As clinical director of the University of Utah Hospital's Infectious Diseases/HIV Clinics, Dr. Ries oversees 1,000 patients and directly treats 500. She also teaches about HIV care and regularly travels throughout Utah to provide HIV treatment to patients in rural areas. This means that she is responsible for some 90 percent of the HIV patients in Utah and surrounding areas. She is so revered that Utah's People Living With Aids (PAW) coalition not only bestowed its first activism honor upon her 18 years ago, but also named it after her: The Kristen Ries Community Service Award.
It's an apt honor for the doctor who, after graduating cum laude from Women's Medical College of Pennsylvania, landed in Salt Lake City in 1981, about the same time AIDS began appearing in California. In private practice and later at the University, Dr. Ries witnessed the spread of HIV into Utah and was among the first -- and the few -- to take action. "There were a lot of doctors who would not treat the disease because of fear of the unknown or on moral grounds, since it was first identified as a gay male disease," Dr. Ries recalls.
Today, despite progress in medicines and treatment, the noted medical ethicist and outspoken advocate for HIV care decries the fact that more isn't being done to ensure equality of treatment. "The greatest failure is that we have not been able to get more people interested in care of the underserved," she says. "A lot of people in medicine don't want to take care of poor people."
It isn't hard to understand why Dr. Ries, who reads ethics and philosophy as well as mysteries for relaxation, might be baffled by such attitudes. On her night table is a copy of Camus' The Plague. "You can probably guess why it calls to me," she says.
How long have you been practicing?
I've been practicing for thirty years.
Can you describe how your work has changed since you started?
I have always been passionate about medicine and delivering good care. In the last 20 years, my practice has become almost all HIV/AIDS focused and I have become more and more involved in training and education to be sure that the patients will have care.
What's the best thing about your job?
The patients. They have patiently taught me all that I know.
What's the worst thing about your job?
The political climate of trying to serve the underserved; striving for equality.
What have been your greatest successes and failures?
The greatest success: the quality of care that we have been able to deliver on a daily basis. The greatest failure: that we have not been able to get more people interested in care of the underserved. A lot of people in medicine don't want to take care of poor people. But there are dedicated people out there and it is improving.
What is the biggest challenge you face as a clinician?
The biggest challenge is to continue to work on a daily basis and to not burn out.
Is there anything particularly challenging or different about working in AIDS care in a place that is largely Mormon?
Yes, as in any conservative community, things continue to improve, but slowly, and lately Salt Lake City may be going more conservative as goes the country. Even the Mormon people have become much more accepting. An example is the PBS documentary The Smith Family about Steve Smith and his struggles with homosexuality and how he was infected with HIV and later infected his wife.
In general, can you describe how has your ability to treat people with HIV changed over the years? Is it easier to give care, for instance, for the uninsured?
Things have gotten a lot better, but now things are back to ground zero. Medical care in America is at risk.
Are you seeing more women in your clinic lately? From which community?
Yes, but not a lot. They are mostly minorities.
What are the particular needs for women with HIV?
Housing, drug treatment and general support.
What percentage of your clinic are immigrants. Where do they generally come from?
Many from Mexico, Central and South America.
Any other immigrants you work with?
We are one of the 12 centers for HIV-positive immigrants. We have about 35 patients from Africa. This has been a remarkable experience. Most have done very well and assimilated well.
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 who you had nothing to offer in terms of treatment?
I'm sure in retrospect that I had post-traumatic stress disorder, but now it seems I am much more stressed with the current difficulties with getting care for people.
What do you think is the biggest problem people with HIV face today?
For many of the patients, the biggest problem is the lack of life's skills. This has often been the risk factor that led to the behaviors that led to infection and makes life so difficult.
What other risk factors contribute to HIV?
Childhood trauma and being human.
Do you think that prevention efforts are sufficient?
No, we are not reaching the right population; we need research on how to do prevention. We also need to be honest and frank about the disease and prevention.
What single change would you like to see in HIV care?
For HIV care, as well as care for all illnesses, we need a coordinated, streamlined program rather than the patchwork quilt that delivers unequal care.
What education or counsel do you provide to newly diagnosed patients?
We always must be totally patient-centered and begin with the knowledge that the patient has already. One size fits one!
If you were infected with HIV today, at what T-cell count would you begin treatment?
I don't know. Theoretically right away, but likely would wait until 250-300.
What's the key to a great healthcare provider/patient relationship?
Partnership and mutual respect, with clear boundaries.
How do you feel about patients who take a proactive role in their own treatment?
The best patient is a proactive patient. Many of my patients are proactive. It is important to be aware of the difference between being proactive and being in control simply for control's sake.
Who was your all-time favorite patient and why?
I don't have favorites. All my patients are special to me.
What is the most useful thing you have learned from your patients?
How do you maintain a positive outlook and avoid burning out?
Look at the whole picture and staying positive and realistic.
If you weren't a clinician what would you be? Why?
I wouldn't be anything but what I am.
Who would you like to dedicate this award to?
To my parents who helped me to become who I am!
Where did you grow up?
I grew up on a dairy farm in Pennsylvania.
What did you want to be when you were a kid?
I always was going to be a doctor, but as a kid I didn't know what that was. It has been a gift.
When did you decide on medical school?
I'd always wanted that since childhood. But I had trouble in college and my grades weren't good enough. It wasn't until I was in graduate school studying secondary education that I discovered I was colorblind and that had affected my learning. So, I went back and earned my way into medical school. It was like getting a second chance to be what I always wanted to be.
What made you decide to go into HIV care?
Well, I was around before HIV/AIDS even started appearing. And when it did, it quickly became obvious that there was a pressing need. There were a lot of doctors who would not treat the disease because of fear of the unknown or on moral grounds, since it was first identified as a gay male disease. In fact, it was known as GRID, for Gay-Related Immune Disorder. No one would take AIDS patients, including the University. And it was their loss.
It's also a terribly interesting disease because of all the social and ethical issues that it embodies in terms of care. At first we thought we could cure it. Then we thought we couldn't. Now we're more into long-term care giving, hoping for a cure. I have one patient I've been seeing since 1983 and he's still around and kicking.
Who were the most influential people in your life, both professionally and personally? Why?
My parents. Even though we were extremely poor, they were good role models and provided a positive value system. They taught me about the value of hard work and doing your best even in trying times.
What do you do in your spare time?
I love to read and get outside here in the great Rocky Mountain west. Maybe some day I'll travel a bit, see Alaska and the Galapagos Islands.
If you had anyplace to live besides where you live now, where would you live?
Nowhere else. This is home and I love it. Getting up in the morning and breathing in that good, clean, fresh air is really wonderful.
What's the best vacation you ever had?
A trip to Antarctica.