Photograph by Risha Koli

A lab technician finishes an HIV test for a patient. Bloomington Hospital's Positive Link is among area programs that have shifted their emphasis from treatment to prevention.

Jill Stowers runs on a tight schedule. While her office is located on Bloomington's East Miller Drive, she finds that her job takes her all over central Indiana.

As program manager for Bloomington Hospital Positive Link, the regional AIDS medical service, Stowers says she travels around Monroe and surrounding counties for Positive Link outreach events every week.

Despite a hectic agenda, Stowers is happy to give time to discuss the change she jumpstarted in Positive Link -- its transformation from a care site for AIDS patients to a comprehensive service focusing on HIV prevention.

Testing made up a small sector of Positive Link when Stowers took the job two years ago. But through her team's dedication, the prevention division of Positive Link evolved into one of the hospital's most available and accessible services.

"We travel around to central Indiana places like homeless shelters, jails or schools every week to provide testing," she says. "In the last couple years, we've seen prevention expand and really grow into a full program on its own."

HIV present in the local community

Human immunodeficiency virus (HIV) is most notable because it frequently leads to AIDS, causing the body's immune system to fail. The disease has killed millions and has earned the world's attention as a global epidemic.

Stowers recognizes the international impact of the disease, but she understands that the most effective method for battling the epidemic requires working within the community.

According to the Indiana State Department of Health (ISDH), more than 7,000 people in Indiana have HIV. Of those, 168 of live in Monroe County, which serves as a constant reminder of HIV's effect on the community.

"As more data was released, more people began to see the local effects of HIV," says Stowers. "We arrived at the realization that working toward prevention was a communitywide need."

Positive Link Prevention Coordinator Emily Brinegar works closely with Stowers to plan prevention programs and educate communities. Like Stowers, she began working for Positive Link two years ago and helped expand the prevention division.

"Any prevention effort is always a few years behind the actual need," Brinegar says. "During the past few years, once the government had solid data, we were able to shift our focus and apply for more prevention funding."

Community outreach raises prevention awareness

To achieve the goal of fighting the disease within the community, Stowers and her team launched a community outreach program.

Staff members sit on different community boards, such as Community AIDS Action Group (CAAG), appear monthly on three radio shows and give weekly presentations at community events on the importance of prevention. They even began a bar outreach, where staff members visit bars to pass out condoms and pamphlets.

Photograph by Risha Koli

Student Global AIDS Campaign (SGAC) plans the annual AIDS Walk to benefit Positve Link. SGAC is one of many community organizations that Positive Link partners with for community outreach events.

But perhaps the most notable accomplishment is Positive Link's outreach testing initiative. Two to three times a week, Stowers and her staff travel around Central Indiana to provide HIV testing to the seven counties that Positive Link serves.

"Our numbers have grown exponentially," Stowers says. "When I started working, we only had three partners, and we did 12 outreach projects a year. Last year, we did just under 198 outreach projects. In 2004, we conducted 300 tests. Last year alone, we conducted nearly 1,500 HIV tests. We've all been amazed at the rapid growth."

Rapid testing attracts more testers

A crucial element to the prevention division's expansion is rapid testing, a recently developed test that produces results within 15 to 20 minutes.

According to the Centers for Disease Control Web site, about 25 percent of the infected population remain undiagnosed and unaware of HIV infections. When Stowers came across these statistics, she knew HIV prevention needed restructuring.

"That struck me as a huge hole in public health," Stowers says. "It's so expensive to provide services to help infected patients, but if you provide the resources up front to prevent that, you save a lot of money. More importantly, you save lives."

Positive Link began offering rapid testing in 2005. These tests reshaped the hospital's capability to provide HIV testing, prompting dramatic growth in both accessibility and availability.

With the conventional form of HIV screening, test subjects had to come back almost two weeks later for their results. Stowers says that only around 75 to 80 percent of people actually returned for their test results.

"We were really concerned that up to 25 percent of the people who tested conventionally didn't know their status," Stowers says. "With rapid testing, we know that 100 percent of our testers will receive their results."

IU Health Center looks to Positive Link

Kathryn Brown, the health and wellness educator for the IU Health Center, says the Health Center has also stepped up its emphasis on HIV prevention in recent years.

Unlike Positive Link, however, it does not provide free HIV testing. The ISDH also requires the IU Health Center to conduct confidential testing rather than anonymous testing, meaning it must report all positive test results.

"I wish we could do anonymous tests so we could bring in more students to get tested," Brown says.

She says the IU Health Center has a great relationship with Positive Link. Because it cannot offer the same benefits as Positive Link, the Health Center partners with it once a year for a free IU HIV Test Day at the Indiana Memorial Union.

"HIV testing is very important on a college campus," Brown says. "We've seen an increase in the number of students who get tested each year. But most students who are educated on HIV testing go to Positive Link."

Despite fickle funding, future looks bright

Since it began offering HIV testing 15 years ago, Positive Link has worked to keep testing costs affordable. Stowers' work now focuses on providing free, rapid testing. But unfortunately, Positive Link remains on the bottom of the funding food chain.

"Basically, how our prevention money comes down to us starts with Congress approving a bill," Stowers says. "Then it goes to the Center for Disease Control, and they fund the Indiana State Department of Health, and the state funds us. So if there's a cut anywhere in that chain, it affects us. We're at the very bottom of that chain."

Nevertheless, Positive Link makes every effort to provide free testing. When Positive Link made rapid testing available two years ago, it offered it for free until last summer, before state funding cuts forced them to charge.

The state increased funding in January, allowing Positive Link to offer free, rapid testing once again. But Stowers recognizes the feeble nature of financial support.

"Funding is up in the air frequently," she says. "When we're able to get free tests, we do free testing. Right now, we know we'll have free testing through May. After that, we may or we may not. We never know."

But even funding cuts don't interfere with Positive Link's mission to provide affordable testing, says Prevention Coordinator Brinegar.

"Even when we charge for rapid tests, we typically lose money because we establish the price as close as possible to the actual cost," Brinegar says. "If people have to pay for the test, we want them to get it at the most affordable price."

Funding for testing is an issue Stowers and her team plan to gear their work toward in the coming years. But for now, the prevention team at Positive Link remains optimistic and proud of the leading and promising prevention division they created.

"The money for HIV prevention has always been there, but it hasn't been in Bloomington before the last couple years," Stowers says. "We simply saw it as a need to do more work in prevention, and we went for it."

Risha Koli can be reached at .