Not So Complicated
Alisson Sombredero, MD, offers to physicians compelling approaches to HIV care
by Chael Needle
Alisson Sombredero, MD, is more than two months into her fellowship and couldn’t be more pleased: “It’s fantastic. I’ve learned so much and I have already been exposed to so many cases, so it’s been amazing.” Awarded a 2012 Minority Clinical Fellowship by the HIV Medicine Association (HIVMA), she has been paired with two mentors at the University of California in San Francisco (UCSF) and Oakland’s East Bay AIDS Center (EBAC).
Since first being inspired to pursue the field of HIV/AIDS at her alma mater, Universidad de la Sabana Medical school, Dr. Sombredero has gone on to complete a clinical internship in HIV medicine in Spain and to work as a physician in Colombia, where she provided services to the rural communities of Tumaco and Cali on the Pacific coast, supervised research, and spearheaded health campaigns against leishmaniasis and syphilis/HIV co-infection, among other accomplishments. Completing her residency training program at Highland Hospital in Oakland, she worked primarily with Latino immigrant patients and became attuned to the benefits of culturally tailored care as well as the need for more HIV awareness and knowledge about medication adherence among this patient population.
About twelve years ago, when she was in medical school in Bogota and practicing internal medicine, Dr. Sombredero first felt inspired to learn more about AIDS when she had to deliver the news of a positive diagnosis to the previously non-infected partner in a serodiscordant couple.
“They were a gay couple and I was thinking to myself, ‘If it happened to me, I would hate this person for doing this to me,’” she explains. “Then I told the couple that the other partner was also infected. And I was absolutely amazed about what I saw because they cried and they hugged each other and they said, ‘You know, we are together. We’re going to be together forever and we’re going to be supportive to each other. It doesn’t matter what happened before.’ That made me definitely pursue taking care of HIV patients. They are absolutely amazing; they are fun to work with. They are usually younger and have a lot of goals in their lives and that makes the work…so much more exciting.”
The fellowship has also given her an opportunity to educate other primary care physicians about HIV/AIDS, and she has found that physicians, especially interns, are receptive. Primary care physicians often defer HIV-positive patients to specialists, fearing that HIV is not in their wheelhouse. Says Dr. Sombredero: “I understand [this attitude] because they haven’t had exposure to [HIV] patients, so they really don’t know how to treat them or how to approach them. They feel that HIV is a really complicated field, but actually it’s not. It’s not so easy, but it’s not so complicated!”
Overcoming one’s fear and knowing about the resources available to patients is one way that physicians can make a dent in the disproportionate burden of the impact of AIDS on Latino and other underserved communities, says Dr. Sombredero. “Physicians need to test for HIV. Usually in a primary care setting, if patients come in with an STD the physicians may think about [HIV testing] but it’s not part of primary care yearly testing.”
Being a compassionate physician is another: “African-American and Latino communities have a lot of stigma about HIV and these patients are usually very isolated. They are depressed. They are ashamed. And I think the system also contributes to that. It doesn’t help them because doctors are not very well educated about how to approach the patient and how to help the patient.”
When it comes to HIV awareness and treatment awareness among members of a diverse Latino population, cultural sensitivity is just as important for physicians to hone. “Tailoring the communication to the culture would be key because the patient won’t feel so ashamed and they can start conducting awareness, for example with youth, when they go for physical exams. They can raise awareness, talk about condom use and risk factors in a nice, polite way but also in a realistic way so that they can break the stigma.”
Alisson Sombredero hopes that the fellowship will allow her to continue on as an HIV specialist and focus on HIV patients and care, “but also to explore what has been happening with the HIV Latino community in the area and research the smaller organizations in the Bay Area and bring that knowledge to a Latino clinic,” she says. “One of my projects is creating a Latino clinic at UCSF and also at EBAC. And it’s happening. Little by little I’ve been getting Latino patients. But I want to approach the community and see which other tools I can [gather] to make it a better and friendlier place for the Latino community to come and receive care, as well as break the stigma and increase awareness of HIV.”
Chael Needle interviewed Natasha Travis, MD, another HIVMA Minority Clinical Fellow, for the September issue.