The Bronx Ink

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.

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 AIDS Walk participants march down Southern Boulevard raising awareness for HIV/AIDS in the South Bronx (BENJAMIN BERGMANN/The Bronx Ink)

Against the backdrop of gray skies, the roughly 100 participants of the Third Annual Community Board 2 AIDS Walk replaced the usual truck racket in the area with the odd chants of “HIV! GET TESTED!” and “SAFE SEX! USE CONDOMS!” Marching between Westchester and Hunts Point Avenue, the group called attention to the community-wide stigma of the disease, something the organizers believe may be a key obstacle to eradicating the virus. “We need to break the silence once and for all,” said Millie Colon, a community board activist and chairperson of the AIDS Walk. “People are no longer dying for lack of medication, but rather due to a lack of communication and education.” Silence is literally killing some Bronx residents. Colon encountered AIDS over 20 years ago when her nephew passed away from the disease. Three years ago she lost her brother to AIDS, after he spent four years refusing to see a doctor for fear of community backlash. Though the fight is deeply personal for her, Colon recognizes the larger context. She urged the community to overcome the “fear barrier” of getting tested, and she encouraged those who are infected to “come out of the closet” and receive the proper medication.

Millie Colon, chairperson of the Community Board 2 AIDS Walk, rallies the marchers before the walk begins in Hunts Point (BENJAMIN BERGMANN/The Bronx Ink)

From time to time the marchers, color coordinated in red and white, stopped along the 45-minute route to listen to community voices and pray for those that have lost their lives to a disease first recorded in the city 33 years ago. One of the marchers, Carmen Rodriguez, surprised many by revealing that her husband, who had been secretly living with HIV for 25 years, passed away last Monday. “He didn’t want nobody to know” she said, gently dabbing at her mascara-stained tears. “He was in denial for many years and when he started treatment eight years ago, it had already caused too much damage.”

Carmen Rodriguez stands outside the Hunts Point Recreational Center after revealing to the group of marchers that her husband passed away from AIDS just last week (BENJAMIN BERGMANN/The Bronx Ink)

Rev. Kahli Mootoo, a Hunts Point pastor and former AIDS activist, commanded the megaphone for large parts of the walk, educating sidewalk spectators on the importance of getting tested. “The issue of HIV is losing steam” he said. “People are no longer scared of it, but does that mean they are not getting infected? Of course not!” Even though HIV numbers are consistently falling across the city according to the New York City Department of Health, the percentage of people dying from the disease continues to skew heavily towards low income neighborhoods. The Bronx has the highest death rates among the five boroughs, while Manhattan has the clearest survival advantage in New York City. These numbers were much more even back in 2005. Though the organizers did not focus on these issues, Rev. Mootoo himself believes the issue is deeply entangled with poverty and political will. His view is that as long as HIV-related issues are contained in the most disenfranchised neighborhoods, city officials will see no reason to take action. “We always say the squeaky wheel gets the oil. Our community doesn’t have the power to squeak loud enough,” Mootoo said with a smile. “And god knows we could use some more oil around here.”

About 100 Hunts Point residents marched from Southern Boulevard to Riverside Park to raise awareness about HIV/AIDS. (ADAM PEREZ/The Bronx Ink)

Orlando Torres III looks like the kind of guy who doesn’t back down from a challenge. At 49, he’s six feet tall with broad shoulders and long legs. But his tough appearance is deceptive. Every morning, Torres has to swallow three different medications: Norvir, Truvada and  Viramune to keep his body’s defense mechanism working. He has been HIV positive for more than two decades.

On Saturday morning, he joined a group of Hunts Point residents, activists and people living with HIV/AIDS. They gathered at Southern Boulevard for the first AIDS Walk in the history of the neighborhood. The goal of the march was to raise awareness about the disease. About 2.3 percent of all residents in the Hunts Point and Mott Haven section of the Bronx were living with HIV or AIDS in 2010, according to data from the New York City Health Department. Yet, many people still don’t know much about the virus.

Torres says that by the time he was 21 years old, he had been a sex worker and deeply involved in the drug lifestyle. He had been charged for 68 convictions and three felonies over the course of his criminal career, among them burglary. While in prison, Torres says he discovered he was HIV positive. That was in 1992, but his doctor estimated he probably became infected in 1984.

When Torres left prison after eight years, he went to a probation-mandated 90-day substance abuse program, where he began his HIV education. Now, he wants to tell others about the dangers of unprotected sex or drug abuse. But he also wants to fight the stigma faced by people living with HIV.

“HIV is not who I am,” Torres said.  “Just like HIV doesn’t define me. What defines me is me. If you don’t own yourself, how can you own anything else?”

HIV rates in the Bronx are about 1.7 percent of the overall population, according to 2007 data from the New York Department of Health. In New York City, the prevalence is 1.4 percent.

The 2.3 percent HIV infection rate in Hunts Point is similar to developing countries like Haiti or Ethiopia. In Hunts Point and Mott Haven, 3,131 people were living with HIV or AIDS in 2010. About 61 percent of them were Hispanic like Torres, whose family comes from Puerto Rico. Blacks make up 36 percent, while 2.4 percent of Bronx residents with HIV are white.

There is no updated data available, said Soraya Pares, program manager at the Community Healthcare Network, a group of non-profit community health centers.  But Pares says she doesn’t expect the numbers to change much this year.

Pares thinks the main reason for the high infection rate in the Bronx is a lack of education about how the virus is transmitted. She says many people with HIV in Hunts Point have drug problems and may have been infected with used syringes. The New York Health Department’s statistics show that most people get HIV/AIDS through sexual intercourse.“When people look healthy, their potential partners tend to think there is nothing wrong with them,” Pares said. “Then they don’t use protection. But you can’t see if someone has HIV or not until the AIDS virus breaks out.”

HIV is so common in Hunts Point that almost every member of Community Board 2 knows someone who has been affected. Milli Colon, 59, a board member who organized the AIDS Walk, has lost 17 friends or family members to AIDS. Her brother died from it and her niece is fighting “full blown-AIDS” at the moment, she said.

“I’ve reached my mission with this event,” Colon said.

But there’s still a lot of work to do, she said. People with HIV are stigmatized, even by their own families, she explained, and don’t want to get tested.

During the march, she sat in the truck at the head of the parade. Through loudspeakers, she addressed the crowd of about 180 people walking behind the truck.

“I’m proud of you for coming out today,” she said.  “I’m proud we are fighting the stigma together.”

Torres walked a few feet behind the truck.

“We can’t conserve life by keeping secrets,” he said.

The truck drove on, playing loud salsa music. A man danced in the street between the truck and the crowd. People stopped at the sidewalks and watched while other residents looked down from the windows of apartment buildings.  Some of them waived at the marchers, acknowledging their presence, but they didn’t join the walk or comment. Still, for one day at least, HIV was out in the open in Hunts Point.

Adam Perez contributed reporting.

Participants wore red ribbons to symbolize their solidarity with Hunts Point residents infected by HIV. (ADAM PEREZ/The Bronx Ink)

The Iris House South Bronx Outreach Center, an HIV/AIDS clinic and information center, opened its first location in the Bronx, reports the Bronx Times.

The clinic, which opened Monday, will be serving the Crotona community and will help to prevent the spread of HIV as well as those that are already positive.

Iris House already operates two locations in Harlem.