On Dec. 9, the Orange County Health Department will host a media event (to be attended by Orange County Mayor Richard Crotty) at its Lake Ellenor administrative offices in an effort to reposition itself on the public perception radar. This is a time when public health seems to be on the tip of everybody's tongue. Long considered an institutional eyesore and an intimidating proposition altogether, OCHD is set on reintroducing itself as the vital resource that it is, even launching plans to redecorate its satellite spaces to make them more appealing. Beyond the standard free HIV and sexually transmitted diseases testing and the much-utilized women's services, the department offers an extensive menu of services, programs and resources for the citizens of Orange County; some are eligibility-based and some not. Currently, the department is reaching out into the community to confront some pressing issues and to face the controversy those "issues" imply. We sat down with OCHD director Dr. Kevin Sherin, along with HIV/AIDS program coordinator Debbie Tucci and epidemiologist Bill Toth to look deeper into what they are up against.
Orlando Weekly: In general, what's the credo of the services you're providing?
Kevin Sherin: Our big mission statement is: "Leading the way to healthier communities." So our purpose for being here is to try and work with the community to make this a healthier community. We do that through a whole variety of services – everything from soup to nuts. What we try to do is diagnose health issues and make sure that the community is working together, and that the parts of the health equation are working together to try and solve these issues.
OW: Do you think that people know that?
Sherin: I think there's a large group of people who probably don't know we're here. And the people who use us for services would probably know the types of services that we provide. Largely, health departments in Florida are seen as clinical providers to poor folks. But they are more than that, and they do more than that.
OW: Are there efforts going on within your health department to reach out further, as far as changing that perception?
Sherin: Yes, and I think given the history here, it's going to be a long-term process; it's not going to happen overnight. We're going to do as many different things as possible to try and reach the community and let them know how they can work better with us. The public health system is more than just the health department: It's your hospitals; it's your specialists; it's your primary-care physicians; it's all the people in your community-based organizations – everything from law enforcement to schools.
OW: Considering what happened in New Orleans, is crisis preparedness something that's constantly on your mind?
Sherin: Yes. I had just started here, and four days after my family moved into our house, the back end was ripped off by Charley. So, yes, preparedness is on our minds and not just because of hurricanes. We have a whole office that just works on preparedness, and they are working with the community. And again, community is part of this. It can't just be one little department that's working on preparedness – it's EMS, the employers, the schools, the airport; it's the tourism industry. That's why we have this little prop today. [He hands us a bottle of hand-sanitizer.] Talk about bird flu, this is the No. 1 way to prevent it. Wanna wash your hands?
OW: All of a sudden, I feel very dirty.
Sherin: [Laughs.]. If we could grow a whole culture around the issue of hand-washing, probably, as our epidemiologist has told me, 70 percent of the infectious diseases in our community could be controlled – just because of this. We could do a whole lot better by protecting ourselves against bird flu, or, God forbid, bioterrorism, just by doing this.
OW: Within the gay community, both HIV and the meth explosion are seriously at issue. Is there an effort to specialize your focus on such niche groups?
Sherin: There are challenges in doing it. We're trying to focus our efforts better, but the challenges are trust levels. Historically … there were mistakes that were made. There was confidentiality that was busted. It left a lot of distrust in the gay community but also among others.
OW: What sort of distrust?
Debbie Tucci: In the past, before I was here … with HIV, whenever you tested positive, the organization had to offer partner notification in the sexually transmitted disease department of the health department. At an AIDS service organization that offers free testing, they can give a person their test result, but if that person has a partner that they want notified, confidentially … that happens at the health department level. It's called "confidential partner notification." In the past, there were some problems with the way people were located, and it wasn't done in the most confidential or discreet way.
OW: I've personally found that there's a lot of ambivalence in the gay community, and particularly in gay businesses, to even admit that there is a problem, be it AIDS or drugs. How do you get around that?
Tucci: It's hard. We haven't gotten around it. The way that we've tried to do it is to partner with the non-profits. They go out and help us spread that word around that you need to take a responsible approach. … We completely understand the business end of it. But from our perspective, for something as easy as making condoms available to people, we're willing to go up and down 441 and give out free condoms – because we get them free –to every hotel or motel, not just The Parliament House. So we're not targeting anyone. I think that was the stigma, and they have to get over a stigma, themselves.
Bill Toth: Here's an example of how we got our foot in the door with … a small segment of the gay community. We were noticing in 1998 and 1999 that we were having a pretty heavy spike in hepatitis A cases. From an epidemiology standpoint, when you go from six per 100,000 to 13.5 per 100,000, you have to ask, "What happened?" and "What can we do to intervene and make it better?" Of the 127 cases we had that year, 80 percent of those cases were among men, and some bells went off.
Then we looked a little further, and part of that interview sheet we have for hepatitis A asked if … they were having sex with men. We got the answer. Yes, 60 percent were having sex with men. Which, again, is more than you would expect. Then we looked a little further and found out that 50 percent of those were food-service workers. The probability of being a gay man in a food-service capacity and therefore potentially transmitting into communities in outbreak mode was 35 percent.
I tried to … offer at cost or for free immunizations [at AIDS service organizations], and there's where the hands started to go up. The guys … said, "Why are you picking on us?" I said, "It's just the facts, and there's got to be some way we can get you guys some shots so this doesn't go up any further."
It wasn't until we approached Joy Metropolitan Church, where there was someone there that I knew who said, "C'mon over. We'll do it between services." We took that as a lever to go over to the gay and lesbian community center and said, "We don't want to create a venue but just piggyback on something you're doing." So they tried to create a block party right there on that section of Mills [in the "rainbow district"], and none of the businesses were having it. There's that stigma again. When I went back and said, "How about a health fair? You can charge for a health fair; you can charge for booth space, and we'll provide vaccines and give the shots." And our rates dropped down from 13.5 to 6.2 within the space of a year because of that process. It took that kind of grassroots effort, and we won a national award for it.
Sherin: It's the same with the crystal meth issue. We know it's a much bigger problem; you know it's much bigger.
Tucci: I've just come from a meeting with [Mayor Crotty's] meth task force. In his area most of the labs they're busting are in the 441 corridor, the Apopka area. I asked him specifically if these labs were big enough to be supplying the numbers that we're seeing. None were. So the question is, with the number of people that we're seeing, where are they getting it? Is it the Internet?
OW: How involved is the mayor's office?
Tucci: With the crystal meth task force, Mayor Crotty wants to take the lead. He felt very strongly about putting it together. But … the education committee is wondering who are the people we're targeting, since it doesn't seem to be the big problem that it was in Polk County, at least from the standpoint of the busts. They're not seeing the soccer moms like they do in the Midwest, or the rural farm kids. When I say it's in the gay community, I only know it because I'm there. So can we say that? Do we really want to just target that community? Because I don't think they're the only ones using.
Tucci: It seems to grasp other people in other areas. In Minnesota, they have a billboard campaign showing before-and-after pictures – the dental damage, the skin spots.
OW: How hard would it be to get something like that going here?
Tucci: That's what the law-enforcement people are doing. They already have the artwork. Nobody's reinventing the wheel. By January, the next meeting of the task force, I believe they're going to bring the artwork.
Sherin: So we can run a very prevention-oriented thing, even if they don't truly get it as to what the extent of the problem is. It's controversial to say, but I think some of the reasons things are the way they are is because of the economy. To confront it, they'd have to admit there's a problem. And if there's a problem, they're going to lose tourism dollars.
OW: With health care being such a hot-button topic and with the upcoming 2008 presidential election promising heated discussions on the subject of a national health care system, how do you think local health departments will factor into the equation?
Sherin: Our main mission is health access. What are the overarching goals for the community? They're the same as the overarching goals for the system on a national level – to provide access and eliminate health disparity. If national health care comes along, it's not going to eliminate what we're doing. We're still the prevention side, and we're still going to have a need for outreach to specific populations.
We're kind of the little engine that could, and we're always going to be pushing those preventive services. I don't think that most of the health care system is as well equipped to do that.
[email protected]