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 King County, Washington
Seattle leads the U.S. pack for ending-the-epidemic goals—but an injection-drug HIV outbreak in late 2018 and disproportionately high HIV rates in African Americans show that the wealthy, progressive city still has gaps to close.
Need-to-Know Stats About HIV in King County, Washington:
- In 2017, people living with HIV in the county were 85% male, 84% transmitted via sex between men, 54% white, 20% black, and 15% Latinx. (As of the 2010 census, the county was 69% white, 15% Asian, 9% Latinx, and 6% black.)
- Between 2008 and 2017, the number of new diagnoses annually has been halved, with decreases in all racial categories.
- The state and county estimate that 93% of those with HIV in the county have been diagnosed and 85% of those diagnosed are virally suppressed—however, such rates were lower among black folks than among folks with HIV in general.
- In 2015, the county was the first urban county in the U.S. to reach the “90-90-90” goals for HIV reduction set by the World Health Organization. (That means 90% percent of all those with HIV diagnosed; 90% percent of diagnosed in care; and 90% percent of those in care virally suppressed.)
- It is estimated that 20% of men who have sex with men (MSM) in the county are on pre-exposure prophylaxis (PrEP), including 38% of MSM reporting behaviors that put them at high risk for HIV.
- The state and county estimate that 47% of MSM in the county who inject crystal meth are HIV positive.
- It is estimated that 12% of all folks with HIV in the county experienced homelessness in 2018.
Despite widespread needle exchange, the county in the first ten months of 2018 experienced a nearly four-fold rise in HIV infections among those who inject drugs compared to the entirety of 2017. The spike was attributed to a cluster outbreak in the homeless population of North Seattle.
Successes and Challenges Facing HIV Service Providers in King County, Washington
We talked with Steven Sawyer, executive director, and Aaliyah Messiah, programs director, at POCAAN, People of Color Against AIDS Network.
Aaliyah Messiah: I’ve been here 30 years. I came three years after it started. The agency was started in 1987 when it was noted that there was no HIV education happening for black people in Seattle, so some people started educating themselves, then secured grants to hire three outreach workers, including my sister, Sheila, who took to the streets. They went into drug-infested areas, places nobody was going, and talked to people using needles.
They also started identifying gaps like people coming out of prison who were not being educated about HIV, so they got a grant to do that work. They were also finding men and women who were positive whose children were being removed from them by foster services. When I was hired in 1990, it was to do direct service work with HIV-positive individuals. I was hired as a liaison between the community and the health department. I’d go into homes and urge people to get themselves and their children into medical care. There was so much stigma, substance use, and depression that I had to dispel a lot of fears and build trust to get people into treatment and care.
Tim Murphy: Tell us a little bit about POCAAN today.
AM: Our annual budget is close to $1 million—mostly government funding with some very limited private funding, donation money, that we use to put on Pacific Northwest Black Pride with the LGBTQ center, Gay City.
We have a staff of about 15, probably about 85% African-American, about four women, two trans folks, two openly HIV-positive folks, about six LGBTQ folks. We have about 40 clients living with HIV—about half African American, half Latino. About half are men who have sex with men. But with all our outreach, we probably touch about 1,000 people a year.
TM: What is your gamut of services?
AM: We have medical case management for HIV-positive folks, with a peer navigator who is HIV positive. We have two non-HIV-specific programs, one for young adults 12 to 25 and another for those 22 to 55, working to house them, a prison diversion program called GOTS, Get Off The Streets. We house individuals who have had substantial criminal histories with multiple felonies who otherwise might have a hard time getting housing after prison. We also have an eviction prevention program.
We have HIV and STD testing and support groups and also host Narcotics Anonymous (NA) groups. We have a PrEP program. I don’t know how many it serves, because it’s so new. We work with schools to stop the schools-to-prison pipeline.
TM: Do you have any LGBTQ-specific programs?
AM: Yes, we have a transgender economic empowerment program that works on job training. We don’t have a program now specifically for MSM. We have no needle-exchange program—we did in the past.
TM: How would you characterize the HIV situation in greater Seattle?
Steven Sawyer: We’ve achieved 90-90-90 here, but as the head of an organization serving MSM of color, I think that gentrification in the city has pushed [people] out into more rural areas—folks of color who bear a great deal of the HIV burden in Washington state, which makes it more difficult to get the disease under control. With the advent of PrEP, the uptake has been well-received in Caucasians, but folks of color are struggling to get that same level of uptake, so we just launched a project partnering with Gay City, which has not been able to reach MSM of color, so we’re going to see if we can.
TM: What are you most proud of?
SS: We’ve always been really centered in the community. I was on the POCAAN board of directors for five years prior to becoming the E.D., which I’ve been for three years. I come from the South, and I’m a third-generation preacher.
We’ve really tried to engage with the younger demographics. Pacific Northwest Black Pride is my baby. We do it with a focus on health and well-being, a festival with lots of classes and educational pieces, and it’s been really well-received and has engaged a younger demographic. Black gay men are not just numbers and HIV stats. We want to know that we are being looked at holistically. We held a job fair where we were able to help people repair their credit. I’m really proud that POCAAN has been here for 33 years and is growing, even in a city with a relatively small people of color population.
TM: Where do you feel most challenged?
SS: Funding. Organizations of color are not funded at the same rate and given the same opportunities [as other groups]. Often, funding flows to larger groups that have hit their 90-90-90 goals. It doesn’t trickle down to black and brown folks.
TM: What would you put more funding toward?
SS: Right now our baby is our PrEP clinic. It’s not up and running yet. We were just awarded a grant to do some sampling, working with the University of Washington. We just hired someone to help us set it up. We’ve done some preliminary work like surveying, and hopefully we can partner with Walgreen’s or some pharmacy. I’d like to be able to permanently fund that work. We would go outside county limits to reach more POC [people of color] if we had the money that allowed us to.
I’d also like to be able to do more HIV and STD testing—our funding is pretty restricted.
TM: In Seattle, as in many places, MSM of color are disproportionately reflected in the HIV rates. What’s behind that in Seattle?
SS: There’s still a lot of shame around being black and gay. The church contributes to that trauma, with folks being pushed out and a don’t-ask-don’t-tell attitude around sexuality. Also, I think a younger demographic is just not as well-informed around the disease as we were, because money has shifted. All our funding now centers on Treatment as Prevention [TasP, making sure HIV-positive people are on treatment and hence cannot transmit HIV] and PrEP. The idea is to get as many folks on PrEP as you can and as many positive folks to undetectable. But that doesn’t speak to the root of the issue for folks of color who struggle with identity and self-esteem, shame, racism, and all the isms that pile on top of that. If I can’t get my mind wrapped around loving me, then taking a pill is not my priority.
TM: What is POCAAN doing to address those underlying issues?
SS: That’s why we started Black Pride, to create a space where people can talk about these issues. We did a workshop on being queer in the black church, and we had preachers come in from welcoming churches, traditional preachers married to women, including one who teaches divinity at the University of Seattle.
TM: Are you seeing a lot of meth use in MSM of color?
AM: It’s the number-one drug we see.
SS: Definitely. It wasn’t about POC when we first heard about it, but now it’s prevalent. This year we started a group to address not just meth but addiction in general, to give folks a place where they can talk to each other and support each other on the road to sobriety. We have a peer navigator who came here very much in that struggle, and we’re really proud of the work that he’s done. [Ed: He is featured in the “Positive POV” interview, below.]
Positive POV: Leon Peoples
We talked with Leon Peoples, 32, of Seattle, who is a new peer navigator at POCAAN. He was diagnosed with HIV in 2015.
Tim Murphy: How’s the job going?
Leon Peoples: Pretty good. I’m getting to know my 15 clients, following up to make sure they’re taking their meds and attending their appointments. Sometimes I go with them and speak on their behalf if they’re not able to understand. Some of them are negligent on taking their meds all the time. They say they’re too busy or they lose track or they’re just nonchalant, and I tell them it’s important to take them or they might end up not working. I don’t try to scare them, but often people don’t take this seriously until their life is at risk.
I’m also going through training right now to do HIV testing. I need to learn info on PrEP and also how to counsel pre- and post-testing. I haven’t had anyone test positive yet, but I know what it feels like to test positive. We say that the test is “reactive” or “nonreactive,” then have to do a confirmatory test if it’s reactive. If it’s nonreactive, we follow up with regular testing every three to six months. We also offer PrEP. I’ve found out that people are kind of nonchalant about taking PrEP, because they feel like they don’t need it as long as they are testing negative. Even if they don’t use condoms, they’re like, “No, that’s OK.” I ask them, “If you tested positive, how would this affect your family?” Because it can happen to anyone.
TM: Can you share your personal story?
LP: I was born and raised in Sacramento, California. I’ve only been in Seattle going on two years. I was diagnosed in Sacramento. I got in a relationship there with an older man, trusted somebody I shouldn’t. He was manipulative, a narcissist, and I was really brainwashed back then and had no voice of my own—and he was filling a void in me. I didn’t know he was positive until I got my own test back and called him, worried about him, and he said, “Thank God I don’t have that anymore.” I’d asked him plenty of times before if he was positive and he’d say no, and we’d always use condoms, but the one time I decided not to, that’s when it happened.
TM: What was your reaction to your diagnosis?
LP: I was terrified, confused, shocked, and really, really scared, because I wasn’t knowledgeable on the subject. All I knew was how it was in the ’80s. I thought my life was over. It literally flashed before my eyes—everything I ever wanted, a family, kids, started to go out the window. I thought, “Nobody will love me, and how am I going to tell anyone this?” I didn’t know anyone who was HIV positive and doing OK.
TM: So what happened next?
LP: One of the doctors in Sacramento explained everything to me and reassured me, but overall I still felt the same. On my way back home, no lie, I was going to jump in front of the train tracks, but something told me to go home. I needed some type of comfort, and I finally mustered enough courage to tell my older cousin, and she cried with me and hugged and comforted me. She wasn’t knowledgeable about HIV, but she was there for me. My mom and I don’t have a good relationship, and she used my HIV status to come at me later on.
The guy I’d been in a relationship with worked at Safeway, and he tried to go tell my cousin that I gave it to him and was sleeping around. He had me terrified. I don’t have the type of close relationship with my family that I should. I felt like the black sheep of the family. My family said that I was pretending to be gay for attention. So I dropped off the radar and moved to Salt Lake City, where I almost died from a perforated ulcer. After I recovered, I moved to Texas, then back to Washington State.
This is when hard drugs started coming into it—before, it was just alcohol and weed. Now I was homeless and on drugs and promiscuous, but thank God I kept taking my meds, because I was scared to die. But I’d be up on drugs for days.
I’d met this guy who was a drug dealer and he was fond of me, so I used that to get what I wanted and went over his house one day to get high, and I ended up not leaving the house for the next two months. I still took my meds; he’d go pick them up for me. But then one day I got up and was so unsatisfied. I didn’t recognize myself in the mirror. I couldn’t walk outside, because I hated the sunlight. So one night I waited until 2 a.m. and walked over a friend’s and talked to her, broke down, and never went back to the dealer’s house.
But I was still doing drugs and on the streets. I’d heard about POCAAN from a guy I used to mess around with. So I went there and told them I wanted to get off the streets, get off drugs, get my life together, and they put me in a transitional house until a rehab bed opened up for me—my third time in rehab, the James Oldham Treatment Center. A lot of amazing things happened there. I heard a lot of stories and told my story and ended up graduating with honors. I had housing lined up, but it wasn’t ready when I left, so I was back out on the streets for two weeks waiting, but I didn’t get high.
But I got my place in the University District and was there about a year, then on my birthday, I won the Section 8 raffle and got my voucher and looked for another place. It took months, but I found a place in downtown Seattle, Chinatown, and I’ve been living there since. Then I did a three-week job-readiness course with Pioneer Human Services, for people who were in addiction and ex-cons, and after I graduated, I got a job working for the program, being a resident monitor, managing three of their apartment buildings for people in recovery and ex-cons. Then POCAAN offered me this job.
TM: Can you talk a little bit more about how POCAAN has helped you?
LP: There’s been times when I just needed somebody to talk to, because I felt like I was going to break, and Miss Olivette [Foster, a case manager] would always talk to me and make sure I had what I needed, toiletries, things to eat, bus tickets. She found me the housing before I went to rehab. They were really here for me—not just with words. They really put the pedal to the metal.
TM: You’ve had quite the journey in your life so far—what do you make of it?
LP: I’m still searching in certain areas, but I feel like I’ve conquered a lot, especially given that there wasn’t much family to help me.
TM: What caused your change of mind to quit drugs?
LP: When I was in treatment, it took my counselor forever to get me to write down my story and share it with the group. I didn’t want to relive that. But when I finally did, it was 12 pages long, and sharing it helped a lot of people. I’ve always thought that I was ineffective in all areas. I didn’t think I was capable of helping someone else get out of a ditch. To this day, a couple of friends from treatment still call me and tell me how much it meant to them when I shared my story. That was what started to change my mind.
TM: What do you think is missing for guys struggling like you did in terms of help?
LP: I think it’s available for everyone, you just have to find your right avenue that’s going to affect you. It might be an experience you had just talking with another person, or it could be camaraderie, having someone behind you. If you don’t have that, you’re not going to know that there’s a difference out there that you can grab onto.
TM: Have you thought about going back to school for social work?
LP: Actually, I’ve partly finished my alcohol and chemical dependency training and I want to finish to get my certification to be a substance counselor. I don’t think I’ll ever stop doing community work, because it’s something I’m passionate about. I’ve been there and I know exactly what it feels like. Maybe somebody else wouldn’t understand, but I can.