Obstacles to successful care of HIV are common for HIV patients. Actively exploring these obstacles, and formulating strategies for navigating them, is an important prelude to treatment initiation.

CYNTHIA RIVERA, MD: So in my experience and in clinical practice, we focus on things like CD4 counts and viral load, and obviously, all those clinical things that we need to assess as providers, but I’m finding that one of the most important things to really touch on and focus on are the complexities of our patients. 

Our patients have a myriad of social issues, issues with getting access to care, sometimes things happening in their lives. We need to listen to our patients. We need to sit down and actively, through verbal and nonverbal communication, really let them know that we’re their advocate, that we’re there for them, and that we are here to assess them as whole, take care of those social issues that impact their treatment as well as the disease itself. 

HIV does not occur in a vacuum. There’s multiple issues with our patients that we really need to explore and build a relationship with our patients so that they can help us help them really.

DERRICK BUTLER, MD: Once you’ve explored obviously the clinical implications with the patient, now you delve into that, the social issues and around their lives and how they live their life, and as you’re starting, you know saying are they ready to start and what their life situation is in terms of how HIV treatment is going to fit into that lifestyle. 

LEANDRO MENA, MD: One of the things that I like to do is at the end as I summarize, you know, everything. I ask my patients, well, what do you think? Do you think you’re ready to start taking this medication? And the second question that I ask them is, well, what do you think are the challenges that you may encounter you know, coming to your appointments or taking medication everyday? And sometimes they will say no none, and then I’ll take the opportunity to say, well, how about this? I mean how about relationship dynamics? I mean sometimes around a new HIV diagnosis are issues in a relationship.

DERRICK BUTLER, MD: I mean how do we make it as least disruptive for that patient in terms of finding those questions. Their living situation? Who do they live with? Do they know their status? Do they know their sexual orientation? Do they work? Is this going to interfere with somehow them keeping their jobs? What’s their transportation issue? 

LEANDRO MENA, MD: One thing that you mentioned I think is interesting is about the issue of working, right, and how difficult it can be, for example, for some people to come to an appointment because if they miss work, they miss earnings. In our clinic, we have a legal partnership, right and we make sure that our patients are aware of their rights and things about discrimination based on housing, health insurance, and employment. 

DERRICK BUTLER, MD: In my practice, too, and in also yours, I have some patients who are undocumented patients here in our country, and sometimes that has been a barrier to a few patients who are afraid that you know coming to care in the system will somehow you know jeopardize their status or they may be at risk for punishment. 

CYNTHIA RIVERA, MD: Just like patients with substance abuse who are afraid perhaps to admit to some of these behaviors because of legal ramifications. 

DERRICK BUTLER, MD: I agree. We work in communities of color for the most part, and there are some areas there’s some distrust of the medical system, and we are now that representative again as we’ve talked about, make sure that we show that we care about the patient, that we are concerned about their health, that we are trying to empower them and that we are not just another cog in a machine that they already may have some distrust for, so kind of help them to bridge that, which could be some potential barrier too. 

CYNTHIA RIVERA, MD: Our patients really teach us a lot about issues within the community. Without that trust, we are really being able to engage with our patients, we really don’t know about community-specific issues that impact not only them, but our ability to give them the best care possible.