Friends for Life

One Doctor Takes HIV Prevention Into the Hood

Between 2001 and 2002, 11% of all HIV diagnoses in the city of Chicago were in young people ages 13 to 24. Within the adolescent division of the county hospital, one out of three youth diagnosed with HIV had already developed AIDS. Most of them were identified through another marker of risk for HIV, such as syphilis and pelvic inflammatory disease.

Frustrated with what seemed like a hopeless task of encouraging her young patients to make changes in their behavior, one adolescent medicine doctor decided to take HIV and STD prevention out of the clinic and into the hood.

Dr. Margo Bell

The Robert Taylor Homes are low-income housing projects located in the heart of Chicago's South Side. With a long-standing reputation for a culture of drugs, violence and crime, it isn't exactly the first place that comes to mind when you think of prevention education.

I entered the building at 40th and Dearborn, directly behind a young mother carrying one child across her shoulder and dragging the reluctant other by the hand.

"This don't make no damn sense," she complained, releasing a heavy sigh of frustration as she headed towards the stairs. Before I could ask what was going on, an older man, positioned in front of the elevator and soliciting people for spare change, looked at me and said, "It's broke. You got a dollar?"

Not exactly enthused about the idea of hiking up eight long flights of stairs in this security-less fort of a building, I reached into my pocket for a dollar to give to the man and prepared myself for the dreadful trek.

The graffiti-covered stairway reeked of stale urine. I immediately began to feel badly for the young mother who couldn't have possibly gotten her toddler up those stairs without him coming in contact with the filthy surfaces. The reality, however, is that hundreds, perhaps thousands of African American families in the Robert Taylor homes, and other housing developments throughout the city, live in such a state.

Not quite sure of exactly what to expect when I reached the apartment that was my destination, I hesitantly knocked on the door and was welcomed by a friendly older women with a small baby boy in her arms.

Pamela Carter is a babysitter and family friend to many of the children who live in the housing development. On that day, she was hosting the Friend-to-Friend Network, as she had many times in the past. Over the next half hour or so, several young African American adolescents began to fill her living room, anticipating their hour of uninhibited straight talk with Dr. Margo Bell of the Chicago HIV Risk Reduction Partnership for Youth (CHRRPY).

Friends For Life: One Doctor Takes HIV Prevention Into the Hood

Dr. Bell, general adolescent medicine doctor and pediatrician at Stroger Hospital of Cook County, barely looks any older than her young patients. She and her colleagues at CHRRPY started what is now known as the Friend-to-Friend Network (F-to-F) in August of 2003.

Since its inception, the Friend-to-Friend Network has educated more than 1,500 young people in the city of Chicago about HIV and other STDs, in an environment that they choose, that is safe and comfortable for them. Primarily through word of mouth, the network has become so popular that there is currently a waiting list of young people who would like to host Dr. Bell and her staff for a training session with their peers.

"The demand is so great that we could be booked for five or six days a week," says Dr. Bell. "But because of limited resources and funding cuts to HIV prevention programs overall, we have to limit the Network to a maximum of two or three sessions per week."

Her staff consists of two paid outreach workers and Community Peer Educators who have sat through at least one session and expressed an interest in helping to organize and facilitate future groups. Each presentation lasts for about 45 minutes to an hour and includes discussion about HIV and STDs (with pictures), a condom demonstration, a peer HIV testimonial and the distribution of educational pamphlets and safer-sex kits. The dialogue is structured in such a way that it is real enough for young people to "get it," without being so fluffy or technical that it goes in one ear and out the other.

"I am often amazed at how misinformed some of our young people today are," says Dr. Bell. "I had a young man in a session once who said, 'You can't give me no pussy! I only hit it from the back.'

"We were all wondering what he meant and some people thought that he was implying that he was gay. But he was talking about protecting himself against HIV by only having anal intercourse with girls. I had to clear that up in a hurry, letting him know that anal sex is the riskiest sex there is.

"There are also lots of misconceptions about oral sex as well," she adds. "Many of the kids don't know that you can get infections such as chlamydia and gonorrhea from oral sex."

Though some may consider Dr. Bell's brutally honest approach to prevention to be a bit over the edge, many agree that her method is necessary. One African American pastor from Chicago's West Side told her, "I don't really agree with some of the things that you say, but I know you have to say them. My congregation needs to hear it. Our community has a problem." His community, Chicago's Austin neighborhood, has the highest number of HIV-positive youth in the city.

Through the Friend-to-Friend Network, Dr. Bell has come to understand the importance of developing relationships with her clients outside of a clinical setting.

"Young people need to know that we (doctors) are human," she tells me on a Friday evening, way past regular office hours. "This is not just about HIV education, but it's about establishing a relationship, which is extremely important. These kids call me about anything that is going on in their lives and I allow them the space to do that. Unfortunately, some of them don't get that kind of support from other adults in their lives."

When asked to describe the biggest challenges to her work, Dr. Bell is easily able to identify two. The first she labels distractions.

"I was doing a session once and there was a guy in attendance who was a drug dealer and people were constantly knocking on the door for him," she says, seriously. "But the interesting thing was that he kept telling them to come back because he was in the middle of something. Now, although that was a distraction to the group as a whole, it showed me just how necessary this project is. I may have never gotten him into my clinic. Through F-to-F, we are able to reach an underserved population that may not be able to access this information otherwise. For that reason alone, I can deal with the distractions."

Dr. Bell also mentions that engaging the Latino community around HIV can also be incredibly challenging, primarily because of cultural beliefs concerning sexual behavior. "Catholicism is widely practiced throughout this community," she explains. "It can be extremely difficult to introduce condom negotiation, for example, to people who are raised to believe that monogamous, heterosexual relationships between married couples are the only acceptable kind."

However, Dr. Bell admits that the rewards that come from educating and empowering young people far outweigh the obstacles that she encounters. Her team has been able to test more than 200 people for HIV, identifying five HIV-positive youth and linking them to care.

"Unfortunately, we can't test everyone who wants to be tested," she says with a bit of frustration in her voice. "Our department is only funded to conduct a certain amount of tests and once we have reached that number ... that's it. Because we are more of a community service gesture than an actual research project, we are often turned down for funding that we request."

But Dr. Bell is determined not to let funding be an obstacle. She is continuing to educate Peer Health Educators who can carry out the Friend-to-Friend Network on an even broader scale. She is also planning to transition the Network into a research project so that, hopefully, it can begin to receive the funding that it needs to achieve maximum effectiveness.

"It is really just an issue of time on my part," she says. "As a doctor, I am required to wear so many different hats. Aside from this project, I also see patients in clinic three to four days a week and teach residents. It is really difficult, sometimes, to do all that is necessary to ensure that programs such as this one become as effective as they have the potential to become."

Her goal for the coming year is to make the time to do the tedious work necessary to secure the financial means that F-to-F needs to achieve maximum effectiveness. With new HIV infections steadily increasing within communities of color, the Friend-to-Friend Network offers the hope for change that many in the community have been praying for.

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