For many sexually active teens, one drop of blood can tell the future.
In 10 minutes, a rapid test can tell if a teen has human immunodeficiency virus, or HIV, a disease that attacks the immune system and can lead to AIDS. Being HIV positive changes more than just your sex life, and for teenagers, a positive diagnosis comes at the most tumultuous period in their lives.
Promote to Protect is the only program in Miami-Dade that focuses on finding, testing and linking HIV-positive teens and young adults to medical care. P2P offers free, anonymous and confidential HIV testing, STD screening and treatments to anyone age 13 to 24. The program, at the Mailman Center for Child Development, is part of UHealth — the University of Miami Health System.
Miami is the epicenter of HIV infection in the U.S. In a 2014 report by the Center for Disease Control, the Miami area ranked first in prevalence of HIV infection. It leads Miami-Dade County leads the state in HIV transmissions, followed closely by Broward County. From there the numbers drop drastically. Although teens are not the dominant age group for HIV infection, they are part of the 26,000 people living in Miami-Dade with HIV.
P2P’s newest outreach method is a short film about two girls with HIV. Teen girls training as HIV-peer counselors wrote the script. UM film students comprised the crew; Alex Moreno and David Frankel, who directed The Devil Wears Prada and Marley & Me, produced the film.
Moreno said peer counselors can use the film as an icebreaker in their educational speeches. This kind of education is pivotal, he said, after Florida eliminated the mandatory health education credit in high schools.
P2P tries to fill the gap by visiting health fairs, football games and clubs across Miami-Dade in its mobile clinic van. Every teen who visits the clinic walks out with condoms and pamphlets. One in five teens also leave with the knowledge they have a sexually transmitted disease (STD) or HIV.
P2P uses a rapid test for HIV. In 10 minutes, one dew drop of blood can determine if there are HIV antibodies in your system. One bar means you’re safe. Two means you’re reactive.
This doesn’t automatically equate to a positive HIV diagnosis — that requires a full lab test that takes three to four days — but Moreno said the quick test is “99.9 percent accurate.”
Once someone finds out they’re HIV positive, they have to sign a waiver acknowledging the results. From this point on, the HIV-positive person can’t donate blood, semen or body tissue. It’s recommended that anyone HIV positive have sex with condoms — and a felony for someone with HIV to have sex without first informing their partner.
No one but the person tested is required to be informed of the test results, based on privacy laws.
After a positive test result, Grechen Mills steps in. Mills runs SMILE (Strategic Multi-site Initiative for the Identification, Linkage, and Engagement in Care). She arrives with emotional support, by way of a therapist, and financial support to link HIV-infected teens to the government forms and funding for their care.
Most of the time that’s through the Ryan White HIV/AIDS program, named after a 13-year-old Indiana boy diagnosed with AIDS in the ‘90s who fought discrimination after he was expelled from school because of his infection. Ryan, a hemophiliac, had contracted HIV from a contaminated blood treatment. The program helps more than half a million people every year.
“The healthcare system is hard to navigate,” Moreno said. “These kids are pretty much on their own.”
Mills also helps patients locate and inform their sexual partners. “We work like the FBI here,” she said. She recalled one 19-year-old patient who brought in a 79-year-old partner for testing.
“He was telling me about his experiences in the Korean War,” Mills said.
Partner testing can be tricky. From the time of exposure it can take three months for the body to build up a noticeable level of HIV antibodies.
Mills asks newly diagnosed patients about their support system and who they plan on talking to about their diagnosis. Most of the time her clients don’t want to tell their parents, and she does everything she can to help them.
For Ryan White care, the program used to require a notarized head of household signature before care could be administered, but Mills got the rule changed to protect their privacy. Less than a year after that change, she saw a 25 percent jump in clients using Ryan White care.
“We have kids here that entered the program when they were 15. Now they’re about to age out and their parents still don’t know they have HIV,” said Peggy Renaud, a UM caseworker with P2P.
P2P receives funding from the federal government and is supported by UM and the state health department. It is one of more than 20 testing sites in Miami-Dade. Legally, the program is required to report the number of HIV positive cases it encounters.
From January 1997 to December 2014, more than 15,000 cases of HIV were reported in Miami-Dade. In 2014, 1,400 cases were reported.
Keeping an eye out for diagnosed teens can be disheartening and difficult work.
“They don’t have parents, they don’t have caregivers,” Moreno said. “Or they do and they want to do it on their own.”
Renaud hosts group sessions twice a month for HIV-positive kids. She feeds them, gives them bus passes and gift cards to grocery stores to buy food or barter with their hosts for room and board.
“They feel comfortable enough to hug all of us,” she said. “If we could give them our arms we would.”
“We’re pretty much all they have,” Mills added. ‘We’re their family.”