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Join George Kerr, III, a community health advocate. We delve into the complex world of HIV management, especially among aging individuals. George brings his expertise to the table, discussing “U = U,” aging-related challenges, and the vital role of primary care providers. Join us for an engaging conversation that sheds light on the evolving landscape of HIV care and the need for comprehensive support.

George Kerr, III is a community health advocate.

He discusses his KevinMD article, “Patients aging with HIV: What role can doctors play?”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast and get CME for this episode by clicking on the CME link in the show notes. Today we welcome George Kerr III. He is a community health advocate, and today’s KevinMD article is titled “Patients aging with HIV: What role can doctors play?” George, welcome to the show.

George Kerr: Thank you for having me.

Kevin Pho: So just start off by briefly sharing your story and journey to where you are.

George Kerr: Well, I’ve been living with HIV for 28 years now. When I first started, back in 1995, it was a totally different disease than it is today. At one point I was taking 27 pills a day, and now I’m down to two pills a day, plus other pills, for blood pressure, a statin and so on. It’s a big difference with the medication, so I am really blessed to be in the position I am today.

Kevin Pho: All right, so over the decades of living with HIV, you’ve clearly seen the evolution. What are the remaining challenges today for patients with HIV?

George Kerr: Interestingly enough, stigma is still number one. And then being educated about it, because the disease has changed so much, and when you’re aging with HIV, there is so much you need to know. When I first started, the provider would take care of everything and schedule it: “OK, go here, go here, do this, do that.” Now you really have to manage the manager, manage your meds and manage the whole process. So a lot still needs to happen. Electronic medical records are a huge issue; my primary care provider getting reports from specialists outside of my HIV care is somewhat of a challenge.

Kevin Pho: One of the things you mentioned earlier was that the stigma still persists today. What do you mean by that? Maybe give some examples of how the stigma currently shows up.

George Kerr: There are still people who don’t truly understand how you get HIV, and I’m hearing a lot about AIDS and AIDS medication and things of that nature. So there needs to be more education: It’s an HIV medication, and this is what you need to do to protect yourself. There is PrEP out there now for people who have not gotten it, and there needs to be more education about that, and about doxy-PEP and other things to protect yourself.

Kevin Pho: Now, you’re a community health activist. Tell me some of the things you’re doing to try to overcome that stigma and educate the population about HIV today.

George Kerr: Interestingly enough, I just attended the United States Conference on HIV/AIDS. It was here in Washington, D.C., one of the largest ones we’ve had, with over 4,000 people coming together and talking to the community about that. And interestingly enough, on the Lyft ride home one night, the Lyft driver asked me, “What’s going on here?” I said, “Well, we’re here for a conference.” He said, “Oh, yeah? What type?” I said, “HIV and AIDS,” and he said, “Oh, is that a tech conference?” So in that brief ride home, I was able to educate him about what HIV is and why it’s still here, because a lot of people think there’s a cure, particularly that if you’re rich, there’s a cure, and there’s not. So it’s just one-on-one conversations out in the community.

Kevin Pho: All right, let’s talk about your KevinMD article. You touched on this earlier, some of the issues patients with HIV face as they age. The KevinMD article is titled “Patients aging with HIV: What role can doctors play?” How did your article come together?

George Kerr: I was talking to Dr. Miranda Ward about this. I was interviewed about aging with HIV, and I started talking, and they said, “You know what? There are really two articles here, and there’s got to be one for the clinicians.” So after some going back and forth, we decided to focus on that. It was kind of organic that it came out that way, and it happened very quickly. I was really kind of surprised: Within a couple of days, we were able to turn it over and get it out into the spheres.

Kevin Pho: All right, tell us some of the key points you write about.

George Kerr: Just having a conversation with your primary care doctor or your clinician, the clinician and the patient talking about sex, because as we age, we are still having sex, and it’s really important that we are safe about it. And the role that U=U plays. There are some clinicians out there who know what that is and some who don’t. U=U is “undetectable equals untransmittable,” and that’s one of the key prevention messages that I think has been widely promoted recently. I am so excited about that, because it once again addresses the stigma that if you’re HIV-positive, you’re dirty, and we’re not.

Kevin Pho: So you mentioned that half of all people with HIV are now over the age of 50. What unique challenges do older adults face when managing HIV, and how can doctors ask about and address these unique challenges?

George Kerr: It’s interesting, because recently, at a doctor’s appointment, I was talking to my primary care provider about it. I said, “I was told that I need to get an anal Pap.” She looked at my records and noticed that I’d never had one, so I was able to go ahead and get that medical procedure. It’s just that open communication when I go in: “OK, are there any vaccines I need to get?” I am working hard to stay up front with my health care, and for them to come to the table, and we meet in the middle and talk about this.

Kevin Pho: Now, how about you yourself? Have you had some personal experiences, or can you share an anecdote about some of the challenges you’ve faced obtaining care when interacting with our health care system?

George Kerr: One of the things that has happened over the last couple of years is that I’m having short-term memory issues. For example, I am not able to sit down and write anymore; it really is a challenge for me to do that. I will be in the middle of a conversation, talking, and all of a sudden I’ll forget what I’m talking about, and it’s just a total blank slate. So I go to my doctor, and they say, “Well, you’re just going to have to live with it. It’s something with HIV. We’re not sure, and we don’t know why, so you’re just going to have to deal with it.” From a patient’s point of view, that’s really scary: I’m losing some cognitive memory and I’m not sure where it’s going, and to be told, “Oh, well, you’re just going to have to figure out how to live with it.” That’s a challenge.

Kevin Pho: Now, on the flip side, tell us about some of the more positive interactions you’ve had with the health care system. In an ideal encounter, what are some questions primary care clinicians can ask older adults with HIV?

George Kerr: One of the issues we are living with is our mental health status, so asking us how we’re doing is really key. If we are suffering from depression or anxiety, having the clinician know about that, and doing that scale where we see where we’re at and at what grade, is important. I am truly blessed that I have a therapist, and we meet almost on a monthly basis to address some of the issues with my depression and anxiety. It’s integrated, because my primary care and my mental health services are all in one clinic, so they have all the records and they can talk to each other. That is a true blessing for me.

Kevin Pho: So go into more detail about that intersection between behavioral health issues and those living with HIV. Talk about some of the challenges this population faces.

George Kerr: One clear example for me was when, wearing another hat, I was called and asked about mpox, formerly known as monkeypox. When that started rolling out, the rates were climbing at a rapid pace, and there was a lack of communication about what it was and what we could do to protect ourselves, and it was targeted at gay and bi men. It really reminded me of the early days of HIV, back in the days of GRID. So when that happened last year, with the misstep in the public health messaging to us, ever since then I’ve really been thinking about the early days of GRID, and about what we can do as a community, as advocates, to really ensure that we get good public health communication out into the community.

And with all the anti-science out there now about vaccines, I just recently got my second booster shot, and it’s so key that we can trust the science, the FDA and everyone, that what they’re doing for us is really helping us. I believe that, but I don’t know if the wider community has bought into it. So dealing with these types of issues, thinking about it all the time, and having the daily reminder of taking my medication, it can weigh you down. It really helps to go in and be able to sit and talk to someone and be honest about what you’re thinking, what you’re feeling and how it sometimes upsets you. So having that leverage there is really key.

Kevin Pho: Talk about some of the resources patients with HIV can turn to in case they need additional support.

George Kerr: One of the resources is the 2-in-1 module, which talks about COVID and HIV. It’s run out of GW University and funded by Gilead. There is the Reunion Project, an organization you can turn to about HIV and aging at the national level. And then, of course, there’s the local support of your department of health and your department of behavioral health within your community. So there are some resources out there. Some areas are a lot better than others, but just reaching out to your local activists can help you as well.

Kevin Pho: We’re talking to George Kerr III. He is a community health advocate. His KevinMD article is titled “Patients aging with HIV: What role can doctors play?” George, tell us some of the take-home messages that you want to leave with the KevinMD audience.

George Kerr: Well, for the clinicians: Listen to your clients, and when they say they are feeling a certain way, believe them. There’s a lot we’re having to deal with, a lot of unknowns out there, so just be reassuring. And to the community: Find a good clinician, and be open with them about everything.

Kevin Pho: George, thank you so much for sharing your perspective, time, and insight, and thanks again for coming on the show.

George Kerr: Thank you. Thank you.