HIV Care in 2013

Hundreds of clinicians and social workers gather in Chapel Hill for the latest information on caring for the state’s HIV population

By Lisa Chensvold

Getting her HIV-positive clients to take their drugs consistently and keep regular clinic appointments is the greatest challenge faced by Fran Deshazo-Mock, a social worker in the Cape Fear Valley Health System.

HIV care providers from across the state gather at the Friday Center in Chapel Hill

HIV care providers from across the state gather at the Friday Center in Chapel Hill

Recent advances in treatment have turned HIV from a life-threatening illness to a chronic, manageable health condition. Today it is estimated that, with as little as one pill a day, people living with HIV have the same life expectancy as anyone else.

But people must take their medication daily and see their doctor regularly.

On May 6, nearly 500 physicians, nurses, pharmacists, social workers and other HIV care providers gathered at the Friday Center in Chapel Hill for a day-long conference, where engagement in care and drug adherence were the two main themes.

Now in its 18th year, the annual HIV update is the state’s largest HIV education event and draws health care providers from across North Carolina. The conference, “HIV Care in 2013: Trends in Clinical Care and Caring for Vulnerable Populations,” is hosted by the UNC School of Medicine and UNC Eshelman School of Pharmacy, in partnership with the North Carolina AIDS Training and Education Center (based at UNC) and the Greensboro Area Health Education Center.

Deshazo-Mock, who is the only HIV social worker in the Cape Fear Valley Health System and sees hundreds of clients, has been attending the annual conference for about ten years.  Because many of her clients struggle with alcohol, drugs or homelessness—sometimes all three—it is hard to get them to make their HIV disease a priority.

“This is great,” she said about the conference’s focus on retention and adherence. Time and again she has seen her homeless clients get their lives back on track, taking their medication and living in stable housing. “But it only takes one trigger,” she said, and their HIV regimen goes out the window.

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Kimberly Smith’s presentation is piped in to the overflow room at the Friday Center.

In the opening talk, Dr. Thomas Giordano of Baylor College of Medicine gave an overview of (mostly) domestic programs to improve retention and adherence. In some studies, something as little as a follow-up call to patients who missed or cancelled an appointment can be enough to prevent them from falling out of the system.

Other research has shown that peer navigators can help those newly diagnosed with HIV, people who are struggling to understand their condition, possibly dealing with side effects to their medication, and face social stigma.  Having someone to talk to who can relate to what they’re going through is critical.  “No matter how empathetic I am as a physician,” Giordano told the audience, “I don’t have HIV.”

The conference featured two different tracks, one geared toward clinicians, the other toward social workers, psychologists and substance abuse counselors. Topics for clinicians included newly approved drug regimens and how to use them, caring for HIV and Hepatitis C co-infected patients, drug interactions and oral and dermatological manifestations of HIV. Topics for social workers and counselors included HIV risk perception in women, medication adherence, and personality disorders and HIV.

Lauren Wright, a substance abuse counselor in Durham, was attending the event for the first time. Because drug and alcohol abuse put people at a much higher risk of getting HIV, renewing her license as a clinical addiction specialist requires six hours of HIV/AIDS training.  She was looking forward to the afternoon session dealing with substance abuse and linkage to care. “The population that I work with in Durham targets the uninsured, disconnected, people that aren’t already connected to services,” she said.

African-American women are particularly at risk for HIV. Although they make up just 12 percent of the population, they account for more than 60 percent of new infections. In her talk on HIV risk perception in women, Kimberly Smith, a physician at Rush Medical College in Chicago, said that many black women diagnosed with HIV do not exhibit high-risk behavior. They don’t abuse alcohol or drugs and have long-term, monogamous relationships. When they get the diagnosis, they are shocked. “Let’s stop making it about individual risk behavior,” Smith said, and instead make it about a community with a much higher prevalence.

How can we combat the persistent notion that only certain people get HIV? The media could help, Smith said. “They should have someone on Real Housewives of Atlanta with HIV.”