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AIDSWEEK: Homeless able to stick to drug regimen


THIS WEEK, research released by San Francisco AIDS experts shows that homeless people adhere just as well as anyone else to their HIV treatments - if they get help for their other problems, as well.

Between 80 and 90 percent of the homeless or "marginally housed" San Franciscans with HIV who take anti-viral combination therapy are able to adhere to the difficult drug regimen, said David Bangsberg, assistant adjunct professor of medicine at the Center for AIDS Prevention Studies with the AIDS Research Institute.

About 30 percent of those on this anti-viral therapy are doing so well that their AIDS virus is undetectable, he said.

The results seen in these homeless people are comparable to those seen in middle-class HIV patients at San Francisco General Hospital's Ward 86, the researchers said at a Tuesday conference on HIV and the homeless sponsored by the S.F. Department of Health.

"The lesson is, if you get them into care, they do extremely well," said Joshua Bamberger, the physician specialist with the San Francisco Department of Health who organized the conference.

"What is so impressive is that we are working with a population which has substance abuse problems, psychiatric problems and housing problems," said Bamberger. "But when you get them into primary care and address their major problems, you can treat their HIV. If you address these things in a comprehensive way, they take their medications - and live."

The drugs are not offered to everyone, according to a survey by UC-San Francisco's Bangsberg and Dr. Andrew Moss. They found that of 180 homeless HIV patients, about 20 percent were taking the triple-drug combination.

"It is a select group. The people who are on the medicines are probably the most highly functioning, and thus the most able to adhere (to treatment regimens)," said Bangsberg. "Doctors have been fairly cautious in giving them out. The small portion that are on protease inhibitors are doing well."

The key, said Bangsberg, is to "identify those who are having trouble. And if they are having trouble, to intervene and offer assistance to make adherence easier."

The prevalence of HIV among the homeless has not climbed but has stayed steady in recent years at 8.5 to 9 percent, according to the new research. This means that of the estimated 10,000 homeless people in The City, about 900 are HIV-infected.

Of these, about 180 are taking the triple-drug therapy. Many more - 720 - are not.

Homeless people with HIV are faced with what the doctors called "competing priorities" - the daily searches for food, shelter and safety. For those who also suffer from mental illness, substance abuse or alcoholism, treatment of HIV is an enormous challenge.

"If you need to score heroin, it is very time-consuming, very unpredictable," said Bamberger. "You need a provider who can help you organize treatment around what your day is like, connect your treatment with the things you do during the day, whether it is brushing teeth or shooting drugs."

For doctors, "The key is to get to know the person," he said.

To help homeless people stick to their treatments, the experts recommended creating two "Action Point Centers," storefront drop-in centers that would offer counseling, showers, food, pill containers and tools to remind clients to stay on schedule, like timers.

At the center of the issue are the effective new drugs called protease inhibitors, which interfere with the multiplication of the AIDS virus. But the 10- to 20-a-day pill regimen comes with strict rules. One medicine must be taken with meals; another on an empty stomach. One needs refrigeration; others do not.

The growing complexity of treatment coincides with the movement of the disease into a more troubled population - people without homes or meals or clocks, who have a tough time sticking to schedules. Homeless shelters and tenement hotels typically lack facilities for refrigeration and cooking.

Home testing

If you're considering buying a home test for HIV, choose the Home Access test, the only one approved by the federal Food and Drug Administration and the only one legally marketed in the United States. It is available in drugstores or by calling 1-800-HIV-TEST.

More than a dozen unapproved tests are also on the market, but there's no guarantee that these are reliable or accurate. If you have a question about an HIV home test kit, call the FDA's Office of Special Health Issues at (301) 827-4460.

Black church prayer

This week, in response to the devastating impact of AIDS in African American communities, churches are observing the Black Church Week of Prayer. Through a week of sermons, prayer, music and information about HIV prevention and treatment, the churches hope to become centers for AIDS education and compassion.

Federal statistics project that within two years, African Americans will account for 50 percent of all AIDS cases. They represent only 12 percent of the population. AIDS is now the leading cause of death for black Americans under age 55.

About 23 million, or 80 percent, of African Americans belong to a church. Although churches have a history of leading the community through crises, they have been slow to respond to the AIDS epidemic, said Pernessa C. Seele, founder of the New York-based organization The Balm In Gilead, which organized the nationwide prayer week.

The toll

Scott O'Hara, a performer in 26 porn videos, publisher and editor of a gay literary magazine, and author of the books "Do-It-Yourself Piston Polishing (for Non-Mechanics)" and "Autopornography" and the musical "Ex-Lovers," recently at Theatre Rhinoceros.

. . . . . .Date . . . . . .reported. . Cases. . Deaths S.F.. . . .2/1 . . . . 25,136. .17,049 Calif.. . .2/1 . . . .105,121 . 66,450 U.S.. . . .2/1 . . . .612,078 .379,258 WHO(rprtd) 2/1 . . .8,400,000 6,400,000

Figures are cumulative since June 1981. Government officials now compile and release statistics quarterly, not monthly. To contribute to AIDSweek, call (415) 777-7867.


Copyright © 1998 -The Bangkok Pos, Publisher. All rights reserved to San Francisco Examiner. All rights reserved. Reproduced with permission. Reproduction of this article (other than one copy for personal reference) must be cleared through the San Francisco Examiner, Permissions Desk, 110 Fifth Street, P.O. Box 7260, San Franciso, CA 94120.San Francisco Examiner

Information in this article was accurate in March 4, 1998. The state of the art may have changed since the publication date. This material is designed to support, not replace, the relationship that exists between you and your doctor. Always discuss treatment options with a doctor who specializes in treating HIV.