Denise Taylor, MD, AAHIVS
Community Health Center of the Central Coast
San Luis Obispo, California
Dr. Denise Taylor went to medical school at University of California, San Diego from 1985 to 1989 and completed a Family Medicine Residency in Martinez, California in 1992. She worked for a short time in private practice but has mostly worked in government settings like county clinics and correctional facilities since then. Says Taylor, “I find that I enjoy working with the underserved more than I enjoy working with people who are more in my own demographic.” People living with HIV have been a core part of her patient pool since the beginning of her career. In 1997, Taylor began her earnest pursuit of becoming an HIV Specialist. Taylor recalls, “I had recently been hired at a state prison in California and one of the HIV care providers moved to another part of the state. I was asked if I could like to focus on HIV care and I readily agreed since it seemed like an interesting and worthwhile pursuit. During my residency I had taken care of many patients who had died of AIDS and providing primary care to people with HIV appealed to me.”
Taylor works in a few different settings currently including a state prison, county jail, and community health center. The majority of her time spent caring for people with HIV/AIDS is in the local community health center. She contracts with them for one day a week and, until recently, was the sole provider for a period of 15 years. She has two nurses who help her during her clinic day. “I see patients who primarily come from disadvantaged backgrounds. I follow about 150 patients with HIV/AIDS and an additional 100 patients who are transgender. A few patients fall into both categories. I see about 20 patients a day, one day a week. I am seeing more young patients now than when I started, more newly diagnosed and more women. I would say the practice is about 30% over 50 and my oldest patient is about 88. Since I speak Spanish I also have a number of monolingual Spanish speakers on my case load.”
Taylor provides care to a large transgender population. Some people drive over three hours each way for a clinic visit, showcasing how desperate they are for care. Says Taylor, “I opened up my one-day-a-week community practice to the trans community by reaching out to the local support group in our small town. It took a while to build up trust but once the patients came in the practice grew exponentially. I joined an advocacy group and through a variety of outreach methods, I have grown the practice to stretch up and down the coast of central California and also to extend inland to the Central Valley. I am seeing children in my clinic who are being brought in by parents who find my name by word of mouth, newspaper articles, radio, Google search, or through their schools and need information about how to help their children. This practice has grown out of my HIV practice (in the prison there is unfortunately a big overlap in the trans and HIV populations), and I believe it could be a natural extension of any practice that seeks to alleviate suffering.”
Taylor enjoys getting to know her patients and helping them improve the quality of their lives. She finds that because HIV is so stigmatized, many people do not have anyone to talk to about their medical condition. When someone comes in with a new HIV diagnoses, they are almost always anxious about their prognosis, often ashamed about being infected and worried about their future. “With all the advancements that have been made in HIV medicine it gives me great pleasure to allay their fears, give them hope and attempt to normalize their medical issues. I have also tried to integrate my medical practice with my private life and I volunteer with local LGBT and HIV related organizations. I meet the most amazing people while participating in these activities.”
When it comes to treatment adherence, Taylor thinks people will be more motivated to take their medications when they see the benefit. Says Taylor, “If someone comes in and is actually sick, then it is pretty easy to keep them motivated. If someone is well, then the idea of preventing the spread of the infection often is a big motivator to stay on their medication. I try to be as nonjudgmental as possible so that they won’t try to please me by saying they will take their medication and then not take it. I also find monitoring their viral loads can be very motivating.”
In 2016, Taylor spent a year working in a prison in northern Australia and also volunteered with the local LGBT advocacy group in a successful effort to establish a transgender inmate policy before returning home. Traveling abroad to work had long been a goal of hers and she was able to realize this dream with the help of a colleague who was willing to cover her HIV practice while she was away. Taylor also observed the need for HIV care in this area of Australia where a population of 250,000 people was spread across an area twice the size of Texas. One physician was covering the entire Northern Territory which involved flying to remote communities up to 1000 miles away. It was a fantastic learning experience about healthcare delivery in a completely different physical and cultural setting.
Looking to the future, Taylor would like to do more public speaking. “I have a rich experience that has not been entirely linear and I think students and residents need to know there are a lot of unusual opportunities out in the world for them if they choose to follow a different path,” says Taylor. In ten years from now, Taylor hopes for a cure with a vaccine or other medication. “It would be wonderful if there would be an injectable medication that would be in depot form. I imagine the reality is that we will be taking care of many chronic care conditions in our aging population and geriatric medicine training may be increasingly important as time goes on.” In her time away from practice, Taylor likes to ride her bike and participated in the AIDS LifeCycle 2012 that takes place in California. She raised over $10,000 with the help of friends, family and patients. After returning from Australia, Taylor jumped right back into advocating for transgender issues and has helped organized medical conferences for healthcare providers on the Central Coast of California. She has two sons; one entering college and the other starting graduate school in the Fall 2018, and has enjoyed watching them grow up into amazing young men.
Asked why she is an AAHIVM Member, Taylor says, “I think it help patients to know that they have a true specialist managing their care. I like having a resource for information and I even like recertifying as an HIV Specialist as it is good to review and make sure one is staying up to date.”
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