No Room at the Shelter
Illustrations by Elton Tucker
Biggers fought back against the discrimination and the ignorance that gave rise to it. In so doing, he not only helped change the attitudes and policies of the people at Emmaus, but was also instrumental in the development of a model nondiscrimination policy and practical guidelines and educational materials that their creators hope can be adapted to shelters in small and large communities across the country.
In some ways, though, perhaps the Biggers case could only have originated where it did. When he was forced to leave the shelter, Biggers was not put out on the street but moved to a local motel by himself. If this had happened in New York or L.A., where shelters can be crowded and dangerous, often housing hundreds of people in dormitory-style rooms, the idea of staying in a motel might seem like winning a mini-lottery. Not so in Ellsworth, Maine. Emmaus Center is small--very small, housing a maximum of 22 people at any one time among its five-bed women's dormitory, eight-bed men's dormitory, and three "family rooms." And it's not just "three hots and a cot." Residents, staff, and volunteers get to know each other, and in some ways the shelter becomes a community . . . particularly at Christmas. When Biggers was forced to leave, he was cut off from the only social support system he had and was left to spend his holidays alone.
The Legal CasePatrick Biggers was devastated by his ouster from the shelter. He immediately contacted Director Ron King of the Down East AIDS Network, the local AIDS service organization where he had been receiving case management services. (It was DEAN, in fact, that helped get him into a motel and provided some immediate financial assistance.) DEAN helped him get in touch with the Maine Civil Liberties Union, and the state group in turn hooked him up with the American Civil Liberties Union's AIDS Project.
The initial case brought by Patrick Biggers against Emmaus was a complaint filed with the Maine Human Rights Commission charging that the shelter had discriminated against him based on his HIV status. Emmaus countered that Biggers's eviction had not been based on his having HIV but was instead because he had engaged in what it called "dangerous behavior." And what was this "dangerous behavior"? Biggers had told other shelter residents that he was HIV positive. He had handed another resident a cup of coffee, drunk out of one of the shelter's cups, handled dishes in the shelter's kitchen. He had held a baby. Emmaus contended that Biggers was putting other residents and staff of the shelter at risk of HIV transmission through his saliva. They argued that he should not talk about his health status because other residents were afraid to eat at the same table with him and some of them had even started sleeping outside the building. When Biggers was sent to the motel, Emmaus's director had ordered a special, and exceptionally thorough, cleaning of the kitchen area.
Then, in mid-1998, a couple of things happened. The Maine Human Rights Commission indicated that it intended to find for Biggers and against Emmaus, and the ACLU prepared to sue. At the same time, Emmaus found itself with a new director, Judi Joy, who was much more knowledgeable about HIV than her predecessor and much more sympathetic to Biggers's situation. In fact, she was among the people to whom Biggers had been sent by DEAN's Ron King when Biggers had first been kicked out of the shelter.
What might have been a rancorous and protracted lawsuit was transformed into productive negotiation. The Emmaus Center's parent organization, Homeworkers Organized for More Employment, or H.O.M.E., indicated a willingness to work with the ACLU and others to make its shelters more responsive to the needs of HIV-positive individuals. Biggers volunteered to drop his demand for monetary damages in exchange for the adoption of policies and procedures that protected people with HIV. The suit was eventually settled with Emmaus agreeing to a strong nondiscrimination policy and HIV training for its staff and residents, and issuing a written apology to Biggers for the mistreatment he had received that Christmas.
The SettlementReaching an agreement, of course, was just the beginning. The new, fairer approach had to be made reality. Michael Adams is Associate Director of both the AIDS Project and the Lesbian and Gay Rights Project at the ACLU, and worked closely with Emmaus and H.O.M.E. to devise a policy and procedures that would ensure the rights of HIV-positive shelter residents. The focus, according to Adams, was on the provisions of the federal Americans with Disabilities Act that protect people with disabilities--which includes people with HIV--against discrimination in public accommodations. According to these provisions, people with HIV must receive the same services as everyone else, and on an equal basis with everyone else. They cannot be denied services, nor can they be segregated from other residents, by being forced to eat separately or from different dishes, for example . . . or by being housed in a motel. Shelter staff and volunteers cannot harass people with HIV, nor can they tolerate mistreatment of HIV-positive clients by other residents. If necessary, a shelter must make "reasonable accommodations" for HIV-positive residents, for example by allowing refrigerator access for medications, or modifying schedules to accommodate the demands of a drug regimen. Working together, Adams and Emmaus drafted a policy and procedures designed to meet the provisions of the Americans with Disabilities Act and state HIV confidentiality laws.
The second, and equally important, part of the settlement was training the staff of the shelter and implementing the nondiscrimination policy and procedures. Here Adams and Emmaus enlisted the help of DEAN, the Down East AIDS Network, where Patrick Biggers had gone for help after being forced to leave the shelter. Mary Harney, DEAN'S Community and Youth HIV Educator, was asked to design a training curriculum that would meet the specific needs of Emmaus and satisfy the provisions of the settlement. She outlined a six-session training course and by spring of 1998 was ready to test and refine the curriculum.
The TrainingThe first pilot training session was held at the Emmaus Center. Staff were required to attend, and volunteers and residents were invited. In addition, some other staff of H.O.M.E. were present, for a total participation of about fifteen people. This first session was a standard AIDS 101 and was intended to follow the traditional structure: a pre-test that assessed participants' knowledge, attitudes, beliefs, and behaviors about HIV and AIDS; then the training session; then a post-test to measure what had been learned.
The session did not go well. First, Harney arrived to find that the pre-tests were not with the materials she had brought. She went ahead with the session anyway, deciding to rely on the post-test to provide information on the strengths and weaknesses of the training. As the session proceeded, one thing quickly became clear: The shelter was not a suitable venue for this type of training. Residents and others came in and out of the room. Phones rang. There was one interruption, one distraction, after another. At the end of the session, she administered the post-test and scheduled the second session, featuring an HIV-positive woman speaker, for the following week.
The next day Harney looked at the post-tests. It was clear that the HIV information that had been provided simply had not registered with the participants. Some major rethinking was in order. Harney got together with Emmaus's Judi Joy and together they discussed the situation and looked at the people being trained--these individuals whom they knew--and they began to see the root of problem. "We all have different learning levels," Harney says, "and different ways of learning."
The initial AIDS 101 was rescheduled for the same group of participants. It was held in a more appropriate training site, one that was quieter and had more room. Participants had to turn off their beepers and cell phones. This time a pre-test was administered.
The content of the training itself was somewhat modified to include exercises on beliefs, attitudes, and values clarification. Practical instruction on dispensing medications was provided, along with information on the importance of adhering strictly to the schedule of an HIV drug regimen. Participants were taught the Maine Bureau of Health policies on confidentiality and discrimination. Role-playing exercises helped heighten staff members' understanding of the impact of HIV and of their own actions toward people with the virus.
Through this and subsequent sessions, Harney found that the participants gradually built a sense of mutual trust and helped each other work through some of the stickier issues. Stigma and fear are still major problems even in the big cities, where people are almost bombarded with HIV information, and this, after all, was rural Maine.
This mutual trust was especially important as participants grappled with some of their own preconceptions. Some staff members had deeply held longtime religious beliefs about homosexuality, beliefs they were sometimes reluctant to discuss for fear of being labeled prejudiced. But there was, in general, an acceptance that the people who were there were well-intentioned or they wouldn't be there in the first place, and this served as a starting place for an exploration of prejudices, where they come from, how to work around them, and how homophobia is related to other areas of prejudice. In the end, says Harney, the staff bonded around issues of inclusivity.
At the end of the six sessions, the post-test results showed real progress. With the aid of a consultant obtained with the help of the ACLU, Harney and DEAN have fine-tuned the curriculum and conducted subsequent series of trainings that have gone very well. The emphasis, according to Harney, is on starting where people are--listening to off-the-cuff statements and questions, for example, to identify areas that need work, and adjusting the curriculum to meet participants' needs. Harney also talks periodically with Emmaus's Judi Joy, and the women agree that the new policies and procedures, coupled with training that is tailored to the particular needs of staff members, has made a tremendous difference in the type of treatment received by HIV-positive residents, and in the degree of respect and dignity they are afforded.
ReplicabilityThat's all very nice for this little shelter, of course, and for Patrick Biggers and any other HIV-positive people who find themselves homeless in Ellsworth, Maine. But what about the rest of the world?
In March the ACLU published HIV and Homeless Shelters: Policy and Practice, which seeks to spread the lessons of the Biggers case to a larger audience of programs serving the homeless. Written by Michael Adams, who represented Biggers on behalf of the ACLU and who played a principal role in the development of both the nondiscrimination policy and the training curriculum, the publication provides an overview of HIV, homelessness, and shelters, along with a discussion of the legal requirements of the Americans with Disabilities Act as they apply to homeless shelters and individuals with HIV. The H.O.M.E./Emmaus Center nondiscrimination policy and procedures and DEAN's training curriculum are included as appendices, along with other training materials and resources.
In a section entitled "How To Make Shelters Safer Spaces for HIV Prevention & Care," Adams presents an outline of things shelters can do to prevent discrimination based on HIV status and take positive steps toward prevention and service provision. These steps include adopting a nondiscrimination policy; providing mandatory staff HIV/AIDS training, with residents encouraged to attend similar trainings and with curricula tailored to the shelter's population; maintaining strict confidentiality of residents' HIV status; utilizing intake procedures that are nondiscriminatory and sensitive to the needs of people with HIV; treating people uniformly except when reasonable accommodation is necessary; providing a "Consumer Bill of Rights"; making the shelter proactively "safe" by posting the nondiscrimination policies, providing HIV information flyers, etc.; maintaining scrupulous hygiene; observing universal precautions; allowing access to refrigeration and mealtime flexibility; and connecting residents to community-based HIV services.
The purpose, of course, is to provide shelters large and small around the country with the tools they need to make their facilities safer for HIV-positive residents and to enable them to provide those residents with the services they need in their communities. To that end, the ACLU has distributed HIV and Homeless Shelters to a wide variety of shelters and organizations that serve the homeless.
The response generally has been positive, and HIV and Homeless Shelters has been endorsed by the National Coalition for the Homeless, the National Health Care for the Homeless Council, and the National Alliance To End Homelessness. Peter Lozier of the National Health Care for the Homeless Council points out that the issues for the homeless are much the same as those for other populations at risk. "But it's harder for the homeless," he says, "because they have so many survival demands on their time and their abilities." Lozier's organization has distributed the ACLU publication to all of its programs around the country.
Just as Harney stresses that the training curriculum she developed for Emmaus Center must be adaptable to the different knowledge levels and starting places of different participants, flexibility is also the key in adapting the policies and practices developed in the Biggers settlement to larger shelters in urban settings. As Manager of the SRO Homeless Project at New York's St. Vincent's Hospital, Barbara Conanan is responsible for shelters in thirty locations, including one 1,000-bed facility--a far cry from the small "community" at the shelter in Maine. Furthermore, her program is affiliated with a Roman Catholic hospital, and for that reason cannot promote the use of condoms. Nevertheless, Conanan emphasizes the importance of flexibility and adaptability. "You have to adapt it to the philosophy and mission of your institution," she says. "Take what you can take."
The text of HIV and Homeless Shelters: Policy and Practice is accessible via the ACLU's website at www.aclu.org, or can be obtained for $1.00 each through ACLU Publications, P.O. Box 759, Swedesboro, NJ 08085.
Back to the May 2000 Issue of Body Positive Magazine.
This article was provided by Body Positive. It is a part of the publication Body Positive.