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Tari Gilbert
San Diego, California
 


Tari Gilbert
  Nurse practitioner Tari Gilbert is an HIV research coordinator in San Diego, CA whose desire to connect on a personal level with her patients brings an essential, holistic touch to their clinical care.
Connecting With Patients, Hungry for Knowledge

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For Tari Gilbert, HIV nursing is not just about treating a patient's medical problems and sending them on their way. "Nursing involves my intellect, emotions and spirituality," Tari says. "I don't just see my patients' problems as clinical, but I look at the whole picture, what's going on in their life that could create or intensify this problem."

This dedication to connecting with her patients and getting to the bottom of their problems extends to the other half of her job as well -- a study coordinator for HIV clinical trials at the Antiviral Research Center at the University of California-San Diego Department of Medicine. Passionate, motivated and hungry for knowledge, Tari conducts studies and frequently speaks about primary HIV infection and hepatitis C coinfection, the main focuses of her research.

It is her extraordinary personality and her total commitment to her patients, however, that led to Tari's nomination for an HIV Leadership Award. She believes that nursing, particularly HIV nursing, must be a personal affair -- that a good nurse has to act as a guide and an advocate for his or her patients. Clearly, Tari has succeeded in being both.

PRACTICE

Tell us a little about how you got into nursing.

My father was in the theater and my mother was a social worker. We moved a lot when I was a child because of my father's profession. I think because of this, I leaned toward my mother's teachings of practicality and service. I knew I wanted to do something where I could help other people. Someone's life may be improved by what I do, and nursing involves my intellect, emotions and spirituality.

"I don't just see my patients' problems as clinical ... I look at the whole picture."

Can you tell us about your work?

As a nurse practitioner at a clinical research center, I have access to both sides of the patient care spectrum. I coordinate studies and see patients, and diagnose and manage specific health problems more intensely than when I was a nurse. I often treat the patient, know their family and gain emotional accessibility. I don't just see my patients' problems as clinical, but I look at the whole picture, what's going on in their life that could create or intensify this problem.

Is there anything particularly challenging or different about working in AIDS care in San Diego (i.e., more military people or more immigrants)? Can you give specific details? How have things changed in this community over the years?

There are several challenges that are perhaps unique to San Diego. First, there is a large Latino population. This includes people who are monolingual, people who are recent immigrants or perhaps undocumented, people who are living within their traditional culture and may not identify as gay although their sexual practices may include men (which, of course, puts their female partners at risk).

There is also a large military population, which has several implications. First, there is the silence that accompanies being in the military in the first place: don't ask/don't tell. Second, there is the difficulty of seeing your patients be sent off to war. I know they're not supposed to be placed in a war zone when they are positive, but sometimes this detail seems to slip through.

Another difference is the transitory nature of San Diego. This is due, in part, to the military presence, but also to the fact that there are many other people (civilians) who make San Diego a temporary home before moving on. This can make building relationships difficult, and patients can suffer gaps in their health care. And the cost of living in San Diego encourages some to move away, though they may even have to endure a bout of homelessness before leaving for a less expensive area.

One last issue (not entirely unique to San Diego, but I think we were among the first to experience it) is the [crystal] meth epidemic. We've been known as the "meth capital" of the world since the '80s -- a dubious distinction. As meth has penetrated the gay community, HIV prevention has become both more difficult and more urgently needed.

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? 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?

I think that it is easier these days, for several reasons. Funding is less of an issue these days (at least in California -- though that may change), and there is less general stigma about being gay than there used to be, although there remains a stigma about being positive. I think that, though San Diego is a bit more conservative than other California cities, its sheer diversity is so welcoming to people who may have been the only gay person they ever knew in the small town that they grew up in. More of my patients have families who are supportive of them as people, but are not certain if their families would continue to be supportive if they knew they were positive. I also have many patients who put it bluntly: "I was raised in enemy territory and I got out as soon as I could."

Luckily in San Diego, there are structures in place to help with support. We have therapy available within our programs, and there are many support groups I can refer people to. There is housing support, work support, alternative/complementary medicine, etc., etc.

Are you seeing more women in your clinic lately?

Yes, though I'd like to see even more because I know there are many women who aren't even aware that they are positive yet. There are especially more women of color who are positive, relatively speaking to the population.

What are the particular needs for women with HIV?

Many women who are HIV positive are also caring for others -- children, partners. They tend to put the needs of others before their own, and their health care suffers for it. We try to have events designed for women only, complete with childcare, education, dinner, fun, but women (as a rule) seem to consistently put their own needs last.

What percentage of your clinic patients are immigrants? Where do they generally come from? Any anecdotes to share about this community? What are the kinds of issues they face that are different from non-immigrant patients?

We have a fairly high Latino population, though not all are immigrants. In San Diego, the majority of immigrants are from Mexico. I know patients who have fled their country because of persecution for their lifestyle or their transgendered status. I also have a number of patients in bi-national relationships, which is difficult since our country doesn't allow same-sex partners to petition for citizenship.

Any other immigrants you work with?

We have patients from around the world. I'm hesitant to go into specifics with some of these questions because of patient confidentiality, as I don't want to give out possibly identifying information -- sorry!

Are you fluent in Spanish? Do you get to use it a lot in the clinic?

Unfortunately, I'm not fluent in Spanish, but I am able to carry on a conversation and perform a physical. For nuances, we are fortunate to have several highly fluent translators here in the clinic.

"I really feel methamphetamine is a major fuel behind the epidemic."

Can you tell me specifically how methamphetamine has impacted patients already infected? Anecdotes would be great.

Methamphetamine is a serious problem on many levels. It is cheap, easy to find, and completely accepted in parts of the gay community. It lowers sexual inhibitions and heightens the sexual experience -- at least at first. After a little while of use, sexual function actually decreases, so bigger and bigger highs are sought to compensate. Paranoia is another side effect of meth and lives disintegrate with long-term use. I have many patients who come in for testing and relate that they normally practice safe sex, but they were "using meth this one night and things got out of hand." I really feel meth is a major fuel behind the epidemic.

Are you seeing more patients testing positive because of meth? Tell us a little about what you think is going on and which group is particularly affected.

I think this is most prevalent in the gay male (MSM) community. It's seems completely accepted and there is no internal pressure within this community to discourage use. A dialogue has recently begun because a prominent 31-year-old community member died from drug use last month, and alarms were sounded. I am hoping this will be a catalyst for discussion and change!

What happens if someone is illegally in the United States. Can they get treatment? How is this done?

I actually don't know my patients' status (documented or not). I'm not sure of the legalities of this all, but I personally could never deny a patient care because of their status.

How many clinical trials do you manage at any one time? What are the big trials you are now recruiting for or running?

Right now, I am primarily working on a longitudinal, observational acute and early HIV trial. This project includes other trials under this umbrella -- we have several therapeutic vaccine trials starting soon, and are looking at early treatment with several different agents to maximize early immune response. I also work with several HIV/HCV co-infection trials.

How did you feel at that time caring for people who had no treatment options? What was it like to witness all those young men dying?

This was one of the most devastating things imaginable. Before I even became a nurse, I had a high school friend who moved to New York and died of a mysterious pneumonia, which I figured out was AIDS as soon as I knew the term. So I had a personal introduction to the grief before I had a professional one. It just increased my commitment to be the one who would always say yes to caring for these dying young men.

How has being an HIV nurse practitioner changed since you started?

I've only been a nurse practitioner since 1998 and have been lucky that this has been in the era of HAART. Before that, caring was one of the only things available. Now I can at least offer treatment and hope to my patients.

What made you want to go into HIV care?

Personally, I always knew I would be involved with HIV care one day. These are my people. I've lost friends and community to this disease and I want to live to see the end of it. And professionally, it is a very compelling field -- intellectually stimulating, psychically challenging and always rewarding.

What percentage of the people that you see are African American or from a minority group?

Again, not enough, because I know that there are quite a few African Americans who are positive but either not in care or unaware of their status. The majority of our patients of color are Latino.

How has being an HIV nurse practitioner changed since you started?

In the early '80s, I was working in an intensive care unit with many HIV patients. I was willing to take on these patients when other nurses considered it life threatening to care for them. I'm happy that not only the illness, but the way people think about the illness, has changed in the last 20 years. To become infected with HIV today isn't a death sentence like it may have been 10 years ago. I work with a lot of new infections, within the last six months to a year. We are able to test for acute infections, so we receive a lot of patients by referral who would get a negative result on the typical test.

What made you feel differently and more able to deal with people with HIV when so many other nurses were scared?

It blew my mind that people refused to care for HIV-positive patients. As far as I was concerned, everyone should use universal precautions for every patient, so I wasn't as worried about transmission as some people. And I sought out being with gay-identified patients, as I could give them support where others might give them attitude.

How do you keep from burning out?

You must certainly take care of yourself. There needs to be a support system outside your profession. You need some kind of interest that rejuvenates you. Mine is constant education; I always desire to know more.

What's next in your career? When do you expect to get your Ph.D. (and in what?)

I am hoping I will complete my Ph.D. in nursing at the University of San Diego in 2007. I will be performing a phenomenological study researching recently diagnosed men who have sex with men. I'm happy where I am professionally, but I love learning. I am still going to work with HIV patients, because my research will be HIV related. I'll be doing more teaching or research when I get the doctorate, but I envision continuing client care, at least part-time, because of my love for my patients.

"We've been known as the 'meth capital' of the world since the '80s -- a dubious distinction."

Given that there has been more education directed to the general public, why do you think people are still getting infected?

Social conditions, a stigma attached to HIV, homophobia and racism give HIV the opportunity to spread. There needs to be a more realistic approach to prevention on all levels. Individuals need to be honest with themselves about their risk factors. Government funding needs to expand its guidelines to include more than just abstinence.

PERSONAL

What is your life like outside your job?

It's great. I've just become a mother. I live in San Diego, which is a beautiful city. I live near Balboa Park, in a little house with my partner and my two-year-old baby, Maia. She was born in Nepal, and I adopted her a year ago. I went to Nepal to get her. Nepal is a beautiful country -- poor (pollution and poverty) but beautiful. Maia was in an orphanage. She was like a lot of orphans in Nepal, not necessarily unwanted, sometimes their families die or are simply unable to take care of them.

What do you do when you aren't working or playing with Maia?

I knit, sew and cook, and I like to exercise. I walk -- since I've become a mom there hasn't been much time to do much else. I like to be outside as much as possible. In San Diego, we have perfect weather, so I try to spend as much time as I can enjoying it. San Diego may not be as culturally rich as the East Coast cities, but it has a lot of cultural diversity. It accommodates and is comfortable with Latinos, Somalis, Laotians, Cambodians, Indians, various sexual preferences and economic levels.

What music do you listen to?

I listen to a lot of jazz. I like Coltrane, Miles Davis, Thelonious Monk, and on the more contemporary end, I like Cassandra Wilson. I've always admired musicians. If I could get a talent by wishing, I would be a singing pianist.

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