CARING FOR DEPRESSED Clinic battles the despair of HIV patients

"Jean" is friendly, outgoing and typical of many young, sexually active women in the West Baltimore projects. She comes from a broken home where she was repeatedly physically abused as a child, and she has been searching for love.

Every man she has been with, she says, she thought would turn out to be the "right" one in a monogamous relationship -- the man who was going to end her loneliness and take her and her children away from their grim life in the housing projects.


Now, at 22, she is infected with HIV, the virus that leads to the fatal AIDS. She's not a drug-user, but a former boyfriend was. Through sexual intercourse, he passed the virus on to her.

Jean -- not her real name -- was infected by the man she was living with before she met the father of her 15-month old son. So far, the toddler has not tested positive. Her two other children, 2 and 4, are not infected.


Jean discovered she was HIV-infected when she attended a special clinic for pregnant women at the West Baltimore Community Medical Center at Saratoga and Stricker streets.

The clinic focuses on HIV-infected mothers who are often so depressed they shun health care, their babies and the men in their lives. It is the brainchild of Dr. Dorothy Lee, 43, a physician who empathizes with the women because she grew up in housing projects in New York.

"There are lots of sexually active women in Baltimore, like Jean, who are not in monogamous situations and they don't see themselves at risk because they are with that man six months or six years," says Lee. "They are not married, but they consider themselves in kind of a marriage and they're faithful to this man for as long as they're together.

"If you have a boyfriend for six months, that's considered safe," she says. "The women don't seem to worry about where the man has been and what he has been doing the last 10 years. . . . and that's where a lot of the problems are coming from."

The perception by the sexually active woman that she is in a kind of marriage, even though the couple has no marriage license, is the reason why condoms have been ineffective in preventing the spread of HIV in the black community, Lee says.

"If you went out to Minnesota and asked a woman and her husband to use a condom, would they do it?" asks Lee. "Of course not. They have a trust relationship with one another. Well, the woman in the projects looks upon her man as a husband and has the same trust relationship. . . ."

Despite the risk of infection, the woman feels "there's no need to use condoms," she says.

Lee has set up a holistic program in a non-threatening environment that is designed to meet the physical, mental, and spiritual needs of HIV patients. It also seeks to deal with social needs such as housing and income problems.


Since Oct. 19, 1990, Lee has received nearly $400,000 for her innovative program from the Health Services and Resources hTC Administration, a federal agency that distributes funds for HIV projects in needy areas under the Ryan White Act.

Of the 260 patients seen at the clinic on a regular basis, 70 percent are women. Most of the rest are their children and a few are the men in their lives, says Lee, a pediatrician and a preventive medicine specialist employed by Total Health Care, a health maintenance organization that runs several health centers the city. Half of the women patients --like Jean -- are diagnosed as HIV-infected while they are pregnant.

Jean says she has lived in one housing project or another since she was 7. When she was 16, Jean broke away from her mother "because the devil had her in his power," she says. "I never really talked to my mother about anything. She beat me every day, and she had male friends who abused her. . . . I never got love at home, just physical abuse.

"I was always looking for someone to give me a little love. I wasn't running around. I was just looking for someone who would care for me like I would care for them," Jean says in an interview in her threadbare, dimly-lit, third-floor apartment, which brightened somewhat by a solitary ceiling bulb and a gospel music radio program.

"I like men and liking men is what got me into trouble sexually," she says.

Asked if she would do things differently today, she replies, "Very. Sexually active young women need condom protection. And, don't let him say he don't like it because if he don't like it, you don't do nothing. HIV is not something you play around with. I have it and I'm letting you know, it's not good."


Jean says she often visits her father and her girlfriend because when she sits in her apartment for long periods of time, "I start to think about what I have and where I am heading, and then I start breaking down and my children want to know what I'm crying for."

Sex really hasn't been on her mind much these days, Jean says. "What I have been thinking more of here lately is that I want to give my life to the Lord," she says. "He already has my children and I want us all to be together."

The depression that usually afflicts HIV patients makes it difficult to persuade women to seek medical care on a continuing basis, Lee says.

"I went to visit one woman who was not coming to the adult clinic and not bringing her baby in for care," Lee says, "and from the moment I opened the door, the depression fell on me.

"The young woman, about 22, was sitting with her baby in her arms in total darkness. I told her we really needed to see them both in clinic. Her reply was, 'What's the point? There's no cure for this thing. And, I don't want anybody to know anyway.' "

Lee believes the hopelessness of the situation and the stigma of AIDS are the two main reasons why HIV-infected women do not seek medical care for themselves even though they usually bring their babies in to the clinic.


About 45 percent of the HIV population at the West Baltimore medical center are intravenous drug users and 50 percent of those are women, according to Lee. "When you think of IV drug users in terms of women, it's like the bottom of the barrel," she says. "It's such a stigma in most black communities."

Lee has concluded that an IV-drug-using black woman "is probably one of the most depressed and broken persons you will ever meet . . . but they go that way because the brokenness and helplessness in their family situations is so bad."

Complicating matters, the majority of these women are on medical assistance and 90 percent of them have not completed their high school education, she says.

The special clinic -- seen as a one-stop shop -- is open every Friday afternoon. It's a place where a woman can speak to a social worker, case manager or infectious disease consultant and get treatment to ease bouts of an overwhelming HIV infection. The goal is to answer all the problems that day so patients aren't forced to keep running back and forth.

"One of the best things that has come out of this experience has been STAR -- Sisters Together and Reaching," Lee says. "Really, the nurse who works with me and I were both getting worn out from the emotional burdens of these women. STAR is a cadre of community churchwomen -- about 20 in all, who, as 'sisters' to HIV-infected mothers, could, for example, accompany them to the hospital when they had a critical episode."

STAR is kind of a buddy, or spiritual support, system for HIV-infected women, she further explains. But, the churchwomen also are being trained to go back to their churches and create AIDS ministries to support HIV-infected people in their own churches, according to Lee.


"The flip side of what we hope to do with STAR is to be able to change the atmosphere within the church so that it becomes a loving community," Lee says. "We feel that if the church takes leadership, saying that these people are okay to love, then our black community will be able to accept these people. And then, these HIV-infected women can come out of the closet."

Lee says most of her female HIV patients have not told anyone in their families they are infected. "They can't because they are afraid the word will get out into the community," she says. "The stigma is so bad, the women have to keep their terrible secret bottled up. Not being able to tell people and constantly being afraid eats these women up."