The Cascade AIDS Project will be opening an 8,000-square-foot clinic on Belmont Avenue in Portland that will tailor its care approach to patients who are gay, lesbian, bisexual and transgender.
The small clinic will mark a significant expansion into the delivery of care by the venerable patient advocacy organization, which has operated a men’s wellness clinic downtown for the screening of HIV and sexually transmitted infections as well as sponsored mental health counseling for people who are HIV positive through Cascadia Behavioral Healthcare.
Tyler TerMeer, the executive director of Cascade AIDS Project, said the clinic will fill a gap in care by assuring LGBT patients of a culturally competent staff. He expects they’ll hire a medical doctor and a nurse practitioner for the opening early next year. The clinic will accept Medicaid and Medicare as well as commercial insurance.
“After 30 years in existence, 35 years into the epidemic, how do we remain relevant?” TerMeer posited. “We will be seeing an equal number of people who are HIV-negative and those who are living with HIV.”
After the clinic opens, both the STI screening and the counseling will be integrated into the services of the primary care practice on Belmont. The CAP offices will be moving from the Lincoln Building in downtown Portland this July to a new, larger space on Davis Street in Old Town, but the Pivot screening center will remain at the current location until the new clinic opens.
This integrated approach has been a goal of Oregon’s coordinated care model for the Medicaid system, and has worked wonders at the Johns Hopkins AIDS Psychiatry Service in Baltimore, where Dr. Glenn Treisman said 93 percent of its HIV patients are taking antiviral drugs, and the virus is undetectable for 92 percent of these patients.
Treisman said that more than half of all HIV patients have a mental illness, not including addiction disorders. “The infection increases the risk of mental illness and a mental illness increases the risk of infection.”
The antiviral drugs prevent damage to the immune system, help prevent the body from becoming resistant to other needed medication, reduce inflammation and prevent transmission of the disease when undetectable. Treisman said evidence is growing that the virus inflames the nervous system, which increases the manifestation of major depressive disorder or bipolar disorder.
“Our patients have a disease, and it’s often the least of their problems,” Treisman said.
Treisman was the keynote speaker at the Meaningful Care Conference in Portland last Friday, which Cascade AIDS Project helped sponsor. Cascade’s core mission traditionally has been the population infected by HIV, but the new clinic will focus on the broader gay community while accepting anyone.
Benjamin Gerritz, the Prevention with Positives Coordinator for the Cascade AIDS Project, said the new clinic will be especially important in helping patients access pre-exposure prophylaxis, or PrEP, which is being promoted in the gay community to prevent the transmission and spread of HIV.
Gerritz complained that some proactive men had sought the drug from their providers, only to run into resistance or “a blank stare.” He said the drugs hold promise to cut the rate of new HIV infections in half in five years, and men taking the drug do not generally use it as an excuse to have unprotected sex.
“A person accessing PrEP increases the likelihood of using condoms on a consistent basis -- which is perhaps not what is anticipated,” Gerritz said. “They’ve taken the step already to seek the medication. Coupling PrEP with consistent condom use will see a dramatic decrease in new infections.”
