By Deborah Jones, APRN
Many media outlets marked June 5, 2011 as the “thirtieth anniversary of AIDS.” While that choice of words may sound too celebratory for observing the day when five gay men in Los Angeles were given the first official diagnosis of Acquired Immune Deficiency Syndrome, which has since killed nearly 30 million people worldwide, we can be grateful for the progress made in understanding the HIV virus that causes AIDS and the available treatments that enable infected patients to live a relatively normal life.
There was a time when treatment didn’t begin until a patient’s CD4 count (what used to be called T-Cells) was below 200, meaning the body’s immune system was no longer strong enough to fight off illness and infection. Now we’re able to treat patients when their CD4 count is between 350 and 500, and that seems to help with transmission risk and life expectancy.
The medications are still pretty difficult to take, but they have improved a lot in the 9 years I’ve been treating people infected with HIV. Meds used to require refrigeration and patients would have to take them every couple of hours. Now they are more portable and are easier to take. We also have a good system in place in Vermont to help people get their meds. It’s not like that all over the world.
Assisting with all aspects of managing HIV/AIDS has contributed to the progress made in treatment. Patients coming to Brattleboro Memorial Hospital go to the Comprehensive Care Clinic, located in the oncology department on the third floor of the Richards building. The medical staff collaborates with the patient’s primary care physician to coordinate care. Dr. Kemper Alston and Dr. Jeffrey Parsonnet, infectious disease specialists, visit the clinic once a month to see patients. A dietician also attends the clinic to offer nutritional counseling. John Field is a medical social worker and part of the BMH clinic’s regular staff, guiding patients through issues with medical insurance, housing, making needed referrals and ensuring they continue to get the care they need.
The Comprehensive Care Clinic is part of a four-clinic system in Vermont providing confidential treatment and services for all stages of HIV/AIDS, including free HIV testing, prevention counseling, social services and access to medicine. The clinic system was established in 1994 and continues with support from the Ryan White CARE act. The other clinics are located in Burlington, Rutland and St. Johnsbury.
The clinic system has provided the doctors, dietary consultation and social work component since its inception. Psychiatry was added later on and we have also worked with naturopaths and acupuncturists if the patient desires. People living with HIV/AIDS do a lot of their own research. We try to give guidance but we respect there are different ways of managing the condition.
When I joined the clinic in 2002, we had 32 patients. For the past couple of years the number has hovered between 60 and 70. This is not an indication that incidents have increased as much as the fact that more people are getting tested and there are more long-term patients. New cases are rare in our community. Some of our people have been with us through their friends and their partners dying while they have survived.
There is still a stigma attached to being infected with HIV/AIDS and as a result people don’t always get care in their own community. Our patients come from all over western Massachusetts and New Hampshire because it’s more comfortable for them. They are from all walks of life. Many of them are professional people and our main goal is to help them live their lives to the fullest.
Patients are welcome to bring partners and families to the clinic. Sometimes they ask me to talk with their HIV-negative partners about life expectancy, risk reduction and other issues. It’s an honor people trust me to do that.
The free, anonymous HIV test is another important service we provide. The test is done by a simple oral swab and no longer requires us to draw blood. The Center for Disease Control estimates one in five people who are HIV-positive do no know they are infected. Infection rates are rising the fastest among very young people and older adults. They strongly encourage everyone between the ages of 16 and 64 to get tested if they haven’t already, and people who are at risk should get tested regularly.
This year was also the thirtieth anniversary of the first space shuttle launch. The July 8, 2011 launch of the Atlantis was the final flight of the shuttle program. It would be neat if someday our services were no longer needed.
Deborah Jones is a nurse practitioner and manager of the Brattleboro Comprehensive Care Clinic. Confidential counseling and free, anonymous HIV testing can be arranged by calling 802-257-8860.