A Clinic without Walls Aims to Conquer HIV/AIDS
As the nation observes National HIV Testing Day today, the University of Miami’s street-based, rapid-HIV testing program holds the promise of becoming a model for reaching at-risk communities.
The door to community health worker Jakisha Blackmon’s office was festooned with red, white, and black balloons, which also hung like curtains across the ceiling in the conference room. “Survivor” by Destiny’s Child blared from the speaker. The party for Blackmon’s favorite holiday, HIV Long Term Survivors Awareness Day, was revving up in the Liberty Square Community Center when HIV activist Alecia Tramel took the mic and told nearly 60 guests how lucky they are because today, everybody can get an HIV test and know the results almost immediately.
“You don’t have to get tested and wait two long weeks — two long weeks — to get the results,” Tramel told the crowd just three weeks before today’s National HIV Testing Day. “It’s 20 minutes at best. Technology is a wonderful thing.”
So wonderful that, for the past 19 years, Tramel has been living and enjoying life with HIV, a fact she was more than happy to share at the long-term survivors celebration hosted by the Miller School of Medicine’s Community-Based HIV Awareness for Minority Populations, or CHAMP, program. The novel, street-based, rapid-HIV testing initiative employs community health workers like Blackmon to administer the simple mouth-swab test anywhere — under a tree, in a car, outside a store, at house parties, even on house calls — to the African-American and Haitian populations most at risk in Miami-Dade County of contracting and dying from AIDS-related complications.
“We peddle HIV tests like drug dealers push drugs,” said Sonjia Kenya, Ed.D,, M.S., M.A., associate professor of medicine and public health sciences who launched CHAMP as a pilot project in 2012 with support from UM’s Clinical and Translational Science Institute. “We use the same strategies. We hang out on street corners, and say, ‘You gotta have this. It’ll make you feel better.’ Only what we have really does make you feel better. We empower people to take care of their health and their communities and we do it through testing, education, and linkages to care.”
Now, thanks to a new, three-year, $1 million grant from the state Department of Health (DOH), CHAMP has the potential to become the standard for reaching minority communities where HIV infections are still rising and still the leading cause of death among young, black adults — despite the availability of free pre- and post-exposure medications that prevent its transmission or keep the virus at bay.
Last year, the CHAMP team interacted with nearly 3,500 people and performed nearly 1,000 HIV tests in Miami’s Overtown, Liberty City, and Little Haiti neighborhoods, about 3 percent of which were positive. But now, as an official DOH partner, CHAMP not only just doubled its staff and budget, but has direct access to DOH’s test-and-treat programs, ensuring that people whose tests are positive get into care and receive 30 days of medication the very same day.
“That’s huge for us,” Dr. Kenya said. “Historically we spent half our time banging on clinic doors to get them in to see the doctor. Now, we’re on the VIP list at the club.”
Yet CHAMP is as much about education as it is about testing and accessing immediate care. People who agree to take the rapid test are rewarded with a $5 gift card, and those who refer five more people who take the test are rewarded with a $25 gift card. As Blackmon, who once lived in the Liberty Square housing project across the street from her office, noted, the incentives often produce magical results. They have helped create a small but committed band of champions who spread the word about preventing new HIV infections, or about the ease of accessing care.
“I may be just one community health worker from UM, but I do not work alone,” said Blackmon, who returned to Liberty City after earning a Master of Divinity degree from Emory University. “I rely on the support of the community. They’re the ones knocking on the doors, and spreading the word.”
Dr. Kenya, who joined UM in 2007 to develop HIV outreach programs, came up with the idea for a clinic without walls after the U.S. Food and Drug Administration approved the use of rapid, home-use HIV testing kits in 2012. At the time, she wondered how to reach the highest-risk people in the mostly black communities, like Liberty City, where new HIV infection rates were and continue to be the highest in Miami-Dade County.
Many, Dr. Kenya knew, were people who didn’t have access to or faith in the traditional health care system, who still thought HIV was a death sentence, who didn’t know that the federal Ryan White HIV/AIDS Program would provide the free medications and services that enable low-income people living with HIV to have normal life spans, without the risk of transmitting the disease to anyone else.
“A lot of people are scared to take an HIV test because they don’t know they are eligible for Ryan White insurance if they are positive,” Kenya said. “Their thinking was ‘If I take a test I won’t be able to afford treatment so it’s just easier not to take the test.’’’
Her solution for dispelling that myth came from a community survey.
“Our HIV scientific advances have not made it to the most vulnerable populations,” Dr. Kenya said. “That was problem, and the community taught me that I needed to take testing out of the clinic, and that I needed to have people who looked like them, who spoke like them, do the testing.’’
Today, the CHAMP team, which includes three community health workers, is comprised of UM employees who would do what they do for free — because they already have. Every team member volunteered for CHAMP before joining the UM staff. For instance, Kiera Wallace, who is CHAMP’s program manager and hopes to go to medical school, started working with Dr. Kenya as a student research assistant when she was earning her undergraduate degree in psychology.
For Blackmon, CHAMP isn’t merely a job. It is a calling.
“I love what I do,” Blackmon said. “I am a liaison in a high-risk community who connects high-risk people with resources, and that is purposeful work. Our work just doesn’t happen in a building. It happens on the street.”
As National HIV Testing Day, which CHAMP will observe today with outreach in Overtown’s Gibson Park, drew nearer, Blackmon took a short walk around Liberty Square earlier this week and spotted a couple of men talking under a tree. Before long, one of them was sitting at the folding table she set up in front of a vacant apartment in the nation’s oldest public housing project. He was eager to collect the $5 gift card for taking his first rapid HIV test, and when he learned how he could get a $25 gift card, he promised to return promptly with five more men. He was true to his word.
Within an hour, all the men were tested, and one of them received the news he already suspected: his test result was reactive for HIV antibodies. But barely another hour passed before a counselor from one of DOH’s test-and-treat clinics met him at Liberty Square, and was ready to take him to an appointment with a doctor, for a 30-day supply of anti-HIV medication.
“And that,” Dr. Kenya said, “is exactly how it’s supposed to work every time.”