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If physicians across the state comply with the Center for Disease Control’s new guidelines for HIV testing, then the good news is that doctors will catch countless new cases in the early stages and reduce the spread of the disease. The bad news is that it will strain the already limited state resources and require that more physicians become comfortable with and knowledgeable about treating and referring AIDS patients.

The new guidelines, released in September 2006, recommend yearly HIV testing for every adult.

“This is huge,” said Dr. Dan Moore, a family practice doctor who cares for more than 150 HIV patients a year through White River Rural Health’s HIV CARE clinics in Kensett, Jonesboro and Batesville, and treats half the state’s HIV-positive prisoners in Newport. “It’s going to require extra money and resources to treat these patients, but ultimately, it’s a good thing. With HIV/AIDS care, early detection really does result in a better prognosis.”

Since 1983, more than 6,800 Arkansans have been diagnosed with HIV. Sixty-two percent of those have been AIDS cases. Out of the 6,864 HIV cases diagnosed (as of a March 31, 2007 Arkansas Department of Health and Human Services report), 1,843 patients have died.

The trend in recent years has been a decrease in AIDS cases, but a concurrent increase in HIV cases, said Derrick Newby, MPA. Newby is Arkansas coordinator of the Delta Region AIDS Education and Training Center and on staff at Jefferson Comprehensive Care Services in Pine Bluff.

About a third of the HIV population, those that are aware of and conscientious of their diagnosis, is being extremely safe, he said. Another third is being moderately risky in their behavior, and a final third is driving the bulk of new cases by being extremely risky. This least responsible third predominantly includes people unaware they have the virus.

“Once patients become aware of their status as HIV carriers, typically their risk behaviors go down substantially,” Newby said. “Most of them will deal with their disease status more responsibly once they know. It’s the ones who don’t know and who are spreading it that we need to worry about.

“If we can get physicians to implement these guidelines, I expect we will start seeing a statistical improvement in new diagnoses within three or four years. Once more people know they are infected, it should greatly curtail the spread of the disease,” Newby said.

Before the revised CDC recommendations came out last year, the Delta Region AETC mission was to recruit family practice physicians and other specialists interested in also becoming HIV specialists. The goal was to increase access to HIV care throughout the state, particularly for rural or otherwise underserved populations. It wasn’t easy.

“We were losing that aspect of the battle because of the stigma still associated with HIV patients,” Newby explained. Even when physicians were interested in helping address the problem, too few would commit to providing routine HIV treatment. HIV specialists risk reducing their existing non-HIV patient base. Those patients sometimes fear going to a doctor known for HIV care, worrying that anyone seeing them go to this physician will jump to the conclusion that they, too, are infected.

Moore agreed that the social barriers to HIV care are a constant challenge. “People with HIV or AIDS are terrified of anyone knowing, so they’re afraid to come to support groups, afraid to tell their family, afraid to come to the doctor, afraid to get their prescriptions, afraid to get help of any kind,” Moore said.

Physicians, too, have a lot of hesitancy in dealing with AIDS patients, though Moore said that reluctance is more apparent for disease-specific treatment than for non-related care. “I think that comes from not having experience and training in the treatment,” he said, “rather than from a lack of compassion or unwillingness to work with these patients. And they do require a lot of time.”

HIV CARE’s clinics, which are among the three programs in the state that received federal funding for HIV clinics before the Bush administration stopped all new HIV clinic appropriations in 2002, is able to dedicate more time per patient than the average physician’s office, and has more multidisciplinary resources. Besides the physical exams, HIV patients receive care and evaluations from a social worker, a psychologist, a nutritionist, a dentist, and others.

Newby’s organization’s task now is to provide physicians and practitioners from all specialties with basic training in recognizing the signs and symptoms of HIV infection. Because HIV tests are not yet able to detect the virus at the initial infection, success depends on physicians having a “higher index of suspicion” about patients presenting with flu-like symptoms.

“Too often these get misdiagnosed at the initial infection, when the patient is most infectious,” Newby said. “Doctors, particularly in ER settings, just aren’t trained to include an HIV risk assessment in their evaluation. But if we miss this chance for diagnosis, often it is years down the road before patients find out they are carriers.”

A few uncomfortable questions about lifestyle choices and risk behaviors can make all the difference. “I would encourage doctors to ask those questions of every patient, and know what referral sources are available, even if you do not choose to pursue additional training in becoming an HIV specialist for your area,” Newby said.

Also, pursue grants for additional AIDS programs. “Southwest and Northwest Arkansas don’t have any Ryan White programs,” he said, “there’s definitely a gap there, and there are still some funding opportunities available.”

About a third of Moore’s HIV patients have AIDS. Most are doing extremely well;
very few are terminal. “Better treatment regimens equal better outcomes,” he said. “Now, HIV patients are dying more frequently of non-related conditions. Even if you are HIV positive, that’s probably not what will cause your demise.”

For information on the White River Rural Health HIV CARE program, visit www.HIVcareprogram.com. A comprehensive list of Arkansas HIV/AIDS resources can be found at www.deltaaetc.org/arkresources.html.



September 2007

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