When Fears Keep People Away, Providers Take Aids Tests to Streets

"Whatever she has, I have," Irick Blair said jokingly, looking at his girlfriend as he waited to take an HIV test at Pellissippi State Technical Community College in Knoxville, Tenn.

Blair was among more than 40 students to come through the doors of the school's chapel, where volunteers set up camp to mark the National Black HIV/AIDS Awareness Information Day in February.

Before entering a cubbyhole room to have the inside of his cheek swabbed, the 20-year-old went through a risk-assessment evaluation, answering frank questions from a counselor about whom he chose to share his bed.

With a grin, Blair, the father of a 2-year-old, told how he lost his virginity at 15 because he was curious and "wanted to explore."

Most of the time, Blair used protection during his "exploration." But it's those times when sex "just happened" that brought Blair to this makeshift waiting area, anticipating the "Who's next?" call before he received his OraSure test.

Blair said that day that he thought he already would know if he had HIV. Taking the test would confirm that he doesn't have the virus.

It would be at least two weeks before he received his results. Meanwhile, Blair put his testing day behind him and resumed his routine of being a college student and operating his car-wash business, Irick's Detailing Unlimited.

"Knowing is a Beautiful Thing," proclaims a national HIV/AIDS prevention and awareness campaign targeting young people.

But many people don't see the beauty, said Kristin Ehrens, HIV-prevention health educator at the Knox County, Tenn., Health Department. Ehrens said a negative stigma keeps people from coming to the health department for HIV tests, so the health department has to go out into the community to help put a halt to new infections.

About 27 percent of HIV cases diagnosed in 2003 in the United States were among people ages 25-34, the Centers for Disease Control and Prevention reported. Minorities may be especially at risk: Though they make up about 13 percent of the country's population, they accounted for more than half of all HIV cases diagnosed between 2000-03.

The number of HIV diagnoses among blacks decreased slightly between 1999 and 2003, but the number of those diagnosed with AIDS whose white blood cell counts are dangerously low or who have one of 20 infections that prey on people with HIV increased during this time period, the CDC said. And survival rates among blacks are significantly lower than those among other races, possibly because blacks are less likely to seek medical care before getting sick and, consequently, are less likely to catch the virus in its early stages, when antiretroviral drug therapy is most effective.

A Kaiser Family Foundation study found that, by 2004, more than half of adults had never been tested for HIV, the majority because they didn't think they were at risk for the virus. Others reported a fear of needles or of giving a blood sample; concern about confidentiality; a lack of knowledge about available testing; and fear test results would show HIV infection.

The CDC estimates about a third of about 1.5 million Americans with HIV don't know they're infected. What's more, health providers worry, some believe not knowing is better than knowing.

Those working to lower the numbers have turned to giving away snacks and supermarket gift cards to lure people to HIV testing sites such as the one at Pellissippi.

This year, the Knox County Health Department introduced a "buddy" campaign, similar to the "Buddy Check" breast-cancer prevention campaign that encourages women to remind each other to do self-exams and get mammograms. Ehrens hopes the campaign will prompt people to "come and bring a friend to get tested" for HIV, she said.

If peer pressure doesn't bring in the numbers, Ehrens said, volunteers go to where the people are, sometimes setting up in bars in a back room or storage area to provide tests, as they did in June during National HIV Testing Week.

Sometimes volunteers work out of their cars in the late-night and early-morning hours, testing the homeless and prostitutes. A 2004 study found the risk of HIV could be as much as five times higher among the homeless and very poor.

Those they don't reach in clubs may be reachable in church, said Ehrens.

"Whatever works to prevent the spread of HIV, we'll do," said Ehrens.

A few weeks after being tested at Pellissippi, Blair gave his name to the communicable-diseases receptionist at the Knox County Health Department. He tried to explain that he was there to learn the results of his HIV test, but he stumbled over the words, finally trailing off.

Blair took a seat. He said, "I guess I am kind of nervous, since she told me to take a seat. ... I thought I was going to get my results and be out the door."

Shortly afterward, in a small, sterile room, Ehrens debriefed Blair about the testing process before she gave him his results.

"Your test came back negative," she told Blair, who sighed with relief.

"You may want to come back in six months to follow up this test to ensure you remain negative," Ehrens told Blair. If he became infected fewer than six months before the test, the virus might not yet have shown up.

Blair isn't sure he'll return for another test, "because if you are going to the health department, then people automatically think you have something."

Ehrens said such attitudes are common.

But the message of prevention wasn't lost on Blair.

"I have to practice safe sex," he said. "That's the end of the conversation."