Health Worker Brings Bad News to the AIDS Infected

Patricia Villegas has delivered sad news to many people, but she can’t forget one 22-year-old woman: She was pregnant, and she was infected with the AIDS virus.

Villegas points to the straight side chair next to her desk in a tiny, windowless office, closes her eyes and pauses as the ache resurfaces.

“She was sitting there and when I told her she was HIV positive--I’ve never seen this since, either--I saw her break into a cold sweat,” she says.

A year later, the woman was dead. Her baby was healthy.

“They’re all very sad cases, but I think the ones that for me that are the most difficult are the women, and especially the women who are single parents, because they have so many decisions to make,” Villegas says.

As a communicable-disease field representative for the Ingham County Health Department, Villegas tells patients the results of their AIDS tests. If the results are positive, she helps patients inform those whom they may have infected and urge them to be tested.

It can be dangerous work that takes Villegas to the fringe of the drug world, as well as into the homes of white-collar workers.

It can be depressing work that forces her to adopt a professional detachment to protect her own emotions, while showing a caring manner.

It can be frustrating work when partners who desperately need to hear of their exposure to the deadly virus cannot be found.

“A lot of the time they may be individuals who say they’ve had sexual contact with (people) in a very casual sense of the word. They don’t know much about them; they had sexual contact while under the influence of alcohol or drugs,” she says. “That’s a majority of the cases I’m finding.”

Sometimes, Villegas sets out to find patients’ sexual partners knowing little more than their first names and the description of the house where they live.

“All I have is that he lives on Smith Street and he lives in the second block, the second house, which is a two-story, white frame with black shutters, with a broken-down car in the front,” she says.

“So we go down Smith Street to the second block to the second house, looking for those locating markers and find John Doe, if that’s correct information.”

Villegas may wear blue jeans and a Hard Rock Cafe T-shirt to knock on the door of what she suspects are the homes of drug dealers and users. Sometimes, police escort her.

“I’ve not seen guns, but I know that they may be there. They (drugs) may not be out in the open, but I know that they’re there,” she says.

Villegas knocks on the door, presents her identification and determines if she has the right person. In a private setting, she asks if they know what HIV is and tells them someone they know has tested positive for the virus and indicated they were exposed to the virus.

Confidentiality is strictly protected. Neither threats nor bribes will induce her to reveal who listed the individual as a contact.

Villegas lets the news sink in before suggesting testing or offering information on safer sexual behavior.

“Sometimes they are angry. Fear, anger, guilt, shame. It may be verbal. It may be just behavioral in the sense that they may get very sad, very frightened, very quiet or they may try to inject a sense of humor into that,” she says.

Those whose addresses are known are mailed information or contacted by phone asking them to come to the health department. The reason for the request is not revealed to protect their privacy.

Under Michigan law, doctors and local public health officers who find someone who tests positive for the human immunodeficiency virus have a duty to warn those known to have shared needles or had sex with the individual.

All states have HIV partner-notification programs of some kind, according to Janet Riessman, spokeswoman for the AIDS Action Council of Washington.

In some programs, the state counsels individuals to notify their partners on their own. In others, doctors or other professionals notify partners when the patient asks for help. Still other states offer a combination of the two.

Between January, 1992, and June, 1993, Michigan health departments interviewed 1,031 HIV-positive clients about partner notification. In that time, 6,195 partners were tested and about 3.2% turned up positive for the virus.

Villegas, who has an undergraduate degree in psychology, was drawn to the work partly because she felt her own sex education was inadequate and she wanted to help others.

She has been formally notifying partners of HIV-positive people since 1987 and handles five to 10 cases as month.

“I don’t think it gets easier. I think what has happened is that I have learned a healthy detachment as a professional,” she says.

In Oakland County’s health department, appointments are never scheduled after 4 p.m. AIDS Coordinator Joy Schumacher says staff charged with delivering the depressing news need an hour to come to grips with their feelings before leaving for the day.

“It’s hard. Basically you’re handing somebody (the potential) for a chronic illness that is probably going to end their span of life in a shorter time than they planned,” she says.

“These are people just getting started in their life, and they have goals. I find it hard to tell someone.”

Still, it’s an important step in slowing the spread of AIDS.

“I believe in it very strongly. I think you have to think little, think small and think you’re making a difference,” she says.

“Innately, people aren’t really amoral. Most people care about other people.”