The VA Southeastern Louisiana Health System, nine Ochsner locations, and CrescentCare were all designated Leaders in LGBTQ care by the Human Rights Campaign Foundation in 2018. They were among 418 facilities surveyed across the U.S. to receive the designation. (Photo by Ted Jackson, NOLA.com | The Times-Picayune) ORG XMIT: NOLA2015061614435814(Ted Jackson)
By Maria Clark NOLA.com | The Times-Picayune
Three New Orleans healthcare providers have been recognized as “LGBT Healthcare Equality Leaders” by the Human Rights Campaign Foundation for their commitment to provide inclusive environments for their LGBT (lesbian, gay, bi-sexual, transgender) patients and employees.
A total of seven Ochsner locations — including Ochsner Baptist, the Ochsner Medical Centers on Jefferson Highway, Kenner, North Shore and its West Bank Campus — as well as the New Orleans Veterans Administration Hospital and the CrescentCare Community Health Center were recognized in the HRC Foundation’s annual Healthcare Equality Index (HEI) released March 27.
The index scores facilities on their policies and practices aimed at creating more inclusive environments for LGBT patients, visitors and employees. This year, 626 healthcare facilities around the U.S. participated in the survey. Providers can elect to participate and are graded in the areas of LGBT patient-centered care, LGBT patient services and support, employee benefits and policies, and LGBT patient and community engagement. To earn a healthcare equality leader designation, the facility has to score a 100 in each of these categories.
The HEI was created to address health disparities and inequalities LGBT patients can sometimes experience in healthcare settings. About 52 percent of transgender patients and 9 percent of lesbian, gay and bisexual respondents said they believed they would be refused medical services because of their LGBT status, according to the index.The survey showed remarkable progress among participating facilities, including a 63 percent increase (70,000 hours) across the board in LGBT care training across all 626 hospitals surveyed over the past year.
The release of the 2018 HEI coincided with the deadline for public comments on a proposed “conscience” regulation at the U.S. Department of Health and Human Services. The proposal would protect health care providers who refuse to perform, accommodate, or assist with certain health care services based on religious or moral grounds.If approved, it would allow a provider to file a complaint under the Federal Health Care Provider Conscience Protection Statute, if they feel they have been discriminated against for objecting or refusing to participate in medical procedures — such as abortion, sterilization or sex reassignment surgeries — that go against the provider’s religious or moral beliefs.
This was the second year in a row the VA Southeast Louisiana Healthcare System was recognized by the HRC Foundation for their care for LGBT patients. They provide mental health services, pre and post-surgery care for transgender patients, and offer a transgender support group that meets every Friday, which is coordinated by a licensed clinical worker, among their services for this patient population.The clinical worker, Danielle Rosenfelv started the group about five years ago. At the time, the participants were mostly transgender women older than 50.”Now we serve just as many trans men and people as young as early as in their 20s,” she said. “We have a large population of transgender veterans, and there is a commitment by the VA to serve all of those who have served.”
In 2013, the VA issued a directive to standardize care for LGBT veterans, including creating non-discrimination policies for veterans and their families, creating guidelines for access to care for transgender and intersex veterans and increasing information and training to providers on topics related to LGBT health.
It’s estimated that over 134,000 American veterans are transgender, and over 15,000 transgender people serve in the military today, according to the National Center for Transgender Equality. Ochsner has focused on standardizing training for all employees and establishing non-discrimination policies throughout the system, explained Dr. Brandy Panunti, an endocrinologist at Ochsner who works with transgender patients.
This includes establishing the correct coding when a provider needs to order gender-specific exams (i.e. pelvic exams) so a transgender patient isn’t denied coverage because the needed exam does not match the gender listed on their documents.”How people identify may not be reflected in their legal documents or on their insurance,” Panunti said.In a 2015 U.S. Transgender Survey, transgender people reported experiencing denial of care because staff were not trained to “code” gender-specific exams. “Overall, the health system is a slow one, and we have a lot of catching up to do,” said Panunti.
Of the hospitals that did not participate in the Healthcare Equality Index but were scored based on research over the past year, 63 percent have patient non-discrimination policies including both sexual orientation and gender identity, and 53 percent have LGBT-inclusive employment non-discrimination policies. About 93 percent had equal visitation policies.
This is the third year in a row that CrescentCare received the Leader in LGBT Healthcare Equality designation. The federally qualified health center began in 1983 as the NO/AIDS Task Force, a non-profit dedicated to fighting the AIDS epidemic in New Orleans.
“Dignity for patients and employees has always been at the heart of CrescentCare’s mission, going back to our foundation as NO/AIDS Task Force,” said Augustin Correro, a spokesperson for CrescentCare.
“The steps toward inclusion and affirmation are such simple ones to take but are immensely meaningful to so many people. As an organization that wouldn’t exist without the dedication of the LGBT community, we promise to continue showing our dedication every day,” he said.
As a resident advisor at Tulane University, a former student frequently talked with his peers about the importance of getting tested frequently for sexually transmitted infections.
He went to Essence Fest last July with a group of friends and saw that a free testing site had been set up. Already used to getting tested, he decided, why not?
Perhaps it was because of his experience working as an RA and being familiar with the true ramifications of a life with HIV, that he was able to accept his HIV-positive test results calmly.
“Everyone else was freaking out. I thought, ‘Well this is inconvenient,'” said the young man, who is now 23. He asked not to be named in this article because his family does not know about his HIV status.
The day he got tested, the Tulane graduate was given medicine that could counteract the virus – and within a week, he said the virus was undetectable.
“I caught it early,” he said.
The treatment of HIV has dramatically changed and health workers, including in New Orleans, are pushing to expand access to testing sites as medication becomes more accessible and easier to take. HIV specialists say that the quicker a patient is consistently taking anti-retrovirals, the quicker they will be able to lower their viral load to the point where HIV is undetectable in their blood stream.
The Mid-City health center CrescentCare partnered with the New Orleans Office of Health Policy on an initiative to start treating newly diagnosed patients with those retroviral drugs within 72 hours of testing positive for HIV. So far, 131 patients diagnosed with HIV have been placed on rapid treatment as part of that initiative, called Rapid Start, since it launched in December 2016.
Putting HIV patients on a consistent treatment plan, early in their diagnosis, so that the virus is suppressed and unable to spread is an essential part of the fight against the HIV epidemic. Louisiana was second in the country in 2016 for the highest number of AIDS cases and third for new HIV cases, according to the Centers for Disease Control and Prevention.
“There is data that shows if your viral load is undectable you can’t transmit the virus,” said Dr. Jason Halperin an infectious disease specialist with CrescentCare. “That’s why we are trying to get patients on treatment the day of (diagnosis).”
The time between testing and treatment for newly diagnosed HIV patients has typically been 90 days to allow time for necessary lab work. But in New Orleans, where the rate of new HIV cases has consistently kept the city in the top five in the country for several years, 90 days is precious time.
The Rapid Start initiative was based on studies that have been conducted in places like San Francisco, Haiti, and South Africa that showed that immediate treatment with antiretroviral therapy leads to quicker suppression of the virus, retention in care and a decrease in the death rate, according to a study published by Halperin and his team of researchers at CrescentCare.
“It’s harder to keep people in care when there is a longer gap in treatment,” said Halperin.
Louisiana ranked No. 2 in chlamydia, gonorrhea, syphilis rates
Louisiana ranked No. 2 in chlamydia, gonorrhea, syphilis rates
The state is also ranked No. 2 for HIV diagnoses.
Patients in the Rapid Start program get set up with same-day appointments. The initial visits are streamlined so that the patient can quickly get their medication. Rapid Start covers the cost of medication for the first 30 days, while the clinic evaluates other insurance options.
Patients also get connected quickly to an HIV specialist for ongoing management, and get follow-up appointments within four weeks.
“We don’t want to lose patients, retention is very important,” Halperin said.
As of noon on March 14, the clinic has 131 patients on the Rapid Start initiative. Ten other patients had left the clinic since they got connected to Rapid Start in December 2016.
“The vast majority we have confirmed are in care in another state or local clinic,” said Halperin. “92.3 percent of our patients provided care through the initiative remain at CrescentCare.”
The STD/HIV Program for the state’s health department is battling HIV rates in Louisiana with a combination of prevention and treatment tactics. This includes marketing and making preventative medication called PrEP (pre exposure prophylactics) more available to high-risk candidates. Those include men who have sex with men; transgender women; intravenous drug users; people who engage in risky sexual behavior, such as having sex with multiple partners in a span of six months; or are with a partner who is HIV positive and not being treated effectively.
Additionally, they are looking at working with clinics to try to establish more places that provide testing and rapid treatment, according to DeAnn Gruber, the director of the program.
In Baton Rouge, the Open Health Clinic is offering same-day referrals to a medical appointment but has not yet implemented same-day treatment, according to Gruber.
In New Orleans, Dr. Sue Ellen Abdalian, a specialist in adolescent medicine, also offers test and treat for newly diagnosed HIV patients. She works out of several locations, including the Drop-In Center at Covenant House, the infectious disease clinic at University Medical Center and Tulane’s T-Cell Clinic.
Abdalian is currently conducting a study that will focus on 750 HIV-negative high-risk MSM (men who have sex with men) and transgender women between the ages of 14 and 24. The study will offer free sexually transmitted infection screenings every four months. The participants will be assigned to groups receiving a combination of support either through a peer support group, a life coach or through text messages offering health tips. In New Orleans, this age group accounted for 32 percent of all new HIV diagnoses in 2015, according to the state health department.
“We are hoping that none of them become HIV-positive,” she said. If they do, a key part of the study will be implementing rapid treatment after diagnosis.
Teens also have much more immune resiliency and she believes the study will show that, through test and treatment, patients will be likelier to remain in treatment and have suppressed viral loads to where they won’t be able to infect another person.
“We don’t want them walking out without medication in their hands if not in their mouths,” she said.
When Arthur Banks, 47, first heard a radio ad about a pill that could prevent HIV, he thought it was a scam.
When taken once a day consistently, the pill — marketed as PrEP — could prevent HIV in more than 90 percent of cases, the ad told him.
“I couldn’t believe it. I went in and found out it wasn’t a scam,” said Banks, who has now been on PrEP for the past year. “For me, it made sense. I have an active sex life and I thought, why not protect myself? You never know what your partner has done in the past.”
In a city that has consistently been in the top five in the country for the number of new HIV cases, health workers in New Orleans are pushing to expand access to PrEP, believing it’s the key to preventing the new infections that have kept the city at the epidemic’s forefront for too long.
In recent years there has been a strong marketing push for PrEP in billboard ads across the city and the state. At the state level, DeAnn Gruber, the STD/HIV Program Director for the Louisiana Department of Health and Hospitals, recently spoke about the state’s marketing efforts of the preventative medication through social media apps as well. Additionally, the department is set to launch a program called TelePrEP this spring that will allow potential candidates to talk to a provider through an online platform so that they can get a PrEP prescription remotely.
“If there is an area of the state where the individual may not be familiar with the provider, or able to find a provider who is comfortable prescribing PrEP, it may save them from having to travel,” explained Gruber.
Health workers say this multi-layered effort is necessary, especially in the South. PrEP adoption has lagged here compared to other parts of the country, even though southern states account for 30 percent of the epidemic in the U.S., according to AIDS.gov.
PrEP has been available since 2012, when the Food and Drug Administration approved use of the anti-HIV medication to lower the risk of someone getting infected with the virus. Taken on a daily basis, the medicine can reduce the risk of getting HIV from sex by more than 90 percent. Among people who inject drugs, it can reduce the risk by more than 70 percent. It works by blocking the ability of the HIV virus to attach to T-Cells.
The use of anti-retrovirals as a preventative measure against HIV is well-known within the LGBT community, to whom PrEP has been traditionally marketed. In larger markets such as New York City, where PrEP has been made more widely available since 2012, the number of new HIV cases has steadily declined in recent years. Data showed that new HIV cases declined by about 2,000 in New York City between 2012 and 2016, coinciding with the approval of PrEP and other preventative measures such as routine HIV screenings being made more available.
Efforts to match those numbers in Louisiana are hindered by several factors including poverty, access to care, poorer health outcomes, stigma, racism, homophobia and lack of sexual education. Louisiana has been in the top five states for the highest HIV rates compared to other states for a number of years. Last year, New Orleans came in second and Baton Rouge third in the U.S. for high case rates compared to other large cities, according to theCenters for Disease Control and Prevention.
Health care providers have focused on getting PrEP to high-risk groups including men who have sex with men, people engaging in high-risk sexual behavior such as condom-less sex with multiple partners, those who have a history of sexually transmitted diseases, or are having sex with a partner diagnosed with HIV who is not being effectively treated.
Bruce Hinton, a physician’s assistant with CrescentCare, adds to that list that living in a high-prevalence HIV area like New Orleans should also be considered a major risk factor.
He recalled how in one day in February three newly diagnosed patients were put on HIV medication in one day at the clinic.
“New Orleans has such a casual attitude about sex that we have seen HIV rates explode. When you have three people in one day put on HIV medication it’s an epidemic,” he said.
According to current estimates of diagnosed HIV cases in New Orleans, approximately six percent of the population living in the 70119 ZIP code where CrescentCare‘s testing site is located at 3308 Tulane Avenue are infected with HIV.
“I tell my patients if you fall under at least of the risk factors you are a candidate for PrEP. By living in New Orleans, you automatically fall under one of those risk factors,” Hinton said.
Traditional marketing of PrEP has been geared primarily towards men who have sex with other men (MSM). The use of the prevention pill has increased in the United States but health providers still have their work cut out to increase its use among minorities.
Although the number of patients on PrEP has grown to approximately 77,000 in 2016, almost 75 percent of those patients were white. Only 10 percent were African-American, and 23 percent were women, according to data provided by the drug manufacturer Gilead.
That’s despite the fact that minorities are seeing soaring rates of HIV diagnoses: A 2016 CDC report noted that if current HIV diagnoses rates persist, about one in two black men who have sex with men and one in four Latino MSM will be diagnosed with HIV during their lifetime.
“We need to make sure that the people on PrEP mirror the people most at risk of being infected,” Hinton said.
In New Orleans this includes even individuals who wouldn’t traditionally be considered high risk, such as heterosexual women.
“Women represent about 25 percent of the HIV epidemic, with African-American women being disproportionately affected,” explained Catrina Coleman, a health educator and one of the people leading outreach efforts about PrEP for CrescentCare in New Orleans. “This is the only HIV prevention that is completely in control of the woman. If I could stand outside handing out information about PrEP all day I would.”
Her main marketing tool is word of mouth. She has visited beauty salons to talk to stylists about it in the hopes they will spread the word to their clients.
The reaction from the women has been a combination of shock and dismay.
“They tell me, “Why weren’t we informed? Why wasn’t this communicated to us before?” she described.
Yet another barrier to HIV prevention is the primary care doctor who is uninformed about PrEP and what it can do, according to Dr. Stacy Greene, the associate medical director and infectious disease specialist with St. Thomas Community Health Clinic.
Patients who might benefit from PrEP are not likely seeing infectious disease specialists, he explained.
“Primary care providers are the first point of contact with this patient population, but they aren’t having these conversations. There is so much fear surrounding HIV, people are afraid to go to the doctor and ask about PrEP,” Greene said. “They need to start breaking down these doubts.”
He estimates that about 33 percent of primary care providers are not knowledgeable about PrEP. There are also providers who know about the medication but aren’t comfortable prescribing it because they feel like it is out of their scope of practice to prescribe it, he added.
The clinic held a PrEP symposium in New Orleans in March for primary care providers across the state to discuss the HIV epidemic and prevention efforts geared to primary care providers.
“If more family physicians and other primary care providers feel comfortable prescribing PrEP, this strategy for reducing HIV pervasiveness may reach more people who are vulnerable to infection,” Greene said.
For another patient who is prescribed PrEP through CrescentCare, the pill has meant consistent access to healthcare, because patients have to be screened for STI’s four times a year to be on PrEP. The 29-year-old woman chose not to be identified for this article because she has not spoken to her family about her work in the sex industry over the past four and a half years.
“Sex isn’t this thing where I have to worry about hurting myself,” she said. “I think I have a much healthier capacity for being sexually active. I still use condoms, I have sexual health conversations, I am still careful and guarding my health. This is something where I feel I have a safety net.”
With the help of his local health department in New Orleans, Jason Halperin, MD, and colleagues are starting patients on ART within 72 hours of their HIV diagnosis — most of them within 24 hours. A recent study showed that the intervention cut the median time to viral suppression by more than half, and he believes its success can be replicated in other clinics around the country.
“I want to demonstrate to people that this can be done in the resource-poor areas of this country, like the South,” Halperin told Infectious Disease News.
“We really are on the frontlines of the HIV epidemic in the United States,” Halperin said.
Halperin oversees HIV services at CrescentCare, federally qualified health center that runs a large pre-exposure prophylaxis clinic in the city with almost 900 active patients. They conduct approximately 10,000 HIV tests in the community each year. The disease predominantly affects young black men who have sex with men, and the core of their work is committed to this population, he said.
Before the intervention, patients with an HIV diagnosis had to wait 4 to 5 weeks before starting ART, which Halperin suggested is “better than average,” but the lapse still increases the risk for HIV transmission. There are several reasons for the delay, he said. First, it can take up to 2 weeks or more to sort out patients’ insurance, which is often provided through the Ryan White HIV/AIDS program. Second, providers frequently choose to postpone treatment until they know the status of their kidney and liver functions and their CD4 cell counts. HIV drug-resistance testing is also recommended for patients with HIV before selecting an ART regimen, tacking on even more time. Finally, the price of the medication and whether payers will even cover the expense is yet another challenge.
“I really had to lay out all these barriers to start dismantling them,” Halperin said.
With the expansion of Medicaid in Louisiana in 2016 — “a gift from the heavens,” according to Halperin — the clinic could enroll patients in Medicaid services on the same day as their HIV diagnosis. In December of that year, they started a test-and-start strategy called the CrescentCare Start Initiative (CCSI), which links newly diagnosed patients with a treating provider and starts them on ART within 72 hours, ideally within 24. But first, they needed help from the city’s health department.
“So, I got in touch with the Office of Public Health (OPH), and I said, ‘This is our plan: I guarantee that we are going to have a higher rate of linkage and an impact on our time to viral suppression and hopefully 2-year data that show retention and sustained viral repression,’” Halperin said. “‘What I need from you is that when I fax you the form for Ryan White services, you fax it back within an hour. I don’t care how you figure it out, but if you can do it, I can see these patients [within 24 hours].’”
CrescentCare proposed to use Ryan White funds to cover the first 30 days of patients’ medication, giving them 4 weeks to figure out how to refill the prescriptions. The OPH agreed.
“So now, within an hour of a diagnosis I can get patients Ryan White services,” he said. “I can get them signed up for Medicaid if they meet criteria, and 4 weeks of medication are provided.”
Halperin argued that knowing the genotype was unnecessary before starting patients on ART because evidence suggests there is a low risk for resistance to the integrase inhibitor Tivicay (dolutegravir, ViiV Healthcare), which is used in combination with Descovy (tenofovir alafenamide/emtricitabine, Gilead Sciences). In addition, if lab work comes back within 24 hours and indicates that a patient has kidney damage, they can be switched to a new regimen.
In 2016 the state was only second to Georgia for the highest number of new HIV diagnoses. The rate of new cases was 29.7 per 100,000, according to the Centers for Disease Control. One out of five people do not know they are infected in Louisiana.
If current HIV diagnoses persist, one in two black men who have sex with men (MSM) and one in four latino MSM will contract HIV in their lifetime, according to CDC data.
Although highly treatable, the virus which attacks the immune system as it progresses into Auto Immune Deficiency Syndrome (AIDS), can also be prevented.
First approved in 2012 a medication called PrEP or pre-exposure prophylaxis, has been marketed to patients who are at substantial risk of HIV infection. The medication has shown to reduce the risk of HIV transmission by up to 92 percent, according to the CDC. PrEP has also been marketed in New Orleans, but health workers have found several barriers that have made it difficult to access high-risk patients locally.
“There is still so much stigma surrounding HIV in general. Patients feel ashamed to come to their doctor to ask for PrEp. Some people feel that they can’t afford it,” said Dr. Stacy Greene, the Associate Medical Director at St. Thomas Community Health Center. He is also an infectious disease expert.
St. Thomas Community Health Center and CrescentCare are two of the largest providers that can prescribe PrEP in New Orleans.
This weekend, St. Thomas Community Health Center along with the Bureau of Infectious Diseases for the Louisiana Department of Health will host a two-day symposium for primary care givers and health workers on the subject of PrEP and the HIV epidemic in Louisiana, offering information about the high-risk populations in Louisiana that would benefit from the medicine, how they can cover the cost of the prescription, and how to implement an HIV prevention plan.
The event is open to primary care physicians, health workers and individuals interested in learning more about the HIV/AIDS epidemic in Louisiana and will take place at the Hilton Riverside in New Orleans on Fri. March 2 to Sat. March 3 at 8 a.m. A link to the agenda is available here.
“Despite low awareness, primary care providers are already writing more prescriptions for PrEP than are specialists. If more family physicians and other primary care providers feel comfortable prescribing PrEP this strategy for reducing HIV pervasiveness may reach more people who are vulnerable to infection,” said Dr. Greene.
Maria Clark covers healthcare and immigration for NOLA.com | The Times Picayune and NOLA Mundo. Reach her at email@example.com or 504.258.5306.
CrescentCare’s new comprehensive health center at 1631 Elysian Fields Ave. will combine four of its current service sites in New Orleans and add space for expanded dental, primary health and behavioral health services. The facility is expected to open in early 2019.
The 65,000 sq. ft. facility includes 32 examination rooms, another eight for dental services as well as space for behavioral health therapy and psychiatric services.
NEW ORLEANS, LA (WVUE) – Hundreds of New Orleans’s homeless will be getting a home this holiday season. Local organizations banded together to rescue families in need and the disabled from the streets.
Nettie Clancy has been living under the Claiborne bridge with her dog for more than a year.
“I have Lupus plus depression so you know, it’s tough and there’s no where you can go. To the shelters, but I have a dog and so you can’t take the dog and that’s all I have. He’s my baby,” said Clancy.
She’ll tell you horror stories of what it was like being a disabled woman with no where to go.
“I’m by myself, got so many men trying to pay you for sex, drugs, people overdosing and dying – and rough, very rough,” said Clancy.
Now, she and her best friend will have a roof over their heads just in time for the holidays.
“It’s amazing, it’s like God is so good, so good,” said Clancy.
UNITY of Greater New Orleans, with the help of 60 other local organizations, were able to rescue Clancy and others from the streets. Over the past 80 days, the group says it’s moved 56 homeless families out of emergency shelter, and 182 disabled homeless neighbors into permanent housing. Their campaign is called “200 Homes for the Holidays,” but this year, they were able to give more than 238 people a home for Christmas. The group says it’s been their most successful campaign ever to house the homeless.
“It’s a miracle that so many people who have suffered for so long – children, chronically homeless individuals with disabilities – all got housed for the holidays. Now, they’ll have a safe, warm home after years on the streets,” said UNITY of Greater New Orleans Executive Directo, Martha Kegel.
Clancy will receive rent assistance and a case manager who will help her become self-sufficient.
“I connect them with resources within their community, cause I’m the one that’s finding them the house. In finding the house for them, the home rather, I’m familiar with the city and things like that, I may say there’s a food bank there or a grocery store here,” said CrescentCare Housing Specialist Keishone Sylvester.
Clancy says she and her dog couldn’t be more grateful to finally have a place to call their own.
“It’s going to be quiet, and there’s not going to be no fights, and there’s not going to be no drugs, and Jesus thank you – just amazing,” said Clancy.
UNITY of Greater New Orleans says their work isn’t done yet. The coalition plans to help even more homeless families find a permanent place to live for the New Year. That’s something the group says is critically important when you consider a recent count found 62 homeless people died on the streets of New Orleans this year.
UNITY says Entergy provided a lot of the funding to make 200 Homes for the Holidays, happen.
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By Fritz Esker Contributing Writer New Orleans added one more address to its growing list of clinics during last week’s National Health Center Week. On August 15, CrescentCare broke ground on a new health center at 1631 Elysian Fields Ave. The new facility, which will be near the corner of Elysian Fields Ave.