HIV. In the 1980s these
three letters meant almost certain death to those infected, mostly gay men and
hemophiliacs. Because of this, fear
spread across the general population and presented an obstacle as intimidating
as the disease itself. People worried
you could catch HIV by kissing, or sitting on a toilet seat, or from a
mosquito. The fear became so pervasive
that a Florida community burnt down the home of three hemophiliac children infected
with HIV to prevent them from attending school.
Changes in HIV treatment over the past 30-plus years have
helped stem this fear. The disease is no
longer associated with swift death. Antiretroviral
drugs have allowed infected patients to live long, productive lives. These drugs also stop the spread of new
infections. There is even a pre-exposure
medication that prevents high-risk populations from contracting the disease at
all.
Increased education has also helped displace the fear. People understand catching the disease doesn’t
come from a random act. They know that
those with HIV don’t pose an imminent threat to their own safety.
Now, that fear has been replaced with complacency. Despite medical improvements, the number of
new infections has remained constant for the past 15 years. Nationally, there are 45,000 new cases every
year. In Minnesota, there are 300, 160
of which occur in Hennepin County.
The continued discrepancy of improved treatment without a correlated
decrease in infections has led The Hennepin County Public Health Department
(HCPHD) to develop a plan to reduce, and eventually eliminate the HIV epidemic
in Hennepin County.
HCPHD’s strategy has two key operating principles: to reduce
health disparities and promote health equity, and to integrate public and
private responses to HIV. In essence, the
principles intend to ensure people have access to services and that these
services are integrated across the health-care spectrum.
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According to Jonathan Hanft, the Ryan White Program Coordinator for HCPHD, the main focus of these principles is to get better care to more people. The Center for Disease Control (CDC) estimates that 14% of people with HIV have not yet been diagnosed and are not receiving appropriate health care. Also, for those diagnosed with HIV, 27% do not receive regular medical care. Without proper care, they don’t have a suppressed virus, HIV is more likely to harm their health, and they can continue to transmit the disease.
The HCPHD believes that adherence to these principles will lead to a reduction in the number of infections, will ensure care access and retention, and will facilitate empowerment for disproportionately affected communities.
To reduce infection rates people need routine HIV testing. This testing needs to be available at a variety of access points, whether it be a clinic, chemical health program, mental health program, or social service program. With more testing, HIV can be detected earlier, which will decrease inadvertent transmissions and will allow those infected to be connected to care.
Another method to reduce infection rates is through expanded programming for Pre-Exposure Prophylaxis (PrEP) and Post-Exposure Prophylaxis (PEP). A person takes PrEP before coming into contact with HIV. This medication helps reduce the risk of infection by up to 92%. A person takes PEP within 72 hours after he or she has come into contact with HIV. This medication reduces the risk of infection by 96%.
By making sure that people are tested regularly, and increasing the number of people who use PrEP, HCPHD hopes to reduce the number of new infections by 5% by 2018.
For those who do contract HIV, ensuring access to medical care and retaining that care is vitally important. Part of that means making sure that a person can access medical services within 24 hours of testing positive for HIV. It also means coordinating care for those who are exiting other institutional settings, such as CD or corrections.
Adversely affected communities must also be empowered to raise awareness about stigma and complacency. Such communities include gay men, African-Americans, Latinos, and women of color. Partnering with smaller communities builds trust towards the larger medical community. Working with these communities helps ensure that all services are culturally appropriate.
Finally, education needs to continue to be a focus to reduce HIV infections. While fear may no longer be a great motivator, it cannot be replaced by complacency and acceptance. This education will include sex and health education, as well as personal speakers.
Integrated care models, such as Hennepin Health (HH) are important in achieving these goals. HH can provide uniform testing throughout their network. They can use data analysis to identify those who need care but are not getting it. They can provide a variety of social access points when referring to housing, or chemical health, or mental health providers.
On May 31 an HIV training will be presented to HH care coordination staff, which will increase knowledge and effectiveness when working with other providers and clients.
Since HH has many programs in various, impoverished communities, they can also help raise awareness about HIV treatment. They can work with community members to help identify barriers to treatment and provide workable solutions.
HCPHD would like to ensure that all people living with HIV have healthy, vibrant lives, and that fewer and fewer people become infected. For those like Jonathan Hanft, who have seen the progression from death to effective treatment, the battle is to eliminate the disease and what it represents altogether.
Where many died in the 1980s, today many others live long, happy lives. “When antiviral treatments first came out,” said Jonathon Hanft, “people who were dying came back to life.”
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Asthma is the most common chronic disease of childhood. According to the Center for Disease Control
and Prevention (CDCP), 8.6% of all children have asthma. For African-American children, that number
increases to 9.9%.
Children in inner cities such as North Minneapolis have greater
contact with pollutants than suburban and rural children. Freeways spill car exhaust across
neighborhoods. Substandard housing can
contain mold. Parents are more likely to
smoke.
There is also an inequity of asthma services for low-income people. Sometimes children don’t have stable housing or live in foster care, which impacts access to medical services.
NorthPoint recognized these barriers to care and responded by establishing the Asthma Clinic.
The Asthma Clinic is funded through a 2016 reinvestment grant from Hennepin Health (HH). The grant will pay for hiring a nurse and a social worker in order to strengthen care coordination and achieve better aftercare results. By improving these services children will receive preventative care, rather than episodic care.
“Providers normally can see patients for 20 minutes or so,” said Naima Bashir, Strategic Initiatives Manager for NorthPoint. “That is not enough. We will reach them in the way that they need.”
The Asthma Clinic has two unique aspects meant to provide exceptional care. The first is that they will have various points of contact with patients. Rather than just see children at the clinic, they will see them in the community, at places where children spend most of their time.
In order to accomplish this the HH reinvestment grant will help NorthPoint develop a collaboration with the Minnesota Visiting Nurse Agency (MVNA.) These nurses will see patients at home or even at school. They will help parents to understand that there are a circle of people available to help.
MVNA nurses will also help provide asthma-specific education. “They will be instrumental in providing training to the nurse we are bringing aboard,” states Carla Lucas, Nursing Supervisor.
The second unique aspect of the Asthma Clinic is their focus on children in foster care. Many aspects of these children’s lives are unstable, including housing and school. Establishing them in a health care home allows them to receive consistent and equitable health care.
The Asthma Clinic makes sure all children have an asthma action plan, are seen in the clinic twice per year, are educated on how to control it at home, and have a home visit to assess their environment. The clinic will also help identify asthma triggers and manage medication.
Medical Director Doctor Paul Erickson notes, “Letting every child have an optimal environment to be healthy is what we’re about. Our vision is to partner with the greater healthcare community as well as patients and their families to help them be as healthy as they can.”
For all the inner-city children with asthma, this vision is a breath of fresh air.
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Once, when he was twelve, Bryant B. went camping with two
friends. They walked miles into the
Wisconsin wilderness before putting up a tent and building a fire. As they were driving stakes and gathering
sticks Bryant talked about giant bears and how they roamed the woods looking
for children. Soon, his friends became
scared and went back home.
Bryant stayed. He lay
in the dark with a hatchet nearby, his attention tuned to every sound—the
snapping fire, chirping crickets, perhaps even a hooting owl. When he heard a rustling in the woods that
slowly mounted to a loud crashing sound, he expected to be a victim of his own
horror story. Eaten by a bear. Instead, it was his dad, who came to help because
his friends left.
In some respects, Bryant still sits in those woods waiting for help. Due to alcohol abuse he is isolated from his son, a job, and, until recently, a decent place to live. Now, instead of his dad bursting through a clearing to help him, it’s service providers. HCMC’s Coordinated Care Center. Bell Hill Treatment Center. Hennepin Health’s social service navigators. And Project for Pride in Living’s (PPL) Cabrini Partnership Transitional House.
Bryant started drinking in college. He drank until he quit school. He drank until he couldn’t get up for work in the morning. He drank until his wife left him. He drank until he lost his home.
That isn’t to say that his life was wasted. It wasn’t. Even when he drank, Bryant worked most of his adult life as an electrician. He was good at his job. He paid his bills every month and had a family who loved him. He loved being a dad. He was living an average-guy kind of life.
Then everything fell apart.
For three years Bryant stayed in shelters or on the streets. While he made the best of it, drinking with friends and joking around, he knew that he was missing out on his son’s teenage years. So he started putting things back together.
Putting things back together started with going to HCMC’s Coordinated Care Center. The Coordinated Care Center helped Bryant with medical needs such as a primary clinic and pharmacy services. More than that, though, they treated him like a person who deserves respect. “They are really nice people,” Bryant says. “They care.”
After his basic medical needs were met, the Coordinated Care Center referred Bryant to Hennepin Health’s social service navigation team, who helped get him into treatment and resolve his homelessness.
Now Bryant lives at PPL’s Cabrini House, a 24-bed transitional sober housing program. Program Manager Mani Vijay and Case Manager Sonya Hollaman provide supportive services for Bryant and other residents of the program. They help people manage mental health, maintain sobriety, and break the cycle of homelessness.
As one client noted, “If you are willing to give your all, they will give you their all. They will always listen and never judge.”
Within this environment Bryant is gathering days of sobriety like an armload of twigs ready for the fire. He is warming his hands by working 20 hours a week as a janitor, and hopes to get back into the electrical field.
Most importantly, Bryant is talking about reconnecting with his son. He wants to perform those regular dad tasks he couldn’t do when he was drunk, like help his son buy a car, and talk to him about girls so he doesn’t have his heart broken.
“I’m getting old, now,” Bryant says. “I have gray hair. I’m going bald. But I want to be positive about the future. I have a lot to do.”
When Bryant says this, the determination in his voice is evident. It’s easy to imagine him as a boy alone in the woods, holding a hatchet near his head to fight off renegade bears. It’s also easy to imagine him getting back on his feet and doing exactly as he says.
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The Hennepin County Medical Center (HCMC) now offers home
healthcare and hospice services through the Minnesota Visiting Nurses
Association (MVNA.) These services
became fully integrated in 2016, and will allow patients to transition medical
care from the hospital or clinic to their home.
The main goal of this partnership is to provide a continuum
of care that improves patient outcomes and increases satisfaction. Rather than each party having episodic
contact with patients, their collaboration ensures cohesive care from entry to
exit.
HCMC and MVNA now share electronic medical records through Epic, which allows providers to better monitor care. The MVNA also has staff within the hospital that help connect patients to services. Their registered nurses and community health workers provide in-depth case management services.
Even though this collaboration is new, metrics already indicate a decrease in hospital readmission rates. In addition, the collaboration can minimize the length of stay in acute care settings.
“Our partnership is really about improving patient satisfaction,” said, Jen Van Liew, Vice President of Community and Care Transitions. “We can treat people where they want to be treated.”
Hennepin Health expanded care from individuals to families in 2016. The MVNA has a strong community presence working with families, which makes them a natural fit. Last year they provided more than 80,000 visits to 19,000 clients.
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