SHE TELLS IT LIKE IT IS, BUT DELICATELY

Mary Jay was already six weeks into her new job, though Tuesday was her
first real day out in the field, which is how she found herself in a Toledo
crack house.

"It was my first time in a crack house, actually, although I've worked with
lots of people who use crack,'' she says.

Before this latest job, Ms. Jay worked for several years at David's House,
helping HIV-positive people. And before that, she worked for a drug and
alcohol program.

"It seems every task I've done in the past led me up to this [job]. I take
it very seriously,'' says the 36-year-old. "It's an important role.''

Tough, too. As the new member of the Toledo-Lucas County Health
Department's partner notification team, it falls to Ms. Jay and her
colleagues to deliver the news to individuals who test positive for
syphilis or HIV. "We contact them and get them treated, and we ask them
about partners, people they've possibly gotten it from or possibly given it
to. And we continue, we contact them and get them treated.''

As she describes this process, I can't help but think of Ms. Jay's job as
something like a Moebius strip of sexually transmitted diseases, a
never-ending, twirling strand of information the notification team must
chase down.

"Yes,'' she says, answering the first and most obvious question I toss her
way, "it can be very awkward. To be successful in this job, you have to
have a certain finesse, you have to be able to make people comfortable. We
stress confidentiality. I'd never call you and say, 'Hey, guess what? Bill
Jones says he had sex with you.' It's handled very sensitively.''

For one thing, it's not done over the phone. "We arrange a meeting with
them, either at their house, or here at the office, or some other safe
meeting place. When we call, I say, 'We need to talk to you about an
important health matter.' And if they hedge, I say, 'You need to take this
seriously.'''

Most people do. Ms. Jay: "Usually people are very happy to meet with us.''
That's how it went in the crack house.

"This person was identified as a dope dealer, and this was the only way to
find him. And he was very nice. But when we first went to that gentleman's
house, we had to say, 'Look, we're not the police.' We showed our county
badges. If he thought we were the police, I'm sure he would have treated us
very differently.''

The notification team isn't the real police, or even the sex police: "We're
not judgmental. Otherwise, people won't talk. We always tell people, 'We
don 't care what you're doing, we just want to know who you're doing it
with.'''

This is street-level public health. Ms. Jay says the Centers for Disease
Control aim to not only control but eliminate syphilis, using just this
sort of protocol.

At a training session last week in a local hospital, Ms. Jay learned of a
10-week-old infant "with all the classic symptoms'' of AIDS, and it got her
thinking.

"Maybe partner notification way back when could have saved this child from
HIV. I can't stress enough how important our work is for the community, and
I don't just mean in the crack houses. The people [in this job] before me
have been out to houses in very wealthy neighborhoods, and it's just a
matter of time before I get out there, too. This is not just an inner-city
problem.''