ost people will try to avoid people on the street who ask for money. Wilbert C. Jordan, however, is not one of them. As director of the Oasis Clinic, the AIDS program at King/Drew Medical Center in Los Angeles's Watts district, Jordan counts among his patients many low-income people who are all too familiar with living on the streets and seeking out a hot meal.

That is why Jordan was not surprised when about four years ago as he was on the way to a neighborhood center, a man who used drugs stopped him and asked for money. "I said no,' Jordan recalls. "And then when I came out of the center, he was still there. While talking to him, I noticed that there was a mobile [health] unit across the street in the park, so I asked him what they were testing for."

The man told Jordan the health workers were trying to find drug users and get them tested for HIV. "He told me that they didn't know where to find those people," Jordan says, "but that he could—if they gave him some money. So I looked at him and said, 'You can't find anything.' And he said, 'Yes, I can.' So I said, 'You bring me somebody, and I'll give you some money.'"

They both kept their promise. The man took five people to Jordan's clinic; four of them learned they had HIV. But Jordan learned even more. "It became obvious to me that if patients—who we have ignored—played a more key role, then we could find even more patients," he says. "The patients know who is at risk. They know who goes to the bathhouses or to sex clubs or out cruising. But we don't."

That observation led to the unfolding of a program that has surprised many not only because of its success but also its simplicity. "I have a health provider talk to clients who come in to the clinic to see if they may have friends who are at risk," Jordan explains. "If they do, I ask them if they think they could get these people to come in and be tested. And then I tell them that if they do bring them in, I'll give them two movie passes. Then we give them an appointment to bring their friends in. If they miss that appointment, then they need to call in and make another one. We don't contact them, and we don't make any phone calls. We don't know who that person's friends are until they walk through the door."

Getting people at risk to make—and keep—that appointment has long been the focus of HIV education and prevention programs. The Centers for Disease Control and Prevention estimates that 650,000 to 900,000 people in the United States are living with HIV—and that as many as 30% of these individuals are unaware they are infected. Others are aware, but they are not getting any treatment. Individuals in these two groups are most at risk of spreading the virus to others. But finding them is far from easy.

It is estimated that roughly 40,000 new HIV infections occur each year, and it is apparent that a disproportionate number of these occur among people of color. Between July 1999 and June 2000, more than 50% of those who became HIV infected were African-American while 19% were Latino—yet African-Americans and Latinos represent only 13% and 12%, respectively, of the U.S. population.

Even so, this knowledge has not translated into the establishment of community intervention programs that succeed in finding people most at risk. The majority of community programs find that at most 3% of the people they get to take an HIV antibody test are HIV-positive. Compared with these programs, Jordan's statistics are off the charts. At the Oasis Clinic more than 300 people have been brought in by someone they know for HIV testing. Nearly half (48%) were HIV-positive. Only two failed to go back for their results.

Because Jordan's program has been so effective, it has received funding from several pharmaceutical companies. Now Glaxo Wellcome has gone a step further. The pharmaceutical firm has used the Oasis Clinic as the model for its newly launched Living4Life, a Glaxo Wellcome Positive Action Program, which will establish programs similar to Jordan's in 20 cities across the country over the next two years.

"Frankly," says Carl Pelzel, Glaxo Wellcome's vice president of HIV/oncology sales and marketing, "we have spent lots and lots of money on programs that have lots of bells and whistles associated with them, but none of these has come anywhere close to having the type of success Dr. Jordan has had."

Mark Briggs, a patient of Jordan's who is also a patient advocate, has watched the program blossom. He alone has referred 20 people to Jordan. "For patients, this is a chance to help give others information," he says. "When it is someone you know who is talking to you, the trust factor is higher. It brings down the stigma of getting tested, and it makes people more comfortable with the idea of going to the clinic to get treated."

There have been other benefits for both individual patients and the community. "I have found that those people who bring others in become more compliant with their own medication regimens, says Jordan, "and that is the biggest plus. Some of my most nonadherent patients—my most terrible patients—they suddenly are saying, 'I have to take my medicine. My children (the people they brought in) are watching me.' And I look at them and say, 'Thank the Lord that something is getting you to take your medicine.'"

Another benefit, says Jordan, "is that if you bring in 10 people, and three are positive but the other seven are negative, those other seven may still be doing high-risk activities, and they know who the other high-risk people are in the community. So based on who our patients bring in, it gives us a better idea of where our efforts should be focused."

Alexander Gonzales is another patient who is helping to make that happen. Over the past few years he has brought more than 40 people to the Oasis Clinic to be tested or to start treatment. And he has not stopped there. "I'm an HIV poster [boy]," says Gonzales, who has become well known in the community as someone people can turn to for HIV and AIDS information. Gonzales not only takes people in to be tested but lets them know that he will be there for them when they get their results. "It's hard to go back and get your results when you are scared and all alone," he says. "But if someone has invested that time in you and will be there afterward, it makes a difference."

"I do this because Dr. Jordan is an incredible doctor," Gonzales adds. "I know that if I take someone in, they will be getting quality health care. Dr. Jordan believes that just because his patients don't have money doesn't mean they shouldn't be treated as well as everyone else. He expects all of us to be treated as if we are cash-carrying customers, and he makes sure that we as a community get what we need."

In donating $1 million to establish 20 Living4Life programs, Glaxo Wellcome hopes not only to aid specific communities but to attract additional funding for such programs from other large corporations. "We can now go forward to corporate America and to Fortune 500 companies and say, 'Here is a program that has demonstrated that it can get patients in, tested, and into therapy,'" says Pelzel. "It would be so easy to increase the total number of folks who understand their status if each one of the Fortune 500 companies would look into their own community and fund programs like this that can help their workforce or their customers."

While listening to patients praise Jordan, it is hard not to wonder how much of the program's success is about the program and how much is about the doctor himself. "That is why we are going to measure everything about the 10 programs we start in 2001," says Pelzel. "It is possible that they will work only in certain environments, like in the inner city, but not in, say, white male environments. And if that is the case, we will need to make adjustments for the next 10 in 2002. But at least we will know that in certain environments it can work."

What is clear, however, is that for the program to be successful elsewhere, those involved will need to share Jordan's philosophy that "the centerpiece of HIV has to be the patient."

"We who are HIV-positive are clearly the ones who have the ability to get people in," says Gonzales. "As people start to get to know me, they realize they need to get tested too. It becomes real life."

[EDITOR'S NOTE: Just prior to press time Glaxo Wellcome was due to announce the 10 cities where its Living4Life programs would be launched in 2001. Visit our Web site at www.hivplusmag.com, where we will provide an update once the list has been released.]