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Golden Compass Program Launches at San Francisco General Hospital

The Golden Compass program is now open at Zuckerberg San Francisco General Hospital's Ward 86, offering one-stop shopping for HIV-positive people age 50 and older. The program, which started seeing patients this past fall, held its official launch party on February 3.

Funded by a $100,000 grant from the San Francisco AIDS Walk, Golden Compass brings together a wide range of services for older people with HIV including geriatric care, hearing and vision services, and social support groups.

"We welcome the new challenge to deliver the best care to the diverse HIV-positive population we serve," said Diane Havlir, chief of the HIV/AIDS Division at ZSFGH. "The Golden Compass program is the first in the U.S. to specifically focus on the needs of people age 50-plus. This opportunity reflects the success of HIV treatment."

Currently 60% of people living with HIV in San Francisco are age 50 or older, and more than 20% are over age 60, according to the latest SF Department of Public Health HIV Epidemiology Report. People age 50 and older accounted for 11% of newly diagnosed HIV cases in 2015.

"Older HIV-positive patients experience all the pieces that go along with HIV and other chronic conditions, all the pills to treat those conditions, and all the side effects and possible drug interactions," said Golden Compass associate director Meredith Greene, a geriatrician with an extensive background in treating people with HIV.

HIV-positive people are at higher risk for age-related problems such as cardiovascular disease, bone loss, and cognitive decline, and research shows that these conditions may occur earlier than they do in HIV-negative people. Many also deal with isolation and the trauma of losing their friends and loved ones to AIDS.

"We've entered uncharted territory -- people with HIV didn't plan to live, and I don’t think the healthcare system planned for them to live either," said Vince Crisostomo, program manager for the San Francisco AIDS Foundation's Elizabeth Taylor 50+ Network. "San Francisco has been unique in its community response throughout the history of this epidemic and this is the next chapter. Hopefully now that people know we have something to offer them, they will come out of isolation."

Many older people with HIV are also dealing with pressing financial issues and affordable housing is often cited as a critical need.

"When I talk about my generation of HIV survivors, more than half did not retain the affection and support of their biological families," said long-time activist Cleve Jones. "We lost almost all of our closest friends during that horrible time before effective treatment. During years when we should have been saving money and building pensions, we were on the front lines of a war that consumed all of our attention."

"Add to that the reality of the cost of living in this town, and we're seeing what remains of our social networks decimated by gentrification," Jones continued. "I'm really glad this program has been started, but I'm also concerned that more and more people are being relocated and won't be able to take advantage of it."

4 Compass Points

Based on guidance from focus groups, the Golden Compass program is organized around the 4 points of the compass. Most participants emphasized that they wanted centralized services under a single roof.

"This is really a great program because all those services are there on site," said Jeff Sheehy, who was recently appointed the first HIV-positive member of the SF Board of Supervisors. "It's the holistic quality of the program than makes it so necessary and so outstanding."

North represents the heart and mind, featuring services related to cardiovascular and neurocognitive health. Cardiovascular care is provided by Priscilla Hsue of UCSF, a well-known expert on diagnosing and treating cardiovascular disease and inflammation in HIV-positive people. The program's weekly brain health classes will help clients improve their memory and "brain fitness."

East represents bones and strength, featuring osteoporosis screening, strength training, gentle exercise classes for all fitness levels -- including for people who use walkers or wheelchairs -- and education about how to improve balance and prevent falls.

West represents vision, hearing, and dental care -- services focus group participants said they often had difficulty accessing. The program will do age-appropriate screenings and help clients get glasses and hearing aids.

Finally, south represents networking and navigation. Isolation and loneliness were common themes across focus groups for gay men, women, and people who inject drugs. The program features monthly drop-in support groups facilitated by social workers.

Golden Compass services are offered on Friday afternoons at the Ward 86 HIV clinic. New patients receive an in-depth geriatric consultation, a review of their medications, and simple memory and cognitive screening.

"We look at everything together using a holistic approach," Greene said. "We have a multidisciplinary team of physicians, nurses, pharmacists, and social workers -- it really takes a team of people to take good care of an older person with HIV."

Close to 1400 patients seen at Ward 86 are over age 50, according to Greene, and more than 100 have been evaluated by the Golden Compass program so far. People over age 70 and those with issues like cognitive problems or falls will be seen sooner.

In addition to serving people in San Francisco, Golden Compass aims to serve as a resource to help other providers set up similar programs.

"As people are living longer, you have to help them live well," said Ward 86 medical director Monica Gandhi. "To our knowledge we're truly the first program providing wrap-around services for older HIV patients. We want to disseminate this innovative model of care. Everyone HIV-positive over 50 should have holistic specialized care."

2/7/17