John Hilgeman  0:00  
This is John Hilgeman from Lambda Reports, and our guest this morning is Don Cuvo, manager of Metro AIDS program. Don, welcome to our program, and maybe you could tell us a little bit about what Metro AIDS is. 

Don Cuvo  0:13  
Thank you, John, simply put, Metro AIDS program, or Metropolitan St. Louis AIDS Program, is the Public Health Service of both the City and the County. Our purpose is to gain control over this HIV AIDS epidemic and to help our community come to terms with it. Basically that means that our job is to understand the epidemic. Numbers wise, how many cases there are, how many deaths there are, how rapidly it's growing, what risk groups it's it's affecting? Is it changing? And we have a very elaborate computerized program that helps us to track all that information in our offices. We also have graphs on practically all our walls showing the pace of the epidemic, and and, and this visual approach really helps us to keep a good awareness of the way the epidemic is, is moving. 

The way that we control the epidemic, or should be controlling the epidemic is through a a series of services that are pretty standard in all the public health clinics around the country. In a nutshell, they are our HIV counseling and testing program, and many people know about this in the community because of our anonymous testing site at 634 North Grand. And just let me mention for your for your listeners, 658-1159, is the number to call for anonymous testing in St. Louis and St. Louis County. In addition to that, we have a very active educational program, and we have two individuals on our staff, among others, who are well known to your listeners then, and they are Don Connor and John Thompson, both of whom are and have been very heavily involved in providing training and education to our community. They have provided training to practically all of the AIDS service organizations. And in addition to that, they provide extensive training in healthcare institutions. 

One of our emphases as a public health program is to help the healthcare community prepare itself for the treatment and intervention of persons with AIDS. They have provided training in all the public health clinics in the St. Louis Regional Medical Center and in the County clinics as well. And let me say that this is a continuing activity. We are never satisfied with the level of care on every case that goes into our public health center. There's always turn around and with, with staff members, people coming and people going. So we need to keep our our in service training programs pretty much constant, so that we have some confidence in the abilities of the public health centers to to treat the disease. I'm sure you and others are very aware of the eight or 10 or 12 doctors who treat most of the cases in our area, for people without resources, however they seek treatment at the St Louis Regional Medical Center or at the six public health clinics in our community. And that basically is Metro's job is to help these public health clinics be prepared to effectively handle persons with AIDS and at various stages of their of their illness. 

So I've covered counseling and testing and also education. Education is much broader than what I've just mentioned. We will meet practically every request for any kind of public speaking or training activity. The other two services that I that we offer, are not well known to the public, and they don't really impact the public that directly they're both. Both of them are basically data collection functions. One of those functions is called sero prevalence studies. Sero, as you know, is the word for blood prevalence. Is the word that helps us understand the level of something. So what we're trying to understand is the level of HIV infection in our community. Now this is a we are one of 130 sites in the country that's participated in these CDC studies. And in a nutshell, what we do is we analyze blood from individuals who are treated for health problems other than AIDS, for example, women who go to prenatal clinics, individuals who are treated for substance abuse, and in some other categories, as well, but the end result of this whole nationwide study is to come up with a picture of the extent of HIV among various risk populations, now. So we're doing our little part in that. We are conducting this study in about 13 sites, including our jails and city and county jails, and what we've done is identified risk populations, and we found out where they are. 

Now, let me also mention that the that the federal government also has relationships of this nature with hospitals, with Health Student Health Services in college, with the armed services. For example, every new recruit the armed services is tested, and that becomes part of the data. Every major hospital in most communities are part of the study. There is a major hospital in St. Louis that is part of that study, and what they do is they provide a sample of blood taken for whatever reason among their their population. So when you look at the results from the from the armed forces, from college students, from women of child bearing aids, from HIV, rather from IV drug users, and from persons admitted into the hospital for whatever reason are we should have a very good picture in our country of the rate of infection in the population. Now, let me just say that none of this data taken separately really tells you very much. It's when you put it all together on a nationwide basis that you have some fairly reliable numbers as to the extent of infection in our, in our general population. 

The last, the last service that we provide, is a service that's called surveillance. It's an old time CDC word. It's a word that we probably ought to leave behind, but really it's a data collection function. As you know John, they, it is the law in all 52 states that HIV, rather, let me say, take that back, that AIDS cases are reported to the state health authorities, and in the city and county we are that authority, so doctors and hospitals and laboratories report to us cases that are in their particular service that are positive, and then we go about filling out finding more information in order to complete a report. Now let me say that while individuals are reported by names, the names of the individuals do not get sent to the CDC. They are strictly local. They're locally kept. Now this data collection function is very, very important. I'll give you examples that. You might be aware and your listeners might know about the HIV Care Bill that has just been passed by the Senate and the in the House of Representatives, and it's felt that the President is going to sign it. Well, this provides emergency funding to some 13 cities with the highest incidence of AIDS cases. Well, we're not in that and and so as you can see, our city and county can possibly miss out on on monies to care for our sick individuals unless we have our numbers straight. Now, I know that there is a great reluctance among our in the community to provide information about themselves and having AIDS, and I understand this completely. However, there's another side of that coin. And the other side of that coin is that, as with most opportunities for federal money, you have to demonstrate the need and and as long as we feel that we're not gathering all the cases of AIDS, we were always going to be under reporting. John, when I first took the job about three years ago, we were estimating that we had about 80% under reporting, meaning that we were only finding 20% of the cases. Well, since that time, we provide a lot of training to physicians and a lot of training to health care providers, and we've let them know how this information is useful to our community, and we've had much better success at working with physicians and seeing the necessity for reporting, we now estimate about a 20% under reporting. We're never going to know all the people that are out there that have AIDS and and and we want to know only because it's our way of documenting the epidemic in our area. Otherwise, if we don't know that kind of basic information, likehow many have AIDS we're certainly not going to be able to get to pull down the care money that we need. 

So that's our programs. That's, those are the programs are funded by the state. Let me put it this way. They're funded by the federal government through the state. So it's, it's federal CDC money that gets funneled to us through through the state. We we have about $600,000 a year of that kind of money to cover these public health services. Now, in addition to those public health services, we also have a program that that is geared toward finding IV drug users and getting them into treatment, both HIV treatment and drug treatment. Now, as you know that, that individuals who abuse IV drugs are at risk for HIV infection. We know what's happening in other major cities. We have no reason to believe that we're going to be spared, that even though the infection has not hit this area yet. I have, as I said, no reason to believe that it's going to pass over as we can only presume that we're going to have the same kind of devastation among IV drug users that has been experienced elsewhere. Now, another interesting feature about looking at data is that we are able to watch the epidemic. We are able to watch statistically the epidemic as it grows and expands across the country. And is particularly true with IV drug use. We watched IV drug, IV drugs and HIV moved from New York City to Trenton and Newark, Cleveland, Detroit last fall, the epidemic, rather the infection and IV drug users hit in Chicago.

John Hilgeman  11:59  
So it's hitting 

Don Cuvo  11:59  
So it's moving in our direction and our our hypothesis is that when when IV drug users from Chicago get sick, they're going to come back to the home to their hometowns in Belleville and Collinsville and and East St. Louis and Southern Illinois and and what we know about IV drug users is that they crave the substance, and we feel that they even though they're sick. And here they're going to continue to shoot drugs, and they're going to infect our population here in St. Louis and East St. Louis. And so it's, it's, if you have the data, you can predict how and when the infection is going to hit certain populations. Now, the city has funded a program called Community Outreach for Risk Reduction. We call it core. CORR. What this is basically, is an aggressive outreach to individuals who are HIV, excuse me, individuals who are IV drug users.

Now, most people would say, Well, how do you reach IV drug users? You know, they're not the kind of people that's going to come and check in with you. They lead a rather secretive life, and they're kind of like evening and street people and well, how do you get to them? What we try to do is we've tried to reach the IV drug users through the various social institutions that they come in touch with. Now among those social institutions are the judicial systems and the correctional system. We know that if people are going to be shooting IV drugs, are going to get get in trouble. They're going to get to the courts, and they're going to get to the probation department, they're going to get put in jail. So our program, we reach the IV drug users through referrals from the municipal courts. By the way, the Municipal Court not only refers IV drug users, but they also refer persons engaged in in high risk sexual activity like prostitution or cruising the parks, and and we provide educational activities, direct, clear information about the disease and how to prevent it to these individuals. We also provide education and training for all the inmates of the city jail and the medium security prison known as the workhouse. We've trained every police officer, every correctional guard, every fireman in the in the city, and that's an ongoing process. We update it every year. So in a nutshell, that's our city funding. 

John Hilgeman  14:39  
Okay, I'll tell you what we're running to the end of our time right now, maybe we could continue this discussion, and before we conclude for today, could you once again give me the address and phone number of Metro AIDS, 

Don Cuvo  14:51  
Right. The most important number is our phone number, 658-1159. Anybody can call for information and also that's the number to call for a an anonymous test. We're located at the City Health Department 634 North Grand, right across the street from Powell. Powell Hall. 

John Hilgeman  15:10  
Okay, thanks a lot. Don Cuvo from Metro AIDS, and this is John Hilgeman for Lambda Reports. Hope you can join us again next week. 

Transcribed by https://otter.ai