Sensitive Sleuthing Helps Cut Infant HIV Rates in Florida

In 1998, Florida's Legislature established the Targeted Outreach for Pregnant Women Act (TOPWA), an effort to find women of child-bearing age at risk for HIV or addiction and, if necessary, help them deliver healthy babies. Initially, the act allocated $100,000 for agencies in the most populated counties: Miami-Dade, Palm Beach, Broward, Hillsborough, and Orange. With additional federal subsidies, TOPWA now covers 12 Florida counties.

In Palm Beach County, where Families First runs TOPWA, the program has five outreach workers and a $165,000 budget. Since TOPWA was passed, rapid HIV testing, antiretroviral therapies, Caesarian birth, and other medical interventions have helped reduce state HIV cases among those under age two from 113 in 1992 to four in 2004.

Jocelyn Paul, the senior outreach worker for Palm Beach County's TOPWA, speaks English, Spanish, French, and Creole and searches for potential clients at strip malls, diners, coin laundries, supermarkets, salons, and along streets and alleyways.

"Where people go, that's where my fliers need to be," she said, driving a van supplied with HIV and pregnancy tests, prevention pamphlets, important phone numbers, and prenatal "goody bags" packed with brochures and a bib that says "I'm a healthy baby because I'm a TOPWA baby." Paul's fliers, in Creole, Spanish, and English include her cell phone number.

Throughout the day, Paul receives calls from nurses and doctors' offices on behalf of patients and from others wanting to get tested. Paul has administered the rapid-result OraQuick oral HIV test in fast-food restaurants, the van, and halfway houses.

Paul is flexible: One potential client called, telling her she could not leave work and did not want Paul coming to her house. She would try calling again after the weekend. Paul meanwhile visited a woman at a halfway house who was 17 weeks pregnant, had relapsed into drug abuse, and had yet to visit a physician.

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