The rise of combination of potent anti-retroviral agents capable of long- term profound suppression of plasma viremia has been shown to prolong survival for individuals infected with HIV (Cohen, Oh., Farici, AS, 1998.) Appropriate applications of the guidelines available to clinicians and adherence to the complex medical regiment by patients have dramatically altered the prognosis with patients with late stages of HIV disease. However, in Puerto Rico, as in the US mainland, there is an increasing concern whether advances in pharmacology and benefits of early intervention are available to a great number of drug abusers. Characteristics inherent in the lives of drug abusers, such as continuous pressing need to obtain money for drugs, leaving drug abusers little time and psychological energy to follow the demanding regimens that are necessary for current medical and clinical intervention to be effective. Moreover, drug users are believed to neither take prescribed therapy, not attend follow-up appointments. Although these beliefs have been challenged by studies in Europe and the Mainland, changes in health policy in Puerto Rico and in US mainland have raised more questions among drug researchers, health care and drug treatment providers. Recent transferring of medicated monies to managed care providers funded by medicated monies to serve uninsured and poor Americans. Moreover, populations with high prevalence of infectious diseases, such as drug abusers, might not be the preferred patients of health care system driven by cost concerns. The overall goal of the proposed project is to begin understanding the process associated with help seeking for health problems, focusing on HIV/AIDS related diseases among Puerto Rican drug injectors residing in the North Metropolitan Health Care Region in Puerto Rico. This region is under the new policy of managed care, sine June 1998.
