By Catherine Cuellar, KERA Reporter
http://stream.publicbroadcasting.net/production/mp3/kera/local-kera-614028.mp3
Dallas, TX –
Host: Texas has the largest HIV population in the country. But we also have the lowest reimbursement for Medicaid. Experts say that's part of the reason only a small number of doctors are willing to treat AIDS patients. KERA's Catherine Cuellar has more on what some patients go through to get treatment, especially if they live in rural areas.
Cuellar: Scott Smith of San Angelo, Texas, has had full-blown AIDS for 14 years. He drives about four and a half hours to Dallas to see a doctor.
Smith: This is a one-month check-up
Doctor's assistant: And medication-wise, this is your list right here?
Smith: [laughs] yes, that's it it's a whole page
Assistant: He'll be with you in a few minutes.
Cuellar: Smith's had some close calls in his lengthy battle with AIDS.
Scott Smith, AIDS patient: I went home in January to my mother's home in West Texas to hospice with a two day prognosis, and here I sit. Ha ha. I bounce like a bad check.
Cuellar: Years ago, Smith's family rented office and clinic space to a young doctor, Jaime Vasquez, who now treats AIDS patients in the Oak Lawn neighborhood of Dallas. When doctors in West Texas and Austin gave up on him, Smith's family connections helped him get care here, even though Vasquez isn't accepting other new patients.
Smith: There really were no doctors with enough specialty knowledge to see me any further in West Texas. Very few of them would admit to turning me away, but they claim "we simply don't know." There were a few doctors who made great attempts in San Angelo, but without the knowledge of the long-term effects, which really very few doctors have. And most are developing at the same time I'm developing this knowledge at this point. There are a great many of us well into unchartered territory because we're still here 15, 17, 20 years down the line.
Cuellar: It's estimated that only 1% of doctors nationwide treat HIV and AIDS. Patients are usually poor, uninsured, and time-consuming to manage. Dr. Keith Rawlings, medical director for AIDS Arms in Dallas, says these are just a few of the reasons doctors don't treat HIV.
Keith Rawlings, AIDS Arms: I see young people who are interested in going into medical school who are very passionate, very committed to go into caring for populations like this diverting into other areas because they are coming out of school with a significant degree of indebtedness because of the cost of education, and taking care of a poor population 317 is not the best way to pay loans. And I also see individuals who have maintained the commitment to HIV work not going into domestic but the international arena. It is actually easier now on some levels to get a graduate, a new resident, a new fellow in infectious diseases or other disciplines to go to Botswana than it is to get them to go to Birmingham.
Cuellar: So healthcare systems treating people with HIV and AIDS are facing a crisis. Especially in Texas, which has the fourth-largest positive population in the country. For 15 years Glen Moreland has been a case manager for HIV and AIDS patients from the three rural counties surrounding Sherman.
Glen Moreland, Your Health Clinic: In '93 we had 40 cases. Now we have over 100.
Cuellar: Sherman has fewer than 40,000 residents. But Moreland considers the clinic where he works unusual because they have more than one doctor.
Moreland: We're very lucky to have doctors because they've been long-term long-based here. As far as medical care goes, our patients in these areas 208 find no greater treatment than what they're receiving here.
Cuellar: But since 90% of HIV and AIDS patients live in metropolitan areas, Moreland says it's tough to convince local officials and private donors there's a problem they must pay to address.
Moreland: What our area lacks, we don't get a lot of funding to help with the uninsured, the underinsured. If anything's missing, we need people helping us, funding us, getting funding because it's very important. If the community could pitch in and help more, that would be important.
Cuellar: According to the Centers for Disease Control, 40% of patients with HIV and AIDS live in the south, and almost half of new cases are here - from Texas to Florida to Virginia. With few treatment centers outside major cities, doctors need new incentives to treat AIDS. Without a change, patients like Smith may die before they get the care then need.
Vasquez: So how are you?
Smith: I'm OK
Vasquez: How's this cocktail?
Catherine Cuellar, KERA news.