The Unwanted Test
A tenth-grader at G. Holmes Braddock High School has been keeping a secret from her fellow students: She is HIV-positive. It is her private burden, one she has been shouldering since she was a little girl. But Brandy (not her real name) had a moment of panic a couple of weeks before the school year ended. A group came to Braddock High and tested more than a hundred students for the virus. Even though the testing was voluntary, it didn't feel that way to Brandy. She was afraid other students would wonder about her if she refused to take the test. "I already knew I had it so I didn't want to take it, but I felt like I couldn't say no," she asserts. "They made it seem like it was part of the class."
Brandy came home from school upset and told her mother, who was dismayed there had been no parental notification for a procedure as invasive as drawing a student's blood. She called the school but says officials claimed not to know anything about it. There's a good reason for that. According to school district officials, HIV testing is almost never performed at schools. The exception is that testing does occasionally occur in schools with full-service health clinics. "It's not our policy to do testing at school sites," says Jacquelyn White, district supervisor for HIV/AIDS education. The district's own Website, which lists its policies and procedures regarding HIV education and testing, clearly advises employees to refer students to the county health department if they want to be tested or feel they may be at risk.
So what happened? According to district officials, a navy Junior ROTC instructor at the school, Cmdr. William Welp, asked a local organization to do a presentation and offer testing to cadets in his class. The organization was the National School of Technology, a training institution for medical personnel with a campus in Kendall. The NST is not registered with the county health department to conduct testing, but NST brought along Care Resource, a well-established agency that is. Ronny Barnett, who runs the youth-health intervention project for Care Resource, says the JROTC kids wanted the service and that their parents "signed consent forms and everything."
The hitch occurred when the room NST and Care Resource planned to use wasn't available, so the presentation was moved to the Braddock gymnasium. Barnett was asked to bring literature for up to a thousand students. "There were gym classes going on and some of the teachers requested we include their classes," Barnett recalls. "I was concerned and let [NST organizers] know: 'Hey, we have a lot of other kids involved here.'"
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But NST was not concerned about that. And neither, apparently, was the school, which failed to inform the school district's HIV/AIDS Education Program. Normally all campus presentations are supposed to be scheduled through this office in order to assure that correct procedures are followed in discussing a sensitive subject. "This office should be notified," confirms White, adding that after New Times informed the district of the testing at Braddock, she spoke with Care Resource and the school's principal so it doesn't happen again.
Several hundred students attended the presentation, which lasted about 45 minutes and was conducted by both Care Resource and NST. Students were then told that a mobile testing unit was outside if they wished to be tested for HIV. More than one hundred were tested. Care Resource provided counseling to students while student nurses from NST conducted the actual tests. Most students had their blood drawn, while some opted for the less invasive saliva method of testing. "NST did the blood-drawing," Barnett says. "That's why they organized this."
Care Resource then sent the tests to a lab and returned to Braddock with the results. Those who wanted their results were instructed to come to the front office. The tests were anonymous; students were identified only by a number. Barnett claims that a majority of students picked up their results, but happily, no one tested positive.
Barnett's recollection matches that of several Braddock students found hanging out at the school's baseball fields last week. None wanted to be quoted, but the general consensus was that an announcement was made -- anyone who wanted to go to the presentation or be tested could get out of regular class to do it. Brandy describes a slightly different experience. She says the students in her personal-fitness class were told that instead of regular class, they would be going to the gym. She got the impression it was not voluntary. "It was part of class time," she says. "Nobody signed a paper or anything. People were saying, 'What is it for?'"
Few would object to educating students about one of the most destructive diseases of our era, and Florida law does allow children to be tested without parental consent. But testing doesn't normally occur in schools because generally they are not qualified to deal with the potential aftermath of a student receiving a positive result. "You really need to ensure that the adolescent has the emotional and intellectual capacity to understand the pros and cons of taking the test," explains Ketty Ledan, director of the Miami-Dade County Health Department's early intervention program.
William Blouin, a nurse practitioner in clinical immunology at Miami Children's Hospital, treats a number of children with HIV and AIDS. Blouin was extremely concerned to hear about Brandy's distress and the "haphazard" manner in which he believes the school allowed the testing to occur. From long experience he knows that many kids with HIV are constantly afraid other people will somehow find out they are infected and shun them. He also thinks a school is not the right place for testing because discovering you have the virus is emotionally devastating. He thinks it's the kind of thing that would be better handled by healthcare professionals who are fully prepared to treat an adolescent. "We know suicide is an issue for children in high school," he says. "We know peer pressure is an issue for children in high school, and they may not feel like they can opt out of testing. As much as I don't want to see HIV spread further than it has, I can't see that [schools] are well equipped for this."
Junior ROTC is an elective high school course generally taught by retired military personnel. It is unclear whether Welp was familiar with the district's rules regarding HIV education and testing, or how his effort expanded beyond his class. "No one was forced to do the testing," Welp maintains. "Nobody's arms were twisted." He referred all other comments to the school's principal, Manuel Garcia, who did not return several calls. Neither did Marisol Quiñones from the National School of Technology, who Barnett says organized the school's involvement. (The health department's Ledan says that because NST is not registered to provide testing, there may have been a breach of protocol. "We will investigate," she promises.)
Care Resource's Barnett admits it was unusual to be asked to perform testing at a school site, but he defends what happened at Braddock. "The students were pleased because they don't have services out there," he argues. "A lot of them are sexually active, let's face it."
There are some unexplained discrepancies in the story New Times was able to piece together. For instance, district officials and Welp say nearly 1000 students participated in the presentation, but Barnett guesses the number was more like 300 to 400 kids. The district says about 180 students were tested, but Barnett claims the number was closer to 130. And Barnett says none of the students tested positive. Yet Brandy says she was among those tested and she has been HIV-positive for years.
Barnett expresses confidence in his testing. "The lab doesn't lie," he insists. "I think you were misinformed by this young lady. Your information was definitely incorrect." Blouin, however, says there is always a small possibility for a so-called false negative result, a possibility that increases during mass testing. The consequences of a false negative, he adds, can be dire because it creates a false sense of safety. Even worse, for those who already know they're infected, it can provide an excuse to deny the truth. "Denial is a very primitive defense," Blouin says. "I've had kids who've decided they don't have it and stop taking their medicine. One child always sticks in my mind. He decided to stop taking his medicine and was dead two years later."
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