Although he has been a physician assistant since 1987, Wes didn't begin to focus on HIV until the early 1990s -- when one patient in particular changed his life forever. "It was spring of 1993. I was just learning about HIV," Wes recalls. "He was the third HIV patient I had met. I didn't recognize him at first, and then he said, 'Don't you recognize me?' And I realized I had known him 15 years earlier."
Wes says that, at that moment, he envisioned Christ knocking three times at Peter's door -- this long-lost friend, his third-ever patient with HIV. It was an image that, Wes says, told him to "pay attention." Wes realized that the missionary-type work he had sought all his life was right in front of him -- as a healthcare worker treating people with HIV. "We both cried, and it was then I realized that taking care of HIV patients was my mission field, my calling," he says. "I have never doubted it since."
Though Wes describes himself today as "not overtly religious or spiritual," he says that "each person's pursuit of their individual path to the holy excites me. I believe in a creative force that many would call God. The greatest gift is life in the here and now, and we must make the most of it. I tell my patients, 'Part of your health is going to be forgiving yourself. You did nothing wrong in getting HIV. I don't do guilt, so let's get that out of the way. If you don't have any guilt, you're way ahead of the game.'"
Wes learned his own lesson about guilt at age 19, when he was in college and struggling with his homosexual feelings. He had sought both medical and religious "cures" for his homosexuality. Finally, believing he was an "awful reprobate," as he puts it, Wes was on the verge of taking his own life. But a voice in his head told him to stop -- that he was exactly who and what he was supposed to be. "A peace washed over me that I can't explain," he says, "and my tears turned to laughter."
And also, years later, into hope and healing for the HIV-positive people who would one day come to him for their care.
Wes is fluent in American Sign Language, with knowledge of French, Chinese and Spanish. He seems to take pride in his ability to set his patients at ease and the feedback from his patients affirms his success at this. An astonishing 13 of his patients nominated him. "He is the best health care provider I have had in my 17 years of HIV." "From day one, Wes was probably the most personable doctor I have ever met in my life. He immediately got to know me on a personal level and made it extremely easy for me to ask even the most personal question ..." "I had T cells in the teens. I felt I couldn't make it on my own. After meeting Wes, I knew I wouldn't have to."
Who are your patients at the Jemsek Clinic in Charlotte?
My patients range from the transiently housed to the well-to-do. Straight, gay, transsexual and everything else that doesn't quite fit into a box. We are a mix of urban, suburban and rural. The number of immigrant patients is increasing every week. We see many poor patients and yes, African-American women is the fastest growing sector. I see lots of patients with who pay for their care through Ryan White and the North Carolina AIDS Drug Assistance Program (ADAP). The rest are a mix of Medicaid, Medicare and private insurance. I see a few deaf patients where I use sign language and their issues are the same as those who can hear and speak.
What made you decide to learn sign language?
I had a uncle who was deaf and I was fascinated with how he talked with his hands, so I grabbed a book and taught myself sign language.
Is there anything particularly challenging or different about working in AIDS care in the South? Can you give specific details?
I am a Southerner so I can say what I am about to say! HIV is growing rapidly in the South because of a lack of education and a misguided mentality that thinks if you preach abstinence, people will listen. Teenagers are barely more than hormones in tennis shoes. Fifty-five miles per hour is the law and how many of us drive 55?
Is there a "down low" phenomenon in this community? Is this new or just newly named?
It is newly named. We have always had this phenomena. I can't tell you how many cash-paying John Smith's and Jane Smith's I have come to clinic for HIV testing and also treatment for STDs that they do not want to bring home to their wives/husbands/partners.
In general, can you describe how has your ability to treat people with HIV changed over the years? Do you feel people walking into the clinic today feel less stigmatized by the disease? Are their relatives more supportive? Are there more options for them for support?
Treatment has improved over the years but, at least here in Charlotte, there is still an HIV stigma that makes it hard for some to seek out and get treatment. I have maybe a hundred or so patients that drive over an hour to come see me instead of being seen in their home town by their local primary care providers because of their fear of disclosing their HIV status.
Are you seeing more women in your clinic lately? From which community?
Yes. Over half of all my new cases are women and 80% of those are minorities.
What are the particular needs for women with HIV?
First and foremost, the needs are the same for all women: access to healthcare, transportation and childcare. Women experience more side effects and opportunistic infections sooner or at a higher CD4 count than men, so there is a need to watch our female patients more closely.
What percentage of your clinic are immigrants. Where do they generally come from?
About 10% are immigrants and most are Latino. There is certainly a cultural effect that has to be taken into account when designing treatment options.
Any other immigrants you work with?
Our clinic is very diverse. We have no immigrants working here but we do have gay, straight, bisexual, male, female, black, white, Latino, Christian, Jewish and pagan employees.
Since you have worked in HIV from the very beginning, can you describe your experience in the initial years. How did you handle having so many patients that you had nothing to offer in terms of treatment? Were you more stressed out in those years than now?
The early years were tough. A lot of hand holding and funerals attended. The stress level is the same, but the source is different. Early on, it was the inability to treat and the loss of so many lives. Now it is medication side effects, long term effects of HIV on the body, maintaining adherence and patient's access to healthcare.
Can you tell me specifically how meth has impacted patients already infected?
The number of gay men seroconverting each year declined here until crystal meth made its appearance in the gay community in Charlotte around 2001. Most of my new gay male seroconversions now involve crystal use promoting unsafe sex. In my HIV-positive patients who use crystal, we are seeing rapidly developing mutations and detectable viral loads despite 100% compliance to the medications.
What's the best thing about your job?
The patients and the team of nurses and support staff who make what I do possible.
What's the worst thing about your job?
When I lose a patient.
What have been your greatest successes in your work? Greatest failures?
Greatest success is seeing my patients live full healthy and happy lives. I can't think of any greatest failures or anything that I would label as a failure. I have made mistakes, which are always opportunities to grow and learn.
What is the biggest challenge you face?
Emotional burnout. HIV demands a lot of care and compassion. There are so many elements to the care of persons living with HIV that it is easy to experience burnout.
What do you think is the biggest problem people with HIV face?
The continued social stigma of feeling like a second-class citizen or a pariah.
What do you think is the biggest risk factor for HIV?
Lack of education about the disease and its prevention.
What single change would you like to see in HIV care?
National health care. More access to health care would improve the health of those living with HIV and could prevent the spread of HIV.
What education or counsel do you provide to a patient who is about to begin treatment?
I personally counsel patients on treatment options. I supply them with written literature and Web sites, and the patient and I work as a team to initiate treatment.
What treatment regimen would you choose if you had to begin treatment today?
The regimen would vary depending on my circumstances. I generally follow the DHHS guidelines, but I do tailor a regimen to the individual. If I had to choose a regimen right now for me, I suspect I would choose Truvada and Sustiva.
What's the key to a great healthcare provider/patient relationship?
Trust and commitment.
How do you feel about patients who take a proactive role in their own treatment?
I have many patients who are proactive. I welcome those patients. Proactive patients tend to be more adherent and healthier.
Who was your all-time favorite patient and why?
The third HIV patient I met. It was spring of 1993, and I was just learning about HIV. I was scared and so was he. I didn't recognize him at first and then he said, "Don't you recognize me?" And I realized I had known him 15 years earlier. We both cried, and it was then I realized that taking care of HIV patients was my mission field, my calling. I have never doubted it since.
What is the most useful thing you have learned from your patients?
Be honest with them and promote a nonjudgmental atmosphere so they can be honest with me.
How do you maintain a positive outlook and avoid burning out?
Good question. I don't always succeed. Generally, no matter how bad it gets, I try to remind myself that I am making a difference. Oh yes, and I tell myself, "Every day above ground is a good day!"
If you weren't a clinician what would you be?
I would be in a religious vocation. I have always had a spiritual side, and what I do daily with HIV involves a level of spirituality. In many ways, spirituality defines my practice and me. I believe that there is spiritual aspect to the practice of medicine. I don't equate spirituality and religious, although they do overlap and many people approach their spirituality through religion. I always try to get my patients to believe in themselves and think positive thoughts. I want them to perceive themselves as being healthy and well. I truly believe it helps my patients to live healthier and longer lives through this kind of spiritual approach. I do note that my patients who are active in a house of worship, or who meditate or do some other form of self reflection, are healthier than those who do not.
We'd like our readers to get a sense of you as more than just a clinician, by sharing a little personal information about yourself. Where did you grow up?
Several small towns in Rowan County, North Carolina.
What kind of work did your parents do?
My father worked the freight yards for Southern Railway. My mom worked as a bank teller, telephone operator, secretary, bookkeeper and owned a dress shop.
When did you decide that you'd like to be a physician assistant?
April 1984. I moved to Durham, anticipating acceptance to medical school. While I waited, I met my neighbor, who was a physician assistant. I did not know what physician assistants were but I was excited and immediately went to the Duke physician assistant program and applied.
Who were the most influential people in your life, both professionally and personally?
My parents, Joel and Coleen Wes. Charles Yates, my high school French teacher, and Brenda Shepherd, my high school science teacher. They were very much my mentors. My roommate in college, Avijit Roy, who showed me the world. Frank Montgomery, who always gave good advice and great fried liver mush sandwiches! And finally, my partner, Trey, the man who has always believed in me.
What do you do in your spare time?
What free time?!? LOL. I love to travel. And I love to read.
Do you have a partner? Pets?
My partner is Trey Owen and we just celebrated our 18th year together. Our family includes two miniature schnauzers, Maximillian and Berkeley, seven and 11 years old.
Where do you live?
I live in Charlotte, North Carolina, in a diverse neighborhood.
If you were to live anyplace else, where would it be?
Chicago in the United States and Sydney, Australia, internationally.
What's the biggest adventure you ever had?
My first trip to Malaysia with my roommate in college who was from Malaysia. It was my first trip out of the USA. I think I took a whole roll of film of the clouds just outside the plane window.
What's currently on your bedside table for reading? What book would you say has had the most impact on you?
I have a stack: Manifold Space by Stephen Baxter, Patrick by Stephen Lawhead and Truth and Fiction in the Da Vinci Code by Bart Ehrman. The book that has the most influence on me is The Truth About Christianity by Bishop John Spong.
What kind of music do you listen to?
I like all kinds, but lately I have found my radio tuned to country music, which I swore I would never listen to.