By CINDY GEORGE HOUSTON CHRONICLE
Jan. 17, 2009, 8:56PM
In most health care settings, the married mother of three who arrived in the emergency room with severe back and abdominal pain would not have been considered for an HIV test.
The 39-year-old office assistant said she’s been in a committed marriage for 15 years and was screened for the virus that causes AIDS while pregnant with her youngest, now 4.
But when Maria Zaldivar’s blood was drawn at the Memorial Hermann-The Texas Medical Center’s emergency room one recent night, she was offered HIV screening among other tests.
“They asked if they could do that blood work, and I said it was fine,” said Zaldivar, who suffered from gallstones and tested negative for HIV. “It’s not something you think about getting done.”
Houston is one of 25 areas with high HIV infection rates that is involved in a national initiative from the Centers for Disease Control and Prevention to make testing for the virus a regular part of medical care — just like screenings for high blood pressure, diabetes and cholesterol.
Two years ago, the CDC suggested routine HIV testing in all health care settings in the United States, but few hospitals, clinics and doctor offices began screening everyone because of the cost.
Still, experts say, testing is critical, because one of the best ways to prevent new HIV cases is for people with the virus to know they are infected.
Now, the CDC is spending more than $35 million nationwide on a testing program that provides grants to selected health departments, hospitals and clinics. The goal is to test 1.5 million people this year and identify 20,000 HIV-positive people who currently don’t know they have the virus.
Money started flowing to Houston in 2007 to help pay for the tests as well as counselors who assist patients dealing with news that they have a chronic, but treatable, condition. Since then, the Houston health department and participating health care providers have received more than $1 million.
Last year, emergency centers at Memorial Hermann-Texas Medical Center and Ben Taub General Hospital along with two clinics run by Legacy Community Health Services started routinely testing adults for HIV under the program. The project is to expand to LBJ General Hospital’s emergency center this spring.
In the six months since the Houston program started, more than 100 people have learned that they are HIV positive.
“It is a prevention strategy to identify the people who have the virus and don’t know it,” said Marlene McNeese-Ward, who heads the Houston health department’s HIV prevention efforts.
The Houston area’s HIV infection rate is nearly twice the national average. About 1,700 Harris County residents became HIV-positive in 2006, according to the latest health department figures available. An estimated one-fourth of the people living with HIV in Houston — as many as 6,000 — do not know they have the virus, experts say.
Institutions in other cities with high infection rates, including New York, Chicago, Philadelphia, Los Angeles and Washington, have received grants to participate in the project.
In Texas, HIV testing is routine for pregnant women to protect babies from infection, for inmates entering state prisons and for those donating blood. In most other instances, an HIV test is done upon request.
McNeese-Ward said the routine testing program catches the virus in a wide range of people, allowing those found to be HIV-positive to get into treatment sooner, live longer and reduce the chance they will transmit the virus to others. Emergency rooms, which treat large numbers of the uninsured, are especially vital for finding new HIV cases, because an estimated half of the people in the U.S. with the virus have no health insurance.
The project’s greatest promise, McNeese-Ward said, is that the hundreds, maybe thousands, who are diagnosed with HIV under the program will nudge policy-makers across the country to mandate HIV tests as a part of routine medical care.
1 percent positive
In the last half of 2008, Houston program sites screened more than 11,000 people. The 103 who discovered they had the virus accounted for about 1 percent of those tested. This year, Houston officials expect to check 70,000 people under the program and identify at least 600 who are HIV-positive.
An HIV test is offered to all adults who have blood drawn at Ben Taub’s emergency room, about 40 percent of patients. Only a few people have declined the test, hospital officials said.
Half of the new cases detected through the program have been found at the public hospital, which serves as a safety net for the uninsured. About 2.3 percent of the nearly 6,000 adults tested at Ben Taub have been positive, including 50 who were newly diagnosed and 81 who already knew they had the virus.
Dr. Shkelzen Hoxhaj said he might have sent a recent patient with pneumonia home until he learned the person had HIV.
“That meant we had to keep them in the hospital for more intensive treatment,” said Hoxhaj, who directs Ben Taub’s emergency center. “The fact that we’re (testing) more routinely has really helped improve the care of patients.”
Dr. James McCarthy, emergency director at Memorial Hermann in the Medical Center, said screening everyone’s blood reduces the fear and shame associated with HIV.
“Most of the recommendations from the CDC are picked up and followed, but there was a great silence about this one,” he said.
“There’s still a lot of stigma about HIV testing and the disease itself.”
Memorial Hermann, which launched the project last June as Houston’s first program site, offers HIV tests to patients ages 18 to 64, whether they are having blood drawn or not.
About one in five decline the test, McCarthy said.
Historically, those seeking HIV tests went to the Montrose Clinic in the heart of the city’s gay community, which was Houston’s first site to offer anonymous testing. Now called Legacy Community Health Services, the clinic and its sister location in the Fifth Ward offer treatment from pediatric care to family planning. Both sites are involved in the routine testing project.
Former truck driver Tony Walker, sidelined from work by high blood pressure, turned to Legacy after losing his health insurance. He was diagnosed with congestive heart failure and, for the first time, was offered an HIV test.
“I have no problem being tested,” said Walker, 51, of Houston, “because if there’s something there, I’d like to know.”
Early detection
Memorial Hermann’s McCarthy said the value of the program bears out in data showing that those who discover they have HIV shortly after infection can stay healthier, keep themselves out of the hospital and defer health care costs for years.
“The one thing that the community needs to know is that the prevalence of this disease is far greater than most of them think,” he said.
“There are a whole lot of people walking around with HIV. And if more of them know it, the better off everyone’s health here is going to be.”
Dr. Joseph Gathe, a Houston HIV specialist in private practice who treats 3,500 patients with the virus, applauds the strategy but said the project might have missed some people he recently diagnosed — a married couple in their 70s and a 15-year-old girl who reported having 16 partners. All three fall outside target age groups.
“The average physician doesn’t really offer HIV testing routinely to people unless they think they need it,” said Gathe, who has advocated HIV screening as a national standard of health care.
“It’s a disease of behavior, and nobody knows what your behavior is,” he said. “This project takes all of that out of the equation and just does the test.”
