Philly Project Transforms Youth HIV Care

Cauzell Harris was familiar with struggle. Family issues left him homeless at 14 years old. He dropped out of school and began running the streets doing whatever he needed to survive. But when he received an HIV-positive diagnosis, he wasn't prepared to deal with that struggle -- at least not on his own.

The 19-year-old West Philadelphia native found out he was HIV positive at a rapid HIV mobile testing unit in 2014. In disbelief, he went to Philadelphia FIGHT, a community health services nonprofit organization, to get retested.

"When I found out, I was scared and didn't know what to do. But I knew I didn't have time to mope around or blame other people for where I was," he said in a telephone interview. "I didn't know much about HIV, and I had to get information."

So he went to the Youth Health Empowerment Project (Y-HEP), a program for teens and young adults run by FIGHT, to find out his next steps.

"I found out about Y-HEP when I was about 15 or 16. I just walked in one day; I kept going because of all the support I got," Cauzell said. "When I found out, I was confused about what was going on. I just knew I wanted to live a normal life."

The doctors and nurse practitioners who provided primary care for Cauzell counseled him on what it means to be HIV positive, how it affects his immune system and CD4 count, and where he can go for treatment.

"Since I was already welcomed at Y-HEP, I decided I wanted to be treated there too. I felt like a lot of doctors at other places wouldn't understand me or the life I live, but the people at Y-HEP look at it from a different perspective," he said.

There was only one problem: Y-HEP wasn't equipped to provide continuing care to an HIV-positive person. Though Y-HEP is a medical center, it had specialized in pediatric primary care for at-risk youths. The staff did not include an infectious disease specialist and wasn't specifically trained in the ongoing care needs of HIV-positive people.

"I met Cauzell after he was diagnosed," said Meghan Bernetich, CRNP. "It was brought to my attention that he would be more comfortable coming to Y-HEP for his HIV care. At that time, we had a few patients that were newly diagnosed but out of care."

"As a team, we sat down to see how this could work. We were able to get the necessary training on how to provide HIV care in a primary care setting. And as a backup, we have an infectious disease specialist available to us," she said.

·   That was two years ago. Since launching the program, Y-HEP has begun providing treatment to five other HIV-positive teens and young adults. The program is not as comprehensive as some of the larger, more established pediatric HIV programs in the area -- they do not have a staff of case workers and psychiatrists to offer wrap-around services -- but the program has been helpful to Cauzell and the others getting treatment in what they consider a safe place.

"Y-HEP had been my support for years. Meg is like a second mother to me," Cauzell said. "I see the Youth Health Empowerment Project as a place that helped me change my outlook."

Now 22 years old, Cauzell is no longer on the streets. He will soon graduate from Job Corps with a certificate in forklift operations. He also serves as a youth minister at his local church, where he does praise dancing, and visits Philadelphia schools as a motivational speaker.

"The older I get, the more I see there is for me in life. I'm surprised by how I've made such a rapid change," he said. "Seeing the difference I can make in other people's lives through my testimony has been a turning point for me."

Soon, Cauzell will transition from pediatric care to adult HIV care, which Bernetich recognizes can be difficult for many young adults. But as the first group of Y-HEP HIV patients begins this transition, Y-HEP is starting to build a bridge to lighten the anxiety and shock.

"The transition from pediatric to adult care is tough. Medication adherence is a recurrent problem for some people who don't have the kind of doctors that are chasing them down or stalking them," she said. "We're working with the Lax Center [an adult HIV care program at Philadelphia FIGHT] and other places to help with the transition. And we will always be there for him if he needs help."

"I'm hoping wherever his care is transferred, we have a relationship with them to keep an eye on him," she added.

Cauzell says he will do the work even if the next clinic doesn't have a relationship with Y-HEP. "Y-HEP is my family, and you never want to distance yourself from your family."