In the 1980s, an HIV or AIDS diagnosis was regarded as an almost certain death sentence, and treatment options were often limited to emergency rooms.
Fast forward 30 years, and this disease, while still dreaded, is no longer nearly as lethal as it once was. Today many of those diagnosed with HIV can focus on managing a difficult but treatable chronic illness.
This new reality is on display at the new AltaMed clinic in Santa Ana, a place where the present and future of HIV and AIDS treatment is being put into practice.
Beyond the usual drug therapy, the clinic, which opened in December, will be offering individual and group therapy for patients and may even host Zumba classes. The clinic also provides dental care for their patients, which many find difficult to obtain elsewhere.
“It’s the well-being of the entire individual,” said Angel Rosario, AltaMed’s administrative director.
Taking a holistic approach to treating patients is “the way to go,” said Sarah Kasman, executive director of Shanti Orange County. Having worked with the Orange County's HIV and AIDS community for more than 26 years, Kasman appreciates the work done by the new clinic.
AltaMed, the largest nonprofit operators of medical clinics in Los Angeles and Orange counties, provides primary medical services to more than 930,000 underserved patients. The decision to expand its services to the HIV and AIDS communities of Santa Ana comes as the clinic began noticing the rising population of newly infected residents, according to Rosario.
The new Santa Ana clinic employs a bilingual staff and plans to expand to full-time hours and employ more doctors. The office has worked with 70 patients since the launch of the new location.
AltaMed doctors hope their efforts will contribute to a greater awareness of HIV and AIDS in Orange County, a place where conservative politics and cultural traditions of the Latino community can interfere with educational efforts.
The story of Irene Smith, an HIV-positive patient, illustrates the importance of AltaMed's new efforts.
“I’m not an exercise person, but I love to dance, so Zumba would be great for me as far as the exercise part of it goes,” Smith said. “And I think it would [help patients because] you get to interact with everybody else as they’re with you, and if someone’s not feeling good or if they’re feeling depressed that day, you can relate to them.”
Smith, 37 and a longtime resident of Santa Ana, was diagnosed with HIV in the summer of 2013 after complaining of lower abdominal pain and fatigue. Regardless of symptoms, AltaMed administers free, routine HIV testing for all of its patients, and through this they learned of Smith’s infection.
Unaware of how long she had lived with the virus, Smith assumed the worst. She had little knowledge of HIV and worried whether she passed a death sentence to her two sons and boyfriend.
Education, Smith believes, exhibits itself as the best defense against spreading the virus, and she wishes there was more discussion about the disease in daily life. “If you don’t know about it, of course you don’t know what you’re supposed to be doing,” she said.
Barriers to Awareness
“[Orange County parents] think, ‘Not in my backyard,' " said Kasman as she explained being rejected to speak on HIV and AIDS in high schools.
Santa Ana stands as the city with the largest number of infected residents per capita in Orange County. And this projection, unlike Laguna Beach’s HIV community, is among newly infected adolescent, homosexual African-American and Hispanic residents.
“Stigma is huge in Orange County and all over, no matter what subgroup they’re in,” said Kasman.
Kasman also mentioned how alongside the lack of education, young people often believe they are immune to contracting the disease. She claimed this is due to medical advancements and how young people don’t know what an infected person “looks” like.
“Oftentimes, an infected person won’t show symptoms for up to five to eight years,” Kasman explained.
Along with the lack of education in the young community, the topic of sexually transmitted diseases seldom comes up in conversation in the average household. The topic is taboo in almost every culture, and conservative and religious groups tend to reject conversation about the disease even more.
In Santa Ana’s large Hispanic population, the subject of sex, gay sex, contraception and sexually transmitted disease prevention is hard to find.
“The culture inhibits the discussion of HIV,” said AltaMed’s Rosario. “You have ideals such as: machismo, familismo, respeto that can hinder the conversation about [HIV] prevention.”
In 2012, Latinos constituted 34 percent of the Orange County population but they accounted for 51 percent of people diagnosed with AIDS and did not know they had HIV, according to figures released by the organizers of National Latinos AIDS Awareness Day.
Having dealt with many Hispanic clients in Los Angeles, AltaMed produced a telenovela called "Sin Vergüenza," which addresses the need for HIV and AIDS testing and treatment for reluctant patients.
“So we ask patients to check it out,” said Dr. Prashanti Alekal. “If there’s ever a concern, it’s a nice way to introduce the subject without you having to communicate about it directly. It’s like a first step. and it’s done very nicely.”
Even with such efforts, however, public health advocates have a long way to go in the education of vulnerable communities. This reality is revealed in the attitudes of Smith and her boyfriend. Even after learning of Smith’s diagnosis, the couple still engages in unprotected sex.
“They say it’s harder for a man to get it from a woman than from a woman to get it from a man,” Smith said. “So we just go off of that. I bring condoms, we have condoms, but no, he doesn’t want to use them. He doesn’t want me to feel alienated.”
After learning of her diagnosis, Smith abstained from sexual activity for a month before her boyfriend convinced her “go back to normal.” Her boyfriend tested negative for HIV on the same day of Smith’s diagnosis but remains careless of contracting the chronic disease.
This behavior isn’t unique to Smith’s relationship. Medical providers often counsel couples where only one partner is infected about how to engage in safe sex. Even so, proper protection can never be guaranteed.
“Ultimately, it’s really up to the patient,” said Rosario. “Whatever sexual practices that they have, it really comes down to whether they want to use protection or they don’t want to use protection.”
Cleo Tobbi is a Los Angeles-based freelance writer and graduate of UC Irvine. You can reach her directly at email@example.com.