LAU R IE PEAR M AN
LAU R IE PEAR M AN
Dr. Clay Roscoe works daily with HIV patients at the Wellness Center, the only clinic in Idaho dedicated solely to the care of HIV patients. Despite better care options, infection rates have yet to drop.
a quick mouth swab that can reveal their status in minutes. More than 1,000 people have taken HIV tests through ALPHA this year. “Every year that goes by there is an increased awareness in the health-care provider community. Each year I see more health-care providers doing HIV screenings,” said Dr. Clay Roscoe, a physician at Boise’s Wellness Center, Idaho’s only clinic dedicated solely to the care of HIV patients. “[Yet] we really haven’t seen a drop in new infection rates, and I’d like to see that in my lifetime.” Apathy partly stands in the way of that drop, Roscoe said. “There’s more of a laissez-faire attitude because it’s known that the anti-viral treatments are well tolerated. I’m always a bit worried the guard is down, especially with the younger generation.” Generation Y never woke up to headlines reporting the death toll of a mysterious new disease called AIDS. For some, it seems Magic Johnson has lived a lifetime being HIV-positive. Idaho’s youngest generation can’t recall the time their Meridian predecessors walked out of class to protest a gag order that silenced discussion about STDs. And activists note that editors aren’t clamoring to fill newspapers and newscasts with HIV stories. “It isn’t a sexy issue,” said Jose Alfredo Hernandez, a case manager at the Wellness Center. The Meridian School district eventually lifted the gag order and offered parents the option of enrolling their students in sex education classes that covered information about HIV and other STDs. And administrators scaled back their censorship of Meridian High School’s student newspaper. As the veil of silence lifted, students started reading about what it was like to live with HIV. In a 1994 Meridian Warwhoop article, Meridian students met a vibrant young man who loved photography and painting. Rick Clara was a popular Borah High School student. He liked to use the word “normal” as the adjective that best described him. He also contracted HIV at the age of 22.
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Clara started his days by swallowing four pills. He took another four pills in the afternoon. He finished his day with a dose of another seven pills. Intravenous drips punctuated the 17 pill-a-day regimen. “What I dislike most about having AIDS, is people judge you before they even know you. There’s this stigmatism that comes with having AIDS—that you’re gay, a drug user, a bad person,” Clara told student reporters. Young, white men, the demographic profile Rick Clara fit at the time he was exposed to the virus, still test positive for HIV at a rate that surpasses any other Idaho demographic group. Idaho’s 20- to 29-year-olds are contracting the virus faster than any other age group in the state. The rate of infection for that group increased by 147 percent between 2002 and 2007, according to the Idaho Department of Health and Welfare’s Office of Epidemiology and Food Protection. But the disease cuts across race, class and gender lines—a fact that not everyone gets, Hernandez said. He said that race, class and gender play roles in who gets tested and when. “We know that Latinos are not getting tested until very late into the disease,” he said. Whites accounted for 77 percent of Idaho diagnoses between 2002 and 2007. But the Office of Epidemiology and Food Protection noted increasing numbers of diagnoses among Hispanics and blacks. “We’ve done a good job with [testing] women as it relates to pregnancy. At primary care health clinics like Terry Reilly, for example, they do a really good job of doing OB [HIV] screenings for their patients, and we’ve gotten a handful of patients through that process,” Hernandez said. The Centers for Disease Control and Prevention now recommends that women undergo pre-natal HIV screenings. It’s just one of the many new guidelines that have changed the way HIV is now treated and diagnosed. Activists and doctors say a lot has changed, and at the same time, too little has changed since students first meet Rick Clara.
| NOVEMBER 25 – DECEMBER 1, 2009 | BOISEweekly
Duane Quintana, founder of ALPHA, is a vocal activist for HIV and AIDS education and prevention. His group has become the state’s largest HIV testing organization.
In 1994, ALPHA was nearly a decade from inception. Wellness Center funding was still down the pipeline. And many considered the disease a death sentence. “It’s night and day,” Roscoe said of the treatment he has seen evolve since his med school days in the ’90s. “I was seeing people take a cereal bowl full of pills with lots of side effects.” Now many HIV patients stave off AIDS with just one pill a day. Many can even hold off on taking medications. “You’re not going to die of AIDS in this country,” Roscoe said, noting that with monitoring and treatment, people with HIV can have a normal life expectancy and now die of the same things that kill the general non-HIV positive population. The care of HIV patients has also become less fragmented, said Wellness Center manager Jamie Perry. People who test positive for HIV can now find a health-care home at the clinic housed under the Family Medicine Residency of Idaho program. Beginning next year, the program is slated to become just one of two residency programs in the United States that trains HIV specialists. The Wellness Center brought HIV medical care, referral services, support programs, nutrition, testing, counseling and case management under one roof in 1998. The center and its satellite clinic in Pocatello saw 511 patients last year. Between 2007 and 2008 the number of patients treated at the clinic jumped between, but for the most part, patient volumes have held steady over the years with only slight increases from one year to the next. And the center treats everyone—regardless of if they have health insurance. A joint study between Harvard and Stanford universities estimates the average cost of treating an HIV patient at $20,000 per year. Funds from the Ryan White Treatment Modernization Act help the Wellness Center cover medical costs for middle- to low-income patients. And the clinic works with all patients to ensure that they get the care that they need. If a person is diagnosed as HIV-positive tomor-
row, they can be assured that they can access medical care through the clinic, regardless of their ability to pay, Perry said. But challenges still slow the fight against the disease. More physicians need to make HIV tests as routine as cholesterol tests, Roscoe said. “If you’re a health-care provider in rural Idaho, it’s not going to be on your mind every day,” he said. And HIV patients still face a host of social challenges, Hernandez said. Low incomes, difficulty accessing housing and a shortage of rural health-care providers may hamper some patients’ ability to comply with treatment, he said. And there’s still a fight to change attitudes. Nearly 30 years after researchers first identified HIV and AIDS, people with the infection still face stigmatization. People still hold prejudices about who gets HIV, POZ’s Hofmann said. And many still face an uncompassionate community, according to Hernandez. The Wellness Center recently changed its name from the HIV Services Clinic at patients’ request. They felt stigmatized just walking into an office displaying the letters HIV, Hernandez said. If Hofmann fits a stereotype, it’s that of a successful, professional woman. She’s well educated and well published. She excelled in her journalism career, earning command posts at East Coast magazines. And the cover of Hofmann’s memoir shows a beautiful woman with a long mane of blonde hair, perched atop a horse. The book’s title also hints at the secret she kept for so long. I Have Something to Tell You reveals how Hofmann came out as HIV-positive. “I wanted people to know that HIV was alive and well. And I wanted to contribute to the de-stigmatization of the disease.” In I Have Something to Tell You, Hofmann reflects on coming out very publicly— on the cover of POZ—and about life as a journalist, and the power of the media in fighting the disease. “One of the things that I think about as a journalist is, ‘Why do we always have to go to WWW. B O I S E WE E KLY. C O M