hiv and meth-dream on

Thugs and badmen
punks and lifers
locked up interns
pigs and snitches

Rest your weary heads, all is well

You won't be strip-searched, torn up tonight
you won't be cut up, bleeding tonight
you won't be strung out, cold, shaking to your bones
wishing you were anywhere else but right here
So dream on

in june, hrsa published a new document which breaks down quite a bit that is already known about hiv positive folks who use crystal meth. there has been quite a bit of press over the last five years over this particular intersection of crises and i have come to believe that this 5 page overview is thoughtful and concise. i have also come to believe that as a nation and a culture, americans are far far behind the eight ball in understanding substance abuse and in our infancy in dealing with it. just take a look at our prison system if you need some validation on this point.

here is my current favorite excerpt from the document. the thoughtful approach that can be financially supported by the ryan white program could perhaps be utilized to garner further understanding to apply to the rest of our citizens who struggle with meth addiction but without hiv. you can read the rest of the article after the jump

Provider Strategies
Treating HIV-positive meth users requires intensive collaboration among mental health specialists, dentists, pharmacists, social workers, primary care physicians, substance abuse counselors and, in some cases, correctional employees. “Treating patients requires a team. We have an electronic medical record where we share everything, and we have case conferences almost every week,” says Disney. “The case manager makes sure the patient is connected with resources and . . . following their plan; the pharmacist meets with the client and checks to make sure they’re sticking with an HIV medication regimen; the physician is tracking the lab numbers; I’m helping them deal with the deeper emotional issues, and the dentist is working to improve oral health,” Disney adds.

Part of an effective strategy includes dispelling the myth that meth is harder to treat than other drugs. According to Shoptaw, meth users’ rate of retention in treatment is virtually the same as that for other drugs (3 out of 5 people complete treatment).5 Although no specific guidelines exist to screen for meth, some providers use general substance abuse screening tools, a modified CAGE questionnaire or, in some cases, diagnostic testing with informed consent.9

Shoptaw advises providers to use the “5 A’s”: ask if the patient uses meth, assess if he or she is willing to quit meth, advise in a clear voice that it is a good idea to quit, assist the patient with finding intervention, and arrange for followup. Providers should also become familiar with co-occurring disorders and create a referral system with medical professionals in their area who treat those disorders.6

Cultural competency is vital to help providers under­stand not only the drug but also the user population and the reasons for use. Equally important is detection of underlying mental health problems. Inclusion of mental health specialists extends to emergency rooms, where it is important to identify whether patients’ mental health problems are meth induced.

Providers are seeing a specific type of memory impairment among meth-using clients. According to a longitudinal memory performance test conducted by colleagues of Shoptaw, word recall and word recognition among meth users is worse than among clients who do not use meth—even after 6 months of abstinence. No real difference for picture recall and picture recognition tests was found between meth users and other clients.32 Providers should therefore use pictures and write down instructions as well as explain information to patients.

In addition to addressing psychological changes, providers can help counter physical changes resulting from meth use by advising patients to hydrate and to avoid wearing hats so as to lower base body temperature and reduce the risk of malignant hyperthermia. Similarly, patients should be advised to consume protein to help repair muscle fibers and naturally produce and replace dopamine.2 To treat xerostomia, providers can recommend the use of artificial saliva products or sugar-free citrus candies to stimulate saliva production.33

today's sound choice is tongue-in-cheek definitely... christian falk featuring robyn "dream on"

days like this...

today was a full day. i stayed up late last night dicing jicama, peppers, and cilantro to make a salad to serve at a fundraiser for the AIDSWALK. i dropped it off at 7:30 in the morning before i went to participate in the priorities process for ryan white funding - basically setting a budget for the 2010-2011 year. this year it was held at the governor's residence. funny thing though. i worked there part time for a year and a half when i moved back to denver from san francisco. i hadn't been back since i started working working full time at the airport in 2006. it was good to see old friends and have a giggle or two.

there were more interested parties this year than i have seen in the other two years i have done this. it is seemingly tedious work, but budgeting is never really sexy unless there's s surplus. and we are not expecting a surplus in the next couple of years.

had to run back to the office after priorities to drop off a card. a nurse who works in our building had donated $500 to us and i had a thank you card to get signed by everyone. i had two emails from colleagues asking for the recipe for the salad.

i went to the verizon store after work to get a hands free device for my vehicle. i have had too many stupid close calls and i don't want to take any more chances. i can't wait to try it out.

i have a lovely feeling of satisfaction and accomplishment here at the end of this day. i am going to savor it as best i can. it is days like this that make the whole journey back to reality worth the trip. it's days like this (as well as the confetti jicama salad) leave a great taste in the mouth.

hope your havin' your own days like this....

here's the recipe for confetti jicama salad....
borrowed from an old southwestern cookbook (circa 1988)

2 jicama peeled and diced
4 peppers (red, yellow, green) seeded and diced
1 jalapeno seeded and diced
radishes to taste.. diced
1 bunch cilantro
1 tbsp. cumin seed
1 c. rice wine vinegar
salt and pepper to taste

mix everything ( but cilantro) and refrigerate and marinate overnight.
toss before serving and add cilantro.
be prepared to share, because everybody loves this!!! great for summer.

today's sound choice is an older house classic. ( which i still love) shaun escoffery with "days like this"... there were more than a few mornings that i greeted the sun dancing to this song at the endup in sf.

a blessing

ryan white an american hero


no need for words from me today....
just silent prayer from sarah mclachan to you....

Spend all your time waiting
For that second chance
For a break that would make it okay
Theres always one reason
To feel not good enough
And its hard at the end of the day
I need some distraction
Oh beautiful release
Memory seeps from my veins
Let me be empty
And weightless and maybe
Ill find some peace tonight

bless you.......... bless us all...........

lead........empower........deliver

world aids day 2008
(click here for info about world aids day in your city)

for more about ryan white click here

today's sound choice sarah mclachlan and pink at american music awards-

in the arms of an angel

h.o.p.e.

there is a little drop in center in denver whose mission is to provide a place for homeless persons with hiv to find respite during the day. it is the basement of a brownstone and hosts a washer/dryer for people to do their sparse laundry, there are cots to provide a place to rest legally and not have to wander. there has recently been a shower added to allow for personal hygiene to become more accessible, and meals from angel heart are delivered on a daily basis.

it is run by an rn named lisa wheeler and she counsels with clients about their meds, their medical appointments, their needs, and their general health. she is patient, firm, caring, intelligent, and reliable.

h.o.p.e. is not funded by ryan white funding. it is a program of the visiting nurse association, yet almost all the ryan white agencies use her hospitality and services to assist them in their daily interactions with the hard-to-reach and hard-to-keep-engaged clients. a hot meal and a kind word can go a long way in reaching a struggling soul.

this year, i have asked lisa to provide a wish list for items that would make her job easier in the coming year. i happen to know that she uses her own funds to provide many things throughout the year when her own funding falls short. i am going to as strength in numbers, the rebuilt+ committee, and the entire ryan white system to participate in a holiday drive to help provide these not-so-very expensive needs and present them in a thank-you delivery this holiday season. somehow, i am really looking forward to the holidays this year.

here is an article from a former client of h.o.p.e. my plan is to publish it in the december sin newsletter. i hope you'll understand my motivation.

Drug addicted, in full blown AIDS, and making a geographical change, again. I arrived in Denver December 4, 2005. I stayed with a friend in Aurora. Our relationship got bumpy, imagine that, two drug addicts having problems with each other, and I was out doing the sleazy dive motels up and down Colfax. I still hadn't reached my bottom. I began using in Denver. Eventually I got my own apartment and used and used. After only one year, to the month, I was evicted and homeless. This still wasn't enough. I talked about getting a job and resuming my career, literally, a "pipe dream". I let my nursing license lapse. I eventually ended up in the "court system". The best thing that could've happened. I saw the light. I met an angel at a place called the "Hope Program". The "Hope Program" is a day shelter for people who are homeless and HIV positive. HOPE is an acronym for Homeless Outreach Pharmaceuticals and Education. The way I was helped by Hope was multifaceted. It gave me structure and help prioritizing my life. The "Hope Program" has also grown. They now have a shower and cots. There is also facilities to do laundry and hot meals. The blessing is that the "Hope Program" gave me a safe environment without judgement. I took the sound advise of my probation officer, the judge in drug court, my psych support staff, my councelor in the drug rehab program, and several people in two 12 step programs.

The Hope Program helped me to see the importance of medication adherence, medical management and the having a support system. I also belong to a community action group called PBI (Prevention Before Infection). I take people for HIV testing at "It Takes a Village" and "Brother Jeff's Health Initiative" with a focus on sex workers. I volunteer at the "Hope Program". I participate as a member of the "Mayor's Planning Council". I'm an active member of "Coloradans Working Together (CWT)". I do outreach for "Addictions Research Treatment Services (ARTS)".

I've come full circle. I made it through drug court. I joined the workforce again. I am able to make choices as to my career. I think I've found direction in my life. I now do outreach and co facilitate a "Healthy Relationships" class. I do AA and CA daily. I'm working the steps and have a sponsor in both groups. I also have had an undetectable viral load for a couple of years and decided to take the Hepatitis A and B vaccines. I am closer to a loving a full life. I'm still working on me and am thinking about having a significant other in my life.


I would like to profess my undying appreciation and unconditional love for Lisa Wheeler of the "Hope Program" and Roseann Prieto of "ARTS". Those two have been directly responsible for helping me become closer to the person I want to be and giving me a great big universe.

Clarence Mack RN BSN

the shape of my heart

The heart has its reasons that reason does not know. -Pascal.

the planning council that i serve on is planning to begin the process of a development of a 3 year comprehensive plan starting in march 09. there are overhauls and modifications to the entire hiv ryan white delivery system that will benefit from being addressed. our job as a council is to look forward and see what changes might be in order and benefit us and find ways to sail in those directions. the last comprehensive plan honestly looks as if it were cut and pasted from an earlier plan with no little or no meaning attached. more just a documment to get done in order to meet a deadline. that's not the shape of my heart.

the exec committee, which i also serve on, will be the first to take a look at the possibilities. the thing about foreseeing change is that it's easy to discuss but much trickier to try to implement that change. this will begin to determine the shape of our hearts. our mini-retreat is tomorrow and i am not sure how it will go, but i am ready to give it a go.

we have to become ready as a small group, a representation of a larger group, which is a sample of the larger under-the-poverty-level(ryan white) system of hiv services delivery, to look at things from a different light. we have to stretch our minds and our hearts and welcome new ideas.

i work within this healthcare system and i certainly see deficits. probably the most glaring is that the delivery system has become a provider/client makeup in lieu of the community model that founded it. i would like to see a return somewhat to that original somehow. i believe that poz persons can be more than just subjects. i would like to think that poz persons with some success in walking through their troubles can be invited to share their strength and those successes with other coming behind them and do so with grace and dignity.

something i know i am working on in my heart is the ability to transfer the unlimited caring and love for my work and the people i find there to the folks in my personal life. i sometimes give clients a lot more wiggle room and understanding than i do my friends and family. there is something a little twacked about this picture.

either way though, for me, this is a very long way from crouching in the corner of a bathhouse room, afraid to go forward in life, and trying hard to forget where i had been. or spending several years trying to be too tough to get sick and die and pretending that it doesn't hurt.

And if I told you that I loved you
You'd maybe think there's something wrong
I'm not a man of too many faces
The mask I wear is one
sting