Transit Strike Strands HIV Patients

In another example of the MTA strike’s disproportionate effect on the most vulnerable elements of society, HIV and AIDS clinics in Los Angeles County are reporting missed appointment rates as high as 50% since bus drivers walked off the job in mid-September.

Although health-care facilities are reporting more missed patient appointments overall, some health officials are especially concerned about the effect of the strike on the thousands of low-income HIV-positive patients in the county--because consistent monitoring, dosages and adjustments are crucial elements of the drug cocktail programs many patients use to combat the virus.

“One of the really important things with the new cocktail medications is adherence to both the medical appointments and the therapies,” said Mark Henrickson, director of the Northeast Valley Health Corp.’s HIV services division in Van Nuys. “If people can’t get [to clinics] for monitoring of their blood levels, they’re going to be hit with potential long-term consequences.”

Northeast Valley’s HIV clinic is one of those most seriously affected by the strike, with 70 no-shows--or half of the clinic’s total appointments missed--since Sept. 18, Henrickson said.

The L.A. Gay & Lesbian Center’s Lambda Medical Group, which operates a number of special HIV programs in Los Angeles among its general health-care services for the gay community, reports a no-show rate of 25%.

Last week, the AIDS Healthcare Foundation, which operates seven clinics in Los Angeles County, saw 15% fewer patients than normal. This week, those numbers improved when AHF-commissioned vans were dispatched to pick up stranded patients. “But that was out of our own pocket, and we’ll only be able to do that for a short period of time,” said Cesar Portillo, a spokesman for the private nonprofit foundation.

Keith Waterbrook, director of health services for the Gay & Lesbian Center, said that with the strike only three weeks’ old, its effects haven’t been devastating for bus-dependent HIV patients--yet.

“There’s flexibility,” Waterbrook said. “If you miss an appointment this week it’s not that horrible, but it means you need to be seen within two to three weeks. But if [the strike] continues, the impact will be very severe on our patients.”

Neal McCarty, 46, of Northridge, is on two AIDS cocktail treatments; he also suffers from emphysema. Normally reliant on buses, McCarty has been using his bicycle for medical appointments and grocery store trips. Worried about discolored phlegm he’s noticed recently, he made an appointment at the northeast Valley clinic Tuesday--a 30-minute trip by bike--but missed it, he said, “because I didn’t have the strength to ride down there.”

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Byanka Uriarte, 32, of Reseda, who is HIV-positive, has missed three appointments for hormone treatments and blood monitoring since the strike began. “Without the blood tests I have no way of knowing whether the [HIV] medication is working,” Uriarte said.

Missing a prescription dosage is also a problem, said Dr. Robert Bolan, director of the Lambda Medical Group. “Brief periods off medication result in the virus reactivating and being able to reproduce in the presence of some of the remaining drug in the system,” he said. “And that’s the circumstance under which [the virus] develops resistance.”

Bolan and others are worried about bus users getting to drugstores to have prescriptions filled. “When you’re talking about a medically indigent population, waiting until the last minute to fill a prescription is not unusual,” AHF spokesman Cesar Portillo said.

Each year, Los Angeles County receives approximately $37 million in federal Ryan White CARE Act funds--the county’s main source of money for the HIV services that help 18,500 low-income patients with HIV and their families, according to Gunther Freehill of the county’s Office of AIDS Programs and Policy. About 5% of the funding goes to subsidized transportation, including bus and taxi vouchers and van services.

But bus vouchers aren’t much help these days, and established taxi and van services can help only so much during normal weeks. The Gay & Lesbian Center’s Waterbrook said the center has about $150 in taxi vouchers to give out each week.

Northeast Valley Health Corp., which has one van serving five Valley HIV clinics, now turns down five to six people per day who need rides, Henrickson said.

“We’re booked solid, and we’re desperate,” he said.

Meanwhile, at the clinic, he added, “We’ve got doctors sitting around looking at each other saying, ‘Where are the clients?’ ”