UNHERALDED FOOT SOLDIERS TURNING TIDE IN SYPHILIS BATTLE

Indianapolis No Longer Tops The U.S. In Cases, Thanks Partly To
Disease Intervention Specialists.

Juanita Haywood clutches a small canister of Mace in one hand, an
envelope marked "confidential" in the other.

Ever vigilant, Haywood rattles the front gate before unlatching it.
The air is still. She has not surprised the home's occupant. Nor does
there appear to be an attack dog on the premises.

Haywood proceeds to the front door, but no one responds to her
repeated raps.

With a sigh, she leaves the envelope behind -- a warning about a
serious matter: sexually transmitted disease.

Haywood is part of a little-known cadre of Marion County public health
workers called disease intervention specialists, whose efforts have
helped lower the county's syphilis rate. Their mission: to track down
people who have been exposed to syphilis and other sexually
transmitted diseases, including HIV, gonorrhea, and chlamydia. But
that's only the first step. The operation isn't a success unless those
at risk get tested and seek treatment.

The federal Centers for Disease Control and Prevention recently
credited the county and its 11 disease intervention specialists for
reducing local syphilis cases -- the vast majority of which occur
among blacks. Since 1999, when Marion County ranked worst in the
nation, that rate fell from 407 to 301 in 2000.

And the numbers have continued to decline this year.

Dr. George W. Counts, assistant director for syphilis elimination
activities at the federal agency, said Marion County is "making
excellent progress."

"I think we'll always have a little bit of syphilis," Haywood says.
Experts attribute much of the syphilis problem here to crack cocaine
use and unprotected sex, often involving prostitutes. "I know they're
shooting for zero. I won't say it's impossible -- nothing is
impossible -- but we're working with human beings here."

Locating the sexual partners of those human beings isn't always easy.
When someone tests positive for a sexually transmitted disease at a
health department clinic or hospital, public health workers interview
the patient and try to compile a list of others who may have been infected.

Sometimes -- as in the case of a married minister who'd had an affair
with a woman in his congregation -- people lie. Sometimes -- as in the
case of a drug-addicted prostitute -- people try to help but simply
don't know the names of all the people they've had sex with.

That's when the public health workers play detective. On a recent
afternoon, Andrea Suhrbur and Kerrie Kikendall knocked on half a dozen
doors looking for the steady boyfriend of a prostitute who'd tested
positive for syphilis. They knew only his first name.

Their first stop was a tiny, dark house that smelled like a cross
between a foundry and a horse barn -- the woman sometimes works out of
the basement. The owner of the house told Suhrbur and Kikendall what
kind of car the man drives, as well as the general neighborhood where
he lives. He told them to look for broken-down cars in the driveway.

The women knocked on one door, then another, asking for the boyfriend
by his first name. Ultimately, Kikendall walked out of a dilapidated
house flashing her partner a thumbs-up. Not only had she located the
boyfriend, he'd agreed to come in and get tested.

"Sometimes you never find them," Kikendall says. "Sometimes they don't
even exist, and you spend three days chasing somebody completely bogus."

Embarrassment is part of the problem. When people come to the county
health department-operated Bell Flower clinic for testing, they don't
have to show identification. They can make up a name or address to
retain their privacy. They may provide a fictitious list of partners
just to get the public health workers to leave them alone.

Many patients are unaware of the strict confidentiality law that
prevents the Health Department from revealing their personal
information, even to other government agencies. They worry that if
they list the correct address, bill collectors or the police may come
looking for them. But their fears are unfounded -- the information is
kept secret.

Teen-agers are often the most deceptive, Haywood says.

"They're the hardest ones to deal with because they're trying to hide
stuff from their parents," she says. "They're having unprotected sex
at alarming rates."

When a parent answers the door, confidentiality law prevents Haywood
from telling why she's there. Some parents accept Haywood's envelope
and agree to pass it along. Others harass her to tell them what's going on.

Some haven't seen their children in months.

The disease intervention specialists know they'll never find everyone
on their target lists, so they work proactively, too, heading out to
neighborhoods on the Near Northside, Near Eastside and Eastside, known
as "hot zones" -- where the syphilis problem is more concentrated.
There, they offer free blood tests to groups of people hanging out on
the streets. These same areas often also have high crime rates, since
prostitution and intravenous drug use increase the risk of contracting
sexually transmitted diseases.

One time they were taking a blood sample from a known drug dealer on
the man's front porch. "Another guy pulls up in a car, starts an
argument, and pulls out a gun," Kikendall recalls. She ended the
procedure abruptly and high-tailed it out of there.

These details often are left out of family discussions, she says. "I'm
afraid it will scare them."

Haywood, who is single, is more leery of men and more careful in
relationships because of her job; she once asked a boyfriend if she
could take a blood sample to check for sexually transmitted diseases.
He agreed and came back clean.

So what motivates these health detectives? Certainly not the salary,
which ranges from $25,600 to $38,313 annually -- and no extra pay for
this hazardous duty. Most of the money for their salaries and the
county's other efforts to eliminate syphilis comes from grants from
the federal Centers for Disease Control and Prevention. The federal
agency awarded Marion County $455,000 last year.

"You get to meet people you wouldn't normally meet, and go into their
homes and talk to them," Kikendall says. "Every one of them is a
learning experience."

Haywood agrees.

"I really enjoy it, which is really scary. You meet some pretty
interesting characters."

But the ultimate payoff comes from educating people about their health
and helping them to make better choices. Not long ago, Haywood left
one of her letters with the mother of a young man at risk for
syphilis, which can be fatal for newborns. Within a few hours, he
called to make an appointment.

"He said, 'My girlfriend is pregnant. Does she need to come, too?' I
said, 'Yes!' "

Both tested positive and were treated immediately, saving the baby.
Haywood keeps those moments in mind as she knocks on yet another door,
envelope marked "confidential" in her hand.