When Antonio Rivera was released from prison in 1990, he knew exactly where his future lay: in raising awareness about HIV and AIDS in his Harlem community.
“At the time when I was incarcerated in the early ’80s,” Rivera said, “I’d seen a real fine line between the inmates and the correctional staff on knowledge about HIV/AIDS,” a situation exacerbated in prisons “by intravenous drug use and the demographic of the criminal.” In an effort to protect himself, Rivera conducted research and enlisted the help of relatives, who investigated the topic for him at the library.
Today, Rivera is the director of education and client services at Forging Ahead for Community Empowerment & Support (FACES) NY, a Harlem-based nonprofit organization that offers assistance to minority AIDS patients and their families. For many such organizations, the struggle against the disease and its socioeconomic effects has been a lengthy, tricky battle, and economic woes and shifting cultural attitudes may exacerbate existing difficulties.
FACES NY was founded in 1985 under the name Minority Task Force on AIDS.
“Our founders saw how HIV/AIDS was destroying families, shattering lives, and ruining the very fabric that kept community whole,” executive director Violet Tabor said. “They believed a difference could be made by providing services that would help to stem this devastation.”
The decade in which FACES NY was founded was the heyday of the AIDS epidemic, particularly in Harlem, where the prevalence of drug use and unsafe sex practices aggravated its spread.
“You had crack dens, the gay community, heroin, other sexually transmitted diseases, and women with commercial sex work,” Rivera said.
FACES works with over 10,000 individuals every year, providing housing, education, legal assistance, community outreach, and treatment programs. That number includes both patients and family members, many of whom depend on the income of the AIDS patient.
The organization plays a vital role in Harlem, which has disproportionate rates of HIV/AIDS. According to the Bureau of HIV/AIDS Prevention and Control at the New York City Department of Health, in 2006 the mortality rate from AIDS in economically disadvantaged areas, including the south Bronx, Brooklyn, and Harlem, was almost double the rate in other areas. In Harlem, the mortality rate was 19.8 percent, compared to 12 percent for the rest of the city.
A related report showed that the number of HIV/AIDS-infected individuals per 100,000 was 119.8 for Central Harlem and Morningside Heights, compared to 62.8 for the rest of Manhattan. The age-adjusted death rate was 30.9 percent for Central Harlem and Morningside Heights, and 18.7 percent for the rest of Manhattan.
FACES is only one of many AIDS-related organizations in the area, and many hospitals, community centers, and places of worship provide a range of services.
The Columbia-affiliated Harlem Hospital operates an AIDS center, at which, according to the New York City Health and Hospitals Corporation, residents may “obtain confidential, convenient HIV testing, as well as expert treatment and counseling, regardless of ability to pay or immigration status.”
In addition to testing—AIDS centers citywide tested over 160,000 people this year—the center coordinates with the hospital to provide care for HIV-positive or AIDS-diagnosed patients.
Within the Health and Hospitals Corporation network, the Renaissance Health Care Network Treatment and Diagnostic Center on West 125th Street offers an HIV/AIDS program that, according to a Renaissance statement, “reaches out to the at-risk population of Central and West Harlem, with the staff conducting more than 4,800 counseling sessions annually.” The center’s focus is on support groups for HIV-patients and their families.
Meanwhile, the University supplements treatment with research. Columbia’s Medical Center and School of Nursing operate AIDS research centers, which provide inpatient and outpatient care, support, and education, train medical students in the HIV/AIDS field, and run clinical studies.
One of the largest local grassroots organizations is the Harlem United Community AIDS Center, Inc., which opened in 1988. Its eight offices, scattered from 116th to 126th streets in Central and East Harlem, accommodate housing, medical, case management, prevention, and support divisions. This breadth and depth—in 2007, the organization worked with nearly 4,000 individuals and came into contact with 33,000 more via intervention, education, and awareness programs—makes it one of the biggest, if not the leading, AIDS-oriented community center in the area.
Riverside Church has its own Global HIV/AIDS Ministry, which works on HIV/AIDS issues on every continent but Australia and Antarctica. Riverside also provides a Spiritual Outreach Service Program, and promotes public policy awareness through collaborations with secular institutions.
These and other Harlem-based AIDS initiatives speak to the deep effect the disease has planted in the community. But while FACES and other organizations offer a number of comprehensive programs to address the individual and social effects of AIDS, Rivera emphasized that such organizations alone cannot counter larger cultural trends.
Rivera noted that complacency has developed around the issue in recent years, as the urgency surrounding AIDS in the United States has dwindled.
“Five years ago, maybe even 2002, the CDC [Centers for Disease Control and Prevention] issued a statement saying that HIV was chronically manageable. That gave a false sense of hope, of immortality,” Rivera said. “Now the younger generation hears from that, and they’re thinking that HIV and AIDS are like diabetes or high blood pressure.”
Additionally, stereotypes about the virus and disease have masked newer issues.
“The community is ill-informed,” Rivera said. “It’s still shocking to think that many people believe only gays and heroin users” are susceptible to AIDS. And while CDC statistics show that the correlation between intravenous drug use and HIV infection has dropped, Rivera presented a recent statistic that 40 percent of new HIV infections are among black or Hispanic women.
Shifting attitudes about sex have made young people more susceptible to HIV transmission through unprotected sex, and Rivera argued that the New York government is partly to blame.
“There are riskier sexual practices,” Rivera said, “and the city and state have been remiss in a sustainable social marketing campaign” to address the issue.
Still, he said, “We have an outreach staff that’s more based in contacting the hard-to-reach population. They engage the gatekeepers to the gay venues. We also have door-to-door, and three individuals who go to shelters.”
“Our next step is trying to link people to come,” Rivera added. “About 25 percent don’t.”
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