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Jodi Tullman
San Antonio, Texas
 


Jodi Tullman
  As an HIV nurse responsible for the treatment and care of HIV-positive Air Force personnel in Texas, Jodi Tullman has had a unique perspective on a section of the U.S. epidemic that often goes unnoticed.
Research Nurse in a Texas Military Medical Center After a quarter century as a nurse, Jodi Tullman is still enthusiastic about her chosen profession. "I've got the best job in the world!" she says. After a long nursing career in the Air Force, traveling around the country and the world with her husband and two children, she entered HIV care four years ago. She took her current position at the Wilford Hall Medical Center in San Antonio, Texas, because she felt a desire to contribute to ongoing research of HIV in the military. The military has done some of the most extensive research on the natural history of HIV, in part because the virus is a concern for its soldiers (particularly overseas), and in part because HIV's impact in many countries has become a national security issue.

Although there are about 150 HIV-positive Air Force men and women now serving on active duty, Jodi says that since the beginning of the epidemic, more than 1,300 active members have been diagnosed with HIV. She is constantly amazed by the courage of her HIV-positive patients -- though she admits that people with HIV in the military still face stigma, disclosure issues and potential reassignment, since HIV-positive officers cannot serve overseas. Fortunately, many of these officers have Jodi to rely on for outstanding care and support.

PRACTICE

What is it like for someone with HIV in the military?

We have approximately 400 patients in our research group, 150 still in active duty. The remaining patients are medically retired from the military. We have a few military-dependent spouses, approximately less than 1% of our population. There are mostly males in our HIV trial; less than 1% are females. The ages of our patients range from 19 to mid-50s, with the vast majority between the ages of 25-40. Since the beginning of the HIV epidemic, more than 1,300 Air Force active duty members have been diagnosed with HIV infection. Our active duty patients speak about the many additional challenges they face including stigma and disclosure issues. Some patients also talk about their regrets about the resulting limitations on their military assignments, as currently they are unable to be stationed overseas once they are diagnosed HIV positive.
"Since the beginning of the HIV epidemic, more than 1,300 Air Force active duty members have been diagnosed with HIV infection."

How often must military members test for HIV?

Active duty military members are currently tested for HIV every two years, prior to overseas deployment, and during evaluation for any new sexually transmitted diseases. Once they test positive, they return to Wilford Hall Medical Center twice a year for medical evaluation throughout their entire military career. Wilford Hall Medical Center coordinates HIV care and referrals on all active duty Air Force members. After retirement, if they are enrolled in our Natural History study (this program follows HIV-infected people in the U.S. military healthcare system to see how they are doing over a long period of time), the Henry M. Jackson Foundation will fly them in twice a year to continue their participation in the HIV research program. For patients who agree to participate in our natural history study, we collect data and offer support and encouragement after their diagnosis, regardless of mode of transmission.

What education or counsel do you provide to newly diagnosed patients?

We provide a two-week process for all newly diagnosed patients that includes educational classes, participation in support groups with other military members, mental health evaluation, consultation with a public health nurse, consultation with a military chaplain, if requested, and one-on-one consultations with nurses for any patients needing additional support.

What's the best part of your job?

Being able to make a difference in the lives of my patients. Listening to them, being able to direct them to the care they need. Being a sounding board to help them make a decision they are wrestling with. Also, working with a dedicated team of professionals. I am the clinical research coordinator for the Henry M. Jackson Foundation for the Advancement of Military Medicine. This job uses a lot of my nursing skills, a mix of research, gathering data, clinical evaluation, patient education, counseling newly diagnosed patients and database organization. All the skills I enjoy using are present -- I haven't been bored in four years. I have never worked with HIV patients before. I feel intellectually stimulated and hopefully can share that with the patients as well.

What is the most important thing you have learned from your patients?

I am constantly amazed at the courage my patients display as they deal with all the physical, emotional, and psychological challenges that go along with this disease.

Do you have a favorite patient?

I have fond memories of so many patients over the years that it would be hard to select just one. They are all unique and I am in awe when I observe the strength and courage that many of them display when they are in their weakest condition.

What have been your greatest successes?

I am proud of my experiences with team building, whether it has been a nursing unit, committee or a special project. I feel successful questioning the status quo and getting policies changed because it is the right thing to do.

What is the biggest challenge you face?

Assisting patients and families through the death and dying process. I feel I have to use every nursing skill that I have to assist patients through that process. I haven't lost many patients in my four years here -- our patients are doing really well, so I don't have to deal with it on a day-to-day basis.

What change would you like to see in today's HIV care?

I would like to see research being available to a wider population. Many of my patients live in different areas of the country and want to be involved in other HIV research projects, but unless they live in a big city, they are unable to find any that are close to their home. I think being involved in research gives patients hope in finding a cure for HIV/AIDS and the satisfaction of knowing that they are doing something for the greater good of mankind.
"It could be just one time, your unlucky day when all the factors are in line, and the virus is passed."

What HIV-related studies are you currently working on?

Currently, I am working on the HIV/AIDS Natural History Study, a tri-service (Army, Navy and Air Force) study of HIV disease in United States Military Beneficiaries.

While I am in South Africa in May 2005, I will continue assisting with Project PHIDISA: A Prospective Epidemiological Cohort Study of HIV and Risk-Related Co-Infections in the South African National Defense Force (SANDF).

What do you think is the biggest problem people with HIV face?

People don't want to have side effects to their medications. Nausea or diarrhea keeps them from being able to function normally and many patients now have to deal with metabolic changes. Their cholesterol and triglycerides are skyrocketing due to the medications and some are dealing with diabetes and issues of fat redistribution or facial wasting.

What are the biggest risk factors for HIV?

The biggest risk factors are a lack of education and the feeling of invincibility. Certain behaviors are more dangerous than others. It could be just one time, your unlucky day when all the factors are in line, and the virus is passed. This foundation serves the Air Force population and we do routine testing of people in the military and some of the patients who come to us so young and naïve. I don't know how many patients I have counseled that have said, "I didn't think it would happen to me" or "if I knew this earlier, I may have changed my behavior."

Do you think that the prevention efforts widely available today are sufficient?

I think there are groups that aren't really being targeted. I firmly believe abstinence-only sexual educational programs are unrealistic. Even if we teach people to avoid certain situations, they may still be presented with them and have to think quickly. I believe that if you give people the right information, they have a better chance at being able to protect themselves. There is also the down low phenomena -- J.L. King, the author of a book about this, called On the Down Low was on the television show Oprah. J.L. King spoke about down low phenomena in the African-American community, when a man with a wife or girlfriend sleeps with men on the side. These men don't see themselves as gay, so they don't look at any of the prevention efforts targeted to gay men.

If you are living with HIV or were to become infected, at what T-cell count would you begin treatment?

I would probably wait until my T-cell count dropped below 200. The more we find out about side effects of medications, the more I would prefer to wait until I absolutely needed to. I would try to choose a treatment regimen with minimal impact on my busy, active lifestyle.

What's the key to a great healthcare provider/patient relationship?

Listening to what the patient is really saying, not just to the words being spoken.

How do you feel about patients who take a proactive role in their own treatment?

I want patients to be involved in their care! I want them to be an advocate for their own healthcare. Many of my patients are extremely proactive. I am happy when they call me about new treatments or research they have heard about or read on the Internet. It keeps me on my toes and makes them more informed.

PERSONAL

Where did you grow up?

I'm from a small community in upstate New York. I am the second child of a family with nine children (7 girls, 2 boys). My siblings and I remain very close despite living in five different states. We have a monthly chat room that we participate in to keep up with the news on everyone. We also get together once a year at my parents' home in New York -- they still live where I grew up.

When did you decide on nursing school?

I started college with the intention of becoming a speech and hearing therapist, but decided halfway through the first year that I really wanted to be a nurse and switched my major.

What made you decide to go into HIV care?

I was getting ready to retire from the military when the chief of the Infectious Disease department told me there was going to be an opening with the Henry M. Jackson Foundation in their HIV research program. I applied and started working the day after I retired from the military. I just celebrated my four-year anniversary in this position.

How has your job changed since you started in nursing?

I joined the Air Force, got married and had two children, retired from the Air Force, and got the best job in the world. I am now able to see the bigger picture, of family and society, and that affects my patient care. When you first start in nursing, it's easy to get caught up in the details. After several years, you become more concerned with what the patients' needs are and more time goes into discovering what is really bothering the patient.

Who have been the most influential people in your life, professional and personally?

Personally, my father was influential because of his ongoing encouragement for education, and my mother for her spirit of volunteerism. Professionally, I would have to say I have been influenced by every woman I worked with who successfully juggled their careers and families.

What work would you do if you weren't a nurse?

I would be a professional counselor; I am currently enrolled in a graduate program in counseling. I feel that I have good instincts about people and I enjoy helping them work through the difficulties in their lives.

"If you give people the right information, they have a better chance at being able to protect themselves."

What are your hobbies?

I love to read, watch movies, travel and hike. I work out three days a week, and sometimes we travel. I like outdoor activities, and I want to learn to kayak this summer. I'm a die-hard Survivor fan. I'm also going to run a marathon when I'm 50, as I've had some practice with some road races (10K and 15K).

What about your family?

I have been married to my wonderful husband for the past 23 years. He retired from the Air Force as a Colonel two years ago. He was an aircraft maintenance officer. After his retirement, he signed up for the Air Force Reserves, where he now works as an Emergency Preparedness Liaison Officer (EPLO) for the state of Texas under Air Force National Security Emergency Preparedness (AFNSEP) in support of the Office of Homeland Defense. He has truly been my rock throughout my entire career. He deserves a special award for staying with me for all these years! We have two terrific sons, Andrew, 21 and Brian, 18, and a cat named Christy.

Where do you live? What kind of community is it?

I live in a small community on the outskirts of San Antonio, Texas. The town is extremely spread out; there is the Alamo, so it's kind of touristy town, but low key. The city is quaint and there is a lot of culture and history.

If you could live anywhere else, where would you choose?

Being in the military for 20 years, we lived in many places: Texas, Florida, New Hampshire, Idaho, North Carolina, Nevada and Japan. Plus I completed my nursing degree in New York before I joined the military. Every place had its unique qualities, but I would have to say that my favorite assignment was in Idaho because of all the outdoor activities. Although we love living in San Antonio, I think Idaho would be our next choice.

What the best vacation you've ever had?

I would have to say it was a vacation to Acapulco, Mexico, two years ago with my husband, children, parents and parents-in-law. Although it was a logistical challenge with so many people, I cherish the memories. Our parents are getting older, and it was a nice time to spend together.

What's the biggest adventure you ever had?

Last year, I traveled to South Africa for three weeks to work on Project PHIDISA, a collaborative effort between the U.S. Department of Defense, U.S. National Institutes of Health and Medical University of South Africa, to help set up a research program to provide HIV treatment to the South African National Defense Force members and their families. I saw advanced cases of AIDS that I have never seen in my current position and people were so anxious to get into the clinic and get on medication. I also had the opportunity to explore a bit of their beautiful country and meet some wonderful people. I will be returning this year in May for another three-week assignment.

What are you currently reading?

Currently, I am reading my counseling textbooks, but I usually love to read medical thrillers. I just started the book, We Are All the Same by Jim Wooten, about a young boy in South Africa who was born with HIV.

Is there anyone who you would like to dedicate this award to?

I would like to dedicate this award to the team of professionals I work with at Wilford Hall Medical Center who continue to advance the field of HIV research and make a difference in the lives of the individual patients we see. I'm here because they asked me to be part of their team and I've never worked with a team that works so well together.

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