Embracing Telemedicine: One Doctor’s Experience

For Dr. Gene Voskuhl, Medical Director at Resource Center’s LGBTQ Health facility in Dallas, Texas, telemedicine started as a means to help rural patients with the added benefit of shortening his own exhausting commute. He now believes that telemedicine serves a broader purpose. When asked how telemedicine is linked to ending the HIV epidemic in Texas, he responded, “Without a doubt, I am convinced that telemedicine is an option for people who have barriers to medical care. Sometimes it is as simple as transportation, time, sometimes it’s kids or family. I am convinced this will increase retention to care and the number of people in treatment.”

Dr. Voskuhl began exploring telemedicine in 2018 when he was working with the Callie Clinic in Sherman, Texas. He lived in Dallas and commuted to Sherman three days a week while also working part time with the Resource Center as they worked to open a new primary care medical program. He loved the people and the patients at the Callie Clinic and wanted to find a way to continue to work with them even after the new Resource Center LGBTQ Health facility was up and running.

In 2019, Dr. Voskuhl attended a two-day training at Texas Tech that provided IT training for telemedicine. That summer, he created a home-built system, which he now refers to as a bit of a “Frankenstein system,” while the CFO/IT staff at the Callie Clinic pulled the in-house telemedicine equipment together. They used a Zoom platform which had patient health information (PHI) encrypted. Patients at the Callie Clinic would go to the clinic and Dr. Voskuhl was able to see them online from his home. That was the beginning! When the Center’s LGBTQ Health opened, Dr. Voskuhl was able and willing to continue to serve his patients at the Callie Clinic using the telemedicine platform.

Once the coronavirus arrived, things began to change. With more barriers in place for patients to physically attend clinic appointments, it became an easy decision to add telemedicine at Resource Center. They had already been exploring the use of telemedicine for PrEP, so this just put the plan into high gear. Additionally, the Texas Medical Board (TMB) temporarily relaxed some of their previous telemedicine restrictions. Providers are now allowed to conduct video or phone appointments whereas in the past appointments had to be live video (synchronous) calls. Dr. Voskuhl is able to connect to patients at the Callie Clinic through the clinic’s EMR system. Instead of dialing in to the Zoom platform, he can dial into the Callie Clinic directly on his phone and patients have the option of telemedicine via video or telephone. At LGBTQ Health, he starts with a telemedicine visit to do an initial screening and can then have patients come in if he needs to see them in person. When asked if he hopes the TMB will continue to allow phone appointments he said, “Absolutely! Partly because Texas is so big and diverse that coronavirus hot spots will continue to pop up – so allowing me or other physicians to deal with those locally makes the most sense. There is no other way to think about this other than that the flexibility allowed has saved lives.”

Dr. Voskuhl has learned a few lessons, both about himself and about telemedicine.

  • Personally, he still requires some face-to-face time with clients and co-workers.
  • He has found that it is good for him to be on a schedule while working from home and it is important to go out at times.
  • Listening is the most helpful aspect of his telemedicine calls.
  • Asking people about their experience with telemedicine and what he can do differently is important. Some people love the telemedicine option and some absolutely hate it – they just don’t feel connected. He believes you can’t force telemedicine on people: “You can support it, but you have to be flexible.”

Dr. Voskuhl goes to the Callie Clinic once a month to see patients who prefer in-person visits, although he is not traveling right now due to the coronavirus.

From a technical perspective, lighting and especially audio are very important. You have to project a little bit more on the camera and be more animated on screen. There are a lot of little lessons to be learned – “like you have to move the mouse around every now and then or the screen goes dark!”

Dr. Voskuhl’s advice for others is, “Don’t be afraid – it seems daunting, but it is really not.” He said, “Hey, we did it, anybody can do it. There are online resources out there, online (TexLatrc.org for example), in-person and on the telephone. Don’t be afraid, because if you don’t know the answers there are people with the answers who can help you figure it out.”

Initially, he believed telemedicine was a way to link rural patients to care. Now, he sees that urban folks have many of the same barriers to accessing medical care. Telemedicine is a good way for many different patients to connect to medical care. When asked if he recommends telemedicine for others, Dr. Voskuhl said, “Absolutely, this is a tool for Texans, for our HIV folks and PrEP, to connect with medical care. One, it is important and two, it’s not that hard!”


Dr. Gene Voskuhl graduated from the University of Oklahoma, where he specialized in infectious diseases and eventually helped launch the University’s HIV Clinic. He later worked at Gilead (the manufacturer of PrEP medication Truvada) as a medical scientist, instructing fellow physicians on how to safely treat LGBTQ patients and prescribe appropriate pharmaceuticals. Volunteering for Resource Center gave him an even deeper insight into the needs of the LGBTQ and HIV populations in North Texas, and further fanned the flames of his passion towards equity in healthcare. He is currently the Medical Director at the Center’s LGBTQ Health facility, which provides affirming and compassionate care in a stigma-free environment.

A Quick Look at Strategies Helping Us End the Epidemic

Can you explain how we’re going to end the HIV epidemic in 4 minutes? In this short (roughly 4 minute) video Philip A. Chan explores the preventive strategies helping us tackle HIV and the possibility of ending the epidemic. 

(Click here to see video if it doesn’t appear in your browser.)

Antiviral medications work in a couple different ways. Some keep HIV out of immune cells, and others work to stop the virus itself from replicating. When HIV is effectively treated with antiretrovirals, many people living with HIV can lead healthy lives. Another advantage of antiretroviral treatment is that people’s viral levels become undetectable and they do not transmit HIV to others. In people living with HIV, antiretroviral medications can dramatically reduce HIV transmission. This is called “Treatment as Prevention.” Pre-exposure prophylaxis, or PrEP, also uses antiretroviral medication preventatively in people who don’t have HIV.

One of Achieving Together’s focus areas is to promote the continuum of HIV prevention, care, and treatment. Medical advances, such as pre-exposure prophylaxis (PrEP) and other antiretroviral medications, change the way we think about HIV prevention and treatment. The continuum of prevention, care, and treatment starts with awareness and continues with testing and systems of care that are in place to promote these interventions. We aspire to integrate the prevention and care continuum through a status neutral lens, meaning care should happen regardless of status.

HIV Home Testing

Saturday, June 27th, 2020 is National HIV Testing Day.  Knowing your HIV status is the critical first step to living a long and healthy life.  In Texas, there are roughly 16,000 people living with HIV and unaware of their status.

While we are all staying safe during the coronavirus epidemic by staying home and practicing social distance, HIV testing may be a challenge.  Many testing sites have limited hours or have changed other practices to keep their communities safe.  One exciting new strategy that organizations may be providing to ensure testing is available to their communities is HIV mail order self-testing kits.

HIV self-testing (or HIV home testing) is a promising testing modality, especially for individuals who do not or cannot access HIV services in traditional healthcare settings. The availability of home HIV tests may help increase awareness of HIV among people who wouldn’t otherwise be tested. During the coronavirus era, interest in home testing is stronger than ever for many people.

In the U.S. the OraQuick In-Home HIV test is the only FDA-approved home HIV test. This test kit is designed to allow users to take an HIV test with the collection of an oral fluid sample and find out their result within 20 to 40 minutes.

Virginia, Arizona, and New York City have piloted the delivery of home test kits and found that this process enabled them to reach individuals who hadn’t tested recently. In some cases, they have succeeded in reaching a higher positivity rate than traditional testing strategies.  

  • New York City: 28% of testers hadn’t tested in the previous year and 14% hadn’t ever tested. They reported a positivity rate of 0.3%
  • Virginia: 29% of testers hadn’t tested in the previous year and 21% hadn’t ever tested. They reported a positivity rate of 1.3%; 88% of new positives were linked to care within 30 days.
  • Arizona reported a positivity rate of 1.2%.

In a recent NASTAD video, presenters from Virginia and Arizona shared their experience:

eSTAMP was a national randomized controlled trial designed to evaluate the public health benefits of mailing HIV self-tests to Internet-recruited gay, bisexual and other men who have sex with men (MSM) in the US in 2015 and 2016. Compared to men in the control group, men who were mailed HIV self-tests:

  • Tested themselves more frequently
  • Identified significantly more prevalent HIV infections
  • Did not increase sexual risk behaviors
  • Shared the study HIV self-test with members of their social network, resulting in many more persons becoming aware of their HIV infection.

In addition, the new program TakeMeHome is currently piloting a national free home HIV testing program. The program, which is a partnership between Building Healthy Online Communities (BHOC), Emory University, and NASTAD, will allow state and local health departments to offer free, confidential HIV and STD testing delivered securely and discreetly. During the pilot phase, TakeMeHome will target MSM who use dating apps, but project leaders expect to expand to other populations in the future.

Juneteenth


Image credit: Dallas Morning News

When many Americans think about the abolition of slavery in the United States, they think of the Emancipation Proclamation, issued by President Lincoln on January 1, 1863; however, for enslaved people living in the Confederacy at the time, this declaration did not grant them freedom. In Texas, it was almost two and half years later that enslaved people gained freedom upon the defeat of the Confederacy in the spring of 1865 at the end of the Civil War. On June 19, 1865 Major General Gordon Granger from the Union Army arrived in Galveston and proclaimed that all enslaved people in Texas would henceforth be free individuals. This date became known as Juneteenth and has been celebrated ever since with festivals, parades, picnics, and other celebrations throughout Texas, the South, and even the rest of the United States.


Juneteenth Celebration in Austin, 1900, photo courtesy of the Austin History Center

Juneteenth buggy in Galveston, Image courtesy of Houston Press

Despite the proclamation of freedom made on June 19th by Major General Granger, he did note that “The freed are advised to remain at their present homes, and work for wages…they will not be supported in idleness either there or elsewhere.” This addendum provided a preview of the Black Codes and Jim Crow laws that came to reign in Texas and the rest of the South that sought to control and restrict the lives of African-Americans after Reconstruction.

After Reconstruction, states in the south passed a number of vagrancy laws that “allowed local courts to arrest individuals deemed idle, to fine them, and force them to work if they could not pay the fines.” These policies created a large increase in the number of imprisoned African-Americans, many of whom were leased out to work on former plantations with the prisons using their wages to run the system. Eventually, as plantation owners died or sold their plantations, a number of these properties were purchased by the state as the site of state prisons and farms (many of which are still in existence today in southeast Texas, including the Jester, Wayne Scott, Clemens, and Darrington units) to create a self-sufficient prison system where prisoners lived and worked in often brutal conditions to grow crops and raise livestock to feed the prison system. In addition to the disproportionate incarceration of African-Americans during the 20th century in Texas, Jim Crow laws and policies such as segregation, voter suppression, and “red lining,” along with terrorism by white supremacist organizations, continued to make Texas a hostile and oppressive place for African-Americans to live. Redlining and segregation, the effects of which are still in place today, forced African-Americans to live in undesirable neighborhoods and did not allow them access to credit, thus inhibiting wealth-building. Additionally, these neighborhoods were underserved in terms of transportation, adequate housing, education, healthcare, food, and recreation, and were often near environmentally-hazardous industries. You can learn more about this policy and see maps of the different redlining policies from many Texas cities by clicking here.

Despite the successes of the Civil Rights’ movement of the 50s and 60s at ending state-sponsored segregation and expanding voting rights, challenges still remain. You might hear people claiming that we just need to “get over it” or leave “history in the past” or “that happened before I was born.” We at Achieving Together acknowledge that as the author William Faulker wrote, “The past is never dead. It’s not even past,” and that past inequities have not been resolved and continue to negatively affect the African-American community in Texas. Issues such as over-policing of neighborhoods and police brutality along with the War on Drugs/Crime and the school to prison pipeline, health disparities, continued institutional and personal discrimination, and the lack of educational and work opportunities have led to inequities that have created the current environment which have seen Americans across the country of all races in the streets protesting and supporting the Black Lives Matter movement. Achieving Together recognizes that these inequities persist today and negatively affect the health outcomes of African-Americans in Texas; therefore, the guiding principles, the goals, and the focus areas of the Achieving Together Plan to end HIV in Texas support the elimination of barriers to equity and equality. You can read more about these different aspects of the plan here: https://achievingtogethertx.org/achieving-together-plan/. Achieving Together emphasizes our commitment to equity and our need to engage in the difficult work to end racism and fight for an equitable world for all Texans.


Protestors in Houston on 6/2/20 ride in the Black Lives Matters march in support of George Floyd who was suffocated to death by police officers in Minneapolis, Minnesota on May 25, 2020, Courtesy of Reuters

Despite these obstacles and challenges throughout history, Juneteenth celebrations have continued in earnest and June 19th was declared an official state holiday in Texas in 1979 by Governor Clements. Presently, many Texas communities celebrate with festivals, parades, picnics, marching band competitions, and other celebrations of African-American culture in Texas. A quick internet search will reveal many Juneteenth plans in your area.

We’d like to offer up this Audre Lorde quote as a reflection on how we can all celebrate Juneteenth this year and stand together to fight inequity past, present, and future. “You do not have to be me in order for us to fight alongside each other. I do not have to be you to recognize that our wars are the same. What we must do is commit ourselves to some future that can include each other and to work toward that future with the particular strengths of our individual identities. And in order for us to do this, we must allow each other our differences at the same time as we recognize our sameness.” Finally, in closing, we’d like to share our fellow Texan, Beyoncé, singing a traditional Juneteenth hymn, also known as the “Black National Anthem,” Lift Every Voice during her historic Coachella 2018 Homecoming performance here:

2020 LGBTQ+ Pride month

As we roll into pride month this year, so much is different than previous years.  In unprecedented numbers, Americans are taking to the streets to protest police violence and systemic racism that continues to result in the murders of Black people.  As pride events across the country are adapting to the restrictions of COVID-19 and going online to connect and celebrate LGBTQ+ identities and communities, it is important that we remember the roots of pride month.  What we celebrate in June are the Stonewall Inn Riots that erupted against the targeted and oftentimes violent policing of LGBTQ+ people. The Stonewall uprising is widely considered to be a crucial event that spurred the modern LGBT rights movement in the United States. Check out last year’s post to learn more.

While we celebrate pride this month, we must also understand that LGBTQ+ liberation is also rooted to direct action and must support all civil rights liberation efforts.   This pride month, it is crucial that we lift up the voices and experiences of Black and other LGBTQ+ people of color, and remember that from the beginning of the Stonewall uprising, it was Black and other LGBTQ+  people of color leading the charge for liberation.

Multiple pride celebrations across the country, and here in Texas, are going virtual this year.  We’ve compiled a short list to highlight some of the events taking place.

Dallas Pride

Dallas Pride will be moving online for a virtual celebration. While the COVID-19 pandemic has forced people apart, Dallas Pride sees “the opportunity to bring even more people together.”  Check out their website for updates on the virtual schedule, performers, and online events.

PRIDE SAN ANTONIO

PRIDE San Antonio will be moving online for a celebration on June 27, 6-9pm. Join them to show your support! You can learn more on their webpage.

Rio grand valley pride

RGV Pride, in collaboration with organizations and individuals from across south Texas, is hosting events throughout June. You can keep up with them and all the events on their Pride Calendar.

HOUSTON VIRTUAL: REEL PRIDE – PRIDE FILM FEST

Houston Pride is postponed but they are hosting a virtual film fest June 20th. Tickets are $10 and you can learn more at their website.

san francisco 50th anniversary virtual pride

San Francisco plans to host a virtual pride to celebrate their 50th year of Pride. Check out their website to learn more.

miami virtual pride

Miami Pride is also holding virtual events throughout June, learn more here.

Boston pride virtual events

Check out all of the Boston Pride events here.

west hollywood pride events

West Hollywood Pride has also gone virtual this year, check out their website to learn more.

san diego pride virtual events

You can learn more about all the San Diego Pride events here.

human rights campaign’s pride inside campaign

To help everyone celebrate pride safely this year, HRC has launched the Pride Inside Campaign. The campaign website provides resources to celebrate pride safely including this fantastic Pride Inside Activity and Coloring Book (fun for adults and kids)!

Global Pride

In addition to these online celebrations, The European Pride Organizers Association (EPOA) and InterPride, a consortium of local Pride organizations in the US and internationally, are organizing a huge, worldwide Pride event to be held entirely online. They plan to host a 24-hour online Global Pride event on June 27, the anniversary of Stonewall, which will feature musical performances, speeches, and other Pride-related content each hour. While organizers recognize that being online isn’t the same as attending an in-person event, they hope that the online format will reach people in countries that are unsupportive of LGBT people and allow them to participate in Pride.

Global Pride recently announced the first wave of speakers and artists appearing at the online event. World leaders and Grammy Award-winners are among the line-up, including Carlos Alvarado Quesada, President of Costa Rica – which this week legalized equal marriage.

You can learn more about the Global Pride event on their website and sign up for the event on Facebook

How are you celebrating Pride this year?