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Op-Ed: Where do we go from here on HIV care?

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urlby Dr. Stella Fitzgibbons

“I never thought about AIDS until I read it on my husband’s death certificate.”

This is not a character in a play; this was a patient I saw in my office. She had spent 20 years with this man, and while she may have wondered if he was getting a little on the side, she never suspected that his lengthy illness could affect her own health.

The biggest shock for me came after her positive test, when I tried to send her to AIDS Foundation Houston for education and support.

“Oh, I can’t go there,” she said. “Somebody from my church might see me.”

If you attend an “open and affirming” church, live around people who left the closet years ago, or just hang out with a liberal crowd, you may not realize how many Americans think that HIV is a problem only for “those people.” Getting uneducated people, or members of some churches, to admit they need testing is hard even if you guarantee confidentiality; getting them treated is even harder if they’re uninsured or on Medicaid. And did you ever hear a TV report on human trafficking mention STDs? It’s not cool to turn off potential donors, even though Googling “human trafficking and HIV” yields dozens of articles.

It’s been clear for decades that HIV is spread by exchanging body fluids, no matter what your sexual orientation. Multiple partners, needle sharing, and trading sex for favors spread it. And having sex with an at-risk person means that you share that risk.

But a large segment of America still thinks you have to be a homeless heroin abuser or a gay man living in Montrose to get the disease. So testing programs keep turning up people, often very sick people, who never dreamed they could be HIV-positive. How can we help them, and how do we prevent more from getting infected?

Employee insurance is good for HIV drugs, from antiretrovirals to antibiotics and other meds that prevent or treat the complications. And the Affordable Care Act’s provision for pre-existing conditions prevents people from losing coverage when they change insurance carriers. Treatment not only lowers viral loads but also makes them less infectious. But insurance covers only part of those who need it.

If you’re uninsured or on Medicaid, you’d do well to live in Harris County. The Harris Health System (formerly Harris County Hospital District), with three hospitals and clinics all over the county, will see any Harris County resident on a sliding scale based on income. It takes at least eight weeks and a lot of paperwork to get their “gold card,” and more waiting for an appointment with your local clinic. Why bother? Because at the end of the red tape is something called the Thomas Street Clinic.

The Thomas Street Health Center provides cutting-edge medical care and medications under the supervision of specialists from Baylor College of Medicine and UT Health Science Center. Good place, good people…but now we’re back to my first paragraph. How do we convince the public—not just people who need testing and treatment, but the families and friends they need to support them—that HIV patients are not all hookers, ex-cons, drug abusers and drag queens?

The LGBTQIA community has had the answer for years: more people need to come out. Magic Johnson shouldn’t be alone in demonstrating that HIV is something you can live with. We need housewives, truck drivers, teachers, and other regular folks to step out of the shadows and tell people what they and their doctor are doing.

They need to tell their churches and social clubs and coworkers. And stand strong against the “How did he get that?” questions and those who made my patient afraid to get help. They will find out who their real friends are, and which churches really practice what they preach.

When I was caring for AIDS patients in the 1990s, I found out just how powerful the gay community could be, not only in helping individuals but in getting out the information people needed to hear about the disease. Maybe the time has come to pass the torch to a different group.

Stella Fitzgibbons, MD, has taken care of HIV patients since the HIV test first became available, and is still seeing people with advanced HIV disease who could have stayed healthy if they’d been tested and treated.

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