Has combination therapy halted the tide of death in London’s African community ?

Since the Vancouver conference, news of the latest HIV/AIDS treatments has locked the world in an upsurge of optimism. This mood was summarized by Dr. Charles Farthing, who declared that "we should be dancing in the streets." But does the African community living in the UK have cause to dance in the streets ? Research from around London’s hospitals is showing that very few of us are benefiting from the new combination therapies. Something needs to be done, and done now !

Some startling findings come from North Middlesex Hospital, an advanced treatment center for people living with HIV/AIDS. North Middlesex regularly sees at least 120 Africans living with HIV/AIDS. It provides combination therapy to about 60 patients overall. Another 20 or so are receiving UK-licensed protease inhibitors. Combination treatments, however, are restricted to people with AIDS-defining illnesses in cases of emergency. The hospital reports no significant drop in the number of admissions for other HIV/AIDS related conditions.

’Too late’ for treatment?

According to Dr. Jona-than Ainsworth, funding has not been the biggest problem. Too many people, he suggests, present themselves too late for treatment : "Most of the patients we see come through the Accident and Emergency Unit. Eighty percent already have a CD4 count below 300 and an AIDS-defining illness." In addition, "every week, I see one or two patients with a CD4 count of 10."

Such low CD4 counts make it very difficult to reconstitute the immune system, which may already have become irreversibly damaged. Overall deterioration of health can be brought on by a long history of opportunistic infections, kidney and liver complications, etc. This can leave the body unable to cope with compliance to, and the side effects of, any new treatments.

Newham General Hospital provides treatment in a region of east London where 15% of the population are African or Caribbean. Newham General is used regularly by about 130 Africans with HIV/AIDS. It is however, still treating people with monotherapy only.

"My CD4 count has fallen from 150 to 30," said one person with AIDS. "I have lost weight, had several infections, and now I have developed PCP pneumonia. But still, they are giving me AZT and septrin only."

Here, funding is indeed a big problem. East London and City Health Authority has a deficit of UK £14 million to settle in its budget for 1996-97.

Changing clinics

No protease inhibitors are available at Newham General, nor can the hospital perform viral load tests. Defending the Hospital Trust, Dr. Anthony Wisdom pointed out that those with seroconversion and CD4 counts below 200 are put on some form of combination treatment (most likely AZT with DDI and/or ddC).

"Most of our patients have been on monotherapy and are stable," explained Dr. Wisdom. "We are offering good care and prolonging life. But we are seeing fewer and fewer patients, probably because people are changing to other clinics where they can access protease inhibitors."

Dr. Wisdom urged the HIV community to make "a political fuss" when money for treatment is not made available. Apparently, the hospital has been assured that it will receive additional funding for the 1997-98 financial year. Protease inhibitors can now be prescribed in cases of emergency.

Kings College Hospital sees another 130 African patients, of whom only 28% presented themselves voluntarily for HIV tests. According to Dr. Anthony Pozniak’s statistics, the remaining 72% had to learn of their status through other circumstances. For examples, some were forced into taking tests ; some learned that their partners were HIV+ ; some were admitted to hospital for other reasons, and routine tests showed them to be positive ; some got tested to oblige insurance/work requirements.

Dr. Pozniak also addressed the problem of late diagnosis and the consequent difficulties in treating advanced HIV/AIDS. Many of his patients have been referred locally. He notes that almost all of his patients were concerned about confidentiality, and feared meeting others from their community in the same clinic.

List of priorities

Fear about confidentiality is one reason why many people put off taking their first step into a clinic. Their condition develops and becomes more advanced. For the African community as a whole, priorities place issues such as immigration, poverty, housing, and unemployment at the top of the agenda. Next come concerns about child care, isolation in a new country, and uncertainty about families left in Africa. HIV/AIDS comes near the bottom of many peoples’ list of priorities. Low levels of awareness often cause people with HIV/AIDS to overlook, ignore, or not recognise early warning signs of poor health.

A recent study by NAM Publications looked into the effectiveness of HIV/AIDS information and publicity. It acknowledged that one in seven people in the UK with HIV/AIDS is African. Yet out of the 752 respondents to their survey, only 16 were African. So are the messages of prevention reaching our community ?

Increased uptake

Many hospitals are reporting improved quality of life in their patients, and increased interest in combination therapies. From St. Mary’s Hospital in Paddington, pediatrician Dr. Sam Walters told MAHA : "Patients now ask me about combination treatment before I get to tell them about it." He reported increasing willingness to take the drugs, although there is still apprehension about AZT. The mother-to-baby transmission rate has dropped to around five percent.

The death toll from HIV-related illnesses in the African community, however, is still high. nm

Africa Advocacy Foundation
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