America Living With AIDS

AM E R I C A Living With A IDS

users, prisoners, adolescents, and children-all of whom have experienced
difficulty in gaining such access. Fre
The loss of
my mother, the loss of my
three children, the lack
of services have left me with
a wish for death. But then I
think I want to live.
And I want to stop using drugs,
but I need someone to care
for me. Right now I have
known for two years that I am
HIV positive. Fortunately,
I have not gotten sick.
YVETTE
January 1991

quently individuals enroll
in clinical trials because it
is their only means of
access to primary care.
Primary care providers
are increasingly being
called upon to help people with HIV disease
choose among potential
investigational therapies
and monitor the administration of such drugs.
Information about
drugs under study and
eligibility requirements
for clinical trials must be
made widely available for
care providers and
patients alike. News
about the latest results of
clinical trials also must be

administered by pharmaceutical companies. This can make medications
available to a great many individuals
for whom there are no alternatives.
However, the process of gathering data
to monitor patients' reactions to drugs
under study is extremely time-consuming and may differ from drug to
drug (even though individual patients
may need a number of such drugs
over the course of their illness). The
time and paperwork involved is
daunting for individual care providers
who lack the resources of clinical
investigators. Some of these problems
could be obviated by the development
of uniform guidelines for data collection for drugs dispensed in expanded
access programs, including data for
individuals simultaneously taking
multiple investigational drugs. Ways
must be found to assist health care
providers in the administration of
such efforts.
The percentage of AIDS cases related
to injection drug use has increased
sharply, from 18 percent before 1985
to nearly 33 percent in 1990-1991.
There are an estimated 500,000 to 1.5
million injection drug users in the
United States, and only 15 to 20 percent are estimated to be receiving
treatment for their drug dependency.
Drugs other than injected ones, particularly alcohol and crack cocaine, are
also strongly implicated in increased
risk of HIV infection because of the

rapidly communicated to health care
providers who may not be directly
involved in conducting clinical
research studies. In some cases, it may
be appropriate for federal agencies to
conduct widely targeted mailings concerning breakthroughs in HIV care to
supplement information available in
medical journals and through professional associations. Access to a growing number of therapies is also currently available through the parallel
track or expanded access programs

56