Latinos Living With HIV/AIDS in NYC

Not surprisingly, the larger and now older HIV/AIDS agencies -- in service since the first decade of AIDS -- flourished in Manhattan. However, recognizing the need of bringing their services to minorities, the most affected group, some have established partnerships or offer "satellite" services in the other boroughs. GMHC now provides legal services in Queens Pride House. The Hispanic AIDS Forum has opened offices in Queens and the Bronx. Community-based organizations have thrived in neighborhoods with scarce social and medical care. Still, there are many problems encountered outside Manhattan, including local communities rejecting the opening of HIV service agencies, or correlating homosexuality, drug use, and prostitution with HIV infection. Some politicians and other local figures also seem reluctant to acknowledge increasing HIV infection among their constituents.

Following is a profile of several organizations and agencies that serve Latino individuals and communities.

Bronx AIDS Services (BAS)

• Administrative office: 540 E. Fordham Road, Bronx NY 10458
  Phone: 718.295.5605

• Prevention Center: 2633 Webster Avenue, Bronx, NY 10458
  Phone: 718.295.5690

• Prevention Annex: 7 West Burnside Avenue, Bronx, NY 10453
  Phone: 718.561.1478

Bronx AIDS Services (BAS) is a non-profit organization designed to meet service needs of residents in this ethnically and culturally diverse community. Services are available for individuals living with HIV/AIDS, for people who think they might have been exposed to HIV, and for those at high risk of exposure. Founded in 1986, BAS provides: food, nutrition and counseling; legal advocacy, outreach, prevention and education; domestic violence education; peer mentoring; and case management services. In addition, services available for those at risk or affected include: HIV counseling and testing; prevention case management for adults; prevention services for adolescents; and outreach and education for young men who have sex with men (YMSM).

At present, the agency's demographically diverse staff of 88, of which roughly half are bilingual and predominantly community residents, is comprised of people with or working on graduate or professional degrees in social work, public health, law and other fields, as well as some working on their GED. Services are enhanced by 40 regular volunteers who give over 1000 hours monthly. Cultural and linguistic sensibility-designed programs are offered, when possible, by staff mirroring clients' ethnic and cultural background. Thus, attempts are made to match Latino clients to staff who speak Spanish and/or are sensitive to their cultural nuances.

The BAS team is divided among three facilities in the Bronx. A recently renovated 10,000 sq. ft. facility housing administrative offices and conference space also provides case management, legal services, a food pantry and nutritional counseling. The two story Prevention Center includes office space and two large classrooms used by outreach and HIV education staff. HIV testing and counseling are available in confidential meeting spaces onsite and through a mobile outreach unit. The YMSM Outreach and Education Program and the Prevention Management Program are also located here. The Prevention Annex, the newest space, is on the second floor of a building shared with The Salvation Army. It houses prevention programs for seropositives and services for MSM, and will soon accommodate adolescent prevention services, concentrating mainly on girls. The latter is an initiative recently re-funded by the New York State AIDS institute. BAS intends to continue expanding on prevention work.

Cultural challenges when serving Latinos include strong stigma attached to HIV, "machismo" complex, language barrier, and lack of empowerment and knowledge of the health care system in this country.

"Issues of substance use are recognized and accepted as such in the Bronx. HIV services are often assumed to be connected with it. However, homophobia is a real problem, especially in some of the borough's more fundamentalist churches," says S.J. Avery, Executive Director. "Historically, young MSM of color receiving our services indicate their utmost need for a safe space, an issue tying in with prevention and education. It would be fair to say there is continuing prejudice and undercurrent of denial around LGBT issues. It is easier to say a man got involved with drugs than with another man. Thus, our challenge is to change behaviors regardless of sexual identity," concludes Avery.

Since implementing systematic data collection and management software in 1995, 5,219 clients with HIV/AIDS have been served. Approximately 2,500 more clients are estimated to have been served prior to systematic data collection. Roughly half are identified as Latinos. Presently, BAS has 1,645 active clients, of which 806 identify as having Latin-American background.

The Coalition for Hispanic Family Services (CHFS)

Founded in 1990, the Coalition for Hispanic Family Services is located in Bushwick, Brooklyn. This community-based comprehensive family service agency aims to strengthen Latino families. It provides culturally competent services that build upon strengths of their culture and lead them towards self-reliance. CHFS works with marginalized families in North Brooklyn and adjacent communities, by helping them tackle problems of child abuse and neglect, domestic violence, drug and alcohol dependency, homelessness, HIV/AIDS, and mental illness. Programs offered are foster care and adoption, therapeutic foster homes, HIV/AIDS supportive services, case management and custody planning, visual arts and after-school literacy programs, family-based mental health services for seriously emotionally disturbed children, mental health treatment for children and their families. Also, a voluntary program designed to strengthen the roles of fathers and the development of La Providencia Health Center, a collaboration project with Brooklyn Hospital Center.

This family-focused agency with staff of 95 is about 95% bilingual and bicultural. Social services are provided by case managers, case workers, and certified social workers. Mental health providers, teachers, and LPN's complete the personnel.

Proyecto Familia is CHFS's comprehensive HIV/AIDS service program offering bilingual walk-in, crisis intervention services, and intensive case management (on call 24 hours/7 days a week.) A considerable number of Proyecto Familia's consumers are individuals who are recently released from prison, undocumented immigrants, homeless individuals, and families, as well as former and active injection drug users. This program offers individual, family, and group counseling as well as home visiting services. Bilingual support groups target special needs and concerns of sub-populations: women, MSM, heterosexual men, adolescents, and children. Support groups reduce social isolation and deal with issues of accepting and understanding HIV/AIDS, addressing issues of HIV disclosure and harm/risk reduction techniques, health promotion, and treatment adherence. CHFS, in collaboration with Brooklyn Legal Services, provides permanency planning services, assisting HIV positive parents to plan for the future care and custody of their children as well as preparing health proxie and wills. Advocacy, escort and translation services are provided to assist clients with housing, health insurance, public benefits, and immigration and entitlement assistance problems.

La Salud de la Mujer Latina (Latin Woman's Health) will be an expansion of Proyecto Familia offering alternative therapies. Services will include: yoga, relaxation, meditation and stress management technique sessions, acupuncture, drop-in creative arts group activity, massage therapy, and creative writing workshops for Latina women at high risk for HIV infection and women living with HIV, their partners and families.

CHFS has served approximately 1,011 families since 1997; 98% of these clients have been Latino, many from Central and South America. For this fiscal year, Proyecto Familia serves approximately 380 families.

HIV Law Project (HLP)

Founded in 1989 and presently located in downtown Manhattan, in the City Hall area, HLP has provided advice and representation to people living with HIV/AIDS in over 16,500 cases and initiated several class action lawsuits. In addition, it has trained over 100 women activists, and participated in policy advocacy impacting hundreds of thousands of people with HIV/AIDS locally and nationally.

The mission of the HIV Law Project is to protect the rights of people living with HIV/AIDS. Tracy L. Welsh, executive director, remarks "our resources are focused on providing legal and advocacy services for underserved HIV-affected populations, including low-income women and their families, communities of color, undocumented and recent immigrants, low-income members of the LGBT communities, the homeless and injection drug users. Over the years, we have expanded our services to include advanced advocacy and leadership training for HIV-positive women, community legal education, technical assistance to other service providers, and social support services for clients."

Each year, HLP provides services to over 1,200 clients, of whom 39% are women, 60% men, and 1% identify as transgender; about 20% are part of the LGBT community. Of the client base, 45% are Latino. Some challenges encountered when serving Latinos are: dealing with cultural barriers within Latin-American communities; reluctance of many to trust the agency due to perception that it is "government-like," and assisting many undocumented clients in applying for benefits when they lack identification.

Recent cuts in Ryan White funding affected the agency's funding and as a result, one staff line was eliminated. Today, the HLP staff of 16 includes: seven attorneys, two paralegals and one social worker. The professional staff, of which 60% is bilingual and 50% speak Spanish, provides legal and advocacy services including: discriminatory treatment, HIV-related confidentiality issues, housing and eviction prevention, denial of financial and medical benefits, immigration law, public and private health insurance issues, consumer and creditor/debtor law, employment law and benefit issues, last wills and testaments and advanced planning, and permanency planning and other family law matters. HLP also provides technical assistance, community legal education and advocacy training for HIV-positive women.

Since July 2003, HLP commenced monthly on-site intakes at the ACCESS II program in the Bronx. Assigned cases are then followed-up by appropriate staff for advocacy or representation. HLP is similarly associated with the AIDS Treatment DATA Network. Both programs refer numerous Latino undocumented clients. These programs are unique as they are not insurance driven, that is, Medicaid is not required for service. This is vital for the undocumented immigrant community.

Lower East Side Harm Reduction Center (LESHRC)

Located in the heart of Manhattan's Chinatown, LESHRC has been in service for eleven years. The two-story loft building, a former manufacturing space, unassumingly stands amidst commercial spaces just North of Canal Street. The administrative offices occupy the second floor, while the ground level is devoted to client services.

"Since opening in 1992, we have anonymously registered more than 17,000 individuals into the needle exchange program," states Raquel Algarin, director of prevention services, "Our present caseload of 300, of whom 80 are living with HIV, speak with a prevention case manager. A study showed the rate of new HIV infection among those regularly using needle exchange programs decreased more than 60%."

LESHRC staff is comprised of 15 staff, two interns, and 12 volunteers. Professional staff imparts confidential services such as counseling and referrals, while the needle exchange remains anonymous. The practice of maintaining anonymity increases likelihood that injectors may come, bring syringes, and speak about their drug use while keeping their HIV status private. There is a misconception that needle exchange is only about illicit drugs, but LESHRC provides syringes to any injector, including diabetics, those using steroids or hormones, or self-medicating people with HIV/AIDS.

To keep used needles off the streets, LESHRC provides 10 syringes and the option to exchange one old for a new one. Re-using syringes is discouraged, but safety procedures are taught in case of emergency. During the LESHRC in-take process, participants receive a coded ID card. A private interview follows to assess potential service and referral needs, verify knowledge of injection risk reduction procedures, and educate about HIV and Hep C transmission. Finally, they are shown where to find bleach, alcohol pads, cotton, cookers, condoms and asked if they need to exchange.

LESHRC offers the following services: needle exchange, acupuncture, street outreach, hepatitis testing, holistic health, a volunteer program, women's and men's programs, peer education, mental health services, and a mobile health unit.

Latinos are the largest ethnic group receiving services at LESHRC, although language barriers present challenges, as do cultural, religious, and social factors. LESHRC reports that Latino men sometimes regard condom use as emasculating, while less empowered women fail to request their use. Men who have sex with men but are not gay-identified perceive themselves at lower risk of HIV infection. HIV stigma and same-sex relations are regarded with shame. Seeking health-care raises issues of trust and social status, especially if clients are unable to pay.

AIDS Center of Queens County (ACQC)

• Rego Park Site: 97-45 Queens Boulevard, 12th floor, Rego Park, NY 11374
  Phone: 718.896.2500

• Jamaica Site: 175-61 Hillside Avenue, 4th floor, Jamaica, NY 11432
  Phone: 718.739.2525

• Far Rockaway Site: 1600 Central Avenue, 3rd floor, Far Rockaway, NY 11691
  Phone: 718.868.8645

• Long Island City Site: 42-57 Hunter Street, LIC, NY 11101
  Phone: 718.472.9400

The AIDS Center of Queens County (ACQC) was founded in 1987. Its three main locations, in Rego Park, Jamaica, and Far Rockaway, are full multi-service sites. Each is New York-state licensed, providing clinical services for both mental health and HIV primary medical care. The Long Island City site is currently being developed to offer such services. In addition, the three main sites offer food bank services to people with HIV/AIDS, as well as the general community

Among the agency's staff of approximately 140, about 60% identify as Latino. As the population of Queens has become of proportionally greater Latino descent and identification, more clients and staff belong to this population. Over the past several years, changes in the diversity of participants and staff has led to all services at ACQC being not only culturally and linguistically appropriate and competent for Latinos, but also run for and by members of this population. The agency's staff, many of whom live in local communities, provide services including: clinical mental health services, HIV primary care, comprehensive case management, civil-legal services, prevention and education programming, and food bank services.

ACQC is the leading HIV housing provider for the borough. The agency has separate housing offices, but these services can be accessed readily via the main offices. The agency provides housing placement assistance, independent living skills education and training, and scattered site apartments for the general HIV population, people diagnosed with HIV and substance use and/or mental health problems, and recently released prisoners with HIV).

ACQC has an outreach and education program specifically for Latino MSM. The agency also offers early intervention and ADAP access outreach for undocumented immigrants, the majority of whom are Latino. The agency encounters legal and social challenges when serving Latinos. Consistent with the realities of Queens today, many clients are unable to obtain needed services due to their immigration or citizen status. Today, ACQC serves a total of 2,411 individuals, 882 (37%) of whom are Latino.

"The funding situation is complex, since CDC resources are being flat funded in a time of increasing need. Changes in federal funding to a more clinical-medical approach over negative at-risk individuals partially benefits the agency. On one hand, its co-located medical care could benefit, but ACQC loses opportunities to expand the agency's major prevention program for Latin-American MSM," states Anthony Perri, director of community relations. "If national policy also becomes local policy, then ACQC is directly affected. At a fundamental level, it would be Latin-American MSM who would be directly affected by this potential change in policy."

The agency experienced reductions in its Ryan White funding as part of the city-wide cuts. Four programs were directly affected: case management, harm reduction/recovery readiness, mental health, and legal services. The Ryan White funding is provided as a "last resort" for uninsured individuals or individuals not eligible for Medicaid. Undocumented immigrants, mostly Latinos, primarily also benefit from such programs. Although cuts were not so deep to require staff layoffs, little room is left to maneuver.

Due to the financial challenges mentioned above, ACQC has identified and applied for funding to provide legal services for undocumented HIV-positive immigrants. The agency is looking to develop novel and expanded testing services. Mental health services for special need populations are being investigated, as are diverse housing models such as supportive single room occupancy and transitional housing. Lastly, comprehensive models of HIV primary care and early intervention, along with general community health care, are being investigated.

Queens Pride House (QPH)

Originally opened in September 1997 as the Queens Lesbian & Gay Community Center, Queens Pride House (QPH) moved to the current Woodside location in May 2001. Its mission, to create a safe space for the LGBT people in Queens, aims to establish programs to meet the needs of under-served subpopulations such as immigrants, people of color, women, and youth.

Through Queer Links, counselors advise on medical, legal, social and mental health resources to LGBT friendly services in Queens and other boroughs. In October 2002, the Stonewall Community Foundation funded a landmark partnership between QPH and GMHC Legal Services for immigrant people with HIV in Queens. This association, in the most ethnically diverse county in the country, is significant because delivery of good public health care is hindered by cultural barriers such as language and socioeconomic status.

"Immigrants enrich the borough's diversity enormously. Unfortunately, some may bring along prejudices regarding LGBT and HIV issues, such as the misconception that AIDS is a gay white man's disease," explains Pauline Park, an openly transgendered member of the board of Queens Pride House, describing beliefs held by some fellow Koreans and others. "Pride House has a commitment to outreach to LGBT immigrants by providing a safe space for people to be open about their sexual orientation, gender identity, or HIV status; they can contact QPH confidentially by phone, e-mail (queenspridehouse@aol.com) or through the Web site (www.queenspridehouse.org)."

Staten Island AIDS Task Force (SIATF)

• St. George Site: 56 Bay Street, Staten Island, NY 10301
  Phone: 718.981.3366

• The Place: 25 Hyatt Street,
  Phone 718.448.8802

• Stapleton Site: 380 Van Duzer Street
  Phone 718.273.5833

• Port Richmond Site: 166 Port Richmond Ave.
  Phone 718.442.7220

The flagship location of the Staten Island AIDS Task Force (SIATF) opened in October 1988 as a coalition of volunteer health care and social service professionals, community members, and people affected by AIDS. Soon after the St. George location opened, three more storefronts were inaugurated in the borough's most affected areas. In addition, services are provided at Arthur Kill Correctional Facility. A staff of 74 is assisted by 75 volunteers. Since 1989, 17,000 Staten Islanders living with HIV/AIDS have received services and support for their families.

SIATF is the only non-profit community-based organization in the borough providing HIV care, education, and prevention services. They include: benefits and housing advocacy, short-term counseling, referrals to medical care and mental health services, drug treatment, support groups, child-related services, food programs, legal services, and treatment education.

The HIV/AIDS Helpline offers confidential referrals for HIV Testing, Client Services, support groups, risk reduction education, medical care, and anonymous counseling. Bilingual case managers are available to work with Medicaid-insured Latinos with intensive needs as well as with undocumented immigrants. Since September 11, 2001, the latter have been increasingly hesitant to reveal their immigration status, in spite of dire need. Because Port Richmond has a high Spanish-speaking(mostly Mexican) population, the SIATF office provides bilingual information and HIV counseling, testing, and referral. Translation services are offered by a bilingual community worker, who advocates and escorts clients to appointments. Accessing services is frightening for many recent immigrants; SIATF workers advocate on their behalf and support them in obtaining services.

"Recent immigrants communicate differently than individuals who have lived longer in this country. For instance, the slang used by some Puerto Ricans doesn't translate to that of Mexican or Colombian immigrants, so outreach conducted in the Bronx, focused primarily at Puerto Ricans, would not work at Port Richmond," states Sam Rivera, director of outreach and education.

SIATF maintains a presence via community integration programs such as: a "buddy" testing program, age-peer support for young people who wish to get tested, and an LGBT wellness program to provide services in a safe and caring environment.

"We embrace any opportunity to do outreach in the community to inform them and try to alleviate some of the ignorance and prejudice," declares Ronnie DiGiacomo, director of communications. Since commencing systematic reporting in 2000, SIATF has served 1,042 HIV-positive individuals, 400 of whom were Latino. Today, with active clients around 462, 157 are Latino, 296 are male, 165 are female and one is transgender.

"We have been trying very hard to expand services for HIV-affected family members," shares Executive Director Diane Arneth. "Our concern is that many people with HIV have children who are at risk of falling into poverty, or worse, behavior that will turn them into our next batch of clients. Ill parents disrupt the family dynamics putting these children at a disadvantage to grow up healthy and thrive as productive members of the community."