Home medication for people with AIDS and other infectious diseases improves their quality of life and dramatically cuts the costs of medical care.

This is the opinion of Atlanta-based specialist, Dr. Robin Dretler, who has spent the past week in Bermuda at the invitation of the the Allan Vincent Smith Foundation.

AIDS treatment in the US, he says, has reached such a level of sophistication that the disease is now an `out-patient' disease, with hospital care only necessary for last-stage patients.

Dr. Dretler points out that in Bermuda there are currently 295 reported cases, with 272 deaths -- a far higher mortality rate than that of the US, which now averages at 40 percent.

"From these figures we can see that people with AIDS are living longer in the States. We have better availability of effective drugs and, because doctors have seen more HIV, they are better trained.'' Now, he is working, through the Foundation, to help medical workers on early diagnosis of HIV symptoms and improved treatment. He says he is very encouraged by the interest shown by local physicians and nurses in these areas.

"We have been using a system of home intravenous medication therapy (HIMT) for quite a few years now. We realised most infections which require extended courses of anti-biotics could be administered just as easily in an out-patient facility or even at home. Typically, patients were lying around in hospital, sometimes for as long as six weeks, bored and depressed. This `home' scheme has been so successful that we now have only about one percent admission rate.

HIMT helps people to get back to life and back to work. People who were spending weeks at a time in hospital are not going in at all now. This is especially important for AIDS patients because they have a limited life expectancy -- and don't want to spend it in hospital. Insurance companies love it because it's cheaper, and it's no harder to administer! So I hope I can help Bermuda with this.'' Dr. Dretler, who has been advising local physicians for several years now on certain AIDS cases, has been conducting feasibility studies with the Island's health workers to see if a similar system can be set up here. He believes that Bermuda's population of around 60,000 could easily support one or two full-time nurses to set up medication as required.

"They can also do this for other infectious diseases. For example, people with diabetes or osteomyelitis (bone infections) often require extended courses of antibiotics, so this is a service that can be used by several groups of people. At least half of the people on my programme in Atlanta, for instance, are diabetics.'' The Foundation and health care workers are also aware that there is a need for increased education on AIDS in Bermuda, so this has formed the other aspect of Dr. Dretler's mission.

"Complacency is now the greatest enemy,'' he explains. "There is still so much denial and the thought that `it can't happen to me'.'' Dr. Dretler, who is attached to Atlanta's De Kalb Medical Centre, with 800 doctors on the staff, says he is increasingly dismayed by apparent indifference to the fact that AIDS is now seriously affecting the general population.

"We are talking about people of all classes and backgrounds. For example, at our hospital, we have two women and one man, all adult children of doctors who have HIV. None of them are drug users and you could say they come from privileged backgrounds. But they were promiscuous. And what we have to remember is that the word `promiscuous' means, quite simply, having more than one partner. Just one. I am also taking care of several doctors who have AIDS.

I have more ministers of the church than hairdressers who have AIDS.'' Ironically, Dr. Dretler, who has dealt with at least 1,000 AIDS cases in the last ten years, originally decided to specialise in infectious diseases because there were relatively few chronic infections.

"When I started out, there was no such thing as AIDS. That changed as soon as I got in! In 1983, I saw the first case that I could actually recognise as AIDS, but I realised, in retrospect, that I had seen AIDS cases -- but at that time, we didn't recognise it as that.'' Because of the enormous stress involved in caring for patients with HIV, Dr.

Dretler says he tries to limit these to one-third of his overall work load.

"It is heart-breaking work. Especially as we see it entering the general population -- it really brings the whole tragedy very close to home.'' There is more than a hint of frustration in his voice as he pleads for people to change their sexual behaviour and to educate the young on the dangers of all sexually transmitted diseases, but especially AIDS.

"We've to get to the children before they are teens. I often give talks at my daughter's school and I've been very surprised that children of privilege -- it's a private school -- know so little. Doctors' children seem to be the worst informed! It's a problem for many parents to talk about sex but if we don't constantly teach them about the dangers of unprotected sex, we will have a whole new group of adolescents who are totally ignorant. We seem to have lost the sense of urgency about AIDS -- at the very time it's entering the general population.'' He also makes a rousing call for the empowerment of women.

"Women don't seem to realise the power they have in a relationship. They have the power to say `No! Not unless you use a condom' -- I can assure you, men will soon get the message! Women must realise they are not only endangering themselves but their unborn children.'' To drive his point home, Dr. Dretler says that a person who becomes sexually active at 15 and has one sex partner a year through the age of 21, results in a circle of 625 people who are sexually connected in just one year.

"This is a very efficient time period to spread any disease -- including venereal disease -- yet people with six partners in six years do not think of themselves as being promiscuous.'' Anyone who wishfully thinks that AIDS is `evening out' should note the statistics quoted by Dr. Dresler from two US sentinel hospitals. In one, testing men between the ages of 24-44, there was a 25 percent rate of HIV positive and in women, 16 percent, with the second hospital reporting 16 and eight percent, respectively.

"But these tests are conducted anonymously, and people cannot be informed of the results. So we have all these people walking around without any idea that they have contracted HIV. So I would say: You may trust your own judgement in relationships, but do you trust everyone else's? And, I would ask, `Are you ready to die for love?''' FOUNDATION HOSTS AIDS SPECIALIST -- Dr. Robin Dretler (centre), Atlanta-based AIDS specialist, pictured with (left) Mrs. Adrianna Goodfellow and Mr. Martin Smith of the Allan Vincent Smith Foundation.