KC Care Interview and Reflection

Interview: We had the opportunity to interview two HIV experts at the Kansas City Care Clinic, D. Rashaan Gilmore, the Principle Community Liaison, and Kaylon Sanders, a PEER at the clinic, who is HIV positive.

Questions:

Why did you choose this field? 

Sanders: Kaylon first became involved by participating in a project, entitled Visual AIDS, which was a photographic exhibition geared toward establishing positive images for HIV positive men. From there, Kaylon was inspired by his interest in helping others, and his passion for this issue, to continue to be involved and make a difference. 
The following link provides more information on the Visual AIDS project: http://fox4kc.com/2014/06/06/visual-aids-aims-to-reduce-stigma-for-black-men-who-are-hiv-positive/
Gilmore: Rashaan became involved at the KC Care Clinic after being offered a position to work on a CDC funded project. 

In what ways have we progressed as a community in terms of how we deal with HIV and AIDS? In what ways do we need to improve as a community?​
In 2009, for the first time in Kansas City, the transmission rates of HIV from African American men aged 16-29, was higher than any other transmission rates for any group of Caucasian men. There had been a lot of attention placed on AIDS as a "white gay man disease". As a result from this statistic, people became more optimistic with these numbers that are showing that HIV transmission is decreasing. However, this is misleading because for young African American men, the numbers are skyrocketing. We need to allocate more attention to all of those affected by HIV. In terms of the improvement, Kansas City has clinics such as KC Care, churches, and agencies that 

Do you believe there is enough time and funding going into HIV research?
There is not enough time being invested in a cure. However, there are a lot of drugs being produced that are designed for treatment. Some companies are advertising "treatment is the cure" for HIV, however, this is a fallacy. The reason why there is less of a focus on a cure may be in part due to the weaker campaign, or push, for finding a cure. For example, for Breast Cancer, the campaign for finding a cure has been focused on all types of women, and is insistent on fighting cancer and finding a cure. With slogans like "Find a cure", the awareness and support raised for this issue has been tremendous. However, with HIV/AIDS, people do not seem to be optimistic about finding a cure, as it has been regarded as a "death sentence disease". In addition, while this has improved since the 1980s, HIV/AIDS was considered to be a gay man's disease. Thus, there is a stigma for the people who are traditionally regarded as suffering from this disease. These two reasons are important factors for why the time and funding for a cure has not been sufficient. 

Can you tell us more about the LTC HIV support program?

LTC is linkage to care, it is a short term 90 day program that is centered around providing information to those who have just been diagnosed with HIV. The goal is help the individual understand what this means, and arrange for a confirmatory test (a full blood draw). When this happens, a peer will become involved and provide support for the individual. In addition, LTC includes providing information about medicine, future changes that will be necessary, etc. 

What do you do as a PEER at KC Care? How does your diagnosis help you to mentor others? 

I work with those who have been diagnosed, or those returning for care, and help them along their journey ( providing support, guidance, etc.) While anyone can offer sympathy or empathy, only a person who has experienced the same diagnosis can truly understand what it feels like to find out that you are HIV positive. Therefore, I can help mentor people from my experience, as I understand what this can be like, and I have experienced first hand how life changing this is. 

What has been the most rewarding part of your career? 

As a PEER at KC Care, the most rewarding part of my job is finding out that one of my clients has become undetectable. This term refers having less than 20 copies of viral loads, or having a CD4 level above 200. Most of the clients that I have worked with are now undetectable. Once someone has become undetectable, the chance that he or she will pass on the virus with an HIV negative individual drops from 98% to 2%. 

Are you currently on medication for HIV? If so what is the medication routine like (number of times taken a day, has it changed over time, etc.)? 
My medication regimen has changed three times, this has been due to allergic reactions that I have have with Truvada. Truvada is a PrEP (Pre-Exposure Prophylaxis), which is a method for people who are HIV negative, but at high risk for getting it, it prevents HIV infection. Truvada is also used for HIV positive individuals to try to help treat them to have less than 20 copies of viral loads, and thus be undetectable. I am currently on Stribild, which has 3 medications with one booster. All regimens have a standard of at least three medications. 

More on Medication:
As a result of the evolution of the virus, the way in which we select the medicine that people use is influenced. When a person is diagnosed, he or she will take a genotype test. This test will test your own virus with every type of medication that is available. If the test comes up as green, it means that your strain of HIV is sensitive. If the result comes up as yellow, it means there is partial resistance, and if it is red, it means that it is highly resistant. By taking that blood test, information may be gathered about someone's personal HIV, and from there, a cocktail can be hand picked. The process of carefully selecting medication that works for your HIV, as well as consistently taking that medication is important to prevent the likelihood that the virus will become resistant. 

On Missouri Law: 
Missouri and 19 other states have laws about HIV transmission and exposure. If you are positive and are about to engage in sex, whether or not you are virally suppressed, you are required to disclose your status. There have been many unfortunate cases in which people have taken advantage of this law. For example, a man and his partner were involved for seven years. This partner was aware of his status and even accompanied him to medical visits. However, once they broke up, he prosecuted his ex partner, and claimed that he was unaware of his status. Although they had the proof of the medical visits, this individual was found guilty. In another case, an HIV positive woman who was undetectable spit on an officer. She was charged with assault on a police officer and was sentenced to 37 years in prison. It would take exposure to 2 gallons of saliva for someone to become infected.

Reflection: 
Upon learning more about HIV/AIDS, we have all become so much more aware of the issues that still affect many people today. We were particularly surprised to learn about the rising numbers of transmission among African American men, compared to the numbers with Caucasian men. It was also interesting to see the evolution principles that we have learned about being put into action. The genotype test that patients use for determining what type of medication is best for that individual is based on the fact that individuals have different types of HIV, which all have different resistances to different medications. Perhaps the most eye-opening was learning about the HIV laws that Missouri has. It was heart breaking to hear about the cases in which people took advantage of this law in order to criminalize HIV positive individuals. While being positive within itself is not easy, we have learned that there is so much more to it than the health issues. There is the stigma, the difficult commitment to one's health (like taking a pill everyday for the rest of your life), as well as the law. In fact, HIV is the only chronic illness for which you are required to disclose your status. As a result of having the opportunity of speaking with Rashaan and Kaylon, we have a better appreciation for the project, as we know have a better idea of how HIV changes lives, beyond from just the physical bodily consequences. In closing, we thank Rashaan and Kaylon for their willingness to share their insightful thoughts on HIV/AIDS. We are all also more aware of the KC Care clinic, and its dedication to support HIV individuals. Below are some of the  pamphlets that are currently being circulated at the Clinic