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AIDS Program: Seeing Is Relieving

Doctors in clinics, vans in Baltimore to witness pill taking

TUESDAY, Nov. 20, 2001 (HealthDayNews) -- In what may be the largest program of its kind, the city of Baltimore has started monitoring 200 patients with HIV in poor neighborhoods to make sure they take their medicine.

The purpose of the experimental project is to help patients with unstable lives have a place to keep their medicines and also to prevent the development of drug-resistant strains of the virus that causes AIDS, said Dr. Peter L. Beilenson, Baltimore's health commissioner. The participants, who are screened so that only the most motivated will be part of the project, will visit clinics and vans to get their medication.

"These are people who do not have medicine cabinets in their home because they don't have a stable home," Beilenson said.

This isn't the first time public health officials have spent money and time to make sure people follow their drug regimens. So-called "directly observed therapy" is common across the country in the treatment of tuberculosis and sexually transmitted diseases.

For five decades, doctors have used this approach for syphilis or gonorrhea, said Dr. Hunter Handsfield, director of the STD Control Program for the public health department of Washington state's King County. "We know that a lot of those folks don't take all their medication. It's as little as 10 percent in some [groups] and as high as 50-60 percent in others."

In Baltimore and other cities, doctors watch patients take tuberculosis mediations during a period of six months or a year. Unlike AIDS, however, tuberculosis can be cured in that period of time.

The Baltimore program will target patients in three zip codes that are home to the most HIV cases in the city, Beilenson said. "We ran focus groups and [found that] people wanted something community-based that would allow those who didn't have stable homes to have a place to store their medicines and take them."

The $129,000 program, funded through grants, will last for at least a year.

In much of the United States, AIDS is still largely a disease of gay men, many of whom have stable lives, jobs and medical insurance. But about three out of every four AIDS patients in Baltimore were infected through intravenous drug use or are sex partners or children of drug users, Beilenson said. The patients tend to move frequently, often spend time on the streets, and rarely have a primary care doctor, he said.

No one will be forced to take the drugs, and city officials will only take on people who are motivated, he said. "We don't want people who have been going on and off [the drugs]. We want people who want to do this."

The risks are high for patients who fail to follow the instructions of their doctors. If the patients take breaks between doses, the AIDS viruses inside them are more likely to mutate and learn how to become immune to the drugs. Patients who miss as few as 5 percent of their doses may be in trouble, Beilenson said.

An estimated 14 percent of the 5,500 AIDS patients in Baltimore are resistant to at least one drug.

The situation is not yet dire in the United States because few patients become immune to all three classes of drugs that make up the so-called AIDS "cocktail." That means the drug-resistant patients usually have alternatives.

But some doctors fear that a "superbug" will arise that won't be vulnerable to any of the three drug classes.

What To Do

Learn about drug resistance from this fact sheet from aidsinfonyc.com.

Think you should get tested for the virus that causes AIDS? Get information in this Q&A from the San Francisco AIDS Foundation.

SOURCES: Interviews with Peter L. Beilenson, M.D., health commissioner, Baltimore; Hunter Handsfield, M.D., director, STD Control Program, public health department, King County, Seattle.
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