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Caseworker for AIDS deals in fear Awaiting test outcome is 'longest week' in patient's life

THE BALTIMORE SUN

The day after tennis great Arthur Ashe announced he had AIDS, Linda S. Stromberg's office in the Carroll County Health Department was swamped with calls.

More than 20 people wanted an appointment for a free, confidential test for HIV and AIDS.

A registered nurse, Stromberg, 39, became the county's only caseworker for acquired immune deficiency syndrome last August. Each week, she tests as many as 20 people who are worried that past behavior has put them at risk for the fatal

disease.

It takes a full week to get results from the test.

"That is often the longest week in a person's life," she said.

At first, Stromberg knows her patients only by a four-digit number, which is affixed to both a questionnaire and a blood sample. Patients answer blunt questions about sexual behavior and drug use. The blood is forwarded to a lab in Baltimore, where it is tested for human immunodeficiency virus antibodies.

During those seven days before results are returned, panicky patients call Stromberg, asking for reassurance. The majority of those tested, she said, are at relatively low risk and receive a negative result.

If the test is positive, the patient becomes a name, no longer an anonymous number, and she makes a follow-up appointment.

"As calmly as I can, I help them understand what a positive test means," she said. "It's not an immediate death sentence. There is no cure, but we have weapons in our arsenal that will prolong people's well-time."

She double-checks with another test, which also counts the number of T-cells in the blood. That count shows where a patient is in the infection's cycle.

"T-cells are the body's main line of defense against infection," she said. "Normally, a person has 800 to 1,500 T-cells, which mobilize to fight everyday infections. In AIDS patients, that count drops to 200 or below, and they become susceptible to illnesses that healthy people ward off routinely."

Stromberg has continued to work with six of those patients since they were identified.

"It's heart-rending to see what happens to them," she said. "Their immune system is so weakened that they are susceptible to all sorts of infections. It's a real emotional roller coaster, which takes a toll on everyone involved."

Usually, only a "core group" knows the patient, who often feels ostracized because of the illness, she said.

The patients want their condition kept secret and typically ask her to visit "incognito."

Instead of a uniformed nurse in a Health Department vehicle, their neighbors see a visitor in casual clothes getting out of her family station wagon.

"There's still a lot of fear out there," she said. "Some people are afraid they can contract the disease through casual contact.

"The only way to get AIDS is through sexual contact, shared needles or a needle-stick injury, or in rare cases -- one in 50,000 -- through a blood transfusion."

During Stromberg's visits, she assesses the patient's needs for medical assistance, equipment and home health care. The most pressing needs usually are for housing, transportation and money for medications, she said.

She takes all the necessary precautions and said she never fears for her own health.

"We are much more of a threat to them, health-wise, than they are to us," she said. "Our germs are overwhelming to them."

When the T-cell count drops below 200, she advises a patient to stay away from crowds of people and to stop working.

"I may refer them to a physician here, a hospital in Baltimore or to the hospice."

Carroll County General Hospital has treated AIDS patients, said Deanna Dell, vice president of the hospital's patient care services.

"We are certainly capable of handling them," she said. "Sometimes they are referred through a private physician here."

Stromberg said Carroll "is deficient" in doctors willing to deal with AIDS patients. The Health Department lists only four. Dr. Chris Conyers, a family practitioner in Hampstead, said the lack of physicians dealing with the county's AIDS patients may not be due only to unwillingness.

"AIDS is a relatively new disease, and recently trained doctors are more comfortable treating patients with it," he said.

For the 10 years before Stromberg began her job here, the Health Department recorded 24 cases of AIDS. Half those patients have died.

In the past nine months, the list has grown by at least six more countians. Conservative estimates say that number will quadruple by the end of the year.

"I wouldn't be surprised if that happens," she said. "Carroll County is no different from the rest of the state."

Conyers agreed. His practice includes several AIDS and HIV-positive patients. He said many more patients with the illness live in the county and get care elsewhere.

"In this county, we have AIDS patients from every risk group, including heterosexuals and women with children," said Stromberg.

Conyers said Carroll County has the resources and equipment to care for those patients. He said he was impressed with the staff of the Health Department, especially in the home-care and counseling areas.

Stromberg sees education as the best way to stem the tide of the epidemic. She frequently lectures to middle and high school students and to parent groups.

Recently, she gave a class on sexually transmitted diseases as part of the seventh-grade Family Life Unit. Many of 12- and 13-year-old boys questioned her about AIDS.

To explain the phases of the disease for the children, she drew a chart on the blackboard. The spectrum-of-illness graph begins with the point of infection and shows the virus' progression from a positive HIV test to full-blown AIDS.

"A person could have this disease for years before even looking sick," she said. "You don't have to sleep with hordes of people to get it. Teen-agers who make one mistake can get it.

"This virus doesn't discriminate. It only cares whether you give it an opportunity to enter your body. And, once it's there, doctors can't do anything to get rid of it."

As she discussed the behavior that puts people at risk for the disease and stressed abstinence, the children were attentive and concerned.

When she asks how to avoid the illness, several replied, "By not having sex."

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