New H.I.V. Test Lets Officials Reach Out to the Street
By CAROL POGASH

SAN FRANCISCO, Dec. 15 - Once a week in the shadow of City Hall, a leaf blower blasts air into tubes, lifting up a big bright yellow tent. A line of the homeless, addicts, the mentally disabled and people who say they are "in transition" wait, seemingly oblivious to the cold.

They shout to one another good-naturedly. A passer-by might think that someone is offering a free trip to a climate where flamingos preen. In fact, the tent is part of a demonstration project by the Centers for Disease Control and Prevention that takes rapid H.I.V. testing to city streets.

The eight-month-old experiment is also under way in Boston; Chicago; Detroit; Kansas City, Mo.; Los Angeles; and Washington, where the tests are given in gay bars, teenagers' clinics, shelters for the homeless and drug-treatment centers and to sex workers. The goal is to carry new technology to persistent pockets of undiagnosed H.I.V. cases. The Centers for Disease Control estimates that of the 900,000 Americans with AIDS and H.I.V., one-fourth are unaware of their condition.

"Without knowing it, they may be transmitting the virus to others," Dr. Ronald O. Valdiserri, director of the agency's H.I.V.-AIDS prevention program, said in a recent teleconference. "Use of the rapid tests is key to the success of these efforts."

The test is the OraQuick Rapid HIV-1 Antibody test, a pinprick blood test. It shortens the wait for the results of a test from two weeks to 20 minutes. That can be the difference between learning the results and not finding out for many participants.

"This makes a huge difference to fragile, marginalized communities where people have disorganized lives," said Dr.. Sandra R. Hernández, the former director of the San Francisco Public Health Department who is chief executive of the San Francisco Foundation, which offers grants for community programs like this one.

Continuum, an AIDS organization in San Francisco, provides the tests and tent. The organizers have tried to make it less intimidating than a clinic or a van displaying a health department logo. Participants can snack on free food and watch an Eddie Murphy comedy on a television set.

"The tent is more approachable," the Continuum executive director, Mark Cloutier, said. "It's playful and carnival like."

Participants are offered $10 grocery vouchers, cups of instant soup, health bars, juice, toiletries, unlimited number of condoms and, for addicts, a needle-cleaning kit. And bottled water. For people on the streets, water may be as difficult to find as a bathroom.

Recently, two participants, Deborah Brooks and Terrence Davis, old friends, were giddy about their momentary good fortune. But there was a catch. They had to answer direct and often graphic questions about drugs and sexual practices.

In a traditional setting, they might have been asked, "Tell me why you're here?" in front of strangers with other medical needs, said Cicily Emerson, director of prevention services at Continuum.

Under the tent, Ms. Emerson said, where everyone is having the same test, a counselor in a private space can ask more intrusive questions, beginning with, "What brings you in to be tested today?" and moving to sex and drug histories.

In the 20-minute wait for his results, Mr. Davis conferred with a counselor. He had spent nearly half his life in prison for drug-related crimes and occasionally, he said, had been less than careful with sex partners. The counselor asked what he would do if the result was positive.

"It's scary," Mr. Davis conceded. "But it's not going to make me commit suicide."

Nationally, federal studies have found that 90 percent of people who learn that they are positive alter their risky behavior, lessening the chance of spreading the disease. Participants who test positive in the tent are funneled to health programs, making them more likely to behave responsibly, Mr. Cloutier said.

Women who are negative but have positive partners are offered more counseling. A $790,000 grant from the Centers for Disease Control to Continuum for two years also pays for $10 food vouchers for some participants for every friend they bring in.

A few participants grasped their possessions in droopy plastic bags. Others wheeled suitcases behind them. Even though the city has confiscated park benches from the area and installed sharp-edged iron fences to keep the homeless and transients off the statues, the plaza near City Hall remains their territory, which is why the yellow tent goes up in the same place every Tuesday.

For decades, the largest number of people with AIDS here lived in the Castro, an upscale gay neighborhood with gingerbread Victorian houses. More recently, the most densely populated section for H.I.V. and AIDS has shifted to the Tenderloin, a mixed area with immigrant families, transients, users of intravenous drugs and the homeless. On Thursdays, the yellow tent is there.

Of the 650 people tested at the two sites, 40 have been found H.I.V. positive. Twenty of those had previously been tested, according to city records. That has raised the question of whether the experiment is concentrating on the neediest areas.

Officials are considering moving the tent to Bayview, a predominantly African-American area, and under a freeway, where the most alienated homeless people congregate.

For now, the City Hall site remains. After his counseling session, Mr. Davis was told his test was negative. He sighed and smiled.

Ms. Brooks, who said she injects amphetamines and whose lover is a female sex worker, learned that she, too, was negative.

"The counseling must be working," she said, "because I'm listening."

Ms. Brooks scooped up hygiene packets and dashed into the street, taking her $10 voucher to buy vodka.