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Home / Health / Homeless people with HIV: A place to heal becomes a matter of life or death

Homeless people with HIV: A place to heal becomes a matter of life or death



This is the second part of a two-part series on rising HIV among homeless people. The first part looks at how public and private health systems need to adapt after being prepared unprepared for the challenges of this outbreak.

James Macht was in the emergency room five or six times in the summer and wasted. The 6-foot-2 man, who was lanky on his best day, continued to fall until he reached a weight of 115 pounds. He suffered from a poor diet and uncontrollable diarrhea caused by his HIV.

On August 1

4, the OHSU hospital eventually admitted him to a fungal infection on his arm, bronchitis, and norovirus, which he suspected had occurred in Portland's overcrowded homeless shelters.

T cell count, an indicator of the strength of the immune system, was in the single-digit range. A healthy number is 400 or higher.

Power is one of the thousands of homeless people across the country who have recently seen an increase in HIV cases. The area around Portland is one of the areas most affected by this new form of HIV transmission, which is rapidly increasing among intravenous drug users and their sexual partners . In Multnomah County, 71 people were diagnosed with HIV this year, almost doubling the number of HIV infections reported in 2016 and 2017.

The outbreak will be more and more difficult to stem as people like power are struggling to find the stable shelter they need to effectively treat their HIV infection.

In Portland, social workers and health care providers quickly face the challenges of finding homeless people and helping them get medicines. It is a race against time to prevent the spread of the virus and keep the infected alive.

Homeless people like power, however, may not be able to take a daily pill if every day is a survival attempt.

That's what power haunted OHSU during its three months as it slowly increased until it reached 150 pounds. He knew that decades of untreated HIV had so badly damaged his immune system that a lack of good food and hygiene and exposure to the wet winter in the Pacific Northwest would probably lead to an emergency room or worse.

But his options were grim: he could enter a nursing home at the age of 41, hope for a permanent home, or be thrown out on the street.

"I know I can not stay here forever," he said as he tried to balance his fifth cup of coffee for the day with trembling hands. "I do not know what to do when I leave the hospital, man, I will not survive another winter out there."

HIV led to the streets

HIV was taking over from an ex-girlfriend

At this time, she was not aware that she had HIV – he is not even sure she had HIV, and when he tracked her down after her diagnosis, she was already dead. [19659015Powerwhosayshenevertookanyintravenousdrugswasconfusedwhenhefelttiredallthetimehewouldsleepthrough10hoursjusttowakeupexhaustedhewasgettingrespiratoryinfectionsandotherinfectionshethoughtitwassomethingIncidentallyhecontinuedtoworkasatravelingsalesmanandatthetimeofhisfourthhospitalvisittoTexaswasinformysterioussymptomsthathelaterlearnedwasararetypeofpneumoniae

body so long that the white blood cells targeted by the virus – T cells – had fallen hundreds of points below a healthy average. Power asked his doctor what the pneumonia meant to him, but he said the doctor patted his shoulder and said, "Do not worry, you have AIDS." Then he went out.

At first, he lay for hours In bed, paralyzed with desperation, he was told he was still seven years old, but still he resumed his job, hoping to stay busy at least, knocking on doors in Portland and selling cleaning solutions when he got sick again

Power checked into the hospital and when he was released a month later, he had lost his job because he could not keep up with the schedule and he returned to a motel until his money was used up and then landed in Portland's streets.

There, power became one of the more and more homeless on the West Coast, finding HIV another barrier to access to stable housing – and the Ma The lack of stable living space, on the other hand, makes her ill.

Portland, like most places, has no special way to provide homeless services to people living with HIV. Federal studies have shown that the number of homeless people with HIV increased from more than 7% to 9% between 2015 and 2017. In the first three years of a five-year plan for health authorities across the country, a reduction to 5% was targeted. The percentage continues to grow. This is alarming because data also shows that people who have no home are less likely to see a doctor regularly and less likely to achieve good health when in treatment.

But no matter how sick and immobile Power and people in his position, they have to produce the same paperwork, show up in the same offices and stand in the same rows as everyone else who needs an apartment.

James Power meets Mary Tegger, a physician assistant at Multnomah County HIV Clinic in Downtown Portland. November 12, 2019 Beth Nakamura / staff

Hard to Stay Healthy

AIDS used to be a death sentence. However, over the decades, drugs have become so effective that the borderline between HIV and AIDS is largely a measure of the passing weight. Someone with a T cell count below 200 is considered AIDS sick.

People who regularly take medication do not stay that low for long. And if they do, they can be even healthier with a low T cell count than someone with a higher T cell count who is untreated.

Even HIV medications are easier than ever before. The standard is similar to contraception – one pill a day at the same time. And it can deliver such a high rate of effectiveness that someone can not make his virus detectable because there is so little virus in his bloodstream.

This is a tremendous improvement in the quality of life for people who feel cut off by their HIV status from friendships or relationships.

Like many people living on the street, power will never be able to handle its HIV virus like that.

Hopelessness or defiance led him to temporarily resist treatment that gave the virus the opportunity to do so. Even if he tried to take his medication consistently, it was stolen while staying in people's quarters, thinking the bottles contained opiates or other pills that could produce high levels of heat.

Prior to landing at the hospital, Macht said last His medication had been stolen four times within a few months. This can make it impossible to stay on track as most insurance plans only pay for the triple replacement of stolen drugs.

James Macht woke up feeling alone in the world, he said. The Portland resident suffering from AIDS says he has a relationship with his youngest friend. November 5, 2019 Beth Nakamura / staff

Hard Treatment Without Accommodation

Power is being treated in the publicly funded HIV clinic Multnomah County in northwest Portland. The clinic is one of several facilities that are equipped with federal funds to be innovative and do more than just meet the medical needs of patients.

Approximately 20% of the hospital's 1,400 patients are homeless or, like power, in apartments or outside apartments director Emily Borke.

When an insurance company threatens to shut down power too often for the loss of its medication, the district pharmacy is still replenishing the prescription – possibly in one or two weeks' doses instead of a full month, if that is the case. Will be stolen again to lose it less. You can also give them medicines in sodas which make it easier for some people to keep track of their pills rather than looking for the amber bottle in a backpack.

But these solutions did not work for power.

These interruptions in his prescription routine are dangerous and give his virus a chance to strengthen his body's defenses against the drug. Once the daily one-pill therapy stops working, the treatment becomes more complicated. Several tablets must be taken at the same time, which means that more tablet bottles are lost or stolen. Or in the hectic cycle of packing and unpacking your things to commute back and forth between the lines for the clinic, the shelter, and the meals, instead of the required two different pills, two pills could be taken simultaneously.

The more complicated the medication regimen, the more side effects. One of the worst situations for people on the street or in shelters is nausea and diarrhea. Without access to closed and clean toilets and showers, the side effects can be distressing and uncomfortable.

Here power has been found again. Ongoing gastrointestinal problems make it almost impossible to gain enough weight to cope with its other obstacles that make navigating a social service system even more difficult than the paperwork: legs affected by neuropathy, five teeth to eat, so bad Eyesight that makes it difficult for him to read.

The district's HIV clinic brings relief. He has a case manager who picks him up in a taxi and buys new pants or other errands with him. Two years ago, the clinic hired a full-time housing specialist to help patients find accommodation as quickly as possible and then permanent housing. She also tries to relieve the burden of a housing system that forces power to leave the hospital once a week to visit an office so he does not lose his place on the waiting lists of the apartments.

The clinic's medical staff also spends a lot of time talking about the priorities of patients, who are sometimes not medical. You have mental health issues that can interfere with taking medication. Nevertheless, the lifestyle for power is so brutal for his immune system that the clinic, when his health inevitably turns around, points to the worst reminding him to the emergency department.

On the way from his appointment at the Multnomah County HIV clinic, James went to meet a friend. James, right, was too weak to go up the stairs to find a seat after climbing a few stops to his apartment on the MAX train or knowing that a Bud Clark Commons address meant he was homeless , He said he had been turned away in recent months after several brief examinations, even though he had lost weight and was feeling infections.

His primary care provider Mary Tegger from the HIV clinic said he was probably right. It is extremely frustrating for them to send their clients to the hospitals so that they can not be better delivered the next week.

Some of Tegger's patients are able to control their HIV. But for those who are too scattered or sick or too deep in addiction or depression to take medication, they end up in a private health care system that stigmatizes homelessness and drug use, or lacks resources for receiving HIV patients.

Tegger said that power is a textbook example of why the HIV clinic prioritizes housing and other social services for its clients. His T cell count was in the double digits when he entered the OHSU hospital and would likely fall behind as soon as he was released when he returned to a mat on the floor of a shelter.

"His nutritional status is so bad, his immune system The system is so bad, it could mean the end for him, because his body has so little to fight," said Tegger. 19659049 Power left the hospital in mid-October. He spent four nights in a men's house and then moved to the Biltmore Hotel, a building managed by the nonprofit organization of the homeless administration in Central City.

Normally, power was a bit grumpy and vivid on the day he moved in optimistic about the future. First, he would get glasses. Then new prostheses. And then, he said, he might sign up for a college class. He was looking forward to the future.

But only a week later he began to lose weight again. He left the hospital at nearly £ 150, but the constant exercise of finding three healthy meals a day had worn him down. He was back at 127 and dropped.

He told his doctor that he took several medications every day, but she knows he has not always done so in the past.

Mostly power is lonely. He tells the people he meets that he feels like a red jelly bean in a bag of blue beans because of his HIV status. And as long as he is still able to infect other people, he feels too guilty and ashamed to build new romantic relationships.

This stress did not subside just because he had found a place to stay. He turned 42 last week and knows that getting back on the road would make a healthy life impossible.

"I do not care how good your diet is, how much you exercise," said Macht, sitting on his bed in an otherwise empty flat after the first night he slept there. "It's going to catch you, you have to take your medicine, it's like turning that hourglass with the sand, how big is yours, kid, you're running out of time."

"Either you're housed and take yours Medication or you are dying. "

James Power leaves his apartment in downtown Portland to go to Sisters of the Road to eat a bite to eat.The elevator of his building did not work that morning, reflecting the three flights Faced with Mobility Problems, November 5, 2019 Beth Nakamura / Staff

– Molly Harbarger

[email protected] | 503-294-5923 | @MollyHarbarger

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