Miami Herald - August 5, 2008
Fred Tasker, ftasker@MiamiHerald.com

Researchers at hospitals in Miami and Atlanta have teamed up to see if they can break the grim cycle in which crack addicts engage in risky sex, become HIV-positive, then spread the condition to others through more risky sex.

"These are people forgotten by the system. They've been living with HIV for a long time. They've never been on medication. A majority have progressed to AIDS," said Dr. Lisa Metsch, associate professor in the UM med school's department of epidemiology and public health.

She and a researcher at Atlanta's Emory University are testing an eight-session intervention program aimed at getting the addicts into HIV treatment and long-term drug programs.

Metsch and Dr. Carlos del Rio, professor of medicine at Emory University School of Medicine and Grady Memorial Hospital in Atlanta, presented their findings Monday at the 17th International AIDS Conference in Mexico City.

The two interviewed 190 crack-addicted, HIV-infected, sexuallyactive patients who were admitted over 14 months to Grady Hospital in Atlanta and Jackson Memorial Hospital in Miami for medical problems associated with HIV, including infections, diarrhea, pneumonia, cancer.

CARE AND COUNSELING

As the patients' medical problems were being treated at the hospitals, Metsch and Del Rio worked with them, sometimes at bedside, to get them in long-term HIV medical care. They also provided group counseling to reduce risky sex practices and got them into drug treatment programs. "We pay them $10 per session to come," says del Rio. "At the end we give them a diploma. For a lot of them, it's the first time in their lives they got something."

The two will report progress as the 14-month program continues, and hope it will become a nationwide model for treating addicts.

The program is part of a five-year, nationwide HOPE study (Hospital visit is an Opportunity for Prevention and Engagement) funded by the National Institutes of Health.

In interviews, researchers sought to learn which life situations were most likely to push addicts toward having unprotected sex with an HIV-negative or unknown status partner -- possibly spreading HIV. They found women were more likely -- perhaps because they had to trade sex for drugs. Women also were more likely to be homeless, report annual income of less than $5,000 and lack any healthcare.

"On average overall, the addicts have three diseases -- HIV, mental health problems like schizophrenia and substance abuse," del Rio said.

The researchers also learned that:

* One-fourth of the addicts had had unprotected sex in the previous six months.

* Half had not seen an HIV specialist in the past six months, and three-quarters were not on HIV medication.

BATTLING BACK

Crack addiction is the common denominator making treatment so difficult, they said. "The high is like nothing you've ever experienced; better than any orgasm," del Rio said. "The low is unbelievable. . . . You go to sleep thinking about where you're going to get your next hit. And, as opposed to heroin, there's no treatment, no methadone."

A major problem is the hypersexuality associated with crack use and the patients' heavy involvement in sex for crack and money.

"It's survival sex," says Metsch. "Women are dependent on male partners to help get drugs. They have to support themselves and their families."

The patients' plight is not solely their own, the researchers say; They're likely to spread HIV or AIDS to others. One-quarter of the study participants reported having unprotected vaginal and/or anal sex with an HIV-negative or unknown status partner in the preceding six months. Women were more likely, by 32 percent to 18 percent.

"Too many people think HIV is just a chronic disease, and people can live very well with it if they take their meds," Metsch said. "This group is not living good lives. They're sick. They're engaged in hard-core drugs. They're at high risk."

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