Columbia School of Journalism:
The Next Generation of AIDS Prevention
VALERIE REISS
12/11/2002
After nearly two hours in the bitter cold, the AIDS activists still hadn’t found anyone to test for HIV. In the Mott Haven section of the South Bronx on a recent December Sunday evening, most of the kids out in puffy coats and FUBU jackets couldn’t even be enticed by the promise of free movie tickets.
“People are doing their laundry, they’re not thinking about HIV,” said Michelle Allen, an Administrative Assistant for the Adolescent AIDS Program at Montefiore Hospital. Allen was one of several volunteers waiting in the program’s heated testing van parked in front of the Millbrook Houses on St. Ann’s Avenue. The housing complex stands in a neighborhood with one of the highest AIDS and poverty rates in the country. This stop was one of many in their “Get Tested Week” from December 2-10, which also included in-school HIV testing throughout the city.
These events come at a time when the city’s health care providers are concerned about a pending wave of HIV infection in young people — of the 40,000 new infections estimated each year in the U.S., 50 percent are in people under 24. But the statistics are tricky. Until 2000, New York State only collected data on AIDS cases and not HIVinfection. As a result, local AIDS statistics do not reflect current infection rates. And because the disease takes about ten years to move from infection to illness, today’s 24-year-olds with AIDS are yesterday’s 14-year-olds with HIV.
Doctors, nurses, counselors and activists must rely on social and medical indicators, such as rates of sexually transmitted diseases, to measure HIV. And these indicators show an increase in infection and risk especially for young African-American women—locally and nationally. The Centers for Disease Control has released several recent bulletins about these findings.
Because of this tangle of youth, poverty, race, politics and sexuality, those working at Montefiore’s Adolescent AIDS program also struggle with the myriad problems of gaining access to, educating and testing adolescents at high risk for the disease.
Overall, program coordinators considered their testing week a great success. Expecting to test only ten to 15 young people per van stop, they averaged about 30, for a total of 204 by the final day — not including those they tested in schools. Next week, the teens will return for their test results. When they do, they get a free movie ticket each.
As part of the outreach on Sunday evening, Jessica Rivera, an on-staff Youth Advocate who helped design the program, slowly walked through dimly lit streets with a yellow supermarket bag filled with condoms, lubricant and chapstick printed with “Protect More Than Your Lips.” Most of the young people she approached accepted the goodies, but declined to be tested even though there are no needles involved. Their HIV test is called Orasure and only involves the painless collection of mouth cells. A long swab with a spongy tip is gently rubbed against the patient’s inner cheek. Test over.
The most painful part of the testing process is often the questions health workers ask before they test: “How many sexual partners have you had?” “Do you have an adult you can talk to about this?” “What would you do if you tested HIV positive?” If workers find the answers disturbing, they will halt the test. For example, if teens say they will kill themselves if they test positive, workers halt the test and refer them to the hospital, where they can be tested in an environment with more facilities and support.
There is not much support on these streets. It is a land of unsupervised kids hanging out in public spaces—something rarely seen just 20 minutes south, where pricey or well-funded after-school ballet, soccer and other programs keep kids busy. One group Rivera approached in front of the Millbrook Houses was listening to a small boombox blaring, “Can I Live to My Last Day?” by The Locks. A tall girl tentatively accepted Rivera’s offerings, smiling, and a boy bragged that he would test one of the condoms later that night. Rivera also gave them pamphlets, pointed out the testing van and moved on.
Two girls on St. Ann’s Avenue looked young—their faces and bodies appeared barely past puberty. But when offered free condoms, they paused a moment, laughed nervously and accepted, filling their winter jacket pockets with handfuls of condoms and mini-packets of lubricant. Rivera convinced them to come to the van to be tested. No needles was the dealmaker. One of the girls, whose name is also Jessica, said she was tested a few weeks ago, but wanted to double-check because she is two months pregnant.
This blend of experience, naivete and youth is dismaying to health and social workers, even though they see it again and again. “It’s not shocking, it’s just sad,” said Carol Tobkes, Director of Training, Outreach and Prevention for the Montefiore program. Cultural conditions and attitudes that put these girls in peril, said Tobkes, 40, who has a degree in pediatric health and has been doing AIDS work since 1988. “Girls believe sex and love go hand in hand,” she said. “They get duped.”
Swinging her yellow bag as she walked, Tobkes passed a lone girl with a striped headscarf who accepted the condoms. When the girl looked puzzled at the lubricant, Tobkes said, “They make everything slide.” The girl laughed.
The most challenging part of her job, Tobkes said, is getting past the grown-ups. “Many adults don’t recognize the risks that kids have,” she said. “And there’s a fear among agencies that the parents will get up in arms even though the kids have a right to the information.”
Back in the overly heated van, the nurse practitioner and several other volunteers got restless and discussed leaving early. But Tobkes and Rivera stocked up on water, warmth and potato chips, re-loaded their bags and headed out again.
They soon approached three boys at a phone booth, who took turns talking on the phone and accepting condoms and pamphlets. They agreed to get tested and two of the boys, both in FUBU jackets, one black, one red, started walking with Rivera. A younger boy with an undone doo-rag hanging down like long rabbit ears was still on the phone. The boy in red, Angel,18, said the boy on the phone did not need testing: “Nah, that’s my brother. He’s a virgin.”
The younger brother, Jonathan, 14, yelled, “I ain’t no virgin!’ and Rivera beckoned him with her hand. When the older brother repeated, “He doesn’t need this, though,” Rivera said quietly, “There isn’t anyone like that,’ and Jonathan came along, his “ears” swaying around his face.
After Tobkes and Rivera returned from a final trip, the boys had wrapped up their tests. “I want another one of those “dam” things, said Angel of the multi-colored dental dams in plastic candy jars. Allen handed him a bunch. “Here, take all the flavors. Plain, vanilla, strawberry,” she said. “You can’t have too many.”
Angel laughed. “I like the no-needle thing,” he said. “It’s good that this is here. People know about it and they can come and get tested.”