In light of the federal government plan announced in February 2019 to end the HIV epidemic in the U.S. TheBody has created a new series called Eyes on the End. This series will include a snapshot of the HIV epidemic in each of the 48 counties, seven states and two cities targeted within the plan. These profiles aren't meant to be the definitive story of the epidemic in each locale, but rather -- through sharing some basic statistics and interviews with a few key stakeholders -- to provide some context for what's occurring there, and what it will take to end the epidemic in that area.
The Big Picture: HIV in Wayne County, Michigan
Wayne County is located in southeast Michigan and is home to four of the 10 cities in Michigan with the highest HIV prevalence rates: Detroit (70% of cases in the county), Highland Park, Inkster, and River Rouge. The county accounts for 36% of all HIV cases in Michigan.
Need-to-Know Stats About HIV in Wayne County
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With nearly 7,000 people living with HIV, Detroit has the state's highest rates, making up a third of all state cases. The city's HIV rates are four times the state average -- 719 people per 100,000, versus 163 per 100,000 statewide.
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In 2017, 76.5% of all Detroiters living with HIV were male and 78% were black (14.7% were white; 4% Latinx). Detroit is 79% black, 14% white, 7.6% percent Latinx.
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New HIV diagnoses annually remained in the low to mid-300s from 2013 to 2017. In 2017, 13.5% of those diagnoses were also an AIDS diagnosis.
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In both Detroit and Michigan generally, young black men who have sex with men (YBMSM) 15 to 29 years old are the only demographic group experiencing an increase in new diagnoses. Per 2017 data, YBMSM in Detroit account for 0.4% percent of the city's population but 38% percent of new HIV diagnoses. In recent years, new infections among non-YBMSM have been halved while new cases among YBMSM have doubled.
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In 2017, 20% of Detroit residents living with HIV were not receiving care, with that rate as high as 39% in certain zip codes.
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In 2018, 82% percent of Wayne County residents living with HIV (excluding Detroiters) were in care and 91% percent were virally suppressed; in Detroit alone, those numbers were 80% percent and 83% percent.
Successes and Challenges Facing HIV Service Providers in Wayne County
We talked with David Perkins, vice president of health integration services and the Ryan White HIV/AIDS Program at Matrix Human Services.
David Perkins: I've been in this role since 2012. Before, I was with the Visiting Nurses Association of Southeast Michigan. Matrix is a $40 million community-based nonprofit that offers a full range of services to all different kinds of populations. We have a staff of nearly 500 and serve more than 20,000 people a year with programs that include the largest Head Start agency in Detroit, youth assistance to aid in school retainment, adult services including financial education and obtaining a high school diploma, low-cost housing, food and clothing.
My program works with people living with HIV; right now, via Ryan White funding, we fund 11 clinics throughout southeast Michigan to provide care to people living with HIV who are under- or uninsured. We offer wraparound services, medical case management, early intervention for people who are newly diagnosed or struggling to stay in care, mental health counseling, smoking cessation, copay and deductible assistance for people with private insurance, HIV and STD testing and counseling, support groups for people living with HIV, and WAGS. That's Wonderful Animals Giving Support, gift cards to people living with HIV for their pet food or veterinary bills.
We don't have direct funding for housing or transportation services, but we're in a coalition with two other agencies who do those things, Arab Community Center for Economic and Social Services (ACCESS) and Oakland Livingston Human Services Agency. We also link with other community agencies that offer PrEP [pre-exposure prophylaxis], then we follow up with our clients about it. There are about 18 different PrEP programs around southeast Michigan -- including Planned Parenthood, the STD clinic in Detroit, and the Be Well Medical Center.
Our staff is close to 30 and very diverse, lots of LGBTQ folks and those living with HIV.
Our clients reflect the local epidemic: 79% male, 57% African American, 60% MSM [men who have sex with men], and 47% between the ages of 25 and 44. Among our young black MSM, 43% identify as heterosexual.
Tim Murphy: How would you describe the HIV situation in Wayne County?
DP: Detroit is the epicenter of the HIV epidemic in Michigan. The majority of cases are black men who have sex with men, with the rest of cases being in those who became positive through injection drug use or heterosexual sex. Rates among MSM in general have gone down, while they've gone up in black MSM. The challenges are a lack of information. There's just not the support out there for young people to be cognizant of the need to take more precautions, especially with the proliferation of hookup apps now.
I'd attribute the overall drop in MSM cases to the Detroit Health Department's ramping up both the U=U [undetectable equals untransmittable] campaign and more rapid-start treatment programs for people testing positive. They've also started a program where someone from the department or from a pharmacy will reach out to someone if they don't pick up their HIV meds.
TM: What are you most proud of?
DP: We're providing services 24/7 as part of our coalition with those two other agencies and eight ERs, so we immediately wrap our services around anyone in those settings who's newly diagnosed. Also in the last year, we opened a new clinic in Sterling Heights via ACCESS. In our coalition, we have universal consent, which enrolls you automatically with all three agencies. We share the same database and meet twice a month to review cases.
TM: What are the major challenges?
DP: Transportation for clients getting to appointments. We have a very weak mass-transit system. One of our fellow agencies gets transportation funding, but it's limited and you have to do it through a Medicaid transporter, which will run late and you'll miss your appointment. Even for people who have jobs and can afford a car, the cost of car insurance in this city is astronomical, and several people drive without it.
Another challenge is affordable housing. With the economic recovery of Detroit, rents are increasing, so some people are being pushed out of their neighborhoods.
TM: What are your goals in the years ahead?
DP: We want to increase our outreach in early intervention services through communities. Our testing side goes out to parks and clubs, and our case managers are at the different clinics. We continue to look at how to reach young black MSM, whether that's recruiting them to be on staff or having community advisory groups that meet every month.
TM: Any stories to share?
DP: We had a young gay black man who hadn't finished high school who got kicked out of his home and then found out he was positive. He felt his world was coming to an end. But he worked with our staff, which got him on meds. Then with a lot of counseling, he was able to get his high school diploma and then got a scholarship and is now enrolled in college. So that's a success story.
Positive POV: Leslie Guinn
We talked with Leslie Guinn, 59, of Brownstown, Michigan, who is an addiction-recovery peer counselor and was diagnosed with HIV in 1984.
Leslie Guinn: My story is more gripping than fiction. My entire life has been such a spiritually led journey, so what I'm doing today with my life is giving back to others.
I grew up in the projects of West Dallas, Texas, with an alcoholic single parent who kicked me out of the house because I was homosexual. Actually, I used to be a transsexual. And when my mother was dying, she asked that I do her makeup when she passed, which I took as a sign of acceptance and asking for forgiveness.
Anyway, before that, I became an IV drug user with track marks on my arms, a street prostitute hooked on crystal meth. In 1984, while high out of my mind, I was hit by a drunk driver. I had a compound fracture and was rushed to Baylor University Medical Center. The next morning, when I came to, they said, "Oh, by the way, you're HIV positive." I cried a little bit, then went on to be treated for the fracture and continued using drugs after being discharged. It was that era when many were dying rapidly, so I was waiting my turn and planning to be fucked up when it happened. I watch the TV show Pose, and it evokes so many memories for me of those times.
I worked periodically. I had a friend who'd come find me on the strip, clean me up, and get me employed, and I'd do well for a period. But I was ignorant to the fact that I was an addict. I was an attractive young man who'd be taken care of by the dope dealers, and that sustained my existence for a time.
So I continued to use until the late 1990s. I was never on HIV meds, and luckily I've never been sick from HIV. I started a relationship with someone and moved with him to Detroit in 1993. We briefly got clean, then started using again, then he died -- I think from HIV, but I'm not certain, because we never talked about it. But in the late '90s, I was introduced to Narcotics Anonymous by the man I call my godfather, Gerald Murphy. He helped me get my high school diploma and driver's license at age 36. He said to me, "I'm sick and tired of you not seeing something in yourself worth saving -- you need help." So I went to my first N.A. meeting that day. I stayed clean for more than six years, then relapsed for two, but now I have 17 years clean and I'm certified by the state of Michigan as a peer recovery coach. And the very place I work today is the place I went to get clean.
TM: So what have all the ensuing years been like for you?
LG: A gift. An out-of-body experience and a reality check on who I am. I often tell my clients and 12-step sponsees that we are not our circumstances. They're just things piled on us that keep us from doing what we were originally born to do.
TM: So what's your relationship to Matrix?
LG: I got introduced to a caseworker there, Dorothy Dempster, who's still there, and Shelley McAllister, my therapist. My godfather and my doctors and all of them formulated a team around me that brought me to the person I am today. I'm doing this interview because they asked me to. I've done many a talk about my drug addiction, but I've never spoken publicly about my HIV diagnosis. I'm very fearful and nervous right now. But I cannot express deeply enough what Dorothy and Shelley have done for me. So to come from fear into faith and help someone else is my duty. I'm about to be 60 years old, and I don't give a damn anymore what other people think about me. I am what I am, just like the song.
TM: What's your job like?
LG: I'm a peer recovery coach and an intake coordinator. I'm one of the first faces that people see when they come in. I do an assessment, put them at ease, get them some food, share my own story. I go through their belongings to make sure there aren't any drugs, and walk them through the 21 days they'll be here. My Higher Power brought me this job. It keeps it real for me. My 12-step sponsees referred me for this job. I needed 500 hours of training for certification, and this place paid me while I was training here, also waiting tables on the side. I was awarded Employee of the Month after six months.
TM: What is a typical day like?
LG: I'm here from 8 a.m. until 6:30 p.m., mentoring clients, keeping people from leaving, keeping fights from breaking out, making sure people are up on their hygiene and facilitating group and one-on-one sessions, doing discharge planning. Then I get home to my four-year-old Lhasa Poo, Shadow, and five-year-old tabby cat, Boots. I unwind for the day, watch a little TV, go to bed, and get up and do it all over again. I still attend 12-step meetings once a week and speak to my sponsor every night religiously.
TM: What role has HIV played in your life?
LG: I used to be very active with Black and White Men Together -- Detroit, and we'd go the Ruth Ellis Center together, named for one of Detroit's most prominent African-American lesbians, and we'd talk to young folks there about safer sex and condoms. When it comes to HIV, there's still a lot of ignorance, shame, and guilt behind it, but I'm seeing changes. I'd say that 50% of people are still ruled by stigma, and 50% are informed. As for PrEP, I think it's a great thing if it's used for the right reasons. I'm all for anyone doing something to protect themselves.
TM: You've had quite a life, Leslie. What do you make of it?
LG: I'm one of the lucky ones who didn't become a statistic. I'm deeply moved by the realization of that. My life is nothing short of a miracle.
TM: What would you say to someone facing a new HIV diagnosis?
LG: It's not a death sentence. Don't put a period where a comma is supposed to be. I remember living all those years waiting for my turn to die, and it didn't come. You need to nurture yourself, and a normal life is possible. I know it because I'm among the least likely who should be here today, but apparently I'm supposed to be!