Start Talking. Get Tested. How to honor World AIDS Day

December 2, 2016

The lamp goes on.

It sits on a table in the office at the Multnomah County HIV clinic, one of the oldest federally-funded HIV clinics in the nation. Staff have treated patients for a quarter century, and some of those early clients are with them still, living healthy lives with the help of advancing viral suppressants and intense case management.

Maurice Evans became a patient navigator with the county's HIV clinic after years of learning to advocate for himself.

But each year, staff quietly recognize the passing of many others. When they get the news, someone turns on the lamp.

“For some, there’s no one to notify,” Jodi Davich, manager of the county’s HIV clinic, said Thursday before a ceremony to honor World AIDS Day. “We are their family.”

Things have improved dramatically since the early 1990s, when HIV killed most of its victims. Today the clinic cares for 1,400 patients, and 87 percent of those people have a suppressed HIV viral load -- the gold standard of HIV medical care.

The clinic has adopted the model of “patient-centered medical care home.”  Each client is assigned to a team comprised of a doctor,  nurse,  medical assistant and a social worker. The teams help patients address their barriers to care such as homelessness, addiction or mental illness. A client may also get a patient navigator to help them through the institutions and systems that have historically discriminated against people living with HIV.

Medical advances continue to raise hopes of an end to the epidemic.

Caitlin Wells of Cascade Aids Project said access to testing and treatment for HIV increased with the Affordable Care Act. In 2012, the Food and Drug Administration approved the use of an existing antiretroviral drug as a Pre-Exposure Prophylaxis, or PrEP. The drug PrEP is a single pill clients take just once a day, and it is startlingly effective in keeping HIV negative people from becoming infected.

“It was an exciting moment for those of us working in the HIV community,” Wells told the board Thursday. Cascade AIDS Project has hired two PrEP navigators to educate patients about the drug and encourage providers and insurance companies to prescribe and cover it.

“PrEP is going to be the game change of game changers,” said county clinic manager Davich.

But it can’t change the game fast enough. While more people are able to manage the virus and have rich lives, diagnosis rates aren’t improving across the board.

“Just as many young black men of color are being diagnosed today as when I was diagnosed 32 years ago,” said Maurice Evans, a county employee who helps clients navigate services.

Evans said he was diagnosed with HIV when he was 28. It was the early 1980s and the disease was a virtual death sentence. Now 60, he helps other people living with HIV to access services and systems that for many years turned people like him away.

“We have to change the way we view HIV if we want to see an end to this pandemic,” he told the board. “We have got the science down. But we don’t have the love and compassion in our hearts.”

Perhaps that’s what makes patients come to the county’s downtown Portland clinic, sometimes daily. Because for them, the clinic staff are the only family they have. The ones who love them and walk with them.

Staff from the Multnomah County HIV clinic and the Cascade AIDS Project

This year was like most, when almost every month, staff walked into the office to discover they had lost one more patient. The first came on a Sunday, the last day in January. The next day the lamp turned on.

They mourned again on a dry Thursday in late February. Then a week later. And two weeks after that, on a Saturday when the office was closed.

A week later they lost a patient. It was 63 years to-the-day after Jonas Salk announced a vaccine to prevent polio. April was a good month, in a macabre sense, because they turned on the lamp just once. In May two clients died. And June. And July.

August 8 was a Monday. And the lamp turned on.

September 9 was a Friday. And the lamp went on.

September 27 was an unusually tense Tuesday with national attention turned to the presidential election. Media buzzed about Donald Trump’s performance at the first presidential debate the night before. Cartoonists poked fun at both candidates’ disapproval ratings.

And the lamp flickered on.

Staff turned on the light twice more in October. Once, on the 10th year anniversary of North Korea’s first nuclear weapons test. The second on the the day in history when Wall Street crashed, triggering the Great Depression.

November was blessedly still. The lamp stayed dark.

And in that darkness, there is hope.