We need to talk to each other
Lessons Learned On National Black HIV/AIDS Awareness Day
Dr. Lisa Fitzpatrick, a CDC-trained epidemiologist and practicing infectious disease physician, has a simple explanation for why HIV infections continue to rise: “At the end of the day, people who are HIV positive are spreading HIV to people who are HIV negative. There is really no good excuse for this.”
Fitzpatrick, who was recently featured in the PBS Frontline documentary “ENDGAME: AIDS in Black America,” spoke to an audience of about 50 people for a National Black HIV/AIDS Awareness Day luncheon at AIDS Action Committee on Feb. 7. The crowd consisted of a mix of members of the public, social workers, and HIV/AIDS advocates; about a third of the audience described themselves as HIV positive.
Fitzpatrick’s question to the audience as to why HIV infection rates are so much higher among Black Americans than the general population (in Massachusetts, for example, Blacks make up only six percent of the population, but comprise 29 percent of those living with HIV/AIDS) generated a lively discussion.
“People don’t trust their doctors,” said one woman. “We don’t like to talk about it,” said another. “We aren’t honest with each other,” added one man.
Fitzpatrick offered that she was sometimes embarrassed by her profession when it came to dealing with HIV/AIDS. “Providers do a bad job,” she said, noting that it’s not unusual for a doctor to fail to suggest to patients who are sexually active that they get tested for HIV. She said when she sometimes asks fellow doctors why they are not suggesting an HIV test for patients, they will tell her that most of their patients are older. Fitzpatrick’s response to her colleagues—which prompted much laughter? “I ask if they are prescribing Viagra.”
But Fitzpatrick, who also blogs about health policy issues for the Huffington Post, was most pointed when talking about the need for people who are HIV positive to be accountable when it comes to halting the spread of HIV. She told the story of a patient of hers who had learned that she was HIV positive after suffering through a bout of unexplained illnesses. An emergency department doctor suggested that she get tested for HIV. The patient learned that she was positive. During a follow up visit with Fitzpatrick, the woman brought her partner along so he could get tested because she was concerned that she had passed along the virus to him. He also tested positive. But during the course of the visit, the woman’s partner disclosed to Fitzpatrick that he had previously been treated for HIV.
The incident, which Fitzpatrick wrote about in an opinion piece for the Washington Post, was so unsettling that Fitzpatrick said it caused her to question the long-sacred practice of patient confidentiality. “How do we find a balance between protecting people with HIV and holding them accountable for having exposed people to HIV?” she asked.
One audience member answered that she had been HIV positive for more than 20 years. It is easy to think about what you would say or do when you are negative, she said. “When you are living with it, it is just not that easy.”
The solution, Fitzpatrick said, will be found in reducing stigma around HIV and AIDS.
She told another story of a relatively well-off patient of hers who has not disclosed her HIV status to her children. The patient’s health has been poor and she does not take her HIV medicine regularly. As a result, her HIV viral load is high. By contrast, she has another patient who is homeless and another who is addicted to cocaine. Both take their HIV medicine faithfully and both have undetectable HIV viral loads.
The patient who is keeping her HIV from her family is doing so because she is afraid that she will be cut off from her grandchildren, Fitzpatrick said.
Fitzpatrick closed by asking everyone in the audience to talk to 10 friends about HIV in February and to 10 more in March and 10 more again in April. “We need people who are HIV positive talking with people who are HIV negative,” Fitzpatrick said. “It’s up to us.”