El Rio's Special Immunology Associates provides primary care (inpatient and outpatient) as well as consultative care to approximately 1500 persons living with HIV infection throughout Southern Arizona. SIA is the largest provider of care to HIV-infected patients in the area. The goal of SIA is to provide accessible, affordable, quality ambulatory primary health care to HIV/AIDS infected patients; provide community education and information regarding new treatments and therapies to improve the quality of life of those living with HIV/AIDS; and provide for the behavioral health/counseling needs of people living with HIV and AIDS.

Research by J. Kevin Carmichael, MD, unit chief of SIA, suggests that the major risk factor of death among persons in the SIA clinic is the presence of substance abuse and mental health issues that prevent these persons from fully benefiting from antiretroviral and other therapies. For this reason, quality HIV treatment requires a comprehensive range of services that will best enable patients with these risk factors to start and stay on treatment. SIA has a truly integrated system of care, wherein medical care, mental health, substance abuse, case management, and advocacy are provided in a one-stop multidisciplinary approach. All disciplines document in the same chart, staff and patients together, coordinate efforts to optimize the success of treatment. Through advocacy activities that access drug assistance programs, compassionate use programs, and grant funds, El Rio/SIA distributes millions of dollars of HIV/AIDS medications at no charge to patients.

The project also makes extensive use of continuity of care counselors (3Cs) who do whatever needs to be done to ensure no one falls through the cracks of the system. This may entail eligibility assistance, coordinating with AIDS service organizations or with other care systems, such as disability and mental health; delivering medication boxes; and assisting with food, housing, and transportation. They also provide health education, including supplemental medication adherence and secondary HIV prevention counseling. Their final role is to provide an extra ear to hear patient concerns and problems that patients may not bring to the attention of the physician. The role of the continuity of care counselor is critical to the clinic’s success because we have found that keeping people with HIV infection in care and adherent to medications is the key to keeping them alive and living meaningful lives.

The Arizona Border HIV/AIDS Care Project extends the SIA approach to improve the collective capacity of community agencies, county health departments, and community health clinics/centers throughout southern Arizona to provide targeted outreach and counseling to at-risk border populations, activities which will result in increased testing, identification, and service provision to those infected with HIV. Strategies include training border physicians in the treatment and care of HIV/AIDS patients and providing information on the availability of HIV-related services in border communities. The project targets individuals, largely Latino, residing or working within 62 miles of the Arizona-Mexico border, who are infected with HIV, but not receiving primary health care. The project works to develop a level of comfort and acceptance of HIV/AIDS in rural community health centers so that they will provide health care that is perceived as supportive and non-threatening.

Based on its status as a national model, in 2002, El Rio/SIA was asked by the US Health Resources and Services Administration to host a conference that, for the first time, brought together all the border states in the US and Mexico to discuss and coordinate HIV treatment and prevention.

To learn more about El Rio’s HIV/Early Intervention Project or El Rio’s Special Projects of National Significance Programs, contact Steve Trujillo at (520) 628-8287.