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Sunday, May 15, 2005

Teams take to streets with AIDS FACTS

The Commercial Appeal, May 15, 2005
By Michael Kelley

Nothing spoils a walk in the park like seeing a used condom in the grass. Unless it's not seeing one.

That's how AIDS prevention workers see it. Every discarded sheath of latex helps hold back an HIV tide that still poses a threat in Memphis, especially among African-Americans.

In Zip Code 38106, a predominantly black area of South Memphis where field investigators spent about half their time during a 2002 AIDS study, they didn't see a lot of used condoms. In Zip Code 38104, a racially diverse area in Midtown, they were all over the place.

The observation was anecdotal, but it was emblematic of a trend that was well under way at the time - the migration of the epidemic from mostly white male homosexuals to the black community in general.

In Shelby County, where black and white populations are roughly equal, the shift is dramatic. From the beginning of the AIDS epidemic in 1982 until the end of 2003, the last year for which state Department of Health statistics are available, 2,879, or 73.4 percent, of those who had fallen ill with the disease in Shelby County were black.

During calendar year 2003, 362 (88.5 percent) of the new Shelby County HIV/AIDS cases and 268 (89.9 percent) of the new AIDS cases were among African-Americans.

Memphis-Shelby County Health Department figures show a shift in new AIDS cases from 54 percent black in 1992 to 84 percent black 10 years later. Black female cases rose from 13 the first year of that span to 88 the last year as a trend developed: the spread of HIV through male-to-male sexual contact among men who carried the virus home to female sexual partners.

Sharron Moore-Edwards, a field team investigator in the 2002 study and community service director at St. Andrew AME Church, and co-worker Dan Chatman are among those on the front lines of the effort to stop the spread of HIV in the African-American community.

Dressed in jeans and polo shirts with "Project Hope" logos stitched on the front, the outreach workers, both products of South Memphis and both former addicts, visit bus stops, basketball courts, shopping strips, nail salons, beauty shops or wherever they can get "a good audience," Moore-Edwards said.

They carry "Safer Sex" packages containing condoms supplied by Friends for Life and HIV/AIDS literature.

The contacts on the streets are brief, but sometimes can lead to a testing session, group counseling or an individual meeting for more intensive education and enlightenment on the realities of the epidemic.

"We usually go out at peak times in the evening when people are out and about," Moore-Edwards said. "We saturate neighborhoods - wherever there are masses of people."

Project Hope is one of five community-based organizations that run HIV/AIDS prevention programs in Memphis, quietly perking along on funds provided by the federal Centers for Disease Control. The budget for all five, including Project Hope, held steady at $421,200 for 2005 after a small increase last year.

A lot more could be done to attack the spread of HIV/AIDS in areas where risky sexual behavior and drug use occur, said Dr. Jebose Okwumabua, professor of health promotion at the University of Memphis and field team coordinator for the 2002 Rapid Assessment, Response and Evaluation (RARE) project.

Okwumabua's group recruited drug addicts, prostitutes, gay men and experts on neighborhood culture to identify pockets of high-risk activity within the 38106 and 38104 areas, two of six Zip Codes in Memphis where high rates of HIV infection were reported.

RARE team members photographed discarded drug paraphernalia behind liquor stores, timed how long pairs of men spent in the woods together in Overton Park, made themselves inconspicuous for direct observations of risky behavior at several locations, conducted group and individual interviews and street-corner surveys of drug dealers, hustlers and prostitutes. They collected data for nine months and outlined an action plan.

Okwumabua came away convinced that the best way to attack the problem is through community outreach programs that confront people late at night in areas where at-risk groups congregate. He maintains efforts in Memphis are not as aggressive as they should be. And there is little in the way of splashy media campaigns designed to address the spread of HIV/AIDS.

"As health care professionals we need to do a better job of reaching poor and underserved populations," Okwumabua said.

That's not to say there haven't been some changes in the way Memphians approach HIV/AIDS prevention to meet the needs of African-Americans.

Friends for Life, an old hand at the prevention effort, is approaching a 50-50 ratio on the racial makeup of its staff and board of directors. One of the group's educators works with prostitutes on a shift that puts him on the street at 2 a.m. The organization sponsors Wednesday night support group meetings for young gay black men that attract participants from all over the Mid-South.

With them, "it's like back in the '80s," said executive director Kim Moss. "These fellows go into the hospital with a cough and come to find out they have pneumonia, and then they find out they have AIDS."

Testing is a major component of the effort. The Memphis-Shelby County Health Department's infectious disease unit is shifting its resources this year to hire 10 phlebotomists so that it can step up its testing program.

Vincent Glover, manager of the health department's infectious disease section, said a part-time staff managed to test 6 percent of the new male inmates at the Shelby County Jail during the first quarter of the year and 23 percent of the women at Jail East. Both figures are expected to rise when the department is able to offer testing at the jail full-time.

"We know more people used to think (AIDS) was a death sentence, and now it's seen more as a long-term manageable disease," Glover said. "But in order to get treatment you have to be tested."

To persuade people to be tested and lure them back for the results, community-based organizations are giving away everything from gift certificates to T-shirts. They follow up with counseling and direct those who are infected into treatment programs.

Faith-based groups in Memphis generally don't buy condoms or dental dams, but they allow them to be distributed by other groups at their events, and in some cases distribute them on behalf of groups such as Friends for Life.

Still, progress has been slow in the effort to bring HIV/AIDS out from its veil of mystery and encourage more public conversations about the subject.

Novella Smith-Arnold, whose Calvary Episcopal Church outreach ministry includes funeral services for AIDS victims, says the lines of communication are still not open.

Families "will call me because many ministers are not gay- or AIDS-friendly," Smith-Arnold said. "A lot of times the minister doesn't even know."

A former Shelby County Jail chaplain, Smith-Arnold advocates distributing condoms to inmates and talking openly about the down-low issue - the problem of women contracting HIV from men who have had sex with other men "on the down low," often in jail.

"We've got many black men on the down low, because it's an abomination to be gay in the black community," she said. "So you lie. Behind bars you can do anything, because nobody knows you're doing it. You're on the down low."

The communication gap is a major target of the 10-year-old African-American Pastors Consortium, which in April brought 135 people together for two days of discussions at Mississippi Boulevard Christian Church. The group included faith leaders, health care professionals, social workers and people who have either been infected or in some other way affected by HIV.

A new twist is to integrate AIDS education with information on other diseases that disproportionately affect the African-American community, such as cardiovascular disease, stroke and diabetes. That attracts more people to the HIV/AIDS message by helping demystify the disease.

Much of the organization's work centers on children, promoting abstinence and faithful monogamy without avoiding what can be a touchy subject - protection.

"The main part of our program pushes abstinence," said Rev. Melvin Lee of Macedonia Missionary Baptist Church, executive chairman of the pastors' group. "But we realize children can become engaged in sex, and we have to educate them to take care of themselves."

According to health care professionals and a growing number of clergy, that means providing information - and supplies - that encourage safer sex to young and old alike. There's too much at stake, especially for the African-American community, they say, to leave matters in the hands of fate.

Edition: Final; Section: Viewpoint; Page: V1
Copyright (c) 2005 The Commercial Appeal, Memphis, TN


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