26 | QSALTLAKE MAGAZINE | FEATURE
Qsaltlake.com |
Issue 289 | DECEMBER 6, 2018
University of Utah Health PrEP Clinic staff on opening PHOTO COURTESY JORGEN MADSEN day in May.
UofU Health’s free PrEP Clinic is a game-changer in HIV prevention BY STEPHEN DARK
When Jorgen Madsen came out to his family in late 2015, his father told the 23-year-old medical student a cautionary tale about the only gay man he knew. His father’s friend had been ostracized by the small, rural Utah town where Madsen grew up in the wake of his HIV diagnosis. Only seven people went to his funeral. “The story of my dad’s friend made HIV very scary for me personally,” Madsen says. “The way that town reacted: people don’t talk about him; he’s one of those secrets. I didn’t want that to be me.” Madsen approached gay life with trepidation. After learning about the dating app Grindr, he downloaded it, only to be traumatized by the dozen men immediately asking him for sex. Madsen took the world of dating very slowly. His first kiss with a boyfriend at the end of their third date was an emotional revelation. “I’d never felt anything more pure, more honest,” he says. Shortly after that date, Madsen went to the hospital for treatment on an old bone break that had painfully flared up. This was the first time he identified himself as gay. “The experience was less than ideal,” he says. Through the walls, he heard the nursing student who had taken down his details tell the doctor, “I’m afraid he’s at high risk, being homosexual.” Medical staff grilled the terrified student about his sexual activity, even though it only amounted to a lip-locking farewell at the front door. “They didn’t
believe me,” he says. “They still screened me for everything. I felt so vulnerable.” An attending opened the door and shouted, “We need an HIV test in here.” Madsen sank further down into his chair. They told him he should start taking PrEP, which stands for Pre-Exposure Prophylaxis. Essentially a one-pill-a-day intervention, it has proven up to 95 percent effective against HIV infection. A Lancet study on “rapid, targeted, high-coverage roll-out” of PrEP in New South Wales published in fall 2018 made international headlines, revealing that PrEP usage led to “a rapid decline in HIV diagnoses.” When Madsen asked why the staff thought he should go on PrEP, they replied, “Well, you engage in risky behavior.” It was just a kiss, he thought. While highly effective in combatting HIV, PrEP is also very expensive. Madsen would have to pay $1,500 a month, half of which his insurance would then reimburse. As much as he wanted to take PrEP, he couldn’t afford it. “I felt like a hypocrite being a medical student and not doing everything I could to be safe,” he says. Afterwards, he sat in his car in the hospital parking lot, humiliation washing over him. As he stared numbly out of the window, he cried. Over the next two years, Madsen got a crash course in the paucity of LGBTQ health resources in Utah. He joined forces with two doctors at University of Utah Health, Susan Keeshin, MD and Adam Spivak, MD, along with a fellow medical
student, Julie Weis, and the local nonprofit Utah AIDS Foundation, to improve health care for the LGBTQ community. Their main efforts laid the groundwork for what at that time was only the second free PrEP clinic in the United States. Madsen and his allies found that while it took a collective effort of passionate, activist-minded medical staff to stake out a new frontier in LGBTQ health culture, inside the clinic it came down to communication between providers and patients to realize their dreams of change. Madsen and the rest of the clinic’s leadership had four goals for the HIV prevention clinic: to serve the LGBTQ community, to educate the community about safe sex, to build trust between patients and LGBTQ-allied and gay medical professionals, and to educate the medical community about LGBTQ health issues. Part of that last goal was learning how to take a patient’s sexual history in a non-judgmental manner. That involves recognizing the role humility plays in HIV care, Keeshin says, especially given the fact that patients are typically underserved. Doctors who work with them, “have to check race, sexuality, and privilege at the door,” she says, “whereas a lot of other specialties you don’t.” In March 2018, the clinic began opening its doors every other Saturday morning from 9 a.m. to 1 p.m. Spivak and Madsen (the dreamers, the big-vision guys) and Keeshin and Weis (the practical engine of the clinic that keeps it motoring) volunteer their time, along with a rotating handful of medical students, several case managers, and a physician’s assistant. In just six months, the skeletal crew squirreled away in the back of the Redwood Health Center on Salt Lake City’s west side has been all but overwhelmed by its own success. Ninety-eight percent of their patients are young gay men, and close to 40 percent identify as Latino, so the clinic has reached the most at-risk populations with little more than word of mouth. This, however, is just the beginning. One Voice Recovery director Patrick Rezac told Keeshin he’s tried unsuccess-
