Federal Cuts Hit HIV Work in Brooklyn

Almost seven years have passed since Tree Alexander first met the man who would change his life forever. They met in a clothing store, exchanged phone calls for four months and dated for half a year before moving in together. The issue of safe sex had already been addressed: Both were HIV negative. At least that’s what Alexander’s partner said.

But he was wrong. And not only had his partner not revealed his status, he had even stopped taking his HIV medication, a decision that almost cost him his life. In a few months, the partner began to display some of the classic symptoms of the onset of AIDS–a cold that wouldn’t go away and significant weight loss. Then he fell critically ill from pneumonia. As Alexander waited next to what he thought was his lover’s deathbed, the doctor delivered the dreadful news: His partner had lied to him; he was HIV positive. Alexander hurried to a nearby clinic the next morning to draw blood. After two fretful weeks, he learned that his partner had given him the disease.

Now a HIV/AIDS worker with Brooklyn Men Konnect, part of the Brooklyn AIDS Task Force, the 26-year-old says that his story is nothing new. In a recent interview with City Limits, Dr. Monica Sweeney, Assistant Commissioner, Bureau of HIV/AIDS Prevention and Control, at the New York City Department of Health and Mental Hygiene (DOHMH), says the transmission of HIV by a partner who hid his status is a significant health concern in the city.

“It’s a major, major problem. Make it capital letters. I can’t say it enough,” she says.

In the office where Alexander works in Crown Heights, spreading the disease through non-disclosure isn’t the only growing HIV problem, though. This area in Central Brooklyn is also seeing the emergence of a trend that mirrors developments in New York City, as a whole: the steady increase in new infections among young men who are having sex with other men (MSMs).

Meanwhile, changes in federal funding are making it harder for some front-line clinics in Brooklyn to mount an adequate fight against a changing epidemic.

New demographics, fewer dollars

By June 2011, close to 130,000 people were living with HIV/AIDS in New York State, almost 112,000 were in the city, though the true infection rate is probably at least 20 percent higher since many don’t know their HIV status. For the first half of 2011, Brooklyn led the city, with 495 or 28 percent of new HIV diagnoses. More than 27,000 people in the borough are estimated to be living with HIV/AIDS (PLWHA), second only to Manhattan, with more than 33,000 PLWHAs.

The latest data from DOHMH shows that while rates of new HIV infections have almost halved in ten years, for the first time more than half of new HIV infections were among MSMs, with young men under 30. Gender, race and age shape today’s HIV crisis in the city. 93 percent of new HIV/AIDS diagnoses among females were in black or Hispanic women. The city has seen a steady decline since 2001 in new diagnoses for older gay men, but the figures have been rising over the decade among the young. MSMs newly diagnosed and older then 30 were mostly white, while almost 80 percent of newly diagnosed young people were black or Hispanic.

Kings County continues to be an HIV/AIDS epicenter for African-Americans, women, and children in the city and the U.S., says Dr. Jeffrey Birnbaum, with Central Brooklyn its focal point. Birnbaum has been operating HEAT/FACES, a network of HIV/AIDS clinics in the borough, for almost 25 years. Recently, at one clinic in Bedford-Stuyvesant, a 21-year-old woman who had learned that she is HIV-positive had just come in, mad enough to kill her boyfriend, who hid his HIV status from her.

Late last year he was notified by the Health Resources and Services Administration (HRSA) that an important grant from the Part-D Program of the Ryan White Care Act would not be renewed after 23 years. Dr. Birnbaum’s network of clinics in Brooklyn had been the bulk recipient of the grant in recent years, receiving close to $1.7 million annually out of a total $2.1 million awarded for the entire borough. The cuts meant shedding 20 members of staff, including, nurses, a doctor and case managers at each of the eight sites, which served more than 1,100 HIV/AIDS patients. Brooklyn’s “HIV community has been hurt in irreparable ways,” Dr. Birnbaum says.

The grant last year was “recompeted,” a HRSA spokesperson, Martin Kramer says. Since then the grant for the entire borough of Brooklyn was cut 83 percent, with Kings County Hospital Center remaining its sole awardee, receiving $350,000 for the current fiscal year to treat low-income women, children, infants and youth.

Kramer explained that applicants for the grant were reviewed and scored by an “independent Objective Review Committee” and that HRSA is “confident the new Part-D grantee will provide more clinical care than the previous one.” He added that New York City, considered to be the epicenter of the disease in the nation, received the highest amount of Ryan White funds anywhere in the country, and that Part-D funds a small fraction of the total entitlements program.

For fiscal years 2012, New York City, which administers Part-A, received close to $120 million in funding, while New York State received more than $162 million. While he wouldn’t say how much the Part-D program in New York had been defunded, figures provided for Part-A and Part-B showed cumulative reductions close to $1 million.

While the Ryan White Part-D Program takes up a small amount of total funding under the entitlement program, “more than 37 percent of women receiving medical care in Ryan White Programs do so through Part D, in addition to receiving critical case management, psychosocial and treatment adherence services,” reported the AIDS Institute recently, a national non-profit. “In 2011, the Part D Adolescent Initiative is one of the leading national efforts to link HIV positive youth to comprehensive medical care and support services,” it added.

Birnbaum says the federal cuts impact his program’s ability to counsel people like Alexander’s partner to disclose their HIV status to the partners, and make sure their partners get tested.

Talk in Washington of further cuts to other parts of the Ryan White Care Act for the city have doctors in the HIV/AIDS field “terrified,” says Dr. Leonard Berkowitz, a physician at the Brooklyn Hospital Center.

Why cuts hurt

The loss of case managers can have serious consequences for the patient and the spread of HIV, says Ivy Gamble-Cobb, of the Family Center in Brooklyn. Case managers, she says, ensure those living with HIV/AIDS keep to their schedule of doctor’s appointments, and take daily doses of medication on time, a task that is often, doctors say, made more difficult when patients are dealing with poverty, homelessness, or domestic violence.

Gamble-Cobb’s clinic lost its Part-D grant totaling $750,000 last year, leading to the termination of its HIV program. HRSA’s decision to defund has her baffled she says since her clinic has been scoring in the high digits for many years.

She says an emerging HIV/AIDS crisis in the American south is forcing the federal government to reroute funds from New York, though the HRSA spokesperson would not confirm this, except to say that “for the first time 19 new locations across the United States received Part D funding.” According to Centers for Disease Control (CDC) statistics, New York is only one of eight major urban centers of HIV/AIDS in the United States. Cities in southern states make up the bulk.

Concerns about defunding of other parts of the Ryan White Act were amplified when the Bedford-Stuyvesant Family Health Center took a significant cut in federal funding. In 2010, it lost over $250,000 from the Ryan White Part-A Program, forcing it to lay off more than seven staff members, including case managers, its HIV/AIDS program director Norma Reyes says.

According to the latest data from DOHMH, Bedford Stuyvesant-Crown Heights remains an HIV hotspot. It is one of four epicenters in the city and the focal point, doctors say, for the disease in the borough.

Though the rate of new infections in the area is down almost 60 percent from the start of the last decade, it recorded the highest number of new infections for 2010: 220. Almost 7,000 people in the area Bedford Stuyvesant-Crown Heights are living with HIV/AIDS.

As was the case citywide in 2010, young men under 30 made up the bulk of new infections, compared to 21 percent a dozen years ago.

Explaining a shift

The increasing prominence of young, black and Hispanic MSMs in the HIV caseload reflects a “confluence of factors,” says Sweeney. One of them is “treatment complacency,” the ideas that the impact of HIV/AIDS on one’s life is minimal. As C. Virginia Fields, president & CEO of the National Black Leadership Commission on AIDS, puts it “complacency among the young that HIV/AIDS is just a matter of taking one pill a day” can make them less likely to practice safe sex.

While Birnbaum says that HIV “can be” a one-pill-a-day disease, and that patients can live long and high-quality lives, HIV/AIDS is still a very challenging health condition. Living with the disease involves a lifetime of doctor visits, Berkowitz says, while the drug cocktail used to fight HIV/AIDS can mean nightmarish side-effects, says Dr. Freddy Molano, of the Community Healthcare Network in New York. Alexander says that though HIV medication is becoming less toxic, he has seen many cases of clients reporting near-delusion side effects.

Adding to the misconceptions about the impact of the disease, says Alexander, is a generation gap: Young people engaging in risky sexual behavior “did not see the bodies on the sidewalks of Christopher Street,” he says.

In Central Brooklyn, according to Dr. Birnbaum “poverty, substance use and stigma surrounding HIV make for a lethal combination.”

A recent study by Molano and his colleagues found that gay and bisexual men are increasingly using networking apps like Grindr, Scruff, Manhunt, and Growlr on their mobile devices to hook up. Researchers found that the vast majority of respondents considered unprotected anal sex dangerous, yet “almost half of respondents (46.4 percent) admitted to engage in unprotected anal sex “often or sometimes” versus 53.6 percent who reportedly never engage in it. Displeasure with condom use and impulsive behavior were cited as core reasons.

A recent report by the Center for Disease Control and Prevention, (CDC), concludes that the stigma plays a role in deterring people from getting tested.

While Alexander is forgiving, his partner’s infidelity within weeks of getting better severed their ties. However, the last he heard, his former partner continues to hide his HIV status and might be still having unprotected sex he says.