HIV/AIDS disproportionately affects Black communitieswith Black gay and bisexual Black men and Black trans women being the most affected population than any other group in the country. More specifically, one in two Black MSM (men who have sex with men) will be diagnosed with HIV in their lifetime, as compared to one in four Latino MSM and one in 11 white MSM.
Recognizing these racial differences, especially among Black communities, Erie Family Health Centers view the HIV epidemic as a social issue as well as a healthcare issue. Among other things, Erie Family has employed the Lending Hands for Life (LHL) program to help those living with HIV/AIDSor those who are at risklive healthy lives and reduce the number of transmissions in Chicago..
Windy City Times talked with the center's Dr. Santina Wheat and LHL case manager Christian Biggers about the program and HIV/AIDS, in general.
Windy City Times: I wanted to start with something general. Did you think HIV/AIDS would be around for 40 yearsand there would be no cure or vaccine?
Dr. Santina Wheat: I think not. I thought that we would have a vaccine or cure by now. That being said, I have been pleasantly surprisedfrom my time from medical school until now, caring for patients with HIVthat we have is much better [than before]. It's much more manageable.
I feel like I have conversations with people who say, "It's not like what you saw in the movies, or when we were younger." I do wish we were further along, though, and had a cure or vaccine.
Christian Biggers: I can agree with what Dr. Wheat said. I do know, from stories I've heard from people doing ART [antiretroviral therapy], that what they have today is a lot better than what they had. You don't hear about side effects any more. Then, when you have the time and resources to truly educate people, you can see the difference.
WCT: Have you noticed a more casual attitude about HIV/AIDS, as compared to a few years ago, in part because new treatments are available?
CB: For me, with the clients I encounter, I don't see people have a more nonchalant attitude about it. That's partially due to stigmas. There are more commercials that educate people, but there still are stigmas associated with the virus.
DSW: I would add that when someone is diagnosed, that person takes it very seriously. However, I would say [regarding] my patients who are not living with HIV, I am somewhat surprised that they are a little bit more casual than I would like them to be. I do feel like I've seen a rise in a lack of concern with [HIV-negative] people.
WCT: It's definitely disconcerting that minorities are disproportionately affected by HIV/AIDS.
CB: It is pretty sad, just because of the poor access to care, especially in Black and Brown communities.
DSW: The CDC says that one in two Black men who have sex with men will be diagnosed in their lifetime, so it's a huge distinction. It certainly hurts my heart, as a Black woman, to see the differences.
WCT: Stigma and healthcare access are major factors, as you've mentioned. Are there any others that account for the disparities in the numbers?
CB: I would say overall resources, which tie into education and food resources. There are theories that people face that could put them in vulnerable conditions.
DSW: I don't think that it could be said enough that there is systemic racism, and that systemic injustices occur. Those make things much more challenging for some communities than others. And it's just impossible to talk about any sort of health inequity without talking about things like access to healthcare, access to education. Getting information on how to protect one's self is different because of how our society is set up.
WCT: Lending Hands for Life has been around since 1989. What does the program entail?
CB: Our program is actually broken down in various ways. We focus on HIV, hep C and PrEP. I'm able to do the rapid HIV test, so I'm able to educate clients who come in. We can educate on PrEP if they're negative as well as the necessary steps if they are positiveand they should know they're going to have a support system, regardless of the result.
As well as education, outreach is very important, even if the client doesn't belong to one case manager. We want to make sure they know that we care, and that they take their medication and get to their medical appointments as well. We take a deep dive to access any barriers they may face, such as housing disparities; if you're homeless and sleeping on the [subway], the last thing you're going to worry about is your medicationso we try to provide proper resources.
We listen to clients so they feel supported, and sometimes they feel so comfortable they call us to see how we're doing. Sometimes they check on us more than we check on them.
DSW: All of the things Christian said are spot-on. Another aspect is that we are primary care-focused, so when patients or clients come to us I tell them that I can take care of themand their families. That way, they don't have to feel like they're going someplace different than their friends or families. And we're able to provide care for patients with and without insurance. But I feel the most important thing is that, although HIV is manageable, there are patients with other conditions, such as high blood pressure. This place focuses on their entire health.
WCT: And how has the program had to pivot during the COVID pandemic?
DSW: I think the most obvious way has been with the way we provide care. For patients who did not need to come in, we changed to telehealth; for some of them, that was great because they didn't have to drive for results. Our teams had shifted a little bit: Initially, at some sites we were trying to separate patients who potentially had COVID from those who didn'tbut that was earlier; now, we're able to provide more flexibility.
We've really looked at what we're able to do virtuallywhat doesn't require patients to come in.
CB: To piggyback on what Dr. Wheat said, the telehealth appointments have made things so much easier for clients. Before COVID, it was hard to get certain people in because of their work schedules; the telehealth appointments made things easier. Case managers also were willing to come on site to help clients who had certain needs.
WCT: What do you feel are key similarities between the COVID and HIV/AIDS pandemics?
CB: Touching on what Dr. Wheat said earlier, I'd say racial disparities and racial inequity in healthcare are [common to both]. Looking at the numbers of those who've received the vaccine and the numbers of those with HIV, I'd say there's a correlation.
DSW: I agree. I feel like the COVID pandemic was not as easy to potentially push aside, as the HIV/AIDS pandemic might have been. Because of that, I think we've seen a different groundswell of movement with COVID. You asked me about not having a vaccine for HIV/AIDSbut, on the flip side, how is it that we have a vaccine for COVID already?
I struggle with this one. I agree with Christian in that we've seen the disparities hold true. We've seen some positives, like people coming together to fight COVID.
I think it's interesting how information has changed. We used to say certain things about HIV that we don't now. That evolution is the same with COVIDalthough, obviously, on a much more rapid basis.
WCT: Also, with HIV/AIDS back in the '80s, there was a much slower reaction. It took [then-President] Ronald Reagan years to even say the word "AIDS."
DSW: Yesand it was about who it touched [gay men] in the beginning. Of course, COVID hit everybody so quickly.
WCT: Is there anything you wanted to add?
DSW: We're really trying to look at ways to change health inequities. We're trying to make sure we reach everyone. We want everyone to live their healthiest life possible.
CB: I agree. Just seeing how efficiently providers and case managers communicate with one another is just mind-blowing. I was definitely not expecting the relationships to be as strong as they are. You can see the passion people have here when it comes to serving their clients.
For more on Erie Family Health Centers, visit ErieFamilyHealth.org .