NEWS
African Americans with HIV/AIDS: A Protracted War

Sunday, November 02, 2003
Oakland Tribune

The mean stretch of San Pablo Avenue heading up towards 30th Street in Oakland is where the county's HIV emergency is most glaring.

Young African American women stand clumped together, at bus stops and in front of rundown liquor stores. Cars and trucks driven by single men slow down and stop, then drive away with a new passenger.

``Man, it is thick out here today,'' said Dawn Skelton, an outreach worker for an Oakland group called Cal-PEP, which provides HIV testing and substance abuse counseling for sex workers and other high-risk people.

Skelton and another outreach worker, Nyisha Underwood, park their car near a bus stop where several teenage prostitutes in thin miniskirts or tight jeans and four-inch heels are gathered. They've never seen these girls before. It's 3:30 in the afternoon.

``Hey, ya'll want some condoms?'' Skelton waves to the girls, who answer in the affirmative.

The girls stuff the condoms in the small handbags they carry pressed against their underarms, which also hold cell phones and mace. One girl - only 14 years old - tucks a few packets inside her black pleated skirt.

Many of the girls didn't have condoms until Skelton and Underwood showed up this afternoon. When asked, they all said they will use the ones given to them. But condoms are expensive, and the sex workers - who can make between $25 and $100 a date - often rely on customers to provide them.

Scared of HIV?

``I'm scared of everything,'' said one pretty African American woman in her early 20s, who wears a delicate pink headband. She said she is earning money to support her young children after escaping an abusive relationship.

But HIV isn't at the forefront of her mind. She and several of the teenagers were chased by a pimp just moments before; meanwhile her pimp, an 18-year-old boy with red-rimmed eyes, was taking the money she made. ``I'm used to chasing my kids around the house, not being chased by some pimp,'' she said dryly.

Skelton - a former sex worker - expressed worry after spending a few hours up and down San Pablo on this particular afternoon. ``Those ones really got to my heart,'' she said. ``Only one of them mentioned a mama. They're so young and they don't know anything.''

This Wednesday marks the fifth anniversary of Alameda County becoming the first municipality in the nation to declare a state of emergency on HIV/AIDS among African Americans. The state of emergency was meant to bring money and awareness to the epidemic - at a time when 41 percent of infections were among African Americans, who make up only 18 percent of the county's overall population. It was also intended to lower infection rates and provide better treatment for those who already had the disease.
Activists and county officials who work day in and day out on this issue point to significant accomplishments over the past five years. People with the disease are living longer, fuller lives. And the community is more aware of how to preventMDULMDNM it. Local groups have more forums to strategize together.
But the five-year anniversary won't come with any fanfare or celebration. African Americans in the county are being infected at even more disproportionate rates than five years ago. In 2002, half or more of the local AIDS cases were among African Americans, compared to 42 percent in 1998, when the emergency was declared. And while the number of AIDS cases peaked in 1992 and continues to decline, case rates in Alameda County exceed state and national rates, according to county figures.
Even more at risk today are African American women, who account for 65 percent of all women in the county with AIDS. These women are primarily contracting the disease through heterosexual sex with male partners, though IV drug use remains a consistent source of infection. Latinos, too, are catching up, accounting for 20 percent of AIDS cases, about on par with the percentage of cases among whites.
After five years battling the disease, it would seem that condoms and other tried-and-true tools to combat infections would be widely available to high-risk groups, such as young sex workers. But that's not always the case. Slowing infection rates among all groups remains a daunting task.
``Poverty leads to unsafe sex, drugs and crime,'' said Ronald Person, director of the county's Office of AIDS. ``Within the African American and Latino community, we've got a high unemployment rate and lack of education.'' Men who have sex with men - the largest group by far being infected - still account for 63 percent of AIDS cases in the county. ``You can't miss the forest for the trees,'' said Dr. Kathleen Clanon, director of Highland Hospital's HIV/AIDS program. ``Most people we see are still men who have sex with men, and many are African American men. I feel they are our biggest challenge.''
While infection rates aren't slowing down, funding to fight the disease is. When the state of emergency was declared, the Congressional Black Caucus, with leadership from Rep. Barbara Lee, D-Oakland, secured $37 million in emergency funding to affected counties such as Alameda and Los Angeles. A local task force on the emergency was formed, with $200,000, of which half came from the Office of AIDS and half from the county Board of Supervisors.
It's unclear how much money actually came in for the state of emergency out of the $37 million figure, at the time widely reported. Lee's office puts the number at $5 million. The county Office of AIDS received a one-time grant of $500,000. And community-based organizations, like Cal-PEP, got some funding. Additional monies were secured through the Minority HIV/AIDS Initiative, a $400 million federal program pushed by the Congressional Black Caucus and approved by President Bill Clinton in 1998. But the bulk of the county's $13.7 million AIDS budget is for treatment - from the 1990 Ryan White CARE Act, a nearly $2 billion federal program that helps underserved people living with the disease.
Overall, the county had had minor funding increases over the past five years, though it lost $23,000 in Minority HIV/AIDS Initiative funds this year. About one-fourth of the Office of AIDS money goes to prevention and education, the rest to treatment for people already infected, and about $2 million goes to Contra Costa County programs. Lee has her doubts that domestic AIDS programs will get more funding over the next few years. ``I'm sure the Republicans are not going to allow us to move forward,'' she said. ``This administration has not been good in terms of AIDS.'' This year's federal HIV/AIDS Bureau, administered through the Department of Health Services, saw only a slight budget increase over the previous year - from $1.9 billion to just over $2 billion.

Arnold Perkins, director of the county's Public Health Department, said the large numbers of infections among African Americans and Latinos is one reason why less money is being allocated. ``As the complexion and the complexity of the disease has changed, the money has dried up,'' Perkins said. ``By complexion, I mean as the disease continues to affect more people who are darker in hue there has been less funding. By complexity, I mean we serve a much more difficult population. Many are homeless, or drug abusers.''
County Supervisor Keith Carson said AIDS is wrapped up in the general lack of funds for health care. ``Public health is sort of like the public defender's office,'' he said. ``It's kind of at the bottom of the food chain.'' Oakland, the city with the most AIDS cases, is not an island in this. Hayward, Berkeley, Fremont and Dublin - where Santa Rita jail is located - also have high infection rates.
Lisa Carver runs programs for IV drug users and youth at Tri-City Health in Fremont, serving 12 cities in south and west county, from Hayward and Newark to Pleasanton and Livermore. ``There's less jobs, less services, less drug treatment, less affordable housing,'' she said. ``We cringe when people ask if we know a shelter they can go to. Shelters have long waiting lists. But people need to have hope in order to not have HIV.''

A second chance

Lamar Calhoun is a trim 48-year old African American man with a graying beard. In July 1996, he was admitted to Highland Hospital in Oakland with eight opportunistic infections. Quickly diagnosed with HIV, he stayed at Highland for the next nine months, near death. When he went in, he weighed 187 pounds and didn't know he had HIV. When he came out, he weighed 110 pounds and was told he had six to eight weeks to live.
Three months later, he was still alive. In another few months, he was walking up and down stairs with one of his eight siblings. ``Eventually, we were down the block,'' he said. Calhoun is one of the growing number of success stories who, thanks to antiretroviral drugs, can turn back the tide of the disease and live long lives.
``I consider myself very lucky,'' he said. Many of his friends diagnosed before the mid-1990s are dead today. But Calhoun believes that people are being lost unnecessarily to the disease. He runs a peer counseling group for the newly infected called the Living Well Program at Highland Hospital. Many people in his group have mental health problems, like depression, and need housing and other services. Under tight federal, state and local budget constraints, some people are not getting these services, making it more difficult to stick to the medication regimen demanded by HIV drugs. ``People with HIV need a stable, clean, more controlled environment,'' he said. ``You've got to be able to make yourself a hot meal and take a bath.''
One problem with securing services is that no one is sure how many HIV-positive people are in the Bay Area. Most available figures are AIDS cases, though experts agree that AIDS rates no longer reflect the true picture of the epidemic. An estimated 800,000 to 900,000 people in California are HIV-positive, according to the state Department of Health Services. In 1997, the National Centers for Disease Control and Prevention put the number infected in Alameda County at possibly 7,000 people. But anecdotal evidence suggests that number could be much higher. This summer, Highland Hospital did a pilot project on the new OraQuick rapid HIV test, which gives results in 20 minutes, compared to traditional tests that typically take a week. The hospital tested high-risk patients, such as pregnant women who had received no prenatal care, men who have sex with men, and injection drug users. Out of 100 people tested, 15 came up positive, a rate the state and the hospital found astonishingly high.

Other anecdotes: Tri-City Health in Fremont recently tested 50 youth, and got 5 positives. Calhoun recalls testing people in East Oakland one day in 2001 and getting a 7 percent positive rate out of 150 people. Rafael Rosas is someone who the county hopes will help find high-risk people. Called a ``bridge'' worker, he connects people with services through the Bay Area Consortium for Quality Health Care. Rosas is a big-hearted Latino man whose cell phone rings constantly, and he seems to know everyone he passes on the streets of Oakland.
Diagnosed with HIV in 1999, Rosas, like Calhoun, has a back-from-the-brink story of his own illness and recovery. He was also addicted to crack, getting hooked in the mid-1980s, giving it up after his diagnosis. These days, he spends much of his time talking to people about HIV and drug use. He's motivated to reach anyone and everyone who will listen - especially people on crack. ``All they know is they're out there making money, and when you're on crack, you're more likely to do whatever anyone asks sexually to get more crack,'' he said.
Speaking with women is also a primary focus.
``We have to get the young Latinas, especially the ones with children because you know right behind that child comes another one - they're having unprotected sex,'' he said while handing out pamphlets in the Fruitvale District to moms with strollers. State health officials said bridge worker programs could be on the chopping block next year, though they account for a tiny portion of the state's overall budget. At the county level, less than half a million dollars goes to bridge programs.

Constantly scrambling

Stopping people from getting infected is one the of the battles that the U.S. government now believes it is losing. In April, the CDC issued a startling new directive outlining a shift in prevention strategy in the fight against HIV/AIDS. Instead of focusing on HIV-negative people from converting to positive, it will enlist HIV-positive people in practicing safe sex so they don't infect their partners. This strategy is controversial among AIDS activists and physicians.
``There's no money attached to it,'' said Hazel Wesson, executive director of the AIDS Project East Bay, one of the largest community groups in the county. Wesson just got word she was turned down for a $1 million grant from the CDC that would have provided testing, counseling and social networking. No other East Bay group that applied for the grant got it, though several in San Francisco did.
Cal-PEP, the group that does outreach to sex workers on San Pablo Avenue, also was turned down for funding this year. In late September, it closed its long-standing day treatment center for substance abusers, some who were HIV-positive. The program cost about $500,000 a year to run and served more than 100 people. And WORLD, or Women Organized to Respond to Life-Threatening Disease, the oldest and largest group for HIV-positive women in the country, is also facing tough times. It now shuts down one day a week and has discontinued its popular newsletter. Though its annual budget is only $450,000, even coming up with that money to run its support groups and other programs has been tough. ``We're constantly scrambling,'' said Maura Riordan, the group's executive director.
If Oakland-based WORLD were to close its doors, it wouldn't be the first to do so. The oldest HIV/AIDS organization in the county - and one instrumental in getting the state of emergency declared - shut down last year due to financial mismanagement and lack of funding. Called AMASSI, the group served hundreds of people who were infected, and many more at risk. ``AMASSI was a big loss,'' said Person, of the county Office of AIDS. ``A lot of agencies got money but not infrastructure. There just wasn't any training for capacity building.''
Cal-PEP and other groups now have technical advisory help through the federal Office of Minority Health so they can expand and contract wisely. No program, it seems, is safe. The state lost $5.25 million in prevention funds for local health programs this year. Next fiscal year, the state may go to waiting lists for its AIDS Drug Assistance Program, which pays for expensive drugs for infected patients. Already, several other states have gone to waiting lists and lotteries. In West Virginia, two people died from AIDS while on the waiting list for antiretroviral drugs.
State officials said Alameda County is doing its best. ``They have a tremendous challenge to address such a significant problem,'' said Michael Montgomery, chief of the state Office of AIDS. ``We appreciate all their efforts.''
Some of the county's successes have nothing to do with money. ``One thing that has been taboo has been discussing AIDS in the church, especially the black church,'' said county Supervisor Carson. ``Now we see more churches hosting forums, that's been a major step.'' Others complain the drive are no longer there to fight the disease, though the stigma surrounding the disease persists. ``I've been personally disappointed in the state of emergency,'' said Dr. Clanon of Highland Hospital.``That such a stunning declaration didn't result in anything different. The budget problems alone make things difficult, but it's still business as usual. As a result, Latinos and African Americans are being infected with a completely preventable disease.''
Dr. Lisha Wilson, medical director of the AIDS Healthcare Foundation Magic Johnson Clinic in Oakland and San Francisco, added that the disease ``isn't in people's faces... I don't know if enough people are making a concerted effort.'' Finding partnerships with powerful lobbying groups - the NAACP or the Urban League are two frequently mentioned - is something that could give the emergency a new spotlight, but such connections haven't borne fruit. And being so close to San Francisco is considered a mixed blessing. East Bay activists and officials gripe about being a forgotten stepchild, competing for funding with a bigger, more famous AIDS-afflicted county.
``Sometimes I feel like, well, people aren't dying anymore,'' Wesson from AIDS Project East Bay said. ``People may feel there are other causes they'd like to give to instead....''
Her voice trailed off. She paused and said. ``As far as we've come, we haven't gone anywhere.''
Contact Rebecca Vesely at rvesely@angnewspapers.com

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