When you're diagnosed with HIV, it can feel like your fate has been written. You have questions, such as whether you’ll live, how much treatment will cost and whether people will still love you.
Nurse practioner Dionne Bell tries to answer some of those questions and offer options. Bell says patients are given their results and then immediately offered counseling. In the flurry of forms and blood tests, Bell and her colleagues at CareSouth Clinic, on Florida Boulevard in Baton Rouge, are starting to use a new model to help patients get into and remain in treatment. “If we have confirmatory testing and nothing else is needed and the patient is ready...they could be seen the same day,” says Bell.
With a program called Rapid Start, which began in San Francisco General Hospital in 2013, the goal is to offer patients the treatment and counseling they need right away, from the first visit.
According to medical professionals, that’s important. As soon as someone contracts HIV, cells start exploding with copies of the virus - bringing achy flu-like symptoms. What on the surface seems simple is actually causing damage, taking years off of your life. Treatment to suppress the virus right away can give back some of that time.
Program director Austin Matthews has high hopes for the new protocol and says the need to improve services is especially crucial in Baton Rouge. Baton Rouge has the highest incident rate of people living with HIV,” says Matthews.
Now, more people are getting diagnosed due to the recent expansion of Medicaid. “Fifty percent of the people that are coming into my clinic have never even known that they would ever have health insurance,” Matthews says.
More people have insurance, so more people are getting tested. That means more people are getting diagnosed with HIV. Insurance isn’t the only barrier to treatment. There’s a stigma around having HIV - people with the virus are sometimes seen as “dirty,” “failures,” or like they deserve it.
Matthews adds, “What that means is, when people get HIV in Baton Rouge, they don't get to treatment. It takes five, six, seven, ten years.”
Then there’s the challenge of getting help once someone is diagnosed. Many primary care doctors say they’re not equipped to treat HIV, so they make referrals to specialists. That’s daunting because their clinics are sometimes far away and expensive. There is help, but many don’t know how to get it. And that is why HIV care is more than the medication.
Like, ‘put pill in, remove HIV’ - that's not how medicine actually works and that's not how infectious disease control works,” Matthews explains. “Provide patients with the tools they need to be successful and happy and healthy and the outcomes are they're happier and healthier, and we have fewer virally unsuppressed people.”
For providers like Bell, Rapid Start asks an important question: “What do I need to do to help you get on track to take this medicine or do you want to take medicine now? Because it's your choice.”
Having that choice empowers patients. In the past, medications have had short and long term side effects. Today, meds are less toxic, can come in one tablet, and work fast.
It is the treatment beyond just medication that models like Rapid Start are working to change. As Bell says, it’s easy to give out medication - it’s hard to change people’s minds and behaviors. Many don’t come back after the first appointment.
Bell says, “Out of everybody I’ve done Rapid Start with I want to say maybe half will come. Maybe half. Sometimes they’ll have to get the counseling and the coaching when they come back to see me... so whatever keeps them on track.”
She says it can feel like an uphill battle, but it’s one worth fighting. Rapid Start is already being used at a number of clinics in the greater New Orleans area. For more information on HIV services in your area, visit AIDSVu.