Easing the Shock of a Grim Diagnosis

Teresa Martinez-Ponce got the news from her boss: A woman had delivered an HIV-positive baby at Ventura County Medical Center and then disappeared, leaving the boy to be put up for adoption.

The name and address the woman had given were false.

Martinez-Ponce, an outreach worker with the county’s Public Health Department, was assigned to the case. Her mission: Find the woman and make sure she was being treated for AIDS.

As one of nine caseworkers, Martinez-Ponce is on the front lines in the county’s daily battle against the HIV virus and the spread of AIDS.

In 2002, she was chosen to run the state’s Bridge Program for Ventura County, which targets those who are newly diagnosed. Many of them speak only Spanish; often their families have no idea they are ill.

So it falls to Martinez-Ponce and her colleagues to get them into treatment -- as confidentially as possible, and as gently and quickly as she can.

“Quite often, people will get a medical diagnosis and go into a funk,” said Diana Goulet, coordinator of the county’s HIV/AIDS services. “They don’t get treatment for days, weeks, even months.”

The state-funded Bridge Program is coordinated by the Early Intervention Section of the state Office of AIDS, along with the Centers for Disease Control in Atlanta. It comes as a result of a policy shift by the CDC that places more emphasis on treating those with the disease than on general prevention programs.

“The epidemic is 20 years old now,” Goulet said. “Initially, we tried to educate the public on how to keep themselves safe. That hasn’t worked as well as we’d have liked. The CDC in Atlanta has made a major policy shift to focus on treatment” for those who test positive.

Through 2003, 925 Ventura County residents had been diagnosed with AIDS, said Lynn Bartosh, head of HIV/AIDS surveillance for the health department. Of those, 535 have died.

Because the state did not require doctors to report cases of HIV until July 2002, the county doesn’t have exact numbers for those whose illness hasn’t progressed to AIDS. But the county does know that 145 cases of HIV and/or AIDS were reported last year, Bartosh said.

Goulet said the number of Latinos with AIDS remained steady for years at about 33%. But it began to climb in 2003, Goulet said, as did the number of women infected with the virus.

It’s too early to speculate on reasons for the increase among Latinos, Goulet said. However, “It points out the need for increased outreach and intervention efforts.”

Those diagnosed with HIV or AIDS were primarily male. Historically, the breakdown has been 90% male and 10% female, Bartosh said, although the number of women has been rising.

Men still contract the disease primarily through sex with other men, Bartosh said, while women get it through heterosexual activity or intravenous drug use.

But all the statistics are just numbers, Goulet said.

“What’s more important,” she said, “is that the people who are infected get treatment to reduce the possibility that they will transmit the virus to someone else.”

That’s where Martinez-Ponce comes in.

The 33-year-old mother of two was born in Simi Valley and grew up in Moorpark and Camarillo before settling in Oxnard.

She is well-suited for the early intervention job, Goulet said.

“Teresa is a lifelong Ventura County resident, fluently bilingual and, even more important, fluently bicultural,” she said.

That can come in handy when working with older Latinos.

“I’m sure it’s the same in other cultures,” Martinez-Ponce said, “but if you’re a Mexican lady, nosy friends want to know, ‘Why are you so thin? what’s wrong?’ ”

Martinez-Ponce began working for the county 6 1/2years ago, first as a case aide, then as a case manager and now as coordinator of the Bridge Program.

Soft-spoken but direct and matter-of-fact, she said “there’s this little wall you have to build around you.”

But one case still brings her to tears, five years later.

The patient was 32, very poor, married with children. He had learned he had AIDS in March, and Martinez-Ponce met him in September. He died a month later, hours after she had helped get him into an AIDS hospice. The entire family was still in shock about his disease when he died, she said.

“Some people get to go to where they want to go [emotionally] before they die,” she said. “Some never do.”

In her Bridge job, Martinez-Ponce is often at the doctor’s office when the HIV or AIDS diagnosis is delivered. The doctor will then ask the patient if he or she wants to speak to Martinez-Ponce.

If the answer is yes, Martinez-Ponce explains what help is available from the public health department, through which about 80% of the county’s HIV and AIDS patients are treated.

“I’ll let them know about what we offer, the crisis team, try to make an appointment [with county doctors] right on the spot,” she said.

She also attempts to line up a second meeting with the patient, who may still be in shock over the news.

Since she knows that many patients won’t tell their families about the disease right away, she offers to go wherever they’d like to talk.

“I might meet them in the library, a park, wherever they’re comfortable,” Martinez-Ponce said.

Sometimes Martinez-Ponce must become a private investigator to find her patient. In the case of the new mother, the obvious lead didn’t pan out, since the ambulance that delivered her to the hospital had not picked her up at her house but on the street where she had collapsed.

Martinez-Ponce finally tracked the woman down through a taxi voucher.

Today, both the woman and the baby are in treatment and doing well.

Many of Martinez-Ponce’s clients are Spanish-speaking, she said, and live in a conservative culture.

“One lady is constantly thinking what’s going to be on the death certificate,” she said. “She doesn’t want to shame her family.”

One of Martinez-Ponce’s success stories is Ricardo, 34, who moved from Mexico’s Michoacan state first to Seattle and then, about six months ago, to Oxnard.

He appreciates Martinez-Ponce and her efforts.

“She pays attention to what’s needed,” he said in Spanish, adding that Martinez-Ponce has come up with financial assistance, food or clothing when needed.

That assistance has allowed him to keep a job and pay for an apartment, said Ricardo, who did not want his last name used.

Ricardo, who is HIV-positive but has not developed AIDS, takes credit for getting himself treatment. But he knows that Martinez-Ponce and the county have helped him stay relatively healthy.

“I don’t want death to come because I’ve done nothing about it,” Ricardo said. “I want it to come after I’ve done my all.”

Ricardo sets a good example, Martinez-Ponce said. He knew that medical care would make a difference in the quality of his life, and he’s making sure he gets it.

The Bridge Program is just one of the ways the public health department is fighting AIDS and HIV.

In an effort to get more people tested, the department occasionally sends a van to heavily trafficked spots, such as a market or church parking lot, and offers on-site testing.

And in another state-funded program, a licensed marriage and family therapist works intensively with 25 patients thought to be at the highest risk for transmitting the disease.

But that’s after they’re in treatment. With some patients, the hardest part is getting them to admit they need help in the first place.

“I have a lot of clients who say they’re doing well, everything is fine,” Martinez-Ponce said. “But they’re not doing well.”