Minorities Have Less Access to HIV Drug Trials

Half as likely as whites to receive novel therapies

WEDNESDAY, May 1, 2002 (HealthDayNews) -- Blacks and Hispanics make up more than half of all AIDS cases in this country, but they're only half as likely as whites to participate in clinical trials of new drugs to treat HIV infection, a new study has found.

The two minority groups were also about half as likely as whites to receive experimental therapies for HIV, the virus that causes AIDS. Even when patients tried to get experimental treatments, whites were about 12 percent more likely than blacks to receive them.

The study looked at 3,000 people with HIV between 1996 and 1998, and found that 14 percent them participated in a clinical trial. That's a surprisingly high number, the researchers say, considering that rate is about 4 percent for cancer patients. Roughly a quarter of the HIV patients took an experimental drug regimen.

Another 8 percent said they tried to get such treatments, but failed. People enrolled in health maintenance organizations were about half as likely than those who paid for their care to enroll in drug trials. People with fewer years of education, those with no or minimal insurance, and those whose doctor practiced eight or more miles from a major research center also had a markedly lower chance of getting into a clinical study.

The Centers for Disease Control and Prevention's latest numbers show that 56 percent of people with full-blown AIDS are black, Hispanic or belong to another minority group.

That, the researchers say, only sharpens the importance of their findings.

"With each passing year, the rates of increase [of HIV and AIDS] in minority communities are greater than in white communities," says Dr. Allen Gifford, an HIV specialist at the University of California, San Diego, and lead author of the study, appearing in tomorrow's issue of the New England Journal of Medicine.

"It's tough for some African-American or Latino patients to feel confident that the medication their doctor is offering them is the right thing for them if there aren't many African-Americans or Latinos" enrolled in the trials testing that drug, he says.

Beyond faith in the health-care system, there are other good reasons to want greater minority participation in HIV and AIDS studies, says Gifford. Evidence suggests ethnic groups may process drugs differently, and the course of their disease may progress at different rates.

"When we're planning and conducting research, there is a need to have the key patient groups that we're concerned about, just so that we can be sure we know how effective [therapies] are likely to be in those groups," he says.

Phill Wilson, executive director of the African-American AIDS Policy and Training Institute in Los Angeles, calls barriers to experimental HIV drugs "a huge problem" for minorities. "And I don't think people are doing enough about it," Wilson adds.

Although drug companies and researchers may avoid recruiting minorities because they're worried about compliance, Wilson says that's a "red herring, and it speaks to the inherent biases that exist on the part of some researchers."

He says race and ethnicity appear to play no part in adherence to medication. Rather, he says, the only factor that does reduce compliance is steady employment.

Gifford agrees, and says doctors need to make enrollment decisions based not on their perceptions of how groups behave, but rather on a patient-by-patient basis.

Carlos Arboleda, director of treatment education at the National Minority AIDS Council, says disparities in access to trials and treatments exist for several reasons.

Minorities are generally less invested in the health-care system than whites. However, blacks in particular may be suspicious of HIV and AIDS studies, since a small but sizeable bloc believes the disease is a conspiracy aimed at them, Arboleda says: "The feeling is that they're not going to be guinea pigs."

What To Do

For more on HIV, AIDS and race, try the Centers for Disease Control and Prevention or the National Institutes of Health.

You can also find out more about racial and ethnic health disparities, try the Agency for Healthcare Research and Quality.

SOURCES: Allen Gifford, M.D., assistant professor, medicine, University of California, San Diego, VA San Diego Healthcare System; Phill Wilson, executive director, African-American AIDS Policy and Training Institute, Los Angeles; Carlos Arboleda, director, treatment education, National Minority AIDS Council, Washington, D.C.; May 2, 2002, New England Journal of Medicine
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