AIDS in Indiana County

Project Three: Solutions

 

Phone Interview with Malinda Cowle

 
 

Hello, my name is Megan. I’m a student at Colgate University, but I’m originally from Homer City. 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:

  1. What services do you provide/What is your group doing to help win the fight against AIDS? (treatment, testing, prevention education, other services, etc.)

> education and outreach mainly. Annual observance of world aids day. PA funded for HIV by regions. Work with South Western Pennsylvania AIDS Planning Coalition to maintain case management stuff. $ given to PA, PA gives to planning coalitions, they decide how to fund services in area. Community care management

  1. I’d like to gauge your concern for HIV/AIDS in Indiana County? Do you think it’s a problem, or do you feel it’s under control, that you are doing a good job?

>  hidden. See about 10 at a time that people know about [living with HIV/AIDS in Indiana County]. Quiet. Care in Pittsburgh. Not visible presence. Difficult. Not a lot of interest on part of community (there are pockets of interest). People wanting to get involved doesn’t happen. Tried support group in area. Hasn’t happened. Be source of referral make sure sources are available

  1. I have statistics that say 90% AIDS cases in Indiana County have been male, and that MSM is the top mode of transmission (65%). Do you find this to be an accurate reflection of the patients you work with?

> With my experience yes. Worked with gay men infected who may have had infected partner. Worked with one woman who was positive, probably got infected through IV drug use. All rest men.

    1. Why do you think this group, MSM/homosexual males, is such a problem in Indiana County?

> They get tested. One of things hear from community, they believe disease is predominantly Males having sex with Males and IV Drug use (old stereotypes), [a msm] man probably encouraged to be tested by doctor. Regular testing. People who don’t fit stereotype don’t get tested, because they don’t think they’re at risk. Also get tested elsewhere come back. I, if need to be tested, would go somewhere else, out of county. HIV+ statistics recent (CDC didn’t want them until recently), statistics are for AIDS.

 

    1. Are the MSM cases mostly men who contracted in HIV in the 80’s or 90’s, or are there some more recent?

>        90’s. Many didn’t know when got infected. Most cases have been treating/working with 10-15 years. Some younger people. But really really small numbers. Two contacts a year seeking services. Differentiation. If you’re 45 with an established job, vs 27 starting your career, the services you need are different

  1. Are you finding many new infections? Or are most of the cases people who are already sick and riding out the course of the disease?

> most have been diagnosed for year or longer. No new cases being

  1. Barriers to Care Scale:
    1. Is HIV-related stigma a problem? 

> I think it is. People talk about going out of area for service. No centralized location. Conemaugh has some clinics. Don’t see that happen in Indiana. Even testing not as widely available. Satellite clinic in Adagio. Or go to private source. Public health is interested in expanding service in some ways. We advertise National HIV Testing Day– one or two people come in. You don’t see people being too interested in. if knows someone more likely to have

    1. Lack of support groups? 

> I’ve been working here 15 years. I’ve tried to run support groups, but they never stayed, never lasted. Talk to individuals. The service is offered, but no one takes. So it must not be working in Indiana County

    1. Inadequate housing? 

> The number is very small

    1. Long travel distances to care? 

> Travel has always been a problem. Most difficult thing. Want to go someplace, in a rural community, you have to move people further to get certain services. It’s a problem for lots of diseases, not just HIV. Services something people want but don’t have transportation. Can go to Johnstown or Pittsburgh, but it’s difficult. True for Indiana County in general, not even necessarily PLWHA.

    1. Lack of adequate transportation?  > They get vouchers from the Community Care Management. Use friend, taxi service, public transportation. Some support, but not feasible to provide all the support someone needs because of cost. National-level funding to organizations has dropped, Ryan White money dropped. Less money put into services. Legislators think treatment has improved so much that don’t need more money for this stuff. But people need ongoing care. Require money to travel. There’s no infectious disease specialist in Indiana County. There are some who have HIV+ clients. But you don’t see same resources here as in Greensburg, Latrobe, Johnstown.
    2. Lack of HIV-trained health professionals? 

> overall, but training not necessary. Not specialists. Hospital here can care for clients, can handle their care. But I would go to specialist.

    1. Drs. who decline to provide care or intentional breaches of confidentiality? 

> I haven’t heard of any complaints. Assume most clients either have good relation with own physician or a couple physicians work with other hospitals. One of the calls for referrals we get is, “what physicians are in the area?”

  1. Is there a problem with immigrants or people recently released from jail?

> don’t have answer. May see need.

  1. Is there anything else you can tell me? In your experience, what has worked best? Any additional solutions or suggestions you could provide?

> The biggest missed opportunities is pubic school districts. PA mandates HIV education on the elementary level, and again in high school. Controversial. Difficult for school district, don’t use open curriculum talking about sexual activity, intravenous drug use. Don’t have comprehensive sexuality education. Missed opportunity to think about own sexual choices. A lot of programs are abstinence-only based. Fear of community response. Hard questions. But choices made by people of power don’t agree with what research shows works. We’ve displayed the AIDS quilt, it’s a benign education. (“when displayed? I went to Homer-Center and never heard about that”) 1991, every 4 years, 91, 95, 99, I think last time was 2005. It was at IUP [Indiana University of Pennsylvania], and was open to community. Invite community. I worked very close w/ 4H students in marion center in 1999. They made a quilt square. That was the last time the quilt was displayed on the Washington DC Mall [1999]. There have been pockets of good response. But just pockets, not overall response. Last year, for World AIDS Day, we put red ribbons around telephone posts uptown (at IUP), we hung a banner across the street recognizing World AIDS Day. Sometimes radio stations ask us to do something. It’s sporadic, not negative. People are neutral and uninvolved.

THANK YOU!!

 

 

  

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