March 2010

Every time there’s a new issue
public health has to reinvent itself.

then...

In the early years of HIV/AIDS, fear and stigma were barriers to communicating with those most at risk.

now...

"We go where individuals and risk are. We have worked hard to establish good reputations within the communities who can most benefit from our services."

"Our most recent campaign targeted men who have sex with other men. The goal of the campaign was to encourage these men to get tested for HIV and to test more frequently. Noteworthy outcomes included high campaign exposure rates, positive response rates, and changes in HIV testing frequency intentions."

Robert Marks, Disease Intervention Specialist Supervisor, Public Health - Seattle & King County, discusses changes in public health strategies related to STD and HIV.

What is your focus as a public health practitioner?

Currently I work at the STD Clinic at Harborview Hospital where I supervise HIV testing and STD/HIV disease investigation efforts.

How did you find this career focus?

Before coming to public health, I was in retail with a degree in business management. While in this line of work, I got a taste for training individuals and being part of their development. I went back to school to get trained in adult education. My plan was to break into Human Resources, but it was difficult. I began interviewing for everything. I interviewed for Planned Parenthood as a disease investigation specialist and got hired there. After Planned Parenthood downsized, I came over to Public Health - Seattle & King County.

How has the public response to STDs changed over the last 15 years and how has that affected your work?

With the introduction of HIV medication, there has been a lot less fear and stigma regarding HIV, particularly in metropolitan areas. There are upsides and downsides of the medications. Medication is good in that it is helping folks live longer. We are able to help folks get good care. But it is hard in that there is more risk-taking. People have moved out of "crisis mode" and now place less importance on condom use and safety.

There are also budget challenges. HIV treatment, testing, and prevention have traditionally been rather well funded. HIV is being viewed more as a STD along with all the others, its significance has changed and it now competes with other health issues for limited funds potentially affecting our ability to effectively respond to HIV.

Funding may impact availability of HIV medication. It is expensive to get everyone who needs treatment on medication. As we identify more infections, the people with these infections will need to get into care. The good news is that funding appears to be solid for now.

Treatment is a care issue and a prevention issue. If we assist folks get onto treatment and get viral loads down in individuals, they are less infectious and we can potentially stop or slow the spread of HIV within populations.

What are two or three of the most significant changes you have witnessed in the past 15 years in how public health addresses sexually transmitted disease?

HIV medication has improved health. HIV is now a chronic disease for many instead of a terminal one.

Also, we are leaders in the nation with expedited partner therapy. This program gets partners of those diagnosed with gonorrhea and chlamydia infections treated. The person who has been identified as infected can either get medication from a provider for his or her partner, or the prescription can be called into a pharmacy. Partners can get treated without having to have an exam first which breaks down barriers to care and impacts the spread of disease.

Finally, approaches to dealing with drug use and views of drug use are changing. Harm reduction has become much more the focus. Drug use is seen more and more as a medical issue as opposed to a moral issue. We also look at drug treatment as an HIV prevention strategy. Getting folks into treatment helps them live more healthily and make safer choices.

Is your department involved in campaigns?

We are involved in lots of campaigns. We also work with community-based organizations, either by helping with funding or assisting in development.

Our most recent campaign targeted men who have sex with other men. The goal of the campaign was to encourage these men to get HIV tested and to test more frequently. Noteworthy outcomes included:

• 75% of respondents reporting exposure to the campaign,
• 80% of those exposed as having a very positive or positive response to the campaign,
• 38% of those exposed saying that they would test more frequently due to the campaign, and
• 46% of those exposed saying that the campaign affected their thoughts about HIV testing.

In the past, public health viewed itself as being effective when it was going about its business quietly. We are now creating ways to promote ourselves and to help people understand what we do. We have worked hard to establish good reputations within communities who need and can most benefit from our services.

How do you gain the trust of the people you are trying to serve?

We work with community-based organizations and try to work with the folks who know communities best. We help develop skills, provide funding and offer technical assistance to reach at-risk populations. We also provide direct service. For example, we provide testing in bath houses and provide testing for men who have sex with men in other high risk venues. We go where individuals and risk are.

Any other comments?

The Internet has had a big impact on sexual expression among the populations we want to reach. It is easier to hook up and meet intimate partners on the Internet. For certain populations, this makes sex much more available and increases opportunities for risk taking and disease transmission. It has been interesting trying to work with that. Via websites and email, we have been contacting individuals who have been exposed to disease and encouraging them to come in for testing and treatment.

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