Munson Clinic Wages War with Ongoing HIV Epidemic

The opioid crisis ravaging northern Michigan – and much of the country – could result in an outbreak of HIV. According to Victoria Cammarata, a licensed master social worker and medical case manager with Munson’s Thomas Judd Care Center, the growing trend of intravenous drug use in the area could lead to problems that go beyond addiction.

That particular fear relates back to 2015, when an unprecedented HIV outbreak struck the small rural community of Scott County, Ind. Some 210 people in the country were diagnosed with HIV; 95 percent of them had hepatitis C as well. Most of the patients contracted the virus because they were sharing or re-using dirty needles, cookers, cotton or other drug paraphernalia.


“The [Centers for Disease Control and Protection] went crazy,” Cammarata said. “They started evaluating other counties throughout the nation that would look similar to Scott County, and that would be at risk to an outbreak such as that.”

Eleven counties in Michigan were identified, all of which are in Munson Healthcare’s coverage territory.

Ever since that CDC study, Cammarata says that Munson has been bracing for the possibility of an outbreak. Thomas Judd Care Center, Munson’s HIV/AIDS clinic, has seen two new HIV diagnoses for IV drug users in the past month. Cammarata says that even a number that small is substantial.

She also says she thinks the problem of HIV infection among drug addicts is probably worse than it looks right now.

“What I think is happening is that people just aren’t getting tested,” she said. “We know [infection] is happening, we just need to be able to infiltrate those communities and get them tested.”

According to Cammarata, part of the problem is that many people in the area don’t know about the Thomas Judd Care Center. She says that many hospital employees aren’t even aware that Munson has an HIV clinic. The Thomas Judd Care Center has been around since 1994, the same year that AIDS became the leading cause of death for Americans between the ages of 25 and 44.

Another challenge is getting HIV patients to tackle the virus. Cammarata says that many patients at the Thomas Judd Care Center are struggling with other social issues – such as drug addiction, poverty, homelessness and mental illness – that make it more difficult to treat HIV. Thomas Judd offers medical case management to these patients to help them eradicate any barriers that might prevent them from getting HIV medication and taking it punctually each day.

Currently, the Thomas Judd Care Center has 144 patients receiving case management services in Munson’s 25-county region.

That figure does not reflect the total number of people in northern Michigan with HIV. In 2013, the Michigan Department of Health and Human Services estimated that 810 people in northern Michigan were living with HIV. Of those patients, the study indicated that only 466 were in care. Those numbers match with a United States Centers for Disease Control and Prevention report from 2016, which estimated that 50 percent of young Americans living with HIV don’t even know they are infected.

The Thomas Judd Care Center is doing its part to curb the problem. The clinic offers anonymous HIV testing to all patients on a walk-in basis. Each test is just a simple finger prick and only takes 20 minutes to return a result. If the test is positive, the clinic connects the patient with care. If the test is negative, the clinic talks with patients about ways to reduce HIV risk.

For patients that are already infected, Thomas Judd also does coordination of care. The clinic works with infectious disease clinics in Traverse City, Petoskey and Harrison to get patients the care and medication they need. Thomas Judd also provides transportation to some patients to get them to their appointments. Representatives from the clinic will even accompany patients to their doctors’ appointments to make sure those patients understand the care they are receiving.

The treatment ensures that the HIV virus is virally suppressed in all patients, which only happens if they are taking their medication every day. Once the virus is suppressed, it can’t be transmitted.

Cammarata says the HIV/AIDS epidemic isn’t over yet – even though it might not be getting as much press lately as the opioid crisis. On the contrary, she says that rates of infection in northern Michigan have increased since Thomas Judd opened its doors in 1994. The increase is a combination of new diagnoses and of people moving to the area after having already been diagnosed.

One way Munson is helping to stall the rise of HIV in northern Michigan is PrEVENT, a new clinic within the Thomas Judd Care Center that was established in December of last year. PrEVENT is northern Michigan’s first HIV PrEP clinic, or Pre-Exposure Prophylaxis clinic. PrEP is for people who are not HIV positive, but who are at high risk for infection. Cammarata said that target patients would include IV drug users, sex workers, people who are having sex with people they don’t know the status of, or partners of people who have HIV.

PrEVENT also offers Post-Exposure Prophylaxis (or PEP), which patients can take within 72 hours of HIV exposure – and every day for 28 days thereafter – to prevent infection.

So far, Cammarata says that interest in the PrEVENT clinic has been somewhat limited, serving about 10 patients consistently. While Thomas Judd’s hours run Monday through Friday, PrEVENT mostly only sees patients on Tuesday – though exceptions are made in post-exposure cases, or when patients request other times. However, Cammarata still thinks the decision to launch PrEVENT was the right one, and that traffic will increase as Munson continues to get the word out about the clinic to individuals who might be high risk for contracting HIV. Before PrEVENT opened, the closest PrEP clinic in the state was in Grand Rapids.

“We saw that there was a gap in services in northern Michigan,” Cammarata said. “The rest of the state had already started distributing these types of services to their patients.

“We knew that if we weren’t going to do it [in the area], no one else would.”