Standard Operating Procedure

By: Marcus Hopkins, HEAL blogger

As an HIV, STD/STI, and reproductive health educator, one of my primary goals is to provide people with as much current and scientifically accurate information as possible.  In that regard, I feel that I am successful; that success can be measured by the responses I receive whenever I am asked to provide guest lectures at colleges and universities, both from the professors and the students who attend these lectures.

I know that I have achieved my goal when at least one of these people come up to me to tell me how my lecture has altered the way in which they view HIV and the afflicted population – even more so when they tell me that they are going to go get tested after hearing the information with which they’ve been provided.  One professor in whose classes I delivered numerous guest lectures even went so far as to incentivize her students by offering extra credit for any student who went to go get tested after those sessions.

But, how do we, as educators, further our reach into the greater medical community?  Here at HEAL Blog, we are tasked with providing up to date and current information about Hepatitis C and HIV co-infection, particularly as it relates to treatment.  But, how can we ensure that patients will be treated if the medical community isn’t consistently screening for HCV during routine checkups?  This is a problem we have been facing for at least the last decade, as the number of new HCV infections rises within the HIV+ community.

When I first tested positive for HIV, I did so at AID Atlanta, a non-profit organization that offers free HIV testing in downtown Atlanta.  At the time, however, I was not aware of, nor even concerned about, testing for other STDs/STIs.  When I finally decided to take control of my disease in 2007, a full 2.5 years after my initial diagnosis, I had progressed into AIDS, and was referred to an Infectious Disease specialist, Margaret Gorensek, MD, former chairman at the Cleveland Clinic in Weston, FL.

It was under her care that I really learned to take control not only of my HIV, but of my general sexual health.  During my first visit, she relayed to me the following bit of wisdom: “Generally, when someone tests Positive for HIV, they have an accompanying infection.  Where there’s one, there are likely others.”  This bit of logic and sage advice has stayed with me, to this day, and I frequently impart that wisdom on to the students and patients whom I counsel.

With that in mind, I wonder if other doctors in the field of Infectious Disease are also doing their due diligence when it comes to their patients.  In the world of treatment, knowledge is power – the more information you have about your illness, along with any other co-infections, the better equipped you are to be proactive in treating those diseases.

Image of patient having his blood drawn by his physician

The rates of HIV/HCV co-infection are staggering – the CDC estimates that roughly 25% of people infected with HIV are also infected with HCV; the rate of co-infection amongst injection drug users with HIV falls between 50-80%.  Beyond co-infection, the long-term ramifications of HCV infection are equally staggering – HIV/HCV co-infection more than triples the risk of liver disease, liver failure, and liver-related death from HCV, which has risen to the leading cause of non-HIV-related death within the HIV+ population.

To be fair, almost every single clinic in which I’ve been a patient has treated HCV screening as one of its first priorities – Ft. Lauderdale, Johnson City, TN, AHF San Fernando Valley, and Positive Health Clinic in Morgantown, WV – each of these clinics have been rigorous in testing for Hepatitis A-C.

The only experience I’ve had where this was not the case was at Harbor UCLA Medical Center in Los Angeles.  This was the first clinic to which I was sent in CA, and was both understaffed and underfunded, as are most of the state-run hospitals in Southern CA.  The clinic was situated in an annex to the full hospital, and patients were treated more like objects on a conveyor belt, rather than human beings.  The HIV-specific staff, however, were quite adept at their jobs, and did their best to attend to every need of their patients.

The reality, however, is that they simply didn’t have the resources to spend on educating their patients about HCV, simply because doing so would require more time than was feasible for them to spend during their very limited clinic hours.  Perhaps other clinics have this kind of staffing issue, as well.  Is it simply a lack of resources that leads to not screening for HCV?

Perhaps.  Every experience of mine has led me to believe that staffing and funding are two of the primary issues that face our HIV clinics, today.  These two problems are, of course, inextricably linked, and given the way Congressionally approved government funding has gone over the past few years, things don’t look to be getting much brighter.

So, the question stands – why is HCV screening not de rigueur along with other STDs/STIs?  With the statistics so stacked against the HIV+ community, would it not make sense for HCV screening to be standard operating procedure during the course of regular checkups?

For the sake of public safety, that answer should be, “Yes.”  If we fail to take this simple precautionary step, we are doing a grave disservice to patients who might otherwise never know the risks they may face.

Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates.

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