The Chiropractic Response to Global Health Threats

Standing up with the other health-care professions to address HIV/AIDS.

How is chiropractic related to the HIV/AIDS epidemic?  Well, even if chiropractors focus on neuromusculoskeletal health, they must be knowledgeable about the issues and sympomatology of diseases that significantly affect so many people.  Chiropractors have to stand up with the other professions, collaborate with them, and contribute to the management of people with complex health-care needs.  It is imperative for chiropractic to be a responsible collective citizen in the face of global health threats.

The Canadian Memorial Chiropractic College (CMCC) has a long history of involvement with the HIV/AIDS population.  In fact, it was the Community Advisory Panel of the Wellesley Hospital in Toronto that pressed for programming that included chiropractic services.  Consequently, CMCC was able to create the first hospital-based ambulatory chiropractic teaching clinic in Canada, which has logged more than 12,000 patient visits per year.  Upon closure of Wellesley, advocacy from the HIV/AIDS community enabled the continuation of services at the Sherbourne Health Centre and the creation of the current program at St. Michael’s Hospital.

Our priority is to ensure that PLWHAs (People Living with HIV/AIDS) in the central Toronto region will have unrestricted access to chiropractic service without barriers.  CMCC continues its HIV-/AIDS-related activities in a variety of ways:
•     Delivery of chiropractic care to HIV/AIDS patients at Sherbourne Health Centre (priority population at this location).
•     Delivery of chiropractic care to HIV/AIDS patients of St. Michael’s Hospital Positive Care Clinic by the on-staff chiropractic clinicians in the Department of Family and Community Medicine.
•     Ministry of Health and Long-Term Care-funded research project led by myself, along with co-investigator Dr. Hal Huff of the Canadian College of Naturopathic Medicine, through the Ontario HIV Treatment Network (OHTN).
•     Membership on the St. Michael’s Hospital HIV/AIDS Community Advisory Panel.
•     Participation on the Health and Medical Committee and the PLWHA Lounge subcommittee for the XVI International AIDS Conference held in Toronto in August 2006.
•     Ongoing participation in AIDS-related community events.
•     Past involvement including membership on the OHTN Priority Initiatives Program Health Services and Access Committee, National Advisory Group on Complementary Therapies and AIDS and Research Agenda Roundtable for Complementary Therapies and AIDS.

ST. MICHAEL’S HOSPITAL
Patients of the Positive Care Clinic at St. Michael’s Hospital are able to access chiropractic services within the hospital on referral from their physician.  Patients typically present with chronic neuromusculoskeletal problems related to the progressive nature of this anti-retroviral disease, including muscle wasting, fat redistribution (lipodystrophy), and side effects of the ARV therapy that they must take for life.  Patients report a reduction in MSK-related pain and stiffness, increased energy and an improved quality of sleep related to receiving chiropractic care.  While our treatment may not affect the course of the disease, it does appear to help improve the quality of life for those living with HIV/AIDS.

As part of our program at St. Michael’s Hospital, we are collecting clinical outcomes data that will assist in objectively evaluating the impact of chiropractic treatment on this population.

OHTN-FUNDED RESEARCH
A two-phase study was funded by the AIDS Bureau of the Ministry of Health and Long-Term Care, through the Ontario HIV Treatment Network.  The purpose of the study was to modify a current data collection process that the province has been using to collect HIV/AIDS treatment information.

The HOOD (HIV Ontario Observational Database) is the largest database of HIV/AIDS treatment information in the world.  For over a decade, Ontario has been collecting treatment information from HIV/AIDS patients’ charts and entering this information into a central database.  Researchers are able to access this database to study the effects of various treatment modalities.  The data also enables policymakers to understand differing trends in HIV/AIDS infection, including response to treatment.  Unfortunately, however, complementary or alternative medicine (CAM) treatment information has never been collected by HOOD.

The two-part study involved conducting key informant interviews with HIV/AIDS agencies, researchers, clinicians and patients to learn what CAM information would be relevant to collect for HOOD.  Completion of phase one indicated that the four most common CAM therapies accessed by HIV/AIDS patients were chiropractic, acupuncture, massage therapy and use of natural health products.  Each of these approaches received a level of 75 per cent endorsement from all key informant groups.

The second part of the study involved modifying HOOD’s software for the purpose of adding CAM treatment information and to pilot test this at the chiropractic and naturopathic clinics at Sherbourne Health Centre.  Data collection has been completed and the pilot test indicated that the new software was an effective and efficient way to collect this information and that the information was relevant to collect.

In future, if the HOOD program incorporates the software modification, we will be able to collect robust CAM treatment information on a province-wide basis.  This data will be accessible for researchers studying the effects of these types of therapies on the course of HIV/AIDS or on the quality of lives of those living with HIV/AIDS.

PARTICIPATION AT THE AIDS CONFERENCE
For the first time in the history of the International AIDS Conference, chiropractic care was incorporated into the onsite medical clinic.  Chiropractic interns and clinicians also provided comfort massage in the PLWHA lounge at the conference.  As a member of the event’s Health and Medical Committee, I was pleased to assist in the organization of the comprehensive, full-service medical clinic that was accessible to the more than 25,000 conferees.  People could avail themselves of chiropractic care for musculoskeletal complaints through the clinic’s triage process.

Over the six days, we saw complaints ranging from a fractured foot to lower limb, back and neck pain and headaches.  The chiropractor provided assessment, treatment and referral as appropriate to patients who attended the medical clinic. The medical team, led by Dr. Brian Cornelson, treated approximately 100 patients per day.

There were more than 2,000 daily visits made to the PLWHA lounge, a tranquil place to rest, meet, obtain refreshment, and access the Internet.  A total of 55 chiropractic clinicians and interns from CMCC and six massage therapists were engaged in the provision of over 640 comfort massages to people from 58 countries.  People noted that the massage enabled them to participate more fully in the conference and remain for longer periods of time at the venue.  A reduction in pain and muscle stiffness and improved mobility were also reported.

Faculty clinicians in the lounge triaged attendees to ensure that they were not ill.  EMS personnel were stationed in the lounge to ensure that any participants who were unwell received medical assessment/care.  Those whom it was thought would benefit from chiropractic intervention were referred to the medical clinic.

The attending chiropractic clinicians and interns expressed their satisfaction at having made a significant contribution to the conference.  Many reached a broader understanding of the health and social issues around HIV/AIDS.  Most came away with a clearer perspective of chiropractic’s role in health care, particularly pertaining to people with chronic diseases.  Their remarks were poignant, revealing a refuelled desire to help suffering humanity.  Since human rights and access to care were core conference themes, our providers indicated an enlarged sense of their social responsibility.•