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A Provider's Path From Practicing Gerontology to HIV Care, and Everything in Between

March 11, 2011

Bethsheba Johnson, G.N.P.-B.C., A.A.H.I.V.S.

Bethsheba Johnson, G.N.P.-B.C., A.A.H.I.V.S., is an associate medical director of St. Hope Foundation in Houston, Texas.

I am a board-certified gerontological and HIV/AIDS nurse practitioner. Love my "older people!" Mind you, I am not using the U.S. Centers for Disease Control and Prevention definition (which also happens to be my son's definition) of adults older than 50 in my definition of "gerontological." You're not old until 65 -- and I feel that's still young!

How did I go from older adults to HIV? That is a question that I've been pondering for 15 years. Not a logical decision, but a decision nonetheless. The answer to this question lies with a most amazing woman, Dr. Sherry Luck, an internal medicine specialist in Chicago, Ill. Back in 1995, she became my clinical preceptor for my post-master of science as a gerontological nurse practitioner. Dr. Luck was providing medical care to adults in day care. Blew me away!

I didn't realize at the time that she had started an HIV clinic on Chicago's South Side for indigent, underinsured, uninsured and disenfranchised HIV-positive persons -- the people who had been kicked to the proverbial medical-care curb due to poverty and other societal ills. All of the major medical centers were out of reach because transportation was not affordable when you used all your money to eat and have shelter. Dr. Luck truly believed that persons living with HIV should have expert medical care and social services within their own community.

By October 1997, Dr. Luck had virtually dragged me to this clinic at Roseland Community Hospital, where I began part-time. You see, Dr. Luck believed in me and in her vision. I started working one day a week before I left Rush University and Northwestern University (holler Magnificent Mile) to work there full-time.

My first days left me ready to run back to the "top-drawer" facilities, questioning my sanity. I remember one moment in particular when I was shocked to find my patient perming her hair in the exam room sink (after stealing the relaxer kit from a drug store). But after the shock wore off, I had to laugh! There would never be a dull moment from now on. I was good and caught.

Caring for HIV-positive people has been my passion and mission ever since. I wouldn't consider any other field to work in. Over the years, I have run a clinic that was rededicated in Dr. Luck's honor (Luck Care Center in Chicago); volunteered in Ethiopia to assist health care providers in scaling up antiretroviral therapy with the help of the Clinton HIV/AIDS Initiative; taught an HIV curriculum to nursing students in Suriname, South America; and I continue to precept health care providers and lecture (to everyone) across the country.

Bethsheba Johnson (in green) at a meet-and-greet with former President Bill Clinton for Clinton HIV/AIDS Initiative volunteers; Addis Ababa, Ethiopia, 2006.

Bethsheba Johnson (in green) at a meet-and-greet with former President Bill Clinton for Clinton HIV/AIDS Initiative volunteers; Addis Ababa, Ethiopia, 2006.

My friends and colleagues describe me as nurturing, compassionate and extremely down to earth. There is nothing I won't or can't discuss with my patients -- to their chagrin at times (including sex -- I'm a hot mess on that topic). Silence is not my issue!

One of my passions is HIV prevention, in addition to the medical care I provide currently in Dallas, Texas. Another is empowering women in the areas of health, education and finances. Yet another, as you can probably imagine from my gerontology background, is the topic of HIV and aging.

When I began working in HIV, there was a paucity of literature on the topic of HIV and aging, because we had not expected people to live as long as they are currently. This changed with the advent of highly active antiretroviral therapy. As providers, we are observing an increase in patient co-morbidities (cardiovascular disease, neurological complications, decreased bone density, renal dysfunction, hypogonadism and other endocrine disorders, lung disease and non-HIV-related malignancies) in addition to the iatrogenic effects and toxicities caused by the very therapy that has provided longer life expectancy.

How do we assist our clients in teasing apart what is normal aging versus what is not? For example, a woman in her mid-to-late 40s presents with complaints of amenorrhea. Is it menopause, a normal aging process? Or is it a lack of menses due to HIV's effect on the immune system? We know the average age for menopause is approximately 52 years of age, but we also know that HIV can be associated with premature cessation or interruption of menses. Both conditions can present with night sweats, depression and arthralgia. Knowing the natural aging process and the effects of HIV can lead to the appropriate assessment of this issue through a review of the patient's medical history and laboratory work-up. This is just one example of how aging can mimic a disease state, and it's one of many complex issues we will have to unravel in the future as our patients live longer.

Of course, this is only one of many important issues impacting my patients -- and yours as well, I'm sure. I'm looking forward to sharing with you the work that's grown out of all these passions of mine, and to having a dialogue on topics that are clinically relevant to your practice as health care providers, but that you may not often read about in the medical or field-related journals.

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