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Bringing HIV Testing To The Streets

In this final part of our series on HIV in San Diego, we look at a new effort to make HIV testing more widespread.

Above: Lead the Way team members get ready to deploy on a residential street in Hillcrest. They're going door-to-door and offering HIV testing in four San Diego communities: Hillcrest, North Park, South Park, and parts of Mission Hills.

Audio

Aired 7/8/11

Health officials say one of the keys to getting a handle on the HIV epidemic is to make HIV testing more widespread. A new study in San Diego is attempting to do just that, one block at a time.

— The Centers for Disease Control says one out of five Americans with HIV doesn’t know it. Yet the agency says those who don’t know their status are responsible for about half of all new infections.

30 Years Of AIDS In San Diego

Since the first cases of AIDS in 1981, the disease has killed nearly 7,300 people in San Diego County. In this three-part series, KPBS Health Reporter Kenny Goldberg recounts the epidemic's early days, explores how safe sex messages may be falling short, and looks at a unique effort in San Diego that's trying to take HIV testing door-to-door.

Since the first cases of AIDS in 1981, the disease has killed nearly 7,300 people in San Diego County. In this three-part series, KPBS Health Reporter Kenny Goldberg recounts the epidemic's early days, explores how safe sex messages may be falling short, and looks at a unique effort in San Diego that's trying to take HIV testing door-to-door.

A few blocks away from Scripps Mercy Hospital in Hillcrest, a team of outreach workers is taking HIV testing to the streets.

“iPad, packetts, lancets, everything is in here…You guys have pearl tops and red tops, right?”

After a quick check of their equipment, members of the Lead the Way team pair off and head down the block. Today’s mission: go door to door, and offer everyone an HIV test.

David Rodriguez is Lead the Way’s project manager. He said they’ve been in the field for about a month.

"We’ve covered from Mission Hills to North Park. Today we’re in Hillcrest," Rodriguez said. "We have had a number of tests, we’ve had a number of people complete the survey. But no negative reactions of people thinking that it’s too out of this world to have an HIV test offered to them."

Door-to-door testing is just one component of this new program.

Lead the Way also offers free confidential HIV testing at a storefront on Park Boulevard.

Anyone who lives in the 92103 and 92104 zip codes can drop in and be part of the study. Like this woman who didn't want to be identified.

The Lead the Way study has a storefront on Park & University, where anyone in the 92103 and 92104 zip codes can get a free, confidential HIV test, and take part in the study.
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Above: The Lead the Way study has a storefront on Park & University, where anyone in the 92103 and 92104 zip codes can get a free, confidential HIV test, and take part in the study.

"I came here to get tested, because I’m not sure if I’m infected or not," she said in Spanish. "I’ve got a new partner, and we recently started having sex. But I found out he’s promiscuous, and he could be gay."

UCSD’s Dr. Susan Little is overseeing this project.

She says the idea for Lead the Way came out of a theoretical study by the CDC.

It suggested by using a combination of widespread HIV testing,and treatment, you could dramatically reduce the number of new infections. Then, you might actually be able to control the epidemic.

"Now that was a mathematical model," Dr. Little pointed out. "So what we decided to do was break down the model, the sort of strategy trial, into its component parts: testing, linkage to care, and then treatment, and see if, in fact, we could identify a population, and see if we could demonstrate that that sort of approach would actually work, in a real life setting."

Dr. Little said the plan is to roll out the components over the next couple of years. She said it would be very expensive to launch all of the elements at once.

UCSD's Dr. Susan Little runs the Lead the Way study. She says the goal is see if a coordinated strategy of HIV testing, linkage to care, and treatment will help control the epidemic in targeted communities.
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Above: UCSD's Dr. Susan Little runs the Lead the Way study. She says the goal is see if a coordinated strategy of HIV testing, linkage to care, and treatment will help control the epidemic in targeted communities.

"And two," Little continued, "I think people need some time to learn to understand, that this is part of a very big plan, that really could demonstrate, that this community is one of the first in the country, if this works, to show a decrease in new infections, as a result of a prevention intervention."

The idea of making HIV testing more widespread isn’t new.

In 2006, the CDC issued guidelines that called for making testing a routine part of medical care.

At that time, less than half of all Americans had ever been tested. Today, the agency estimates that percentage hasn’t changed much.

That would suggest many doctors aren’t following the guidelines.

Dr. Ronald Kwok is a specialist in internal medicine in El Cajon.

He said whenever one of his patients gets blood work, he suggests they get an HIV test….even if they’re reluctant to do so.

"The whole idea of testing is that the more tests we do on everybody, the more cases we will diagnose," Dr. Kwok explained.

Dr. Ronald Kwok says he offers all of his patients an HIV test, even if they think they're not at risk. He says broader testing is the key to getting a handle on the epidemic.
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Above: Dr. Ronald Kwok says he offers all of his patients an HIV test, even if they think they're not at risk. He says broader testing is the key to getting a handle on the epidemic.

Susan Little thinks 30 years into the epidemic, there’s still a lot of stigma and fear associated with HIV testing.

That’s why one of her goals is to break down that stigma.

To that end, Little said the Lead the Way study is not targeting any particular group of people.

"We are simply asking all adults to take an HIV test," she stressed, "because only by testing everyone, including those who are already positive, who already know their status, can we effectively identify what the size of the epidemic is in our community, and then hope to decrease it."

Over time, Dr. Little hopes to get more than 10,000 people in San Diego to ask themselves this question:

If it’s free, confidential, and readily available, why not get an HIV test?

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