July 17, 2002 – Health care professionals working with HIV and AIDS patients say it's important — in fact, it could be a matter of life and death — for Virgin Islanders to become more status conscious.
One of the most striking reports at a recent international AIDS conference in Barcelona, Spain, documented rising rates of infection among African-Americans. Experts pointed to study findings that nine out of 10 African-American males who test positive for the AIDS virus don't know it, because they don't return to get their test results.
The Source contacted one physician and two counselors on St. Thomas, St. John and St. Croix to get their take on AIDS awareness in the territory. They said they are making it easier to get an AIDS test and are keeping the rate of follow-up high with a vigorous outreach program.
But in spite of these strides, the V.I. health care workers say, they are battling an information gap between those who test positive and all of the people who have come in contact with them in ways that put them at risk. And that's the population with the greatest likelihood of being HIV positive without knowing it, they say.
A recent New York Times article cited a study conducted by the Centers for Disease Control and Prevention in which 5,719 men from six major U.S. cities who were tested for HIV were asked about their results. A total of 573 subjects tested positive. Within this HIV-positive group, 90 percent of the African-Americans did not know they had done so, nor did 70 percent of the Hispanics and 60 percent of the Caucasians. Researchers said the individual findings were available to all who took part in the study, but they didn't know how many of those tested returned to get their results.
For Ivy Moses, working on St. John with a new not-for-profit social services agency called HELP (Helping Others in a Positive Environment), the challenge of raising HIV awareness is best met in the counselor's office.
Taking the HIV test and waiting for results is an anxiety-inducing process, she said. The counselor can take the edge off by providing a lot of information early on. "Most of the people I test do come back for their results, because of the location and because of the availability of the counselors," she said.
Because the general population on St. John is small, Moses said, it's easier to catch up with clients and remind them to come in for their tests results.
On St. Croix, the population is not only much larger but much more spread out, and outreach workers there have a different approach. The group V.I. Care now offers its own HIV testing in addition to the service provided by the Health Department. "We've only been testing people in our office for a year now," director Carolyn Forno said.
This year, V.I. Care teamed up with a local radio station to spread the word about free testing in conjunction with National HIV Testing Day on June 27. More than 60 people took advantage of the opportunity to be tested at no cost. "That was a great turnout, and we saw a lot of people that we needed to see," Forno said.
Last year, Forno said, three out of four people who received HIV testing through V.I. Care came back for their test results. She said she hopes to increase that rate of return this year, in part through providing post-test counseling for test subjects. "We are in the process of receiving those results back right now," she said of the free-day testing, "so we told people on the 27th to wait two weeks to get their test results." She added, "If somebody tests positive, of course, it's important to tell them about the different treatment options that are available,"
On St. Thomas, the head of the Health Department's HIV, STD and TB program (that's "human immunodeficiency virus, sexually transmitted diseases and tuberculosis"), Dr. Gayann Hall, says getting test results — positive or negative — is only half the job. For those who test positive, the program's disease intervention specialist is then tasked with finding the people who have had sex or engaged in other at-risk behavior with the infected clients.
"Everybody who tests positive is tracked down," Hall said. But beyond finding those who test positive, she said, the job of the disease intervention specialist is to "try and get information about who their contacts are, and find them, too."
Health experts in the territory say one of the touchiest aspects of finding the people who have had sex or shared needles in doing drugs with those who are HIV positive is the issue of confidentiality. HIV tests really are confidential, Hall said. "The blood samples are separated from the names, and the names and test results are recorded in a log that's kept under lock and key," along with contact information, she said.
The disease intervention process is called "partner notification," and it's been very controversial, Hall said, "because counselors try to convince people that we're keeping their information confidential, but we have to notify their contacts — without disclosing confidential information."
The intervention specialist "talks to the initial case, talks to the contacts, advises them that they may have been exposed to the HIV virus, and offers them free counseling and testing," Hall said.
Efforts at increasing HIV prevention and treatment have the full support of Delegate Donna M. Christensen, who is a physician. As the head of the Congressional Black Caucus's Health Brain Trust, she attended the XIV International AIDS Conference in Barcelona earlier this month. There, she sat with representatives from Europe, Africa, India and the United States, discussing strategies lawmakers can utilize to try to stop the spread of AIDS and HIV.
Christensen says she came home from the conference convinced that there has to be greater focus on the spread of HIV in the Caribbean, because the situation is on the verge of becoming a major health problem.
"It's the legislative bodies around the world that move the AIDS agendas," she said. "One of the critical issues that has come out at this conference is the need for funding to address the epidemic which has devastated sub-Saharan Africa and is growing at alarming rates in the Caribbean and in minority communities across the U.S."
She added, "HIV/AIDS is truly one of the defining issues of our times. Our response to this threat to communities everywhere will be noted for generations to come."
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