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“Now I’m 34 years old.
My English is a little better. But not so good that I can
work the front counter at McDonald’s. So my job is
at a cooking station. My three boys are in Wichita with me.
My youngest son was with me that day at the clinic.
“I hadn’t been feeling
good for a while. And finally I couldn’t stand it anymore,
so I went to the only place I knew to go. No one there spoke
Spanish so my 13-year-old son did the translating. They had
him tell me that they wanted to do an HIV test. And then when
the results were back, they had him tell me that I was HIV-positive.”
Her first thought, says the young,
HIV-positive mother who is telling her story, was that she
had contracted HIV from her husband. “I told him,”
she says, as she begins to cry, “and he felt bad. He
talked to our sons and asked them to support me. But he told
us not to tell anybody else.”
The woman relaxes as Beth Tackitt,
a bilingual case manager at the clinic, reaches over to take
her hand. “We realized that we needed a Spanish-speaking
support group,” says Tackitt. “If a woman is White
and speaks English, I can find her a therapist. But out here,
if you don’t speak English, there’s not much available.”
A Spanish-speaking support group has
been up and running for 2 years now. And it’s not just
women who come. Men come, too.
“My husband comes with me now,”
the young mother says, tears streaming down her face. “For
the first time ever, he apologized in front of everyone for
how he’s treated me,” she cries. “I can
forgive him, but never forget. I have marks on my body. I
can’t yell at him about how I feel because the kids
will hear. But I want to tell him. He thinks I was poked by
a needle. He doesn’t know that I got HIV from his brother,
who raped me.”
Amber Waves
“We can break down how we’re
finding new patients into thirds,” says Dr. Donna
Sweet, who is the woman’s primary care provider and
the founder of what is now the HIV Clinic of the University
of Kansas School of Medicine/Wichita Medical Practice
Association (UKSM-W MPA). “We find about one-third
through counseling and testing, about one-third from referrals
from other providers, and about one-third who come into
the clinic sick, but they don’t know what they have.
I diagnosed two boys who are high school seniors last week.”
Sweet seems to have lost none of her
energy since she saw her first patient almost 24 years ago.
“His name was Kevin,” she remembers. “It
was 1982, and he had come home to die.” As the doctor
recounts how her practice started, it’s clear that the
drive to take care of a woman who was raped by her brother-in-law,
two newly diagnosed 17-year-old boys still in high school,
and people in small towns all over Kansas, has been constant.
“Kevin shouldn’t have
been here,” she says matter of factly, and adds, “I
shouldn’t have been there either, in a way. I grew up
happy, but poor . . . never lived with indoor plumbing until
I went to college,” she explains. “And college
was only possible because of a full scholarship.
“I had studied immunology, so
I knew more than almost anyone else around how to treat Kevin.
But we had so little to offer—and that’s the part
I still think about—that, and how people with AIDS are
treated. I think about the call made by Kevin’s parents’
minister a few days after he moved home. ‘You and your
husband can come back to church when you want,’ he said
to Kevin’s mom, ‘but don’t bring your son.’”
Country Roads
Garden City, Kansas, is a town of
30,000 in the western part of the State, where thousands
of workers have migrated over the past several decades to
work in the city’s meatpacking plants and feedlots.
In 1988 Sweet drove to the town to hold her first HIV/AIDS
clinic. It’s about a three-and-a-half hour trip from
Wichita, a time-consuming journey for a busy clinician.
“Patients were being identified
as HIV-positive primarily in the local emergency rooms,”
Sweet explains, “and then they were referred to us because
no one wanted to take care of them. But they were poor. They
couldn’t take off work. They could tell no one what
was wrong. There was just no way most of them could get across
the State for a primary care appointment.”
The solution for getting AIDS care
to this rural part of Kansas was a partnership devised by
Sweet and the federally qualified United Methodist Mexican
American Ministries Health Center in Garden City. “The
agreement,” she explains, “was that the health
center would provide the space, and we would provide the clinical
staff.”
It is a relationship that has been
working since 1988—and one that the University of
Kansas has replicated in the small town of Salina and the
town of Pittsburg near the Missouri-Kansas border. Small
towns like these, wherever they exist, are hubs for rural
areas that surround them. People go there to shop, or to
see a movie. And now they can go there for AIDS care.
Random Harvest
The UKSM-W MPA HIV Clinic is the only
HIV primary care provider in Kansas outside of Kansas City.
The clinic has 850 clients—and counting.
It’s not news that HIV/AIDS
prevalence is growing in the United States, nor that it is
growing in what 15 years ago seemed like unlikely places—the
South, medium-sized cities, and rural areas. Yet, somehow
it is still a surprise, even to people who follow the epidemiology
of the epidemic, that it can be found in America’s heartland.
“In the first 3 months of 2006, we saw 30 new patients.
And AIDS isn’t just in Wichita,” says Sweet. “It’s
all over the State.”
The UKSM-W MPA HIV clinic, like so
many CARE Act-funded providers, is proof of the adage “Build
it and they will come.” To be exact, 30 new patients
per quarter arrive. Patients like the mother of three boys
who doesn’t want us to know her name. Like two high
school seniors who never thought it would happen to them.
Patients like Kevin, who, 24 years ago came home to die, and
because of people like Dr. Donna Sweet, did so with dignity
and grace.
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