Transforming HIV Care: From Stigma to Support at Jefferson Einstein’s Immunodeficiency Center

The Immunodeficiency Center (IDC) at Jefferson Einstein Philadelphia Hospital has witnessed a remarkable journey since its inception in 1994, when it catered to just 40 patients, many of whom struggled to access appropriate care due to the stigma and lack of knowledge surrounding HIV. Today, the center has broadened its scope beyond HIV, serving over 1,000 patients with comprehensive services that include psychiatric, dietary, and social work support. Dr. Jody Borgman, a veteran of the IDC and its former medical director, has been pivotal in this evolution of HIV care. In a recent interview, she shared her insights on how treatments have transformed over the past three decades. Initially, patients were prescribed highly active antiretroviral therapy (HAART), which, despite its effectiveness, involved exhausting regimens of 15 to 20 pills daily, accompanied by numerous side effects. The landscape began to shift significantly with the introduction of simpler regimens, including a single tablet containing three medications by 2006, allowing patients to manage their health with just one pill a day. In recent years, pre-exposure prophylaxis (PrEP) has emerged as a groundbreaking advancement in HIV prevention. Although it debuted around a decade ago, its popularity surged over the last few years. Dr. Borgman emphasized that PrEP holds the potential to dramatically reduce new infections, particularly when targeted toward high-risk populations. The IDC's innovative TelePrEP program exemplifies this evolution, enabling patients to access PrEP through telemedicine without needing to visit the center physically. This method involves outreach efforts to educate individuals about their risk and facilitate a streamlined process for obtaining medication via mail or local pharmacies. Despite these advancements, Dr. Borgman highlighted the ongoing challenge of reaching individuals who may be unaware of their risk for HIV. High-risk groups—including men who have sex with men, those who use injectable drugs, and individuals engaging in unprotected sex—are the focus of targeted educational campaigns. The center employs various outreach strategies, including advertisements and public awareness initiatives, to foster understanding and encourage individuals to seek assistance. Access to HIV care has transformed significantly over the years, with a notable decrease in stigma within the healthcare community. Many primary care physicians now provide HIV treatment as a routine service, alleviating the burden on specialized centers like IDC. However, many patients still grapple with the societal stigma associated with HIV, causing reluctance to disclose their status to family and friends. Today, HIV is often relegated to a secondary concern for patients at IDC. Dr. Borgman noted that many individuals, some under her care for over 20 years, are astonished at how HIV has become a minor aspect of their health in comparison to other chronic conditions like diabetes or hypertension. The center's holistic approach emphasizes not only medical treatment but also support for the psychosocial challenges associated with living with HIV, offering a level of care that may not be available in a standard primary care setting. As the IDC continues to evolve and adapt to the needs of its patients, it stands as a testament to the progress made in HIV care, highlighting the importance of comprehensive, compassionate healthcare for individuals facing this chronic condition. The future of HIV care, bolstered by advancements like TelePrEP and a broader understanding of the disease, holds the promise of further reducing new infections and improving the quality of life for those affected.