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Young men of color who have sex with men (yMSM) living with human immunodeficiency virus (HIV) in syndemic environments have been difficult-to-retain in care resulting in their being at-risk for poor health outcomes despite availability of effective once-daily antiretroviral treatment (ART). Multiple methods have been implemented to improve outcomes for this cohort; none with sustainable results. Outpatient HIV staff themselves may be a contributing factor. We introduced multidisciplinary staff to the concept of using a palliative approach early (ePA) in outpatient HIV care management to enable them to consider the patient-level complexity of these young men. Young MSM (18-35 years of age) enrolled in and cared for at the intervention site of the Care and Support Access Study (CASA), completed serial surveys over 18 months. Patients’ Global and Summary quality of life (QoL) increased during the study at the intervention site (IS) where staff learned about ePA, compared with patients attending the control site (CS) (p=.021 and p=.018, respectively). Using serial surveys of staff members, we found that in the era of HIV disease control, outpatient staff are stressed more by environmental factors than by patients’ disease status seen historically in the HIV epidemic. A Community Advisory Panel of HIV stakeholders contributed to all phases of this study and altered language used in educational activities with staff members to describe the patient cohort.

The Scarlet Virus Confident that she could manage her HIV, Ms. M. required little intervention; appointments seemed more like visits with an old friend. She counseled other patients in the waiting room, comforting peers who remained closeted and defamed even in the 21st century.

He was slim in build, and even as he sat in his wheelchair, you could see that he was tall. Infected, he claimed, by a serious bout of sexual promiscuity with women and too much alcohol. He gave me an overenthusiastic grin, trying just a bit too hard to be nonchalant, and said “Hey good-looking, coming to see me next?” I nodded absent-mindedly, trying to get through the note I was writing and simultaneously fending off the 20-odd patients clamoring the halls, all keen to get a word in with the doctor before their chance at an intervention disappeared for another week. Even though we frequented the nursing home far more often than mandated by state regulations, there still seemed to be so much to do and such little time to do it in. I told Mr. J I'd be with him in a minute, and he smiled affably. “I'll be waiting in my room,” he said pointedly, knowing full well it would take me too long to get to him.