Program Gets AIDS Patients To The Doctor

In the nation's capital, African-Americans make up more than 75 percent of the city's HIV/AIDS cases. To combat the disease and its spread, advocates and city health officials have decided to try to improve the link between being tested and being treated. Washington, D.C., and the Bronx in New York will be the site of a pilot research program designed to connect patients with a doctor, and put those patients on anti-retroviral medication as soon as they are diagnosed.

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AUDIE CORNISH, host:

Capitol Hill lawmakers often focus on the problem of HIV and AIDS abroad, but it's the city of Washington itself that's had one of the toughest battles with the disease. Three percent of the city's residents are known to be living with HIV or AIDS. That's roughly 15,000 people. And despite making up a little more than half the population, African-Americans represent more than 75 percent of the city's HIV/AIDS cases.

AIDS advocates, like Ron Simmons, says there are a lot of reasons for those numbers.

Mr. RON SIMMONS (President, Us Helping Us): For years, I'd say maybe for the first decade of the epidemic, they didn't really think of HIV as being a problem.

CORNISH: Simmons is president of the nonprofit group Us Helping Us. It was founded in the 1980s for men like Simmons - gay, black and HIV positive.

Mr. SIMMONS: Back in those days, and people tend to forget this, but the church was saying it serves you right, you know, because you've been sinning. So, if you're gay you should get HIV - I mean, that was the attitude.

CORNISH: That was the first factor.

Mr. SIMMONS: Right. Or those people who are shooting drugs, then you should get HIV. So, no one really cared about it for the first 10 years.

CORNISH: Even though the city started a dedicated public health office to fight AIDS in 1986, it's had trouble sustaining an organized effort. It was slow to adopt free condom programs and had trouble with faulty condom inventory when it tried to ramp up giveaways.

A Washington Post investigation last year turned up alleged cases of mismanagement and fraud in HIV/AIDS housing assistance programs. And Simmons says the city's HIV/AIDS office has also suffered from turmoil at the top, cycling through 13 directors in almost 25 years.

Director number 13 is Shannon Hader. Unlike the past AIDS administrators, she's a doctor and she's worked with HIV-infected patients from Zimbabwe to Brazil.

Dr. SHANNON HADER (Director, HIV/AIDS Administration): You know, I think that there is a fundamental assumption that people have that somehow across the country domestically we have HIV under control and it's just the District that's out of control. And I'm here to say that that's actually fundamentally wrong.

Here in this country we've sort of been resting on our laurels thinking that this is as good as it gets for the domestic response to HIV, when in fact the CDC notes that there's been no reduction in estimates of new infections across the country for the last decade. The difference is we're a very small jurisdiction and so we're sort of one big hotspot.

CORNISH: Hader says until recently the District couldn't tell where the disease was on the rise and it wasn't collecting or analyzing enough data to know where best to target money or services. The city's effort to expand its HIV testing program is central to tracking the disease.

Since 2004, it's doubled the number of people it's tested for HIV to more than 70,000. Much of that is due to the work of folks like Beverly Honesty(ph).

Ms. BEVERLY HONESTY (Family Medical and Counseling Services): I get up, (unintelligible) take this in your hand and don't do it that fast. I want you to swab your upper and your lower gums. Don't go back, keep on going. Okay. Good, good.

CORNISH: Honesty works for Family Medical and Counseling Services, a clinic located in southeast Washington. At least three times a week she and other testers stake out street corners around the city with their Winnebago, stocked with condoms and brightly colored pamphlets and HIV rapid testing kits.

Most of the people she's testing today were referred by workers at the Needle Exchange Program van parked nearby, who provide clean syringes to addicts.

Ms. HONESTY: Okay. My name is Beverly Honesty and I'll be your tester and counselor for this morning. Okay?

Mr. GERALD DIGGS: I know who you is.

Ms. HONESTY: Okay. All right. First, we're going to get started with some general information. African-American?

Mr. DIGGS: Yes.

Ms. HONESTY: Okay. You like having sex with men, women or both?

Mr. DIGGS: No, just women.

Ms. HONESTY: Okay.

CORNISH: Fifty-two-year-old Gerald Diggs works his way through multiple forums and a questionnaire about his sexual behavior and drug use, while he waits the 20 minutes for his results. I ask him how often he gets tested.

Mr. DIGGS: I try to do it on a regular basis because simple fact, you know, I have to make sure that, you know, I'm protecting myself, you know, as well as the partner that I'm dealing with, you know. And I try to make sure that she do the same too, you know. 'Cause, you know, I'm trying to live to be a ripe old age and I never had any type of sexually transmitted disease and I'm not trying to catch them at this point, you know? You know, because I'm getting too old, you know?

CORNISH: Diggs keeps his test result to himself and walks away with a $5 grocery store gift card that was today's incentive. Injection drug use is among the top ways to contract the disease, but until recently the city was banned by Congress from using public funds to pay for needle exchange programs. Some AIDS advocates argued this undermined the city's HIV prevention efforts.

But if you ask one of the testers, like Vernell Betts(ph), it's not just getting people in the door for tests that's the problem; it's what they do with the information if the initial result turns out positive.

Mr. VERNELL BETTS: Over the course of time we've seen many more people not get lengthy care, you know, because they'll refuse to get lengthy care. They'll say, oh no, I'm going to go see somebody else; I'm going to go to another doctor or I have my own doctor. You know, and so we know they tell us different things but our emphasis is really on trying to get them linked. Those are the ones we tend to think have slipped through the cracks.

CORNISH: I heard the flip side of that story from 40-year-old Theresa Skipper(ph). She's an HIV-positive woman who attends meetings at the Women's Collective, an HIV support agency. Black heterosexual women make up the majority of newly reported AIDS cases in the city. Skipper says she put herself at risk by having unprotected sex with male partners.

Ms. THERESA SKIPPER: I found out at the birth of my daughter. I found out I was HIV-positive and my life was a wreck. I was in a domestic violence relationship and my daughter's father wanted me to keep the baby. I didnt want to keep my daughter because I just was told I was HIV-positive.

So, at that point, I didnt get treatment till my daughter was three years old 'cause I was like - when they first told me, I was like I'm dead anyway. I'm going to be dead in the next year. I'm going to be dead in six months. I just looked at it like I'm going to be dead in a year, so it's no need in me taking no pills - just being ignorant.

CORNISH: So once you knew your HIV status, did you continue with...

Ms. SKIPPER: Oh wow. I hid it. I hid it. I hid it. I - I just came out last year. I...

CORNISH: And you said youve had the - youve been positive for...

Ms. SKIPPER: I've had it for 19 years.

CORNISH: Nineteen years.

Ms. SKIPPER: Yeah.

CORNISH: And youve just now admitting it.

Ms. SKIPPER: And I'm just starting to come out. I'm just able to say I am HIV. I'm just able to say that.

CORNISH: It did take you so long...

Ms. SKIPPER: Yeah.

CORNISH: ....to come out publicly about your HIV status.

Ms. SKIPPER: Right. If tell you I had cancer, you're sympathetic. If I tell you I had diabetes, you're sympathetic. HIV, you look at me funny and you want to know how I got it. Why is that? It doesnt even matter at this point. And that's what I had to get beyond. To get beyond: Yes, I have HIV; this is how I caught it. Now what? You know, now what do we do?

CORNISH: Skipper says that no matter how much people talk about improved medications or living longer with AIDS, the stigma remains. And Black community leaders could do more to speak out and fight against the stigma, says Washington's Congressional Delegate Eleanor Holmes Norton.

Representative ELEANOR HOLMES NORTON (Democrat, Washington, D.C. Delegate): Constituents needs to see their clergy getting tested, their mayor, their city council, their highly placed public officials who deal with services. You see enough people getting tested, you keep the issue before people so it doesnt come and go with World AIDS Day, or some such.

Instead, what we know is that you can get this disease and you can learn to live with it. Well, who in the world wants to live with it?

CORNISH: City officials are trying to beef up their efforts when it comes to HIV prevention.

Unidentified Man: Thank you.

(Soundbite of applause)

CORNISH: Last month, they announced a new plan to work with the National Institutes of Health on a pilot program, aimed at improving the length between getting tested and getting care. The pilot research program would have people who test positive for HIV, not only connect with a doctor, but would almost immediately be put on antiretroviral medication. The goal is to reduce the presence of the virus and those who carry the disease, and in turn prevent its spread.

Right now, it's only theory and its only being tested in Washington and in the Bronx. But Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases is optimistic.

Dr. ANTHONY FAUCI (Director, National Institute of Allergy and Infectious Diseases): People ask the question: Youre the director of a research institution, why are you getting involved in the in the trenches blood and guts of what's going on in a public health issue? And the answer is because not only are we going to turn this around for the District, but we're going to make the District of Columbia a model for the rest of the country and the world about how to do it right.

CORNISH: The partnership between Washington, D.C. and the NIH will infuse more than $26 million for research on developing better HIV prevention for high risk groups. And it will establish specialty clinics for HIV patients suffering from other diseases, as well, such as hepatitis or even heart disease.

AIDS advocacy groups say that if nothing else it could draw some of the best research minds to the region, and inspire the most coordinated response the city has ever seen. And they say D.C. has nothing to lose by trying.

(Soundbite of music)

CORNISH: Our piece was produced by Walter Ray Watson.

Youre listening to WEEKEND EDITION from NPR News.

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