HIV’s Have-Nots: Uncommonly Young Patients Hit Bailey-Boushay House

Last summer, Bailey-Boushay House, the Madison Valley facility providing care for people with HIV and AIDS, began seeing what executive director Brian Knowles calls a “disturbing trend.” Many of the new patients admitted to its outpatient unit were young gay men in their early 20s.

The influx of young men, which now numbers more than 20, took Bailey-Boushay by surprise, Knowles says. Up until that point, the facility’s population had steadily gotten older. The average age of the outpatient unit was 48, and some patients were seniors.

We’re trying to figure out what that’s about,” says Knowles of his new clientele. He suspects that the tremendous advances in HIV treatment—chronicled by our cover story this week-- has led to some increase in risky activity as people lose the fear of the virus that they once had.

But the region as a whole has not experienced a rash of 20-somethings contracting HIV, according to Matt Golden, director of the STD program at Public Health–Seattle & King County. So it’s something that may be specific to Bailey-Boushay, which Knowles characterizes as a “place of last resort” for HIV patients. Many come to the facility after failing to stick with previous drug regimens.

And the younger patients tend to have even more problems. They are often homeless, hooked on crystal meth, troubled by mental illness and plagued by experience in the sex trade. “Many have had HIV since their teenage years, some as early as 14,” Knowles says.

And, as Bailey-Boushay’s director sees it, they illustrate a fracturing that has occurred within the larger world of HIV patients. “There’s not the sense of community there once was,” Knowles says. Instead, he says, there are “the haves and have- nots.”

Knowles explains: “It used to be that if you had HIV, it didn’t matter if you were homeless or a bank manager. You all went down the same path.” That was a path to death, or at least to a prolonged state of decline. But then miraculous drugs came out, none more so than the one-pill-a-day medications that have arrived on the scene in recent years. A bank manager today might well take such a pill, allowing her a relatively normal life that is not defined by HIV. Christina Rock, profiled in our cover story, lives such a life. The Bothell resident has two young children, neither of which have HIV, and takes a daily pill that she compares to a multivitamin.

Yet, the kind of patients that arrive on Bailey-Boushay’s doorstep usually cannot take just one pill a day due to their spotty record with previous drug regimes, which has made them resistant to medications used in the latest pills. (Those pills combine three or more drugs.) Knowles says the average patient in Bailey-Boushay’s outpatient unit takes 11 daily pills, including HIV medications , drugs to control side effects and psychiatric meds.

How do you make sure a homeless person take 11 meds a day? That’s a question Bailey-Boushay is wrestling with as it tries to help its newest wave of HIV have-nots.

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