Written by Marybeth Kotrodimos
Featured photo: Dr. Bruce Shiramizu; Dr. Cecilia Shikuma; Dr. Dominic Chow, researchers at the Hawaii Center for AIDS.\u00a0Vina Cristobal photo. <\/p>\n\n\n\n
In recognition of December as HIV\/AIDS Awareness Month, we asked Cecilia Shikuma, MD, Director of the Hawaii Center for AIDS (HICFA); Dominic Chow, MD, PhD, MPH, Director of the Clint Spencer Clinic and Investigator for HICFA; and Maya Barney, BSN, RN, Clinic Manager of the Clint Spencer Clinic if they would take time from their very busy schedules to talk with us about the work they do, the progress Hawaii has made in combating HIV, and how HIV relates to the Coronavirus pandemic.<\/p>\n\n\n\n
HICFA \u2013 formerly known as The Hawaii AIDS Clinical Research Program (HACRP) – is comprised of The Hawaii AIDS Clinical Trial Unit (HACTU), several specialized laboratories; international collaborations in Vietnam, Thailand, and the Philippines; and University Health Partners\u2019 (UHP) Clint Spencer Clinic, which services about 650 patients, including about 250 on Maui and The Big Island.\u00a0 The contribution these researchers and clinicians have made to the control of HIV and AIDS in Hawaii is immeasurable.<\/p>\n\n\n\n
Dr. Shikuma recounted how the Clint Spencer Clinic began by providing medical care to HIV patients participating in the early HIV medication trials held by the AIDS Clinical Trials Group which was a part of HICFA. When they completed their trials the patients were given a list of outside physicians to treat them. \u201cBut the patients would never leave,\u201d she said. \u201cWe therefore continued to provide their medical care, and this dedicated group of individuals living with HIV formed the core of our research participants who made our research program a success.\u201d Over time, she said, there were more and more patients doing that. \u201cThen, fortunately, we got Dr. Chow who was willing to turn this into a real clinical operation to provide primary and specialty care.\u201d<\/p>\n\n\n\n
\u201cThis was the late 80\u2019s and early 90\u2019s,\u201d Dr. Chow said. \u201cTo be fair, a lot of our patients did not feel welcome at many physicians\u2019 offices and clinics, so they struggled to get care elsewhere. Clinical trials were their main source of treatment when nothing else was available.\u201d<\/p>\n\n\n\n
\u201cGood HIV medications were not available until 1996,\u201d Dr. Shikuma explained. \u201cHIV care is very specialized, and a lot of doctors just didn\u2019t have the training to treat these patients.\u201d<\/p>\n\n\n\n
\u201cThere were meds,\u201d Mrs. Barney said. \u201cThey just weren\u2019t that great.\u201d<\/p>\n\n\n\n
Addressing the goal of Hawaii to Zero<\/em> (Zero new HIV transmissions, zero deaths from HIV, and zero stigma toward those living with HIV), Dr. Shikuma said, \u201cRegarding deaths, I think we are very close. No one with HIV should be dying of HIV related infections. While there are some added medical challenges, individuals living with well controlled HIV can now expect to live as long as their HIV-negative peers.<\/p>\n\n\n\n \u201cI think the major research goal is currently to cure HIV,\u201d she said, adding that this is a difficult thing to achieve since the virus works its way into the human chromosome. \u201cSo essentially, it becomes part of you, and to yank that little piece of genetic viral material out \u2013 it\u2019s very difficult and very challenging.\u201d<\/p>\n\n\n\n She said that Dr. Chow and Mrs. Barney are very focused on preventing new infection by following the procedures and guidelines for PrEP (or Pre-exposure Prophylaxis), a prevention method used by people who are at high risk from getting HIV infection. Dr. Chow added that they are very lucky to have Dr. Elizabeth Kiefer, another member of the HIFCA\/UHP faculty, with her expertise with PrEP. About 60 to 80 of the people who receive services from the clinic are PrEP patients.<\/p>\n\n\n\n Hawaii has been recognized for being highly successful in its struggle to control HIV, and the work of the people in the Clint Spencer Clinic and HICFA has been recognized as being very instrumental in achieving that success. But Dr. Shikuma is quick to credit others and other factors for our state reaching such low numbers of transmission and death due to HIV-related causes.<\/p>\n\n\n\n \u201cWe have a very close-knit community with fantastic AIDS service organizations and a very responsive Department of Health (DOH).\u00a0 I think the State has done very well,\u201d she said. \u201cThere are a lot of resources available in Hawaii to individuals living with HIV.<\/p>\n\n\n\n \u201cIf you have no medical insurance, for example, the State will provide you with medication free of charge and will also provide physicians and medical clinics with blood tests on everything that is needed to provide good medical care for that individual,\u201d Dr. Shikuma said. HIV patients \u201care very well taken care of. I\u2019m very proud of our state.\u201d<\/p>\n\n\n\n \u201cThose of us in HIV work,\u201d Dr. Chow said, \u201cwork very closely with the DOH to make sure that those people who are positive are getting appropriate medicine, and not only medicine, but also to make sure that all their needs are met. We have to make sure they have shelter, they have food, and there are social networks that can help them with taking their meds.\u201d<\/p>\n\n\n\n \u201cOur state does a really good job of collaborating between different agencies, working really closely together,\u201d Mrs. Barney added, \u201cno matter where the patient enters the system.\u201d The state is also working to make the PrEP program \u201cmore robust,\u201d she said.<\/p>\n\n\n\n She talked about how those at the clinic make the effort to \u201cnormalize\u201d the sexuality of the HIV patients they see as well as combat the stigma of HIV. She said they have \u201chard conversations\u201d with their patients, \u201cletting them know that they will support them no matter what\u201d but they need that personal information from the patients \u201cor we\u2019ll miss something.\u201d<\/p>\n\n\n\n As for the impact that the coronavirus pandemic has had on the HIV community, Dr. Chow reported that \u201cthe rate of COVID among people with HIV is lower. We\u2019re not sure if it\u2019s because of the antiviral medications that they have already taken, or if it\u2019s because people with HIV tend to be less reckless in their social networks. For our patients, the rates are lower, thankfully.\u201d<\/p>\n\n\n\n Dr. Chow also said that we have learned much about how to handle the coronavirus from our experience with HIV. \u201cHow to treat and manage COVID is actually very similar.\u201d In dealing with other disorders, he said, we \u201chave learned a lot from HIV in terms of the networks that were formed. AIDS Service Organizations that cropped up in the 80s and 90s are models for how to deliver care to the rest of the world. A lot of what we learned from HIV is what we are currently using in managing the second pandemic, which is COVID.\u201d<\/p>\n\n\n\n Dr. Chow said he has felt \u201creally affected by that first pandemic\u201d since he was in high school, and that experience drove his desire to work on HIV. As part of the University of Hawaii, he said, \u201cwe are researchers trying find a cure for HIV.\u201d \u00a0Also he is driven to fight this disease because \u201cthe patients are really committed. I can\u2019t think of another disorder for which patients would come into our clinic to willingly take experimental medications or to do diagnostic laboratory tests to further science.\u201d<\/p>\n\n\n\n Dr. Shikuma said that she loves her work with HICFA. \u201cIt\u2019s really challenging.\u00a0 I like that what we do really contributes to enhancing the medical care of a community of people that probably would be underserved in Hawaii.\u201d<\/p>\n\n\n\n Mrs. Barney said that one of the things that drives her to work in HIV is that an uncle, who she was very close to, lost his life to this disease when she was 8 years old. \u201cI was very aware of him and of his diagnosis. When he died it was incredibly devastating,\u201d she said. She called her work at the Clint Spencer Clinic, \u201cone of the most satisfying jobs I\u2019ve ever had in my life.<\/p>\n\n\n\n \u201cI love what we do here,\u201d she said, \u201cI love the impact we make on patient\u2019s lives. Building relationships with our patients and being the constant support that they know they can count on is a really nice feeling. They make an effort to get to know us. They ask me about my kids. I am just very thankful to be able to work in a community and be somebody who, hopefully, is positively contributing and making our patients lives a little bit better.\u201d<\/p>\n\n\n\n Dr. Shikuma said that she is \u201cvery grateful to our HIV community because they always stepped up and participated in research, saying, \u2018It might not benefit me, but maybe it will help someone else\u2019. They work to make all our lives better.\u201d<\/p>\n\n\n\n \u201cWhat I\u2019ve seen is hope,\u201d Dr. Chow said. \u201cWhen I was in high school, we really didn\u2019t see an end in sight, kind of what we see with COVID. But with hope, and with the commitment of the patients, HIV is no longer a death sentence. It\u2019s a disease that can be managed. I\u2019m hopeful that we can find a cure soon.\u201d<\/p>\n\n\n\n \u201cIf you have a diagnosis of HIV,\u201d Mrs. Barney said, \u201cI urge you to think of this as a chronic medical condition and just take care of it. The diagnosis doesn\u2019t define you as a person. It is just something you need to address. And if you need PrEP, there are so many resources available. Please make sure you are taking care of yourself and protecting yourself, so that we can work toward that goal of getting Hawaii to Zero.\u201d<\/p>\n\n\n\n \u201cTogether,\u201d Dr. Chow added, \u201cwe can all get to zero.\u201d<\/p>\n\n\n\n For more information on how to get help or to prevent HIV, contact the Clint Spencer Clinic at 808-692-1310.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":" December 22, 2020 — The Hawaii Center for AIDS (HICFA) discuss how those with HIV have been affected during the pandemic. <\/p>\n","protected":false},"author":14,"featured_media":14260,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"nf_dc_page":"","_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[1],"tags":[41],"class_list":["post-14201","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized","tag-department-of-internal-medicine"],"jetpack_featured_media_url":"https:\/\/i0.wp.com\/uhphawaii.org\/wp-content\/uploads\/2020\/12\/44098595820_359b2040d4_4k-scaled.jpg?fit=2560%2C1762&ssl=1","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/uhphawaii.org\/index.php\/wp-json\/wp\/v2\/posts\/14201","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/uhphawaii.org\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/uhphawaii.org\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/uhphawaii.org\/index.php\/wp-json\/wp\/v2\/users\/14"}],"replies":[{"embeddable":true,"href":"https:\/\/uhphawaii.org\/index.php\/wp-json\/wp\/v2\/comments?post=14201"}],"version-history":[{"count":2,"href":"https:\/\/uhphawaii.org\/index.php\/wp-json\/wp\/v2\/posts\/14201\/revisions"}],"predecessor-version":[{"id":14262,"href":"https:\/\/uhphawaii.org\/index.php\/wp-json\/wp\/v2\/posts\/14201\/revisions\/14262"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/uhphawaii.org\/index.php\/wp-json\/wp\/v2\/media\/14260"}],"wp:attachment":[{"href":"https:\/\/uhphawaii.org\/index.php\/wp-json\/wp\/v2\/media?parent=14201"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/uhphawaii.org\/index.php\/wp-json\/wp\/v2\/categories?post=14201"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/uhphawaii.org\/index.php\/wp-json\/wp\/v2\/tags?post=14201"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}