Initial treatment of AIDS virus patients found to be racially biased

March 17, 1994|By Newsday

Black people infected with the AIDS virus are far less likely to get state-of-the-art treatment than are whites, researchers report, even when both have employer-paid medical insurance.

"We were really astounded to see the racial differences that exist," Dr. Richard Chaisson of Johns Hopkins Medical School said. "And after reviewing care for people with HIV disease, I'm forced to conclude that there really is a racial difference in how physicians are treating people."

In the Baltimore study, which is to appear in today's New England Journal of Medicine, Dr. Chaisson ordered a careful survey of treatments provided to 838 patients prior to their admission to Johns Hopkins' HIV program between March 1990 and December 1992. Typically, the patients previously had been seen by a private doctor or public clinic.

The results -- which compared whites and blacks of identical HIV disease stages, ages, genders and health insurance status -- were "startling," Dr. Chaisson said. Some 63 percent of the whites had been on AZT, the key anti-HIV drug. But only 48 percent of their black counterparts were on the drug.

Even more striking were differences in use of drugs to prevent potentially fatal bouts of pneumocystis pneumonia, or PCP. These drugs clearly extend patients' lives, and are among the most strongly recommended parts of AIDS care.

Eighty-two percent of the white patients in the Hopkins study were already on PCP prevention drugs when they entered the Johns Hopkins AIDS program, compared with only 58 percent of blacks.

"When we saw this data we wondered whether blacks were reluctant to be treated, were more skeptical of AZT or more distrusting of the medical system," Dr. Chaisson said. But after six months under care in the Hopkins program, no racial differences could be discerned in patients' willingness to take either AZT or PCP prevention drugs.

"So the problem was at the level of primary care," Dr. Chaisson said. "I think it has to do with the level of knowledge of the doctors in these communities, their lack of familiarity with HIV. We can't attribute it to poverty -- all the patients were poor. We can't attribute it to black patients not wanting therapy, because they did want the medications."

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