The Bronx Ink

Charles Aviles, a 36 year-old Bronx resident, will always remember his mother’s childhood friend Ronnie when he thinks about growing up during the 1980s. Ronnie had treated Aviles like a son, helping him with things like tying his sneakers.

“He had one of those million-dollar smiles, like nothing ever bothered him,” he said.

But when Aviles was just 10-years-old, Ronnie passed away suddenly. That was when Aviles first became aware of AIDs. The global epidemic continued to rage throughout Aviles’s childhood years and into the early 1990s.

HIV and AIDs rates have decreased globally since the peak of the epidemic in the 1980s, and earlier this month, New York Gov. Andrew Cuomo announced that the number of HIV diagnoses in the state had declined by 28 percent since 2014. But that doesn’t mean progress is evenly spread: just as the Bronx was disproportionately affected during the crisis’s peak, today it is one of the Center for Disease Control’s 45 HIV hotspots across the country.

There are several factors that feed into the “invisible crisis” of HIV in the south Bronx, according to Dr. Vincent Guilamo-Ramos, director of the Center for Latino Adolescent and Family Health. HIV rates are higher among Latino and African American populations, which disproportionately populate the borough. There are also generally higher rates of HIV among men under 25 years old, particularly those who are gay and bisexual. The Bronx also has the largest youth population of any of New York’s five boroughs. Language and cultural differences also play a role.

Both government and non-profits have been trying to address the issue with outreach programs tailored to specific demographics.

For example, hair care professionals were one of the groups identified by the CDC as potential partners for its Business Response to AIDs initiative, which began in 1992. The program partners with businesses, health departments, community based organizations and government agencies to provide public education on HIV. As barbers in New York are already required by state law to receive training on contagious disease transmission associated with their professional duties, training centers for hair care professionals were an obvious group to incorporate into the program.

Aviles, who is training to become a barber at the Beyond Beauty & Barber Academy in the Bronx’s Westchester Square neighborhood, is also being trained to talk to people about HIV. For Aviles, it’s important not just to have practical knowledge about safe barber practices – sanitizing equipment, taking care with pimples and open wounds – but also about how the community provided by space can facilitate difficult talks.

“Barbershops are the places where you let loose, where you want to be able to talk sometimes and at home you can’t really have certain conversations,” he said. “But when the fellas are around, it’s a great environment to have certain conversations.”

But despite efforts like the CDC’s, there are several reasons that HIV rates remain high across the Bronx today.

There are fewer health services in the area than elsewhere in the city, and Latinos and African Americans are disproportionately uninsured, or have inadequate coverage. For many, that means that PrEP, a highly effective antiretroviral drug, often isn’t available to them. Bronx residents generally have lower incomes than in other parts of the city, Dr Guilamo-Ramos said, and other expenses might seem more urgent than medication for a chronic health condition.

People also feel scared about going into formal spaces like hospitals or clinics to take an HIV test test, said Daniel Leyva, the Latino Commission on AIDs’s press secretary. This discomfort can be especially prevalent among Latinos and people of color, who can feel socially and culturally excluded in places like sexual health clinics.

“It’s really sad to see that a lot of people in our community are still dealing with so much stigma,” said Ivan Ribera, a community engagement specialist at Latino Pride Center whose daily work involves approaching people to talk about HIV prevention.

All of this has grave consequences for the Bronx. The borough’s rate of premature deaths from HIV was twice as high as the New York City average in 2018, according to Community Health Profile data., which put the Bronx’s rate at 12.3 deaths per 100,000 compared to Brooklyn’s 6.4 and the New York City average of 5.9. In total, the Bronx saw 792 premature deaths from HIV last year.

Moreover, the South Bronx itself is a pocket with much higher HIV death rates than anywhere else in New York City. Morrisania, Mott Haven and Hunts Point were among the worst-affected areas.

Dr. Guilamo-Ramos has piloted a number of pioneering outreach and education programs in recent years, but described youth infection rates as a “raging epidemic”. As a result, two of the programs he runs – Families Talking Together and Fathers Raising Responsible Men – target teenagers and work with families to communicate on the issue.

Ribera said he talks to approximately eleven people a week on an individual basis as part of his outreach work, and that much of it involves trying to get people to use condoms. “There’s this idea that NYC condoms don’t work,” he said, alluding to rumors that condoms issued by the city’s Health Department are faulty. “So we try to push condoms, to eliminate those patterns.” In addition to approaching people in the street, Ribera and the Latino Pride Center produce discreet boxes filled with a range of differently-sized and -flavored condoms and leave them in places like barbershops.

Churches are another space being leveraged to offer a culturally-specific outreach service, due to their standing in minority communities and the close personal relationships they often cultivate in areas such as the Bronx.

“Churches are becoming a mediator between communities and its services people who are nervous about seeking services somewhere else,” said Leyva, adding that they can be particularly important for people who don’t see themselves as a part of at-risk groups or who don’t realize the breadth of health services they are entitled to use. “At the end of the day, it’s about promoting safe spaces for people to discuss sensitive issues.”

In Aviles’s mind, the necessary outreach work to combat HIV in the Bronx shouldn’t pose as many challenges as it appears to. “It doesn’t mean you got the cooties or anything like that. You’re just a normal person,” he said. “Things happen.”

THE BRONX, New York—Vivian Young has lived in the Bronx her entire life, but now, at 65, she’s worried about what it would take to remain living there.

“I love it here,” Young said at a town hall at Monroe College in University Heights last Thursday night.

She said affordable housing for seniors is getting harder to come by.

Over 40 borough residents attended the town hall hosted by Bronx state senators. They expressed concern over health, housing and criminal justice.

Young is also concerned about public health, noting that the Bronx has high diabetes rates.

In the borough, 16% of adults have diabetes, according to New York City Health Department data. Only 11% of adults in the city as a whole have the disease. The department notes that around 164,000 adults have not been diagnosed.

Steven Pacheco, 29, a student at CUNY’s John Jay College of Criminal Justice, wanted to hear about how lawmakers were prepared to handle marijuana convictions, rehabilitation into society, and market access, concerns rooted in racial inequality.

“The culture is rich, the people are beautiful,” Mr. Pacheco said of the Bronx. “[But] it’s the last borough in everything.”

Sen. Luis Sepúlveda spoke on the legal system and its treatment of people of color. As the chair of the Crime and Corrections Committee, he said he had visited 13 facilities, which had conditions he described as “an abomination.”

Five state senators from the Bronx listened to residents’ concerns, but they also publicized their own accomplishments during the recent legislative session.

Sen. Gustavo Rivera said he was proud of legislation that “codified the ACA in law.”

As lawmakers touted accomplishments throughout their speeches, attendees applauded.

To get something done in the legislature, said Sen. Jamaal Bailey, “you have to go through the Bronx.” He is the Chairman of the Codes Committee. Each of the legislators at the town hall  chair a committee.

In the 2018 Midterm elections, Democrats picked up eight seats in the New York Senate, gaining control of both branches of the legislature and ending the divided government. This allowed them to pass 248 laws, according to official counts.

While just over 40 people showed up, in addition, one in five were staffers for legislators or Monroe College. The moderator opened the panel over a half hour late.

Freshman Sen. Alessandra Biaggi, occasionally sipping from a jar of kombucha, explained how she reestablished the Ethics Committee after years of hiatus. She also held sexual assault hearings.

After the event, Ms. Young expressed disappointment that Sen. Serrano was late due to parent conferences at school. 

“I think he could have just stayed home,” she said.

However, she was encouraged that by Sen. Rivera’s efforts at health care legislation.

According to Sen. Rivera, there’s more to do. “[We’re] just getting the training wheels off.”

In a cubicle on the second floor of the historic Banknote Building in Hunts Point, Thelvis Alston worked the phones one September afternoon, canvassing potential clients for the new data services startup he helps to run. Sector-Wide Health, which opened in January last year, has faced stiff competition from larger companies ever since the Affordable Care Act contributed to this growing economic sector in the borough.

The company has had a “difficult” start, said Alston, a 41-year-old Bronx native and vice president of operations.  Building a client base of doctors who want help digitizing their medical records has been “slow but steady.” Bronx’s healthcare industry has been on the upswing over the last five years. One reason for the mini-boom is the Affordable Care Act, which offers more medical access to more people throughout the borough. Between 2009 and 2013, the sector added nearly 5,000 new jobs in private hospitals, clinics, and other agencies. But the growth has not affected all businesses equally. Small businesses such as Sector-Wide Health have trouble breaking into a market face with so many larger healthcare organizations and agencies that are significantly better funded, like the Urban Health Plan for example.

Alston believes there is still an untapped need by doctors need to digitize their medical records to comply with new regulations for Medicaid and Medicare incentives under the Affordable Care Act. Sector-Wide Health are best situated to fill that need. Alston regularly meets with neighborhood doctors to identify what type of digitization software would work best for their practice. He then guides them through the transition process. “It’s about talking to doctors just to get them comfortable with the thought of where their business is going to go in the next ten years,” Alston said. Sector-Wide Health’s growing number of clients mainly include private practitioners and small clinics in the Bronx.

Joe Carrano, another Bronx native, remains upbeat about the prospects for healthcare outfits, both big and small, in the borough. “The industry is huge and healthcare technology is really growing here right now,” said the 25-year-old Carrano, who is director at the Bronx Business Incubator in Hunts Point. The incubator houses 66 start-ups and eight of them, including Sector-Wide Health, are in the business of providing healthcare and healthcare-related service.

Carrano believes the Bronx has more room for growth, for the healthcare and healthcare-related industry, than any other borough. Its close location to Manhattan and its relatively cheap real estate makes it attractive for investors, he said. The incubator provides startups with consultations, networking opportunities, and affordable office space. It has approximately 180 workspaces, comprising virtual offices, physical workstations, conference rooms, and meeting areas. “It’s up to entrepreneurs in the Bronx to shape the development of the business community,” said Carrano.

For Sector-Wide Health, the road ahead is uphill. It is still relatively new, has a comparatively low budget, and comprises a small team of employees. The Affordable Care Act, Alston believes, provided an important point of entry into the market. In order to survive against bigger, better-endowed competitors, the startup has to quickly carve out a niche area of service.

Some entrepreneurs believe the Affordable Care Act works against small businesses in an already saturated healthcare industry. One of them is Michael Harris, a registered nurse and owner of a startup called Transparency in Registered Nursing. His startup, founded in 2009, brings “high-tech nurses into the homes of patients” for both emergency treatments and long-term outpatient care. Harris believes the Act “drove out small businesses” that have no interest in doing business with the insurance plans that are part of the marketplace. Unless businesses sign up to be part of the marketplace, he said, they cannot exist within the healthcare ecosystem created by the Act.

Harris’ gripe with the Act boils down to “nine insurance companies in downtown New York State” that control the marketplace, and the participating hospitals and practitioners that provide “substandard treatment.” He said those are the main reasons why he did not sign his company up to be part of it. Harris would not specify which of the nine insurance companies he talks about but there are at least 16 participating in the Affordable Care Act marketplace in New York State. As a result, he now markets his services mainly to people who can afford insurance plans that offer “unbiased, out-of-network benefits.”

Alston does not share Harris’ skepticism and remains optimistic about the future for healthcare startups. He thinks opportunities and benefits created by the Affordable Care Act will eventually benefit small business outfits. “People will catch up,” he said with a smile.

by the staff of the Bronx Ink and the Brooklyn Ink

Video by Dan Lieberman and Rania Zabaneh

Text by Matthew Huisman

First came the campaign for healthcare, then a year of debate in Congress. Yet at the end of a nine-hour deliberation and a vote that will send the bill to the president’s desk this week, people seem unclear about what the law means to them.

On Monday morning the reaction of hospitals, businesses, politicians and people in the Bronx and Brooklyn was one of confusion. Jennifer Brookland examined the numbers, breaking down people enrolled in Medicaid and what it could mean for the people of the borough. We found that the majority of small businesses won’t be adversely effected by the bill, as business leaders greeted it with optimism.

State and local politicians added their own input on the legislation. Brooklyn Republicans were disgruntled, calling the law a slippery slope toward socialized medicine. State Assemblyman Joseph Lentol who represents Fort Greene, Williamsburg and Greenpoint praised the bill. Fellow Democrat Charles Barron, City Council representative of Brownsville and Canarsie as well as parts of East New York and Flatbush, had some harsh words for “blue dog” Democrats who watered down the bill.

The legislation also sent ripples through the Health Care Industry where Brooklyn pharmacists reacted with apprehension and confusion. Nursing homes faced similar confusion about the insurance coverage for seniors and those on Medicaid. One Brooklyn doctor with a 25-year career feared an increase in the number of patients  which could mean less one-on-one time between doctors and their patients. At the Montefiore Medical Center, some are concerned funding will be cut for low-patient care. While legal immigrants will enjoy the benefits of the law, undocumented immigrants won’t have access, which, many say, runs contrary to the goal of greater access to health care.

One of the lesser known facets of the bill is the revamping of the college loan system. The government would be the direct lender rather than going through private banks.