Author: Lucy Bradley-Springer, PhD, RN, ACRN, FAANSource: Mountain Plains AETC
You can look back, but don't stare. -- Gary Reiter, MD
Twenty years ago in the spring of 1988, I applied for a new job. I knew nothing about HIV infection - its emergence on the national scene had barely made a ripple in New Mexico where I lived. But I heard about a job that sounded good, and I was fortunate to be hired as the coordinator for the New Mexico AETC, a local performance site (although we didn't call it that back in 1988) of the Mountain Plains AETC (MPAETC).
As it turned out, all of us in the MPAETC region were starting from scratch. We lived in an 8 - state region with some of the country's lowest HIV incidence rates. Providers in our states didn't think HIV was important, and many saw it as a moral issue that they didn't want to learn about. Twenty years later, we are still an extremely low incidence area (fortunately) and we still have care providers who avoid HIV (unfortunately), but we see fewer of those and a lot of the reason for that has to do with the efforts of the MPAETC.
The initial plan in 1988 was to adopt an existing HIV curriculum and move forward to teach providers in our states. That plan crumbled quickly when we discovered that the few available HIV curricula did not meet our needs. So we decided to create our own. I will spare you the details of the efforts that ensued. Suffice it to say, if we had known what we were getting into, we never would have gone into the curriculum-producing business. What evolved, however, was a 5-inch thick, 3-ring binder full of HIV-specific information liberally sprinkled with teaching and evaluation tips. By 1989, armed with our manuals, we set out to train the trainers who would carry the word to the far reaches of the region. In New Mexico, we trained almost 500 educators, provided them with the curriculum, and sent them out with promises of support (which, I am happy to say, we actually delivered).
Looking back, I can see how far we have come. Over the years, MPAETC has become a major producer of enduring materials targeted to key providers. This was not the original intent of the program, but it was what evolved because it was what we needed to do. Our materials are now used all over our region as well as nationally and internationally.
More importantly, however, we learned early on that providers in our region needed to hear the basics and so we have focused on primary care roles in the epidemic: assessing risk, giving prevention messages, dealing with occupational exposures, including HIV in the differential diagnosis, getting people tested, using consultation and referrals, treating HIV-infected patients, and working to decrease stigma and discrimination. We work with HIV care experts in our region - many of whom are part of the MPAETC network - to make sure that providers in the region have access to cutting-edge information and support.
It has been a long and unpredictable journey, but the national AETC system has proven that a program dedicated to helping providers change their behaviors can make a difference in the delivery of health care.