For two months recently, Maximus Clary took a powerful set of drugs that held the promise of sending the AIDS virus in his body into retreat. Then he threw his pills out.
He hated the drugs' side effects, which left him feeling nauseated and generally lousy. So he went back to ginseng and licorice root.
"In my family we believe in the natural stuff, the herbs and stuff like that," said Clary, 30, who is African American. "I tell people, 'don't put your faith in those medications.' "
He is one of many missing from the treatment revolution that has dramatically cut AIDS deaths and revived thousands in the last two years.
Although the high cost of new drug therapy keeps people off the treatment rolls in some parts of the country, that is generally not the case in California. The state has poured more money than any other into a program that pays for AIDS medications for those who can't afford them.
"Everybody can get drugs," said Larry Mims, a Los Angeles AIDS prevention advocate with the Black Lesbian and Gay Leadership Forum. "It's not if you have insurance or don't have insurance. That's not the issue." Rather, experts say, a complex host of social and cultural factors is often at work, with the AIDS-savvy, better educated and medically sophisticated more likely to be using the new medications. And in a trend that accentuates rising infection rates among minorities and women, research indicates that they are not taking the drugs to the same degree as whites and men.
To understand why, consider the contrasting practices of Dr. Gary Cohan and Dr. Wilbert Jordan.
Disparities in Knowledge, Support
Cohan is a partner in Pacific Oaks Medical Group in Beverly Hills, one of the largest private HIV-AIDS specialist groups in the country. His patients are mostly middle-class or upper-middle-class gay men. They get tested for HIV, the virus that causes AIDS, and usually come to him well before the disease has progressed to full-blown AIDS.
They know the medical lingo of viral load--the level of AIDS virus in the blood--and protease inhibitors, one of the key new drug types. They are likely to know others with the disease and can fall back on a well-established support network, where AIDS is neither shameful nor hidden.
Jordan's patients at the Oasis Aids Clinic at Martin Luther King Jr./Drew Medical Center are mostly poor and minority. The closet looms larger in this world. There is less acknowledgment of AIDS risk, less community support, more fear of the stigma of the disease and more suspicion of the medical establishment.
