Successes and Challenges Facing HIV Service Providers in Orange County
We spoke with Philip Yaeger, executive director and CEO of Radiant Health Centers.
Philip Yaeger: I started here as a volunteer in 1993 in the food pantry, then was hired as the food pantry coordinator. I've been the CEO the last 11 years. Our main office is in Irvine, with two satellite offices in Santa Ana, one a CDC [Centers for Disease Control and Prevention]-funded, high-impact prevention site and the other a medical suite we just opened. We were founded in 1985 by a small group of volunteers living in and around Laguna Beach who were seeing friends and loved ones develop this mysterious new illness. So they held a small backyard party to raise $25,000 and ended up raising $30,000 and started AIDS Services Foundation Orange County.
Last World AIDS Day, we launched our rebrand to Radiant Health Centers, to reflect our expanded mission. We still want to end the HIV/AIDS epidemic in O.C. [Orange County], but we were seeing five to six new infections every week -- and research showed that it wasn't because of a lack of awareness or having multiple sex partners, but actually because of a lack of access to appropriate health care. So we realized that if we still wanted to have this vision of ending the epidemic here, we need to address health care inequities in the LGBTQ community, and that with our prior name, people not living with HIV would not look to us as an appropriate option. So our new mission statement reads that we provide "compassionate care for all, including free HIV testing and other specialized medical and comprehensive social services."
Tim Murphy: How did the agency evolve?
PY: Initially, we focused on helping people die with dignity, because that's all we could do. In the mid-'90s, when new treatment became available, it was a game-changer. We planned to close our doors within five years, so we worked on building out the safety net and support services for people with HIV. But around 2005, we decided to focus on prevention and secured our first CDC grant to start HIV testing. Then of course came treatment as prevention and PrEP [pre-exposure prophylaxis], so the possibility of ending the epidemic within the next 10 to 15 years became our new focus.
Our staff is just over 50 and annual budget is close to $15 million. We provide case management to about 1,600 people and care and support to 5,500; our prevention services touch another 5,500. Our staff speaks more than 12 languages, with close to 50% being LGBTQ, more than 50% people of color, 5% transgender, and 10% to 15% living with HIV.
TM: What's your interpretation of the HIV numbers in O.C.?
PY: I definitely want to get the rate of those with HIV who are virally suppressed up to 90%. There's been a huge drop in infections in the white population the last decade, which I think ties to good access to health care and PrEP, but a significant rise in Hispanic cases, which are concentrated in Hispanic gay and bisexual men ages 19 to 35. Some of them are undocumented immigrants, who may not be accessing services out of fear that deportation authorities will find them. We go out of our way to let them know that none of their information will be trackable or handed over to authorities. We have zero residency requirements for any of our services.
In the broader sense, I think the high HIV rates in that population of the O.C. is due to lack of access to appropriate health care, which we are trying to remedy at Radiant. If you're low-income or if your mom or dad don't have insurance, chances are you don't, either. And if you're under 26 and on your parents' insurance, you might not want them to know that you're on PrEP or getting STI screenings -- so you can come get treatment and care here off their plan, and we'll work around your ability to pay. About 35% to 40% of all our funding is Ryan White, CDC and HOPWA, but we also have Title X reproductive health funding, and we're a 340B pharmacy provider, which provides about 30% of our funding, which also comes from individuals, foundations, and our three annual fundraisers, including AIDS Walk Orange County.
TM: What is your gamut of services?
PY: The bulk of them are still for HIV-positive folks: case management for everything from linkage to care to retention in care. We provide mental health services regardless of HIV status, including to LGBTQ seniors; nutrition services to non-HIV clients if they're dealing with debilitating or chronic health issues; transportation services, primarily to clients with HIV, but also without if really needed. We also provide sexual health and family planning services, STI [sexually transmitted infections] screening, PrEP prescriptions. Next month, using a telehealth platform [providing services and communication with the clinic via laptop or app], we'll launch a rapid-start program where we get people on HIV treatment within one to three days of HIV diagnosis.
We also have multiple housing services. If someone presents with homelessness, we can house them immediately in a hotel or sober-living facility for up to six months, as long as we have a plan in place to transfer them to permanent housing. We provide rental assistance, utility assistance, move-in deposit assistance, and life skills workshops and trainings. We partner with nonprofit housing developers -- one with 22 units, another with 21. And for two years now, we've had state funding to give more than 200 households up to two years of monthly rental assistance in a program that mirrors Section 8, with another 300 households receiving some sort of financial assistance from us.
We also have programs for families affected by HIV/AIDS, such as a weekly support group for kids who are infected or affected, such as having a mom, dad, or someone in the family living with HIV. This includes a three-day summer camp that's often the family's only vacation, plus back-to-school backpacks, gifts that parents can give to their kids at the holidays, wintertime concert trips, and summertime water-park trips.
Now, with our expansion into medical care, we'll begin providing direct HIV care. Our ultimate goal by 2022 is to be an LGBTQ health center with an HIV specialty, a stand-alone site of 5,000 to 10,000 square feet that offers medical, dental, and mental health all under one roof.
TM: Wow. That's a lot of services. What are you most proud of in recent years?
PY: Our ability to look to the future for not only those already living with HIV, but those at highest risk within the LGBTQ community. That and being willing to take that next step into medical care and services, and all the work we've done around PrEP.
TM: Where do you feel stuck?
PY: The lack of awareness, and what appears to be the lack of interest, from the general health care community in understanding the unique needs of LGBTQ folks -- and the lack of awareness around PrEP. A 19 year old came in and said that he went to ask his doctor for PrEP, and the doctor said, "We don't do that or know anything about that, so you're gonna have to go someplace else." And six months later, that same individual became HIV positive. That's part of what drove us to expand to the high-risk LGBTQ population. Prior, if someone told us they were interested in PrEP, we had a list of about 12 providers, but with a two-, three-month wait to see them. We thought, "Wait, we're losing people, and we need to close this gap," so that's why we hired nurse practitioners and expanded into medical. Recently, a young man who'd been trying to get PrEP for months finally came to see us and had his prescription within 24 hours.
Another frustrating thing is young people who don't think they're at risk for HIV, even if they show up here with anal gonorrhea. This is despite all our efforts. We engage them in conversations, provide them with information, and follow up with them even after a PrEP or HIV-meds prescription is written to make sure they got the meds and are taking them. Definitely in the coming years, our main goals are to finalize that stand-alone LGBTQ health center and to get the rate of those with HIV who are virally suppressed up to 90%.
TM: Nice. Tell us a story you really like.
PY: We have a lot of staff here who were clients, including one who's been with us nearly 15 years and is now the benefits expert. But another story is: Years ago, our family program had a lot of HIV-positive kids in it -- less so now, with the ability to prevent transmission from mother to child via HIV meds -- and as they got older and became teens, we found that some of them were acting out sexually, or with drugs, isolating, dropping out of school, stopping their meds. We realized we needed to create some kind of ongoing support for them. So about three years ago, we had someone from MAC [Cosmetics] come in to do their makeup before a night on the town, movies, and dinner. Well, they spent hours telling their stories and comforting each other, a lot of tears. They never made it out of the room that night.
Positive POV: Daniel Garza
Daniel Garza, 48, of Laguna Beach, is an actor and a Radiant client and board member. He was diagnosed with HIV in 2000.
Daniel Garza: I host a podcast called Put It Together. My elevator pitch is that it's a show about where you come from, where you are now, and what the journey's been like. It started with my wanting and needing to share my own story. The point is to inspire others on their journey. I started this in 2012, when I was about five years clean and sober and moved to California from Houston and was trying to fit all my pieces together.
Other than that, I'm an actor, stand-up comedian, reiki master, and an HIV advocate. I have a boyfriend. I spend a lot of time checking the news for auditions and checking in [with] my agent. I'm in Hollywood right now to have lunch with an actor friend, and later today I have a stand-up show. I recently came off disability after 18 years, so I don't have a ceiling anymore on how much I can make, so I can experiment and be creative. But the flip side is that now I have to come up with an extra $1,000 a month. I still haven't ruled out pole-dancing ... I'm only 48! As long as the pasties stay on, I'm good. And I've been doing more acting work where I'm just in the background on the street or whatever.
Tim Murphy: What's your HIV story?
DG: I was diagnosed with AIDS in 2000 while living in Houston. I had 108 T cells and weighed 110 pounds. Family I hadn't seen in years came to the hospital to say their goodbyes. My turning point was when a priest came and I asked, "Am I dying?" and he said, "Only God knows that." I said, "Then why don't you get a note from God and bring it to me?" He said, "It doesn't work that way." I said, "Then get the fuck out of my room." Then I asked my doctor, "All I care about is, will my hair grow back and can I walk out of here on my own?" Because they brought me in in a wheelchair. Well, 19 years later, here I am.
I wasn't shocked by my diagnosis. I'd been a crackhead and an alcoholic and had had a lot of questionable sex. But I thought I was invincible. I thought, "If AIDS didn't kick my ass, then nothing will," so I kept drinking and drugging until my sober date of June 2007. The endpoint was when I stole a laptop from my job and ended up going to jail. My probation officer said, "It's either three months in rehab for you or a year in jail." I actually thought about this. I asked, "Is this like Oz on HBO jail? 'Cause if it is, I'll go." And the P.O. said, "No, it's not that kind of jail." Anyway, I showed up drunk and high in court. They thought I was insane. I said to them, "If you let me walk now, I'm done." I meant that I was going to kill myself. So they sent me to rehab -- and the minute I walked in and sat on the couch, I felt like I was home and ended up there for three months.
And that was the start of my spiritual journey. I started going to 12-step meetings and moved to California in January 2009. I was on the waitlist for an apartment in Laguna Beach and finally got it and moved there with the guy I was in love with, but when we broke up two months later, he went back to Houston and I stayed. I was dating for the first time as a sober person with HIV in a new city, and I found out that putting my HIV status on my dating profile was not getting me any dates. So I took it off, but then I felt like a hypocrite because I was doing advocacy and being open about my status elsewhere. So I put it back on and then I met Christian, who is now my partner of seven years. He's HIV negative but had dated someone positive before me.
I'm also an anal cancer survivor. I was diagnosed on Cinco de Mayo, 2015. I was having a lot of bathroom issues, feeling very bloated, so I went to the doctor and was diagnosed with a hernia and had surgery for it. But six weeks later, I was still having issues, so they did a finger check and found a mass, which was then biopsied as cancer. I did 40 rounds of radiation and two weeks of chemo on a pump. But the damage from the radiation caused complications, and so now I'll have an ostomy bag for life, which is the biggest thing I've had to deal with. I'd finally found a partner who accepted me and everything had fallen into place. On the way home from my diagnosis, I said to him, "If you wanna leave, this is the moment," and he said, "No, I'm staying with you."
TM: Tell us a little about your HIV advocacy.
DG: I go to high schools and colleges and give them HIV 101 and share my story. Students ask me what dating is like, how my family handled my diagnosis. I'm also part of Positively Fearless, which is five of us living with HIV who share our stories via videos and live appearances. We just got back from the United States Conference on AIDS [USCA], where we were on a panel about how HIV affects different aspects of our life, such as mental health.
TM: What's the HIV situation in O.C.?
DG: We're seeing bigger numbers in Latinx teens. I'm working with Radiant to try to bring more Latinos to the table via the client advisory committee. I think a lot of folks, when they think of the O.C. [long known for being rich, white, and Republican, even though it trends increasingly nonwhite and Democratic], they don't think that we're so heavily Latinx, but we are -- and there's not enough information going out there to students. The O.C. is still conservative and backwards when it comes to young people and sex. They won't allow us in the whole school system to do an HIV education class, so we have to go through the individual schools and it's very restricted as to what we can say and do. But I was sexually active when I was 13 and was molested as a child, which I think tied into my later issues with sex and drugs. I thought you always had to have sex on the first date and obey whatever your partner wanted.
TM: What are your goals going forward?
DG: I would love to merge my entertainment advocacy and spirituality reiki work into one, create some show where I can teach people a little bit about HIV but also make them laugh and heal through energy. I'm working on it. I'm also working on my stand-up, doing the rounds at open mics. My stand-up coach compared me to Joan Rivers. I'm very in the moment and will rip into the audience!