BLACK HEALTH & AIDS

As a medical resident at Harlem Hospital during January, 1979, I vividly recall a young man who was literally wasting away with a mysterious illness characterized by persistent fever, the inability to swallow due to an infection involving his oral cavity, severe painful non healing sores involving the rectal area. His memory was poor and his attention span was limited. He volunteered no information concerning his illness. The patient eventually died as a result of pneumonia. We now know retrospectively, that this was certainly one of the first cases of AIDS.

Now, exactly 18 years later, how is this disease affecting the African American communities here in New York City and elsewhere? What progress has been made in the diagnosis and treatment of patients with AIDS? Finally, what can we do to slow the spread of this epidemic?

The AIDS epidemic will reach it's 16th anniversary in June of this year. To commemorate this milestone, here are 16 chilling facts about AIDS and the African American and Latino communities.

1. In 1993, Gay men comprised less than 50% of the total number of new AIDS cases reported in the United States.

2. The majority of the AIDS cases reported since 1993 have involved heterosexual men and women.

3. Approximately 11% of all AIDS cases now occur among non-drug using men and women.

4. African American and Latino men accounted for 67% of the cases of AIDS diagnosed during 1995 here in New York City. 5.African American and Latino women accounted for 87% of the total number of AIDS cases among women in New York City during 1995.

6. African American men are less likely than white men to receive medications which effectively treat HIV and prevent the sometimes fatal infections such as PCP (a form of pneumonia) which often complicates HIV. A study published nearly three years ago conducted by investigators at the Johns Hopkins University indicated that among men attending a public clinic in Baltimore, approximately 80% of the white men were receiving what was then considered standard therapy for advanced AIDS while only 48% of the African American men were receiving the standard drug treatment. The authors of the study speculated that multiple factors including socioeconomic issues, physician attitudes, patient misconceptions or lack of trust may have contributed to this disparity.

7. A study conducted at the Grady Hospital Center in Atlanta and published last year indicated that women with HIV/AIDS were significantly less likely than men to receive standard therapy for the disease.

8. In New York City, over 90% of the infants and young children with AIDS/HIV are African American or Latino.

9. AIDS/HIV is the leading cause of death among young adults in New York City.

10.Nearly 14% of the men and women seeking treatment at a major sexually transmitted disease clinic in Trinidad a few years ago were seropositive for the AIDS virus HIV.

11. Dr. Henry Francis, an African American AIDS Researcher in Baltimore reported last year that economic and personal problems in urban indigent HIV patients' lives inhibited the effective implementation of HIV prevention. Dr. Francis and colleagues went on to note that nearly 60% of the AIDS patients failed to report for scheduled follow-up appointments for treatment of HIV/AIDS and half of the patients refused to take AZT or to comply with other recommended therapy. Dr. Francis went on to state that among the urban indigent in Baltimore, early economic and social intervention may be as important as establishing an early medical diagnosis.

12. An infant born to an HIV positive mother has approximately a 20% chance for becoming infected with the AIDS virus (HIV). A multicenter study known as ACTG 076 published in 1994 clearly indicated that the risk of transmission could be reduced to approximately 8%, if the HIV positive mother is treated during the second and third trimesters of pregnancy with the agent AZT and if the infant receives the same drug for the first six weeks of life. Dr. S. Fiscus, along with Dr. A Adimora and others at the University of North Carolina and Duke University reported last year that transmission rates among the patients enrolled for study dropped from 21% in 1993 to 5.7% in 1994. Dr. Adimora previously served on the staff at Harlem Hospital Center before accepting her present position on the faculty at the University of North Carolina. The investigators concluded that the use of AZT in HIV positive pregnant women and their infants significantly reduced HIV transmission from mother to new born among the patients in North Carolina.

13. In November, 1995, the first of a new class of agents known as protease inhibitors became available for general use. Researchers noted that the protease inhibitors were extremely potent agents and were significantly less toxic than some of the older agents such as AZT however, use of these agents alone invariably resulted in the emergence of resistant strains of HIV. It is now recommended that physicians treating any patient who is seropositive for HIV with a CD4 helper cell count < 500 should administer three drug therapy which would include one of the new protease inhibitors such as Indinavir (Crixivan) along with two other agents: AZT (also known as Retrovir) and 3TC (also known as epivir). This combination has resulted in dramatic improvement in the clinical status of most patients. The T cell counts nearly always increase significantly while the viral load drops. Many patients note an increase in exercise tolerance, a decrease in fatigue, weight gain and an overall improvement in sense of wellness.

14. Despite the advances in medical therapy many African American and Latino patients continue to reject physician recommendations for therapy. Many patients rely totally upon nutritional programs, herbal formulas and other empirical modalities of unproved efficacy.

15. Although effective, combination drug therapy for AIDS is costly. Annual costs may exceed $7,000 / year.

16. Most commercial insurance plans, Medicare and Medicaid will cover these costs. Many states such as New York have programs which will provide supplemental payments (Aids Drug Assistance Program ADAP). Most of the pharmaceutical companies which manufacture drugs used in the treatment of HIV/AIDS related illness have compassionate use programs for patients without insurance who do not qualify for Medicaid. Physicians can usually assist the patient in enrolling for these programs and social service workers in hospitals and public clinics will also provide assistance and information for patients in need.

During the past 16 years, the AIDS epidemic has exerted a major negative impact upon the African American & Latino communities. However, we now have effective medications which are capable of controlling HIV and in many cases reversing many of the signs and symptoms of the disease. Although we do not have a cure, the new combination treatment regimens have yielded impressive results. HIV transmission from mother to child is now a preventable disease. In the African American and Latino communities HlV testing should be encouraged especially among pregnant women or women contemplating pregnancy. Those who test positive for HIV should receive counseling regarding treatment and should be encouraged to receive one of the new combination drug regimens if criteria are met.

Copyright ©1998: The Black Health Net. Medical information on this site is for educational purposes only. Use of the Black Health Net indicates your agreement with our medical disclaimer.

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