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"Our hope is that we put a dent in the HIV epidemic that is happening in our community and motivate other students to consider this important issue wherever they end up practicing medicine," Covas says.

After earning her MPH from Columbia University’s Mailman School of Public Health, Tiffany Covas spent two years focusing on HIV prevention services and sexual health education as the coordinator for Project STAY’s mobile health team in New York City.

“I felt like this was making an impact on the epidemic because we were screening and educating people who didn’t often make it to a doctor—we often provided individuals with their first HIV/STI tests,” Covas says, adding that Project STAY primarily works with vulnerable adolescents in alternative high schools, GED prep programs, juvenile reentry programs, and LGBTQ organizations.

When she came to Wake Forest University School of Medicine, Covas connected with Aldric Jones (last week’s “Five Questions for a Fellow” interviewee)—who, like her, noticed a lack of opportunities to obtain sexual health and HIV prevention services in Winston-Salem. So they applied to become North Carolina Schweitzer Fellows—and they’re spending their Fellowship year expanding at-risk North Carolinians’ access to life-saving HIV/STI education and screenings. The results so far have been both surprising and inspiring.

Why did you decide to develop your particular project?

Aldric and I both noticed the lack of opportunities to obtain sexual health services in Winston-Salem, and we wanted to make it easier for the general community to obtain these services—especially because of Winston-Salem’s high incidence of syphilis and other STIs. Just screening and treating syphilis, chlamydia, and gonorrhea can prevent HIV, because HIV is more easily spread to and from a person who is infected with another STI.

Additionally, we wanted to increase our school’s focus on sexual health. Not only is it important for the community to have access to screening and education about sexually transmitted infections, it is important for medical students to have the opportunity to learn about these issues in and out of the classroom.

That’s why we developed our Schweitzer project. As Schweitzer Fellows, we are working to decrease the disparity in sexually transmitted infection rates in Winston-Salem by working with high-risk individuals to provide education, screening and treatment. We are collaborating with the Forsyth Co. Dept. of Public Health and AIDS Care Services to find community organizations with the highest need for these services. We are also collaborating and integrating our project into the Delivering Equal Access to Care (DEAC) Clinic, Wake Forest’s free student-run clinic for uninsured residents of Winston-Salem (Natalie Cassell and I serve as the Executive Co-Directors).

My first service oriented task for the Schweitzer Fellowship was to implement opt-out testing for HIV & syphilis at the DEAC Clinic, followed by offering other STI screenings for our highest-risk patients. Annual opt-out testing for HIV is the current recommendation of national organizations such as the Centers for Disease Control and US Preventative Services Task Force. (For more information on opt-out testing, click here and here.) Since nearly all medical and physician assistant (PA) students volunteer at our clinic at some point, DEAC’s new opt-out policy is giving students the opportunity to practice implementing a recommendation that is often ignored all over the nation but especially in our conservative community.

The next step at the DEAC clinic is to implement chlamydia and gonorrhea screening for higher risk individuals who desire screening at the clinic. Additionally, for our Schweitzer project we are developing the infrastructure to have a long-lasting outreach program for students to get involved in going out to community-based organizations and providing not just screening, but counseling and educational services to individuals who are at high risk for these infections.

What do you hope will be the lasting impact of your project on the community it serves?

We hope that our educational workshops and one-on-one counseling will change the behavior of some individuals and decrease disease transmission.  Since we offer treatment for STIs such as chlamydia, gonorrhea, and syphilis, we will be able to decrease the spread of these infections to others and prevent some of the long-term consequences of not getting treated (such as infertility or even death, in the case of syphilis). Treating these infections also decreases the chance that the treated individual will get HIV should they be exposed to it.

This is a prevention strategy which does not require behavior change (such as condom use or getting their partner tested prior to having sex). While ideally we would love to convince everyone to wear a condom every time that they put themselves at risk, we know that this is an idealistic goal. So it is great to know that we have another tool to prevent disease transmission: treating and curing bacterial infections which increase the risk of obtaining other infections.

This approach has benefits to both the treated individual and the community at large. Our program offers screening and education at community based settings, which is extremely important: many individuals do not have access to healthcare or know how to obtain free screenings. Our project will provide screenings for people who normally can’t make it to the doctor and have possibly never been screened for STIs or HIV.  Bringing screenings and education to a place where people are comfortable and already have a trusting relationship with the staff can help bridge their trust to us and will make a large impact on transmission rates.

Additionally, Aldric and I (along with a few other medical students) have started the Sexual Health Awareness Group at our campus to increase awareness about sexual health issues at Wake Forest School of Medicine. This new student organization will allow our new outreach program to have continued and lasting influence on the community at large.  Additionally, the medical and PA students involved with the organization will have many opportunities to engage with the community and learn how to address sensitive sexual health issues with their patients. When students choose their specialty, they may not spend as much time obtaining a sexual history—but this learning experience will always be with them and will put STIs and HIV on their differential when they are relevant.

Additionally, opt-out testing at DEAC as been integrated into triage and should continue so long as we maintain our partnership with the Forsyth County Department of Public Health. Therefore, not only will the students involved in our Sexual Health Awareness Group be exposed to the importance of HIV prevention, but nearly all medical and PA students will gain some exposure via opt-out testing. The impact that this program has on students will spread to other communities when the students graduate and move on to become clinicians all over the country. Our hope is that we put a dent in the HIV epidemic that is happening in our community and motivate other students to consider this important issue wherever they end up practicing medicine.

What do you think is the most pressing health-related issue of our time, and how do you think it should be addressed?

I think the most important health issue of our time is making sure that everyone has access to healthcare regardless of socioeconomic status. I think that this is a human rights issue and that the health disparities that exist within our own country are astonishing.  Unfortunately, I am not sure how to solve this problem and I don’t think anyone else is, either—and the state of our current economy complicates the issue further.

Putting a little money into prevention and services before people get sick would save us a ton of money later (as opposed to paying for complications from a simple medical problem when uninsured individuals end up in the emergency room).  Overall, a national healthcare program that emphasizes preventative medicine may end up being more economical—but it requires an initial investment that our nation is struggling to cough up. There is no clear-cut answer, especially given our economic situation, and if I had the answer, I would definitely go into politics.

What has been the most surprising element of your experience as a Schweitzer Fellow so far?

So far, things have been going well. I guess what has been surprising has been the amount of both resistance and excitement about this project—and seeing resistance turn into support and excitement for the project.

In implementing opt-out testing at the DEAC clinic, many student leaders had complaints and were resistant to change. Luckily, I had the support of the other Executive Co-Director, the advisory board, and our Clinic Operations Director, Patty Wang. During the first month of implementation, several students shared with Patty and me how surprised they were when the people they asked accepted the testing. The students were coming to the realization of how important it is to offer this service to anyone despite their age, race, sexual orientation, or religion. It has been exciting watching other students realize that our patients really want and appreciate this service. I think it will influence these students long-term, and while that is the impact that I had hoped to achieve, it was definitely surprising to see obvious signs of success so early in the project.

What does being a Schweitzer Fellow mean to you?

I am excited to be a Schweitzer Fellow. It has provided me with opportunities to learn from other students who are interested in service.  I have always had a passion for serving disadvantaged populations, which drove me toward a career in public health and medicine.

I am honored and excited to participate in the Schweitzer Fellowship.  I enjoy meeting other Schweitzer Fellows from many different backgrounds and disciplines who are all working to combat health disparities.  I think that the “Fellows for Life” alumni program is a great way to keep Fellows in touch with each other. Having the alumni network of people that have similar interests will provide future opportunities to partner together to work on grants and projects with Albert Schweitzer’s ideals in mind: eliminating health disparities and improving the quality of life for all. I think that is an awesome way to live, and I am really proud to be a North Carolina Schweitzer Fellow. 

Covas is a Schweitzer Fellow in North Carolina. Click here to read more about The North Carolina Schweitzer Fellows Program and the Fellows like Covas it supports in creating and carrying out yearlong direct service projects that impact the health of vulnerable communities. To make a gift to The North Carolina Schweitzer Fellows Program in honor of Covas’ efforts to increase access to HIV/STI testing, click here.

Each week, Beyond Boulders delivers a new installment of “Five Questions for a Fellow” – an interview series with Schweitzer Fellows across the country and in Gabon, Africa who are leading the movement to eliminate health disparities. For an archive of previous “Five Questions for a Fellow” interviews, click here.