Internist Speaks Volumes for Those Suffering in Silence

A Cincinnati internist has focused her career on bringing attention and help to patients who are often neglected by policy makers, such as women with HIV and AIDS, and people suffering from drug addiction.

Everyone needs an advocate, a champion. Someone taking up the fight on their behalf to correct an injustice that occurred or an imbalance that exists.

Where HIV, AIDS, and women are concerned, that champion is Judith Feinberg, MD, a professor of internal medicine at the University of Cincinnati College of Medicine.

Feinberg is nationally renowned for her work on HIV and AIDS, and his contributed significantly to their effect on women. She has also brought to light the importance of working harder to include women of color in clinical drug trials designed to broaden the medical community’s knowledge about AIDS.

“Women are kind of the forgotten part of HIV,” Feinberg explains. “They don’t get very much attention. It’s not like they can go to a gay bar. There’s no sort of natural community for women who have HIV. Most of them end up bearing that in silence.”

So Feinberg speaks for all of them.

Shunned and Overlooked

Feinberg says one of the challenges facing women with HIV and AIDS is one of access and attention. Many of them have no one they can turn to because they don’t feel that their families will accept them.

“About 30 percent of the people that we’re seeing in our clinic are women,” she says. “That’s a significant amount of the population. That’s why I’m drawn to it.”

But there are other issues. Feinberg says that women have been excluded from studies in this area, so there is a paucity of information available to clinicians for guidance. What has come to light from studies comparing women and men is that women respond with much more nausea than men across a range of medications. That’s an education problem.

“I think because being gay got so much press early on that many people are just not aware of [women and HIV/AIDS],” Feinberg says. “Everything about being a female and having this disease tends to isolate women. And often the only time they can be open about it is when they see their doctor.”

Hepatitis C Challenge

Feinberg’s work as a researcher and caring clinician is not limited to patients battling HIV. She’s also heavily involved in the area of substance abuse. She created a syringe exchange program in Cincinnati designed to address heroin addiction and to cut infection rates of HIV and Hepatitis C.

“That’s a big tragedy,” says Feinberg, referring to the substance abuse issue. “In this county, Hamilton County, Ohio, which encompasses the Cincinnati and close suburbs, we had 250 who died of a narcotic overdose in 2014. That’s five a week. It destroys families. If that isn’t a tragedy then I don’t know what is.”

The syringe exchange program, however, has had a host of hurdles to overcome, not the least of which is the conservative nature of the Cincinnati populace.

“This end is the red end, Cleveland is the blue end,” Feinberg says. “You know, John Boehner comes from a Cincinnati suburb.”

But the challenges go deeper than simply political ties. Feinberg says that people—even sympathetic, educated people—don’t truly understand the meaning of harm reduction, which is a very important public health principle. The tendency is to equate the syringe exchange program to aiding and abetting—even enabling in many respects.

“But that’s like saying if you have glasses in your house you’re enabling people who come to visit who are alcoholics,” Feinberg says. “People don’t start shooting up because they have clean needles. They shoot up because they’re addicted to drugs. People will shoot up whether they have clean needles or not. The idea of harm reduction is to keep people alive and healthy until they get with the drug treatment program.”

Three-Year Grant

Feinberg recently received a 3-year grant for $900,000 from the US Centers for Disease Control and Prevention to prevent Hepatitis C from spreading throughout rural and suburban areas in southern Ohio. The project is called StOPHeP, or Southern Ohio Prevents Hepatitis Project. The focus is on harm reduction, and Feinberg acknowledges there is much stigma, bias, and ignorance to overcome in making the program a success.

“People say, ‘Why do you care? They’re just junkies. These people got what they deserve,’” Feinberg says. “I don't know. Everyone has sex sooner or later. The tragedies of the Catholic church show you that even people who say they’re not going to have sex, have sex.”

The grant money will go toward hiring peer navigators and outreach workers to connect with 18- to 30-year-olds who inject drugs and have contracted or are at risk of contracting Hepatitis C. Feinberg plans to use social media—in the form of a closed web site—like Facebook and Twitter to reach study participants.

“That’s the way they get their news,” she says. “That’s the way they communicate. You have to reach them where they are.”

A Non-Fiction Life

When she’s not busy at work, Feinberg describes herself as an avid reader. And her genre of choice is fiction.

“My work life is non-fiction,” she explains. “What’s going on with my patients is non-fiction. All the reading and research and other stuff I have to do is non-fiction. So, when I can escape into someone else’s story, it feels so good. I was a Humanities major before I ever thought of going into medical school. So it’s really mother’s milk to me.”

She’s also loves to cook, is an avid gardener and a semi-pro photographer who loves to travel and take photographs. But the reality, she says, is “how much time do I have to do all these things? I have some real limitations.”

Despite the limitations her professional side places on her personal life, Feinberg is not about to introduce any changes. She says that her commitment to public health and research enables her to reach more people than she ever could as a practitioner.

“The fact that AIDS and HIV are now a manageable chronic condition when they started in 1982 as something that was uniformly lethal is amazing,” she says. “It’s nice to feel like you have made an impact. That makes all the long hours feel so much better.”