February 20, 2025
Courtenay Harris Bond/Philly Voice
Mark Knox, 61, of Philadelphia, says his life has stabilized with the help of the Sana Clinic at Prevention Point Philadelphia, where he has been receiving integrated primary care, addiction and HIV treatment for about three years. With the help on antiretroviral injections, Knox can no longer transmit HIV to another person.
At 61, Mark Knox is facing health issues that come with age and from years of using drugs. He still struggles with the depression that precipitated his heroin use.
But after decades of addiction and incarceration, Knox, of Philadelphia, has been in recovery for five years and is focused on mending his relationships with his daughters and grandsons. He moved into his own apartment several years ago after extended periods of homelessness. Getting consistent treatment for HIV at Prevention Point Philadelphia – the Kensington-based public health and social services nonprofit – has been a big part of his healing journey, Knox said.
"I was tested (for HIV) while I was incarcerated," Knox said. "They told me I was positive, but I didn't really believe them."
Knox received another positive HIV diagnosis several years ago while seeking services at Prevention Point and started taking a daily antiretroviral pill, which helps suppress the growth of the virus and improve the immune system. Every other month for the past few years, Knox has been getting Cabenuva shots, another HIV medication, through Prevention Point's Sana Clinic, which integrates HIV care, primary care and medication for opioid use disorder in a low-barrier setting.
The viral load in Knox's blood is now suppressed to the point that it's undetectable, meaning he cannot transmit HIV to another person.
Stigma around HIV is still alive, and diagnosis "still comes as a huge shock to individuals," said Dr. Jessica Meisner, director of the Sana Clinic.
That is why Sana is a fast-track program. If someone discloses their HIV status or tests positive at Prevention Point, Meisner or a case manager meets with them the same day, if possible, and starts medication right away. This improves treatment adherence and outcomes, Meisner said.
In addition to receiving antiretroviral medications, people have access to primary care, wound care, reproductive and sexual health care, hepatitis C care, and diabetes and blood pressure management at the Sana Clinic. Meisner also has helped many of her patients get medications for opioid use addiction. They include Suboxone and Sublocade, which reduce overdose risk, physical dependence on opioids and cravings for them.
This wrap-around medical care, combined with case management services for securing everything from state identifications to housing, helps people who attend the Sana Clinic stabilize their lives. Because it can be difficult for patients who are unhoused or have substance use disorders to keep regular appointments, Sana Clinic offers drop-in services Monday through Friday. It is an example of low-barrier community care that meets people where they are in their lives and onboards them to medical and social services as they are ready.
Statistics suggest this harm-reduction model is working.
In 2022, there were 62 new HIV diagnoses in Philadelphia among people who inject drugs, a 94% increase compared to 2016, according to a report from the city's public health department. Increasing fentanyl use, homelessness and involuntary displacement from encampment clearings likely contributed to HIV transmission among injection drug users, the report said.
At the Sana Clinic – which is fully funded at $500,000 annually by Philadelphia's Division of HIV Health – 77 patients are currently on different forms of HIV treatment. All of the 34 patients who have received Cabenuva through the Sana Clinic have achieved suppressed viral loads.
The impact is a reduced community viral load —"which is major," Meisner said. "It has a huge positive impact on the Kensington area."
Courtenay Harris Bond/Philly VoiceDr. Jessica Meisner is a Penn Medicine infectious disease, addiction and internal medicine specialist. She also runs the Sana Clinic at Prevention Point Philadelphia, integrating HIV treatment and primary care in a harm-reduction model.
The Sana Clinic is "very grassroots," Meisner said, "just me, an Excel spreadsheet and my amazing case managers who do outreach."
Meisner, a Penn Medicine physician certified in internal, infectious disease and addiction medicine, sees patients as frequently as possible when they first start at the Sana Clinic, getting to know them and figuring out what kind of support they need.
"Once their HIV is suppressed, we're talking about blood pressure," Meisner said. "'Let's do your Pap smear. Let's figure out your mammograms,' all the other stuff.
"I have some who come in once a month for (medications for opioid use disorder), and some who sometimes come in almost weekly because … they have more urgent needs that we're addressing. As long as I'm here, I'm always willing to see people."
Her Sana Clinic patients are not people who would be apt to visit her Penn Medicine clinic, Meisner said.
"They're not going to go to a bigger building that is very intimidating, and also, if you show up 10 minutes late, they won't see you," Meisner said.
The Sana Clinic is "catching people who would never get caught or treated elsewhere," she said.
Meisner and her case managers accompany patients to appointments and advocate for them. They visit patients who are hospitalized, bringing them clothing, snacks, books – and make sure they get their Cabenuva injections on time.
Meisner and the caseworkers also have built relationships with officials at the Philadelphia Department of Prisons and other county jail systems to make sure Sana Clinic patients who become incarcerated still receive their HIV medications.
"In almost three years, there have been only two missed doses," Meisner said. "I'm so proud of that. That is something that other clinics haven't been able to do."
Knox described Meisner as a "beautiful person," encouraging him to take care of his overall health and get medical tests he wouldn't otherwise know about or would avoid.
"She tells me, 'You got to go get this, check this out. We're going to look at all this,'" Knox said. "She's really looking out for me."
