Ryan White Clinic Marks 15th Anniversary of Caring For HIV/AIDS Patients

Fifteen Years of Caring: Infectious disease specialists, Dr. Helmut Albrecht (left) and Dr. Charles Bryan (right), review a patient’s record.

His skin had a grayish pallor, he shook from the chills, and felt absolutely awful. Antoine Parnell * was 22 years old, HIV positive, and scared of the lingering symptoms that had taken over his body for the past few months. As he waited on his first appointment at the clinic, the Columbia resident was suddenly pulled into a bear hug by a nurse. Her immediate acceptance and reassurance were a turning point for Parnell. “From that point on I felt at ease with my diagnosis,” he said.

Parnell’s appointment was at the Midlands Care Consortium Medical Clinic, which has cared for indigent and underinsured people with HIV infection and AIDS since 1993. Backed by federal funding, it was established by the USC School of Medicine in association with Palmetto Health Richland, the Columbia Free Medical Clinic, and other local agencies. More commonly referred to as the Ryan White Clinic, it takes its name from federal legislation enacted after the death of hemophiliac and teenage AIDS activist Ryan White.

Through a coordinated network of agencies and other providers, the clinic’s patients also have access to mental health treatment, dental care, and substance abuse counseling. Assistance with basic needs, including food and housing assistance, is handled through such organizations such as the Cooperative Ministry, the South Carolina HIV/AIDS Council, and Palmetto AIDS Life Support Services (PALSS).

For Parnell, the clinic has represented far more than a place to receive medical care. Once inside the doors, the stigma he felt as a gay man with HIV/AIDS was never an issue with the infectious disease physicians, nurse practitioners, and nurses on staff. “I walked in as Antoine Parnell and that’s who they saw me as – a whole person with an illness that needed treatment.” As the staff taught him about the disease he had been diagnosed with three years earlier, the young man learned that he wasn’t facing an imminent death sentence. “They were telling me that I could live longer taking medication. I saw a ray of hope for me.” That ray of hope still shines 12 years later as he continues to live with the disease.

Parnell’s longevity as a patient with AIDS is no longer unusual. The development of effective antiretroviral medications has made a dramatic impact on the lives of people with HIV/AIDS. “It used to be that when a patient was diagnosed with HIV we couldn’t tell what the progression of the disease would be. Some might do well for five, ten, or even 15 years, while others went downhill quickly and within a year or two would begin to get sick with HIV-related symptoms,” said Dr. Charles Bryan, Heyward Gibbes Distinguished Professor of Medicine at the USC School of Medicine. Dr. Bryan was chair in the Department of Medicine and played a pivotal role when the clinic was established. “Today, most patients can keep on going for a long, long time. It is similar to diabetes mellitus, in that if you learn about your disease and take your medicine you can do very well,” he added.

A Changing Epidemic

Since the Ryan White Clinic opened a decade and a half ago, the patient base has grown from an initial handful of individuals to some 1,200 men and women a year. As people live longer with the disease and new infection continues, the number of patients keeps increasing. “This has become a major problem since the current federal funding is not keeping up with these trends,” said Dr. Helmut Albrecht, a professor of clinical internal medicine and chief of Internal Medicine’s Division of Infectious Diseases. The situation is particularly dire in the Midlands, which is ranked in the top ten nationally for new HIV infection in metropolitan areas. “This is comparable to rates in cities like New York and San Francisco, which for most people is shocking. We are in the absolute forefront of the epidemic,” Dr. Albrecht noted.

Without the intense media focus and public hysteria that used to surround the disease, AIDS has faded into a quieter epidemic. It’s also undergone a significant demo- graphic shift. “It’s shifted from a white, gay, male disease and become a lot more heterosexual,” said Dr. Albrecht, explaining that HIV infection is now concentrated in minority populations and lower socioeconomic groups. He notes in particular that girls of color between the ages of 13 and 18 represent the highest increase in new infection. “In the South, it has not been easy  - politically, ethnically or religiously - to make this a topic of discussion, which you have to do to prevent spread of the disease,” he said.      

Meeting Patient Needs

As the face of AIDS has changed, the Ryan White Clinic has adapted and expanded its scope of services. This includes a satellite clinic for patients in Sumter. With a steadily increasing number of female patients, a dedicated women’s clinic is also offered one day a week in Columbia. “This is part of our empowering women,” said Dr. Albrecht. Housing needs are managed through a program made available through additional federal and local resources. Even incarcerated individuals are specifically addressed. In 2007, the Department of Internal Medicine was awarded a federal grant to provide HIV testing to inmates in the Richland County jail and to assist HIV-positive inmates in securing necessary services when released.

It’s not uncommon for the clinic’s patients to be unemployed, homeless, or struggling with alcohol and/or drug addictions. A strong case management system helps to link patients with appropriate resources. Dr. Albrecht provides an example, “Consider a patient who could benefit most from a medication that requires refrigeration. This particular patient lives under a bridge. For him to be able to have this medication is going to be very difficult.” Yet the physician has discovered that the obstacles which can be the most challenging to health care providers can also become the most gratifying aspect of their work. “South Carolina has a rural epidemic. It’s striking how much of a difference you can make here by helping patients,” he said, citing transportation as a particular problem for individuals who live a considerable distance from the clinic and other services. Dr. Bryan added that the role of the clinic’s nurses in problem solving has been essential. “We found out early on that while you needed the doctors to diagnose and see the patients, the nurses were invaluable in terms of following the patients for continuity and helping them work through all their issues,” he said.

While Antoine Parnell needed help with day-to-day needs when he first came to the clinic, he has since returned to college and been employed at the same place for al-most ten years. In addition to a stable job, the clinic’s health care professionals have been another constant in his life. “Most people don’t have the type of relationship with their doctors and nurses that I have with them. Not only have they been there for me, but they make you feel like you are part of the family.”

Parnell’s experience with the Ryan White Clinic has been replicated in similar fashion many times over the past 15 years. “Without the clinic most of these patients would pretty much be at sea. This has literally become their lifeline,” said Dr. Bryan. Parnell readily agreed. “There are no awards or accolades that could adequately ex-press my gratitude and how I feel about them. They really, truly saved my life.”

* Name changed to protect the patient’s privacy

Reprinted from Connections newsletter, August 2008

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