Growing up as a gay, Latino man in the 1990s, Dr. Philip Ponce saw the devastating impact of HIV and AIDS.
It pushed him to a medical career.
“A lot of people in my community were dying of AIDS. I knew I wanted to work with other gay men, and I knew I wanted to take care of people with HIV,” Dr. Ponce said.
Dr. Ponce is the Medical Director at Kind Clinic San Antonio, a clinic that provides sexual health services such as HIV testing and treatment, STI testing and treatment, access to HIV prevention medication known as PrEP (pre-exposure prophylaxis) and PEP (post-exposure prophylaxis) and gender-affirming care.
He’s also an assistant professor of infectious diseases at UT Health San Antonio and director of transplant infectious diseases at the University Transplant Center.
Despite a busy schedule that balances clinical care, research, and teaching, Dr. Ponce feels rewarded by making an impact in his community.
“Helping folks who I think otherwise would not get help is really motivating and kind of sustains me through even the challenging periods,” Dr. Ponce said.
What Drew Him to Study Infectious Diseases
Dr. Ponce was born in Trinidad and spent his childhood moving around the Caribbean before his family settled in Philadelphia, Pennsylvania.
His father was a Methodist minister, which partially influenced his work.
“I am not very religious, but in the Methodist Church, there’s an ethos of equity, fairness, and justice. And that’s really what I want to see for everyone, especially folks that have been historically marginalized,” Dr. Ponce said.
He was first drawn to a medical career after a death in the family that seemed preventable.
“After working in the US for about 20 years, my granddad decided to go back to Jamaica. And within a year of moving back, he had a heart attack and died. I think what was really upsetting was that it’s something that was potentially remediable or survivable in the US, there were just no resources there. I thought for a long time that I would go into medicine, and I would do global health,” Dr. Ponce said.
But his focus shifted from global health to infectious disease when he realized the work that could be done within the US healthcare system, especially as the AIDS epidemic rose in the 1980s and 90s.
“I knew I wanted to work with other gay men, and I knew I wanted to take care of people with HIV, so that prompted me to go into Infectious Diseases. I’ve had that interest since I started in medical school,” Dr. Ponce said.
Dr. Ponce has faced barriers and challenges throughout his career because of his identity.
“How do I say this nicely? I’m a fat, gay, Latino immigrant. I have strong opinions about things. I feel in many ways, I’ve kind of been underestimated, and maybe undervalued in many situations,” he said.
Unfortunately, Latinos often encounter implicit bias, or preconceived stereotypes, from their peers, whether that’s in the classroom or doctor’s office.
“Most healthcare providers, for example, have implicit bias ─ positive attitudes toward white patients, and negative attitudes toward patients of color,” according to a Salud America! research review.
For Dr. Ponce, having supportive mentors helped him persevere.
“I have fantastic role models in my parents, and so I think they just kind of instilled in me to thrive, and that no matter what the barriers are, they’re not insurmountable. Just keep working at it, and you’ll get where you want to go,” Dr. Ponce said.
Dr. Ponce’s Work at Kind Clinic
After finishing medical school at the University of Pennsylvania, Dr. Ponce did his residency at the University of California, San Francisco.
He worked in the Bay Area for several years doing internal medicine and HIV primary care before taking a fellowship in Boston through a combined program with Massachusetts General Hospital and Brigham and Women’s Hospital.
After the fellowship, Dr. Ponce moved to San Antonio to be closer to his family. He began teaching at UT Health San Antonio in 2018.
Then in 2020, he started at Kind Clinic as the Medical Director.
At Kind Clinic, Dr. Ponce starts his day early.
“I usually get in … about an hour or so before we start seeing patients, and a lot of that time is spent catching up on administrative duties. The medical literature changes pretty rapidly, so it also gives me a little bit of time to read and study up on things. I then see patients for most of the morning,” Dr. Ponce said.
He then heads to his other jobs in the afternoon.
“I change roles, and I go to University Hospital. And then I round with the solid organ transplant teams and take care of patients there,” Dr. Ponce said.
Even when he’s not physically at Kind Clinic, he’s still on call and ready to provide support to his team.
“A lot of my role is working with our mid-level providers, NPs and our PAs, answering any questions that they should have during the course of patient care, so I’m always on call for them whenever they need me. I do chart reviews of patients they’ve seen periodically, so I’m doing that in the background as well,” Dr. Ponce said.
At least once a week, he likes to meet with his staff and dedicate some time to teaching.
“It’s usually half an hour to an hour, where we talk about clinical cases that have arisen during the week, or we talk about a specific topic that they want more information on,” Dr. Ponce said.
At Kind Clinic, many of Dr. Ponce’s patients are Latino, like him.
He works hard to break down barriers that Latinos often face in seeking healthcare.
“I think 50% of our clientele are folks of Latin heritage. A lot of what we try to do is we try to break down many of the barriers that they face. So if you don’t feel comfortable going to the doctor in your community, you’re able to access many of our services through TeleKind, where you can have a phone or a video visit interaction with the clinician who can provide a lot of the services. We have a very user-friendly website that allows you to schedule with us and to access a lot of information as well,” Dr. Ponce said.
Having staff members at Kind Clinic who are Latino Spanish-speakers and can provide culturally tailored care to Latinos is also essential.
“I think it’s very helpful and empowering for many of our clientele to see that they can receive care in their own language from people who share a common LGBT and Latin heritage, and I think it allows us to retain these folks in care,” Dr. Ponce said.
The Disproportionate Effect of HIV on the Latino LGBTQ Community
One of Kind Clinic’s main services is helping patients with HIV treatment.
Unfortunately, Latinos are disproportionately affected by HIV.
“Especially with the Latino population here in South Texas, gay, young Latino men are incredibly high risk for HIV acquisition. They are the number one demographic that has new cases of HIV diagnosed,” Dr. Ponce said.
There are several reasons why this disparity exists, according to Dr. Ponce.
“I think there’s a lot of cultural factors that play in. There’s still this culture of machismo, and then there are some communities that are still quite religious. Acknowledging your LGBT identity and coming to terms with it is a little bit difficult, because you have these cultural factors working against you,” Dr. Ponce said.
Lack of healthcare resources is also an issue.
“In a lot of communities, especially along the border, there’s one doctor or one clinic. And so you may not feel very comfortable, due to concern for stigma and issues around privacy, going to that clinic or going to that doctor and saying, ‘Hey, I’m gay, I need STI testing, and I want to do PrEP,’” Dr. Ponce said.
With limited access to sexual health clinics that serve LGBTQ people, there’s also a lack of education around safety and prevention.
“Logistically, it becomes a barrier for people to get tested and know their status and then to access a lot of healthcare resources. It also means the kind of educational counseling that we can do in the clinical setting is limited, so people may be putting themselves at higher risk than they need to just because of lack of information,” Dr. Ponce said.
That also means that people are unaware of options for treatment that are no or low cost and don’t require insurance.
“Many of our communities within San Antonio and the larger South Texas area are economically marginalized. Many of our clients sort of had an inkling that something was wrong and that they might have acquired HIV, but the thought that they would need money to pay for testing, care and medication, prevents them from accessing care,” Dr. Ponce said.
Thankfully, health providers centers like Kind Clinic are working to break down the barriers and fight the stigma against HIV.
Continuing to Fight the Stigma
The public perception and negative image of HIV has improved since the epidemic of the 80s and 90s.
But that doesn’t mean the stigma isn’t still there.
“Things have definitely gotten better. And I think the biggest misconception is this terminology that’s still very prevalent in both the LGBT and the heterosexual communities of being ‘STI clean’ or ‘dirty.’ Because you have HIV doesn’t mean that you’re ‘dirty,’ it means that you are unlucky to get a transmissible illness. It has nothing to do with your moral character, your judgments, anything like that,” Dr. Ponce said.
Focusing on safety and treatment is important in fighting the stigma.
“If you have HIV, if you don’t have HIV, it’s all a matter of being empowered about your sexual health and taking care of yourself. I think things are slowly changing for the better,” Dr. Ponce said.
Treatment for HIV has also come a long way since the outbreak of the epidemic.
“HIV is not how it was. Thankfully, it’s not a battle like when I grew up. HIV at this point is a chronic but very treatable illness. Especially if you are diagnosed with HIV early before it has a chance to affect your immune system and get started on medications early and stay on medications, you will live a normal lifespan and you will remain healthy. HIV is something that you live with nowadays, not something that you need to die from,” Dr. Ponce said.
To learn more about Kind Clinic, which has locations in San Antonio and Austin, as well as Dallas in early 2022, visit kindclinic.org.
The post Dr. Philip Ponce: Increasing Access to HIV Treatment for LGBTQ Latinos appeared first on Salud America.