Dr. R. Scott Hitt Explains How The American Academy of HIV Medicine Helps Deliver Quality Patient HIV Care                      

by B. Andrew Plant

R. Scott Hitt is a physician, a statesman and an entrepreneur, though he sounds more like a patient advocate when discussing the organization he helped to found, the American Academy of HIV Medicine. “Our mission is simple, really,” he says, “we want to ensure better care for people living with HIV.”

Even if the mission is stated succinctly, the AAHIVM, which had its beginnings in 1999, has grown remarkably fast in scope and influence. Hitt, who serves as the Academy’s CEO, told me the organization now has some 1,600 members who provide direct care to more than half of the patients in active treatment for HIV disease in the country (approximately 275,000).

“Many medical organizations are about identifying the best and most elite in a field, and that’s important,” Hitt says, “but we are about inclusion. About lowering entry barriers for medical professionals [who treat HIV]. We want to make it easier to become an HIV specialist.”

You may notice that this physician does not only refer to physicians. That’s because the Academy, an independent organization, is proud to note that ten percent of its members are frontline nurse practitioners and physician assistants. The others are indeed physicians, drawn from the fields of infectious disease, internal medicine, family practitioners, and general practitioners.

And this is no country club; forty percent of the AAHIVM’s members receive Ryan White CARE Act funding, and nearly twenty percent of its members practice in community clinics.

So what does this diverse membership get from the Academy?

“We ensure better care through education programs,” Hitt says proudly. “We had the first core curriculum defining what it means to be an HIV specialist. We were the first to really quantify, ‘What are the needs of the patients…?’, ‘What do practitioners need to meet those patient needs…?’”

AAHIVM now boasts a “study guide of the basics”—an HIV textbook of sorts, seminars, advocacy on behalf of its members and, central to its mission, a credentialing process. “There had been no standard curriculum, no external validation or test,” Hitt notes. “So, when you see a medical professional [and they have been credentialed by the Academy], you know they have met certain criteria, they have a certain knowledge base and they stay current on the things necessary for them to provide quality HIV care.”

Every two years, Academy members must meet credentialing requirements which include experience, education, and external experience components. As for experience, they must maintain current and valid state licensure as an M.D., D.O., P.A., or N.P, and provide direct, continuous, ongoing care for at least twenty HIV patients over the previous two years.

The biennial education requirement states that AAHIVM members complete at least thirty hours of HIV-related continuing medical education credits. The “external experience” component dictates that members must complete the Academy’s credentialing exam.

“There are good caregivers out there who are not credentialed [by us],” Hitt offers, “but you also have to realize that not every infectious disease specialist is an HIV specialist.” AAHIVM’s eponymously named Web site (www.AAHIVM.org) allows consumers (or others, wishing to make a referral) to find HIV specialists in their area, both credentialed and not, and can even tell you what insurance they take. This reference component also allows you to look up a physician by name to find out if they are credentialed by the Academy.

Because of his role with AAHIVM, you might assume Hitt is an academic or administrative expert. To the contrary, he has been in the trenches. He finished his medical residency in 1987, and moved from Arizona to California.

“I trained at Kaiser, then went into private practice,” Hitt says, “and because of the timing of when I had started my medical career, I started taking care of more and more people with HIV and AIDS. There was still a lot of discrimination (against people with HIV) then. I had a compelling need to help take care of them.”

Around that time, he says, if a provider was sharp, they could catch things early, which was the only real way to gain a foothold against the disease. “As an internist, it was fascinating and challenging,” Hitt says, “finding out just how much you could improve [patient] outcomes, and creating quality time for patients. But it was, of course, depressing, too, because you couldn’t meet all of those challenges.”

The same things still drive him, he says, though he does his part in a different role, through the Academy. “I still see patients out there (figuratively speaking) who are seeing providers who are not up to date,” he says. “Thankfully, increasingly, I see medical professionals who want to know as much as they can about HIV. They want to make every small-but-important discovery they can for every patient they see.”

If that sounds a bit like an activist, that’s because Hitt is certainly one of those, as he will proudly tell you, noting that he got started in HIV medicine at the time extreme initiatives were being floated—like quarantining people with AIDS. The doctor-activist shudders as he tells me about such radical, usually not well-intentioned plans.

“I did what I could then,” he says, talking me through his community and political involvement, but doing so without ego. “I joined the board of the Gay and Lesbian Service Center and the AIDS Healthcare Foundation. I got involved in politics and helped found the [gay and lesbian] Victory Fund.”

All the while, he was getting a lot of satisfaction out of taking care of 500 or more HIV patients…and keeping an eye on federal efforts to keep up with the needs of people with HIV, medical and insurance systems, and pharmaceutical companies. Activism and involvement led Hitt to the White House. He was appointed by President Clinton to serve on the Presidential Advisory Council on HIV/AIDS (often called “PACHA”), and was chairman of that body from 1995–2000.

Then came talks of what was to become the Academy, officially founded in 2000 with Hitt as then-volunteer leader of the effort. He eventually became the paid executive director, now CEO.

“It’s been five years that I have worked on and for the Academy,” Hitt tells me, “and it is time to bring in new leadership.” He goes on to say that he will soon begin a well-planned, active transition to the role of consultant to AAHIVM.

One of his final acts as the CEO—and one of his first roles as consultant—will be leading another transition. That is, the Academy’s move from Los Angeles, where it was founded and remains today, to Washington, D.C. Lots of change for the small (eight employees, eight consultants), young organization.

“The AAHIVM has started getting more involved in public policy,” Hitt says, “and already has strong ties to Washington, so this is a logical move.”

As an example, he goes on to tell me about a recent Academy initiative, calling on its members and their colleagues to write letters to members of Congress about a particular issue. “We thought that, conservatively, if fifty people write in, that would be a good goal for a first-time effort,” he says, laughing a bit. “It turns out that 2,700 letters were generated from providers. That kind of advocacy, that kind of voice in Washington is powerful.”

Indeed, the AAHIVM has staked its ground and gained a respected reputation. The Academy’s opinion is sought out on subjects ranging from Ryan White (federal HIV program) funding to California’s initiative to lay ground rules for HMOs in regards to HIV care. That state now requires HMOs to allow patients to see an HIV specialist, if they so choose; one criteria the state lets HMOs use to determine who is an HIV specialist is the Academy’s credentialing program.

Hitt says he is pleased with the Academy’s evolution, heartened by the response (to the AAHIVM) from medical professionals and excited about the organization’s coming changes.

For information about the Academy, including how to locate HIV providers in your area, visit www.aahivm.org. The American Academy of HIV Medicine is located at 836 N. La Cienega Blvd., PMB 303, Los Angeles, California 90069-4708. It can be contacted by phone at (310) 278-6380 or (866) 241-9601 (toll-free); or by

e-mail at info@AAHIVM.

B. Andrew Plant is an Atlanta-based freelance writer and is Editor at Large of A&U. He interviewed Andrew Tobias for the November 2003 issue.

February 2004