Getting to Zero: Making HIV Screening a Routine Part of Health Care

HIV is a serious public health issue that affects us nationally and at the local level. It is estimated that, in the U.S. today, more than 1.1 million people are living with HIV—and 1 in 7 of them do not even know it. The City of Alexandria has the highest prevalence of HIV infection in Northern Virginia and the 5th highest in the state: 755 per 100,000 people, compared to the statewide rate of 291 per 100,000.

Alexandria Health Department, in conjunction with Neighborhood Health, a multi-site community health center, is taking critical steps to combat this growing issue. With the help of a $540,000 federal grant, we have developed a City-wide HIV initiative: “Getting to Zero” with the aim of achieving Zero HIV Deaths. Zero New Infections. Zero Stigma.

Alexandria’s biggest challenges: Stigma and lack of information. The stigma associated with HIV and HIV testing keeps far too many people from learning their HIV status.

Our “Getting to Zero” solution: Implement universal HIV screening in Alexandria and neighboring communities. The U.S. Centers for Disease Control and Prevention (CDC) recommends that every person ages 13 to 64 be tested for HIV as part of routine health care. People with certain risk factors should get tested annually. Screening offers to identify people living with HIV and get them into treatment.  Early treatment will not only help the person being treated but also greatly reduces the risk of transmission through sex. Further, knowing one’s HIV status often motivates individuals to engage in more responsible behavior.

Most doctors today do not routinely offer HIV testing.  And most patients do not ask for it—either because it does not occur to them or they are embarrassed or afraid to get tested.  We aim to make HIV testing as routine as getting a cholesterol test in the City of Alexandria. We see this approach as one way to eliminate stigma and improve HIV status awareness.

Launching Universal HIV Screening in Alexandria

Universal HIV testing is the key to “Getting to Zero.” In the same way, the partnership between the Health Department and Neighborhood Health is key to universal HIV screening across Alexandria.

Our organizations have a longstanding relationship. In fact, Neighborhood Health evolved from a small neighborhood clinic that the Health Department started over 20 years ago. Today, Neighborhood Health is a Federally Qualified Health Center with clinics in Alexandria, Arlington, and Fairfax County.  Our two organizations often develop joint programs, and even share office space. With this new federal grant, we jointly aim to screen 9,000 people in just over a year.  This is a huge undertaking but, working together, we know we can make this goal a reality.

The Health Department brings both community outreach and epidemiological expertise to the table. Grant-funded outreach workers will work with high-risk communities, educating residents and encouraging them to get tested. The Health Department will also provide education and counseling to community residents on two Saturdays every month at the Neighborhood Health clinic at 6677 Richmond Highway in Fairfax.  In addition, the Health Department will conduct outreach with private physician practices in Alexandria and recommend that physicians screen all patients for HIV. We will also offer continuing medical education credits to incentivize physicians to participate in this initiative.

Finally, and most importantly, this initiative strives to build relationships with and support those who learn they are HIV-positive. After each positive result, a Health Department nurse will meet with the person to provide counseling, answer questions, and identify others who may be at risk through contact (so that these additional persons may be contacted and advised to get tested). We know that these are sensitive conversations that require a great deal of trust and discretion: we may be asking about whom someone has shared needles with, or whom they’ve had sex with. This grant will help fund the essential staff needed for this essential work.

Neighborhood Health provides the critical resources to treat people who test positive for HIV. Currently serving more than 18,000 patients, Neighborhood Health also receives federal Ryan-White funding to provide care to people living with HIV. Neighborhood Health has the resources to provide people living with HIV a medical home that meets all their everyday health care needs. Neighborhood Health’s leadership long ago envisioned implementing universal HIV testing. With funding from this new grant and the Health Department’s help, Neighborhood Health is turning that vision into a reality.

Everyone should know: you do not have to be a current patient to get tested for HIV through this initiative. More information is available at www.alexandriava.gov/health.

Building Trust, Ending Stigma

Our organizations aim to meet people where they are—not where we want them to be—without judgment, so that we can provide them with the information they need and convince them to act on it.

Our project is fundamentally aimed at driving behavior change. Together, our organizations want to shift perceptions around HIV screening in physicians and patients, so it becomes a standard part of health care. To do so, we meet people where they are, with compassion and empathy. This is the surest and most sustainable way to change perceptions and behaviors in a community.

Today, HIV is essentially a chronic disease: people can live long, healthy lives if they are in treatment and taking care of themselves. We know that approximately 1,200 Alexandria residents have tested positive for HIV. In one year of universal screening, we estimate that we will diagnose up to 90 new patients. For us, this is the first step in “Getting to Zero.”