Bay Area Reporter - November 30, 2006
Heather Cassell, h.cassell@ebar.com

"We are really delighted to be getting it because we are working in a neighborhood that is pretty much of a high need and dental care is always one of those issues and treatments that people living with homelessness, mental illness, and addictions don't often actually access because they are taking care of other needs while they're not really taking care of these kinds of issues," said Colm Hegarty, director of resource development and public relations at Tenderloin Health.

Tenderloin Health must raise an additional $120,000 annually from private sources to operate the program, which is expected to start next year. The grant will provide $400,000 a year, said Executive Director Tracy Brown.

Routine oral health care can detect early and advanced symptoms of HIV disease such as leukoplakia and candida, as well as oral cancer and other serious problems such as "meth mouth," caused by methamphetamine abuse.

"Providing dental care for the homeless living with HIV in the Tenderloin - a very important element to that is providing dental care where the people are at physically," Hegarty said, referring to the geographical issue clients face. "So it's not a barrier now for people to get dental care, because they don't have to get themselves on a bus out of the Tenderloin out to the University of the Pacific in order to get dental care. The idea is to provide services actually where the people are at."

Tenderloin Health has partnered with the Tom Waddell Health Center, which provides dental services for HIV-positive clients for a few hours a couple of days a week. Receiving this award likely will dramatically improve services for the 1,800 Tenderloin Health clients and together the two agencies will be able to provide in consortium of services fulfilling Tenderloin Health's goal stated earlier this year in the Bay Area Reporter that it plans on being a "one-stop-shop" for all health services for the community.

Tenderloin Health was created earlier this year as the result of the merger between the Tenderloin AIDS Resource Center and Continuum.

Caroline Brown, DDS, dental director of programs and development for the Native American Health Center in San Francisco, which also received the same grant, agreed that providing services, especially by specialists locally, is very important. The clinic provides services to the Native American and Latino communities in the Mission District and nearly all of their clients are HIV-positive. Brown told the B.A.R. that many dental specialists don't accept Medicare or Medicaid. The only one that does is located in San Jose. If the patient can't travel to San Jose to receive the services, oftentimes the clinic directs clients to San Francisco General Hospital for tooth extractions and other specialized services.

Both agencies, which are members of the San Francisco Community Clinic Consortium, are developing pilot programs to provide direct services and gather information to assist with understanding oral healthcare needs and providing dental services to the HIV community over the next five years.

"The health department is thrilled," said Samantha Steven, director of dental services for the Department of Public Health. "There is a huge need for these services."

Dr. Barry Zevin, medical director of community offsites for the Tom Waddell Health Clinic, said that the services resulting from the funding resolve several barriers that have made it difficult for patients to receive oral healthcare. The barriers range from receiving culturally competent care to general fear of going to the dentist to navigating bureaucratic systems at multiple healthcare facilities and government agencies. Tenderloin Health and Tom Waddell Health Clinic as well as the NAHC hope that by centralizing the services locally, and by providing comprehensive healthcare and support, they will be able to increase the level of patients receiving dental care and the quality of culturally competent services.

When asked by the B.A.R. if Tenderloin Health and the Tom Waddell Health Clinic plan to work with NAHC, Zevin said that he wasn't sure why the Health Resources and Services Administration selected two agencies within the same location, but that built into the five-year process is support for the clinics that received the award to work together. Tom Waddell Health Clinic already works with NAHC, but Zevin is interested in how their programs differ and whether they will evolve in distinct separate directions or "cross-pollinate."

The awards totaled more than $6.5 million from the Special Projects of National Significance program of HRSA to support creative and innovative oral healthcare programs for people living with HIV/AIDS that can be replicated throughout the country. The awards are separate from the annual grants provided by the Department of Health and Human Services and the HIV/AIDS Bureau, which administers the Dental Reimbursement Program that UCSF School of Dentistry and UOP receive annually for HIV-positive patient curriculum and training for all dental students.

"Our view is that looking after HIV patients is part of the duty of all dentists and dental specialists so it's integrated into all our curricula," said Dr. John Greenspan of UCSF School of Dentistry that provides HIV inclusive dental instruction.

Dr. Richard Fredekind, associate dean of clinic services at UOP, which trains dental students and provides general dental services for HIV-positive as well as low-income patients, agreed. Both doctors pointed out that there are many complications when dealing with dental hygiene and the reduction of the immune system in patients. HIV not only increases general teeth and gum care problems, but there are also infections that are HIV-specific related to oral care.

"The important thing is that these are people who are high risk of HIV or living with HIV" dental care is pivotal in being able to identify if someone might be infected with HIV," said Hegarty. "If somebody is infected with HIV [and] if they are receiving dental care, it's probably going to be a lot easier scientifically to tell when someone is facing issues of disease progression or a particular infection might point to something more complicated happening down the line."

061130
BR061107

Always watch for outdated information. This article first appeared in 2006. This material is designed to support, not replace, the relationship that exists between you and your doctor.

AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.

Copyright ©1980, 2006. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content. .