When George Bush presented his Emergency Plan for AIDS Relief to Congress in September 2004, he called the pandemic “the greatest health crisis of our time” and promised $15 billion for the “prevention, treatment and humane care” of those living with or at risk of contracting the virus. “[This] unprecedented commitment will bring new hope to those who have long walked in the shadow of death,” he crowed.
What GWB failed to mention is that the money comes with strings. To receive funds, HIV/AIDS organizations are required to condemn prostitution; failure to do so results in the cessation or denial of U.S. dollars.
In May, Brazil’s decision to refuse $40 million from USAID shocked the international AIDS community. Since prostitution is legal in Brazil, government officials told the press that they had decided to forego the grant because stigmatizing sex workers would hamper their treatment and prevention efforts.
Activists around the globe cheered Brazil’s chutzpah, but missed nary a beat in their own efforts to control the disease. Unlike right-wing fundamentalists, AIDS groups know that viral transmission will not be halted by moralizing. Instead, advocates work the streets, laboring at the grassroots to teach safer practices to those at highest risk—prostitutes, IV drug users and the sexually inexperienced.
One such group is Project Street Beat, a $2 million program of Planned Parenthood of New York City. Shortly after Brazil’s defiant declaration, Street Beat workers hit the corner of Fulton and Classon in Crown Heights. There, they approached people—many of them prostitutes—to urge them to get tested for HIV in a Mobile Medical Unit parked a few feet away.
A nurse practitioner staffs the Unit, a 31-foot van, providing gynecological and breast exams; dispensing condoms, dental dams, oral contraceptives and Plan B, the “morning after” pill; giving Depo Provera injections; and testing for HIV, STDs, Hepatitis C and pregnancy. Services—ongoing care or a one-time visit—are free, funded by grants from city, state and federal agencies.
Planned Parenthood started Street Beat in 1988. “It originated in the Bronx and initially served a population of IV drug users,” says Street Beat Project Director Jamal Peterkin. “As the epidemic expanded, money became available to provide additional services to additional populations.”
Three times a week, year round, Street Beat’s 35 staff members provide services to Brooklynites facing the highest risk of infection. They concentrate their efforts in Bed Stuy, Brownsville, Crown Heights and East New York, but make periodic forays into areas with pockets of poverty: Coney Island, Park Slope, Sunset Park and Williamsburg.
According to a 2002 study by the Fifth Avenue Committee, 25.1% of borough residents are at or below the poverty level, making them vulnerable to multiple health problems, from asthma to tuberculosis to AIDS. Brooklyn has been hit hard by the virus; as of February 2005, 22,592 of the city’s 92,021 people with HIV/AIDS lived in the borough.
“Our contracts allow us to provide services in zip codes where the epidemic is highest,” says Peterkin. “While we don’t provide treatment for people who have the disease, we make referrals and let our consumers know that being HIV positive does not mean they are going to pass away tomorrow. We help then live with the disease and help those who don’t have it protect themselves.”
“A lot of our consumers won’t go to an agency,” Peterkin continues. “Some have had bad experiences with community organizations—maybe an advocate was supposed to pick them up to go to the doctor but they never showed up or showed up late. At this point that client doesn’t trust local agencies. You have to prove yourself. You have to go to them.”
And they do. Last year, Street Beat saw 22,426 clients. Fifty-six percent were female; 40% were homeless or in the shelter system; and 89% were substance abusers. More than half, 56%, were considered at high-risk for HIV because of unsafe sexual behaviors.
Eric Thornhill, a Preventive Case Manager, works in several low-income Brooklyn neighborhoods and runs Safety Counts, a seven-session group, out of Street Beat’s Bed-Stuy office. “We get people together to identify risky behaviors, whether it is IV drug use or not using condoms,” he says.
He rattles off a list of stages his clients go through. “There is pre-contemplation: we find a person who has been out in the streets as a commercial sex worker and does not use condoms. It may be in the back of her mind, ‘I need to use condoms,’ but it is a thought, not an action.”
In the group, Thornhill works to change this. “We hope to get her to practice safe sex on a consistent basis, moving her from contemplation—having the need to use condoms in her mind—to walking with them in her pocket and always using them,” he says.
He teaches group members to protect themselves, demonstrating how to use prophylactics and showing them how quickly an adept practitioner can do this. “We hope this moves her to the ‘action stage,’ where out of five guys she’s with, she uses condoms with two.”
A similar trajectory plays out regarding shared needles. “A person may shoot up six times a day,” says Peterkin. “We try to get them from needles to sniffing. If they sniff twice a day, we try to get them down to once. We give people incentives, grocery vouchers, movie tickets, snacks and metro cards. They see that we are taking care of them and are encouraged.”
Still, not everyone follows a seamless progression from risky to less-risky behavior. “Sometimes people want to keep good standing so they won’t tell us they had seven partners in the last month,” Peterkin says. “They slowly divulge the info when they realize that it is a way for them to better themselves. They learn to be honest because it will help them.”
As important as it is to reach sex workers and IV drug users, Street Beat also recognizes the importance of working with youth before they become sexually active and shortly thereafter. Jessinia Cassiano is a Brooklyn/Queens Team Leader who does street outreach and co-leads Sister-To-Sister, a weekly group for 13-19 year-old women. “We mix social events with a science-based curriculum to teach the girls to see how they put themselves at risk. If a girl is pregnant, we get her to the nurse practitioner and she is counseled to see if she wants to keep the baby. We get her prenatal care if that’s what she needs and also teach her to use condoms during pregnancy.”
“Self esteem and partner communication are stressed,” adds Natasha Abney, another Street Beat advocate. “We do activities. How long does it take to put on a condom? Seconds—even when it pops and they have to start over. We do an exercise where we have a bag filled with panties and each girl picks one. We teach them that the satin ones may cause infection because they do not let the vulva breathe. We encourage communication between the woman and her partners and with her parents. We talk about condom negotiation, how to be assertive. Most of the girls say they’ve had Sex Ed in school, but they’re only told ‘Don’t have sex,’ and ‘Don’t get pregnant.’ We do much more than that.”
Street Beat also coordinates an improvisational theatre group called ONE. Some members are in gangs, others are high school dropouts. “Overall, they’re a good bunch of kids—mostly male—who find comfort in acting,” says Peterkin. “The group offers them a way to see different possibilities for themselves.” ONE performs skits about AIDS, HIV, STDs and risk factors at community centers, churches, schools and on public access television.
The mix of judgment-free programs—street work, counseling, educating teens—keeps Street Beat staff more than busy. Yet despite this monumental task, they remain upbeat, taking pleasure in small victories. “I love the job,” says a smiling Peterkin. “It’s great to touch people in a positive way.”
Like their colleagues in Brazil, Street Beat shrugs off the moral crusaders pushing sexual abstinence and religious salvation. Risk-reduction, they say, is the only effective tactic in the ongoing fight against AIDS. Saving lives, not souls, is their mission.
ContributorEleanor J. Bader