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
"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
"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.
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
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
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.
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
. . . . . .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.