Claire Farel, MD, MPH, is an assistant professor of medicine in the UNC School of Medicine and medical director of the UNC Infectious Diseases Clinic. In answering the most common questions she is asked as a clinician, Dr. Farel illustrates the vast prevention and treatment services available at the clinic, and how they can be accessed.
I love it when patients ask questions. Being able to partner with patients in their care keeps all of us in the UNC Infectious Diseases (ID) Clinic going. Asking questions shows that patients and their families are engaged in what all of us find most important: a healthier life, an understanding of illness and treatment, reliable information to pass along to others, support during stressful times, options for prevention of infection, maybe even a lasting contribution to science.
There are some questions I get more than others. The following are some of the perennial favorites:
“Aren’t you worried you’ll catch something?”
Infectious diseases encompasses all organisms that cause infection – like bacteria, viruses, fungi, etc. – but this doesn’t mean that the person with the infection is necessarily a danger to others. While some infections can certainly be transmitted from person to person, the ones we worry about are the most commonplace and easy to get, including influenza (“the flu”). We protect ourselves and our patients from many illnesses through immunizations and vaccinations (all of us get our flu shots to stay healthy!), lots and lots of handwashing, and education. If a patient or a family member has a cough, cold, or flu symptoms, we ask them to wear a mask when they check in to protect others. All in all, I would worry more about “catching something” in the grocery store, gas station, or other high traffic areas where we think less about protecting ourselves and others.
We take our role in preserving public health seriously and have a lot of educational materials on the topic of HIV and sexual health around our clinic. Talking about HIV and sexually transmitted infections is an important part of our work, as many people are afraid to ask questions or have misinformation. However, it’s important to remember that these infections are not spread by casual contact or even by sharing eating utensils, bathrooms, or hugging and kissing.
“I met the nicest lady in the waiting room. Does she have what I have?”
Thankfully, UNC has strict privacy rules, so it should come as no surprise that we can’t share this information. The important thing to know is that we see patients for a huge variety of reasons. Our waiting room is busy but we also help to care for many patients during and after a hospitalization. We see patients for infections of any type (for example, pneumonia, bone and joint infections, skin infections, etc), to rule out a particular infection, or to provide education and recommendations after a diagnosis.
“Why are there so many research flyers posted?”
UNC is a major center for HIV research, care, and prevention and we are proud of the work we do. The research that takes place at UNC has made huge contributions to the field and we continuously seek ways to make our patients’ lives better and healthier. If you are HIV-positive, we may offer you the opportunity to take part in a research study. We also have an increasing number of research opportunities for people with other infections, especially Hepatitis C. If you choose not to participate, our commitment to caring for you in our clinic will not change. We will continue to offer these opportunities whenever we have them unless you ask us not to!
“My significant other has HIV. What can I do to keep from getting it?”
We love to get the word out about HIV prevention resources. If your loved one is on HIV medications already and doing well with an “undetectable” amount of virus on blood tests, their risk of passing HIV on to anyone else is greatly reduced by somewhere between 92-100 percent. We call this “treatment as prevention,” but there are other ways to use HIV medications to keep from getting the virus. You can take a pill every day to prevent HIV before an exposure, known as pre-exposure prophylaxis, or PrEP. Using PrEP consistently creates a “shield” in your body against possible infection, dropping the risk of acquiring HIV by at least 90 percent. In an emergency situation (for example, if a condom breaks during sex or in cases of sexual assault), you can take a combination of medications called post-exposure prophylaxis (PEP) to prevent infection after an exposure. There’s a fixed window of time for PEP medications to have a benefit, however – so it’s important to start those emergency medications within three days of the exposure. Our emergency department has expertise in providing this care and our clinic team can assist in accessing preventative medicine if needed.
We are happy to see folks who are interested in HIV prevention in our clinic and can offer lots of resources to make taking preventative medicine manageable and affordable – as well as advice on protecting yourself in other ways.
“How can I arrange to be seen in your clinic?”
We have special programs for HIV-positive patients that allow self-referral – just give us a call (information is included below) to arrange an appointment. We require that most other patients get a referral from a medical provider (such as a primary care provider or another specialist). Having your medical records and the initial workup for your problem allows us to provide a focused, expert consultation. We advise that anyone at risk gets testing for HIV and hepatitis C as recommended by the CDC (Centers for Disease Control and Prevention), either through regular healthcare provider, free testing events, or local health departments. We take referrals from all of these sources and provide hepatitis C treatment through our clinic if you have a new or longstanding diagnosis.
Our contact information is below, or many practices can send referrals electronically.
UNC Infectious Diseases Clinic
101 Manning Drive, 1st floor Memorial Hospital
Chapel Hill, NC 27599
Our mission is to provide excellent clinical care and education for all of our patients, whatever their concern, and to offer them every advance and advantage in our field to keep them healthy. Keep asking questions!