They thought it was a fast test, anyway. "Still waiting," says a woman named Robin, who declined to give her last name. "Been here since 11:30. Still waiting." It's 2:30 p.m.
A temperature problem in one of the vans, along with longer-than-expected consultations, has delayed results for the 20-minute tests, which use a finger-stick to take a blood sample. Robin says her counselor who spoke to her prior to getting her results was "naming numbers and calling out acronyms, 400 for this, 200 for this."
It was overwhelming, she says. "I just need to know positive or negative."
A lot more Richmonders "just need to know" too.
Twenty-five years have passed since the disease that would become known as AIDS was first documented by the federal Centers for Disease Control and Prevention. As new treatments allow people with HIV to live longer, health workers say, public discussion of the epidemic has dropped off, causing many to forget about it.
But the threat remains. The Virginia Department of Health estimates that 23,000 people in Virginia are living with HIV. According to the CDC, as many as a quarter of them 5,700 people may not know they are infected.
Through 2005, 1,902 people in Richmond were living with HIV or AIDS, according to the state health department. Again, this number may represent only 75 percent of the actual number of infected people. About 600 Richmonders may have HIV or AIDS and not know it.
Last week, Washington, D.C., officials announced their first-ever public estimate of the number of residents infected with HIV: 25,000, more than 4 percent of D.C.'s population.
According to CDC data, Washington, D.C., has the highest rate of new AIDS cases of any city in the United States 179.2 per 100,000 residents in 2004. The second highest rate, of 39.7 per 100,000, is in New York City. Virginia's AIDS rate, by comparison, is 10.7 per 100,000.
To stem the epidemic, D.C. is beginning a citywide campaign to make HIV screening a standard component of medical exams for everyone from 14 to 84 years old, a total of about 400,000 residents. In a report to be issued later this summer, the CDC is expected to recommend making voluntary, rapid testing a standard part of medical screenings nationwide for people ages 13 to 64.
Will Richmond join in?
Probably not, says Heather Bronson, director of prevention, education and support services for the Fan Free Clinic. "Not that we wouldn't love to test everyone," she says, "but we just can't afford to."
The cost to administer a single OraQuick test is $13.50, says Shannon Marshall, spokeswoman for the Virginia Department of Health. Testing is free to Richmond residents through the city health department.
The Virginia Department of Health is also concerned that it couldn't afford to pay for testing for all Virginians, Marshall says. Still, she says, "the division would be supportive of the new guidelines, because they may enable the identification of HIV-infected persons who wouldn't otherwise be tested."
Because universal testing is not yet possible, the Fan Free Clinic, which tests and counsels people with HIV but does not provide them with medical treatment, has instead focused on testing Richmonders at highest risk for becoming infected. This group includes men who have sex with men, people with multiple sex partners and African-American women who may be unwittingly infected by husbands or boyfriends. The clinic tests at methadone clinics, homeless shelters and, last weekend, gay clubs in the city.
"We're just trying to put ourselves in places that make sense," Bronson says.
Despite an average statewide decrease of 8.6 percent in reported cases of HIV and AIDS from 2004 to 2005, reported cases increased by 7.6 percent in the city of Richmond during the same time period.
Bronson remains concerned about the future. People, especially those who are HIV-positive, are reluctant to stand up and talk about it, she says. Young Richmonders still engage in risky behaviors, she says, because "the message young people are getting is that you can just live with HIV, so it's not that big a deal."
When AIDS first hit Richmond, the diagnosis meant death.
"The first patient arrived in Richmond in the fall of 1983," says Dr. Lisa Kaplowitz, a pioneer in treating HIV and AIDS in Richmond. "And I got a call from two of his friends, asking if I would be his doctor. He had been diagnosed in New York City, kicked out of his apartment all his belongings were burned. He went home to North Carolina and they ran him out of town. He had no place else to go and he had two friends in Richmond. So I said fine. He survived another nine months."
By then, the city's second and third AIDS patients had arrived, also from larger cities. In 1986, Kaplowitz helped establish the HIV/AIDS Center at Virginia Commonwealth University, a place to treat people with HIV, conduct research and provide education. She's now deputy commissioner for emergency preparedness and response at the state health department.
The development of protease inhibitors in 1996, a type of treatment still in use today, gave HIV patients their first hope of long lives. But at the same time, Kaplowitz says, more women and African-Americans were getting infected. "This no longer was a 'gay' disease," she says.
The crowd waiting to be tested at Southside Plaza is mostly black. There are college students, people in their 50s, men and women.
Tia Harris, 25, says she came "so I can know my status." An older man who only gave his first name, Joe, says his wife sent him to get tested because he'd "been bad."
"At least I'll know," he says.
From January to June 2005, 3,255 Richmonders took state-funded tests for HIV. Thirty-eight 1.2 percent tested positive.
The size of the crowd gathered for free tests last Tuesday is a good sign, Richmond Department of Health spokesman George Jones says. When he began working with the health department six years ago, he says, "we couldn't even get people to come near the van."
At Southside Plaza June 27, staff members performed 75 tests. Nineteen more people were tested at the department's clinic the same day, Jones says. Of those 94 tests, none was positive.
For those 94 people including "Uno" it was a good day. S