Read and listen to longtime HIV/AIDS physician Dr. George Kent as he discusses his 32 years of work at the Santa Clara County PACE Clinic and what he sees as the new challenges ahead for treating patients with HIV.
Dr. George Kent has been caring for people at the Santa Clara County’s AIDS clinic for over 32 years. He started in 1989 when he began splitting his time between working with HIV patients and being a primary care physician with his own clinic.
“I’m not making this up,” the longtime ally said. “I would deliver a baby in the morning, then go to my private practice, and then to the HIV clinic. After work, I would go to the house of someone who was dying of AIDS and help his caregiver and partner with hospice. The circle of life was amazing to me.”
He has seen the disease evolve from one that was untreatable and incurable to what is now a chronic condition.
As someone who has treated patients since the early days of the epidemic, he remembers how difficult it was. “People my age were dying in the prime of their lives. Many were gay and estranged from their families. There was social stigma. It was a terrible time.”
The Stanford and Case Western Reserve graduate came to the HIV field after a residency at the UCSF-affiliated program in Santa Rosa, followed by training at the CDC as a medical epidemiologist, then returning to San Jose and completing an HIV mini-residency with the AIDS Education and Training Center at UCSF.
Afterwards, he looked around San Jose to see who was caring for HIV patients. One day he went to the Santa Clara Valley Medical Center.
“The clinic was in this little corner in the outpatient department; there were a few exam rooms. A person I met there was Dr. Ira Greene, a dermatologist and wonderful guy. We hit it off. After he got to know me and checked me out a bit, I said, ‘Ira, do you need some help?’ He said, ‘sure, you can join us.’ That was in 1989, and I’ve been there ever since.”
Kent reflected on some of the difficulties in the early days. “We felt a little like a M.A.S.H Unit. At one point we were in a flimsy little trailer in a parking lot. It was hot in the summer and cold in the winter. It made us more cohesive because we really did feel like it was us against the world.”
The PACE Clinic, or Partners in AIDS Care and Education, assembled an interdisciplinary team from the beginning. “You had oncologists, you had infectious disease, you had primary care, and you had dermatology because a lot of these conditions manifested with skin problems.”
Working with HIV was the ultimate medical education for Kent. The virus was a multifaceted issue that impacted family relationships, societal attitudes, and the whole of the LGBTQ+ community when it first hit the United States. There were concerns over confidentiality and end-of-life planning that just did not exist when it came to other terminal illnesses.
“It certainly has made me a better doctor,” Kent said of caring for his patients.
In the PACE Clinic, the staff kept a whiteboard where they recorded the names of the people that died each month. “At the end of the month, we’d have a service. We would all get in a circle and say something about each person that died. We light a candle and have a memorial service, and then we’d have to erase the whiteboard and start over the next month.”
Witnessing the deaths of so many young people took a toll on Kent, and he needed time to cope with the stress and burnout. “I took two months off during the height of it,” he said.
Things started looking up for HIV patients in the early nineties, more than a decade after the first cases were discovered in the United States. With protease inhibitors and other medical therapies, the virus no longer claimed the lives of the majority of people in Kent’s care. “People just came back to life.”
Some of those individuals are still alive today. “I have these 25-year relationships with these patients who were basically at death’s door.”
Although Kent recognizes the magnitude of his work back in the early years of the AIDS crisis, he doesn’t want to glorify it. “We were all there on the front lines, and we felt like we were doing something important and meaningful.”
Today, HIV is no longer a death sentence. It is a chronic condition that can be managed with medications and even prevented with treatments like pre-exposure prophylaxis, or PrEP. Kent is hopeful some of his patients might see a cure for HIV in their lifetime.
He believes more primary care physicians need to be trained to work with HIV to expand access to treatment and help normalize the condition. By giving patients the option to see their regular doctor, the medical community can make living with HIV part of mainstream medical care.
“I see HIV as a primary care condition,” Kent said. “I don’t think you have to go to a specialty clinic just because you have HIV.”
Advances in HIV treatment have only been part of the battle; the other is getting people into care and keeping them in care.
Today, healthcare disparities among those affected by HIV complicate the “Getting to Zero” mission, which aims for zero new HIV infections, zero deaths, and zero stigma.
In particular, he highlighted the importance of reaching vulnerable and underserved communities like the homeless and people of color living in the South. Two barriers that keep Black HIV patients from getting the care they need are medical racism and mistrust of doctors.
“We definitely need more outreach into those communities with culturally-competent clinicians who can establish trust, because our biggest challenge right now is accessing these communities.”
In Santa Clara County, medical teams serve homeless encampments and bilingual Latinx community outreach workers manage care for Latino HIV patients. “The outreach workers will go to someone’s house. If we have a patient that missed their appointments, or didn’t refill their medication, they’ll go to their house. They’ll meet them where they work.”
Translators of every known language are available at the PACE Clinic, which offers additional services like counseling, psychiatry, nutrition guidance, and a treatment adherence program.
“We have world-class institutions here in Santa Clara County with the expertise that you don’t see hardly anywhere else in the world, much less, our country or our state.”
Kent grew up admiring his father’s impact on people as an obstetrician. Working at the PACE Clinic has helped him to fulfill the societal benefit of the medical career he always wanted.
Working in Family Medicine at Stanford Health Care and the PACE Clinic has proven beneficial to him and his patients.
“If one of my Stanford HIV patients loses their insurance, then I can see them at PACE Clinic. I love that because then I don’t have to lose them. So, I have one foot in both worlds—enabling that continuity of care that I think is really helpful. I feel very fortunate.”