Hold the Phone

The dial tone on Oregon's long-running HIV/AIDS hotline may soon go dead.

Since 1987, the hotline has connected thousands of callers with testing and HIV/AIDS services—key to the early detection that is helping more and more people live with the virus and disease.

But state officials say there are far better ways to encourage people to get tested for HIV/AIDS than continuing to spend $75,000 for a hotline. They want to stop funding in March, when the current contract expires.

Improved antiviral drugs have made living with HIV far from the death sentence it once was for Tom Hanks in Philadelphia, says Michael Anderson-Nathe, director of prevention and education at Cascade AIDS Project (CAP), which runs the state's hotline.

But Oregon already lags behind the nation when it comes to diagnosing HIV/AIDS early.

Nationally, about 32 percent of all HIV diagnoses are late stage—meaning the patient already has AIDS at the time of the HIV diagnosis, or develops it within 12 months of diagnosis.

In Oregon, state records show, it's 37 percent. 

"That means they were living with HIV for seven to 10 years before they got tested," Anderson-Nathe says. "That's several years which they didn't know they had HIV and could be transmitting to partners."

The Oregon Health Authority estimates an additional 1,200 Oregonians living with HIV do not know their status. Right now, 5,213 Oregonians live with HIV/AIDS, and there are 275 new HIV infections diagnosed each year.

Fifty-five percent of Oregonians diagnosed with HIV/AIDS live in Multnomah County.

Kim Toevs, manager for HIV, STD and adolescent health in Multnomah County, says it's the wrong time to end the hotline.

"Testing has become a key area of focus," Toevs says. "If people who are infected know about it, they have a really awesome system of care to enter."

State officials say they would keep funding the hotline if it were making that big a difference.

"We're having to look at everything we pay for to make sure that it's cost-effective and make sure it's the best thing for protecting public health," says Ruth Helsley, Oregon Health Authority's HIV prevention program manager.

In 2011, Helsley says CAP got $75,000 to operate the hotline, plus $10,000 for a public information campaign.

At its peak in 1994, CAP says, the hotline fielded 10,219 calls. But the number of calls and online chats dropped to 882 last year—and Helsley says that comes to $89 a call.

This year, calls have dropped further. It now costs about $100 a call.

"That's a lot," she says.

Helsley added that data from the hotline "isn't correlating with increased testing numbers." She says the Oregon Health Authority wants to better target at-risk populations by funding HIV testing, condom distribution and needle exchange, and by linking those who test positive to heath-care providers.

Anderson-Nathe says the state's math excludes the 11,000 visitors the hotline's website received in the past two years.

Callers to the hotline at 800-777-2437—open 9 am to 6 pm weekdays and Saturday from noon to 6 pm—speak with volunteers who can connect them with testing services, clinics or counseling.

Without the state contract, he says, CAP will have to get rid of the one staff member who handles the reporting and tracking of cases, and oversees the 15 hotline volunteers.

Along with the hotline going cold, he says, the website would no longer offer live chat and wouldn't be updated with the latest information.

Toevs says the hotline gives callers anonymity-—allowing people at risk, as well as family and friends, a sense of protection. "Sex and drug use are still stigmatized," she says. "It can be hard for people to admit they may be someone at risk."

That's the crux for Anderson-Nathe—AIDS prevention and treatment is losing steam just when social services know how to tamp it down.

"We have the science, information, technology and tools," Anderson-Nathe says. “What stops us is a lack of political will and resources.” 

WWeek 2015