Pubdate: Tue, 27 Mar 2007
Source: New York Times (NY)
Copyright: 2007 The New York Times Company
Contact:  http://www.nytimes.com/
Details: http://www.mapinc.org/media/298
Author: David Gonzalez
Bookmark: http://www.mapinc.org/heroin.htm (Heroin)
Bookmark: http://www.mapinc.org/women.htm (Women)
Bookmark: http://www.mapinc.org/rehab.htm (Treatment)

FOR SMALLER FIGHTERS OF H.I.V., WEAPONS DWINDLE

If it can be sold, traded or swiped, you can find it at the 
intersection of Mother Gaston Boulevard and Belmont Avenue in 
Brownsville. In this crazy corner of Brooklyn, bleary-eyed men and 
women with faces worn from hustling a buck -- or more -- stand 
outside all-night delis, their eyes shifting about as quickly as their feet.

This is also the kind of place where you can catch a few things 
nobody wants, like a bullet, or a beating.

A small group of women here have taken on another problem ravaging 
the area: H.I.V. They hit the streets and stores twice a week 
dispensing condoms and advice about protected sex while urging people 
to get tested for the virus that causes AIDS. It is hard work, 
stopping other women in midstride to ask them about how they protect 
themselves behind closed doors.

Yet as much as these peer educators from Life Force, a Brooklyn-based 
H.I.V./AIDS education agency for minority women, are used to the 
streets, they are not prepared to wind up on them. This weekend the 
agency may have to start laying off some workers after failing to win 
a renewal of financing for its grass-roots programs. While medical 
advances are helping people with the disease live longer, some of the 
very groups that helped them survive are confronting their own demise.

"People are not dying like they used to years ago," said Ivone 
Negron, a peer educator who is H.I.V.-positive. "But people are still 
getting infected, and we know how to stop that. We are doing what we 
got to do."

Advocates for people living with H.I.V. and AIDS said community-based 
groups like Life Force, which have emerged over the past 20 years to 
confront health crises in poor and minority neighborhoods, could not 
compete with larger groups and hospitals that offer one-stop shopping 
for a variety of services. Others said city health officials favor 
Manhattan-based groups, even though the other boroughs have borne the 
brunt of the disease.

"A lot of groups in New York are feeling the burn because the 
opportunities for little groups are drying up as the bigger ones come 
in," said Kwame Banks, a project director at the Community Resource 
Exchange, which advises nonprofit organizations. "They're out on the 
streets doing the work and don't have time to be philosophical about 
it. They don't even have the time to do strategic thinking."

A substantial amount of financial support for the smaller groups has 
come from the $120 million the city receives each year from the 
federal government through what are known as Ryan White funds. About 
three years ago, a council that recommends how that money should be 
spent reviewed program priorities. The council recommended changes 
that were subsequently adopted by the city's Department of Health and 
Mental Hygiene. The city then turned to the nonprofit Medical and 
Health Research Association of New York City to solicit proposals 
from service providers.

Judith A. Verdino, vice president for special initiatives and H.I.V. 
at the medical association, said the new priorities placed greater 
emphasis on access to care and maintaining treatment. Outreach work 
- -- which had focused on the distribution of condoms and clean 
syringes, among other approaches -- shifted to getting people into 
treatment. Proposals her agency received were scored on a 100-point 
scale on how well they met program requirements.

The resulting grant decisions alarmed some neighborhood groups, 
including Life Force, that failed to make the cut after years of 
support. After a review of those grants last year, the city's 
comptroller said the boroughs outside of Manhattan were shortchanged. 
Officials at the city's department of health and the medical 
association countered by saying they had a mix of services and groups 
covering the five boroughs. "I can say unequivocally it was a fair 
process," Ms. Verdino said. "It is based on how well people are able 
to present their program and show there will be some results."

Nonetheless, the smaller groups have been scrambling since last year, 
trying to survive while scaling back programs, laying off staff 
members and referring clients to new programs. Chris Norwood, the 
executive director of Health People, a community education 
organization in the Bronx, said her group was among 59 programs in 
the city that did not get financing through the Ryan White funds. She 
did receive some money from the City Council to follow up on former clients.

Her group, which had run family programs for adults with the virus 
and mentoring programs for teenagers at risk of contracting it, had 
to refer more than 400 clients to new programs, though she said that 
in some cases, the new programs had not started. That, she said, 
placed people at risk of interrupting their treatment.

Other advocates said that a greater emphasis on medical approaches 
failed to provide enough financing for groups working on other 
issues, like social services or legal assistance for people facing 
eviction. Sometimes the pressures caused by those problems can make 
an individual take a turn for the worse, the advocates said.

"It's not a manageable illness if you are not housed," said Terri 
Smith-Caronia, director of New York City policy for Housing Works, an 
advocacy group that promotes AIDS awareness. "It's not manageable if 
you are selling your body for shelter, food or to meet some need the 
government decided is not a core medical service."

Those are the kinds of vulnerable people, she said, who are best 
served by peer educators who take to the streets in the hope of 
reaching people who live below the official radar. In a bittersweet 
twist for Life Force's two dozen peer educators, it was that kind of 
work that inspired "Life Support," a movie starring Queen Latifah, 
now showing on HBO.

Gwen Carter, the executive director of Life Force, said her group was 
a crucial complement to the medical work being done by the larger institutions.

"The role of a community-based organization is to get people to 
realize the need to get to those medical places; to get yourself 
tested and take care of yourself." she said. "If we all work 
together, it will be more effective. Face it, we're out there. If you 
are waiting for people to come to you, it ain't going to happen."

In recent days, her group has been able to raise from grants about a 
third of the $193,000 in Ryan White financing that will run out by 
the end of this week. (Those funds account for about 40 percent of 
Life Force's budget. The agency also receives money from the Centers 
for Disease Control and Prevention.) And she is exploring the 
possibility of joint fund-raising with another health group facing a 
similar cash crunch. Even some of her peer educators have gotten 
donations -- in the form of $10 money orders -- from local merchants.

Last week, a half-dozen women from Life Force went to the offices of 
a needle-exchange program in Brownsville. Outside, several of them 
stopped women on the street, asking them about how they protected 
themselves during sex. Carol Magee, an outreach specialist who 
started out 13 years ago as a peer educator, asked passers-by how 
long it had been since they had been tested for H.I.V.

"A long time," one woman said.

"Are you sexually active?" Ms. Magee countered.

Less than three minutes later, Ms. Magee was walking with her to get 
tested inside the needle-exchange offices.

"I can identify with these people," Ms. Magee said. "I know all the 
games. They invented a few new ones, but I'm hip to those, too."

Around the corner, three peer educators wedged themselves into a 
coffee shop, where the regulars met them with smiles and questions. 
One woman huddled with a peer to ask about how to use a female 
condom, because her husband refused to wear a condom. A couple of 
women went away with strips of free condoms the educators were handing out.

A hard-faced woman inside the coffee shop who would give only her 
first name, Mary, has known the Life Force workers for almost a year. 
Mary used to be a teacher and wife; she is now a widow and recovering 
heroin addict. Her stony gaze eased when she saw the peers.

"For people involved in the situation we are in, these women are 
supportive and nonjudgmental," she said. "They are a necessary 
community service. They educate the ignorant."

As she spoke, an incoherent woman staggered into the coffee shop, 
only to be hustled outside by Mary and a friend. The woman went down 
the block, bumping into men and trying -- without luck -- to cadge a 
dollar or a cigarette.

"Man, we are like the forgotten people out here," Mary said. "We don't count."
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MAP posted-by: Beth Wehrman