Shelly Repp said she almost quit her job in home health care when she found out she would be working with patients suffering from HIV and AIDS.
“I was scared to death,” she said. “I thought of walking off the job.”
At the time, Repp’s misgivings were understandable. It was 1995 and mortality rates were soaring, with AIDS deaths in the United States topping 270,870.
“At that time, it was a death sentence,” Repp said. “The best we could do was try to make them comfortable.”
Repp didn’t quit, in large part because of her first patient.
“The first patient I worked with was very gracious,” she said. “He made me feel comfortable enough to ask questions and to talk about issues that were difficult for people to discuss back then.”
Thirteen years later, Repp now works as the Region 7 program manager for the Texas Department of State Health Services HIV and Sexually Transmitted Disease department, working on a near-daily basis with those with HIV and other sexually transmitted diseases. Region 7 covers a 30-county area in Central Texas.
While no longer considered a “death sentence” thanks to research developments and medications, HIV is still a serious issue, especially in Region 7, which includes Bell County.
According to reports from the department, the HIV rate in Bell County increased from 9.9 cases per 100,000 people in 2004 to 13.8 per 100,000 in 2011. Repp said the rates are high.
“When you compare them to Harris and Travis (counties), the rates are closer to these more populated counties,” she said.
The upward trend in infection rates is similar to the state as a whole. According to the department’s data, the number of Texans living with HIV increased 34 percent between 2005 and 2011.
Repp said Bell County and Region 7’s location in the center of the state means travelers pass through on their way to other destinations. It’s also close to heavily populated counties like Travis and home to Fort Hood, which keeps its own HIV and STD data.
All of these traits increase the possibility of people infecting or contracting HIV or STDs without being recorded as part of the area’s data.
While the department’s reports contain numerous amounts of data on HIV rates, Repp and other program managers work hands-on with the people those numbers represent.
Texas law mandates the reporting of HIV/AIDS and STDs by health care providers and laboratories. Once a case is reported, Repp and her coworkers are tasked with contacting the infected person. Most often, they notify the patient, collect information and attempt to contact and offer testing to sexual partners of anyone else who may be at risk.
Finding those who test positive isn’t always easy. Repp and other HIV/STD investigators usually have little information to go on once they are notified that someone tested positive.
“Many people don’t always use their real names,” Repp said. “Sometimes all we have to go on is maybe a nickname, or a make and model of their car, or what neighborhood they live in.”
Those are only the cases that get reported. Repp estimated the department receives accounts for about 60 percent of total cases. “That’s 40 percent that we don’t know about.”
One of the ways to help complete that data is simply to get more people tested, which is easier said than done. “We try to get doctors to test their patients annually, but there is still a stigma attached to getting tested,” she said. “It should be a routine part of health care, but does make some doctors uncomfortable to ask their patients.”
Take a test
Like Repp, Annette Grantham deals with the people that make up Bell County’s HIV statistics.
A licensed vocational nurse, Grantham works at the Bell County Public Health District’s clinic on Second Street near downtown Killeen. The clinic offers low cost, walk-in testing for HIV and other sexually transmitted diseases.
“Most people in this area don’t have health care,” she said. “If they think they need to be tested, they come to us.”
The HIV test is simple. After filling out and signing a few forms, clinic nurses draw blood, which is then sent for testing.
“It takes about a week to two weeks to get the results back,” Grantham said.
Bonnie Scurzi, executive director for the Bell County Public Health District, said clinics like the ones in Killeen, Temple and Belton test about 1,000 people each year.
“We also offer counseling on how to reduce the risk for contacting HIV and STDs,” she said. “In the end, it is up to you to come in and get tested if they think they are at risk.”
Still no cure
In 1995, the same year Repp began working with HIV/AIDS patients, the Food and Drug Administration approved “the drug cocktail,” a combination of medication to help treat HIV.
That breakthrough was a watershed for the fight against HIV and AIDS, but also can be a double-edged sword. Repp pointed out that the drugs are treatment, and not a “cure.”
“Yes, the medication is going to keep you alive, but it’s not going to cure you,” she said. “If you have HIV, you’ve just signed on to take that medication for the rest of your life.”
Repp said she hopes more open dialogue about the issue will encourage more people to get tested.
“If you say ‘HIV’ at a dinner table with friends or family, they are going to be uncomfortable,” she said. “We need to be more comfortable talking about it.”