One condom at a time

The health department’s three-person HIV prevention team works to end the HIV epidemic by spreading information and protection.

STORY BY CAYLI YANAGIDA

DESIGN AND PHOTOGRAPHY BY LIN CHOIEDITING BY SOPHIA DONIS

If there’s one thing that’s consistent about the routine for the Columbia/Boone County Public Health and Human Services HIV prevention team, it’s that no day is ever the same. For HIV Prevention Health Educators Cody Jenkerson, Mia Millard and Jessi Woodward, activities range from educating people about sexual health to HIV testing and outreach. The team is part of the HIV/STI Prevention and Intervention unit within the county’s Health Department. As a team, they collaborate with community partners and provide condoms, HIV tests and educational resources to 37 counties in Missouri.

“We are preventing illness, disparity, disease before it resonates,” Millard says. “That’s the goal of public health. Instead of reacting, we’re proactive and trying to intervene with programs.”

In 2019, the U.S. Department of Health and Human Services identified states with high rates of HIV and launched the “Ending the HIV Epidemic in the U.S.” initiative with the goal of reducing new HIV infections by 90% by 2030. Missouri was identified as a priority state, with Kansas City and St. Louis having the highest rates of HIV. The state received federal funding to implement programs to advance HIV prevention, diagnosis, treatment and response.

Central HIV Care Region

The team covers a care region of 37 counties. From Nov. 2021 to Dec. 2022, they conducted 69 rapid HIV tests in their clinic and 107 rapid HIV tests in outreach settings. Residents able to order free at-home HIV tests, condoms, lubricant and dental dams in discrete packaging from ShowMeCondoms.org

On a daily basis, the team meets to go over project planning and presentations for community partners. In 2020, the team gave seven presentations, attended 61 outreach events and participated in 17 community -wide events.

Diminishing stigmas through education

With a home base in Columbia, the team works to inform Missouri communities through open conversations. Sometimes the team goes to high schools and colleges to discuss sexual health, safety and healthy relationships.

The team also holds large testing events and quarterly meetings with the North Central Community Advisory Group, an organization that promotes sexual health, STI prevention and education in Missouri. NCCAG oversees the Show Me Condoms website and makes decisions regarding the website, while the HIV prevention team runs the dayto-day operations.

Jenkerson, who joined the HIV prevention team in Nov. 2021 and has held multiple roles at the Missouri Health Department since 2020, says HIV and sexual health aren’t topics people are comfortable being open about. “A lot of our job is starting conversations and creating places where people feel safe and open enough to express things,” he says.

There is a lot of misinformation surrounding HIV, as well as stigmas surrounding conversations about sexual health. One common misconception is that HIV may be fatal. While HIV can’t be cured, Millard says there is effective treatment to control HIV to an undetectable and untransmittable level. Millard was the second member to join the team in July 2022.

Another misconception is that HIV is a disease that only affects certain groups of people, such as the LGBTQ+ community. But anyone can contract HIV, as well as other STIs. Spreading awareness about prevention encourages people to get tested and know their HIV status while also fighting stigmas around the virus.

The team hopes to overcome these barriers when educating Missourians about HIV prevention. Millard says it’s important to build upon successes and tailor them to the community using new, evidence based-approaches.

“Instead of using scare tactics, we’re giving people the education and tools to make decisions and support their sexual health,” she says.

One resource available to Missourians is the ability to order up to two HIV at-home tests within a 90-day period on the Show Me Condoms website. The tests are delivered straight to a person’s home, as long as they live in the 37-county care region. Residents of the care region can also order free condoms, lubricant and dental dams.

Resources for priority populations

When it comes to planning events and discussions, the group will go wherever they are asked to. They’ve partnered with MU’s Wellness Resource Center, promoted at-home HIV tests through social media campaigns and even distributed condoms to Columbia businesses and bars at drop sites.

Millard says the team does see a lot of college students for STI prevention, but there are other groups who are disproportionately affected by HIV, like the LGBTQ+ and Black communities. This is why the team works with several community partners in order to create presentations that cater to priority populations.

Condom tins are included in each swag bag the team distributes at outreach events. The tin allows for condoms to be taken on the go without being poked or ripped.

The team is currently working with Live Well by Faith to create a presentation for predominantly Black churches in Columbia discussing sexual health and HIV prevention. Through the Live Well by Faith program, seven Black churches have a health ministry to educate members about the importance of healthful foods, exercising, diabetes and blood pressure.

Carla Tigue, a Disease Intervention Specialist for the Health Department, says sexual health isn’t openly discussed in church settings. “It’s a taboo topic,” she says. Tigue added the HIV prevention components to the health program as a way to start conversations about sexual health.

Millard says the presentation will also include information on the medication Pre-Exposure Prophylaxis for HIV, or PrEP, because CDC data shows disparities in Black communities include high rates of HIV and low rates of PrEP usage.

PrEP is used as a preventative measure against HIV and is for anyone who is HIV negative. The medication comes in two different forms: a daily pill or a long-acting injectable.

Hiv In Missouri

Men are diagnosed with HIV 4.6 times more than women, according to the Missouri Department of Health and Senior Services.

“Disproportionate rates of HIV are seen among Black men who have sex with men, Latino men who have sex with men, white men who have sex with men, Black women, transgender women, people with a higher likelihood of acquiring STIs and drug users,” HIV Prevention Health Educator Mia Millard says.

The Centers for Disease Control and Prevention estimates there are 14,500 Missourians living with HIV.

Millard demonstrates the step-by-step process of testing an individual for HIV. After their finger is pricked, the blood sample is collected and inserted into a buffer solution for 15 minutes.

Millard says it is important for people to understand that PrEP is a tool they can use to protect themselves from HIV. “It’s empowering and can give you that peace of mind,” she says.

HIV testing and treatment

Woodward, the newest member of the team who joined in November 2022, says the reasons people get tested for HIV vary and are unique to the needs of the individual. For some, getting tested is part of their sexual health routine. Others get tested because they have sex with a person of unknown HIV status.

“HIV can take several years to show symptoms, so that is not usually a reason that we see folks getting tested,” Woodward says. She adds that people can get tested for STIs and HIV after starting a new relationship so they can share their status with their partner.

Anyone can get tested for HIV with the help of the team at the Health Department building on Worley Street. The free rapid test is relatively non-invasive; a simple finger prick will do. Afterward, a team member sits and provides the patient with sexual health counseling during a 15 to 20 minute waiting period. The calm atmosphere can ease a patient’s nerves and provide them some comfort while they wait for results.

Jenkerson says the team put a lot of time into making the clinic space as comfortable as possible for patients. The space was designed to look different a traditional doctor’s office. A brown leather couch, mini fridge, paintings on the walls and lamps provide a more relaxed setting.

If someone does have a positive test result, Millard says it’s important to make sure people understand that HIV is not what it used to be.

“Patients can feel every single emotion, and we’re with them every step of the way. We give them options for resources and treatment.”

Woodward says that individuals who test positive for HIV can utilize Antiretroviral Therapy, or ART. ART consists of taking a combination of HIV medications

Hiv By The Numbers

The team distributed 131 at-home HIV test kits and over 30,000 condoms to individuals in the Central Care Region.

The Central HIV Care Region, where Boone County is located, had 791 people living with HIV in 2021, according to the MDHSS. About 1.2 million people are living with HIV in the United States, according to the CDC.

HIV is spread through bodily fluids like blood, vaginal fluid, semen and breast milk. HIV can’t be spread by saliva, urine, nasal mucus, air and physical touch like holding hands.

In 2021, there were 4,076 people living with HIV in the Kansas City HIV Care Region and 6,594 people living with HIV in the St. Louis HIV Care Region, according to the MDHSS.

everyday and makes the virus become undetectable in the blood. Although the drug can’t make an individual HIV-free, the pill allows people to go about their daily lives and prevents them from transmitting it to others.

Tracey Bathe, HIV/STI prevention and intervention supervisor at the Health Department, says the team members are well trained on all aspects of their job and still continue to receive training. They’re state certified to conduct rapid HIV and Hepatitis C tests, counsel patients on their likelihood of HIV transmission, give patients positive test results and link them to treatment options.

“Sometimes, even just the conversations can be difficult when we do an assessment and (patients) tell us about life situations that they have gone through that have led them to come here,” Bathe says. “We need to listen with empathy and make sure we are non-judgmental and inclusive in our language.”

Working to understand the perspectives of patients is key to the work the team does. For them, it’s about education and identifying barriers in underserved communities.

“I love that I get to serve the community and make connections with the community,” Jenkerson says. “My favorite thing about this job is that I get to give back to a community that has given me so much. I love working with people. I love working with the community; that’s what gets me going.”