Publication Date




Embargo Period


Degree Type


Degree Name

Doctor of Philosophy (PHD)


Epidemiology (Medicine)

Date of Defense


First Committee Member

Daniel J. Feaster

Second Committee Member

Maria L. Alcaide

Third Committee Member

Lisa Rosen-Metsch

Fourth Committee Member

Margaret R. Pereyra

Fifth Committee Member

Denise C. Vidot


Persons living with HIV are more likely than HIV-negative individuals to experience oral health problems, yet are also more likely to have unmet dental care treatment needs. Dental needs among HIV-positive individuals can also be more severe and difficult to manage compared to the general population, often contributing to the onset of opportunistic oral infections. Furthermore, dental problems in patients with HIV can be associated with low CD4 counts and poor immune function. Due to the underutilization of dental services, oral health problems and symptoms, especially those that are related to HIV infection, remain prevalent in this population. Neglected dental care and oral symptomatology play a significant role in overall quality of life and general health by negatively affecting form, function, and socialization. Oral-health related quality of life (OHRQOL) has therefore become an important construct in evaluating how untreated dental disease can affect overall quality of life and well-being. Research has also shown that HIV-positive individuals do not consistently disclose their serostatus status to their dentists. The purpose of this dissertation study was to investigate the determinants of dental care utilization, presence of unmet dental needs, OHRQOL, and HIV serostatus disclosure to dentists among women living with HIV. To address these research objectives, oral health data collected from the largest cohort study of HIV-positive women, the Women’s Interagency HIV Study (WIHS), was analyzed. The WIHS is a national longitudinal cohort study of HIV-positive and high-risk HIV-negative women that has investigated the progression of HIV disease for over two decades through lengthy biannual assessments of demographic, clinical, and psychosocial data. The WIHS has not routinely collected oral health data on participants since the end of an oral health substudy conducted in the 1990s. For the purpose of this study, an oral health assessment was administered to WIHS cohort participants during the 2016 follow-up study visit. Utilizing cross-sectional data from this diverse, multisite cohort, this dissertation specifically sought to: (1) evaluate the association between the provision of dental insurance with dental care utilization and the presence of an unmet dental need among HIV-positive women in WIHS; (2) analyze the relationship between the presence of an unmet dental need with OHRQOL among HIV-positive women in WIHS; (3) evaluate how frequency of dental care utilization is associated with whether HIV-positive women choose to disclosure their HIV serostatus to their dentist, along their reasons for non-disclosure to dentists.


Oral health; HIV; dental care utilization; oral health related quality of life; serostatus disclosure

Available for download on Sunday, June 28, 2020