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.

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HIV Long-Term Survivors Awareness Day

Tez Anderson, the founder of Let’s Kick ASS (AIDS Survivor Syndrome), started HIV Long-Term Survivors Awareness Day to celebrate the strength, determination, and lives of people who have lived with HIV for 20, 30, or more years.  Many long-term survivors were part of the early days of activism and have roots in the development of the systems that work to prevent and treat HIV today. 

The first HIV Long-Term Survivors Awareness Day was June 5, 2014.  The date of June 5th was chosen because it is the anniversary of the first reporting of cases by the CDC of what would later be known as AIDS.

Long-term HIV survivors bring so many strengths with them to the fight to end HIV.  Many also face a number of unique challenges, including: medical care, medication, housing, and social isolation, and more. You can read more about aging with HIV in Barry Waller’s wonderfully-written previous post HIV and Aging.

This Friday June 5th, Achieving Together is honored to host, listen, and learn from a panel of long-term survivors here in Texas moderated by Barry Waller. Please see the information below on the webinar and read the panelists and host’s bios.

Friday June 5th, 2020

11am-12:30pm CST

Log in at: Achieving Together Conversation Series: HIV Long Term Survivors Awareness Day

You do not need to download any additional software as the platform (GoToMeeting) will run in your web browser.

Or by phone at: (872) 240-3311     Access Code: 160-952-933

Host:

Barry Waller, Austin, Texas

For over 36 years, Barry Waller has worked in the mental health, intellectual disabilities, physical disabilities, and aging fields at both the community and state agency levels in various administrative and management positions. He has a Master’s Degree in Social Work. As the Texas Legislature combined various state agencies, Barry went to work at the Department of Aging and Disability Services (DADS) as Assistant Commissioner over Provider Services. In this position, he managed directly administered services and various contracts with several thousand providers of disability and/or aging services throughout Texas.

Now retired, Barry spends his time working with different community and volunteer organizations. He served for nine years on the Board of Directors at AIDS Services of Austin, where he still remains as a volunteer. He has also served twice on the Board of Directors for OutYouth Austin and currently serves on the HIV Planning Council, a workgroup at the City of Austin on the City’s Age-Friendly Plan, and the Steering Committee of the LGBT Coalition on Aging.

Panelists:

Gary Cooper, Austin

I had just arrived back in Texas and started life with a new partner in 1985 when I tested positive and learned that my t-cells were already depleted; my new partner tested negative, and opted to stay together (we still are.) As the crisis worsened—most of our friends died—I struggled to continue professional employment, hiding my status and coping with several relocations as my partner’s career progressed. Although I’d never been involved in community volunteer work, I threw myself into helping to create the response to AIDS in Little Rock and later St. Louis, continuing my involvement in Austin as a board member of AIDS Services of Austin in the early 2000’s. Once I had gone on disability in 1993 after hospitalization with complications, I no longer tried to conceal my status and continue to make myself available to local media as a long-term survivor (most recently in a Statesman/USA Today article on lessons learned from the AIDS epidemic that apply to our current pandemic).

Glenda Small, San Antonio

I am 63 years old, originally from New Orleans, Louisiana. I relocated to San Antonio because of Hurricane Katrina in 2005, and I decided to make San Antonio my home because I didn’t want to go back & start all over again. I have been HIV+ for 28 years, I have been on the Executive Board of Director’s for B.E.A.T. Coalition Trust for over 10 years; I have been on the Executive Board of P.E.E.R.S. for women (a support group for Women infected & affected by HIV/AIDS) for about 9 years; I’ve served 2 terms on the Ryan White planning Council here in San Antonio; I am on the End Stigma End HIV/AIDS Alliance known as ESEHA; I am a member of the peer mentoring advocacy group here in San Antonio; I was inducted in to Sister Love the Leading Women Society, also the Black Women’s Initiative for San Antonio, and two years ago I received an award from the Top Ladies of Distinction for Hidden Heroes!

Steven Vargas, Houston

Steven began helping people living with HIV in 1989, has been living with HIV since 1995, and was recognized as one of Poz Magazine’s “100 Long Term Survivors” in its annual “Top 100” December 2015 issue. Steven is a board member of Houston’s OH Project which preserves the experiences of Houstonians impacted by HIV, and is serving a four-year term as a Community Member representative to the U.S. Department of Health and Human Services Panel on Antiretroviral Guidelines for Adults and Adolescents. He also serves as a Trainer for NMAC’s Building Leaders of Color program and as a consultant with Project CHATT (Comprehensive HIV/AIDS Training and Technical Assistance), which provides technical assistance to Ryan White planning bodies in reaching their legislative requirements. He is also the Community Co-Chair of Houston’s HIV Prevention Community Planning Group (2020-2021), and serves on the local Ryan White Planning Council as the Co-Chair of the Comprehensive HIV Planning Committee. 

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Whatsinthemirror? Addressing Mental Health Among the Queer Community of Color in Central Texas Through the Arts

Tarik Daniels, the 2019 winner of the Austin Under 40 Award for Arts and Entertainment, sat down to chat with us about his work here in Austin, his journey to becoming a playwright, his passion for tackling mental health in the Black queer community, and his current projects with the organization he founded and for which he serves as executive director – whatsinthemirror.

Shortly after moving to Austin in 2012, Tarik procured his first grant from the city that allowed him to focus on playwriting. While working with the Austin Creative Alliance, he started whatsinthemirror as an initiative of their work, but branched out in 2016 to develop the project as its own independent organization focused on using art to address the intersections of mental health in the black queer community, particularly around HIV. Since 2016, whatsinthemirror has produced a play each year, starting with “The Counseling Session,” Tarik’s first play script based on an experience with suicide he witnessed as a 15-year old in Detroit. Tarik felt a natural fit with writing about the intersections of mental health and HIV in the black queer community, as he found that many folks in his community “weren’t able to find outlets in the mental wellness spectrum that allowed them to be free, to be true about what was going on in their life” and were contracting and dying from HIV at higher rates than their counterparts. He wanted to use art and his story to help others get rid of the shame and the stigma around mental health and HIV. He also says that he’s “always been around people with mental illness; that was normal to me. It was always a battle in our family,” and therefore the combining of passions is such a natural fit for him as he pursues this work. 

The U.S. Department of Health and Human Services Office of Minority Health reports that Black communities are more likely to report serious psychological distress.  The National Council for Behavioral Health found that Black Americans are less likely to seek out treatment and more likely to end treatment early.  The intersections of Black and queer identities only increase daily stresses of entrenched racism and homophobia, increasing the likelihood of psychological distress.  However, there are very few opportunities for accessing competent and affirming treatment. Less than 2 percent of the American Psychological Associate members are Black and many people who do seek out help, report experiencing racism and microaggression from their therapists.

Whatsinthemirror is a healing justice social movement that provides suicide prevention and mental health awareness to communities of color through art, advocacy, and affirming care with a focus on LGBTQIA+ people, youth, and women. The organization currently has two main projects: the development, publication, and promotion of a mental health database for the queer community of color in Central Texas, and their latest project, ArtHeals, started in January 2020 thanks to a grant from COMPASS/Gilead.

The mental health database came out of a realization through their work in the community hosting events connecting mental health/wellness practitioners with community members, and recognizing the need for a one-stop resource for queer people of color in Central Texas to find affirming practitioners. All database listings have been called and vetted by the organization and can be found directly from their website: https://whatsinthemirror.org. While the database currently functions as a Google spreadsheet, their eventual goal is to create a standalone website and app.

Their biggest current project is the ArtHeals project, which was recently awarded a Transformative Grant from the University of Houston Graduate College of Social Work as part of the COMPASS Initiative® to build on community-driven solutions that are reducing stigma and improving the health and wellbeing of those impacted by HIV in the South. With this grant, whatsinthemirror is currently running several support groups (currently meeting virtually) for Black queer people living with HIV and allies. This work also includes a Mental Health Monday Facebook live event. Through the support groups, they feature guest speakers each meeting and spend time planning their culminating event the Art Heals Festival, a multimedia social justice festival, occurring in August of this year. The festival, which will occur primarily, if not entirely online, at this point, strives to end HIV stigma through art, particularly among queer people of color, and will provide a platform for empowering people living with HIV to both showcase their art, but also take part in the planning process.


The festival aims to create a forum for dialogue and collaboration between diverse communities united by an interest in local social justice issues and to support the community of progressive artists, activists and community workers. They are currently looking for provocative, radical, inspiring, empowering, innovative and/or enlightening works from across the artistic media (i.e., film, poetry, performing arts, music, visual arts and anything else you consider art). Proposals must address local social justice/activist/human rights issues. To learn more about the festival, the mental health database, whatsinthemirror, or to submit a proposal, visit whatsinthemirror.org.

Finally, we asked Tarik his recommendations for organizations looking to address mental health among people of color living with HIV in their own work, and you can listen to his response here:  

Tarik Daniels is an AfroQueer artist and HIV & mental health awareness activist. He is the Founder and Executive Director of Whatsinthemirror?, a social movement that provides mental health awareness and suicide prevention through art and advocacy to communities of color. Currently serving as a City Commissioner for Austin’s LGBTQ Quality of Life Advisory Board and HIV Planning Council. Tarik has written, directed, and produced several plays and released a novel, No Bonds So Strong, in 2018 and cohosts the Black queer podcast, What Works for Us. He is the winner of the 2019 Austin Under 40 Awards in Arts & Entertainment, 2019 Richard “Torch” Hopkins Community Leader from Integral Care, and 2020 SXSW Community Service Honoree Award. 

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Think Globally. Act Locally: How Austin is Achieving Together Through Their Fast Track City Plan

By Brandon Wollerson & Laura Still

In many ways, Achieving Together: A Community Plan to End the HIV Epidemic in Texas was the catalyst for advancing conversations about ending the HIV epidemic in Austin. As the Texas HIV Syndicate, the integrated prevention and care planning body for Texas, began the process of developing a statewide ending the HIV epidemic plan, those of us working in Austin started having specific conversations about what we were doing to end the HIV epidemic here. We learned about Fast Track Cities, the global movement to end the HIV epidemic, and how San Antonio was the only Fast Track City in Texas at the time; we felt we needed to add Austin to that list!

The process started organically with conversations among key stakeholders at the end of 2017 and early 2018. These conversations led to many meetings and an alignment of the goals and objectives in Austin with those of the Fast Track Cities global initiative. Austin officially became a participating Fast Track City when Mayor Adler and Travis County Judge Sarah Echardt signed the Paris Declaration on June 20, 2018.

Once Austin officially became a Fast Track City, the planning group assembled working groups under four pillars:

  • Prevention
  • Testing and rapid linkage
  • Viral suppression and retention
  • Ending stigma

The working groups are made up of community stakeholders, including organizations, health departments, and people who are personally impacted by HIV. They are tasked with identifying ongoing needs and barriers to ending the HIV epidemic in Austin and addressing them. Some of Austin’s unique challenges are the racial disparities related to people in care, out of care, and virally suppressed. We also need to work harder to reach the most vulnerable people in our communities. 

Aligning Multiple Plans

Austin’s Fast Track City plan is our local vehicle to address ending the HIV epidemic. Achieving Together set the foundation for our local work by giving us the initial tools and language. From there, we looked at our community specifically to identify Austin’s unique challenges, opportunities, and strengths. Austin’s Fast Track City plan maintains elements of Achieving Together. We customized the plan to our unique community.

Achieving Together and the Fast Track Cities movements also remind us that ending the HIV epidemic is bigger than just our local community, that we are connected to the statewide and global cause and commitment to end the HIV epidemic. It’s a “Think globally. Act locally” mindset.

Taking Action Through Rapid Linkage

Achieving Together recognizes that we all need to rely on each other to support the work and the movement of ending the HIV epidemic in Texas. This is not about just one organization, but more about how we work together as an entire community to reflect the values and aspirations of the plan. One concrete way we can work collaboratively in Austin to eliminate barriers to care is through the creation of a Rapid Linkage to Care program throughout the city. We envision a system of care in Austin that rapidly links persons newly diagnosed with HIV into care and treatment within 72 hours.

We have started by identifying organizations that currently offer rapid linkage programming. Next we will work to improve coordination across organizations that provide opportunities for Rapid Linkage at other points of entry, such as emergency departments and non-traditional testing sites. Eventually we hope to create a status neutral system of care as we build a network and process to rapidly link people to HIV care, we can mirror that for people who need rapid access to PrEP or PEP.

While there are many challenges to ending the HIV epidemic in Austin, we hope that by equipping people and organizations with the tools to realize that the more we do to rapidly link people to care and treatment, the better the outcomes will be for them and for our community. We want to reinforce that everyone has something to contribute toward ending the HIV epidemic in Austin and that when we work together collaboratively and efficiently, we can meet our goals and build community at the same time.

Brandon Wollerson, Director of Clinical Operation, KIND Clinic

Brandon Wollerson is Texas Health Action’s first Director of Clinical Operations. In this role, Brandon oversees the clinical operations of all Kind Clinic locations. Brandon holds a Master of Science in Social Work degree from The University of Texas at Austin and has worked in the HIV field in Austin for over 14 years. He is deeply committed to addressing HIV and other LGBTQ+ health equity issues through his leadership with Austin’s Fast-Track Cities, the Texas HIV Syndicate, and Austin’s LGBTQ Quality of Life Advisory Commission. Brandon lives in Austin with his husband, Scott, and their four-year-old daughter, Addie.

Laura Still, Public Health Program Supervisor, Austin Public Health

At Austin Public Health, Laura has served as Planner for the Austin HIV Planning Council and has recently taken on the new role of HIV Outreach and Mobile Testing Supervisor. Her favorite animal is the unicorn.

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“P.S. I Love You,” a Black Man’s Quest for Love

By Jeaux Nathan Anderson, Jr

Austin Mahogany Project play explores the idea of love between Black Men

The Mahogany Project is a collective of Black queer individuals who use prose/poetry/storytelling and theatre to highlight our experiences and heal our pain.

The Mahogany Project was born after my friend William Lyons attended a conference teaching people how to use art as a vehicle for activism. Since he knew I was a writer, we partnered to create this group. We used our spades nights, formally called “sweet tea discussions” about once a month to come together and would chat about a topic then folks would hang out, drink, eat, and play spades. The shade was incredibly real during these times and it was dope to meet new people as well! We used these gatherings as an opportunity to talk to Black queer men in social settings and get content to use for our shows. The project was born out of exhaustion from other people telling our narratives without our permission. The Mahogany Project has been performing every summer (except 2019) with new volumes of work with each corresponding summer. Our troupe (currently six members, but has consisted of upwards of 15 in the past) writes all of our work and this is pretty much what started me in theatre as a performer and a writer. Performing work written by people who don’t identify as Black and queer isn’t something I am interested in at this time. I want to ensure the voices of our community and our work are being amplified.

P.S. I Love You (PSILY) was the third installment in what we call The Love Jones Series which explores the idea of love between Black men who love Black men. It follows the first installment, Love Jones (2017), and the second installment, For Lover’s Only (2018). PSILY is the conclusion to the series of a Black man’ s quest for love. The love of a partner. The love from community. And ultimately the love of self. I feel PSILY is one of the most authentic pieces I have written before. I drew from my own insecurities to write this show: the hurt and the pain I feel is apparent, but also the joy. 

PSILY is the merging of live music, singing, and poetry to tell a love story. (Think Jill Scott mixed with Tiny Desk Concert and Def Poetry Jam.) The plot for this show is simple: it’s a love story that explores the intersections of race, sexual orientation, and body issues. I use art to heal from pain and scars that I’ve experienced and this show is really no different. As a thicker and bigger Black gay man, the world sometimes strips us of our sexiness and vibrancy. I wanted to use this show to tell the story of someone who sees his insecurities as strengths. This show is to address the feeling of being Black in White queer spaces, being queer in Black spaces and how that impacts being in love with a Black man as a Black man. 

I think our shows are different because they don’t have specific character names usually. The benefit is that people can imagine who that character is for them personally. For our Love Jones Series, I perform as if the story is mine – because it is. I wrote three love stories, each based on the idea that we all get three loves in our lifetime. (I read this somewhere and thought it was cute.) I wrote about my first love who taught me how to be intimate and vulnerable. I wrote about my second love who taught me how to have an adult relationship. I wrote about my last love who taught me to love me. PSILY and the corresponding shows were written to follow this pattern: The hurting, the healing, the hope. PSILY is here to give people hope. We all want someone to win and find the person they are destined to be with. I want to use this show to fulfill the audience who have been on this journey with me for three years. Our next show will have the title Legacy and will highlight not only the legacy of our ancestors, but the legacy we’ll be leaving behind and the fight that will continue.

Since I work in HIV prevention, I think it’s incredibly important to partner with organizations during our shows. Over the past years we’ve partnered with various sexual health organizations to be at our events and to promote their HIV/STI testing programs. Austin Public Health, Kind Clinic, and ASHwell have all sponsored a show and brought their services to the people. Our shows sometimes involve sexual topics and we want to highlight that sex should be fun and pleasurable for both partners. No matter what type of sex you’re having we want you to enjoy it. But we also want to let people know they have options to experiment with ways to reduce risk of HIV/STI transmission. We also want to normalize getting tested with our partners. That conversation has to be had. 

Upon reflection after the show, it was fantastic. Truly amazing. Spectacular. There were tears, laughs, and love. I think the best way to describe the night is we felt triggered and the words/music helped us heal. We moved past hurt and made magic and memories that night. There are no words to describe the night other than for an hour and a half we were all able to reflect on love and feel hopeful. It was dope. We were all able to realize that even in darkness there is light. And the light is in our legacy and lineage as black queer folks!

The ultimate message I wanted people to walk away with is that we can be our own daddy. We can be our own prince charming or princess. We have enough within ourselves to be what we want and to love. We are dope. PERIOD. We define what love looks and feels like for us. I encouraged everyone who came to the show to know that this is a safe space to own that idea. 

Jeaux Nathan Anderson, Jr is a playwright and activist living in Austin, Texas, hailing from Dallas originally. He wrote, produced, and acted in his most recent production, P.S. I Love You, performed by the Mahogany Project at Cheer Up Charlies in February in Austin.  

My name is Jeaux Nathan Anderson Jr and I am proud to say I was born in the “Big D”—Dallas, Texas. I’d say from a young age I was always interested in storytelling. I remember using my toys to create fictional worlds and create characters that were reminiscent of the daytime soap operas my grandmother used to watch. My grandmother didn’t realize it at the time, but during these formative years she was crucial in my development as a storyteller. I became fascinated with the stories of our family that she’d share with me. It was in the 7th grade that I wrote my first piece and, please know, it was awful. The title was Double Dutch Chocolate, which is ironic because I actually don’t even like chocolate. But from there, the seed was planted and I continued to work on my craft through high school and the beginning years of college. During my time as a student at The University of Texas at Austin (UT-Austin) I started to share my work and actually perform. I grew more comfortable with my voice. I came out. I started to grow into the person I am today. Most importantly, I met William Lyons. Will was my first access into what it meant to be a Black gay man and introduced me to many of the friends I still have today. He and I grew from co-workers to “bristers” (brother sisters) during our time as orientation advisers at UT-Austin, and it was with him that I worked to create what is now The Mahogany Project in Austin.

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