9th International AIDS Conference Berlin, Germany — June 6-11, 1993

Int Conf AIDS 1993 Jun 6-11; 9:123 (abstract no. WS-D20-6)
Mahon N, Jones M, McGovern T, Shapiro L, Shubert V, Elovich R, Robinson C, Isbell M, Jacobs S, Williams B;

ISSUE: The burden of the recent resurgence of TB in New York City has fallen overwhelmingly on populations that hve been tragically underserved by the City health care system, namely people of color, homeless people, addicts and alcoholics, prisoners and parolees, and others living in poverty. Members of these groups who are living with HIV or AIDS face a particularly serious threat in the worsening TB epidemic, yet the City has failed to provide them with an adequate protection or services. OBJECTIVES &

METHODS: Based on authors' advocacy experience, identify barriers to TB diagnosis and treatment for disenfranchised people living with HIV in New York City, and detail a TB control strategy that can protect all New Yorkers without the need to resort to inhumane institutionalization or illegal restrictions of liberty.

RESULTS: The City's "system" for TB prevention and treatment is under-funded, difficult or impossible to access, and marked by gaps in services. Many HIV positive people living in poverty face unnecessary risk of TB infection and disease in unsafe hospitals, shelters and prisons. Those with TB disease are routinely discharged from hospitals without follow-up appointments, medications, chemical dependency diagnosis and treatment referrals, housing placements or other adequate planning for ongoing care. Out-patient TB testing and treatment is limited, overburdened and unable to integrate TB treatment with patients' ongoing HIV medical care. Limited pharmacy hours and gaps in Medicaid coverage and other benefits severely hamper the ability of TB patients to obtain necessary medications.

CONCLUSIONS: Compliance with necessary medical care is ultimately a matter of personal responsibility, however, a TB patient will only be able to truly exercise such responsibility if he or she is enabled to meet other more urgent needs, such as food and permanent housing. Consequently, unless adequate, accessible systems of care are in place to make voluntary treatment compliance possible, it is premature, fiscally unsound, and inhumane to detain people in the chronic, non-infectious stage of TB disease. The urgent need to successfully stem the tide of the TB epidemic demands the removal of systemic barriers to patient compliance not the wide-scale detention of individual patients who are denied access to medical care.

Copyright © 1993 - International AIDS Society (IAS). Reproduction of this abstract (other than one copy for personal reference) must be cleared through the IAS.