One of Us

September 26, 1995|By Linell Smith | Linell Smith,SUN STAFF

The young mother on the examining room table at Johns Hopkins Hospital was a few years into her diagnosis of HIV and almost 20 years into an inner-city life with few exits. As gynecologist Dr. Jean Anderson checked her for an abnormal pap smear, the teen-ager distracted herself by talking to a staff counselor, another young woman from her side of Baltimore.

Since Hopkins began HIV screening and counseling at its obstetrics clinic five years ago, Dr. Anderson has discovered that her patients talk more freely to peer counselors than they can to her or anyone else in a white coat. And those who are infected also seem more willing to listen to the advice of peers about how to avoid spreading the AIDS virus.

At this exam, the subject was the death of the patient's young son two years before. And the young woman was saying it was probably a good thing he had died.

Why? asked the counselor.

"The patient said, 'Well, I just have this feeling that I'm going to die soon. And if my son had lived, he would be old enough to really know me and to go through a lot of pain over this,' " says Dr. Anderson, recalling the conversation. "And then she said, 'My daughter is young enough that she probably won't remember me that well. She won't have such a hard time.' "

"And the counselor said, 'When do you think you will die?'

"And she said, 'Probably within the next two years.' "

The patient said she was not too scared about dying. She also mentioned she should probably go to church more because she didn't understand the Bible as well as she'd like to.

Dr. Anderson, nationally respected for her work with women with HIV, pauses as she recalls the pathos of this down-to-earth connection.

"It was just extraordinary to me," she says in a soft voice flavored with a Tennessee accent. "Very, very moving. Here was this 19-year- old talking about dying. About losing one child and leaving behind another child. Wondering about spiritual things.

"And I hear things like that all the time."

Although she directs the hospital's program for HIV-infected women, Dr. Anderson says she frequently receives such soul-baring insights because of the presence of peer counselors -- women from similar backgrounds as those who are infected. These counselors, some of whom are former clinic patients themselves, educate patients about their disease, help them change their high-risk behavior and advise them on issues in their daily lives.

Across the country, medical and social workers are recognizing the benefits of using trained peers to help prevent disease and to change the behavior of a broad spectrum of people ranging from elderly Americans struggling to maintain their independence to teen-agers exploring their sexuality.

Now they are testing this method with the growing population of women who are infected with HIV, a disease that has struck at least 58,000 women.

Last year, women accounted for 18 percent of the nation's newly reported AIDS cases -- an 11 percent increase over the past decade, according to the Federal Centers for Disease Control and Prevention in Atlanta.

An unusually high percentage of HIV patients at Hopkins are women -- 30 percent -- and at least four of every 100 women seeking prenatal care at the hospital's obstetrical clinic are infected with the virus.

Listening to a peer

The CDC has chosen Hopkins as the site of its first study of peer counseling of women with HIV. Begun two years ago, the project will ascertain the benefits of using peer education and counseling to change high-risk behavior while also encouraging infected women to get regular health care.

Peer counseling programs at Hopkins and elsewhere suggest such counselors may be more effective in this work than the nurse practitioners and other mid-level health care workers who traditionally educate patients during physical examinations.

"People take advice and information from people that seem more familiar to them, people that they trust," says Dr. Liza Solomon, director of the state's AIDS administration. "If a woman hears something from a woman she respects, she might be more willing to listen to it than if it comes from a supposed expert who might not speak to the circumstances in her life."

Traditional health care workers can be shocked to learn that HIV is not a patient's greatest concern. Often isolated in poor neighborhoods ravaged by violence and drugs, women with HIV tend to be more afraid of homelessness, of not being able to pay their bills. They worry about domestic abuse and about finding dinner for their children.

"My clients know if they get sick, somewhere along the line they will be taken care of," says one peer counselor at Hopkins. "They're more afraid of how people are going to react to them when, and if, they just find out that they're HIV positive."

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