Beginning in 1987, a team of Vermonters built a statewide network — a safe place for people with HIV and AIDS to receive the best of care. Today, with improved medications, the response to the disease has changed, but the caregivers are still at work.
Christopher Grace, MD, medical director of Infectious Disease at the UVM Medical Center, reflects on the network of Comprehensive Care Clinics (CCC) that serve people with Human Immunodeficiency Virus (HIV) throughout Vermont.
What is the significance of the 25th anniversary of the HIV Clinic?
Dr. Grace: It acknowledges that work done to create this program in Vermont works and has stood the test of time. When we started 25 years ago, HIV was an urban disease. Our challenge was to address the needs of rural populations. These people were dealing with the stigma of the disease as well as nuts and bolts issues like transportation: People were driving far away for care. We developed a model to put a clinic in each quadrant of the state. Instead of having patients come to us, we sent doctors to them. This approach was not unique in and of itself, but it was unique for treating people with HIV.
What are the results after 25 years?
Dr. Grace: We can report, based on our research, that the care provided in the rural clinics is just as good as it is at the UVM Medical Center. This is important as it allows people with HIV to stay in their community and receive care there. More broadly, we can say that HIV treatment has changed dramatically over the past 25 years. People have stopped dying; they are living longer and have almost normal life spans. The new expectation is that you can live with HIV. We need to have a structure in place to provide medication, monitor patients, and keep them strong.
Is HIV on the rise or declining?
Dr. Grace: The number of people we provide care for increases every year. The number of newly infected people has not changed in the US over the past 8-10 years, despite education and awareness campaigns. We are seeing a paradigm shift that includes safe sex education enhanced by testing, treatment , and driving the viral load down. Getting tested is critical: Data show that 21 percent of U.S. residents who are infected with HIV are not aware of it.
What is viral load?
Viral load is the amount of HIV in your blood. We can measure that and determine how many HIV particles are in your blood. It takes 4-6 months to drive viral load down. When it is driven down, the transmission rates for HIV drops drastically. Several studies have shown a decrease of 96% in heterosexual couples.
What has changed in how we treat HIV?
Dr. Grace: One major change is the advances in medication. In 1996-97, new medicines came out. They were rough early versions. They worked well, but people were taking 30-40 pills per day with lots of side effects. Today, medicines are formulated into single pill combinations that are well tolerated by patients and don’t make them sick.
What does the future hold for the HIV/AIDS clinic?
Dr. Grace: The future of the clinics is based on our funding by the Ryan White CARE Act, which may be affected by the Patient Protection and Affordable Care Act as well as the soon to be implemented sequester. The continued funding is vital to maintaining the good work achieved over the last 25 years going. This is not only a medical care issue; it is a public health issue.
To learn more, please visit GetTestedVermont.com, which includes information about infection, testing, and treatment. For further reading, see Dr. Grace’s article in the Journal of Rural Health and the Larner College of Medicine at UVM article “25 Years of Care & Advocacy: HIV Care in Vermont.”
Christopher Grace, MD, is medical director of Infectious Disease at the University of Vermont Medical Center and Professor at the Larner College of Medicine at UVM. He was inspired to research HIV/AIDS while working at St. Vincent’s Hospital in New York City at the height of the HIV/AIDS epidemic. When he saw a need for care in Vermont, he worked with colleagues to launch Vermont’s HIV clinics.