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One foster mom disclosed Amy’s
HIV status to others. Sometime later, a cousin disclosed Amy’s
HIV status at school. She was taunted, and no matter what
she did, the taunting grew worse and worse, and so Amy, a
good student, became the statistic she long thought would
never apply: the 1 in 3 students in the United States who
doesn’t finish high school.
Against All Odds
A long series of unhappy experiences
with foster homes ended with a positive one. At age 14, Amy
moved in with a family who loved her and nurtured her, and
whose father gave Amy his fascination with gasoline engine
mechanics.
Amy had never been given many gifts.
But she knew almost immediately that she wanted to be a mechanic.
She knew it when at 16 years old she became an emancipated
minor and started living on her own. She knew it while finishing
her GED and while working the cash register at Dollar Tree.
And she still knows it as a student at a community college,
where she is taking her first courses in auto mechanics. She’s
at the top of her class.
Amy has other goals besides becoming
a car mechanic. She is determined to keep her virus undetectable.
One day, she says, she would like to be a mother. And she
wants to nurture her relationship with her boyfriend. “It
was hard to tell him about my HIV infection,” she says,
“so I asked a friend to help me do it. As we sat there
and the news came out, I looked up at him. He smiled and said,
‘I’m not going anywhere.’”
Hope comes in surprising places. For
Amy, it comes from under the hood of a car. It comes from
a boyfriend who didn’t run away when he was told about
her disease. And, of course, it comes from Janet Nunn.
Nunn has the poise of a fashion model
and the determination of a pit bull, yet tears well up in
her eyes when Amy is asked how she feels about having HIV/AIDS.
“HIV is a blessing for me,”
Amy says with the confidence of a young woman who knows herself.
“If I didn’t have HIV,” she adds, “I
wouldn’t be nearly as far along in my life as I am.”
Then Amy pauses for moment before adding, “Really, I
am a very blessed person.”
Nunn’s support of Amy didn’t
just happen—and Nunn isn’t alone. She is part
of an alliance that protects, nurtures, and, when necessary,
fights for HIV-positive children and adolescents living in
poverty, often suffering from neglect, and carrying histories
of abuse. To see their alliance in action is an amazing lesson
about what can happen when highly skilled, passionate people
unite for a common purpose. Twice monthly, Nunn and her colleagues
meet for case conferencing in the vast Detroit Medical Center
complex: Nunn, two doctors, nurses, patient advocates, and
representatives from local community-based organizations serving
poor and minority children and young people.
“Eighty-five percent of our
patients have viral loads of less than 1,000,” says
Dr. Ellen Moore, pediatric specialist and director of the
pediatric HIV/AIDS program, as she begins the March 2006 case
conference session. “We’re here to talk about
the 15 percent who don’t.”
Beating the Odds
Dr. Moore is one of the clinicians
who started this HIV/AIDS program for women and children
almost 25 years ago. In the next hour, she and her team
talk about the 15 percent and rebuild their strategies for
reaching them. They talk about how to reach a 17-year-old
boy who goes from foster home to foster home and whose father
has 32 children. They talk about how to find a 7-year-old
girl sent to buy crack for her mother, and about another
patient who has been in and out of congregant residences
for neglected children.
When they address the question, “Do
we really want to change this patient’s regimen, since
we are down to our last option?” Dr. Moore interrupts,
looks down the table, and says to Andrea Motley, an MST counselor,
“What about MST?”
MST, or multisystemic therapy, addresses
the multiple factors—family, peers, school, neighborhood,
and environment—that are related to a specific problem.
It has been used for patients with asthma, diabetes, and
other chronic illnesses. Here, it is used to support adherence.
The strategy calls on family members, community-based
agencies, and other concerned parties to implement what
might be described as a SWAT team approach. It’s
labor intensive, and the clinic has the resources to manage
the approach for just six or seven clients at a time. “There
is a waiting list,”
Motley replies. And Nunn wonders aloud, “Should we
move him to the top?”
A discussion ensues about people on
the waiting list and options for supporting the patient in
the meantime. In the background, the phone rings, as it often
does during the case conferencing session. When Nunn gets
up to answer it, you can see she is expecting this call. It
is from the emergency room at Detroit Medical Center. A baby
has been born to an HIV-positive mother who has never had
any health care.
Improving the Odds
Immediately, the team builds a plan
for seeing the newborn and the mother. The call is a reminder
that this clinic—which has the second-largest cohort
of long-term surviving children and adolescents with HIV/AIDS
in the country—is still seeing new clients. Some are
found by “chasing siblings” of an HIV-positive
brother or sister who is already in care. Some come into care
because they move into the area. And some come through the
hospital emergency room—like the baby who was born while
the care team was holding its March 2006 case conference.
And for all of them, this team is here, standing on the frontlines.
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