His soft demeanor, tall stature and caring voice lend themselves to his cause. He sits back in a chair in his small office in Washington County and talks about why he has seen a resurgence of the incurable disease in this area and around the country, and what role he plays in trying to stop the spread.
As the Disease Intervention Specialist — a name that was changed from investigator — his job begins when a person is diagnosed. The disease is one among several that are considered reportable in the U.S., which means if a doctor diagnoses it in Northwest Arkansas, John must be informed. Once he is notified, the investigation begins. He talks with the person, their family, friends, sex partners and neighbors, all while respecting his obligation to confidentiality, but doing what’s necessary to get the answers he needs.
His title says it all. To intervene in the spread of HIV/AIDS he must find the origin — the person who initially spread the disease — and then anyone who also may have been exposed.
“My job is enormous. I have a filing cabinet with about four drawers of HIV cases in it. I just closed a case with a guy that found out he was HIV- positive and got 23 contacts off of him. So, that’s 23 people I need to go out and advise, test and then if they’ve tested positive, I’ll pick up their contacts,” John explained.
He advises them about the characteristics and dangers of the disease, their right to receive treatment from funds provided by the government, resources for mental and physical health, and their legal obligation to notify individuals they are HIV positive before having sexual contact. Their obligation to notify is one of the most important parts of future intervention, but unfortunately, the law often goes ignored.
“I’ve been doing this for 23 years, and we thought back 23 years ago that HIV would come on strong for 10 or 15 years and then start dropping off. It would have most likely, except that the Internet showed up. And now all of a sudden you have a place for people to go to meet anonymous sex partners,” he said.
And what’s wrong with that? Anonymity means finding the origin can be nearly impossible.
“If I have HIV and I know that I am supposed to tell you I do: How about I meet you at Mount Magazine and I don’t have to tell you because you can’t find me when I go back home. That’s the easiest way for someone with HIV to find a sexual contact and not be responsible for advising them they have HIV. They have found a loophole by remaining anonymous,” he said.
Eighty-one percent of those diagnosed with AIDS in Arkansas are male, and 55.7 percent of cumulative cases in Arkansas in 2010 were from male-to-male contact, according to the Centers for Disease Control and Prevention. This is who John sees as most at risk for this anonymous practice. He said it’s part of the lifestyle of many homosexual men living in secrecy and isolation about their sexuality.
Most of these men, he said, aren’t doing it to be malicious, but when told their sex life may be over, they can’t accept their fate and reach out to unknowing sex partners.
These HIV/AIDS positive partners aren’t just found on the Internet though, explains Michael Burks, president of HIV Arkansas — an organization that provides support groups, advocacy and social events for people living with HIV/AIDS. He contracted HIV from a relationship with a man he thought he could trust — someone he met in this area.
“I was one of those people that was not informed from my sexual partner that he was positive. He knew he was but he did not tell me, and when I found out from a third party I confronted him. When I asked him why he didn’t tell me, he said, ‘You didn’t ask the right questions.’”
Burks said he didn’t ask, so his next reaction was guilt and embarrassment for the role he played in contracting HIV. But what he realized, and what the law supports, is that it is the obligation of the sexual partner who has the virus.
That’s one of John’s responsibilities as an interventionist: to get a signed statement saying the infected patient understands their obligations.
“The way it works is if somebody comes in here and reports contact to a person who is HIV-positive and advises me that person did not tell them, I go out and find that person and I have them sign a second statement that says ‘You’re going to tell your partners you have HIV.’ If it happens again, then I send the information to the prosecutor and they may choose to charge you,” John explained.
But more than likely it will take yet another individual saying they were exposed by this person before the case will be brought to trial. And, even then, most cases are not because of the stigma still attached to the disease.
Burks said he knew prosecuting his ex-partner was an option, but like many individuals, he couldn’t go through with it.
“I didn’t want to take my name through the news in that arena, and I didn’t want to take my family through the news in that arena,” he said. “I did not want to go there.”
In Arkansas, only 10 people have been convicted of the crime of exposing another human to HIV since 2008, with seven of those cases being in 2009, according to the Arkansas Crime Information Center.
One Washington County HIV Clinic physician advised Burks of the most effective way to protect individuals from unknowingly contracting HIV/AIDS, which is to provide adequate accessibility to medication that can minimize the disease in the bloodstream to almost undetectable levels.
But in Arkansas, and many states, federal funding for drug assistance programs is limited and becoming more so. And Arkansas is one of only a few states that does not provide additional state funding for the programs. From 2010 to 2011, the number of individuals receiving medication treatments from the AIDS Drug Assistance Program went down 30 percent, while cases steadily increased.
“What we’re seeing in Arkansas and other southern states is we’re at the epicenter of the epidemic. We have the most cases and the least amount of funding,” Burks explained.
The Center for Disease Control reports that in Arkansas during 2009, there were 4,562 cumulative AIDS cases, with 243 HIV diagnosis in 2010. Yet,
70 percent of Arkansans living with HIV/AIDS do not receive regular medical care, Burks explained.
John deals with a small portion of these cases, and after his initial investigation, John no longer sees many patients because he must move to the next file on his desk. He also believes his workload won’t decrease in size any time soon.
“I don’t see how it can be fixed — let’s face it, sex is an important part of many people’s lives,” John said. “If you tell a skydiver he shouldn’t jump out of a plane because his parachute might fail, will he stop? No, it’s part of the thrill!”
The only thing John said he can do is diligently investigate each case he is handed in order to intervene in the spread of this still-prevalent disease.
Second Annual HIV Awareness Walk
Saturday, Sept. 8
The Jones Center for Families
(922 East Emma Ave.)
For details and registration forms please visit hivarkansas.org. The walk will benefit HIV Arkansas and The Northwest Arkansas Regional HIV Clinic.