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... And the van played on.

. . . AND THE VAN PLAYED ON

With apologies to Randy Shilts for playing with his title, we bring you the next chapter in the saga of the AIDS MOBILE as it plays its message of AIDS prevention in the heartland and wherever it is welcome.

Andy and Sonny, about whom you've read, were driving the van back from a testing site when they stopped at a filling station in a mountain village. The attendant paled when he read the words "AIDS MOBILE' and saw the two men exit the sleeper van. "Two men . . . AIDS . . . no way . . . you pump your own gas,' he told them, backing off and standing his ground. Andy and Sonny laughed about it, and they find that those who at first appear irrationally fearsome soon laugh with them when they take time to explain how AIDS is really spread-- primarily by sex and blood.

I discovered that you have to be careful about emphasizing the word "blood.' A young man who resembled a Harlem Globetrotters basketball star wanted to talk to us in the AIDS MOBILE. I cautioned him that sleeping with a woman is like sleeping with all her sex partners for the past ten years. His eyes widened. He broached a concern: "What if accidentally her period had come up on her and I got that blood on me during sex--would I get AIDS?' He was so comical I could hardly keep a straight face. It would have been funny had his misconception not been so serious. I went back to basics and explained to him that the vaginal fluids from a sexual partner are all that are needed to infect him if his partner is an AIDS carrier. He knows now that blood isn't the only culprit in spreading a sexually transmitted disease. I believe the AIDS virus has been found in all the body fluids, I told him.

Andy and Sonny learn more about their fellow Americans every day, and from hearing their experiences, you come away reassured that people are basically decent about AIDS. They laugh about their fears when they have the facts explained to them. When they believe that what you are telling them is the truth, they can handle it.

The AIDS MOBILE staff has tested 1,056 individuals and discovered 28 to be AIDS positive.

We have tested people of high risk, low risk, and medium risk. From our experience the argument that widespread testing will drive high-risk persons underground just doesn't hold up. It may sound good in theory, but out in the real world, in practice, it appears not to be a problem at all. People at all risk levels seem anxious to be counseled and tested--freely and voluntarily (confidentially or anonymously, as they wish).

After having interviewed these people, Andy estimates that 95 percent of the persons at risk in the country would gladly be tested voluntarily if it were free and convenient to do so. There's persistent talk that mandatory testing would drive high-risk persons underground, but we haven't found anyone wanting to go underground with voluntary testing. So why don't we spend our resources on voluntary testing? Because there is yet another argument: "We can't do widespread voluntary testing because there are too many false positives.'

The Department of Defense has tested in excess of 4 million persons and has recently assessed a false-positive rate of 1 out of 135,000 low-risk individuals (after repetitive ELISA positives and a confirmatory Western blot). The one false positive could be checked further by studying T cells and by culturing the virus from the blood.

An infectious disease specialist at Indiana University, Dr. Judith Johnson, said: "I don't want any AIDS antibody-positive individuals to dimiss their results as being false positive. I fear that patients may deny their high-risk behavior and rationalize away their test results. Most seropositive people, if they review their past history, will be able to find some risk factor,' she said. "For example, after thinking about a positive AIDS diagnosis, a patient might make a comment like "Well, I did have surgery in 1980 with blood transfusions.' Persons who truly cannot find any risks should talk to their doctor about further tests.'

We talked with Dr. Brooks Jackson at the St. Paul Red Cross and to State Epidemiologist for Minnesota Dr. Michael Osterholm. After testing more than 250,000 low-risk patients, they had no false positives. These were low risk, all right--they were blood donors--all 250,000-plus of them. They found 15 positives, confirmed by the Western blot. How did they know that they weren't false positives? Each of the 15 admitted to being high-risk. The actual AIDS virus was cultured from the blood of all 13 patients who have come in to date for follow-up blood testing. The fourteenth patient was already symptomatic. The fifteenth admitted to high-risk behavior.

Having just completed the cultures, Drs. Osterholm and Jackson will be submitting the results of their research for publication. It takes a month to culture out the AIDS virus. The procedure costs about $150 at the present time, but it is expected that this cost will soon drop.

As you can see, this could lay to rest the "head in the sand' attitude that fear of a false-positive test should prevent the testing of low-risk populations. Because the test is so accurate, it should become a routine part of physicals for those who believe they have even the slightest risk.

We asked Dr. Jackson how he thought we should handle the complaints of those who say, "Don't test because some labs might give false positives.'

"Should we use regional centers?' we asked him.

"Well, that's one approach,' he said. "And the other approach is that they let anybody do it and have them pass proficiency panels [tests]. License laboratories that way. You just give them panels to do, and if they pass the panels then you know they're qualified to do it. I hesitate to restrict it to certain centers, although our center would certainly benefit from that. But the lines are just so long to get tested these days.

"They must wait 5 weeks, 10 weeks, and at some places 14 weeks to get an AIDS test. Just to get blood drawn to be tested! You shouldn't have to wait that long.

"And you see, a lot of that is because many centers are making it mandatory that they provide pre-test counseling at the same time. I don't think it's really necessary for low-risk people. You know, people who just want to find out. And of course this counseling takes a tremendous amount of time, and that really backs everything up. They may have the results, but they won't give them to you until you come in for counseling to reduce your high-risk behavior.

"And in the low-risk groups this just takes much time and money, and I'm not sure if it's really necessary in those groups.'

I asked him, "Do you mean people who had blood transfusions who just want to know? Or maybe their child who had a blood transfusion and is now six years old--if negative, why would he need post-test counseling to change his lifestyle?'

"Right,' Dr. Jackson said. "I agree, and it should be made easy and accessible to these people. In fact, I don't even think they should have to see a physician. I mean, if they just want to go in someplace and say, "I just want an AIDS test,' they should be able to get it done and pay their ten dollars or something and get it done. Now, if it comes out positive, I would say that that lab should refer them to a physician for counseling.

"But if you just want to get a simple result back, just for assurance, I think that's perfectly O.K., as long as the labs are qualified to do it and it can be done with a proficiency panel or something that they have to do every three months or six months or whatever. I think that would be the approach to go.

"I still think it is a good idea to identify them [the low-risk AIDS-positive individuals]. Certainly, having dealt with so many of these people at the blood center, I know that all they want is a little assurance, and I just think you should make it as accessible as possible. It's such a cheap test! We only charge seven dollars for it. I mean, this is nothing, you know.'

Dr. Jackson is the assistant medical director at the St. Paul Red Cross and the assistant professor of laboratory medicine and pathology at the University of Minnesota. "The University of Minnesota has an AIDS Treatment Evaluation Unit. We're one of the 19 centers,' he said. "We mainly focus on antigen testing and culture testing. Of course, we do a lot of antibody testing for the Red Cross.

"I've noticed that those who extrapolate about the risk of getting false positives in the low-risk population make it sound a lot worse than it is,' he said.

Dr. Jackson's views about the accuracy of antibody testing seem consistent with those of FDA authorities whose interviews we published in the September '87 Post.

On page 60 of this issue is an expose on the gross inaccuracies of Pap smears. A false negative could result in death from cervical cancer. But no right-thinking medical professional would ever suggest doing away with Pap smears. Quite the contrary, they suggest being tested more often and by labs that can be trusted. False-positive tests can always be repeated.

Likewise, in AIDS, T cells can be checked to discover where the person stands on the continuum of normal to suppressed immune system all the way to severely suppressed immune system. Then, if one wanted further information, the virus could be cultured.

So false positives do not seem to be a valid argument against doing widespread voluntary testing. If there are 12,000 persons in the United States (as is estimated by the CDC) who have AIDS positive antibodies as a result of blood transfusions, shouldn't we accelerate testing until we find most of those 12,000 people? Even if it meant testing 1 or 2 million blood recipients, it would seem worthwhile. In California, the Irwin Memorial Blood Bank reported that at one point prior to the antibody-screening test, one out of every 100 units of blood was infected with the AIDS virus. We should identify the 12,000 persons who are now AIDS-antibody positive from blood transfusions. We prefer to call these people AIDS carriers, for it is almost impossible for anyone to test positive for AIDS antibodies (in a confirmatory Western blot after two positive ELISA tests) without having the virus in the blood to cause the antibody.

Some of the persons who had blood transfusions have already died from AIDS. But the remaining persons could be tested at a cost that would be nominal compared to the expense of having this group of AIDS carriers spreading the AIDS virus innocently.

The public should insist that enough funds be allocated to guarantee that private and public AIDS-testing laboratories be brought up to Minnesota standards so that extensive, voluntary testing can go forward.

Photo: The AIDS MOBILE got a warm welcome at the Teen Challenge homes in Harrisburg; Pittsburgh; Rehrersburg, Pennsylvania; and Wheeling, West Virginia. It was an inspiration to the counselor-phlebotomists to meet the rehabilitiated drug addicts. To date, the AIDS MOBILE program has tested 1,056 persons; 28 have been confirmed AIDS-antibody positive.

Photo: We love our AIDS patients in Indians, and Deborah Taylor is loving proof. Formerly AIDS coordinator for the Indiana State Board of Health, she now heads the AIDS MOBILE. Don Radford (left) and Jim Miller, both AIDS patients and gay, helped her compile ways to stay healthy longer--with AIDS (see next page).

Photo: This is Belle Glade, Florida, with the highest number of AIDS patients per capita in the country. Dr. Deanna James (left) struggles with an overload that will worsen when Dr. Rodney Young soon returns to his practice in Miami. We ask what churches there are in her community with the hope that denominations throughout the country might work with their sister churches in Belle Glade to help educate their drug addicts. The bottom line: Belle Glade men sell their bodies for cocaine and bring AIDS to their wives and girl friends, who bear tragic AIDS babies.
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Title Annotation:AIDS-mobile lab of the St. Paul Red Cross
Author:SerVaas, Cory
Publication:Saturday Evening Post
Date:Jan 1, 1988
Words:2074
Previous Article:Cleaning house.
Next Article:Why be tested for the AIDS antibody?
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