1/
I spoke with a former academic colleague today who had texted me a few days back for some advice but I forgot to call her back.

We didn't always see eye to eye when we worked together, but we always respected one other.
2/
She was reaching out because her son had recently invited her in and told her of his attraction to other men.

He also told her that he had just had his first sexual experience, and the condom had broke.

He's only 20 years old.
3/
He spoke with her 24 hours after it happened, and she was reaching out to me for advice, as her son wanted to get #HIV post-exposure prophylaxis (#PEP).

But he didn't know where or how to get it.

Despite being a family medicine doc, neither did she.

hiv.gov/hiv-basics/hiv…
4/
"I'm so sorry I didn't return your text promptly," I told her.

"That's ok," she said. "You don't realize you helped me anyway, and I remembered you talking about this a lot when we worked together."

Turns out she Googled me and found an article I had written on PEP.
5/
She read it, followed up with the links that provided resources, and helped her son contact a local clinic.

She then sat with him to listen to the conversation on speakerphone.

He spoke with a kind nurse, who asked the right questions, didn't judge him, and reassured him.
6/
"Did they give him the medications?" I asked.

"They did," she said proudly. "He's on day 5 now, and he's out with some friends on a vacation trip they postponed earlier in the pandemic."

I smiled.

We caught up on old work gossip.

She asked how my mother was dping.
7/
I asked her how work was going.

She told me she just got another degree and talked about new job prospects.

I applauded her.

Not only for her work accomplishments.

For being a phenomenal mother.

It's hard raising young Black boys in this country.
8/
Especially if their sexual orientation spans along the #LGBTQ continuum.

She not only accepted her son unconditionally when he invited her in, but she also sprang into action with no judgment or hesitation to ensure he got the #sexualhealth care he needed.
9/
That young man will remember this moment for the rest of his life.

You see...

Sexual health starts in the home.

It begins with a parent who accepts their child for exactly who they are.

So they know that they are loved and their worth when they go out into the world.
10/
To all my sexual health warriors who do the work every day...

Understand that the information we put out there is important and necessary.

Keep writing, teaching, and creating resources for public consumption.

You don't know who you may be helping.

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More from @DMalebranche

Feb 19
A 🧵

I had a talk with a dear friend this morning. I've known him for over 30 years.

He is struggling with the reality of his father's aging and increasingly burdensome medical conditions.

His father is a 82-year old immigrant from the Caribbean.

Like my father was.
1/
In recent months, my friend has watched him struggle with routine tasks.

Air or car travel is cumbersome.

His feet swell, making ambulating tough at times without a wheelchair.

Breathing is difficult due to deconditioning.

He would rather stay at home then go out.
2/
His father has had high blood pressure and diabetes for years. More recently, he had a stroke and a heart attack requiring stent placement.

"I guess this is that time, huh?" my friend asks.

I don't have the answers, but I can feel the exasperation in his voice.
3/
Read 16 tweets
Sep 3, 2021
1/
Yesterday in clinic I saw many patients.

All of them living with #HIV.
All Black.
None of them vaccinated for #COVID19.

We engaged in conversations about their reasons for not getting vaccinated.
2/
Some wanted more time to assess the after effects of the vaccine.

Some felt there was no reason to be vaccinated if they could still catch the virus.

Some saw the after effects of the vaccine impact their loved ones more than the virus itself.
3/
I listened to each and every one of their reasons.

While I encouraged them to get the vaccine, I didn't use scare tactics to do so.

I also didn't try to guilt or judge them into compliance.

One thing was clear, however.

None of them were "anti-vaxxers."
Read 8 tweets
Jun 7, 2021
1/
I've been seeing a patient living with #HIV who has had right hip pain for 5 months.

He is a 33 year old Black man who hobbles around like he's 90.

He just lost his job.

The pain was so great he couldn't sleep at night and was dozing off during his shift.
2/
No one explained to him what was going on. He got an x-ray at an ER five months ago.

He understood that he had a "ruptured" hip.

Doctors who have seen him have only given him ibuprofen and Aleve for the pain.

Both don't touch it.

He cried during our first office visit.
3/
He could barely get up on the exam room table without excruciating pain.

I couldn't rotate his right hip due to the discomfort it caused him.

We agreed to try a low dose opiate and muscle relaxants as needed.

Our clinic would request the medical records from his ER visit.
Read 10 tweets
Jun 4, 2021
1/ "Undetectable = Untransmittable" can be an empowering message for people living with #HIV.

That said, we don't explain to patients that the studies leading to that slogan defined "undetectable" as a viral load less than 200.

Not less than 20, which is the current standard.
2/ So when people are stable on their HIV medications and see their viral load go up to 60, or 100, or 120...

Listen to and address the anxiety they feel, thinking they are not "undetectable" anymore.

Reassure them that they are and you will follow things closely.
3/
As clinicians, we need to do a better job explaining that these small increases in HIV viral load are called "blips."

Blips are common.

A. Doesn't mean the medications have stopped working.
B.. Doesn't always mean you are now "immune" to the meds.

catie.ca/en/positivesid…
Read 6 tweets
Apr 18, 2021
I had to send a 26 year old patient to the hospital yesterday after a telehealth visit.

He is living with #HIV

Had lymphoma 5 years ago requiring surgery and chemo

Has syphilis titers that have stayed elevated for 2 years, even after outpatient penicillin treatment.
1/
Now is having fevers, nightsweats, headaches, blurry vision, and unintentional 10 pound weight loss in two weeks.

His T cell count dropped from 200 to 100, even though he is taking his HIV meds and has an undetectable viral load.

I gave him my cell number just in case.
2/
The admitting hospitalist reached out to me this morning.

Him: "Your patient gave me your number. I guess he wanted me to call you with updates."

Me: "No, I gave him my cell phone so you could call me if you needed more information for your clinical decision-making."
3/
Read 7 tweets
Mar 25, 2021
Did a follow up call with a patient this morning. Gave her her #HIV lab results:

- T cell count over 1000
- Viral load undetectable

No reaction. It was expected. We spoke about other referrals before concluding .

"Anything else I can help you with?" I asked.

She paused.
1/
"Doc, I have a question, but it's more personal."

"Shoot," I responded, unsure where this was going.

"Do you know anyone in the medical field who is living with HIV? Before my diagnosis I wanted to go into the field but I didn't think I could after that."

My turn to pause.
2/
"You're speaking to one," I said.

I could feel the weight lift from her shoulders through the phone.

"Living with HIV doesn't mean you can't work in the medical field," I continued. "There are many people who are HIV positive and work as doctors, nurses, every position."
3/
Read 5 tweets

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