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Blacks Get Short Shrift With AIDS Care

Study finds whites more likely to take drugs early

SATURDAY, Feb. 2, 2002 (HealthDayNews) -- Low-income blacks who suffer from AIDS aren't claiming their fair share of the potent treatments for the disease, a new study suggests.

Researchers in New Jersey found blacks wait longer than whites to begin powerful drug regimens, and they're more likely to not take their medications regularly.

While the findings are discouraging, they do show close monitoring of black AIDS patients does help them take their medications more consistently, says Stephen Crystal, lead author and director of the AIDS research group at Rutgers University.

"You have to go a little further," Crystal says. "If you have individuals for whom adherence may be more challenging, maybe you need a more energetic approach to managing their care."

Crystal and his colleagues studied 1,740 people with AIDS who were enrolled in New Jersey's Medicaid program. Of those, 58 percent were black, 25 percent were white and 19 percent were Hispanic.

The goal of the study was to see if there were differences in how ethnic groups are treated for AIDS. They looked at patients' use of the newer, antiretroviral AIDS treatments from 1996 to 1998. In general, blacks waited about 15 months before they began using the AIDS drugs, eight months longer than their white peers.

Matters got worse.

By 1998, only 65 percent of those who started taking the drugs were still taking them. Blacks were the least persistent users; almost 40 percent reported they had discontinued their treatment, compared with approximately 30 percent of whites.

"It's one of those recurring themes in health care," Crystal says. Researchers often find that poor people have less access to newer, more expensive medical treatments.

The study appears in a recent issue of the Journal of General Internal Medicine.

The health-care system is at fault when blacks receive inferior care, says Ronald Johnson, associate executive director of Gay Men's Health Crisis, an AIDS advocacy group in New York City.

"I personally think that racism is a factor," he says.

Previous studies have shown the health system treats blacks differently, he adds, even when they have the same levels of education and social standing as whites.

Few drug regimens are as complicated as the ones for AIDS patients. Sufferers must take several drugs each day, and missing a single dose could spell serious trouble. The AIDS virus mutates when it is not beaten back by medicine, and can become immune to certain drugs.

That's why AIDS patients are typically put on "cocktails" that include several types of drugs. If the virus wins its battle against one drug, the others are there to continue the fight.

There are plenty of reasons why a patient might decide to not take his or her medication, Crystal says. Motivation, access to health care, the nature of the treatment and the behavior of a doctor could all play roles, he says.

"People have other things that are distracting them in their lives, and there is still a level of distrust (of the medical profession) out there," he says.

The key is to keep in close contact with the patients, and not assume they will simply take the drugs that are prescribed for them, he says.

In the past, it wasn't unusual for public health officials to watch tuberculosis patients to make sure they took their medicine. And Baltimore recently introduced a small program to do the same thing for AIDS and HIV patients.

What To Do

From infection to the full-blown disease, AIDS usually follows a specific pattern in patients. Learn about what happens and when from Boston University.

Learn about AIDS medications from AIDSmeds.com, which is sponsored by drug manufacturers.

SOURCES: Interviews with Stephen Crystal, Ph.D., director, AIDS research group, Rutgers University, New Brunswick, N.J.; Ronald Johnson, associate executive director, Gay Men's Health Crisis, New York City; December 2001 Journal of General Internal Medicine
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