John Hilgeman  0:00  
Good morning. This is John Hilgeman for Lambda Reports, and we're continuing our discussion from last week with Don Cuvo, the manager of the Metro AIDS program. He's talking about the work of Metro AIDS and also some information about AIDS. Don, could you tell us a little bit about the testing program? What all that involves? 

Don Cuvo  0:25  
Okay, as you know, the method of determining whether one has AIDS or not is through the use of a blood test and and in addition to the blood test, there is always health education or advisement or consultation given to the individual at the time of the test. So the test, for us really has two purposes. One is to draw the blood and perform the lab test that determines whether or not the AIDS virus or HIV is present in the blood, and secondly, to take that opportunity for some face to face discussion about AIDS, how it's acquired, how it's prevented. So we feel that one of the most valuable things that we do in terms of education is that one to one contact that we have with an individual while they're being tested, trying to get some straight information across to them. Now there's some terminology or some jargon that people need to be aware of, and I'll try to explain the difference between that. You will hear the use of the term confidential counseling and testing and anonymous counseling and testing, and frankly, they are easily misunderstood. They are not clear. So I want to provide the 

John Hilgeman  1:43  
Okay, that's 

Don Cuvo  1:43  
a clear distinction between the two. Confidential counseling and testing, when you think of the word confidential, you can think in terms of the same kind of relationship where you have with your doctor or your counselor or psychotherapist. That means that that doctor knows who you are. He has your name in the file. He collects information about you, but because of law and professional ethics, information about you cannot be released except with your consent. So we provide that same kind of confidentiality to our individuals that come for testing, we know who they are. They give us their name, we talk with them, and we give them their results. However, we have the same obligations by law and ethics not to share that information outside of the health department. The other kind of testing that people hear about is anonymous counseling and testing. Simply put, we don't ask any information. We enroll people into our into the testing by the use of a control number, and that number is the same number that's attached to their blood sample, and it's the same number that that we use to to to talk with the person when they come back. In other words, they have half the number and we have half the number, and they come up with them number 517, and then we know what to say to the individual. So that's the basic difference. There's a there's interesting and valuable support for both of those approaches. The approach which public health appreciates the most is the confidential approach. Public health is concerned about being able to follow up with these individuals when cures are are discovered and when treatments are made available, remember that we not only deal with knowledgeable, well read, well educated people who when a when a cure is found, will be the first to know it. We also deal with people who are illiterate, who do not have a home, who do not have a TV, don't listen to the news, and we feel a need to be able to contact and find those people when a cure or more effective treatments become available, On the other side of the coin, AIDS is a condition for which people suffer discrimination. There's no question about that, and people are reluctant to put themselves in a position to be discriminated against. Therefore they want their and their anonymity and and we can appreciate that side of it too. Therefore we offer both. 

John Hilgeman  4:44  
And there's no charge for 

Don Cuvo  4:45  
Correct, there's no charge for any of the services offered by Metro AIDS, including our our counseling and testing. Now it does take about seven or eight days or more to get the the results of the test, because we ship the blood samples to the state lab in Jeff. City, and so there's a shipping time back and forth. And people are able to get testing through their private doctor and through the American Red Cross for a slight fee, but they can get them quicker in that regard.

John Hilgeman  5:16  
And when people to get the results, people need to come into the office. And the advantage of that is if, if people, one of the major advantages is, if people are infected, then they have somebody right there that they can hear the news from and can help them deal with the shock of that 

Don Cuvo  5:34  
At Metro AIDS, we don't give any results over the phone, and so positive or negative, they need to come back to our office, and they will be told privately what their results are. In the case of those who are negative, we ask whether or not there are any further questions. We try to reinforce some information that we gave about about risky behavior, and we give the individuals condoms, show them how to use it, encourage it, let them know what other kinds of services they can get in the community. In the case of those who are positive, it's never easy to give this information to individuals. As many times as you do it, it's never easy. It's just as hard each and every time, but we want to be able to also give information to people that are positive. We specifically want them to know what it means and the difference between being HIV positive and having AIDS, we want them to involve themselves in medical treatment as quickly as possible. We give them recommendations for that. And it's true that many individuals need our support at that time, and we will provide that for any amount of time that's needed. Sometimes people just need to sit there quiet and to to comprehend what it means, and we'll provide them with that kind of time.

John Hilgeman  7:08  
Now, what are some of the risk behaviors? Because I know that people used to talk about risk groups, but really it's, it's behaviors that are the risk what are risk behavior? 

Don Cuvo  7:17  
It's behaviors that put people at risk for acquiring HIV and the kinds of behaviors generally are intimate sexual behaviors, specifically sexual intercourse. The the infection through blood, and this is either through dirty IV needles, as in the case of IV drug users. In the past, we were concerned about the acquiring HIV through contaminated blood products. That is no longer a a concern. The blood supply is safe. And lastly, through birth, a mother who is infected will pass on the HIV to the child, and as with all the other antibodies that the mother passes on with the child, some percentage of these individuals will shed that HIV as they do other antibodies from their mother, but it's at least 30% some say 50 babies that will continue with the HIV and virus, and they unfortunately have have will have a short life. Specifically, the sexual behaviors that put people at risk are behaviors in which there is a reason to believe that skin or membranes will be torn, and this happens with anal intercourse, and it can happen with other kind of rough sexual behavior. And so there what one has to do, in that case is either eliminate that practice or to protect oneself with the use of a condom. And how, when we talk about condoms, it has to be a latex condom, not a not a condom made out of natural skin, such as those called foreskin, I think they're called. They're made out of lamb products. They're not at all safe. One must use a water soluble lubricant and and generally be aware that that roughness during sex that could tear membranes is a very risky behavior. 

Also, let's move for a second in terms of transmission by blood. We know that HIV is transmitted through the use of dirty IV drugs. Now let me emphasize it is not the drugs that causes HIV. It is the transmission of infected blood from one person to another through the sharing of the needle. Drug users have a tradition, or by tradition, the the drug needle is shared among number of people. And there's a way to to stop that as well, and that is to sterilize the needle through the use of some products like rubbing alcohol and bleach and various kinds of disinfectants, but bleach is the most the one we recommend. It's cheap, it's it's readily available and and easy, simple to use. They recommend a diluted portion of bleach, ten to one. But let's not be so particular about it. Any kind of bleach, full strength or dilute, is going to do the job. So individuals need to draw the bleach and water into their needle and squirt it out. Do that a couple of times, squirt it out again. What we're concerned about here is saving lives. We also we know that drug abuse is is going to shorten people's lives, but the work of Metro AIDS is to save people's lives from infection with HIV.

John Hilgeman  11:12  
And I think a thing that sometimes people people forget or miss is that drug use is often an addiction, and and people who have an addiction to cigarettes or food or something like that, can can certainly understand that, that if a person's addicted to some particular to a use of a drug, then it's it's not realistic to say, just stop it and expect that without treatment, people are going to be able to do it very easily. 

Don Cuvo  11:38  
That's right. Individuals who are addicted are not going to respond to persuasion. They're not going to respond to logic or correct information. And addiction functions at a at a different level in the minds of individuals who who are drug addicts. And and we feel that every individual who is addicted at some point or another, and has the opportunity to change and and the opportunity to get into treatment. But we never know when that is, and we never know when the person is going to be motivated, and our concern is to keep the person free of HIV infection until such time as they're motivated to enter into treatment.

John Hilgeman  12:19  
We have just a couple minutes. Maybe you could tell us a little bit about some statistics.

Don Cuvo  12:24  
Yes, I can. Since we're the numbers people in the City and County, it's our job to collect those numbers. I would like to give you a picture of how the HIV epidemic is progressing in our area. I'll just start nationally with the figures nationally, to give some perspective, there are around 129-130,000, cases in the United States right now, 60, 61% already deceased. And that comes to about 78,000 people already have succumbed to the, to the illness. Locally, here in St. Louis City and St. Louis County, we have counted 511 cases so far from the beginning of the epidemic until the present time, and 322 of those individuals have already succumbed to the, to the illness. We here in St. Louis have somewhere between a high 50% to a low 60% fatality rate has remained fairly consistent. So what that means is that at any given time, about between 50 to 60% of the people will, are dying of the of the disease. 

The other piece of information that's important, as well as knowing the numbers of people who have AIDS, is knowing something about the numbers of people who are infected. Now we know this through the counseling testing that I talked about a few minutes ago, is also a law in Missouri that individuals who test positive for the HIV virus are reported by name, and and we have some fairly good confidence in our numbers. We know that there's a portion of the individuals who are not reported, but we we feel that our our information is fairly, fairly correct. And since 87 through 90, we have information that tells us that about 740 people are HIV positive in our area. We feel predicting that there's will probably be a minimum of 3000 people in our area who will acquire HIV. This is an estimate, and it can be revised, but we feel that that's, that's what we're looking at in terms of the long term picture, that in addition to the 510 people that have AIDS, we are looking at around 3000 individuals in our community who will acquire HIV.

John Hilgeman  15:11  
Okay, we're going to have to end with this. Once again. I thank you. Don Cuvo, Manager of Metro, of the metro AIDS program for being with us this week. And this is John Hilgeman for Lambda Reports. Hope you can join us next week. 

Transcribed by https://otter.ai