Bringing the Mountain to Mohammed: A Mobile Dental Team Serves a Community-Based Program for People with HIV/AIDS

Despite a direct referral system of oral health linking primary health care and dental care providers, most HIV-positive patients at the Columbia Presbyterian Medical Center had been receiving only emergency and episodic dental care between 1993 and 1998. Columbia University's School of Dental and Oral Surgery offers programs and training in predominantly minority and economically disadvantaged communities in northern Manhattan. Recently, the school developed a mobile program to bring dental health care services to community-based organizations serving people with HIV/AIDS.

On July 1, 1999, WE CARE was opened in Harlem, Washington Heights and midtown Manhattan. Focusing upon African-Americans, Hispanic, low-income women and children, homeless youths, gay and lesbian clients and transgendered individuals, the program offers dental services via a mobile van.

Between July 1999 and July 2000, WE CARE served 283 patients, 73 percent of which were African-American, 25 percent were Hispanic, and 2 percent white. Almost half of all clients were women and more than half suffered from multiple illnesses besides HIV/AIDS, including substance use, mental illness and TB. Seventy-eight percent of clients were between ages of 20 and 49.

Culturally competent services included mobile dental teams offering prevention, early intervention and linkage to comprehensive care. Personnel consisted of highly trained team members (primary care dentist, coordinator, dental assistant and a primary care postdoctoral trainee in general dentistry) able to work with communication and cultural barriers. Teams traveled to outreach sites four days a week. Portable equipment was stationed at each site and instruments were sterilized at the School of Dental and Oral Surgery.

A follow-up focus group of 10 WE CARE patients was convened at one of the sites in June 2000. They reported no regular use of primary care services before WE CARE, and many indicated that it had been more than 2 years since their last dental visit. The participants cited several barriers to seeking care: fear of pain; lack of available services; lack of provider education about their specific needs and concerns; fear of contracting illness, given their compromised immune systems; and, most important, the social stigma associated with HIV/AIDS. All participants expressed high satisfaction with the program and felt that WE CARE was among the best services offered by their community-based organizations.

In their discussion of the program, the authors stressed that "it is crucial to expand the scope of this program and simultaneously to increase efforts to educate other dental providers on the specific oral health needs of patients with HIV/AIDS. If the oral health status and quality of life of this special population is to improve, the concerns of both patients and providers will have to be addressed."

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