Most of the individuals who had not received the medications were not even aware of them, the researchers found. There were no significant differences among men and women or among blacks and whites as to who was more likely to receive the medications.
The in-depth interviews revealed that the most common obstacles to adhering to therapy were homelessness, which can make it difficult to store and keep track of multiple medications, concern about drug side-effects, fear and guilt, Edlin said. Participants said they would be more likely to comply with the regimen if they had clear information about the medications, had access to a clinic or field site, had a home and food, could store their pills in a portable, pocket-sized dispenser, were offered a cash incentive, and had a relationship with an accessible, caring physician.
"We need a concerted effort to address these issues and overcome them in order to allow drug users to receive the same benefits of therapy that other groups are able to have," Edlin said.
Based on the findings, he said the Urban Health Study has developed a model program for cities to help drug users take advantage of, and stick with, HIV therapy regimens. Under the model, cities could establish accessible field sites equipped with bathrooms and showers and a kitchen that would serve two meals a day. The sites would be staffed by health educators and other specialists who could provide peer education and counseling, virologic evaluation, social services, referrals to physicians and other services.
Edlin said San Francisco has provided funding for such a program, which
is being implemented at the recommendation of the Mayor's Task Force on
Adherence. The
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Contact: Corinna Kaarlela
corinna@irtsa.ucsf.edu
(415) 476-3804
University of California - San Francisco
2-Jul-1998