Caring Enough to Learn About HIV

"Why are you all waiting to see my reaction?" a young woman asks several female friends in a hallway of the Vernon J. Harris health center in Church Hill.

They have come together to the Richmond health center to get tested for HIV, the virus that causes AIDS. The woman who asked the question has just left a private room where she talked with the health-care worker who administered the test, which can give results in 20 minutes. Her friends also have been tested and are waiting for their results.

"After the lady says I’m HIV negative, I’m not having sex anymore," one of them says. They all laugh. Their banter is casual, but there is an undercurrent of anxiety and concern.

Like more than 200 others in the Richmond area last week, the young women responded to public-health messages that encouraged people who are or who have been sexually active to get tested for HIV. The virus is transmitted through blood, semen and other bodily fluids. Behaviors such as sharing needles during illicit drug use or engaging in intercourse without condoms put people at higher risk of infection. Abstinence, safe sex and mutually monogamous relationships between uninfected partners are ways to prevent infection.

The Richmond Health Department, Fan Free Clinic, Harris health center, Virginia Commonwealth University HIV/AIDS Center and other agencies sponsored events that provided free HIV testing.

The events were part of National HIV Testing Day on June 27, but local events were extended for several days as health workers tried to reach every part of the city. Free HIV testing is available year round at publicly funded and privately run nonprofit clinics.

Federal health officials estimate as many as 950,000 U.S. residents have HIV, with as many as a quarter of them — 180,000 to 280,000 — unaware they are infected. That puts them at risk of infecting others. Every year, about 40,000 new HIV infections are reported in the U.S.

"I remember the days when we couldn’t get three or four people to come out" for a testing event, said Eleanor Harrison, an HIV outreach worker for the Richmond Health Department. Harrison was one of the organizers of such an event at a Chevron station on Chamberlayne Avenue in Richmond last Monday.

As part of the Centers for Disease Control and Prevention’s "Advancing HIV Prevention" initiative, HIV testing is being made available in nontraditional settings. Tests that can give results in as little time as 20 minutes and that rely on fluid samples collected from the mouth instead of blood samples are part of what is making that community-based testing possible.

"We went out in the community and did HIV awareness and education," Harrison said. "We gained trust. They have to know you care what happens to them."

The result: A steady flow of people turned out for the testing, which had been heavily promoted on local radio stations.

Two small tents provided shade from the afternoon sun as five HIV outreach workers, some from the Fan Free Clinic, worked one on one with those there for tests. They did pre-test interviews and counseling, talking as quietly as they could, and then did the actual tests using the OraSure testing kit, which does not provide results immediately. Instead, the counselors wrote down contact information and arranged to call clients to meet with them later to give them their test results.

Because the test setting was so public and because of the heat — higher temperatures can mess with the results of the rapid tests — health officials opted not to do the rapid tests.

"If we do 100 tests, I’m shouting ‘hallelujah,’ " Harrison said. The tally was actually higher — 110 tested. Harrison thinks HIV and HIV testing is losing some of its stigma. "People see people living longer with HIV," she said. "They know we have resources, medical care and housing."

The tally at the Harris health center — 81 people were tested in about three hours — also pleased organizers.

The hallway was crowded as people waited for test results or to get tested. A table was piled with freebies for those getting tested — pizza to snack on, pamphlets on health topics, key rings, water bottles and a big box of condoms — gimmicky fruit-flavored condoms, condoms-on-a-stick like lollipops, key-chain condoms and matchbook- packaged condoms.

Teresa, who asked that her last name not be used, helped organize the event. She is HIV positive and suspects she was infected by a former boyfriend who, she said, was not truthful about his past. She does confidential and anonymous testing by appointment at the health center. She has been in her job for just a few months and hasn’t yet had to tell anybody they tested positive.

She knows what not to do, she said, based on the way she was told. A hospital nurse gruffly broke the news, she remembers. It was so unexpected she started walking. Before she knew, she had walked several miles. A stranger who noticed her crying at a pay phone took the receiver and told the person on the other end they needed to come get her and gave directions.

"Before we do the test, we talk about the accuracy of the test," Teresa said. She asks clients how they think they would feel and react if the test shows they are positive.

Many say they are prepared for bad news. She leaves them with a hug and advice that "if you love yourself, you are going to do everything in your power to protect yourself."

Whether such testing and education events have on overall effect on HIV infection rates will be part of assessments done by state and local health officials, a city health official said. Test organizers would not say whether any people had tested positive, and some of the test results were not in yet.

In a five-year period ending in 2004, an average of 120 new HIV infections have been reported in Richmond each year. That compares with a five-year average of 37 cases annually in Henrico County and 36 cases each year in Chesterfield County, both of which have much larger population bases.

"Many more people are stepping forward to be tested," said Michael Welch, a Richmond health department official. "They are finding out if they are positive and what precautions they need to take. Right now, that is our measure of having an effect."