9affect anyone. But the disease adversely impacts young people, Afri-
can Americans, Latinos, and people of lower socioeconomic status.
Researchers suspect the reason could be some combination of a lack
of access to health care and higher rates of STIs, among other fac-
tors. Gardner’s colleague Rowan described recently seeing a newly
diagnosed patient who was homeless, a population in Denver that
struggles with HIV. When that person left the clinic, Rowan says, he
was discharged onto the street. “This guy’s got a lot of other things on
his mind,” she says. “His lowest priority is HIV.”
Taking cues from Gardner’s model, clinics like Rocky Mountain
CARES and Denver Health have incorporated a more holistic set
of services—mental health counseling, in-house food banks, dental
care, and access to bus passes or motel vouchers—into their practices
so that they are, in essence, one-stop shopping for those who grapple
with making and keeping self-care appointments. Rocky Mountain
CARES employs seven full-time case managers
who work with upward of 85 patients each, han-
dling these ancillary aspects of their care. It seems
to be working. Today, in about 95 percent of the
nearly 1,000 patients served by Rocky Mountain
CARES, the virus is undetectable—and therefore
not transmittable.FOR THE PAST TWO YEARS, there have been moments,
some more pronounced than others, each day
when 42-year-old Jack wonders how exactly he
contracted HIV. During stretches in his 20s and
30s, he struggled with addiction to drugs and alco-
hol. “It sounds kind of bad, but a lot of those years
are hard for me to go back to,” Jack says. “Most
of that time I was very well inebriated—I’m sure
that’s why this happened to begin with. I made bad
decisions when I was in that state of mind.”
In 2012, trying to recalibrate his life, Jack
moved from Wichita, Kansas, back home to live
with his father in Tribune. He got clean and took a
job at a local lumber yard. To keep busy, he started
remodeling his father’s old house. He fixed up or
replaced just about everything—electrical wiring,
plumbing, drywall, floors, windows. At first, Jack
hadn’t planned on sticking around. “My intention
was just to stay here long enough to work and save
up some money and start over again,” he says. But
his father was having health issues and liked hav-
ing Jack there. Plus, Jack felt comfortable at home.
When Jack got sick in 2017, the thought that
he could be living with HIV had never entered his
mind. He hadn’t considered the disease much at all
in his lifetime, despite the fact that being a gay man
put him at a higher risk for contracting HIV. Like
many other newly diagnosed patients these days,
Jack had no idea how far along the medicine had
progressed. “I thought my life was over,” Jack says of
the moment when he learned he had the disease. He
wondered if he should begin drafting a living will.
Jack’s not alone in his naiveté. Despite years of
intensive research and high-profile awareness cam-
paigns, many misconceptions about the disease
persist. The top myths Rowan lists include peoplecontinuum has since evolved and been adapted by local, state, and
federal officials. In 2013, the HIV Care Continuum Initiative was
established as the next step in the implementation of the National
HIV/AIDS Strategy. In essence, it became the standard model for
treating people with the disease, outlining steps doctors should take
to maximize their chances of success in fighting the virus, not only in
each human body, but also in humanity at large.
Gardner’s model places an emphasis on engaging and retaining
patients in a way that more closely resembles comprehensive primary
care as opposed to, say, handing someone a bottle of pills and hoping
he or she takes the medicine as directed. The procedures are intended
to help diagnose new transmissions; improve the health outcomes of
those who’ve already been diagnosed; bring those who’ve fallen off the
HIV care continuum at any point back into treatment; and reduce
new transmissions through viral suppression. “It’s even simple things
like phone call reminders,” Gardner says, “and
follow-up calls when people miss their visits.”
What might sound easy in theory, however,
can be a struggle to execute in practice. There’s
still a lack of general awareness about HIV as
well as a prevailing stigma and real and per-
ceived financial barriers to treatment that can
This page: Davina Conner began
producing a podcast in 2014 to help
others cope with HIV. Facing page:
Denver Health’s Dr. Sarah Rowan
serves on a local task force that’s
working to boost HIV testing as well
as access to treatment.TOP
DOC TORS
2019