HIV THERAPY RESTRICTED ON EASTSIDE

People with HIV in Vancouver's Downtown Eastside are being denied
potentially life-saving treatment because doctors fear that failure to take
the medication properly will create an invincible new strain of the virus,
AIDS advocates say.

Under provincial guidelines, all those with HIV in B.C. are eligible to
receive drug-combination therapy once the amount of virus in their system
reaches a certain level. The three-drug "cocktail" has had remarkable
success in reducing HIV levels in the body and has dramatically reduced AIDS
death rates.

But outreach workers in Vancouver's poorest neighbourhood say they have
received dozens of complaints from HIV-positive people that they have asked
their doctor for the treatment and been refused.

"When an HIV-infected individual requests to be treated appropriately for a
life-threatening illness, they deserve to be treated," the B.C. Persons with
AIDS Society said in a strongly worded letter sent to all eastside doctors
last month.

The letter said patients were told they could only receive the drugs if they
met certain conditions, including going into drug rehab, taking methadone,
leaving their partner or moving away from the east side.

"These conditions are unacceptable," the letter says. "We find it utterly
appalling that physicians would manipulate people's lives in this way. It
must stop."

Some doctors are worried that people with HIV in the east side -- especially
addicts -- are unable to meet the demands of a treatment that requires
taking as many as 40 pills every day at set times and under certain
circumstances (some during meals, others on an empty stomach). Studies show
one in three people on the cocktail, even those with stable lives, miss
pills.

Improper use of the medication could allow the virus to survive in the body
and become resistant to several different drugs. If that new mutant virus
spread, doctors would be faced with an even tougher-to-beat form of HIV.
There are only a handful of recorded cases of drug-resistant HIV being
transmitted in the world -- and studies in the east side have yet to turn
any up -- but the fear is there, in part because it has happened before with
other viruses such as tuberculosis.

"Doctors are doing this with the best intentions," said Paula Braitstein, a
PWA member and co-chair of the 11th annual HIV/AIDS conference in Vancouver,
which began on Saturday. "But it's a human-rights issue. They're not God,
and it's not up to them to play God."

The letter sent to doctors says: "Whatever public health concerns may exist
must not supercede individual rights to appropriate health care."

The drug treatment, which is paid for by the province, costs more than
$10,000 a year.

People denied treatment can complain to the College of Physicians and
Surgeons, a step the PWA Society is urging them to take.

Dr. Stan de Vlaming, head of addiction treatment at St. Paul's Hospital,
said reports of denied treatment are overblown. "I don't think it happens
very often. . . . The majority of physicians are working quite hard to find
ways to help patients [take the drug cocktail]."

There is also some debate as to whether those in the east side really are
more at risk of failing the treatment. A study presented at this year's
conference by Dr. Patrick Kwong of the Downtown Community Health Clinic
found that of 55 at-risk east-side patients on the therapy, 38 had the virus
load in their body drop significantly.

Checked-by: Don Beck