Wait time for Amelia Court appointments questioned

ASOs strive to see more clients more quickly but, Parkland patients continue to wait months

Nobles1

Raeline Nobles

DAVID TAFFET  |  Staff Writer
taffet@dallasvoice.com

Over the past year, the wait time to get an appointment at Parkland hospital’s Amelia Court appears to have gotten longer, although the staffing level appears to be about the same now as a year ago.

During that same time, community-based AIDS agencies in Dallas say they have expanded services and decreased wait times.

For new Parkland patients, the time from first contact to seeing a doctor can be as short as two weeks. But new patients trying to access services at the public clinic recently have reported waits of as long as four months.

Candace White, Parkland media spokeswoman, said that the clinic is taking new patient appointments as early as February and through March 1. She said she confirmed that with Sylvia Moreno, the hospital’s director of HIV services.

White attributed the delay to an increase in the number of patients accessing the clinic’s services due to successful HIV testing efforts throughout Dallas County. Some of the longer wait times quoted over the past few weeks may have been due to the holiday, she said.

However, when a Dallas Voice staff member called Amelia Court on Tuesday, Jan. 10, to make an appointment, he was transferred to voicemail to leave a message. As of deadline time on Thursday, Jan. 12, more than two days later, no one from the clinic had returned the call.

Another caller to Amelia Court was told that those February and March appointments White cited are reserved for established patients only. The next available appointment for first intake for new clients who want access to Amelia Court is April 23, the caller was told.

The Ryan White CARE Act, which funds many of the treatment programs for persons with HIV, specifies patients must receive “access to care within three weeks of presenting,” Dr. Gary Sinclair, former medical director of Amelia Court, said.

While he was at Amelia Court, Sinclair said that he and his staff reduced the waiting time to access medical care to two weeks. He left UT Southwestern and Parkland two years ago and is now an independent consultant involved in covering for physicians for Ryan White programs.

For years, all Parkland primary AIDS care was done at Amelia Court, located on Harry Hines Boulevard, a block from the main hospital. However, to relieve overcrowding at Amelia Court, doctors with experience in treating people with the virus have been seeing patients at three of the hospital’s Community Oriented Primary Care facilities in Dallas.

Parkland began opening the COPCs in 1987 to relieve its main emergency room of treating non-emergency cases.

The clinics were designed to provide convenient and affordable healthcare throughout Dallas County.

Parkland

HIGH RISE CLINIC | Amelia Court’s HIV services will move to the new Parkland Hospital under construction across Harry Hines Boulevard from the old facility. (DavidTaffet/Dallas Voice)

Some of the facilities also have specialties. Two clinics — Bluitt-Flowers Health Center in South Dallas and Southeast Dallas Health Center in Pleasant Grove — were designated as HIV treatment sites.

A third — deHaro-Saldivar Health Center in Oak Cliff — previously treated adolescents and young adults with HIV, but that service has been discontinued.

Parkland’s clinic has been staffed at about the same level for the past several years.

But as HIV has changed to a manageable chronic illness, Sinclair said that there has been “a normalization of care.”

That normalization may include longer waiting times for appointments at the public hospital, something that is common in other specializations.

But while Parkland strives to keep the wait time for primary care down, some local agencies that provide clinical service to people with HIV at low or no cost say they have expanded their service and will see new patients quickly.

“On a very human level, it can be quite terrifying to want and need medical care and not be able to find it,” AIDS Arms Executive Director Raeline Nobles said. “AIDS Arms built its second HIV clinic to help with these exact problems in significant and positive ways.”

The agency opened Trinity Health & Wellness Clinic in Oak Cliff this past fall and continues operating Peabody Health Center in South Dallas. Both offer full primary care for people with HIV.

AIDS Arms accepts Medicare and Medicaid as well as private health insurance. And like the county hospital, medical care is free for low-income people without any coverage and is provided on a sliding-scale for others.

Intake takes about a week to complete, Nobles said. Once a person who has an HIV-positive diagnosis is registered as a client, doctors at Trinity Clinic can see a new patient that week.

“With fast access to medical appointments at our Trinity and Peabody clinics and five licensed providers, we are a partner in the solution to very large and disturbing access to care problems in our community,” Nobles said.

The agency is seeking to expand the services it offers its patients and is currently looking for specialists in ophthalmology, cardiology and renal care to supplement its care.

In addition, AIDS Arms is involved in drug research trials, something Amelia Court no longer does.

Sinclair said he believed that was part of a shift in federal research dollars away from “’How do we treat people?’ to ‘How do we eliminate the epidemic?’”

In addition, AIDS Arms is offering several new services to its patients at its Trinity clinic.

Legal Hospice of Texas will soon begin providing on-site legal assistance for disability, social security and HIV-related discrimination issues. Bryan’s House will be providing free childcare for patients visiting the clinic on Thursday and Fridays beginning next week. And once a week, onsite psychotherapy services will be offered.

Resource Center Dallas offers a variety of specialized medical services at its Nelson-Tebedo Community Clinic on Cedar Springs Road. Dental care is the most frequently accessed and something not provided by other agencies or Parkland.

With a recent expansion of facilities at the clinic, RCD Communications and Advocacy Manager Rafael McDonnell said the wait time for an appointment is three weeks or less. He said the clinic is able to treat emergencies even more quickly.

This article appeared in the Dallas Voice print edition January 13, 2012.

—  Kevin Thomas

What’s next for HIV/AIDS services?

With drastic budget cuts looming, federally-funded HIV/AIDS treatment, prevention and education programs could be lost completely

Phyllis Guest
Taking Notes

On Dec. 15, four HIV/AIDS policy, planning and treatment groups offered a webinar entitled “Is No Deal a Good Deal? Deficit Reduction, HIV Services and What Comes Next.”

Experts from the AIDS Foundation of Chicago, AIDS United, Harvard Law School Center for Health Law & Policy Innovation and the Treatment Access Expansion Project took turns speaking about different aspects of the challenges HIV/AIDS service providers face in light of political realities in DC. They divided their presentation into four parts and used 50 illustrative slides.

Part 1 was the overview: Deficit Reduction and the Budget Control Act of 2011.

So why does the U.S. have a deficit when, as George W. Bush took over the White House in January 2001, the federal government had a surplus of more than $237 billion? The answer is a trifecta: Bush-era tax cuts (“It’s your money!”), war in Afghanistan (“Gotta get al-Qaida!”) and war in Iraq (“Weapons of mass destruction!”). Thus, in a single decade, we went from the largest surplus in U.S. history to the largest deficit.

The fiscal woods thicken here, so let’s just note that Congress has passed and the president has signed the Budget Control Act of 2011. The act pledges the federal government to sharply reduce the deficit over the next 10 years.

What will such deficit reduction mean for HIV/AIDS programs? According to the webinar presenters, if there is no agreement on revenue increases and the deficit reduction comes solely through spending cuts, it will severely impact three programs of interest to many of us: Ryan White, prevention funding and two so-called entitlements, Medicaid and Medicare.

­THEN AND NOW  |  When George W. Bush took over the White House in January 2001, the federal government had a budget surplus of more than $237 billion. In 2011, the deficit stands at $1.3 trillion.

­THEN AND NOW | When George W. Bush took over the White House in January 2001, the federal government had a budget surplus of more than $237 billion. In 2011, the deficit stands at $1.3 trillion.

A spending-cuts-only approach would affect the HIV/AIDS community in several ways. First, cutting prevention efforts would mean higher rates of infection, worse health outcomes and higher long-term health care costs.

Since Medicare and Medicaid help millions living with HIV/AIDS, cutting the former would likely cause more physicians to drop Medicare patients, and cutting federal funds for the latter would shift the cost to treat very low-income persons to the states. (Good luck with that, Texans.)

Cuts to general health care reform efforts would virtually assure higher costs going forward.

Still with me? Good.

So when the Congress and President Obama could not come to any fiscal agreement, they punted to the Super Committee. The Super Committee was tasked with recommending huge changes to taxes, entitlement programs (including Social Security, Medicare, Medicaid) and discretionary spending (including Ryan White).

The SC came up with nothing. Nada. Zilch.

That means there will be no immediate spending cuts to entitlement programs. But automatic spending cuts  — sequestration — will kick in January 2013 for both defense and non-defense programs.

According to the nonpartisan Congressional Budget Office, without new revenues, domestic spending will drop from about 4.4 percent of Gross Domestic Product this year to about 2.7 percent in 2021. It will then be much lower than it has been since the end of WWII.

Looking at appropriations for the year we’re entering now, suffice it to say that the differences between what the HIV/AIDS research and health care community is seeking and what the Congress is proposing are huge.

Also, the community “vehemently” opposes two policy riders added by Republican members of Congress. The first bans the use of federal funds for syringe exchange programs. The second funds abstinence-only programs.

The webinar ended with a plea for advocacy. Here are the talking points the experts hope we will use:

• The Super Committee actually succeeded in one area: It prevented major cuts to Medicare, Medicaid, Social Security and other essential programs.

• The president and Congress must stick to their promise to cut defense and non-defense spending equally; no caving to deep-pocketed militarists.

• New revenue is essential; without it, HIV/AIDS outreach, prevention, education and treatment programs are lost.

• Preventing new HIV/AIDS cases, providing early treatment for those who do get infected, and funding support services such as housing are not just humane; they are cost-effective.

HIV/AIDS is still running rampant, and no magic cure is in sight. Call, fax, email and snail mail every member of Congress as well as the president.

Work with other activists. Think of other things to do, and do them all. Jan. 2 is not too soon to begin.

Phyllis Guest is a longtime activist on political and LGBT issues and is a member of Stonewall Democrats of Dallas. Send comments to editor@dallasvoice.com.

This article appeared in the Dallas Voice print edition December 23, 2011.

—  Michael Stephens

Focusing on S. Dallas

Wiley says South Dallas AIDS Walk designed to target message of HIV awareness to a different community

TAMMYE NASH  |  Senior Editor nash@dallasvoice.com

Auntjuan Wiley, right, and Jai Makokha
Auntjuan Wiley, right, and Jai Makokha

Dallas County has the highest HIV infection rate in Texas, according to county health officials, and some of the highest morbidity rates in the county are in two zip codes: 75215 and 7521o.

Both of those zip codes are in the South Dallas area, and yet, that area remains dolefully underserved when it comes to HIV/AIDS education, outreach and awareness efforts and HIV/AIDS services, according to longtime AIDS activist and educator Auntjuan Wiley.

“When it comes to HIV services and awareness and outreach, we focus on Oak Lawn and Oak Cliff. South Dallas always gets missed,” Wiley said this week. “And the only medical service provider for people with HIV in South Dallas is the Peabody Health Center.”

That’s why, when he was named executive director of the new Anthony Chisom AIDS Foundation, Wiley immediately set out to find ways to fill that gap. And when he heard about the idea for an annual South Dallas AIDS Walk from Anthony Chisom, he decided right away to get involved. The first South Dallas AIDS Walk is scheduled for March 19, 2011.

The lead-up to the walk began last Thursday, Nov. 4, with a kick-off party that included Dallas City Councilwoman Carolyn Davis, Dallas County Health and Human Services Director Zachary Thompson and more. Wiley’s co-chair for the walk is AIDS activist Jai Makokha.

Wiley is quick to stress that the South Dallas AIDS Walk is not meant to compete — either for participants or funds — with AIDS Arms’ LifeWalk, held each year in October in Lee Park. The South Dallas event, he said, is targeting a whole different audience.

And the walk “isn’t just all about the Anthony Chisom Foundation,” Wiley added. “Some of the funds will come to us, yes. But we have other beneficiaries, too.”

Those beneficiaries, he said, include The Afiya Center, which focuses on HIV/AIDS prevention and reproductive health for women and girls; Welcome House, which provides housing and services primarily for African-Americans with HIV/AIDS; the Ugieki Foundation, which focuses on HIV/AIDS awareness and education and provides an online project management system for charitable organizations; AIDS Arms’ Peabody Health Center; and AIDS Interfaith Network.
Wiley explained that well-known interior and floral designer Anthony Chisom began his foundation, which provides financial assistance to people with HIV to help them pay rent and utilities and buy their medications among other things, after a trip to Africa where he saw the devastation the HIV epidemic had caused there.

“He knew then that when he came home he had to do something. He had to get involved. So he started the Anthony Chisom AIDS Foundation,” Wiley said.

Wiley said he and his steering committee are working to confirm Phil Wilson, founder and CEO of the Black AIDS Institute, as keynote speaker and grand marshal for the South Dallas AIDS Walk. But, he said, walk organizers need lots of sponsors, vendors, walkers and volunteers. And he hopes that many of the businesses and civil and faith community leaders in South Dallas will come on as partners in this effort.

He said the involvement of the business, civil and religious leaders will be vital to the walk’s success.

“South Dallas is, historically, a hard community to reach with the AIDS awareness and education messages,” Wiley said. “There is still a lot of the fear and stigma and shame surrounding HIV and AIDS in South Dallas that isn’t as strong any more in Oak Lawn and Oak Cliff. So it takes a different approach in South Dallas.

“It is very important that we have an aggressive and strategic community engagement piece to this effort. There needs to be a real conversation with the gatekeepers in this community, the community leaders,” he said. “If we can get them involved, then we have a better chance of getting our message to this community.”

Wiley said the walk will be an annual event, because a one-time thing won’t get the message across.

“You can’t go into this community just once with a message and then leave,” he said. “You have to stay there. You have to be visible. You have to let them know we care. We want them to know that this is ‘a walk in South Dallas, for South Dallas.’ That’s our theme.”

While the obvious goal is to raise awareness and funds, “it’s about a lot more than just charity and awareness. It’s about doing the work. Until there is a cure the work has to be done,” said Wiley, who this month marked his 15th year of living with AIDS and this year marked his 20th year of working in the HIV/AIDS field.
Wiley said, “This is about change. Dallas County has the highest HIV infection rate in Texas. South Dallas has some of the highest infection rates in Dallas County. That has to change. It is just time for a change.”

For more information, contact Auntjuan Wiley by e-mail at a.wiley@anthonychisomaidsfoundation.org or by phone at 214-455-7316.

This article appeared in the Dallas Voice print edition November 12, 2010.

—  Michael Stephens

County to partner with community ASOs

Forums planned to gather ideas from community will focus on strategies to prevent HIV infection

DAVID TAFFET  |  Staff Writer taffet@dallasvoice.com

Dr. Steven Harris, left, and Dallas County Commissioner John Wiley Price
EXTENDING THE FIGHT | Dallas County Health and Human Services Medical Director Dr. Steven Harris, left, and Dallas County Commissioner John Wiley Price discuss new efforts to fight the rising HIV infection rate in the county during a press conference on Thursday. (David Taffet/Dallas Voice)

Dallas County Health and Human Services Department officials announced Thursday, Sept. 16, that they are forming a new partnership with AIDS Arms and Resource Center Dallas to begin new HIV awareness and prevention programs.

“We’ve seen a resurgence of numbers,” said DCHHS Director Zachary Thompson.

Among the initiatives announced were community forums to find new ways to create awareness and spread the message of prevention.

“The key is resident input,” Thompson said.

The county will also open a new testing clinic in far North Dallas, an area with increasing HIV rates and a lack of HIV services.

“If money could have cured this, probably we wouldn’t be here today,” said Dallas County Commissioner John Wiley Price.

He said that an estimated one in five people infected with HIV in Dallas County do not know their status, adding that “HIV disproportionately affects certain populations.”

Among the groups with a recent increased infection rate are people age 50 and older. Saturday, Sept. 18 has been named National HIV/AIDS and Aging Awareness Day. AIDS Arms has coordinated a number of testing locations around the county. Those locations are listed on the Dallas Voice website.

Dr. Steve Wilson, Dallas County’s STD/HIV medical director, said that early in the decade the area saw a decrease in the HIV infection rate. By 2006, there was a leveling off.
He attributed that, in part, to increased testing efforts by the county. He also said that current testing detects the virus earlier. At least 30 of the 850 to 900 people diagnosed locally last year would not have been detected with traditional testing methods.

Wilson said that three areas with most of the increase in infection rates are Oak Lawn, Oak Cliff and North Dallas. He said that to address the needs in those areas, the county was partnering with community-based organizations.

Bret Camp, associate executive director of Resource Center Dallas, said that early intervention produces the best clinical outcome.

“With the recent advances in HIV treatment, it is now a chronic, manageable disease,” Camp said. “Testing and education are our best weapons to fight the spread of HIV.”

He said that on Oct. 12 at 6 p.m., Resource Center Dallas would host the first community forum on strategies to join together “to create a successful plan that will reduce HIV transmission and give us healthier communities.”

Camp said they are looking from input from people who are HIV negative and positive and HIV infected and affected.

AIDS Arms Behavioral Intervention Specialist Ed Jones said a second forum would be held in South Dallas at the Urban League, 4315 S. Lancaster Road, on Oct. 28.

Jones said that because on an increased need for HIV clinical services, AIDS Arms would be opening a clinic in Oak Cliff in addition to its South Dallas Peabody Clinic.

One group that has seen a significant rise in HIV infection in Dallas County is younger people age 13 to 24. In 2006, two 13-year-olds were diagnosed. In 2008, a 14-year-old, a 15-year-old and two 16-year-olds tested positive in Dallas County.

Rubin Ramirez
Rubin Ramirez

Price said that until recently, Dallas County was the largest in the country where condoms were not available to younger people because of an abstinence-only sex education mandate.

“In 1992, there was basically a ban by the court,” he said. “Let me say that I am very glad to stand here today and say that has been repealed.”

He said that purchasing condoms was not an issue. Condoms are available at the county health department for distribution.

“They are available as a protection mechanism,” he said. “It is available in your toolbox in Dallas County.”

Dallas County’s Chief Epidemiologist Wendy Chung said that the infection rate among 13-to-24-year-olds is 54 per 100,000. She said that represents a 30 percent increase in recent years.

Rubin Ramirez of Resource Center Dallas said that one of reasons for the increase in infections is apathy.

“People are immune to the message because of treatments available,” he said. “They think things are OK.”

He said the goal was to bring HIV awareness back to the forefront.

Price agreed and said that was a big problem in the African-American community.

“Magic made it. It can’t be that bad,” Price said referring to basketball player Magic Johnson who was first diagnosed with HIV 19 years ago. “There wasn’t anything magic about Magic, and we need to bring urgency to this issue.”

Currently, about 14,000 people in Dallas County are living with HIV. That is a 30 percent increase over the past six years. The growing number is partially due to longer life expectancies for persons receiving medications.

Of that amount, 67 percent of cases are among gay men and others identified as men who have sex with men. Women represent just 22 percent of the cases in Dallas County.
A disproportionately high percentage of HIV infections in Dallas County are among minorities. Hispanics account for 23 percent of the cases and blacks 48 percent.

While Dallas is the third largest city in Texas, it has the highest infection rate, according to AIDS Arms. Since 1981, 15,000 people have died of AIDS-related illnesses in North Texas.

This article appeared in the Dallas Voice print edition September 17, 2010.

—  Michael Stephens