Transnational Partner Notification

Seems like a logistical nightmare right?

But I think we need it. 

The minimal legal and ethical obligation of STD/HIV notification for doctors treating patients in the U.S. is clear – you report it to the local health department and let their disease intervention specialists (DIS) track down potentially at-risk sex or needle sharing partners and let them know they’re at risk for acquiring an HIV or another STD.  But what do you do if your patient is an immigrant from another country, has been diagnosed with HIV in the U.S. and you’re pretty sure he hasn’t told his wife, who is  still living at home in their country of origin?

Working with HIV+ Latino immigrants in Baltimore, this was a common scenario.

What is our duty as physicians and public health providers to these partners (usually wives) back at home?  How can we ensure they are tested – especially considering that typically, they have only ever had sex with their husband and therefore may not perceive themselves at enough risk to be tested.  And they may have more kids.

I’m not sure how we would notify people – it would require system of different countries’ health departments sharing information, and protecting confidentiality of HIV+ patients in transfer could be tricky -but it seems like there’s a need for some kind of public health Interpol service to help ensure partner notification, regardless of which country that partner might be living in.

Reflections on Latino HIV Outreach in Baltimore

So while the past few years I’ve spent a lot of time globe-trotting, this summer I decided to stay in Baltimore, not-so-secretly jealous of everyone else who was traveling and wondering if I should have traveled, despite the short summer.

But on my first day of work with the Baltimore City Health Department’s Latino HIV Outreach Team made me feel like I was back at my last job in Cambodia – everyone was speaking Spanish (I’ve only started to learn over the last year through once-a-week medical spanish classes), my boss had to run off to a funeral leaving us abandoned at Esperanza Center and the person we were supposed to meet with to show us around was MIA.  It took a few hours, but we eventually figured out that she had called in sick.

Despite that somewhat ominous start to the summer, it ended up being a good one.  The Latino Outreach team is 2 years old and they do HIV testing and follow-up care using a mobile unit and at fixed site like Esperanza Center.  The Latino population in Baltimore is growing, and most are recent immigrants (last 5-10 years), who speak little English, may be undocumented and have little access to the healthcare system.  There is also a lot of fear surrounding HIV.

While the main project we were supposed to do (write a survey fto assess HIV risk behavior in MSM) got delayed, we got to work on some shorter venue assessments for future surveys, lay the framework for a Spanish-speaking HIV+ peer support group (there are currently none in Baltimore), help organize a Latino Health Fair (280 served!) and network with other community organizations to see what insight they would have for future surveys and community outreach. 

Best of all, I got to hang out with the community outreach workers – who without fail always seem to be really cool people.  Some of their outreach includes mobile testing on Friday and Saturday nights at local bars (usually the ‘sketchiest’ ones – with commercial sex workers or other high-risk behavior is likely to happen).  As Unfortunately, I was only able to shadow with the mobile unit once (it was a long, cursed summer for that van, it seems it was either broken down, the weather was bad or there was no driver).  But Despite my limited Spanish, they pushed me to help with HIV testing – so I got to figure out how to say questions like, “Have you ever exchanged sex for drugs or money?” and then try to figure out if they were laughing at my Spanish or the awkwardness of the question.  Probably both.

Another refreshing thing about my summer was how open to collaboration my P.I. and rest of the staff was.  I’m used to researchers being quite territorial but we were able to partner with a support group at University of MD (our so-called Baltimore ‘rival’) for the one we were starting and even at last-minute notice, the Latino Outreach Team was willing to help with a faith-based HIV testing initiative called City Uprising to help facilitate testing at Esperanza Center – even though the paperwork and system tused were mostly those of another organization.  And that day, over 100 people were tested at that site!  I look forward to seeing how these collaborations continue to progress.

I don’t come away from the summer with any pending publications and I’m not sure what I’ll put on my scholarly concentrations poster (hopefully we’ll have IRB approval and some results on the shorter survey by next spring??) – but I did get to work at the interface of Hopkins, the health department and other faith and community-based organizations – and I think that’s where I’d like to continue to be in the future – some time with PubMed, some time in the clinic, all the while partnering with other organizations to help implement best practices in public health and creatively figure out how to reach populations least-accessed by the traditional healthcare system.

South Africa Expands HIV Testing, Treatment and Circumcision

http://www.nytimes.com/2010/04/26/health/policy/26safrica.html?ref=africa

It’s interesting to see how tables are turning in the global AIDS epidemic  As mentioned in a previous post, Uganda, former poster child, is struggling.  And South Africa, infamous for having some of the highest prevalence rates in the world and a former president who denied that HIV caused AIDS, now has one that is publicly being tested for HIV (Zuma is also not the lowest risk man, given his polygamy and extramarital affairs

Interesting points from this article are the embrace of these efforts by key political stakeholders – from President Zuma to Goodwill Zwelithini, the king of the Zulus, who is endorsing circumcision.  But on the flip side, I skeptically wonder how much of a rapid scale-up their health infrastructure can withstand and how much of this intense beginning will translate into lasting change.   But it is encouraging that South Africa is no longer in denial and could go on to become a trendsetter rather than lagging behind.