Fighting a pandemic during a second pandemic

Earlier this year, Sarah was experiencing symptoms that she thought might be related to HIV. With the COVID-19 crisis still raging across the country, she wasn’t sure if she could get tested.

But a quick Google search revealed that the local Lansing Area AIDS Network was running contactless HIV testing through a drive-up service off Holmes Road. Sarah figured they would be closed, but online appointments were — and are still — being scheduled for secure testing.

The contactless drive-thru testing option was the brainchild of Nhoua Yang, prevention manager for LAAN. While on a conference call with other HIV prevention leaders from across the country, Yang said she heard another agency’s experience with drive-thru testing. Then she called the state Department of Health and Human Services, which provides most of LAAN’s budget.

“They were really excited,” Yang said. “We were the one of the first to start offering the option.”

In the pre-coronavirus era, testing required a small amount of blood, collected from a finger prick. That also required close quarters with clients, and included a discussion about risk behaviors and prevention options that are uniquely crafted for each individual client.

Now, clients register for appointments online. The usual counseling session is then conducted via secure communications in advance of the testing. Only then do they come to the agency’s offices on Holmes Road, though Sarah — who requested her full name not be disclosed — said the counseling sessions aren’t as “intimate.”

“It just didn’t feel the same,” she added. “I was originally worried that people would be less honest during a phone or video counseling session. But that hasn’t been the case, at all. In fact, people are very open. I think they are happy just to be having conversations with someone.”

Sarah’s counseling session was a few days before her test. The earlier meeting helped alleviate many of her fears and made the process less stressful, she said.

On the day of her appointment, Yang exited the building “dressed very professionally” and wearing a mask. Sarah said she dragged a cart with testing supplies with her. Yang poked Sarah’s finger, took a little bit of blood and put it into the test. Then, a 20-minute wait.

“Then she texted me that my results were ready. She came out and she gave me my results.”

Sarah’s test was negative, she said. But the drive-thru testing is just one example of how staff and agency volunteers are keeping up the fight against HIV in the midst of another pandemic.

It requires what care program manager Ligia Romero called “out of the box” thinking.

“It really pushed us in new ways,” she explained.

Staff still can’t provide many human elements of their job — touch, smiles, being physically present. Those things may seem small, but those living with HIV often struggle with a sense of isolation and lack of human connections as a result of stigma related to the infection.

“We weren’t having clients come in,” Romero said. “We were making calls. That’s just not LAAN. It threw us for a loop. Face to face allowed us to discern how our clients were actually doing. They could tell us they were fine over text or by phone, but when they were there in person, we could see they weren’t fine.”

With the economy mostly shut down, and many of those clients in low-wage service industry jobs, the need for the agency’s small food bank also increased dramatically.

For years, the agency had hosted a biweekly pantry for its clients. That, in turn, became an opportunity for clients to stop, catch up with one another and have a cup of coffee in the agency’s conference room. That — obviously — would not work in the midst of COVID-19.

LAAN staff and volunteers made the decision to begin dropping off food to clients. They also developed limited curbside pick up, but because of COVID, the staff was still unable to make those face-to-face connections.

“We had to call people and tell them we were coming to deliver the food,” she said. “But it also meant telling them that they couldn’t come out to see us. That we couldn’t see them.”

And Yang didn’t stop with creating testing protocols for those with access to a car. She also worked with the Lansing Syringe Access, a private group that distributes sterile needles to people who inject drugs, to identify people in need of testing — anyway to expand outreach.

“We know that people in that risk group are less likely to seek testing,” she said. “So we started providing a limited number of at-home test kits to be distributed by the LSA. They would pass out condoms, COVID information, syringes, Narcan and the test kits.”

Activists and health officials have been ambivalent about home testing kits, pointing to the psychological impact of a positive test result. Studies have reported that up to 65% of newly diagnosed persons will be diagnosed with post traumatic stress disorder within six months of their positive diagnosis. The test result has been identified as the trigger for the trauma.

“We put out cards with those tests,” Yang said. “We know that this group of people is less likely to connect with us, so if this gives them that opportunity, I’ll take it. They are encouraged to call us during the testing process. And they have been.”

She also noted that some people cannot participate in the drive-thru testing as a result of myriad barriers. Some are in abusive relationships, secretive about their sex lives or simply do not want others to know about their risk. Others simply don’t have transportation to the office. After searching for other options, Yang will release at-home testing kits to those clients as well.