Over the years since its founding, AHF has expanded to serve a wide range of people, goals, and global issues. But it is still, at its core, an organization centered around providing care, advocacy, and support for people with HIV and other medical needs. This week, we discuss that mission and how we apply it holistically to patient care.
HIV and Primary Care
Discussing some of the core tenets of AHF
GUEST BIO:
Dr. Michael Wohlfeiler was formerly AHF’s chief medical officer for over a decade, and now serves in an advisory role with AHF and the Department of Medicine.
Dr. Carl Millner is the current chief medical officer at AHF.
Rigness Rush is director of branding for AHF.
CORE TOPICS + DETAILS:
[2:28] - What Does It Mean to be an HIV Primary Care Physician?
Going beyond treating the disease
HIV primary care physicians are primary care providers with special expertise in managing HIV. All providers at AHF must have competency in HIV medicine and primary care, because the reality is that it doesn’t make sense to only address HIV without caring for the whole patient. This is especially true considering HIV raises the risk of other co-morbid conditions, such as high cholesterol and increased risk of heart disease or diabetes. This approach truly saves and transforms lives — just as it transformed Rig’s, who came to AHF as a patient in 2014 and was so inspired by its care that they’re now a director in the organization.
[8:08] - What Makes an AHF Clinic Different?
Unique needs require unique care
AHF offers what we call “wraparound services.” It’s not just about coming in, seeing a provider, and receiving a prescription. It also includes meeting with case managers, benefits counselors, nurses, and more. And while primary care is the goal, it’s all centered around the needs of someone living with HIV. Meanwhile, every person at every clinic is there because they have a true passion for taking care of this unique patient population. AHF is a mission-driven organization, and our clinics are equally mission-driven.
[11:59] - Authenticity and Intimacy
Rigness speaks on the look and feel of AHF clinics
Rig speaks on how an individual living with HIV enters each clinic with a great deal of physical, mental, and emotional factors. That should all be taken into account with the way that patient is received and the experience they have at the clinic. He calls that approach “honest care,” which relies on a sense of authenticity which leads to better retention by engaging the person, not the problem.
[13:47] - Why AHF?
Why should a patient choose AHF when there are other organizations serving this community?
While many other organizations are doing amazing work in the HIV community, Dr. Carl shares that he feels what makes AHF different is the special level of care patients receive at our clinics. “You feel embraced from the beginning to the end of the process…Counselors are warm and receptive, the care management team is helpful.”
He also cites AHF pharmacies as one of the distinct factors that sets AHF apart.
[20:25] - Ending on Advocacy
The missing piece that ties it all together
Dr. Carl emphasizes an earlier point from Rig about another overarching mission at AHF: advocacy. Without the entire organization, and every individual in it, advocating for people with HIV and in the community, AHF’s mission is missing the glue that holds it all together. AHF events, like the We the People march in Florida on July 2nd which will take on LGBTQ rights, abortion, and other human rights violations in the state, are absolutely central to AHF’s values.
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AIDS Healthcare Foundation is the world’s largest HIV/AIDS service organization, operating in 45 countries globally. The mission? Providing cutting-edge medicine and advocacy for everyone, regardless of ability to pay.
The After Hours podcast is an official podcast of AIDS Healthcare Foundation, in which host Lauren Hogan is joined by experts in a range of fields to educate, inform, and inspire listeners on topics that go far beyond medical information to cover leadership, creativity, and success.
Learn more at: https://www.aidshealth.org
ABOUT THE HOST:
Lauren Hogan is the Associate Director of Communications for AIDS Healthcare Foundation, and has been working in a series of roles with the Foundation since 2016. She’s passionate about increasing the public visibility of AIDS, the Foundation's critical work, and how everyday people can help join the fight to make cutting-edge medicine, treatment, and support available for anyone who needs it.
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Lauren Hogan:
Get unfiltered lessons from our leaders at AHF as we uncover real raw stories of where we came from and where we are going. Join us for an unscripted look at the connections our senior leadership have to our mission core values and hot initiatives. AHF is the world's largest HIV/AIDS service organization operating in 45 countries globally, 16 states domestically, including DC and Puerto Rico. Our mission is to provide cutting-edge medicine and advocacy regardless of ability to pay.
Hello, and welcome to the After Hours podcast. I'm your host, Lauren Hogan, serving as your liaison to take you through this journey to learn more about AIDS Healthcare Foundation. Before we start the show, please make sure to remember to check out the show notes so you can follow along. Now, let's get started.
Hello everyone and welcome back to another episode of the After Hours podcast. As always, I'm your host Lauren Hogan, along with my lovely co-host...
Dr. Carl Milner:
Sean Little. Hello, hello, hello.
Lauren Hogan:
So this episode is going to be a really fun one. I'm excited for the guests that we have today. So first and foremost, please introduce yourself. Dr. Wohlfeiler, you first.
Dr. Michael Wohlfeiler:
Okay. So I'm Dr. Michael Wohlfeiler. People generally call me Wolfie. And just last month I stepped down as the chief medical officer after 10 years, and I'm now in more of an advisory role with AHF and Department of Medicine.
Lauren Hogan:
Rig.
Rigness Rush:
Hello, family, your friendly neighborhood ness. I am the director of branding. I moonlight as a sailor scout, and I'm happy here to offer some insight that hopefully will not lead into getting slain with my above and beyond points or me getting [inaudible 00:01:58] for saying something inappropriate. And shout out to Wolfie because I like wolves, but in a different capacity.
Lauren Hogan:
So based on those introductions, like I said, it's going to be a great episode, but today we're going to be talking about HIV, but also primary care and I can't think of two better people to talk about this topic. So my first question is going to be, what does it mean to be an HIV primary care physician? So Wolfie, that's obviously going to go towards you.
Dr. Michael Wohlfeiler:
Right. So what it means is that we're primary care providers but with a special expertise in managing HIV. So we're all of our providers at AHF have to have competency in HIV medicine, but also in primary care, because the reality is that it really doesn't make sense to just take care of the HIV piece and not take care of the rest of the patient, because HIV is associated with a lot of other, what we call comorbid conditions like high cholesterol and increased risk of heart disease and increased risk of diabetes, all kinds of stuff. So it doesn't really make sense to try to treat HIV in a vacuum. So we have always done, at AHF, what we refer to as HIV primary care.
Lauren Hogan:
And Rig, I want to turn it over to you so you can add any additional thoughts from your perspective, or your lens, I should say, because you've been within the HIV and AIDS realm for a long time and have had various positions. So, please.
Rigness Rush:
For those that don't know, I started out as a client. I got diagnosed in 2014, and I am what you would consider an HIV success story. So I came into this... I believe that there are two types of patients, in my personal opinion, there are refugees, and then there are what I consider prostitutes. So prostitutes are people who jump from physician to physician or care to care to chase the benefits and incentives. Refugees are people who come as like last chance. They try to get care, either through issues with finance in terms of paying for medications or stigma or mental health, whatnot. I was considered a refugee.
I came into this mechanism a little bitter and a little jaded. And for me, if it wasn't for some of the providers that I've had the privilege of experiencing and building relationships with within the AHF kind of continuum, the success of becoming virally suppressed and sustaining probably would not have been the case. So as an ambassador of this particular program and this particular care philosophy, I'm 100% team AHF. Dr. Wohlfeiler said something really beautiful about treating the entirety of a person. The one thing that I loved about AHF is I never felt like it was a transactional experience. I knew my providers by name. They knew me by knew by name, and also by risk factor. And I'll keep that cute because this is a PG audience, but they never shied away from any of the baggage that I brought into my specific type of treatment.
And so for me, being an HP professional, starting as a client, and now becoming a national director, I bring this work with me every single day. And the confidence that comes with that, I give it to the credit of the providers that I have within AHF.
Lauren Hogan:
Thank you so much for sharing your story. I appreciate that, and then also combining what it means to have a specific type of care so you can live a healthy life. Welcome Dr. Millner. I know you were a busy man, so thank you so much for hopping on. We started a little bit in progress, but since you're here, I got to throw a question at you already we're talking about HIV and AIDS and primary care and what that means from a physician standpoint, but also from a personal perspective, which you just heard Rig share. So I'm going to ask the same question to you. What does it mean to be an HIV primary care physician in your lens? And do me a favor, Dr. Millner, since you joined in progress, can you give us your official title and capacity of you working here at AHF?
Dr. Carl Milner:
Oh, I'm, I'm Carl Millner. I'm the chief medical officer at AHF. When I was in medical school, my roommate, my first year and second year of medical school died the year after we graduated from HIV, and I was back in 1992 when there were not a lot of ARVs around. And I had an interest in taking care of HIV as a medical student, and that kind of flourished. After that, I was committed to being a part of the solution to honor Raphael, because he was in a wonderful, wonderful soul, human being and part of the reason I wanted to dedicate my life to helping lots of folks like Raphael who could not benefit from the ARVs that were around at that time.
And by the time I finished my residency in '97, there were ARVs about that changed the face of HIV. And every time I saw someone who rose like Lazarus from the dead, it reminded me of Raphael, and it reminded me of the good work to be done with these being a provider to take care of patients like him. And so that's why I became a HIV provider, and that's what it means to be one, every day to honor him and other people who've died without having those treatments.
Lauren Hogan:
That's beautiful. Thank you so much. The next thing I wanted to ask you guys is we've talked... Rig talked a little bit about his care experience being a client of AHF. So I want to ask what makes an AHF clinic or experience so unique? Because a lot of the times we'll say that we have specialty care. So what does that mean? What does that look like? Can you provide a little more insight? And Wolfie, you can go first.
Dr. Michael Wohlfeiler:
Okay. So HIV is a unique population with unique needs and psychosocial issues, and it's really important that they be treated at a clinic or facility that recognizes, that welcomes them with open arms, doesn't make them feel stigmatized, knows what they're doing from a medical standpoint, but also knows how to support patients emotionally and in terms of services that are needed. So we talk a lot at AHF about our wraparound services. So it's not just coming in and seeing a provider and getting a prescription. It's meeting with case managers, benefits counselors, nurses. There's a whole bunch of people that make up a care team at AHF, and everything is geared to people who are living with HIV. And so I think that's what makes us really unique. And the other thing that makes us unique is, I'd say that the vast majority of staff who work at AHF, and especially in the clinics, they're there because they have a passion for taking care of this patient population, and I think that's really important that that passion really translates into like a big hug for the patients that come in.
And I think that's really important, that a patient feel loved and hugged and supported. And I think that's where we're unique.
Lauren Hogan:
Absolutely. Dr. Millner, your thoughts?
Dr. Carl Milner:
I'm kind of sucking what Wolfie said. I think we bring together like-minded people who are very mission driven. And I think that multidisciplinary approach that we have is unique, because I've had a job at a lot of different places, and I've even worked at FQHCs who did it pretty well, but in terms of the nursing care, the outreach workers, the social work, the assistance with the actual care that you receive in the clinic, I think we do it better than any place I've been. I've worked at a prison before, I worked at FQHC where there were various services, but not everyone shared that same mission. And I think... I've always said this. I've been visiting a lot of clinics, and no matter what the role someone has at the clinic, they share a mission to want to give great care, compassionate care to our patients who deal with this disease every day.
Lauren Hogan:
Absolutely. So Rig, I'm going to remix your question a little bit, considering you are a director of branding. So from a branding lens, why is the look and feel of a clinic so important to the patient's experience?
Rigness Rush:
Absolutely. I knew you were going to do that. So two part answer. First part is because you never know what type of patient's going to be walking through your door. At the end of the day, as a client, as a person who is living with this virus, I'm going to be potentially a different person every doctor's visit, situations may be going on, external factors. The way that I show up should still be embraced, acknowledged, and validated. And that's the one thing that I love about the clinics and the sites. Initially, you asked what makes them so unique. I think it's honest care. I think that there's a level of authenticity that I have seen and experienced from the concierge checking me in to the phlebotomist that's taking my blood to the provider that's asking me some of those intimate questions.
The level of authenticity is truly what I think is the vehicle for some of our retention efforts and why people refer and come back. The last part of that question is, it's important because we're dealing with people. AHF engages the person, not just the problem. The provider takes time to start the visit with simply, "How are you?" I don't think people realize how far and how deep that resonates when a person is asked, "How are you?" Before we get into the numbers, before we get into the T-cells, before we get into any other issues, that opening statement humanizes the care. And from a branding lens, that's one thing that continues to set us apart.
Lauren Hogan:
Sean, I'm going to turn it over to you.
Sean Little:
Great. Because I have a few questions. I was recently diagnosed about, oh god, I want to say seven or eight years ago. So I'm also a person living with HIV, but I do not have a HF as my provider or my physician. I go to the Gay and Lesbian Center. And I like it, but it's also... I think my question is, what would make me want to switch over to AHF? Whereas at the Gay and Lesbian Center, [inaudible 00:14:17] is covering, so I have Blue Shield platinum PPO, so they're covering that. I had to do it all on my own, but what makes you guys stand out from I think someone like the Gay and Lesbian Center? And how would you guys be able to make yourselves be even more broadband than the Gay and Lesbian Center? I only went to the Gay and Lesbian Center because it was just kind of like, oh shit, I went there to get tested, and then that was where it all kind of happened. You know what I mean?
Dr. Michael Wohlfeiler:
I think Carl should probably take this because he's based in LA where the Gay and Lesbian Center is that you're speaking of. And I'm based in Florida, so I don't know as well the Gay and Lesbian Center. So, Carl.
Dr. Carl Milner:
They're one of our partners in fighting this disease, and I have nothing but high marks and thumbs up for them. I have had some patients transfer from there and comment to me that there seemed to be a slight difference in terms of how they were perceived. And maybe it was because they saw me, maybe that I was a rate limiting step because I believe that I'm compassionate, and of the reasons I've mentioned earlier in this process. I think the most important thing is finding yourself a great provider, but I can't help but toot our own horn because I really do think we do it better. And this is not, again, a negative ding against the Gay and Lesbian Center, but I think we have that, I think that Rig was mentioning, that welcoming... When you walk into the healthcare center in general, and I'll speak for my own, and I see actually most of the clinics in LA because I've been the regional medical director there, and we walk in and you feel embraced from the beginning to the end of the process.
And I think, besides all the other things that you even Rig mentioned, talking about the nuts and bolts of what's going on with your disease, those things are the things that make a difference, whether the benefits to counselors are warm and receptive, whether the care management team is helpful. Our pharmacy, I think that's one of the things that may make us stand out even more because our pharmacists are American Academy HIV trained and compassionate. I've never met such compassionate pharmacists as well. You go to a Rite Aid or CVS, you'll get a different pharmacist every time. Our pharmacists, they get high marks all the time. So they're part of our care team. So I think those are the things that would make us different.
Dr. Michael Wohlfeiler:
And I would just add to that. Carl kind of implied this, but we've really tried to design a one stop shopping kind of model where everything that the patient needs is right there, including the pharmacy and other wraparound services, and I think that that really makes a big difference, and the fact that patients can take care of all of their medical needs pretty much right at the clinic.
Rigness Rush:
So Sean, first thing first, I congratulate you and I'm proud of you for disclosing that, because as you know, disclosure is a gift. So thank you for acknowledging that. When it comes to answering your question, I'll start by saying go with what works for you first. So it seems like you've done a little bit of self advocating. You mentioned a couple of things like you have PPO and you have some other care insulation that is able to ensure you have quality care there. But the thing I love about AHF is that it's almost like a safety net space, regardless of what happens financially, because we know salaries sometimes are not consistent. Sometimes life gets in the way. And some of those things that you described earlier are things that you have to pay for out of pocket that may be linked to a job or something like that.
I love AHF's mission, which is quality care regardless of the ability to pay. And as a person who has had to access that pathos many times, AHF will basically treat you, regardless if you can pay for it or not. You'll also see yourself at the clinic. Whether that's a effervescent gay man who is living life to the beat of Britney Spears, or you are coming in as an upwardly mobile professional who's a little bit more reserved, you will see yourself in the clinic. And when you can see yourself in the professionals that provide your care, there's more of a connection. There's more of a relation. I don't know...
Actually, I do know that Gay and Lesbian Community Center. I got tested there when I was living in Los Angeles as well, and that was my first experience with PEP. So I know that they have quality people there, but oftentimes, organizations like that, the quality of the services that they provide are linked to the grants that they're able to get every year. And if for some reason those grants don't happen, then your care potentially is brought into question. At AHF, you're always going to have consistent baseline quality care, and so that's just something I would love for you to consider.
Lauren Hogan:
Any follow up, Sean?
Sean Little:
Yeah, I guess I'm convert. That was a really good sell. I was like, okay. Rig, God, you should just go all over the country... Is that what you do? Is that what you do, just go around the country and be like, "Join AHF. We got you?"
Rigness Rush:
No, I am not an HIV celebrity, but I am a branding professional, so I [inaudible 00:20:20]
Sean Little:
Yeah, that was really good. I was like, wow, okay. Yeah, I think I might have to switch over.
Dr. Carl Milner:
And can I add just a little bit to what Rig was saying? Part of our mission statement that was left out is advocacy. We fight for those people who are voiceless. And I think that's something that makes us stand out. And upcoming on July 2nd, we have a We The People march in Fort Lauderdale where we're going to take the streets and fight for LGBTQ rights, abortion, just say the whole Disney thing in Florida, and on and on and on. It's going to be a compilation of things. And we do these all the time, taking on the drug companies for ridiculous drug pricing, et cetera. And that's very much a part of what we do as well.
Lauren Hogan:
So we are at time. So I do have one final question for the group. And that's simply, we talked about a lot of things, about how amazing our care is, why you should be in care, but if you had to just give one nugget, if it was one little thing that you could say to somebody to actually capture them into our care, what would that be? Wolfie, I'll start with you.
Dr. Michael Wohlfeiler:
Well, I think it would be that... I would be... I've got to make it more than one nugget, but it's that we're experts in what we do. We are passionate. Our people are passionate about what we do, and we fight. One of the things that I love about AHF is we are fighters, and we fight battles that other people are unwilling to take on. If we believe in it, we believe that it's going to help our patients or help the community. And I love that part of AHF. So I think that we're really great at what we do. We care about what we do. We fight for our clients. And I think that's a pretty unique kind of organization.
Lauren Hogan:
Rig.
Rigness Rush:
We have this saying in my family, you never know what it takes for a person to get out of bed each morning. And so you want to be sure that you don't unintentionally add to that weight. My experience with AHF through the care side has given me a level of confidence. Because regardless of how I may feel about that medication, what types of tug of wars I may be going through internally about being positive, I know without a shadow of a doubt that people at AHF give a damn. And that in itself is a gift, when you can know that somebody outside of yourself gives a damn about you. Regardless of how you got the disease, regardless of how you're managing the disease, regardless of whatever type of external factors, these people give a damn. And so I don't know what better plane to land than AHF gives a damn.
Lauren Hogan:
And Dr. Millner.
Dr. Carl Milner:
My one nugget is we help people walk through their fear with love and understanding.
Lauren Hogan:
Well, that's beautiful.
Rigness Rush:
Wait, before we leave, before leave, I got to do it. Dr. Wolfie and Dr. Millner, HIV is sort of becoming this normalized experience for a lot of people. What would you say to a person that just got newly diagnosed, let's say this year, maybe in the last couple of months that is now into this process of trying to figure out how to make it make sense? What would you say to them?
Dr. Michael Wohlfeiler:
Well, I tell them first of all, that as long as they take care of themselves, they're going to live a normal life. And another piece which is really important to, because I think a lot of people maybe still don't get this, is that if they remain undetectable, there's no risk of them infecting another person, which really takes a huge amount of stigma away. But I also emphasize, with any newly diagnosed patients, that there's nothing that has changed about the virus and what it does to people If left untreated. And I started in this area in the mid to late eighties. And the truth is that for many years, I had huge numbers of patients die because we didn't have effective treatment. Now, it's amazing. With effective treatment, often one pill a day, people can remain healthy and undetectable.
But they need to remember that it is still a potentially fatal illness if you don't take care of it. And I worry sometimes that people believe that something has changed about the virus or the illness itself and it's less dangerous, and it's not any less dangerous. It's just that we've got really good treatments now.
Lauren Hogan:
Dr. Millner, you want to add on to that?
Dr. Carl Milner:
Yeah, what I was going to say is that I would tell someone you will live with this disease, not die with the disease. Really, that is my opening salvo when I have someone walk into our office who's newly diagnosed, and that's really important for people to hear. Most people know that, but some people don't. They're fearful, and I emphasize that as long as they do what they need to do and take their medication, because it's... That's the important piece because it will have an eventuality that you don't want if you don't take your medication. And the medicines do not cause the side effects that they caused 25 years ago when the new highly active antiretrovirals came out. So it's a pretty simple disease to treat.
Rigness Rush:
That's right. That's why I have an aged pass 33. Back to you, Lauren.
Sean Little:
Same. 27, 27 forever when I got it.
Lauren Hogan:
Well, thank you guys so much for joining us today. This was an amazing episode and I really appreciate you guys' vulnerability and just authenticity in this space. I know it's going to resonate with a lot of people. So as always, thanks for listening, and we'll see you guys, you guys next time.
Dr. Michael Wohlfeiler:
Thank you.
Lauren Hogan:
Thank you so much for joining us. If you enjoyed this episode and you'd like to help support the show, please subscribe, share it with your friends, like, post about it on social media, or leave a rating and review. Follow us on Instagram @afterhours, and see you next time.