On the Case: How a Houston Health-Department Worker Tracks STDs
By Cindy George
June 7, 2010
This article originally appeared in Black AIDS Weekly, the newsletter of the Black AIDS Institute, on May 24.
Somebody in Houston might unknowingly spread HIV or syphilis. And this person's partners may have additional contacts, further circulating deadly infections.
Brooks, a disease-intervention specialist for almost 20 years with the Houston Department of Health and Human Services, says that she has "three good seconds" to figure out how to approach a stranger to obtain "what I'm going to get out of you, which is [the list of] everyone you're having sex with."
Brooks is among a dozen city health workers who track down people who have been diagnosed with HIV and syphilis -- which, because of their severity, take priority over other diseases -- as well as chlamydia and gonorrhea, also reportable by law. If the person has HIV, the conversation is always in person; if not, it may be by phone.
"Hi, I'm Mrs. Brooks with the city of Houston," she begins -- never volunteering her health-department affiliation until she is certain that she is speaking to the actual client. If pressed, she'll say the person accessed city services or that she is a counselor.
In 2008 nearly one-third of Texans living with HIV/AIDS resided in the Houston metropolitan area. One in 90 (PDF) Black people in Greater Houston has the virus, and the area ranked eighth nationally in cumulative AIDS cases in 2007.
For Brooks, a trained social worker, the daily race tests her detective skills. When she finds people, she asks them to name their sex partners and recall the dates.
She has a week to find someone and close the case, the health department's guideline period for stopping the disease before someone is infected or reinfected. Brooks collects as much information as possible from whoever answers the door or the phone -- including names, addresses and phone numbers of relatives or associates. If she's making home visits, she'll even note the license plates of nearby cars and call the owners.
Sometimes she talks her way past grandmothers or spouses to get a few private minutes with the client. If needed, she'll drive the client around the corner and draw blood in the car for testing later.
One late-winter day, she circles back to quiz Marcus,* a married 20-something Black man with syphilis, whom counselors perceived was not being honest about all of his partners. He steps out of his wife's line of sight and admits that he's been fooling around with a "neighborhood trick."
"Your name is never mentioned," Brooks assures him. "I just want to find her and get her tested."
Marcus knows only her first name and where she hangs out. Brooks relents, but not before saying, "I'm going to need you to put a condom on." Some comply and others don't -- she sometimes makes another visit months and years later.
Brooks fields frequent return phone calls as she travels through the nation's fourth-largest city.
"We're following up on a lab report from your doctor," she tells James,* a Black truck driver who found a letter slipped under his front door and vague voice mails when he returned from a haul. He said he knew about the syphilis. She implores him to visit a health-department clinic the next day.
She is told that no one lives at a clapboard house with peeling paint, but she leaves a card anyway for Maria,* a Latina whom an area inmate has named as a partner.
Last winter she finally tracked down Niecy,* whose baby was born with syphilis and cocaine in her system. The young Black woman, a prostitute, had received no prenatal care and said the baby crowned as she was finishing a blow job. Brooks refers Niecy to syphilis and drug treatment and asks where the woman meets her clients so that she can alert the health department's nighttime mobile-testing outfit.
Brooks routinely visits poor, predominantly Black communities, and there have been consistent realities since she began this work in September 1991: People trade their bodies to feed addictions and end up with HIV. Survival sex leaves little room for condom negotiation. Older men who pay for sex with their Social Security checks often end up with more than happy feelings. People don't disclose their HIV status. She often comforts the newly HIV-diagnosed or supports them as they inform their partners.
When Brooks started this job, her daughter was 3 years old. The married mother said that her work has influenced years of frank discussions with her only child, now 22, and her daughter's friends.
And more than most mothers, she is informed and rehearsed enough to talk about anything.
Cindy George is a health reporter at the Houston Chronicle.
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