Michael C. Stefanowicz, DO, AAHIVS (he/him)
Many older providers who experienced the dawn of the HIV epidemic have retired or are nearing retirement, and there is much concern for potential future workforce shortages in HIV care. However, there are examples of new entries to the field of practice that inspire hope. Meet Dr. Michael Stefanowicz. A 2016 graduate of the Philadelphia College of Osteopathic Medicine, Dr. Stefanowicz did his residency at the University of Texas at Austin Dell Medical School and completed the HIV Clinical Leadership Fellowship at the Keck School of Medicine of USC in Los Angeles. His first job out of college was as a case manager for a non-profit called Project HOME, a comprehensive safety net organization for people experiencing homelessness in Philadelphia. “Many of my client were living with HIV,” Mike recalls. “Many of them never received appropriate treatment and passed from AIDS-related illnesses. I didn’t quite understand HIV from a medical perspective at that time but I knew enough from my observations to recognize that HIV was the literal embodiment of structural violence. That more than almost any other medical condition, HIV lives at the intersection of race, poverty, housing status, gender, substance use, sexual orientation and behavior. During medical school I finally found two incredible mentors in Austin, Texas during my residency. Both had been HIV practitioners since the early days of the HIV epidemic. Like many others in medicine my early mentors really influenced my passions and my career path, hence I chose to further my career in HIV medicine by pursuing a fellowship after residency.”
Mike has had the opportunity to practice in a variety of settings thanks in part to his fellowship, including Ryan White recipient clinics both in Los Angeles and in Austin. He has cared for patients as part of a street medicine team, caring for patients under highways and overpasses, on the streets of Skid Row, and plenty of places in between. He characterizes his experience providing HIV primary care for PWH at the LA County Men’s Jail as a privilege. “Ryan White recipient clinical entities have really paved the way for innovative care models for a variety of patients over the last three decades. But most programs housed in brick and mortar sites have failed to reach certain people, namely many persons experiencing homelessness,” Mike shares. “The collaborative model we developed as part of my fellowship in Los Angeles met patients where they are in the literal sense. We delivered ART, provided sexual health counseling intents, treated chronic conditions on the streets and clustered as much care as possible at a time and place of the patients’ choosing, in the least restrictive setting possible. It is the equivalent of a modern day house call for those who are denied a roof over their head. More so, it is a way to build trust and rapport with a cohort of patients who have been all but forgotten by traditional health care systems.”
Today, Dr. Stefanowicz serves as the clinical lead for sexual health programming with CommUnityCare, one of the two largest federally qualified health centers in Texas. His work includes oversight of the organization’s status neutral model, implementation of best practices in positive care, sexual health, STI screening, diagnosis and treatment and also PrEP. He practices in a few different settings including the David Powell Clinic, a Ryan White funded safety net clinic north of downtown Austin that provides care for the largest proportion of PWH in Travis County and the surrounding areas. Mike is also a healthcare for the homeless physician and practices in an ambulatory clinic for people experiencing homelessness.
In terms of patient demographics, Dr. Stefanowicz sees a rather bimodal distribution of patients. Many of his new patients are younger, frequently less than 30 years old, most having recently been diagnosed with HIV. On the contrary, the other subset of patients he sees have been living with HIV for at least a decade and tend to be older than 50. “This speaks volumes to the successes we’ve collectively achieved in helping our patients live longer, healthier lives with HIV, but also the distance we have yet to go in reducing the number of new transmissions in the U.S., especially among young people of color,” Stefanowicz shares, “Because I have a presence in both our Ryan White funded clinic and our homeless healthcare clinic many of my patients are also chronically homeless. The majority of my patients are people of color, predominately Black and Latinx individuals.”
Mike spends the first few minutes of each initial visit addressing patients’ concerns regarding barriers to care. He proactively asks about housing problems, mental health issues, substance abuse, and perceived or felt stigma. “I think it’s important to have an honest dialogue about these items with patients from the get-go. It shows patients that you are a real provider who is in tune with more than just their medication adherence. It shows you practice ‘reality-based’ medicine,” shares Mike. “Some would argue this is not the role of clinicians, especially when we have other team members including social workers and case management. I would argue that in the era of team-based care it’s critical we as clinicians are literate in more than just clinical medicine and academics. We need to be in tune with the day-to-day challenges that our patients face.”
Key to being in tune with patients is establishing trust, which Dr. Stefanowicz refers to as the ‘essential ingredient’ to every patient-provider relationship. “Patients won’t open up to providers about their challenges, or their apprehensions, if they don’t feel like they can trust them,” Mike expounds. “For many patients adherence to ART is not just the equivalent of waking up every day and choosing to take a medication. Adherence is the confluence of medication access, affordability, HIV related stigma, mental health, and health literacy. Yes, I ask about adherence but I also ask about these other items because I know that social determinants of health are extraordinarily influential when it comes to medication adherence. Addressing these barriers, while never adopting a reprimanding stance, results in better outcomes with adherence.”
Dr. Stefanowicz’s next ambition is to build out an HIV component to his current street medicine team. Innovation is needed to build an alternative care continuum for those who have never successfully been linked or been retained in care because of the barriers they face living on the streets. Mike speaks to the challenges, “There are plenty of nuances working on the streets that need to be acknowledged with regards to access to laboratory services, medication access, patient confidentiality, and more. However, I am fortunate enough to have a leadership at CommUnityCare who support innovative and equitable care models that meet the needs of the communities we serve.”
Looking to the future, Mike finds it difficult to accurately predict where the field of HIV medicine will be in ten years’ time given the frenetic pace of change today. However, he expresses certainty that we will be in a better place. “The field of HIV medicine is never stagnant and is always on the move. This is something many of our patients have become quite accustomed to. There are always newer (and mostly better) pharmacotherapies on the horizon. The advent of long acting injectables coming to market this year in the U.S. is certainly one of many paradigm shifts in the field. Ten years from now our care model will be more holistic in a sense. We are moving beyond the concept of HIV primary care and moving towards comprehensive sexual health care within a status neutral framework. This has broad implications for minimizing stigma associated with HIV and other STIs but also in our prevention efforts. Nonetheless there will also be plenty of challenges. Safety net clinical systems still don’t have the resources that are commensurate with the challenges we face on a daily basis. While emergent pharmacotherapies are more common their cost remains a burden to our patients and our health care system as a whole. Lastly, I will say that a decade from now the landscape of who is practicing HIV medicine will look vastly different. Many of today’s practicing clinicians have been serving our patients since the dawn of the HIV epidemic. There is a level of historical and clinical knowledge within that cohort of providers that is irreplaceable. Unfortunately, many of those clinicians are on the cusp of retirement, and generating a sustainable pipeline of competent HIV care providers is a priority for me.”
Beyond his professional life, Mike’s main hobbies include spending time outdoors and spending time with his family. He enjoys hiking, camping, birdwatching, fishing, and taking at least one or two adventures to national parks each year when feasible. Mike shares, “My family is the most important thing in my life. My husband Luis and I recently bought a house here in Austin, Texas, so naturally we’ve spent an inordinate amount of time during the pandemic making home improvements and building out a garden. My grandmother, with whom I grew up, recently moved in with us as well, so the house feels very lively when I come from work each day!”
When asked why he joined AAHIVM as an Academy member, Mike shares, “I wanted to be a part of a broader community that shares my passion for clinical HIV medicine but matches it with advocacy and education. AAHIVM is just such an organization! The last year is just one such example. I was thoroughly impressed by the new virtual platform where HIV providers can support each other with clinical decision making or just conveying expertise from established practitioners in the field to newer HIV clinicians. Being a part of the Academy’s mentoring program is a great way in which expertise can be disseminated and shared. It really reflects that AAHIVM is tuned in with the needs of its core constituencies.”
Read archived Member Spotlights here.