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How HIV outreach is tackling an “invisible crisis” in The Bronx

Aviles looks on as his colleague prepares for a customer in a Bronx barber academy.

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.

HIV mortality rates in the South Bronx, compared to the rest of the city.

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.”

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Closing the gap between health and education in a Morrisania public school

The school health coordinator, Barbara Alicea  speaks to a parent outside P.S. 140. (SWATI GUPTA / Bronx Ink)

Barbara Alicea, a new school health coordinator speaking to a parent via cell phone outside P.S. 140, the pilot site of a national health and learning initiative. (SWATI GUPTA / Bronx Ink)

Elpida Vlachos routinely takes her four children who attend Morrisania’s P.S. 140 on Eagle Avenue for regular doctor check ups. She said she felt confident that none had health problems. So it came as a surprise to the 38-year-old Bronx mother when her children came home one day from school with a note indicating they needed eyeglasses.

P.S. 140 in the South Bronx, an elementary school is the site of a new, national pilot program intended to make sure that students who need treatment for everything from poor vision to chronic asthma receive holistic health care coordinated at the school level. Called Healthy and Ready to Learn, the initiative was launched in September by Children’s Health Fund in three schools, two in the South Bronx and one in Harlem.

All the students in P.S. 140 who failed the vision screening are expected to be provided with two pairs of glasses – one to keep in school and one for home. These children will meet with an optometrist for free and choose the glasses they like, said Barbara Alicea, the school’s health coordinator, who acts as liaison between the health center and the school to bring together local health services for the children.

Also known as the “eye lady” in the school, children rush to hug Alicea as she explained her role. As health screenings continue in the school, Alicea will work with parents to help connect them to  basic needs like housing, insurance, public assistance, domestic violence and immigration issues.

Poor vision is just one of eight health-related barriers to good learning identified in this new initiative aimed at helping schools, parents and health center practitioners triage knowledge and treatment. According to a study conducted by The Center for Health and Health Care in Schools,  an estimated 22 per cent of children aged 6 to 11 have a vision problem.

The eight health issues to be targeted by the Healthy and Ready to Learn program include asthma, dental issues, hearing loss, hunger, behavioral problems, anemia and lead poisoning. Phoebe Browne, the director of the initiative, said that the organization chose these eight issues because they are fairly common, relatively easy to screen, preventable and manageable. The program will measure these health indicators over time next to school measures such as attendance and test scores to assess the program’s impact over time.

Once a child is identified with a particular health issue, the parents are informed and coordination will begin to provide the child with primary care. The program’s next hurdle is to figure out a way to screen for anemia and lead poisoning in school, two conditions that require blood tests to diagnose. “We do not provide primary care, but our school health coordinator will help the family to connect to primary care,” said Colby Kelly, communications director at the Children’s Health Fund.

P.S. 140’s assistant principal believes teachers are pleased to be part of this pilot. “We are monitoring the effects of the program,” said Assistant Principal Kevin Greene. “Eventually, over time, the teachers and parents will see the benefits.” The two other schools in the pilot are P.S. 49 in Mott Haven and P.S. 36 in West Harlem.

Finding local resources for the parents such as dentists, optometrists and primary care physicians is another work in progress. The next step after vision screening in P.S. 140 will be dental check ups and training for asthma control, Alicea said.

Children play outside the main building of P.S. 140 on Eagle Avenue. (SWATI GUPTA / Bronx Ink)

Children play outside the main building of P.S. 140 on Eagle Avenue. (SWATI GUPTA / Bronx Ink)

Poorly controlled asthma is one of the leading reasons children miss school through exhaustion or hospitalization.

Tonette McWilliams, a teacher at P.S. 140, said that she had a student who used to miss an entire week at a time due to chronic asthma since she had to be hospitalized. Severe attacks cannot be treated at home or in the school clinic. Under the new program, once a student has been identified with average or chronic asthma, the school health coordinator will work with the family to provide educational materials and training to train them in avoiding environmental triggers and exercising caution in physical activities. .

“We are looking for a scalable solution to these problems,” Kelly said. “Parents do not know about the triggers and it is a process of discovery, finding out the why.”

Asthma and behavioral problems represent the top two health barriers to learning, according to a 2013 survey of principals and assistant principals administered by the Children’s Health Fund and the city’s school supervisor’s union. In high poverty schools, 67 per cent of school officials identified asthma as a moderate or serious barrier to learning.

“P.S. 140 is located in the poorest congressional district in the country and there are social issues related to poverty and lack of insurance,” Green said. “We felt that having this program would provide us with assistance in some of the issues.”

Around 18 to 20 percent of P.S. 140’s 640 pre-kindergarten through fifth grade students live in homeless shelters; a few more live in foster care homes or transitional housing, said Greene.  As he spoke, a school administrator, Tuesday Brown, brought in a five-year-old boy who was extremely agitated. Greene reassured the child, and returned him to Brown after five minutes, saying he was a cancer survivor, who suffers from hyperactivity.

“Realistically, some students have underlying issues,” said Greene. “To get them ready for high school, college and future careers we have to work hard and build their self esteem and that is where Children’s Health Fund comes into play.”

Health and Ready to Learn is funded by international organizations like H&M Conscious Foundation, Jaguar Land Rover and individual donors. Both corporations have committed to providing the funds that are required for the screenings, trainings and equipment. P.S. 140 is currently working without corporate funding but Children’s Health Fund is in the process of identifying donors. Along with funding partners, it is collaborating with various organizations and experts who are providing valuable data and research.

Children chat with each other as they walk out of school on a Thursday afternoon. (SWATI GUPTA / Bronx Ink)

Children chat with each other as they walk out of school on a Thursday afternoon. (SWATI GUPTA / Bronx Ink)

The Children’s Health Fund was co-founded 27 years ago by singer/songwriter Paul Simon and Columbia University’s Dr. Irwin Redlener. The organization set up two dozen national network programs and 50 mobile units that bring medical care to children in poor neighborhood. One of the oldest national networks is located in the South Bronx in partnership Montefiore Medical Center and the Albert Einstein College of Medicine. The South Bronx Health Center located at 871 Prospect Ave, provides a medical home for underserved children and families.

Healthy and Reading to Learn was launched in response to the need to do more to reach out to more children who need care. Hospitals and mobile vans proved to be insufficient. Organizers believed that going directly into public schools was the next logical step.

School officials at P.S. 140 hope the program will help improve attendance rates, which were 89 percent last year. The goal is to reach 93.5 percent, said McWilliams. “When it comes to education, I’ll try anything,” said Ligia Perez, a second grade teacher at P.S. 140. “And if this program can help then I am on board.”

“If something is going to work,” said Greene, “it can be only through communication between the teachers, parents and the community.”

Posted in Bronx Neighborhoods, Education, Featured, Health, Southern BronxComments (0)