From a minor illness to full-blown AIDS

safety net at grady

  Atlanta's Safety Net

Atlanta’s safety net at Grady

A second chance at life

Three times daily with food

Bethany Bennett couldn't get her mind around it.

An hour earlier, she had walked into Grady’s emergency department with a dry, hacking cough and shortness of breath, and now a soft-spoken counselor was telling her that she had full-blown AIDS. She was only 19. She needed to wake up from this bad dream and get back to her life. Instead, she was being admitted to the hospital for PCP pneumonia, isolated until TB could be ruled out, and then referred to the pediatrics section of Grady’s Ponce Clinic, where she would begin an intense course of antiretroviral drugs to try to extend her life. 

In one sense she was lucky. Without an AIDS diagnosis, Bennett would have been given a prescription for conventional pneumonia and sent home, her immune system continuing to deteriorate. She benefitted from a Department of Human Resources/CDC grant given to Emory doctors in Grady’s emergency department in which every patient 18 or older is given (with their permission) a free HIV test.

The new rapid screening test for HIV works a little like a pregnancy test: the patient swabs his or her own mouth, and the swab is placed in a developer solution, producing a result in 20 minutes.

debra houry

ER physician Debra Houry heads a rapid screening project at Grady for HIV-AIDS.

Of the 400-plus patients screened each month, 10, like Bennett, hear news they are not expecting. That doesn’t surprise emergency medicine physician Debra Houry, who heads the rapid-screening project. What does surprise her is that half of those newly diagnosed have already progressed to full-blown AIDS and 75% already require antiretroviral therapy. 

All HIV-positive patients are referred to treatment and counseling about their own personal risk factors. The test and counseling are covered by the grant, but the treatment is not, and many patients are without insurance or resources to pay. What is more important, however, says Houry, is that the emergency department is proving to be a good place to reach underserved populations with undiagnosed HIV infection. Offering free testing to all patients removes the stigma of such testing and provides opportunities for some badly needed patient education and counseling. A diagnosis of HIV infection gets patients to the care they need earlier and helps protect the public health by making more people aware that they are infectious as well as infected. 

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