On the surface, it’s one of the simplest and most straightforward tasks for our AHF team — testing patients for HIV and giving results. But on this week’s episode, we dive deep with two of our HIV testing counselors about their important, sometimes complicated role at AHF and how it goes far beyond that initial test.
After the Test
Exploring the essential role of AHF’s testing counselors
GUEST BIOS:
Steven Holmes is an HIV testing counselor for AHF based in New York City.
Randy Hubing is also an HIV testing counselor with 14 years of experience at AHF.
CORE TOPICS + DETAILS:
[1:44] - More than Testing
The vital role of HIV testing counselors
What does an HIV testing counselor do? It’s more than just getting a “positive” or “negative.” HIV testing counselors also encourage people to improve their sexual health and habits, make safer choices, and understand the history and context of HIV — particularly in the gay community.
Testing counselors also help those with positive results navigate into the next step — helping them feel comfortable, cared for, and prepared for what comes next both in their lives and in their relationship with AHF as a patient.
[8:54] - Connections and Invitations
Meeting people and getting them tested
How do our counselors connect with individuals and encourage them to get tested? It starts with the confidence to speak openly with people from all different backgrounds — “Hi, my name is Randy, and we’re going to have about 20 minutes of conversation about sex.”
That level of comfort doesn’t come easy. It’s cultivated and mastered over time by our expert counselors. After all, that willingness to connect with individuals about sometimes taboo topics could save a life.
[14:14] - Why Testing Matters
Honoring history by refusing to repeat it
Steven and Randy recall the early 80s, when so little was known about HIV that it was being referred to as “gay cancer.” Back then, things like testing, counseling, and organizations such as AHF were nonexistent.
Today, all those resources exist — and it’s in patients’ best interest to take advantage of them. Not only does early testing lead to better outcomes, but from the viewpoint of older activists like Randy who can list loved ones who suffered and died in those early, ignorant days, it’s an act of tribute to those who didn’t have an option to test or receive support.
[19:13] - Testing Positive: What to Expect
What happens when a patient receives that difficult news?
Randy and Steven walk us through what it looks like for a patient who tests positive.
First, it’s important that they understand the initial “one-line-or-two” test is a screening test, not a diagnosis. In all likelihood, a positive result means they have the virus — but not always. Additional testing, such as a blood test, is required for a confirmed diagnosis.
That said, linkage between the patient and AHF begins immediately. They’ll receive support, contact information, and all the info they need to feel informed and empowered about their potential diagnosis. In many cases, they’ll even have the opportunity to start on medications before that confirmation test comes back.
The sooner you start medication, the sooner you become what’s known as undetectable — that means the virus is present in such small quantities in your body that it’s not actively affecting the immune system and is significantly less likely to be passed along to someone else.
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ABOUT AFTER HOURS:
AIDS Healthcare Foundation is the world’s largest HIV/AIDS service organization, operating in 45 countries globally. The mission? Providing cutting-edge medicine and advocacy for everyone, regardless of ability to pay.
The After Hours podcast is an official podcast of AIDS Healthcare Foundation, in which host Lauren Hogan is joined by experts in a range of fields to educate, inform, and inspire listeners on topics that go far beyond medical information to cover leadership, creativity, and success.
Learn more at: https://www.aidshealth.org
ABOUT THE HOST:
Lauren Hogan is the Associate Director of Communications for AIDS Healthcare Foundation, and has been working in a series of roles with the Foundation since 2016. She’s passionate about increasing the public visibility of AIDS, the Foundation's critical work, and how everyday people can help join the fight to make cutting-edge medicine, treatment, and support available for anyone who needs it.
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Lauren Hogan:
Get unfiltered lessons from our leaders at AHF as we uncover real raw stories of where we came from and where we are going. Join us for an unscripted look at the connections our senior leadership have to our mission, core values, and hot initiatives. AHF is the world's largest HIV/AIDS service organization operating in 45 countries globally, 16 states domestically, including DC and Puerto Rico. Our mission is to provide cutting edge medicine and advocacy regardless of ability to pay.
Hello and welcome to the After Hours Podcast. I'm your host, Lauren Hogan, serving as your liaison to take you through this journey to learn more about AIDS Healthcare Foundation. Before we start the show, please make sure to remember to check out the show notes so you can follow along. Now, let's get started.
Hello, everyone and welcome back to another episode of the After Hours Podcast. As always, I'm your host, Lauren Hogan, along with my lovely co-host.
Sean Little:
Hello, hello, hello. My name is Sean Little. What's up?
Lauren Hogan:
Today, we've got some special guests with us and we're going to be talking about a very important topic. Really quickly, I just want to go around the square and have everybody introduce themselves. Steven, we're going to start with you. Just tell us where you're based and what your role is here at AHF.
Steven Holmes:
I am Steven Holmes. I'm here based in New York City, and I'm a HIV testing counselor.
Lauren Hogan:
Randy?
Randy Hubing:
Good afternoon from Florida, Fort Lauderdale. My name is Randy Hubing. I've been testing for over 12 years with AHF, with the company over 14 years. Good afternoon to all of you.
Lauren Hogan:
Thank you guys so much for being here with us. First things first, please tell what is an HIV testing counselor. Randy, I'll turn it over to you.
Randy Hubing:
That's a very easy question to ask, but a hard question to answer. The easy answer is you do a test, you give the results, and they go on their way. If it's not a negative result, we put them into care. The more nuanced answer might be something like encouraging people to perhaps change their sexual habits to something that might be more safe. I have an advantage of being a little older and talking to much younger people about HIV/AIDS.
Even just historically, it's something that they probably haven't heard directly from a guy like me. It's important to tell young people about HIV/AIDS, the history, and to really encourage them to work on being safe. Today, we have more than one option as far as safe sex and it really is important that especially young gay men, men who have sex with men, are aware of those options.
Lauren Hogan:
Steven, do you have anything you want to add?
Steven Holmes:
Yeah, sure, because I could be long breath. I could just keep going about it because this is something I'm passionate about. An HIV testing counselor role, of course, HIV testing. You're a HIV tester, which means you do HIV tests. The testing portion of it. And then of course, there's a counseling portion of it, which I love to do. Just basically teaching whoever's in my office.
Depending on what the situation is and what they're going through, teaching them what the tests we're doing, what kind of habits they're going through, and just giving them, what you would call it, just advice on how to maneuver what they're doing and just leaving them with a good thought of doing safe practices with sex. Just to keep it simple, testing and the counseling portion and your HIV testing counselor. Basically that's what that is to me.
Lauren Hogan:
I want to go back to the beginning part of what you said and ask this. What made you become an HIV testing counselor?
Steven Holmes:
It's my third or fourth month here at AHF as far as a testing counselor. How I got started personally, I used to work at this hospital here in New York. It's called Brooklyn Hospital. I got introduced to it because someone... I'm a client at Brooklyn Hospital. Someone that works there came to me and was like, "Hey, there's a position open. Do you want to be an outreach specialist? Not an HIV counselor, but an outreach specialist." I was like, okay. Well, I'm not doing nothing at the time.
This was more than 10 years ago. I was not doing anything at the time. I was younger. I was like, hey, I'll try it. Once I got into the habit of doing testing, going to outreach, talking about what we did at Brooklyn Hospital, and it was just something I came to love. Also, just to put it out there, why I'm so passionate about it, I am a living testimony. I've been living with HIV my whole life. My mom gave it to me. Unfortunately, she did pass away. She had other things besides HIV on top of it.
She passed away about more than a decade ago. When I got into testing and thought about this is my opportunity to teach people and also teach myself about HIV, this virus that I also have myself, and just growing and hopefully learning and teaching others along the way. That's how I got into testing. And now that I'm at AHF, which is amazing, I got the opportunity to come back here through my boss, Jason Hill. He came to me and was like, "Hey, so and so and so. Do you want to be on my team?"
I was like, you know what? Sure. This is what I wanted my whole life. Fun fact, before we continue, I used to work for AHF. I would technically say this is my 10th or ninth year here. I was a cashier out of deposit for eight years. I had to leave on personal reasons. Came back when Jason messaged me and now I'm here. Now, it's my opportunity to shine and let them know what I really can do.
Lauren Hogan:
You are just a walking AHF Testament. We love that. Thank you. Randy, I'm going to turn it over to you, if you could share a little bit about why you decided to become HIV testing counselor.
Randy Hubing:
I moved to Fort Lauderdale and walked past the door and out of the closet. It said part-time cashier. Sure enough, I landed in the cashier position for about a year, and then I started testing. It really has been an opportunity to learn about the human condition. Because everybody who comes in, every single person who comes into this office has a different story. You do the test, the casual conversation. That's all fine.
But at some point it often gets down to very basic communication, honesty about things that they may not be able to talk to anybody about, not their family, not their church, not their doctor, things like that. It's so rewarding to have someone walk out and say that they felt comfortable talking to me, something like that. But anyway, I just love doing this kind of work. I'll be frank, I was surprised that I really like doing this kind of work. I certainly was fearful when I first started.
Oh my gosh, what if there's a reactive test? I mean, what am I going to do? And now it's gotten to the point where I feel like if I was going to be told that I might have HIV, I would like it to come from somebody who might be a little older, somebody who might be confident in the next steps, things like that.
Lauren Hogan:
Thank you so much. Next thing I want to get into, so you guys talked about the process and the aspects of being an HIV testing counselor. How do you connect with individuals in the community and encourage them to get tested? Randy, we can start with you again.
Randy Hubing:
I live in an area of Fort Lauderdale that has a lot of men who have sex with men, a lot of gay men, and that automatically starts a very honest conversation between the two of us. I think over the years I've become very good with talking to all sorts of people, different races, different languages, all of that. It really is a matter of attitude when people come in here. "Hi, my name is Randy. We're going to have about 15 to 20 minutes of conversation about sex, drugs, health."
It often evolves into something that involves more like personal things, relationships, what does love mean, monogamy, not monogamy. It's amazing how things can move in a conversation like that. I like to say that if this wasn't all confidential, I should write a book. But I won't be doing that. But anyway, that's what happens in this room.
Lauren Hogan:
Steven?
Steven Holmes:
As far as the connection between the community and us, because I was thinking and listening to Randy, as a Black gay man of the LGBT community and I've been out for a while and just maneuvering myself as such, most of the people that come into my room are from the LGBT community. That's one of my focuses too as well. I'm open to talking to anyone who's willing to listen, be educated, and who basically cares about their health. Once you're in my room, I know that somewhat you care about your health and you want to be educated.
Once they meet me and just let them know who I am as far as I can connect with you, which means I'm a person who has HIV and takes care of themselves, meaning that it's not a death sentence anymore. There's a lot of ignorant people in the world. Just basically connecting with someone on another level where we've all been sexually active, especially at a young age or whenever a person may have started. But just letting them know, hey, this is not a death sentence.
If I had to tell somebody, they're positive, giving them that process of thought of, listen, I know where you are right now, so forth and so forth. Just letting them know that we can connect in a way because, like I said, most of the people that come through my door is from the LGBT community. I feel that connects us in a way. Like Randy said, a lot of young people come into the room. I'm 33 right now, so I've lived a little good life so far. Just teaching the youth about what they're going through, more than likely I've been through it too, and that HIV is not a death sentence.
It shows much respect to themselves that they're able to come to us, get tested, get educated, and hopefully leave on a good note. The thought process of what we talk to each other about in the room, because of course it's confidential, that they would leave with that thought process with them and act better on their decision making.
I think I connect really well with most of my clients and letting them know, I know we've all been once young, et cetera, especially the young youth, and just connecting with them as much as possible and letting them know that once they're in my room, they can have a voice that can listen to what's going on. Because sometimes people, when we get into this room... I know I'm going on. But when we get into this room, sometimes people are telling their life stories.
Sometimes you have to feel empathetic and just, sorry, not empathetic, empathy and just show them like, hey, I understand where you're coming from, so forth and so forth. And just letting them know that it's going to be okay and then giving them the education part of the counseling session. That's it.
Lauren Hogan:
Randy, Steven already answered part of my next question. I wanted to ask your purview then is why do you think, based on the work that you're doing, that getting tested is so important?
Randy Hubing:
Oh man. I remember living in Chicago, listening to the radio and hearing something called gay cancer. That was the summer of 1981. I rolled my eyes back. I remember this. I rolled my eyes back and go, okay, now we got gay cancer, and let it go at that. It's so important to get tested because knowing your status means you can remain healthy. So many people, of course, any older gay guy will tell you about all their friends that have passed because of HIV/AIDS. I can do that as well, but I'm not going to.
It's a time where so many people were sick and died. To talk to a young man today about safety and sexual health, it's almost like I'm working for all those other people who aren't here to do this kind of work. It's really an amazing feeling and an incredible satisfaction in the work that we do here. I absolutely love AHF and being here is just an unbelievably lucky chance for me toward the end of my life like this to do this kind of work. I just feel lucky. Okay? That's all.
Lauren Hogan:
Sean, I'll let you jump in here.
Sean Little:
Yes, I am going to jump in here. First, I'd like to just say thank you to both of you. On a personal note, I very much value you guys because I, myself, I'm HIV undetectable. I have been for about, I don't know, oh gosh, eight years now. I don't even know, I've lost count, which I like because I don't keep it in my brain as an anniversary of the doomsday. You know what I mean? I've gone through the looking glass myself and seeing the light at the end.
I'm going to go off book a little bit because Steven was very thorough, and I also just think like let's put a little personal spin on it. You know what I mean? For one, why don't we take this opportunity for those that are listening, what is the difference between HIV positive and HIV undetectable? Because I think that's a big thing that people just don't don't know.
Steven Holmes:
HIV positive and being undetectable as a person living with this virus, it's very important to know the difference between both, very. Making sure you take your medicine every day, making sure you see your doctors, and making sure you're good. If you take your medicine every single day, try not to miss a dose, you're undetectable where the virus is so suppressed. It'll be undetectable. It doesn't mean it's not there, it's there, but it's very suppressed, and that's a good thing, where it's not controlling your immune system.
It's undetectable where it's so little the virus that it can't be detected by certain tests. Being HIV positive, on another note, is you're not undetectable where you want to be undetectable. Being HIV positive, meaning you are HIV positive person, and your mission is to be undetectable. That's where someone who needs to be undetectable and they need to try to work on being where they need to be, which is undetectable.
You're HIV positive still. It's not a bad thing as far as that. Because once you realize that you had this virus, like I said, your goal is to make sure you're making sure you're healthy, taking your medicines, going to the doctor and reaching to that goal of being undetectable.
Lauren Hogan:
Steven, I just want to clarify too because I think a lot of times we see advertising for like U=U and what that means. Undetectable means that you can't transmit the virus anymore. Correct?
Steven Holmes:
Yes. That's something I could include as well. It's so small that you can't... If you have a mishap... It doesn't mean that you should be out here just doing anything. But if you so happen to have that intermission where you're having unprotected sex, meaning that it's untransmittable. Yes.
Sean Little:
That's wonderful. Thank you so much. Randy, why don't you take us through the process of what happens when someone does test positive, like from A to Z?
Randy Hubing:
Okay, very good. Somebody walks in and they're going to get an HIV test. If they don't know their status for sure, meaning that they've been tested recently and had perhaps no sexual encounters or intravenous drug use, if they don't know their status, you're going to give them the news in a few minutes. The way this usually works is it's going to be a negative test for most people. Once in a while, you're doing your computer work with them, asking them those somewhat embarrassingly personal questions.
You take a look at the test and you're going to see a second line. That means this test is reactive or preliminary positive. In all likelihood that client has HIV, but the tests we use are screening tests. They're not diagnostic. We never say that they are positive in this room. We'll say something like, we need to do more testing. If there are two lines there, I usually pull my chair back, look them in the eyes and say, "This test is not negative. What that means is we have to do more testing that."
Give them a second. Let's see what the reaction is. I do a lot of training in here for new testers. I always tell them, always know where the tissues are. That's very important because somebody's going to want to use them. You can count on it. After they have settled down for a moment, they will almost always ask me is, "Does that mean I got it?" It is hard to answer that question. You can say, "We don't know for sure, but it is true in all likelihood. What we're going to need to do is get a blood draw, and that is going to determine your status for sure."
What I try to do is a second test here. It's an oral test. It's a confirmatory test. We send it to a lab. It takes several days to get back. But what I try to do is connect them with what's what's called a linkage counselor. This is somebody in the company who will set up an appointment with one of our clinics for the client to get a blood draw and an overall health exam. That blood draw is really where they're going to probably start meds even before it comes back. The test and treat program, I don't know if that's nationwide or if it's just in Florida.
It's something where even before the confirmatory test comes back, we want to get them started on meds. It's important to be on meds as soon as possible because the sooner you start meds, the sooner you become undetectable, and that means the sooner the client is healthy and will stay healthy and also the chance of transmission goes to zero when that person is undetectable. People ask me all the time, it's really strange, they ask me all the time is, "Did you ever have to tell somebody they have it?"
I go, "Well, yeah, that's what I do. That's my job." It almost always happens with people who know that they have a fairly high risk of having HIV. When a man who has sex with men comes in here and does not use condoms, unless he's been living under a rock for a long time, he knows that he's at risk. As I say, almost nobody is terribly surprised. Everybody is disappointed. But there you go, that's your job. You try to do this as humanly as possible. I think that's where the human connection between two people comes in.
That person will never forget you. That person can come in a week later and I'll say, "Hello, have you been here before?" It's just a different way of connecting with people. But anyway, it works. This is what we do. Nobody's status changed by coming in here and finding out they have HIV or suspecting they have HIV. What we're just doing is giving them more knowledge about their health. They're more wise about their own health than they were half an hour earlier before they came in here.
It's really important to emphasize that somebody today, these medicines are true miracles. Somebody today takes one pill a day will never get sick, lives as long as anyone else, cannot transmit the virus, can have children naturally. It's just amazing. I am as enthusiastic about medicines today as anybody, and I hope I can transmit that to the client who's probably really afraid of the future and try to calm them into things will get better from today on.
Sean Little:
Thank you. I mean, the medicine is really great. I mean, I haven't ever contracted COVID, and I think it's because I take a super pill every day.
Randy Hubing:
That might be true.
Sean Little:
All right, last question. This is for both of you. Is there anything else we should know about your role in the community that you want to share for anyone who's listening?
Steven Holmes:
Well, my role, I feel just going above and beyond as a HIV testing counselor and just all the experience I've had in the past, just sharing light on the community especially. I have to say this a lot. I'm open to everyone who walks through my door, the education, hoping that they'll leave with what I've told them, which most of my clients have, because they come back, they get tested every three months, et cetera.
Just my role, I feel like I'm here to just educate as much people as possible and giving them a light of they can talk to someone and hoping that whatever I teach them, whoever it may be, LGBTQ or straight, that they'll teach their kids or friends or family members that they learned something today. This is something we're still living with. It's not a death sentence, but it's great to be educated on. Just reaching out to everyone that comes in out of the closet store and letting them know, because we do get a lot...
Because we're by several schools where we're located at, so we do get a lot of kids that come to this out of the closet store. Sometimes I'll go up to whomever I feel like easy to talk to, mostly the kids, and letting them know, like hey. Especially some of them are curious. I see them looking at the condoms and what's this and that, or this is condom, da, da, da. They're curious. Just letting them know, hey, yes, that's a condom. Oh, that's your girlfriend. If you guys are sexually active, et cetera, blah, blah, blah.
We're here to help, get you tested, educate you. Because in a day and age, parents sometime have a hard time conversating with their kids about it and they learn things on their own, from their friends, et cetera. I think it's our job to educate everyone on this matter. That's about it. Just making sure that whether you're Black, white, us as a whole, as a race, the human race, just making sure that we're educated and just going through the process of thinking whatever we teach them that they're going to use in the world today. That's it.
Randy Hubing:
You asked about community activities. I have been on prep now over nine years. I talk to people about prep and I have been for nine years, calling it the best decision I ever made. There is no bigger cheerleader for prep than I am. When it comes to perhaps some kind of community results, I would like to think that people who come through this office will leave with a different or a new outlook on something called prep. If you've been doing any testing or talking to some of the gay men out there online, there's a lot of hookup sites, there is a lot of wrong information about prep.
There is a lot of stuff that I would like to correct. People will come in and give me the regular excuses, the side effects. I'll become a whore, the whole business. I just tell them, "Give it a try. You can stop if it doesn't do whatever you thought it was going to do for you. Give it a try and see what you think." I know a lot of people have been going on prep because of their visit through this office. That's I think my main community. I'm of a certain age. I don't go out much anymore. I don't talk to people sitting at the bar stool next to me.
I'm pretty much right at home. But anyway, I would like to say that is some kind of lasting thing out there that I've done through this work.
Lauren Hogan:
Well, thank you guys so much for joining us today. We really appreciate it, and we will see you guys next time.
Steven Holmes:
Thank you. Thank you. I appreciate it.
Lauren Hogan:
Thank you so much for joining us. If you enjoyed this episode and you'd like to help support the show, please subscribe, share it with your friends, like, post about it on social media, or leave a rating and review. Follow us on Instagram, @afterhours, and see you next time.