Program Reaches Out With HIV Message

Orange County health officials are planning to dramatically expand their participation in a trial program in AIDS prevention that uses telephone calling cards to bring safe-sex messages to people at high risk for contracting HIV.

The novel, state-funded program provides free calling cards with 10 minutes of long-distance time that can be accessed only by listening to a 15-second AIDS prevention message. Health officials and AIDS counselors say the calling card reaches people who would otherwise have little exposure to those warnings, including the homeless, intravenous drug users and adolescents trading sex for money or drugs.

“We approach them on the street and most of them don’t want to give us the time of day,” said Paul Diedrich, an AIDS counselor who worked for the Orange County Health Care Agency as an outreach worker. “[As] a reward for listening to us, they get the phone card.”

The expansion in Orange County is possible because the state Department of Health Services is nearly tripling statewide the number of cards it is offering to counties and health agencies. In addition to increasing the number of cards for English speakers from 50,000 to more than 100,000, the state will also, for the first time, provide 26,000 Spanish-language cards targeting at-risk Latinos.

Agencies in Orange County are at least doubling the number of cards they are seeking, while in Los Angeles County agencies are seeking more than 20 times as many cards, having largely missed out on the program when it was in its demonstration phase last year, said Drew Johnson of the state Office of AIDS.

Health officials call the program an innovative and cost-effective strategy.

The cost effectiveness is demonstrated by a simple comparison, officials say: Running the calling card prevention program for the next year will cost $130,000--less than the full-term cost of treating a single case of AIDS, estimated at more than $150,000. California had 5,500 new cases of AIDS in 1997, and about half of all AIDS patients rely on Medi-Cal for their health insurance, officials said.

About 107,000 calls were made on the 50,000 cards distributed last year, of which 97% were used, program officials said.

“It will more than pay for itself if one person is saved from contracting HIV,” said Johnson of the state AIDS office.

The colorful credit-card-size plastic cards carry the printed message “Respect Yourself, Protect Yourself.” Card users hear a 15-second message that promotes safe sex and urges callers to get tested and to call a statewide AIDS hotline, (800) 367-AIDS.

Where last year all of the cards were targeted at a general high-risk audience, this year there are three additional targets each with its own card and phone message: gay men, as well as Latinos and African Americans, with special attention to women in these latter two groups whose partners have sex with men.

Whether the card’s message is getting across is harder to gauge. State, private and local health officials admit they have no data to prove the success of the calling-card program; because the hotline--run by the San Francisco AIDS Foundation--is widely advertised, officials cannot easily tell which callers were referred by the calling cards.

The foundation provides AIDS information and referrals to local agencies that provide counseling and anonymous HIV testing.

The foundation receives about 120,000 calls a year, with about 5% of the callers “too antsy” to identify where they heard of the hotline, spokesman Gustavo Suarez said.

But in the nether world of outreach to addicts, prostitutes, adolescents and young adults, health officials will try anything to make a connection. Case workers relate numerous stories about the cards’ effectiveness as lure and incentive.

Joint Effort, a counseling, youth service and drug education agency in San Pedro, distributed 750 cards last year to adolescents and young adults and will seek 1,500 this year, program director Maria Marquez said.

The agency has used cards as incentives for completing “behavior-changing” and other programs and found them “very popular,” she said.

In Orange County, outreach workers typically hand out the cards instead of brochures because many in the target population save them.

“It is something people will stick in their back pocket and keep,” Johnson said. “If you give it to a sex worker [prostitute], one day the woman will be in a position to take action and she will have the card. The windows of opportunity are small, but they do arise.”

The Orange County agency, which gave away 3,000 cards last year, has applied for 6,000 this year, said Mary Walsh of the Health Care Agency. County outreach workers use the cards as a lure to persuade high-risk individuals to get tested for HIV.

In Orange and other counties around the state, such workers typically carry equipment to draw blood with them in a backpack. They tell those tested they will get another card when they go to a counseling center to get their results and further counseling, Diedrich said.