HEALTH WORKERS FIGHT AN AIDS RACIAL DIVIDE

Epidemic Among Blacks Is As Daunting As The Struggle
For Civil Rights, Doctor Tells Conference

WASHINGTON - Black Americans are becoming infected with AIDS at
record rates, receiving poorer care than white Americans and dying
faster.

Now, almost two decades into the AIDS epidemic, about 1,000
health-care providers and activists gathered for the first medical
conference on AIDS among black Americans -- a frantic hunt for ways to
fight the exploding racial divide.

AIDS in the United States is evolving from a disease that once mostly
affected white homosexual people into one largely of poor black
people, often infected from dirty drug needles or heterosexual encounters.

Black people make up 12 percent of the U.S. population but a
devastating 45 percent of new AIDS cases. AIDS has been the leading
killer of black people between 25 to 44 for most of the decade. One in
50 black men and one in 160 black women are estimated to be infected.

"This is an historic event," Phill Wilson of the National Black
Lesbian and Gay Leadership Forum told the conference Thursday. "What
we do . . . will determine whether or not we make a
difference."

"This is no less a daunting challenge than we faced in the civil
rights movement," said Dr. Stephen Thomas of Emory University.

The doctors, social workers and activists sought practical, day-
to-day advice on fighting HIV, the AIDS virus, in communities often
wracked by poverty and drugs, where a legacy of racism has left
distrust of the medical system.

How do you get a drug user or a homeless person tested for HIV? How do
you treat the hotel maid who can't afford the time off to go to a
clinic only open weekdays? How do you get the bus driver to keep
taking AIDS medicine when the main side effect is diarrhea?

"We're talking about reaching . . . people who might not have had a
meal since noon yesterday, and they're still sitting in the clinic"
for four hours because the doctor overbooked, said Debra Hickman of
Baltimore's Sisters Together and Reaching.

Then came the thorny issue of preventing and treating HIV in prisons.
"Our men are in the jails. They do come home to their wives and
girlfriends," said a California AIDS worker, describing one reason HIV
infection is growing fast among black women.

Nor do many black doctors specialize in AIDS, said a Colorado nurse
who described herself as the only black AIDS health worker in her
town. White doctors "do care, but they don't understand when I say,
`Patients don't trust you.' "

President Clinton has declared AIDS among minorities a crisis. The
administration is spending $156 million this year and seeking $171
million next year to fight back.

But Clinton last year refused to use federal money to buy clean
needles for drug addicts, one way to prevent HIV's spread. Frustrated
at the ban, administration doctors urged local communities Thursday
to raise the money themselves for needle exchanges.

And critics questioned whether the government's work is fair: One new
program calls for 35 percent of AIDS research sites to be in minority
communities, but two-thirds of new infections now occur in those
communities.

The conference's main goal was to empower workers on the front lines
of AIDS, providing information and resources to help their
communities, said Cornelius Baker of the National Association of
People With AIDS.

"We need to make care more culturally appropriate," he said. "Maybe
clinics need Sunday hours, or you could give health care at church
after Sunday services."

And grass-roots doctors who don't often get to the fancy international
AIDS meetings hungered for the latest data, questioning experts on
which drugs to use.

"We can be flexible," said Dr. Joel Gallant of Johns Hopkins
University. Not everyone needs that much-publicized but expensive
"protease inhibitor" cocktail right away, he said. Newly infected
patients with low HIV levels might be all right not starting drugs
for a while. Got a patient who won't swallow 15 pills a day? Some new
drugs require far fewer.

But there were no easy solutions.

Take Gallant's advice for doctors to test even newly diagnosed
patients' blood to see if their HIV will resist certain drugs. The
immediate response: Medicaid and other programs don't pay for those
tests, so how can doctors use them?