Black and Hispanic Patients Infected with the HIV virus are Less Likely than Whites

Black and Hispanic patients infected with the HIV virus are less likely than whites to participate in clinical studies of new treatments or to receive experimental drugs, according to the first study that has used nationally representative data to examine such disparities. Moreover, underrepresentation of blacks and Hispanics in HIV treatment studies becomes a concern for the applicability of the clinical research to patients in the general population.

The findings indicate that people with HIV infection overall are much more likely to get experimental treatments than are people with other diseases, such as cancer or heart disease. Because AIDS treatment is evolving rapidly Links Of London and because the virus often develops resistance to approved drugs, AIDS activists have lobbied successfully to expand access to new medicines. An estimated 14 percent of the approximately 231 000 adults treated for HIV infection in 1996 participated in a clinical trial, and 24 percent had taken an experimental drug, the study found. Only 4 percent of adults with cancer who are less than 50 years old participate in clinical trials.

But the results suggest marked racial and ethnic disparities in access to experimental HIV treatment. Blacks made up only 23 percent of clinical study participants but constituted 33 percent of adults receiving HIV care. Similarly, 11 percent of study participants, but 15 percent of HIV-infected patients nationally, were Hispanic. In contrast, whites made up 62 percent of participants in HIV trials, yet represented only 49 percent of adults receiving HIV care.

The research team studied a nationally representative sample of 2 864 adults in the 48 contiguous United States who were receiving care for HIV infection in 1996. They interviewed participants three times between 1996 and 1998, asking about their participation in studies, their use of experimental drugs and other personal data, including such factors as their trust of doctors and desire to participate in decisions about treatment. The researchers found that, in addition to being black or Hispanic, several other factors also reduced patients’ likelihood of participating in a clinical trial. They included having less than a high school education, belonging to a health maintenance organization (HMO), and living eight or more miles from a major research hospital. Patients who were white, who were highly educated or who received their health care close to a research center were more likely than others to get experimental drugs.

In an editorial accompanying the study, Tallmadge E. King of San Francisco General Hospital suggested that racial and ethnic disparities in access to experimental treatment may reflect “barriers at the level of the patient, the Links Of London Bracelets physician, the institution and the community. “Doctors may harbor unconscious prejudices toward blacks or Hispanics, he suggested. Patients may be mistrustful or fear that participating in a study will threaten their autonomy. Researchers studying new treatments for drug companies may avoid enrolling members of minorities “because they believe that poor compliance is common in these groups”. Because fewer Black and Hispanic HIV patients participate in clinical studies of treatments