215 drug-using men who have sex with men (DU-MSM) evaluated for possible participation in a controlled behavioral intervention study were tested for 'Hart's law of inverse access,' which predicts that access to prevention resources varies inversely to need. Methods: Hepatitis B vaccination, mental health, and substance abuse treatment were used to measure health resource use; hepatitis B (HBV) and HIV infections and unsafe sex measured preventive care needs. Socioeconomic status indicators included education, ethnicity, and income. Results: HBV-vaccinated men were more likely to be white and college educated. HBV-infected men were more likely to be black, older, HIV-positive, and have higher rates of substance use with sex. When stratified according to socioeconomic status indicators, levels of HBV vaccination were inverse to the rates of HBV and HIV infection. This relationship was not found for psychosocial treatment utilization. Conclusions: Demonstration of Hart's law among high-risk DU-MSM has important implications for future HIV prevention efforts among high-risk individuals. Combining HIV, hepatitis, and substance abuse prevention in primary care and substance abuse treatment settings is discussed.

Original languageEnglish (US)
Pages (from-to)127-136
Number of pages10
JournalJournal of the Gay and Lesbian Medical Association
Issue number4
StatePublished - 1999



  • Hart's inverse care law
  • Hepatitis B
  • HIV epidemiology
  • Prevention

ASJC Scopus subject areas

  • Medicine(all)

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