This brief report article is a retrospective, descriptive, first-person account of following-up on a difficult-to-find client of an HIV/AIDS community-based pre-post intervention and disease prevention Research and Demonstration project in Houston, TX. Through the story about the personal journey of searching for the client, the author experiences an epiphany, especially in light of current events. Specifically, as opposed to social distancing and disconnection, public health disease prevention probably would be better served through leveraging the powerful and positive natural human features of social connectivity and closeness.
Academic Editor: Sasho Stoleski, Institute of Occupational Health of R. Macedonia, WHO CC and Ga2len CC , Macedonia.
Checked for plagiarism: Yes
Review by: Single-blind
Copyright © 2021 Ralph J Johnson
The authors have declared that no competing interests exist.
Significance for Public Health
With all the emphasis and calls for the imposition of social distancing and social barriers to prevent communicable disease, this illustrative essay, though one case study, lends credence and support to the alternative notion that a much more fortuitous approach might be capitalizing on the powerful and innately human need for social connectivity and closeness.
I first met Roland Wayne Jr. (not his real name) through a National Institute of Drug Abuse-sponsored community-based AIDS / HIV demonstration and research prevention project conducted in Houston, Texas in the late 1980s.1The project was being run in demographically marginalized inner-city neighborhoods with a high incidence of drug abuse related to high HIV infection rates. The project’s aim was relatively simple: catch, intervene, release, and recapture. Study Participants (also called “Clients”) were recruited, assessed at baseline, and provided intensive serial sessions of HIV prevention education. Follow-ups were conducted over various subsequent time intervals for a year to evaluate the health education.
The project was my introduction to real-life public health work. It was an incredible opportunity and learning experience for which I will be ever grateful and indebted; and, it led me to pursue post-graduate education in the field. I ultimately left community-based public health work with at-risk street drug abusers for reasons of personal advancement and growth; also, I was getting older and concerned about my personal safety.
One of my jobs on the project was locating transient or itinerate (a.k.a. “Lost-to-Follow-Up” or LFU) clients to improve the project’s “Continuity-of-Care” and the representativeness and validity of its assessment results.2 I used to refer to myself as a “Professional People Chaser.” We collected copious amounts of locator information during the Clients’ enrollments; this information provided leads to help track down clients and re-connect them to the project. The younger, male drug users were much more nomadic and therefore harder to relocate.
Roland Wayne Jr. was one-such Client. I actually conducted his baseline interview and health education intervention sessions myself. Mr. Wayne Jr. was nineteen at the time, of average build with no distinguishing features, a fervent drug user (especially crack cocaine), and had multiple unprotected serial sexual encounters with different partners, particularly IV drug users. He was actively engaged in an irresponsible and indiscriminate living-for-the-moment lifestyle fraught with bad choices—and potentially disastrous outcomes. Nevertheless, he was a good-hearted, likeable, happy-go-lucky, goofy kid; and, I could easily have been him had grace not intervened. I believe he also suffered from the effects of Fetal Alcohol Syndrome. He was barely literate, and a product of his environment. Indeed, he grew up and still frequented a neighborhood featured years later on the National Geographic serial-documentary “Drugs, Inc.” (Houston edition).3
Herein, I use the metaphor of a search or a journey, because through such a search or journey there is profound learning and “…we see ourselves and our world differently for the first time.”4Not to give the ending away, but I did find Mr. Roland Wayne Jr. through my search. A common response might be, “So what?” or, “I never knew he was lost in the first place.” For me, finding Roland Wayne Jr. resulted in a personal epiphany.
When it came time to find Mr. Wayne Jr. again for re-assessment, all of his locator information was old and inaccurate—he had essentially disappeared. His last known accurate address was his estranged mother’s boyfriend’s; and, they were on the run, and left no forwarding address.
Roland Wayne Jr. never mentioned a dad, albeit he was a “Jr.” I figured he and his dad might be estranged too—or worse, his dad was dead. Death was a common occurrence in Roland Wayne Jr.’s world. Yet, I thought perhaps there might be a “Sr.” somewhere out there still alive. It was a long-shot, but what else did I have to go on? I looked in the telephone directory, and to my surprise found a Roland Wayne Sr. (not his real name) living in the same neighborhood where Roland Wayne Jr. grew-up in. The one featured on the National Geographic’s aforementioned serial documentary.3 What were the odds?
I went to pay Mr. Roland Wayne Sr. a visit at his residence, which was just off the main drag Liberty Road in a demographically marginalized area of Houston. “The 5th Ward” was notorious for open and pervasive street drug use and the street sex trade industry.3 I dressed as a social worker: plastic photo I.D. badge, white shirt open at the collar, casual dress pants and comfortable shoes, and a clip board with notepad. I did not want to be mistaken for a cop and get a response I definitely did not want in that area. I learned a lot about costumery in this line of work. I could play the part—official but non-threatening.
The residence was a three-room, wooden, dilapidated house, but had a new coat of pastel green paint. The yard, cluttered with overgrown grass and junk was surrounded by a rusty knee-high wire fence and a gate that stood open and off its hinges. I went to the front door, and knocked. A lady of large girth in a flowered muumuu opened the door. Inside the house was more clutter, with only a few pieces of furniture.
The lady asked my business. I told her I was searching for a Roland Wayne Jr., and that on a hunch, I was trying to get in touch with Roland Wayne Sr. for that purpose. Roland Wayne Sr. was out but the lady asked me, “Is Roland Wayne Jr. in some kind of trouble?” (I had hit the lottery!) I responded, “No trouble, ma’am. I’m kind of like a social worker. I’m not the police. I work for a community project trying to help him.” She responded, “Boy, he could sure use a lot of that.” (I could not go into any particulars for fear of breaching client confidentiality. Thankfully, the lady did not ask.)
The lady was Roland Wayne Jr.’s step-mom and told me she had not seen him for a couple of weeks. But Roland Wayne Jr. had left a note that might help me find him. She went around the corner inside the house. I heard what sounded like a wooden kitchen drawer squeaking opening and closing. She returned with the note—a 3-inch folded-up piece of paper torn from a yellow legal notepad. It had a brief message full of imperfections and misspellings in block letters, scrawled with what seemed like slow deliberate precision using a graphite pencil. You could just tell the author had much difficulty writing but took great care penning words to the paper.
I Am Alright. I Have Moved. My New Address Is (New Address Here).
Your Loving Son,
His step-mom told me I could keep the note. I have it to this day—a souvenir of my journey. I immediately hot-footed-it to the address, which was relatively far away. The address was located in an even more drug-and-street sex trade-addled neighborhood called “Third Ward.” I had a series of personally harrowing adventures in Third Ward on my way to find Mr. Wayne Jr. that constitute a whole other story. Eventually, I found Roland Wayne Jr. in the flesh and coached him back to the project for follow-up assessment.
This was my Epiphany
I found Mr. Wayne Jr. through a simple fundamental fact of human nature. Specifically, we all seek some transcendent sense of social connectedness. And yes, I had leveraged this basic human need to advance my project’s agenda and my own mission. Here was a young man with issues--someone a father might not feel too proud of but cared deeply about—barely literate, struggling to scrawl a brief note to tell his dad not to worry, that he was alright, and where he can be found. The deeper, unspoken message is that he loves his dad and always will. Social scientists, particularly anthropologists, refer to these kinds of notes as “human artifacts.”5 They express the authenticity of the people who crafted them. They also communicate a sense of permanence, a lasting product of oneself and a symbol of a social relationship that can be felt, seen, touched, and carried that transcends the social participants.
Even after more than 30 years later—and more frequently as I drift toward retirement—I still occasionally pull the note out and reflect on my search for Roland Wayne Jr., especially during this time of a global public health crisis leading to social distancing. My search for Mr. Wayne Jr. occurred on the advent of on-line technology seemingly designed and sold to enhance social connectivity; and, the technology merchants have been probably taking advantage of the tactic of playing on human needs to sell it as I used to find Roland Wayne, Jr.. Yet, ironically, that on-line technology is now deployed to impose social distancing and even social barriers in the interest of disease prevention. I cannot help but feel that in the quest for disease prevention through social distancing and virtual technology, we are at risk of losing something innately human about us; we risk losing our humanity. Perhaps a much more powerful and beneficial approach would be one that also leverages human artifacts, caring and social nearness.
Anyway, I never knew whatever became of Roland Wayne Jr. He would be 50 years old by now. I went on my journey and he went on his. Given where he was headed, sadly he’s probably deceased by now; if he was lucky, he’s alive and incarcerated. Yet, my search for Roland Wayne Jr. renewed in me a profound appreciation for the discipline and power of behavioral / social science in the interest of public health and preventive medicine. More importantly, it made me confront a fact about the ultimate goal of all public health behavioral / social and disease inquiry and practice: a perpetual search for those aspects that are uniquely yet universally human.
For in the end, we are all only human.
This project was supported by grants from the National Institute on Drug Abuse to Affiliated Systems Corporation, S R18 TA05156, and also to the University of Texas—HSC-Houston School of Public Health RO3 DA12328. The author gratefully acknowledges UT-MDACC for their in-kind support.
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The study under which the work was conducted was approved by the Affiliated Systems and UT-SPH Committees for the Protection of Human Subjects and adequate informed consent was obtained from each Study Participant.
The Sole Author is the only substantive contributor to the manuscript and assumes all responsibility for content.
The Author would like to gratefully extend appreciation to Drs. J.A. Kotarba, M.L. Williams, and M.W. Ross for proof of concept and critical response; and also, Dr. J. Atkinson for moral support and encouragement. The Author would like to personally thank Ms. Aileen ‘Acey’ Cho freelance copy-editor, for proofing, and copy-editing.