Greg Heartsill has a difficult job. He works as a Disease Intervention Specialist at the Oklahoma City-County Health Department. His coworkers jokingly call him the “Sex Police,” though most disease intervention specialists hate that term. Heartsill gives out the results from tests for HIV, syphilis and other sexually transmitted diseases. He is trained to compassionately tell a person his STD status, to give out the proper treatment, and then educate the person on how to better protect himself in the future.
But that’s not even the hard part. When a client has positive test results, he must interview the person and convince the client to reveal the names of his or her sexual contacts. He must convince a person to disclose the most intimate details of his sex life, with no incentive other than common human decency, and the client’s desire not to be re-infected. Heartsill tries to figure out who likely infected the client, and who else he or she may have infected. Next, he must track down and interview the list of contacts to tell them that they may have an STD and persuade them to get tested. By working through a spider web of sexual contacts, Heartsill attempts to root out the infection and educate those involved, to prevent the STD from spreading further.
“Eliciting partners is the hardest because if you get a couple and one of them maybe just had a baby so the man is not getting sex, and so he goes out and does something and gets syphilis and brings it home. And of course neither one of them are going to admit that a third person is involved. Getting people to confidentially let us know so we can do something sometimes is really tough. That’s got to be the toughest part of the job.”
An effective disease intervention specialist, or DIS, can figure out the best way to get inside the client’s head and put STD testing into a context that makes it important and urgent. They will put the client at ease, develop a rapport, and find ways to elicit names without overloading the person. They must be a good listener and have a nonjudgmental attitude. A DIS may only get one shot at the interview, so he tries to get it right on the first try.
Sometimes, just finding a contact to be interviewed is extremely challenging, especially if that person is a transient, an undocumented immigrant, or someone who doesn’t want to be found. Once a DIS has a name, he’ll search public records and various databases to find an address or phone number. They go knocking on doors and calling phone numbers until they find that contact.
All of these investigations must operate under the strictest secrecy. Heartsill cannot tell the contacts who gave him their name, or reveal why he is even looking for someone. He cannot tell a grandmother why he is looking for her 19 year old closeted grandson, or reveal to the pregnant wife who opened the door why he needs to speak with her husband. He can only leave a card, and ask that the person call him back.
Though Heartsill can educate and counsel his clients, he cannot force them to disclose their sexual contacts, or to change their behavior. As a rule, disease intervention specialists have no contact with law enforcement and do not turn in repeat offenders. Though state and federal laws prohibit a person with HIV from having unprotected sex without disclosing their disease status, people are rarely prosecuted for this crime. Heartsill says that it’s frustrating when they see the same name come up repeatedly, but they would not want to scare away people from disclosing their contacts for fear of being arrested.
“We do keep it separate. We’re not the sex police and if we were involved in law enforcement then I think our efforts would be diminished because of the confidentiality aspect,” says Heartsill. “If they thought we were going to tell the police then they wouldn’t talk at all to us. Our only interest is to get people into care and try to help them keep from being infected.”
One giant roadblock to this goal is the lack of accurate sexual education that is provided to young people in Oklahoma, and the ignorance surrounding the risks associated with sexual activity. “It’s amazing the lack of knowledge about STDs,” he says. Oklahoma students receive little to no structured sexual education in schools.
I took an informal, non-scientific poll of friends who grew up in various parts of Oklahoma to find out what kind of sexual health education they had received growing up. They said that and the sex ed. offered in the state varied from nothing at all (and the human reproduction chapter cut out of the biology textbooks) to a week of classes watching “Captain Condom” videos in high school. The City-County Health Dept. intends to implement a teen pregnancy prevention program in city schools, but the program is still in the planning stages.
The stigma that still surrounds homosexuality in Oklahoma also makes Heartsill’s job much more difficult. Since anal sex is the most effective way to pass HIV, Heartsill works with a lot of men in the gay community. Whether it’s the result of marginalized relationships, low self-esteem from abuse and discrimination, drug use, or just being young and ignorant, an unfortunate number of gay men are not protecting themselves or their sex partners.
Oklahoma City is also home to a sizable “down-low” population – men who have a wife or girlfriend, but who also have sex with men on the side. This phenomenon sometimes results in HIV transmission to unsuspecting wives and girlfriends, since men on the down-low often have more risky sex than men who are openly gay. Being on the down-low is particularly prevalent in the African American community due to a greater cultural stigma against homosexuality. “There is a lot [of shame] and it makes it extremely difficult to get partners because of that. It’s tough. That segment’s been stigmatized throughout history,” says Heartsill.
In contrast, lesbians are rarely at the center of disease investigations since it is more difficult to pass many STDs between two women. Lesbians, on average, also have fewer sex partners than gay men. “If everyone were as healthy as lesbians, we’d be out of a job,” Heartsill says. He has investigated a few rare cases of gonorrhea passed through shared sex toys, but never HIV or syphilis.
In his sixteen years as a DIS, Heartsill has witnessed a few changes in the sex lives of Oklahomans. Though the diseases have stayed the same, new technology has brought great changes to the ways that people find sex partners. Social networking sites like AshleyMadison.com and smartphone apps like Grindr – an app that lets gay men find other available men in their immediate surroundings – makes it much easier for people to have anonymous, no strings attached sex. Locating a sexual contact when a client doesn’t know a last name or home address is exceedingly difficult.
“It’s made it harder because I think more people are having anonymous partners. It’s just a hook-up. And maybe they’ve got a phone number or maybe they don’t.”
One positive change that Heartsill has noticed over the years is that emotionally, it’s easier to give out positive HIV results now that there are drugs to limit the progression of the disease. Telling a person that she has HIV used to be a death sentence, but with effective medical treatment, drugs can drastically increase life expectancy, and reduce a person’s viral load so that it is almost undetectable – and much less contagious. Even if an HIV-positive client does not have health insurance, Heartsill can refer the person to the Infectious Diseases Institute at the University of Oklahoma Health Sciences Center where an excellent HIV clinic can provide medical care and medications at low cost to the patient.
Despite the challenges, Heartsill appears to enjoy working as a DIS. He has a nonjudgmental, sympathetic demeanor that makes me think he accomplishes his job with sensitivity and tact. If I had an STD, I would feel comfortable talking about it with Heartsill.
But the emotional energy required to be an effective DIS is too exhausting for some people. I spoke with a former DIS who worked in the state in the late 90s, but quit after about two years. She asked to remain anonymous, and so I’ll refer to her as Julie Harris. She found the job to be extremely worthwhile, but too emotionally draining to make it a lifelong career.
When Harris worked as a DIS, every day was different. This made the job both more interesting, and more anxiety-producing. She never knew who was going to answer a phone call or open the door. She worked with prostitutes, housewives, college students and drug addicts. Some clients had obviously made several poor life choices, and some people were just in the wrong place at the wrong time.
While working as a DIS she entered all manner of homes, from meth houses to expensive mansions. She interviewed a man at his “sex house” where he didn’t actually live, but where he brought people for sex. She interviewed violent criminal offenders who were handcuffed to the wall of the visiting room at the county jail. She talked to professional-looking men with a fetish for cheap streetwalkers, and closeted gay men who swore that they got HIV from their dentist, or from when they were in Vietnam.
Each individual DIS often has greater success with a certain segment of the population, and Harris was especially good with prostitutes. There was a street near I-40 where Harris knew all of the prostitutes by first name (their real first name) and where they lived. She heard their heartbreaking life stories, their gossip, and even helped one woman tell her mom that she had AIDS.
Harris also took a more “involved” approach than some of her coworkers. Though she never gave anyone money, she would always carry cigarettes just in case someone was willing to go outside to have a smoke and talk about their sexual history. She was also quick to offer something to eat or drink. She figured that a Diet Coke and a $0.59 taco were a small price to pay for a list of contacts.
When she encountered a person who didn’t want to talk to her, she might send another investigator to talk to the person. “I could never get Hispanic men to tell me anything in an interview,” she says.
Informing an unknowing spouse that he or she may have an STD was especially difficult for Harris, since she was essentially revealing that the spouse had been cheated on. Says Harris, “you would sometimes have to say it three or four times and then this light bulb would go on and they’d have this terrible, sad look on their face.”
In spite of the emotional challenges, Harris found some aspects of the job to be quite rewarding. She felt that it was especially gratifying when she could track down someone who might otherwise never suspect they were infected, such as the girlfriend of a closeted man who had HIV, or the pregnant wife with asymptomatic syphilis and no prenatal care.
“You could actually go home every day and feel like you saved someone’s life,” she says.
It’s likely that caring, hardworking disease intervention specialists will always be needed in this state. With the lack of sexual education in Oklahoma, and the squeamishness surrounding sexuality in the society at large, STDs will continue to flourish. I asked Heartsill if he had any special insights in Oklahoman’s sex lives during his many years as a DIS. This was his response:
“Young people are going to have sex. Gay men have a lot of sex. I think that’s just a given. And it’s unfortunate that they haven’t found out as much as they need to know before they engage in sex. We see a lot of people who seemingly don’t have a lot of information about some of the consequences of engaging in behavior that can put them at risk for viruses that are going to be with them forever.”
OKC.net Public Service Announcement: If you are unsure of your STD status then please consult your doctor or visit Planned Parenthood or the Oklahoma City County Health Dept. for testing. A confidential STD screening at OCCHD costs just $15 and includes the cost of medication if you are diagnosed with a bacterial infection.