By Aaron Adler

Two members of Housing Works, a New York-based healthcare and AIDS advocate group, climbed two 40 foot flagpoles at the southern end of City Hall Park in lower Manhattan on Wednesday around 10:45 a.m. The activists, wearing helmets and climbing gear, unfurled a 30 foot banner that read “HOUSING IS HEALTHCARE: HOUSE PEOPLE LIVING WITH HIV/AIDS” after quickly climbing to the top of the flagpoles without being noticed by several police officers in the vicinity.

Police quickly arrived and blocked the sidewalk and the area immediately under the flagpoles and brought in a cherrypicker to bring down the activists. Other Housing Works activists held signs and cheered on Tony Ray and the other unidentified flagpole climber from the ground.

“I am up here today because of the lack of attention to housing for people with AIDS.” said activist Tony Ray through a megaphone high above the crowd, “If people with AIDS have a safe place to live, and a place for them to refrigerate their meds, they are going to stay healthy.”

The two activists stayed on the flagpoles for around 25 minutes before they were removed peaceably by the NYPD and arrested without incident.

The civil disobedience came two days before World Aids Day, a global day of remembrance of those lost to the disease.

By Penny Gray

Back in the mid-1990s, when Dr. Tony Urbina was completing his residency at St. Vincent’s Hospital in Greenwich Village, he witnessed a major turning point in HIV/AIDS care. At the time, medication cocktails were just being introduced to the infected. “There were patients who looked like walking corpses; with [medication], in a matter of weeks, they would miraculously come back from the [brink of] death,” Urbina recalled in an interview.

Over 10 years later, HIV/AIDS no longer is seen as a death sentence but a chronic condition that can be treated with proper medical care. Once again, however, Urbina finds himself at a precipice in the story of HIV/AIDS. Instead of diagnosing middle-aged and older gay males, Urbina’s newly diagnosed patients are frequently minority men, some of whom are as young as 16, who have sex with other men.

What HIV/AIDS Looks Like in the 21st Century

At subway stations throughout New York City, HIV prevention posters are pasted on the wall with the message “Get Tested,” often featuring serious-looking minority men. Are they really the faces of HIV today? And if so, are posters like these promoting prevention and testing or are they alienating the at-risk community?

Data from the New York City Department of Health (DOH) suggests that the faces of the HIV prevention campaign are indeed representative of New York City’s highest HIV risk group in the city: minority men who have sex with men.
According to the DOH, in 2009, gay men and other men who have sex with men (MSM) accounted for 43 percent of the newly diagnosed HIV infections in New York City—more than any other group—and they experienced more than half of new diagnoses (57 percent) among men. Forty-eight percent of all new infections were reported from the African-American community, 32 percent from the Hispanic community and 3 percent from the Asian/Pacific Islander community.

Perhaps even more disconcertingly, a recent study of MSM in New York City showed that 53 percent of those who are HIV- infected were not aware of their status, suggesting that messages of prevention and testing are not being communicated adequately to high-risk groups.

Dr. Donna Mildvan, chief of infectious diseases at Beth Israel Medical Center at 16th Street, has been around the block with HIV/AIDS, having been one of the first doctors in the city to recognize the symptoms in the late 1970s and early 1980s. (“A point,” she said, “we don’t need to dwell on. We just have the long-range view here at Beth Israel, that’s all.”) As she sees it, the minority MSM acquisition of HIV is a recent and troubling phenomenon. For his part, Urbina said he first noticed it roughly five years ago.

“What we’re looking at is a population of young people who don’t see this as a threat,” Mildvan said. “These statistics reflect the fact of a cavalier attitude among young people.”

Indeed, for a generation most familiar with Magic Johnson’s 1991 diagnosis and successful antiretroviral treatment, HIV no longer holds the threat of AIDS and imminent death that it did 30 years ago.

“Now, we can treat patients with one pill a day and we have options about what that one pill will be. It looks easy—looks like it’s not the disease Larry Kramer wrote about in The Normal Heart. But it’s a lot worse and a lot more complicated than other degenerative diseases,” Mildvan was quick to point out.

Dr. Victoria Sharp, director of Saint Luke’s-Roosevelt’s Center for Comprehensive Care on 17th Street, has recognized similar trends in public attitudes. “This disease was once the disease of white gay men. There’s not manifestations as there was 15 years ago, when it was a lot easier to see the physical signs of the disease. These were the walking dead. Now, the younger generation senses that it’s not a problem.”

Sharp is quick to link social stigma to the heightened HIV infection rates among minority gay males. “For many of these at-risk communities, there’s stigma attached to sexual intercourse with other men. So these are MSMs, but they don’t publicly identify as such. They are on the down-low,” Sharp said.

Originally an African-American slang term, the phrase “on the down-low” has been adopted by the HIV medical community to describe men who have sex with men but for social or personal reasons choose not to socially or publicly identify themselves as homosexual.

“Having unprotected sex on the down-low affects infection rates in multiple ways. Young MSMs are infected, but women are infected through men who are on the down-low as well. After all, African-American women are the other group with rising infection rates,” Sharp reported.

Ding Pajaron, director of development at the Asian & Pacific Islander Coalition on HIV/AIDS (APICHA) and Daniel Goldman, development specialist at APICHA, confirmed the prevalence of social stigma in minority communities that makes prevention and care very difficult. Indeed, the Asian community has the highest rate of concurrent diagnosis of both HIV and AIDS, which is a signal of late testing.

“In minority communities, there is stigma associated with homosexuality that makes it difficult for people to access services,” Pajaron said. “It can be really brutal. One of our clients came out to his family; when he did, his parents brought him to the cemetery and said, ‘We consider you dead.’ As you can imagine, this sort of attitude makes it seem dangerous to access services.”

Goldman concurred. “The fact of the matter is that people at risk for this disease are disenfranchised in the city. HIV is affecting the African American population, the Latino population and the Asian/Pacific Islander population, so there is very good reason for resources to go into these communities. Our aim and mission is to provide general primary care to those who are at high risk for HIV. As we speak, we are expanding our services to more at-risk communities,” he said.

In both the public and private sectors, many HIV care facilities are moving to an all-in-one care model in an effort to combat HIV infection trends. One such facility is the Center for Comprehensive Care (CCC), the largest HIV/AIDS treatment center in New York State, which currently serves 5,000 patients in the city.

Sharp, director of the CCC, reasoned, “How can we thin this trend? Well, everybody gets HIV from someone, right? So treatment is tantamount to prevention. If we can put an HIV-infected person on medication, we can prevent them from passing the infection along. As the Center for Disease Control recommends, first get tested and then immediately get linked into care so you can’t pass it along.”

In 2011, the New England Journal of Medicine published results suggesting “a 96 percent reduction in HIV transmission risk to an HIV-negative partner…[is] definitive proof of the concept that antiretroviral therapy lowers the risk of HIV transmission.”

This promising data has solidified the DOH’s own focus on HIV testing as a means of prevention. According to its press office: “The Health Department collaborates with community partners on various initiatives that focus on areas of high HIV prevalence and work with vulnerable populations. Two such initiatives are The Bronx Knows (which just ended in June of last year after a very successful three-year run) and Brooklyn Knows, currently in its second of four years. Both are initiatives designed to routinize HIV testing in clinical settings, facilitate testing for every person who is unaware of their status (i.e. anyone who has never taken an HIV test) by providing free test kits to those who are uninsured, collaborate with non-clinical testing sites and link those who test positive to quality care and services.”

Confronting HIV/AIDS

Authorities seem to agree that HIV testing ultimately leads to both care of the HIV-infected person and prevention of the spread of the disease. But everybody seems to have a different idea about how to arrive at widespread HIV testing. Robert Shiau, AIDS administrator at the AIDS Center of Beth Israel Medical Center, pointed out, “There’s a lot of education out there, but we need to increase access to education on safer sex, condoms and clean needles.”

Mildvan went even further in her convictions about outreach and prevention, saying, “We need to get very, very creative at this point and start making full use of social media. We need novel ways of reaching a populate at huge risk.”

Mildvan pointed to HIV BIG DEAL, a social media campaign run by Public Health Solutions, as a prime example of successful social media. The brainchild of Dr. Mary Ann Chiasson, vice president of research and evaluation at Public Health Solution, HIV BIG DEAL uses 10-minute video dramas to realistically address the social and health-related
dilemmas MSMs face.

But Urbina, the associate director of CCC, suggested the young minority MSM population can’t be pinned down to prevention strategies so easily.

“If the prevention message doesn’t resonate, it isn’t going to be effective, “ Urbina said. “There’s actually data to show that young MSMs have higher rates of condom use than their heterosexual counterparts. And young African-American men have fewer sexual partners than their white and/or heterosexual counterparts. Hence the paradox of higher rates of infection.”

“What’s actually playing out here is that for a young MSM, that one chance encounter is much more likely to lead to an infection. It doesn’t mean they’re having any more chance encounters than a young heterosexual male. It’s difficult because young men are exploring and just awakening to their sexual identities, and hyper vigilance is not a normal response for young people. Sex is a biological urge in all of us, and it’s difficult for youth to accept and internalize the need for condom use,” Urbina lamented.

“There are engaged, talented young men becoming infected because of one chance encounter. We see track stars, we see straight-A students coming in, infected with HIV by the time they get to high school. We’re all struggling with this.
“All efforts at prevention are well- intentioned, but we need to go back to the basics and realize that a community approach is the solution. The sooner we normalize our approach so that it’s about health, spanning across all cultural, ethnic, economic and sexual orientations, the sooner we’ll put an end to HIV.”

By Penny Gray

Avice president at nonprofit Housing Works, Susie Lupert talks to us about the Housing Works Bookstore Café at 126 Crosby St., as well as the other business ventures that Housing Works has going in its fight to end homelessness and AIDS through relentless advocacy, lifesaving services and entrepreneurial businesses.

How did you land at Housing Works?
I have a background in not-for-profits and a master’s in not-for-profit policy, so I’ve been dedicated to the field for a long time. I’ve been here for eight years now, so it’s been the crux of my career.

How would you describe Housing Works?
Housing Works is a grassroots organization dedicated to helping homeless people who are HIV-positive. We’re a unique nonprofit because we believe that profitability isn’t bad. An efficiently run company isn’t bad. I can’t imagine another nonprofit like us. We’re running businesses to raise money to help people.

You’re a vice president—what does that mean in terms of day-to-day practice?
A lot! My job is to generate long-term visionary ideas about our businesses. I run several of the small businesses for Housing Works, and we’re always thinking about how to be profitable while remaining true to our core values. It’s a unique balance of brainstorming about revenue generation while also developing a board of directors, all the while leaving enough space to think about new ways to raise money for the HIV-positive homeless of New York, which is our ultimate purpose and mission. The Bookstore and Café are only two of the businesses I’m responsible for running.

How does the Housing Works Bookstore Café on Crosby Street relate to Housing Works’ wider mission?
We’ve been at 126 Crosby St. since 1996, so it’s been quite a while—long enough that we’re a Downtown institution. We’re really one of the last community spaces left in Soho, and we pride ourselves on being part of the Downtown community. We’ve got many supporters who are die-hard Downtown artists, and we hope that people see us as part of the Downtown infrastructure.

What’s it like being Downtown at the moment?
It’s tough because the rent is high and we have a large staff to support. We’ve started doing private events to subsidize the cost of staying open. People just don’t buy as many books as they used to. It’s a real sacrifice to us to close early to fund the location, but the space just can’t be a used bookstore anymore because we don’t sell enough books. One interesting fact that most folks don’t know is that we actually run another business underneath the Bookstore Café in the basement. It’s our online bookshop, and it generates about $1 million in revenue every year, equal to the bookstore’s revenue. We provide skills and full-time jobs to those who have come through our job-training program—it’s an amazing incubator to make money and provide jobs. It’s also a great form of outreach to let people know about Housing Works all around the world. We put a bookmark in every book we ship out, and we hear from folks all the time who are so excited to learn about us and visit us when they come to New York City.

Do you think the Housing Works Bookstore Café could exist elsewhere in the city?
Sure; it’s replicable, but it wouldn’t be the same. It would probably be purely an events space. People aren’t buying books anymore, which may be sad, but it’s the way things are. The private events keep us open and part of the community, which is what we want to be and do. We couldn’t replace the Downtown community somewhere else in the city, that’s for sure!

What upcoming events is Housing Works Bookstore Café hosting?
Every Friday night we have a happy hour with cheap drink specials and board games. We really want to create a community space for people—what better way to do that than to provide a space where people can economically have a glass of wine before dinner and get to know other? Or, even better, just read and drink. We also host two Moth Story Slams every month. [The Moth is a nonprofit dedicated to telling stories about true life.] We’ve enjoyed that collaboration very much. Dec. 18 is a special day for us as we’ll be hosting “What the Dickens?” a Christmas Carol marathon in which authors and celebrities come and read throughout the day, starting at 1 p.m. That’s not to be missed, and it’s an excellent way to celebrate the holiday season.

What do you love most about your job?
My job is totally unique. I love it because not another one exists like it in the world. Every year I’m taking on projects and job elements I haven’t done the year before. It’s a position that is constantly in flux. And that’s a lot of fun.

Photo courtesy of housing works

By Fred Cicetti

Q. I’m a 65-year-old man who is dating a 58-year-old woman. Recently, my grandson, who is rather outspoken, asked me if I was protecting myself against AIDS. At the time, I thought the question was ridiculous, but now I’m wondering.

A. A growing number of older people have HIV/AIDS. About 19 percent of all people with HIV/AIDS in this country now are over age 50. New AIDS cases have risen faster in the over-50 population than in people under 40.

According to a British study, people over 50 with HIV are more likely to be diagnosed with late-stage disease than younger adults. They are also more than twice as likely as younger people to die within a year of their HIV test.

“We have a group of people who don’t get tested because they don’t think they are at risk,” said Dr. Valerie Delpech, of the U.K. Health Protection Agency Center for Infections in London, who worked on the study.

Since the early ’80s, HIV in people over 50 accounted for about 10 percent of all cases. However, the method of transmission has changed. Blood transfusion was once the major transmission mode. Now, heterosexual contact and IV drug use are the main causes of HIV infection in seniors.

Heterosexual transmission in men over 50 is up 94 percent, and 107 percent in women since 1991.

But there may even be many more cases, because doctors do not always test older people for HIV/AIDS during routine exams, and older people often mistake signs of HIV/AIDS for the aches of normal aging so they don’t get medical attention.

The number of HIV/AIDS cases among older people is growing every year because older Americans know less about HIV/AIDS than younger people, healthcare professionals often do not talk with older people about prevention and older people are less likely than younger people to talk about their sex lives or drug use with their doctors.

HIV (human immunodeficiency virus) is a virus that damages the immune system. This makes you vulnerable to diseases, infections and cancers. When that happens, you have AIDS (acquired immunodeficiency syndrome), which is the last stage of HIV infection.

HIV symptoms include headache, cough, diarrhea, swollen glands, lack of energy, loss of appetite and weight loss, fevers and sweats, repeated yeast infections, skin rashes, pelvic and abdominal cramps, sores and short-term memory loss.

Your health care provider can test your blood for HIV/AIDS. You can also test your blood at home with the “Home Access Express HIV-1 Test System” that you can buy at your drug store.

Anyone can get HIV and AIDS. HIV usually comes from having unprotected sex or sharing needles with an infected person, or through contact with HIV-infected blood.

You cannot get HIV from: casual contact (such as shaking hands with someone who has HIV/AIDS); using a public telephone, drinking fountain, restroom, swimming pool or hot tub; sharing a drink; being coughed or sneezed on by a person with HIV/AIDS; giving blood; or a mosquito bite.

You may be at risk if you do not use condoms, you do not know your partner’s drug and sexual history, you have had a blood transfusion or operation in a developing country, you had a blood transfusion in the United States between 1978 and 1985.

There is no cure for HIV/AIDS. But if you become infected, there are drugs that help keep the HIV virus in check and slow the spread of HIV in the body. Doctors are now using a combination of drugs to treat HIV/AIDS. Although it is not a cure, the drugs are greatly reducing the number of deaths from AIDS in this country.
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If you have a question, please write to fred@healthygeezer.com.