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Washington D.C. Offers Free HIV Tests to Combat Spread of AIDS

August 2, 2006 at 6:40 PM EDT
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GWEN IFILL: In the nation’s capital this summer, a new effort is under way to fight AIDS through testing. Jeffrey Brown has that story.

JEFFREY BROWN: It’s as easy as brushing your teeth and takes only 20 minutes, but up now, at least, it’s hardly been routine for most people to get an AIDS test. The District of Columbia wants to change that and has begun offering this rapid oral HIV test free to residents. It’s the first such testing program in the country.

To combat the highest rate of HIV infections in the nation, the District of Columbia launched this sweeping new program that city officials hope will increase awareness, draw more patients in for treatment, and encourage prevention of the disease.

WASHINGTON RESIDENT: No matter how safe you are, it’s always better to know.

JEFFREY BROWN: An estimated 25,000 of the city’s nearly 600,000 residents are infected, more than 4 percent of the population.

WASHINGTON RESIDENT: One in 20 is just really surprising to me. I didn’t know the rate was that high in D.C.

JEFFREY BROWN: Now the district is offering free tests at mobile vans, emergency rooms, doctors’ offices, and community health centers. Doctors are encouraged to offer the test as part of routine checkups.

The city is also rolling out postcards, banners, and ads like this one to get the word out.

PUBLIC SERVICE SPEAKER: You’ve got to go and take this test, man, and you should come with.

PUBLIC SERVICE SPEAKER: What kind of test?

PUBLIC SERVICE SPEAKER: HIV.

PUBLIC SERVICE SPEAKER: That’s all right. Not me. I use protection every time. I think everything’s clean.

PUBLIC SERVICE SPEAKER: Well, you think. Are you for sure? If not, you should go.

JEFFREY BROWN: According to the Centers for Disease Control and Prevention, about a quarter of Americans with HIV don’t know they have it.

WASHINGTON RESIDENT: I’d rather be sure than not be sure.

Goals of the new program

JEFFREY BROWN: Other cities around the country are now eyeing the capital to see if similar programs make sense nationwide.

And for more on the program, we're joined by the woman who heads it up for the District of Columbia, Dr. Marsha Martin.

Welcome to you.

DR. MARSHA MARTIN, Director, HIV-AIDS Administration, Washington, D.C.: Thank you.

JEFFREY BROWN: What's the problem that this is trying to solve?

DR. MARSHA MARTIN: We're trying to understand the numbers of people in the District of Columbia who have HIV, and we want it make sure that we identify those folks who have the virus and are able to get them into care. And so our goal is to reach all those who are living with HIV.

The second goal is to make sure that screening for HIV is routine in our health settings. It has been recommend by the Centers for Disease Control that HIV screening be routine in all medical settings, and that's our goal.

JEFFREY BROWN: And how do you make it routine? Because that's the kind of word that kind of jumps out at me, the notion of making this kind of test routine.

DR. MARSHA MARTIN: Well, for the District of Columbia, we have said that we want every resident between the ages of 14 and 84 to know their HIV status and to come together and ask for the test. And by asking for the test, they're going to talk to their doctors, they're going to talk to their neighbors, they're going to go into clinics, they're going to try to find out where they can get the test. And by increasing the demand, we hope we'll be able to build the infrastructure to make that possible.

JEFFREY BROWN: It's a completely voluntary program though, right?

DR. MARSHA MARTIN: Completely voluntary, absolutely. We want to encourage, and we want to invite participation. It's voluntary.

After the treatment

JEFFREY BROWN: How effective is the test when people take it?

DR. MARSHA MARTIN: Well, that's actually the wonderful aspect. The rapid testing has shown 99.95 percent accuracy, and we're very comfortable. It's a 20-minute experience. There's no blood necessary to be drawn. And you go in, you request the test, and you're out in 20 minutes. You know your status.

JEFFREY BROWN: So if someone tests positive though, what happens to them?

DR. MARSHA MARTIN: If they test positive in the counseling session, they'll get some time to sort of think about it, understand what that means, and then the counselor will actually talk about what it means to get a positive result from the screening test, that you do need to get referred to a confirmatory test, which is a blood draw. And then once you go from...

JEFFREY BROWN: You have to go for a second test?

DR. MARSHA MARTIN: You have to go for a second test, yes. And then once that's confirmed, then there will be a conversation about what it means. If it's necessary to start treatment, you'll be referred to care.

JEFFREY BROWN: Well, you mention counseling. Tell me more about that, because that's got to be an important component here. Who are the counselors? And what exactly are they telling people?

DR. MARSHA MARTIN: Well, the counselors are trained and certified by health departments. And the counseling involves talking to people about their understanding of what it means to be HIV-positive, to have the virus, you know, that it is the Human Immunodeficiency Virus, that it is a virus that, for right now, causes a suppression of the immune system. It reduces your body's ability to fight disease and that, in fact, you can become sick from illnesses that most of us can manage with just sort of regular routine health care.

And so, once you discuss what it means to have HIV, then you talk to them about how to make sure that you're safe and healthy, and how to make sure that you don't transmit the virus onto someone else. So it's a test that helps us screen for the presence of the virus and then helps us to determine what the next course of treatment would be for you.

Maybe you start medication; maybe you don't. But we want you to be in care, and then we want to make sure you know how to prevent transmission of the virus.

Affordability and privacy

JEFFREY BROWN: Now, I know that this kind of a program is being talked about and debated beyond Washington, D.C. A number of big questions that always comes up: What happens if a person is identified as HIV-positive but then can't or won't get treatment? What happens to them?

DR. MARSHA MARTIN: Well, we want people to understand that treatment is absolutely very important. It's affordable and, in the District of Columbia, as well as across the nation -- depends upon your income -- you have access to free treatment.

And so we will talk to you about the importance of treatment, how to get treatment. It is still your choice to receive treatment. We want to encourage you. And in fact, in some communities, we have social workers, and nurses, and doctors who will visit you in your home, who will talk with you about the importance of care and treatment, and we have it here in Washington, D.C.

JEFFREY BROWN: So government, if someone is positive, and they want treatment, then you're saying we will give you access to drugs?

DR. MARSHA MARTIN: We will give you access to drugs, doctors' care. We'll also make sure that you get the support you need. So it's not just treatment. It's also care, and it's also community support.

Living with HIV is a challenging, very difficult process. And we know that it takes support, medical care, and regular involvement with the health care system. And we want to make sure that everybody knows, at least in the District, as well as around the country, that those resources exist.

JEFFREY BROWN: Another big question, of course, is the privacy question and potential discrimination that still exists for people that are HIV-positive.

DR. MARSHA MARTIN: Unfortunately, discrimination does exist, but it's actually waning. It's really becoming reduced as more people recognize that this is just a virus. This is not about anything that anyone has done that makes them bad or wrong.

And the important part is, once you're tested and you're screened, if you have a positive, that information is reported to the health department, because, again, we're trying to reduce the transmission of the virus.

But that information is kept confidential in the health department; that information does not leave the local community. Data and statistics get reported to the federal government, but no one's name leaves the health department. And all that information is protected and is confidential.

JEFFREY BROWN: You feel confident about that...

DR. MARSHA MARTIN: Absolutely.

JEFFREY BROWN: ... that the information doesn't get out to employers or housing people?

DR. MARSHA MARTIN: Nowhere. It doesn't go anywhere at all.

JEFFREY BROWN: We mentioned that this has been part of a national debate.

DR. MARSHA MARTIN: Yes.

Expanding facilities

JEFFREY BROWN: I know you've been talking to colleagues around the country and the CDC. Are they watching carefully what you're doing? I mean, what questions are they asking?

DR. MARSHA MARTIN: They're watching very closely. And quite frankly, they're very excited about this initiative, because they've wanted to work with communities to help routinize HIV screening, as well as the WHO.

The World Health Organization is also looking at this, because we all know that there is no cure for this disease. But if you catch it early enough, you can get people into treatment and you can live longer, and you can also prevent transmission. So people are looking at it saying, "This is a good, bold, important initiative, and we want to support Washington, D.C., in it."

JEFFREY BROWN: How hard, though, do you think it would be to replicate in other places, in terms of cost, in terms of just different support systems? I mean, that's got to vary in a lot of places.

DR. MARSHA MARTIN: Yes, it is very difficult. We're unique in Washington because we have a task force from the mayor's office that has said we're interested in this, we want this, we want to make this happen. We have hospitals that have come on board that have taken the Centers for Disease Control's guidelines and said, "We want to implement them."

We also have community providers that have come together and said, "We want to expand testing capacities in our community."

And finally, there are concerns that we in the nation's capital have the greatest rates of AIDS cases in the country, and we want to reduce them. The way to reduce your AIDS case rate is to make sure you identify people with HIV and get them into care.

JEFFREY BROWN: And does your program have a time limit? Are you looking at this as a pilot, or how do you see it?

DR. MARSHA MARTIN: Well, we set the goal to have everybody in the District of Columbia between the ages 18 and 84 to know their HIV status by the end of the year. It's about 400,000 people.

Now, if we achieve that goal, we will be thrilled. On the other hand, this is the beginning of routinizing HIV screening, and so if it takes us a year to do it, that will be successful. No one else has tried this. D.C. is going to be the first place to make it work.

JEFFREY BROWN: All right, Dr. Marsha Martin, thanks very much.

DR. MARSHA MARTIN: Thank you.