AIDS victims, doctors must change attitudes

March 22, 1994|By WILEY A. HALL

Last week, researchers reported that black people infected with the AIDS virus are far less likely to get state-of-the-art treatment for their disease than whites -- even after allowing for factors such as education, socio-economic status, or the availability of medical insurance.

The findings were "startling, astounding," says one of the study's authors, Dr. Richard E. Chaisson, of the Johns Hopkins School of Medicine.

But not too startling: "It is striking that in disease after disease we see the same patterns, the same differences in treatment," says Dr. Chaisson. "The differences show up in the treatment of bone cancer, mastectomies, coronary disease, blood pressure and diabetes -- in a whole host of illnesses.

"I'm not saying that physicians are overtly racist," Dr. Chaisson continues. "But many may hold attitudes about the treatment of minority patients that are not necessarily valid."

"What type of attitudes?" I ask.

"A physician may assume that there is no sense prescribing expensive medicine to a minority patient because the patient is not going to follow his directions, anyway," answers Dr. Chaisson.

"Or, the physician may feel that the patients brought the illness on themselves by their own risky behavior. . . . From the top down, health care professionals have got to emphasize that we treat everyone. And we do not pass judgments."

Researchers surveyed treatments provided to 838 patients prior to their admission to Johns Hopkins' HIV program between March 1990 and December 1992. White patients were found to be far more likely than blacks to have received AZT, the key drug for treating the HIV virus, and even more likely to have received drugs to prevent potentially fatal bouts of pneumocystis pneumonia.

The researchers say their study suggests a need for "culturally appropriate efforts" to promote early preventive care in urban black populations.

"Old news," responds Dr. Orlando R. Davis, clinical chairman for Liberty Medical Center's Community Institute of Behavioral Sciences. "We didn't need a study to say there is a need for culturally appropriate efforts -- that's just common sense."

Last fall, Liberty Medical Center, a historically black hospital, established an AIDS treatment and counseling program based on the philosophy of "like treating like."

Because health care in America is dominated by white physicians, African Americans seeking treatment "may face inherent social biases," says Dr. Davis. "Even if they aren't mistreated, African Americans may feel unwelcome. . . . These feelings on both sides create barriers that interfere with what we call the 'therapeutic alliance.' If the initial joining between physician and patient doesn't occur, then everything else that happens from a therapeutic standpoint may be second rate, at best."

Says Vanessa Murphy, a counselor who has interviewed drug users as part of Liberty's outreach efforts: "Addicts will say nobody really cares about them. They fall through the cracks. They'll say doctors will get mad at them, say things like, 'You did this to yourself.' Those kind of attitudes make addicts very reluctant to seek treatment until a medical crisis occurs."

"Other programs frequently neglect the spirituality of our community, and we have found that to be a very important aspect of the process," adds Sherrie Todd, another counselor. AIDS sufferers "are asking questions such as, 'Who am I?' 'How do I deal with this pain?' 'What is death going to be like?' "

In an article on the study published last week in the New England Journal of Medicine, Dr. Chaisson and his colleagues noted that "the efforts of the gay community . . . represent a model of involvement by patients in medical care."

Says Dr. Chaisson, "Many white gay male patients are extremely well-read about treatment options when they come. They often know more about experimental treatments than the physician and are eager to give them a try."

But AIDS now strikes hardest in communities that are poor, urban and black. And the health care providers I spoke with say attitudes have to change: patients' attitudes and doctors' attitudes.

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