Too Many Lower East Side Residents Still Die from HIV/AIDS
Glenn Richardson isn’t sure how he contracted the virus. Today it doesn’t seem to matter to him anymore how he was infected. He accepts the disease as part of his life, as something he tries to survive while too many Lower East Siders still die from this preventable killer.
Richardson, 50, is one of many HIV-positive residents in the Lower East Side, an area that 26 years after the virus was discovered is still hard hit by HIV-related deaths. The reasons are as diverse as its population. A combination of poverty, drugs and low rates of preventative testing and condom use make HIV/AIDS one of the worst health problems in the area, especially among black and Hispanic gay men. Several nonprofits are responding to the situation by providing comprehensive services.
As a bisexual African American who contracted the virus in 1984, Richardson feels society has forgotten about the disease. “Back then it certainly felt like a death sentence. At the time, AIDS was considered a taboo. Today, it’s apathy. Some people deny it exists anymore,” says Richardson, who volunteers as the chairman of the client advisory board at Housing Works, a nonprofit housing and medical service provider for HIV-patients in the East Village.
Without these organizations patients like Richardson would be on their own in the country’s HIV/AIDS capital. New York has the highest AIDS case rate of any city in the U.S. – more than San Francisco, Los Angeles, Miami and Washington, D.C. combined, according to the 2006 Community Health Profile by the city’s Department of Health and Mental Hygiene.
The department’s numbers speak volumes. While the overall HIV-related death rate has decreased by 75 percent over the last decade, HIV is still the second leading cause of premature death in the Lower East Side, including the East Village and Chinatown. Only cancer takes more lives in this neighborhood. With 28 deaths per 100,000 people, the HIV-related death rate in the Lower East Side is twice as high as the city’s average, according to the 2006 health profile; and with 1,740 patients per 100,000 residents, the number of people living with HIV in the Lower East Side is also higher than the city’s average of 1,419.
A Combination of Drugs and Poverty
It is impossible to pin-point one single cause for the area’s problems, and city officials, community activists and physicians agree several factors contribute to these numbers.
“There are two issues,” says Eric Morales, executive director of the East Village’s Housing Works facility. “One is drugs. The second one is socio-economics.” Morales says HIV finds a fertile ground in the drug-prone Lower East Side, where 23 percent of residents live below the poverty level and one in three is uninsured, according to the health profile. He says a lack of counseling and health services combined with drugs make HIV-patients with already compromised immune systems even more vulnerable. “It’s never simply that HIV has progressed to AIDS. There is almost always substance abuse involved,” Morales says.
Dr. Joseph O’Connell, who opened New York’s first private AIDS clinic in 1988, agrees. “There are higher incidents of drug abuse in areas of lower income,” O’Connell says. “Men who have sex with men and IV drug users have the highest number of cases.”
David Rosenthal, executive director of the Lower East Side Harm Reduction Center, has long been aware of this problem. His organization hands out more than 900 clean needles to intravenous drug users weekly and 75 percent of them are returned to be safely discarded. Since 1992, when the needle exchange was instituted, new infection rates among injection drug users in New York have dropped dramatically,” Rosenthal says. Therefore, he believes other factors have just as much influence. “A lot has to do with the lack of testing. If testing is delayed, mortality and morbidity are increased. There is a lack of early recognition,” Rosenthal says.
The health department’s numbers support his assertion. It reported only one in five Lower East Siders get screened for HIV. This is especially troubling since only 38 percent of residents report using condoms. Therefore, it isn’t surprising that one-fourth of those who eventually get tested have already contracted AIDS by the time they are diagnosed.
Ignorance and Underestimation Contribute to Problem
Many activists think two fairly new trends are responsible for these disturbing figures. They say a combination of ignorance about the chances of getting infected and underestimation of the disease’s deathliness have resulted in few people taking preventative measures.
“Particularly young people view HIV as some kind of manageable disease,” says Bill Stackhouse, director of the Institute of Gay Men’s Health at Gay Men’s Health Crisis. “In the early days, the conditions of people living with HIV were horrible, and people saw that it was serious,” Stackhouse says. “As the disease has fortunately become more manageable, the downside is that people don’t view it as serious as they did in the past.”
Marc Gossin, who runs the Always Your Choice medical office on E. 11th St., holds pharmaceutical companies responsible for this development. “Pharmaceuticals create the image that AIDS doesn’t have consequences. They show strong, athletic men who look attractive using only one pill a day,” he says pointing at a half-naked man on a medical pamphlet. “Their message is, ‘It’s OK to get positive so you can look like him.’”
As a patient himself, Richardson describes the medical advances as a “double-edged sword.” He says he knows of patients who have even purposely contracted the virus to receive medical and housing services they otherwise wouldn’t have access to. “Some people just don’t find it as lethal anymore. For a lot of people who are struggling financially it’s a way out,” Richardson says about these “bug chasers.”
Gossin, who treats about 100 patients a week for HIV and STDs, has also dealt with “bug chasers.” “I have taken care of men who I know were negative and have gone to sex parties to get HIV,” Gossin says, adding such cases are rare however.
Blacks and Hispanics Carry Biggest Share
Nevertheless, these cases illustrate how the perception of HIV has changed over the years, while the disease remains a social problem particularly in lower-income communities.
According to a study by the health department, HIV is on the rise among New York’s sexually active gay men, overwhelmingly among blacks and Hispanics. The department’s findings, released in September, showed a 33 percent increase of HIV among gay men less than 30 years old since 2001. The rate doubled among ages 13 to 19. Gay black men received twice as many HIV diagnoses than whites in 2006, and 90 percent of HIV-positive gay men under the age of 20 were either black or Hispanic.
“HIV is a disease of poverty and black people are among the poorest people in the country. Access to health care, education and other services are important,” says Borris Powell, program director of Gay Men of African Descent. He adds social stigmas are another major concern for black HIV patients. “HIV has more stigmas attached than any other disease in history, and blacks are already marginalized in this country,” Powell says.
Housing Works Takes Care of Body, Mind
In response to these problems, Housing Works tries to instill hope and new love for life in HIV-patients by providing holistic services ranging from primary care to mental health to HIV counseling. More than 130 HIV/AIDS patients from all over the city but mainly the Lower East Side use these services. Thirty-six of them live in the facility’s apartments on E. Ninth St. To be eligible they must be HIV-positive and suffer from drug abuse or mental illness. Their services are either paid for by Medicaid or through funding of the city’s HIV/AIDS Services Administration.
Richardson, who worked as an advocate in Washington, D.C. and New York, says too many HIV-infected Lower East Siders don’t know they are eligible for these services or are afraid to reveal their status publicly. Richardson says he, too, wanted to “hide away from society” when he moved to the East Village in 1998. He did so until he discovered Housing Works, which provided him with health services and an environment without stigmas.
“I wouldn’t be here without it,” says Richardson, who doesn’t reside at the facility but spends six days a week there. “If I’d lose Housing Works I’d rather die.”