Local AIDS patients need more help

Sean McIntosh and Dillard Larson are right: I have failed as head of the AIDS Treatment Center in Fort Myers. "…He has become increasingly insignificant," they wrote in a guest opinion last week, adding a host of reasons that missed the point.

Here's the point: I have failed because I'm not insignificant enough. On the day I see the number of patients who visit the ATC drop from the current 650 to a mere trickle, I will have succeeded by becoming almost totally irrelevant.

Meanwhile, McIntosh and Larson both left my clinic near the beginning of 2005 under circumstances I won't detail, because I am not in the business of smearing.

Apparently, they became students of national politics in its most tarnished form. Their exercise in editorial commentary about me is a classic example of "Swift-Boating."

Only weeks after they left, we received a critical audit from the Health Resource Service Administration. It said we needed to be better organized, and to have a better longterm plan, which we created.

Recently we received a grade of 87 - a high score for this kind of thing - in a grant review from HRSA, and the promise of $270,000 in annual federal monies for the center. (We have to raise a great deal more on our own, in order to continue treating patients fully and properly. I no longer accept any salary for my work, as part of that effort.)

That's a vote of huge confidence. We won the grant in competition with the other clinic in town. That suggests that HRSA regulators know a good clinic when they see one, and they can also recognize disgruntled employees when they see them.

As a specialist in infectious diseases focused on H.I.V./AIDS, I do not offer primary care myself (nor do I do neurosurgery, or psychiatry, for example). We have two nurse practitioners who offer primary care at the ATC: many pap smears, EKGs, laboratory testing for venereal and other sexually transmitted diseases, significant vaccinations, and the quality measures required for thorough primary care.

So, the nastiness and ungratefulness of McIntosh and Larson are beside the point.

What we aren't seeing from officials - from Dr. Judy Hartner who heads Lee County's Health Department, or from the state bureau of H.I.V./AIDS - is any idea of where we're at now or where we're going. Nor have they offered even a modicum of leadership aimed at organizing patient-friendly services here.

There is no plan to define and drop barriers to care. They have no AIDS map. They don't know where the patients are by zip code, so they've located services where patients are not. Patients must travel here, or there or elsewhere for different aspects of treatment, and often they have bad unreliable transportation or they're illiterate. Patients must jump through a number of hoops before they can even begin directed treatment for H.I.V./AIDS.

We could not have designed this system more antagonistically if we'd tried; it's the work of mediocre and uncaring bureaucrats.

Treatment designed for patients rather than Dr. Hartner's political bailiwick would offer one clinic in the county: one place where social workers and administrators were sited, one place that has negative pressure air so we do not spread tuberculosis (if a patient coughs, the germs do not leave a room with negative pressure air.)

What else can these public officials do that's different? We have within our grasp the ability to document and record adherence to medicines on a real-time basis. If patients comply, they can stay well.

Since 1994, we have done no form of outreach or prevention. (Asked the following year why the mortality rate from AIDS had risen 155 percent, Dr. Hartner commented blithely that death rates go up and down. She did nothing to investigate the reasons.)

We should resume testing in the schools. We could have H.I.V. testing in sites that are not traditional, such as driver's license bureaus, or the emergency rooms of all publicly funded primary care facilities.

None of this is radical; it's the recommendation of the National Centers for Disease Control. And yet we hear nothing from county or state health officials.

Right now, we have two H.I.V./ AIDS clinics, and an irresponsible health department. County and state officials have a lot to answer for. ¦

- Dr. Robert Schwartz is head of

the non-profit AIDS Treatment Center

on Central Avenue in Fort Myers.

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