STD notification team is discreet, direct

Hillsborough Health Department specialists bring bad news to those infected with syphilis, gonorrhea, HIV

Lorraine Pedro's mornings actually start the night before, with a new list of contacts and a plan for how to find them.

It's Pedro's job to locate the people whose names show up daily on her computer at the Hillsborough County Health Department. Teenagers, senior citizens, executives and prostitutes, husbands and wives. They have one thing in common.

Each is about to receive some extraordinarily bad news.

Pedro has to tell each person on her list that he or she has been infected with a sexually transmitted disease.

"This is black, white, young and old," she said. "It's everybody."

Pedro and eight co-workers at the health department are called "disease intervention specialists." To the outside world, though, they're more like sex detectives, trying to hunt down and treat infections before they spread -- and wreak physical, emotional and financial havoc.

Some people suspect something is wrong; the appearance of an unexplained lesion or pain "down there" got them to a doctor. Others have no symptoms, but a blood test revealed the presence of one of four highly contagious and dangerous infections: HIV, Chlamydia, syphilis or gonorrhea.

People who see a doctor regularly usually get their results from their physician. But plenty don't. They're flagged after taking a test at an emergency clinic or while donating blood. The job falls on the local health department to inform them, educate them about the disease, and encourage them to get further tests or treatment.

Pedro isn't the grim reaper, but she isn't exactly a welcome guest. "Normally people are not violent when you explain why you're there. … Once they calm down, they're usually nice," the fast-talking veteran agent said.

Health fairs can do only so much to prevent the spread of disease. Notification and early intervention is the next step to stop the problem from getting worse, said Carlos Mercado, STD program director for the health departments in Hillsborough and Manatee counties.

The costs associated with untreated sexually transmitted diseases are significant. The 19 million new infections each year cost the health care system $17 billion annually, according to the Centers for Disease Control and Prevention.

In Hillsborough, more than $1 million a month in future medical costs is averted by getting Hillsborough residents to seek treatment, Mercado said.

The workload is heavy. Nearly 8,500 cases of syphilis, gonorrhea and Chlamydia have been reported to the state this year. An additional 200-plus cases of HIV infection are reported each year.

Pedro and the other specialists get 10 to 15 new names a day.

The best-case scenario involves agents reaching out with a phone call and setting up a brief face-to-face meeting. More often, though, they end up using old-school investigative techniques and lots of shoe leather, visiting homes, schools and workplaces, pleading for a few minutes of a contact's time.

If the person will listen, she's discreet but direct, getting as much information out there as possible. Pedro uses polite language, but she's no softie about breaking the news. "You may not get them again," she says of her attempts to notify people and encourage them to get treatment. "You try to knock it all out the same day."

The youngest person Pedro ever had to break the news to was 14 years old. The oldest was 87, in Miami, where she spent three years notifying contacts in the late 1990s. Since coming to Tampa in 2006, she has met contacts in nearly every neighborhood in Hillsborough County, from upper-middle class subdivisions in Valrico to mobile homes on dirt roads in Wimauma.

In a single day, Pedro will reach out to teenagers still in school and middle-aged professionals; she'll talk to young wives on their way out to the grocery store and professional dancers working at strip clubs along Nebraska Avenue. Everyone gets the same introduction and treatment.

If her phone calls are ignored, Pedro visits the home, carrying a plain white envelope. In it is a letter requesting that the person call the health department for important information. It's intentional that no details are given.

Pedro handwrites the contact's name across the front of each notice she serves. Then she adds a red stamp, marking the letter "CONFIDENTIAL." Knowing a lot of people won't be home when she knocks, Pedro carefully crams the envelope into the door jam so only someone with a key can retrieve it.

She notices whether the blinds are drawn, or whether there are newspapers in the driveway. She listens for a barking dog or a TV playing inside. She never drives off right away. The contact may come out a few minutes later while she's still jotting notes. Or a neighbor might stroll by and say when the contact is usually home.

The CDC spends six months training local notification agents. That's where Pedro learned to back into parking spots to avoid showing her license plate.

Contacts who don't call back may get a visit at their workplace or, for high school students, at school. It's not unrealistic to spend hours in a lobby waiting. In public settings, Pedro tucks her Health Department badge in her pocket and calls herself "a friend" of the person she needs to notify.

A phone call or meeting can last minutes or hours. It depends, Pedro said, on how forthcoming a contact is about sexual partners, or whether the person will consent to additional blood tests to clarify the level of infection. Success comes when a contact confirms he or she is getting medical treatment and shares the names of partners who also may be infected.

Realistically, however, investigators know they can't reach everyone. Sometimes the best they can do is give boxes of condoms to bartenders at clubs where sexual activity is commonplace.

Pedro says she won't give up easily. She recently reached out to a young man infected with HIV who agreed four times to meet. He never showed. Pedro waited for an hour outside a fast-food restaurant before admitting she had to close the case she had spent weeks pursuing.

"We've done our job," she said. "He's obviously avoiding us."

A 22-year-old Tampa woman avoided Pedro's phone calls and letters for several weeks last month.

It was at the woman's insistence that she and her husband of six months went to the county health clinic after she discovered a lesion on his penis,a common early sign of syphilis.

Then, when their results came back, the husband called Pedro to discuss his infection, but the woman didn't. "Just 15 minutes in person," Pedro pleaded, when the woman, who asked not to be identified in this story, finally called. Knowing she might balk if given too much time, Pedro pressed and got the newlywed to head to the health department within the hour.

Confidentiality laws require that agents share information with each partner. "We cannot depend on him or give him the responsibility to tell her," she said of the husband.

After they talked, the woman admitted that humiliation and anger kept her away. Hearing that she is infected with syphilis sounded a death knell for her short marriage, she said.

"It's embarrassing. I'm going to get a divorce," she said, crying.

At the same time, the woman said she was grateful Pedro was persistent and patiently answered her questions about the infection, including the long-term risks regarding pregnancy.

"It's the best feeling in the world that someone out there cares about my situation," she said. "My health is important. If my health is on the line, I want to know."

The Health Department's mission isn't to pass judgment. The focus is on preventing the spread of diseases such as Chlamydia and gonorrhea, which can be cured with antibiotics. Left untreated, STDs can lead to long-term complications, including fertility issues.

Sex wouldn't be treated so frivolously if people spent a day with an investigator, Pedro said. Imagine looking for a young female college student infected with HIV. Or a senior betrayed by a longtime spouse. Or interviewing a man who admits he told each of his 31 sexual partners that she was "the only one."

"People still have one-night stands," Pedro said. "They still have sex in the back seat of a car after a night of clubbing."

She doesn't feel guilty about ruining someone's weekend or vacation, she said. Her goal is to prevent that person from having unprotected sex.

"I have this ability to make people lose sleep."