AIDS: Access To Latest Drug Therapies Is Uneven
Many HIV-infected minorities and women are "missing out" on "the treatment revolution that has dramatically cut AIDS deaths and revived thousands in the last two years," the Los Angeles Times reports. California's experience is particularly indicative of the trend. The state's Medicaid program covers new AIDS drugs, and California's AIDS Drug Assistance Program funding "has climbed to $90.3 million, up from $17.5 million two years ago." Nevertheless, a 1996-97 survey of 339 Los Angeles County residents with AIDS found that only 57% of blacks and 53% of foreign-born Latinos were taking protease inhibitors, compared to 71% of whites and 64% of men. Experts say "a complex host of social and cultural factors," in addition to economic barriers, describe why the "better-educated and medically sophisticated [are] more likely to be using the new medications."
The treatment "disparities," according to the Times, are "reflected in AIDS statistics." AIDS is the "leading cause of death among African Americans between the ages of 25 and 44. But the uneven drop in AIDS cases also suggests that whites and men are more often diagnosed early and start taking the new medications." Los Angeles County epidemiologist Paul Simon said, "Whites and men seem to be benefiting more than (other) groups in getting treatment before AIDS develops. The early diagnosis is really important and I don't think we're doing a good enough job in certain communities." The Centers for Disease Control and Prevention surveyed new AIDS cases in California and New Jersey and found that "African Americans, people who inject drugs, people 60 or older, and those on Medicaid or without health insurance were all less likely to have taken a test determining the viral load in their blood -- a key to choosing the proper combination drug therapy. Even when insurance coverage was not an issue, distinctions remained." The Times reports that the "issue seemed not so much to be access to the drugs as the fact that people did not start treatment until they developed AIDS." CDC epidemiologist and study coordinator Dr. Paul Denning said, "The problem is roughly late testing and delayed entry into care."
Personal Fears, Lack Of Social Support
The Times reports that "even early testing is no assurance that people will begin treatment." A Los Angeles survey found that of those "recently found to have HIV, only 41% chose to immediately start the new drug therapies, even after they were told of the potential benefits ... A quarter wanted to think about it and 35% just said no." Those surveyed were "afraid of the drugs' possible side effects, concerned that they might exhaust their treatment options too early in the disease or worried that if they started taking medications, word would get out that they are infected." Walt Senterfitt, a county epidemiologist, said, "People of color and lower education tend to use the new therapies later, and that's not entirely explained by the fact that they have poorer access." Issues such as "trust and the absence of social support may play a role." In the minority community, "[l]ow income is another factor," and for some, "they suspect they will eventually fail, as previous AIDS treatments have," the Times reports. Another factor is the difficult regimen patients on protease inhibitors must follow. Fears about compliance are leading some doctors to avoid prescribing the new drugs to some patients. Suzi Rodriguez, co-chair of the Los Angeles County HIV, Drug and Alcohol Task Force, said, "There is a significant number of physicians who really do feel the addicted population has a tendency to be noncompliant. So they don't want to give them these expensive drugs."
Efforts are being made "to address social issues that interfere with treatment" with the help of federal and city grants. Charles R. Drew University and the UCLA Center for Clinical AIDS Research and AIDS Education "are experimenting with programs aimed at ethnic minorities, substance abusers and people with housing problems to see if regular counseling makes a difference in treatment adherence." Also, the AIDS Healthcare Foundation in Los Angeles is using a $1 million federal grant to manage a "short-term residential program for the homeless and others at risk of falling off the treatment wagon for nonmedical reasons" (Boxall, 4/14).