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Soldiers of Misfortune : On the Trail of Carriers of Sexually Transmitted Diseases, Public Health Workers Battle Not Only Mistrust and the Clock but Shrinking Funds


Cruising slowly in their ramshackle van, the disease detectives prowl the back streets of Los Angeles in search of a contagious hit-and-run artist.

He lived in a makeshift camper. That's all Dave Sullivan and Vanessa Newton-Pulley have to go on. Their tipster, now cooling her heels in the County Jail on some unrelated charge, had bedded down with him shortly before testing positive for syphilis.

One by one, she had rattled off the names of her lovers. But all she recalled of the tryst at 45th Street and Ascot Avenue in South-Central was her companion's first name and a vague description of his rig. Within 90 days--the incubation time for syphilis--the man would be infectious, if he wasn't already. And as he took on new lovers, the daunting task facing the two public health workers would multiply yet again.

And yet half an hour into their search, the two suddenly decide to drop the hunt cold. Already overwhelmed by a mounting caseload, there's simply no more time to canvass the neighborhood for anyone who might have seen the man.

"Sometimes," Newton-Pulley says, "you feel like there's no way to break the chain."

She has good cause to be frustrated. As venereal disease rates increase nationwide, the number of government health workers is dwindling, a trend experts warn could further jeopardize public safety. The reductions are part of Republican efforts to shift financial responsibility for costly health and welfare programs to state and local agencies.

Newton-Pulley and Sullivan belong to the Los Angeles County Health Department's sexually transmitted disease program, whose force has been reduced by a third--from 38 to 25--in the past three years. Paid by the national Centers for Disease Control and Prevention, their numbers have been slashed with federal budget cuts.

Health officials say the savings come at the expense of a critical mission. The disease intervention specialists--also known as partner notifiers or DIS workers--locate and sometimes treat people who have been exposed to one of a number of venereal diseases spreading across the country like some sexual chain letter. In the face of such grim work, local DIS workers call themselves the DIS Squad.

Former U.S. Surgeon General Joycelyn Elders says the cutbacks reflect a shortsighted government policy that will come back to haunt the American public. "The reason many of these venereal diseases are still around is that we cut programs before we get rid of the problem. And do you know what happens? The diseases come back with a vengeance."

Local DIS workers handle thousands of cases each year involving people who lost their gamble with unsafe sex. Day after day, they track a wide range of suspects, all of them clues to an often-baffling conjugal riddle.

The job requires them to be equal parts cop and counselor, nurse and priest. For pay ranging from $25,000 to $35,000, DIS workers frequently draw blood on the street, in living rooms and public restrooms from the sex partners of infected people too busy or too timid to report to a nearby hospital.

With a knock on a door or during an interview at one of dozens of public health clinics across Los Angeles, they face perhaps their most difficult task of all: Doing the follow-up to blood tests. Telling people they have contracted HIV.

"It can be sad, stressful work," says Newton-Pulley who, like other DIS workers, received two years of on-the-job training. "Every day, we talk to people about intimate aspects of their lives that often they have shared with no one else: How they have sex and who they have it with. That kind of talk reaches the very depths of someone's intimacy."

But because of a two-year CDC hiring freeze, there are significantly fewer DIS workers to do the job nationwide. CDC officials acknowledge that they have thinned the ranks of the street soldiers tracking venereal disease--shifting the responsibility to local agencies.

"Community-based organizations need to step forward to become the advocates of behavioral change," says William Parra, acting deputy director of the National Center for Prevention Services in Atlanta, a branch of the CDC. "They're the ones who have the best access to the people who are at risk, not us."

But with Los Angeles County in the throes of financial crisis, there simply aren't enough local dollars to replace the DIS workers. The county is also cutting by 30% its own staff of about 50 public health workers, who do much the same work as DIS workers in neighborhoods throughout Los Angeles. Educational and health screening programs are also being scaled back or eliminated.

Still, the disease cases keep coming. Today, one in five adult Americans carries some type of incurable viral infection such as herpes. When the curable, bacterial STDs such as syphilis and gonorrhea are included, Americans have at least a one-in-four lifetime chance of contracting an STD, CDC studies show.

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