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Changing Care for Changing Needs: A History of HIV Care for LGBT

In 2013, University Medical Center (UMC) of Southern Nevada CEO Brian Brannman saw an advertisement in a medical journal that asked what organizations had done to support the lesbian, gay, bisexual, and transgender (LGBT) community. He responded with policy and training changes that formally documented UMC’s decades-old practice of caring in earnest for the LGBT community, beginning with dedicated HIV care in the 1980s.

In 1985, Jerry Cade, MD, MBA, was running a busy family practice in Las Vegas, where he saw a lot of LGBT patients with HIV. While all patients with HIV are not necessarily LGBT, Cade notes that in Las Vegas, members of the LGBT community compose about 60 percent of the HIV population. “In the early days, it was very rare for me to have a patient who wasn’t gay,” he says. In those days, Cade also paid for labs and other costs for uninsured patients with HIV “because I could afford to do it and no one else was,” he says.

But he had long worked with UMC, “We had a philosophical commitment to each other,” he says. So when the demand became too great for his small practice, he went to the hospital and asked for help. True to its mission to serve the most vulnerable, UMC agreed to help, and the hospital opened its HIV program in August 1985, with Cade as founder and director.

While there were some hurdles, including staff who were unfamiliar with treating the LGBT community, Cade had the backing of hospital leadership. “When a lot of people were running the other way, we stood fast, and we stood by the people in the community affected,” Brannman says. “[The LGBT community] is a segment of the population we are dedicated to serving. It’s a natural part of our role as a safety net provider.”

Cade also credits the local media with introducing the program as a forward-thinking community effort and providing a great deal of education for the public, thus helping to change the perception of LGBT patients with HIV.

The program opened an HIV outpatient clinic with five patients in December 1986, essentially as a means of providing expanded access to AZT for patients. Today, the clinic has 2,000 patients. UMC also opened a dedicated HIV inpatient unit in July 1987, which has since become a medical/surgical inpatient unit with a focus on HIV. The inpatient change responds to the change in treatment for HIV patients.

“Before the good drugs came along, I was essentially a hospice doctor,” Cade says. “Most patients who were admitted with HIV got sick and died quickly.” Cade recalls one very ill patient from that time who did not look like he was going to survive the night.

“On the oncology floor, we had always let partners and/or family members stay with patients when it might be their last night on this planet. Even though our HIV inpatient unit had been open less than a week, I simply wrote an order that the patient’s partner could remain with him through the night. This was long before we had domestic partnerships, which we do now have in Nevada.

A couple of floor nurses questioned the legitimacy of the order. As I mentioned, we did not have a formal policy. But UMC administration made it very clear that at UMC we were going to do what was best for the patient, regardless of any rules or policies for or against the idea. This couple had been together for more than 10 years. The patient was estranged from his family, who had never visited him. I don’t think there was a doubt in anyone’s mind that morally and ethically the best thing for this patient was to spend his last night on earth with the man with whom he spent the last 10+ years.

I have heard horror stories from other institutions about the inability of longtime partners to be a part of their loved one’s care. But it was never a question at UMC that our focus was on what was best for the patient.”

Changing care for better outcomes

With the introduction of antiretroviral therapy in 1996, people started living longer, and many inpatient units closed – UMC’s unit logged a low of two patients in 1999. But instead of closing its facility, UMC chose to adapt to its patients’ changing needs. “Today, most HIV patients who come in have something else going on, whether it’s cancer or cellulitis,” Cade says. “And, most of the new HIV medications do have drug-drug interactions. So by keeping a dedicated space for HIV patients in our hospital, I have a committed and enthusiastic group of nurses who can keep up with these new medications and also stay abreast of how these medications interact with other drugs.”

UMC is also reaffirming its commitment to the LGBT population by reviewing policies and  updating patient forms and human resources documents for staff to ensure the language is explicitly inclusive of group identities and preferences. The hospital also extends equal visitation rights and recognition as next of kin to same-sex partners. “It’s been here within our culture to be welcoming to everyone, but formally going through the steps just cemented it,” Brannman says.

For more information about UMC Southern Nevada’s LGBT initiatives, please contact:

Danita Cohen
Executive Director, Strategic Development and Marketing
University Medical Center


About the Author

Laycox is a former senior writer/editor for America's Essential Hospitals.

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