Justin Goforth, positive for 18 years, once received treatment at an HIV clinic sponsored by the National Institutes of Health. The NIH eventually closed the clinic, Goforth says, because the patients, all on antiretroviral regimens, showed no signs of illness. And sick people were what doctors-in-training came to the NIH to study.
"The medical fellows that came to NIH to learn infectious disease specialty care weren't getting that experience," Goforth says. "Once you get people on a regimen then it's just about primary care and not about the infectious disease care anymore." Goforth, a nurse and a director of several programs at Washington, D.C.'s Whitman-Walker health center, now gets his medical needs met through his internist.
It's been 30 years since AIDS was first diagnosed in the United States, and in that time much has changed--prevention, treatment, life expectancy. But the relationship between doctor and HIV patient may not have evolved along with treatment of the disease. Some experts are now calling for a shift: Where infectious disease specialists once cared for HIVers, now primary care physicians are being called upon to take over treatment.
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