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As Treatment for HIV/AIDS Changes, So Does Role for Specialized Clinics
  Thursday, June 04, 2009 :: Staff infoZine
HealthBy Mavis Baah - Two years ago, the University of Miami's Project Outreach center offered care and treatment for HIV/AIDS patients. Now, the center doesn't exist.
Washington, D.C. - infoZine - Scripps Howard Foundation Wire - Similarly, the University of Illinois at Chicago College of Dentistry's Special Care Clinic provided dental treatment to those living with HIV/AIDS. The clinic closed in December 2007.
Across the country, some clinics and medical centers serving HIV/AIDS patients are closing. Some are folding because of a lack of funding, while some say they don't have enough patients seeking care. Others have refocused their efforts away from specialized care to primary care. Some think the recent advances in HIV medication makes specialized clinics for those living with the disease unnecessary. Overall, the number of HIV/AIDS providers is decreasing but HIV/AIDS funding has increased slightly.
The Whitman-Walker clinic in Washington, the largest HIV/AIDS service provider in the area, found itself in a battle with the D.C. Council when it closed its Northern Virginia facility on March 31, laid off workers and moved toward primary care. The city provided $6 million to the clinic over the past four years.
Councilman David Catania, an independent, the council member most critical of the changes, could not be reached for comment. But on his Web site, he said, "My biggest fear is that, on its current trajectory, Whitman-Walker's days of providing health care to the gay community are numbered."
The clinic asserts that it adjusted its focus to meet the District's needs, where heterosexual sex is the most common mode of HIV/AIDS transmission. In the past, Whitman-Walker focused its efforts on the city's gay community.
"The change has been painful because it caused us to reconsider the services we've offered, to refocus on basic health-care needs of our patients," said Don Blanchon, the clinic's chief executive officer.
"While I would love to be able to solve their other issues that make their life difficult every day, I don't believe that's a practical place for us as a health center ... what we do best is health care," he said.
The University of Miami closed its clinic because not enough patients sought care there. Many didn't return for follow-up treatment. And because the clinic wasn't fully connected to critical resources, the patients who did come in often were sent to other clinics for tests or studies.
"It was impossible to keep the clinic open five days a week for so few patients," said Michael Kolber, director of the Comprehensive AIDS Program at the university. "It came down to what you could afford to keep open for the number of patients you were treating."
Kolber said that funding also played a part in the clinic's closing. The clinic was partially funded by the Ryan White HIV/AIDS Program and Medicaid, but those sources didn't provide enough money.
Peter Ashkenaz of the Department of Health and Human Services' Centers for Medicare & Medicaid Services in Washington, said each state administers its own Medicaid program. He said there could be a variety of reasons for low spending growth in some states.
According to the Health Resources and Services Administration, from 2006 to 2007, the number of Ryan White providers decreased by 94, a decrease of 4 percent. However, the number of providers delivering core HIV/AIDS medical services increased by 13, or 1.4 percent. ( See charts below.)
In Staten Island, N.Y., the Richmond University Medical Center also faced a funding shortfall. While the HIV/AIDS clinic received some federal dollars, including Ryan White money, Jennifer Sammartino, director of communications, said most services were "shouldered by the hospital." When the hospital was sold, management decided it wasn't in its best interest to keep the clinic open. The clinic closed in 2008, and the 200 patients it served were directed to other providers.
The 2010 federal budget request attempts to tackle funding issues. It includes a 4 percent increase - $1 billion - for domestic and global HIV/AIDS activities. Domestic activities would be funded at $19.4 billion while global activities would receive $6.5 billion.
Some feel the funding isn't enough.
"The president's budget did provide increases in funding for HIV/AIDS programs, which we were very pleased to see. However, it was not sufficient to make up for years when they were flatlined or cut," said Trevor Thomas, deputy communications director for Human Rights Campaign, a non-profit advocacy group based in Washington.
The Human Rights Campaign, along with many HIV/AIDS groups, is urging Congress to increase funding.
In New Jersey, the Bergen County Department of Health Services Counseling Center does not receive federal help. Its leaders considered asking nonprofit organizations to pay for patients' HIV-testing.
"We're facing the same thing that's facing the rest of governments across the nation ... officials are tasked with making difficult budgeting decisions," said Brian Hague, chief of staff.
Lack of funding led the Chicago School of Dentistry to shift its focus to patient care that directly applies to teaching dental students.
Dean Bruce Graham said the Special Care Clinic annually treated about 50 patients living with HIV/AIDS before it closed. Now, the school assists 500 patients living with HIV/AIDS out of a total 2,500 patients in its general clinic. He said this number can be attributed to the recent breakthroughs in effective HIV/AIDS therapies that allow those living with the disease to be treated in general population medical settings.
"When it started, there were a lot of oral conditions that were very difficult to treat ... lesions ... Kaposi's sarcomas ... that you just don't see anymore. And now because they're on the cocktail pharmaceutical regimens, their immune systems aren't as compromised as they were ... they can be in routine clinical settings," Graham said.
Some, like Sammartino, say that people living with HIV/AIDS still feel more comfortable in a specialized setting.
"Patients from the other boroughs came here because they didn't want to go to clinics in their home communities because they wanted to keep their status private," Sammartino said.
But Graham said it's difficult to assume that every individual affected with the disease would feel the same way.
"Some of the patients had other issues that led them to feel like they wanted to be in a special care environment ... social or cultural issues not directly related to HIV. There were some patients who felt they didn't want to be in a special environment, if that in itself wasn't stigmatizing," Graham said.
While HIV/AIDS clinics are undergoing a number of administrative changes, most remain dedicated to their patients.
"We recognize the needs of the community and the clinic was something that needed to go at the time but it's not to say we wouldn't revisit the idea," Sammartino said.
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