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Almost everywhere he looks, Jamey Rousey of Smyrna sees the AIDS epidemic in motion.
Rousey, 39, travels regularly to a Midtown Atlanta clinic to see a doctor, dentist, dermatologist and a host of other specialists under one roof. He also attends support groups or volunteers as a patient "buddy."
But few of the faces among outpatients at the Ponce de Leon Center look like Rousey these days. To be sure, most are in advanced stages of AIDS, but fewer are white, male, middle-class and gay --- the profile that was once the definitive tag of People with AIDS, or "PWAs."
"Sometimes, I'm the only white person in the waiting room," Rousey said. "It's not that it bothers me. It's just such a difference from the beginning."
Each year, the profile of HIV and AIDS patients in metro Atlanta is changing. The Ponce de Leon Center --- which is often cited as a model for providing one-stop shopping for the health and social needs of the HIV population --- is one of the first to see that transformation. Outpatients are increasingly minority, heterosexual, female and a mix of urban poor and rural residents, public health officials say.
Of the nearly 28,000 Georgians diagnosed with AIDS, two-thirds live in metro Atlanta. While African-Americans make up 29 percent of the state's population, they accounted for 76 percent of new AIDS cases in 2001. Black women account for 84 percent of all women with AIDS in the state. Homeless cases climb
Some AIDS victims live on the streets, under building stoops or in shelters. They do not have the kind of health insurance, jobs or disposable incomes that the first wave of PWAs possessed.
Among Atlanta's homeless population, 15 percent to 20 percent are estimated to be infected with the AIDS virus --- about 4,000 to 5,000 people. Many of those who are infected are addicted to crack cocaine. Authorities say trading sex for crack is common, and the practice is a major factor in rising rates of HIV and other sexually transmitted diseases.
"We're seeing more and more individuals who don't have the life skills it takes to handle the new drugs," said nurse Angelle Vuchetich, who is the clinic program manager at the Ponce de Leon Center.
"What we have now is an urban, poor population," Vuchetich said. "Their ability to do all that is required [to get treated] isn't there."
Ten years ago this month, the AIDS outpatient center at 341 Ponce de Leon Ave. opened in a renovated six-story building in the middle of a notorious drugs- and sex-for-sale zone. The building, formerly the Presbyterian Center, was purchased and renovated by the Fulton-DeKalb Hospital Authority for about $10 million.
Many of the specialists at the center, which is part of the Grady Health System, are affiliated with Emory and Morehouse schools of medicine and the Centers for Disease Control and Prevention. Last year, the center was selected as one of the nation's top three HIV/AIDS outpatient clinics by the University HealthSystem Consortium, an organization that annually reviews such clinics.
Inside, the former chapel is now a large foyer. Sunlight floods in as clients warmly greet one another and staff members. Hallways and waiting rooms are accented in colors of blue, gray and burgundy and decorated with donated art.
Nowhere do the letters HIV or AIDS appear on any outside sign or door.
Robbie Thompson could be the clinic's poster child. She was once "out there," treading the Ponce and North Avenue corridor and doing whatever it took to stay high. Now, Thompson is on the inside working as a peer counselor.
The Philadelphia native found herself stranded in Atlanta six years ago without a car, job or home after a girlfriend abandoned her.
"I always had my life together. I never thought I'd be homeless and into drugs," said Thompson, a 42-year-old mother of a teenage daughter. "I bought dope right down the street from here. I used [drugs] right on the property. Smoking crack, prostitution, selling drugs. You name it, I did it."
Sitting in her cramped fourth-floor office, she exudes the confidence and pride of a survivor.
"Basically, I'm an example," Thompson said. "The majority of people who walk through this door, I have something in common with. I want to share my experience and give them strength."
But she is not a typical clinic success story. A bulletin board covered in snapshots attests to that. "These are former clients," Thompson said, tallying up the mostly African-American, male faces. "Six, seven, eight of them passed since last Christmas. Most were homeless. Some overdosed. This one refused to give up crack," she said, pointing to one photo. Poor at disadvantage
Drug abuse, mental illness and lack of a permanent residence makes it difficult for many of the patients to take full advantage of the nearly 20 AIDS medications, called protease inhibitors, that could prolong their lives. The drugs are usually combined in intricate mixes of three and four cocktails, adding up to daily doses of eight to 20 pills a day.
To be effective, however, the drugs must be taken on a strict regimen and side effects must be carefully monitored. It's a crucial routine that escapes many of the center's indigent patients.
"[Outpatients] don't come in to see a doctor when a rash shows up," said Vuchetich, the program manager. "They don't understand why they can't take 'drug vacations.' "
Because of that, Grady health officials expect deaths of their AIDS patients will slowly creep back up after years of decline. At the same time, longtime survivors of AIDS, such as Rousey, are running out of drug options as their bodies build up resistance to the new treatments.
"Some people are doing great on the drugs, and some are developing resistance," said Dr. Jeffrey Lennox, clinic medical director and an Emory University professor. "The therapy is very effective for some. But it's hard to tell how many more years patients will live."
The comprehensive care approach at the Ponce center has led to fewer clients skipping appointments and to declines of some common AIDS-related infections, center statistics show.
"The whole point of asking for the clinic was to say 'Let us give good, routine outpatient care, and we'll keep [Grady AIDS patients] out of the hospital, and it will be a whole lot cheaper than hospitalization,' " said Jacque Muther, who oversees policy and grant funding at the Ponce center.
The clinic operates on a $20 million annual budget; about $11 million comes from state and federal programs. Grady Health System's main operating budget and Medicaid and Medicare reimbursements provide the rest.
Initially, neighbors and local businesses bitterly opposed moving Grady AIDS services from downtown to Midtown. Some county commissioners and others questioned the need and cost.
As the fight dragged on for two years, AIDS activists wrapped themselves in red and waved placards reading: "We're Dying from the Red Tape." Such memories help caregivers like Vuchetich continue to face the relentless disease day after day, year after year.
"When I say we took care of people in the beginning of the epidemic, we really took care of them," the nurse recalled. 'When you have someone dying in bed and they want to see their mother or father one last time, and then you telephone the parents and they tell you, 'No. And make sure he knows I don't want to say goodbye.' Well," she says quietly, "it was just awful."
Rousey moved to metro Atlanta from Macon to get better medical care after his 1987 HIV diagnosis. He was 21 at the time and never expected to live past age 25. He had even put a down payment on a casket.
With the help of the Ponce center and the new AIDS wonder drugs, so many years have passed since that down payment that he can't even remember the name of the funeral home.
"If and when this drug regimen fails, I don't know what I'll do," Rousey said. "Maybe there'll be another drug combination for me. I plan on living until I'm 70 or 80."
Copyright 2003 The Atlanta Journal-Constitution