January 2001

From University of North Carolina at Chapel Hill

UNC-CH AIDS physicians open clinic in hard-hit southeastern N.C. county

Chapel Hill -- Infectious disease experts at the University of North Carolina at Chapel Hill School of Medicine have started a new AIDS clinic at the Robeson County Health Department in Lumberton.

The clinic, open Mondays, will allow HIV-positive and AIDS patients to be treated near their homes instead of driving five or more hours to Chapel Hill and back.

"If you're a single mother, for example, who is infected with HIV, the virus that causes AIDS, you shouldn't have to drive so far for a 15-minute doctor's appointment, especially if you don't own a car," said Dr. Charles van der Horst, professor of medicine and director of UNC-CH's HIV/AIDS clinic. "Recently we discovered that 120 people, which represents 10 percent of the patients coming to our clinic in Chapel Hill, were from Robeson County, and so it's a big problem down there."

Robeson, one of North Carolina's poorest counties, is not among its most populous, he said. Still, it suffers one of the nation's highest sexually transmitted disease rates.

"Fifty percent of the syphilis cases in the United States are diagnosed in fewer than 30 counties," van der Horst said. "Several of those counties are in North Carolina, and one is Robeson."

A $100,000 grant from the N.C. Department of Health and Human Services, made possible by federal legislation known as the Ryan White Bill, will support clinic operations for a year, he said. Each week, Dr. Dickens Theodore or Dr. Becky Stephenson of UNC-CH's department of medicine faculty will accompany family nurse practitioner Laurie Frarey to Lumberton to see patients.

Medicaid, private insurance, Medicare and the federal AIDS Drug Assistance Program will cover the bulk of indigent patients' costs. The clinic can provide financial assistance to a few patients who need help with drug costs, van der Horst said.

"This clinic will help a lot, but not just with treatment," he said. "When you don't provide adequate care for people with HIV infection they seek care in emergency rooms, and then often they are desperately ill."

Then they have to be admitted, and that's a major expense for local hospitals, van der Horst said.

"We've been trying to convince hospitals to chip in and help with this because it's in their best interest. Usually this care is not reimbursed. These admissions can cost thousands and thousands of dollars that could pay the salary of a nurse practitioner, who could help patients stay out of the hospital in the first place."

Outpatient care also allows health workers to do prevention activities as well, the physician said. Those who are not being treated also are not being educated about their illness and are more likely to spread it to others.

"One of the interesting things we've learned is that there are only three countries in the world that have decreased their number of new cases of HIV," van der Horst said. "Those aren't fancy, high-tech places like the United States either. No, they are Uganda, Senegal and Thailand, where, from the highest person in the government to the lowest person, from business folks to churches, everybody is united and focusing on curtailing sexually transmitted diseases and HIV."

Until people in North Carolina start taking HIV and AIDS more seriously and boost screening, the state will not see an end to the epidemic, he said.

"This clinic, while a small and modest beginning, is really a landmark opportunity not only to provide compassionate humane care for those who are often marginalized on the fringes of society but also to help stop the spread of HIV," van der Horst said. "We hope that it will serve as a catalyst for local communities and medical centers to step forward and help out as well."

Note: van der Horst can be reached at 919-966-2536.












This article comes from Science Blog. Copyright 2004
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