AIDS in Indiana County

Project Three: Solutions

 

Phone Interview with Barbara Hoza, HIV/AIDS Nurse
 

 

Hello, my name is Megan. I’m a student at Colgate University, but I’m originally from Indiana County. I was given your number by Indiana County SHC. I’m taking a course at college about AIDS, and for my final project I’m trying to determine what the AIDS problem is in Indiana County, and what is being done to solve it. Could I please have a few minutes of your time to ask you some questions?
Thank you:

NEDSS epi disease surveillance system not up to date. Hiv data is now reportable since October 2002. AIDS has been reportable forever.

  1. You work through all of Southwestern Pennsylvania? Are you able to tell me anything about just Indiana County? (other wise all of SW PA is fine, I’m looking for information about AIDS in a rural community)

> a lot of rural issues. Main one delivery of health care. Doctors who specialize in HIV. For people to go to Pittsburgh. Johnstown, Title 3 Ryan White $ from feds, off-branch of Pittsburgh AIDS Center for Treatment. Serves Indiana, Cambria, Somerset, and part of Westmoreland. Gives Indiana clients choice: Johnstown or Pittsburgh. Some infectious disease doctors in Indiana. But better go somewhere where up on it all the time – Pittsburgh.

  1. What is your role as an HIV/AIDS nurse? What services do you provide?

>  I’m growing every day. Every day my role evolves

>  1) prevention. Education, well I’m supposed to. I did when first started this job. Education takes time. I counsel all positives. Go in and tell them they are positive, test them further, refer them to medical treatment

>  2) surveillance – nedss, HIV is reportable, gets reported to me, I report to cdc, that’s how we get money, I do data input

>  3) PCRS Partner Counseling and Referral Services. I need to know who your partners are [if you are HIV+]. Maintain confidentiality, won’t disclose your status, but need to find them and get them tested

>  4)Ryan White clinic in Johnstown. I do blood work, insurance, etc. Always doing partner counseling

>  5. case management

>  I do a lot

>  Counseling and testing for drug, alcohol, methadone clinic – will get high risk needle users. Free counseling testing etc. quarterly, methadone 2ce a month

  1. I have statistics from the PA Department of Health that say 90% AIDS cases in Indiana county have been male, and that MSM is the top mode of transmission (65%). (In SW PA 86.4% male, 59% MSM; 54% MSM w/out Allegheny)Do you find this to be an accurate reflection of the patients you work with?

>  No. The group growing fastest is heterosexual females. They’re getting it from guys. Fair amount of homosexual guys – older cases, mostly from 80’s, 90’s. All new cases are heterosexual male – no new cases are homosexual males. Black males- IV drug users. Females have sex with males that are IV drug users. White female. Maybe [there are new MSM cases] in city, but not here. What happens here in rural and in the city is two different things

  1. Barriers to Care Scale…for the following factors, explain if you think it is a barrier to care/problem for HIV-infected people:
    1. Is HIV-related stigma a problem?  > Definitely. Do not want to come into clinic that everyone knows…For our Ryan [White] Clinic, there’s no sign outside, we hold it at a family medical center in a common area, where people can just think people are getting flu shot, don’t know they’re getting HIV treatment/testing. Some newly diagnosed people don’t want anyone to know. Confidentiality, anonymity. Older gay guys don’t give a damn. They beat the drum, work for HIV. But the black community doesn’t want anybody to know.
    2. Level of knowledge about AIDS of rural citizens?  > very poor (level of knowledge). A guy died recently. He didn’t know he had HIV. He went to hospital, they found he had PCP pneumonia, and he died. He lived in projects, now everyone there thinks they need to be tested. They think you can’t hug, can’t kiss. Not aware that HIV’s not transmitted thru casual contact. We need to raise awareness, get it out there. You can’t just send a message out once, we have a new generation. Think people are educated, but I’ll have people who, when I tell them I’m an HIV/AIDS nurse, say, “how can you dooo that, aren’t you afraid you’re going to get it” [in snotty voice] And these are adults. That shouldn’t happen. MTV is the only one that does good advertising.

                                                               i.      How can we fix that? What should happen? We need to get into schools and talk to kids when young. Parents don’t want that because it’s talking about sex, although it’s really about a disease and how it’s transmitted. Need to change stigma. In the 1950’s cancer called “ca”, didn’t even call it “cancer,” there was a stigma. But now it’s okay, people talk about it openly. Different with HIV. We need to be able to talk about it openly.. once break stigma

    1. Lack of support groups?  > There’s not a lot of support groups. I work with two transgender (not HIV+) clients who need to find support – only in Pittsburgh. HIV has great support in Johnstown (we’re so lucky), there’s a new support group in Indiana. [confidential – can’t tell me name] that’s an expansion of the Johnstown group. Greene and Fayette are down there alone. Somerset too. Support groups are needed. Problem: start for a while, work for a while, but then crumbled. People don’t dedicate selves, don’t commit
    2. Inadequate housing?  > Doesn’t seem to be issue in rural area. Is MAJOR issue in city. Priority in city. Out in country, people have family and friends, if don’t have housing, taken in by relative. Food is issue though. Don’t have food banks.
      TRANSPORTATION – can’t get to food bank. Few and far between.. city food kitchens, etc. not in country

 

 

    1. Long travel distances to care? 

  > transportation is issue. Distances to go. Don’t have transportation. No good public transportation out in rural areas.

    1. Lack of adequate transportation? Elaborate: how get where going? Is there a special transportation service? Use public transportation? Drive self? Relative? 

> have to figure it out on there own. Case management gives them gas cards to use car and buy gas, or give bus tokens. If going to Pittsburgh, that’s a whole day of your life that’s gone. Go on bus, get to clinic, wait, go home, it’s been a full day. If have job, gotta account for day off of work

    1. Employment opportunities? 

> don’t have to disclose, no reason. Protected by Act 148 in PA – guarantee confidentiality. But terrible things happen. People threaten to tell employer

    1. Lack of HIV-trained health professionals? 

> Few and far between, but always someone you can refer them too for help. Fayette and Greene really have a problem (greene go to west vrginia), they get lost in shuffle. Trying to make a difference. Always someone we can send you to. If problem, move to city, where accessible to it all. Well I hate city. Well compromise.

    1. Do you find many people contracted HIV elsewhere?

> Yes, got HIV elsewhere – big job in DC, Texas, but the got HIV+, get sick, AIDS, come home to be with family. Happens a LOT.>

    1. Drs. who decline to provide care?  > There’s a problem with dental help. High risk blood, etc. hard time finding dental care. This stage of game, know which doctor to send them to (NOT family doctor…what does he know about HIV?!). here are your choices: this infectious disease doctor, this clinic, makes choice from one of these. If wanna consult family dr., confidentiality is going to be breached. I’m from Ligonier, and the family doctor in Ligonier, the receptionist went to high school with me. She sees HIV on my chart…”think about it”…most people don’t want people to know. Not going to take too long to get around. Protect self. Go to clinic that specializes in HIV

 

  

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