By Mamta Badkar

Awilda Colon sets up OraQuick tests for HIV/AIDS inside the Bronx AIDS Services van at Highbridge Community Church on November 22. Residents of Highbridge, like Joy Felder availed of the free testing services. Photo by Mamta Badkar

Joy Felder waited patiently inside the plain white van parked next to the Highbridge Community Church in the South Bronx. Health workers hired by Bronx AIDS Services were offering free HIV/AIDS tests inside for anyone who showed up.

Sitting on the couch in an army green jacket, her hair pulled back in a severe bun, the mother of two said she wanted the test to ease her mind. A few months ago, she let down her guard and had unprotected sex. “It’s easy to lose focus when you’re in the moment and tensions are high,” Felder said, waiting patiently for her turn.

Felder heard about the free testing service from a friend, but believes programs like this are critical in the Bronx. Bronx AIDS Services, a non-profit health organization, relies on federal and private funding to provide free testing in areas with the highest HIV/AIDS rates and poverty levels.

Highbridge has one of the highest rates of HIV/AIDS cases in in the Bronx, twice the city’s average.  The Bronx Knows, a borough-wide HIV/AIDS testing initiative which partners with over 70 agencies including Bronx AIDS Services, identified 1,506 new cases of HIV/AIDS in the Bronx as of June 2009.  Of the 433 Bronx residents diagnosed with HIV in 2008, 118 have been living with full blown AIDS, according to the New York City Department of Mental Health and Hygiene.

Why so high? “There’s a fair amount of bisexuality and incredible poverty,” said Dr. Donna Futterman, Director of the Adolescent AIDS Program, Children’s Hospital at Montefiore in the Bronx. “HIV tracks poverty so it combines to be a heavy hit neighborhood,” she said of Highbridge and Morissania.

Futterman said transmission rates have continued to rise in these neighborhoods, even as they decrease elsewhere. “For every 100 people, three are HIV positive in that community,” she said, but reasoned that increased testing would naturally reveal increased diagnoses.

“We’ve let this epidemic languish,” said Futterman. “There’s great work being done but there’s a lot of competing priorities. And if you look at Highbridge and Morissania, you’ll get a picture of them.”

Funding is a perennial issue. An inventory of HIV cases published by the National Alliance of State and Territorial AIDS Directors and the Kaiser Family Foundation in July, found that funding for HIV prevention has been flat since 2004,  with the exception of a $35 million increase in 2007 for the Centers for Disease Control to expand testing. But this new funding has yet to influence the rate of HIV/AIDS in neighborhoods like Highbridge, which remains alarmingly high, even with the efforts by Bronx AIDS Services to increase awareness since 1986.

A tester with Bronx AIDS services has not seen any funding increase for her work in Highbridge and Morrisania over the last decade.  “Instead of us having five groups a week, we’ll have to cut them down to two or one group a week,” said Awilda Colon, who began this work after her sister died of HIV/AIDS in 1993. “They keep cutting. Since the funding is less, the services are less. It actually affects the services that we provide which is sad.”

Now, three Bronx AIDS Services vans cover the Bronx five days a week and sometimes, on weekends. To cast a wide net and maximize its outreach, Bronx AIDS Services also develops ties with community organizations and health fairs. Testing has increased 35 percent since The Bronx Knows first launched its free testing effort in 2008.

A Turkey and a Test?

Meanwhile, Bronx AIDS Services is doing its best to let Highbridge residents know that AIDS testing is available to them. At the Highbridge Community Church on November 22, Marvin Freeman, peer adviser with Bronx AIDS Services, approached people standing on line along Ogden Avenue for a Thanksgiving food distribution organized by another local social service organization, the Muslim Women’s Institute for Research and Development.

“There’s a wonderful van in the back full of resources just for you. There’s also free HIV/AIDS testing available back there,” said Freeman as he distributed condoms and literature on HIV/AIDS. “It’s confidential so no fingerprint and in about 10 minutes you’ll know exactly where you are with this.”

Freeman, looking fit in a black coat and fedora, recognized himself in some of the people in line.  As an HIV-positive gay man and former drug addict, he found himself saying to those he was reaching out to, “I didn’t always look this way, I was in the same exact situation you were.” This ability to bridge the gap between himself and others, made his work easier.

“I was out here in a bad situation drugs, alcohol and no hope,” said Freeman, who first used Bronx AIDS Services himself five years ago as a resource for free handouts. “I’m HIV positive and I have Hepatitis C, and I found out about this program. They had men’s groups at that time that I joined and I used to go just for the Metrocard and the food. I wasn’t looking for relief.”

When he spots people living in isolated, single-room residences, in a situation that is all too familiar, he goes the extra mile to help them. To Freeman, it’s not the disease that is a death sentence, it is the denial.

Denise Richards of The Muslim Women's Institute for Research and Development who helped with the food distribution on November 22, understands the importance of initiatives like The Bronx Knows. In neighborhoods like Highbridge which have twice the HIV/AIDS rate of New York city, hyperlocal efforts make all the difference. Photo by Mamta Badkar

Outreach workers like Freeman are effective because they understand the desperation and through shared experiences, inspire hope. “They don’t view us as outsiders coming in to help them,” said Denise Richards, an executive with the Muslim Women’s Institute. “They kind of see us as equal.  ‘I know Denise she lives three blocks away, she works right here. When she’s speaking to me, she’s speaking to me as my equal.’”

The three free AIDS testing vans operated by Bronx AIDS Services work in teams of five. Two peer educators, a supervisor, a tester and the driver set out about nine on weekdays, in vans to conduct tests and increase awareness. On November 22, they handed out $5 McDonald’s coupons as an incentive to those getting tested.

Each mobile van is required by Bronx AIDS Services to test 56 people a month. One worker said she had sometimes tested a 120 a month. “There have been times when I’ve tested 120 but funding doesn’t allow for more so now I get up to 60 done,” said Colon.

She first administers the Oraquick Advance, an oral swab. If that turns out positive, Colon administers OraSure samples, which are sent to labs. In her 12 years as a tester, Colon said she has only ever had two false positives, both of which occurred because the women were pregnant.

Colon also preps clients, assesses their mental health, informs them about support groups and arranges for medical services through Bronx AIDS Services.

“A lot of times, domestic violence plays a part in not using protection, so it’s just a host of problems that we encounter,” said Colon. “People still think it’s a disease for junkies or gay people and that it can’t happen to them.” But the face of the disease is often is a stay-at-home wife or a senior citizen.

“In my heart I wish people would understand that this is just a sickness like any other sickness, like cancer or diabetes,” said Colon.

Breaking the Religion’s Barriers

Often, religious beliefs conflict with HIV prevention. In an effort to reconcile ideological differences, programs like The Bronx Knows have collaborated with community partners that include religious organizations, Bronx hospitals, major community health clinics and universities.  Muslim Women’s Institute for Research and Development joined with The Bronx Knows in 2008.

In 1997 Nurah Amat’ullah first launched The Muslim Women’s Institute as a kitchen table organization in response to what she believed were her community’s unmet needs. Hunger relief was its first effort. From there the institute branched out to serving other needs, including health scares like HIV/AIDS.

The Institute took on a formal structure in 2005 with an office in the Highbridge section of the Bronx.

“In an area like Highbridge where we have the highest incidences of new infection for people 18 to 24 years of age we would not be a good neighbor not just as an organization, but even as Muslims, if we did not do something to respond to the crisis that faces this community that we are in,” said Amat’ullah. She believes that Muslims constitute about 10 percent of the Bronx population, but that number is difficult to nail down, because records are not kept by religious affiliation.

“We’re still very much a community that is motivated, instructed and guided by what is said at the front of the room in our houses of worship, what is said at the front of the room at the masjid (mosque),” said Amat’ullah. “Our goal is to get more of the Imams to talk to people about the challenges of HIV/AIDS, the responsibility as people, as good human beings to check and know our status.”

The author of a book based on HIV and AIDS in the Muslim community, Farid Esack argued that Muslims have the responsibility to teach other Muslims about the risks of HIV and AIDS from a religious standpoint.  In “HIV, AIDS and Islam,” published in 2004, Esack said Muslims are of the opinion that HIV/AIDS is caused by haram (behavior that is prohibited), like promiscuity and pre-marital sex, and do not acknowledge other means of transmission such as drug abuse, alcoholism, domestic violence, rape and poverty.

“Definitely within the Muslim religion, you know condoms are not condoned. You have your wife and your husband and you’re supposed to have children. So Muslim men and women definitely feel like that’s a no-no,” said Richards. “It’s a very personal choice that they make within their household, between them and their God.”

Muslims in favor of using protection against sexually transmitted diseases seek to dispel the stigma surrounding HIV/AIDs by referring to verses of the Qu’ran and the Prophet’s Hadiths (sayings of Prophet Muhammad) that discuss Islamic values of compassion.

“I tend to come down on the human-compassion side,” said Amat’ullah. “I don’t act in judgment of people’s lifestyle or practices, but try to find ways to give them some ease, some comfort, some protection, against a disease which at this point is still incurable,” said Amat’ullah.

Peer adviser Marvin Freeman plays the piano inside Highbridge Community Church when he takes a break from outreach. Freeman a gay, HIV positive man believes that music and religion have the power to heal. Photo by Mamta Badkar

Often confronted by those who look at HIV/AIDS as a punishment for moral transgressions, Amat’ullah views the disease and the stigma associated with it as an equal opportunity crisis. “Not just for Muslims but for other faith communities, people often believe that if you contract this disease, then you’re being punished by God for something you did.”

But this is fast changing. Dr. Futterman in her work has found African church leaders and imams taking up the fight.

For Freeman, his HIV diagnosis nine years ago was the beginning of his life. “It was like a divine interruption, if you would, and now I’m healthier,” he said. It allowed him to “plug into his life” and reach out to the community at The First Corinthians Baptist Church in Harlem.

“Relationships in Christianity allow you to be effective, to reach the poor, the destitute, the lonely, you know that’s what it’s all about,” said Freeman. “I’m not like the 20^th century leper and I let that be known to the religious community.”