THE FORTUNE NEWS A FORTUNE SOCIETY PUBLICATION • VOLUME XLVII • NOVEMBER 2015
HIV AIDS AND THE CRIMINAL JUSTICE SYSTEM “THE DEGREE OF CIVILIZATION IN A SOCIETY CAN BE JUDGED BY ENTERING ITS PRISONS” —DOSTOYEVSKY www.fortunesociety.org The Fortune News 1
Table of Contents Stanley Richards, Senior VP: Introduction
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Eye on Fortune
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Letters to the Editor
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Three Faces of Fortune
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David Rothenberg, Founder - When Homophobia Took Precedence Over Vital Health Information
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Transitional Health Care Consortium Helps HIV Patients Live Longer, Healthier Lives
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Reducing HIV By Lowering Burden of Incarceration
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HIV/AIDS Services At The Fortune Society
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Kaiser Permanente: Long-Standing Commitment To Help Stop HIV’s Spread
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What Drives HIV Stigma?
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HIV Resource Guide
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Countering The HIV Epidemic Among Black Women On Probation
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Good Fortune For A Long-time Survivor
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DRCPP - Ronald Day: The Power Of Peer Education In Prison
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Center Stage
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Our Mission The Fortune Society's mission is to support successful reentry from prison and promote alternatives to incarceration, thus strengthening the fabric of our communities. We do this by: BELIEVING in the power of individuals to change; BUILDING LIVES through service programs shaped by the needs and experience of our clients; and CHANGING MINDS through education and advocacy to promote the creation of a fair, humane, and truly rehabilitative correctional system. Contact Us 212.691.7554 info@fortunesociety.org
The Fortune Society 29-76 Northern Blvd Long Island City, NY 11101
Walk-in Hours: Monday through Friday 8:00am - 4:00pm
On The Cover Keith Haring artwork Š Keith Haring Foundation
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Introduction The Fortune Society’s Role In Confronting the HIV/AIDS Epidemic
STANLEY RICHARDS Senior VP The Fortune Society Back in the 1990s, at the height of the HIV/AIDS epidemic, up to 50 individuals a day were being released from Rikers and dropped off at Queens Plaza early in the morning with nowhere to go. At that time, I was a Deputy Director at The Fortune Society -- and, in 2002, we formally launched what we still call our “Drop-In Center” to provide a wide range of services to people living with HIV/ AIDS, including connections to medical care, substance abuse and mental health treatment, emergency housing, STD testing, counseling, and other essential reentry services. I remember that the bus from Rikers would stop at 5 AM daily in Long Island City, Queens, which is where our main service center is now located. However, back then, we didn’t have an office there, so we built a relationship with a local donut shop. Fortune staff would wait at the Unlimited Donuts shop on 29th Ave. in the heart of Queens Plaza to greet them. We knew then what is still true today: The first hours after release from incarceration are essential to supporting a person’s successful reentry process. From the very beginning, the Drop-In Center focused on people living with HIV/AIDS (PLWHAs), connecting them to critical HIV medical care, providing emergency housing, and then following up to make sure they remain connected
to those essential services. In many cases, we provided peer escorts, as we still do to this day, to ensure that clients were directly connected to the services they need. We know that for so many people coming home, these Fortune staff were the only people they had in their lives offering the resources, guidance, counseling, and hope for a positive future that formerly incarcerated PLWHAs urgently need and deserve. For far too long, men, women, and young adults involved in the criminal justice system have been experiencing significant new cases of HIV/AIDS. Each year, some 150,000 Americans living with HIV/AIDS are released from a correctional facility, and NYS/NYC correctional facilities remain the epicenter of the AIDS epidemic. In NYC jails, the HIV prevalence rate is 5.2% -- over four times higher than in U.S. prisons (at 1.25%) and far higher than the 0.4% rate for the general population. Approximately 3,800 PLWHAs are released to NYC annually from NYC and NYS jails/prisons. The Fortune Society has played a key role as part of the larger advocacy community to address this reality through education, advocacy, and services specifically tailored to the needs of currently and formerly incarcerated individuals living with HIV/AIDS. Today, The Fortune Society provides services to over 400 PLWHAs annually through the Drop-In Center, as well as a variety of other services, including HIV case management; health education; nutrition counseling and food distribution; along with emergency, transitional, and permanent supportive housing. We are able to provide these essential HIV/AIDS services thanks to our funders, including our government partners: NYC Department of Health and Mental Hygiene (DOHMH), NYS Department of Health (DOH) AIDS Institute, U.S. Department
of Housing and Urban Development (HUD) Housing Opportunities for Persons with AIDS (HOPWA), along with key private foundation partners: Kaiser Permanente, MAC AIDS Fund, Elton John AIDS Foundation (EJAF), and the Keith Haring Foundation. Fortune’s role in the fight against HIV/ AIDS has allowed us to think of what was once considered unthinkable -- reducing the number of new HIV infections to just 750 (from an estimated 3,000) by 2020 and achieving the first-ever decrease in HIV prevalence in New York State as defined by NYS Governor Cuomo. In October 2014, I was selected to serve as a member of the NYS Ending The Epidemic Task Force established to support Governor Cuomo’s three-point plan: (1) Identify persons with HIV who remain undiagnosed and link them to health care, (2) Link and retain persons diagnosed with HIV in healthcare to maximize virus suppression so they remain healthy and prevent further transmission, and (3) Facilitate access to Pre-Exposure Prophylaxis (PrEP) for high-risk persons to keep them HIV negative. My role in the Task Force ensured that the voice, perspective, and ongoing needs of formerly incarcerated people were heard and helped in shaping the recommendations. The Task Force has focused on maximizing the availability of life-saving, transmission-interrupting treatment for HIV. We developed recommendations, which are presented in New York’s Blueprint To End The Epidemic (http://www. health.ny.gov/diseases/aids/ending_the_ epidemic/). The Task Force recommends a vision of zero new infections, zero AIDS-related deaths, and HIV discrimination as a thing of the past. Today, in New York State, we are finally in a position where ending the HIV/AIDS epidemic is actually within our reach!
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The Fortune News 1
Eye on Fortune DRCPP MEDIA AWARDS JUNE 16, 2015
MORTON DEUTSCH AWARDS CEREMONY AT COLUMBIA UNIVERSITY TEACHERS COLLEGE APRIL 16, 2015
GREENWICH VILLAGE SOCIETY FOR HISTORIC PRESERVATION (GVSHP) 25TH ANNUAL AWARDS CEREMONY JUNE 17, 2015
Tom Robbins of The Marshall Project with Martha King, Executive Director of the NYC Board of Corrections.
On the evening of Tuesday, June 16, The Fortune Society held the first annual David Rothenberg Center for Public Policy (DRCPP) Media Awards for excellence in the field of criminal justice. If you weren’t there, you missed a great event. Award recipients included actor Joseph Assadourian, honored for writing and acting in the play “The Bullpen.” Also honored was the WBAI radio show “On the Count” for its tireless work on behalf of the many men and women affected by the criminal justice system. Producer Robert Sims was on hand to accept the award. And journalist Tom Robbins was recognized for investigative reporting for The Marshall Project that culminated in a New York Times article exposing the criminal behavior of guards at Attica.
Fortune Senior VP Stanley Richards and Associate VP of Policy Ronald Day mingling with guests.
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President/CEO JoAnne Page hugs Founder David Rothenberg as Senior VP Stanley Richards looks on with a smile. The Morton Deutsch Award is the glass globe in the center of the table.
The 11th Annual Morton Deutsch Awards Ceremony celebrating distinguished contributions to social justice -- on April 16 -- was a resounding success! About 80 people gathered to hear The Fortune Society be honored for its exemplary practice and advocacy work in the field of criminal justice -- supporting successful reentry from prison and promoting alternatives to incarceration. Three exemplary leaders of Fortune were there to receive the award: David Rothenberg, who founded The Fortune Society in 1967 because he saw a need; JoAnne Page, President and CEO for the last 25 years during which Fortune experienced dramatic growth and magnified its impact; and Stanley Richards, who started at Fortune as a counselor two decades ago and rose to Senior VP, drawing on his own experience with the justice system. Morton Deutsch complimented Fortune on its accomplishments and its approach, noting that its belief in an individual’s ability to contribute to society and its commitment to a humane and effective justice system should serve as a model for the broader moral community. Clients whose lives had been changed by their relationship with The Fortune Society testified to its uniqueness and practical compassion.
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GVSHP presented its 25th Annual Village Awards on June 17 in recognition of those people, places, and organizations that make a significant contribution to the quality of life in Greenwich Village, the East Village, and NoHo. We were thrilled that this year our Founder, David Rothenberg, was one of only six award recipients. As a resident of Greenwich Village for over 50 years, David was honored for his lifetime of achievements -- his work as a theater producer and publicist (most significantly producing “Fortune and Men’s Eyes” that led to the founding of The Fortune Society), his political activism that includes being the first openly gay man to run for the City Council, and his ongoing work with Fortune, especially the productions of Fortune’s original play, “The Castle,” about the lives of four formerly incarcerated individuals who lived in our housing facility, the Fortune Academy (“the Castle”), which is still performed at many locations across the country, including universities, churches, prisons, non-profits, and of course, at The Fortune Society as well.
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Letters to the Editor RECOGNIZED BY BEING PUBLISHED
LOOKING FORWARD TO CULINARY SKILLS TRAINING
To The Fortune Society:
I would like to thank The Fortune Society for the information you sent me. There are not many non-profit organizations that I have run across with so much help for ex-cons.
I am confined in the Texas Prison System! Need I say more? I have two life sentences and will never get out. I have no family. But I write poetry and I would like to get my book of poems published. The only way for me to get recognized is to have my poetry published. Here is one of them. Thank you! Melvin Mobley Tenn. Colony, Texas Memories Were Never Safe … Memories were never safe They twisted, they turned, That become something that changed, and disturbed, Like scars that linger, and cause a lot of sorrow … Knuckling my eyes from the pain inside, What happened during my childhood, That cause me to think this way, Embitterness … Love hurts, and feeds the pain, And I felt the aloneness come crashing down, Like a huge stone onto my heart, And I felt the dark weight of it inside me … Knuckling my temples from the chaos I hide, My mind raced, and jumped between the feelings, Betrayal and confusion, And I fought the panic … Time slowed, then stilled, There was no yesterday, And tomorrow was a lifetime away, Everything was quiet, And the world around me was blank, Memories were never safe …
When I read “A Fair Chance For A Stronger Economy” by Michelle Natividad Rodriguez, I was in a state of shock. To know that an ex-con has a fair start at job searching, I jumped for joy. But what took the cake is when I read that quote from New Jersey Governor Chris Christie. Knowing that it’s backed by a politician was a big plus. All I want to know is where can I sign up for “ban the box.” Thank you guys for that new information. Then I read “All I Want Is A Fair Chance At A Good life” by Brian Pearson. Knowing he had an ex-con tag floating above his head and still got the job, that was a sign to let me know I have a chance as well “at a good life.” What caught my eye and heart was when I read about “Culinary Skills Training.” I’m a person who loves to cook, and knowing there is a program such as The Fortune Society with that class, I am looking forward to my release. This is something I can see as my life career. I can go and on about the great jobs you guys are doing, but you already know that. Derrick General Great Meadow Correctional Facility Comstock, NY
TOOK THE TIME FOR AN HIV TEST To The Fortune Society: In my years of incarceration, I never took an HIV test. When you mentioned it over a month ago, I decided to take the time out to check on my health. The test came back positive. The years when I was with my wife, she used to come up on the tractor for three days and two nights and we did the wild thing without a condom. That did it! The medicine I’m now taking is Etravirine 100mg/Emtricitabine200mg/Tenofovir 300mg. Bernard Jordan Wyoming Correctional Center Attica, NY
THE NYC FAIR CHANCE ACT TOOK EFFECT ON OCT. 27, 2015! It allows people with a conviction history to be evaluated on their merits without compromising safety and security on the job. Key facts about the bill include: (1) The U.S. Equal Employment Opportunity Commission and Department of Labor’s Office of Federal Contract Compliance Programs endorse the policy as a best practice. (2) Employers may still conduct criminal background checks and deny employment to workers with conviction histories that are directly related to the job or pose an unreasonable risk. (3) The Act will assist employers in complying with existing law, reducing negligence liability. (4) Employers who are required by law to conduct background checks and exclude people with specific convictions may still do so. For more information, visit https://fairchancenyc.wordpress.com/
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Three Faces of Fortune My name is Eileen Kobrin, and I spent most of my career as a corporate executive in IT working for very large companies. Currently, I chair the NYC EILEEN KOBRIN Chapter of a Volunteer with fabulous naEmployment tional non-profit Services organization of professional women over the age of 50. The mission of this organization, The Transition Network (TTN), is to support and inspire our members to continue a life of learning, leadership, and engagement in the world. As part of this engagement, we want to positively impact the communities in which we live. Therefore, we developed a Volunteer Program for our organization which seeks out meaningful opportunities for our members to utilize their skills to benefit others. In partnership with Betty P. Rauch, The Fortune Society’s Board Chair, we developed a program for our members to work closely with Fortune’s Employment Services Program whereby our members perform mock interviews, resumé writing, and mentoring for Fortune’s clients. I personally have been doing this for the past 14 months and find it the most satisfying volunteer work I have ever done. To be able to share our experience and knowledge of successful job searching to Fortune’s clients and to have it so appreciated -- not only by the clients we work with but by the staff of Fortune’s Employment Services -- fills all of us with that “good feeling” you get when you know you are doing something worthwhile.
My name is James Harris. I’ve been a client with Fortune for only a few months, but the people here have changed my life. JAMES HARRIS Fortune Participant
I was born in Norfolk, VA, and moved to New York City 13 years ago. Before that, I had spent six years in the Army as a sergeant and was honorably discharged in 1992. When I was in the Army, I was with 13-B(Bravo)-field artillery and drove five-ton trucks with attached 155 Howitzer (tank) or 198 Howitzer (tank). While doing a second stint on Rikers Island a year ago, I met Fortune Drop-In Center staff member Sabrena Washington. I was diagnosed with HIV in 2003 and jail was hard for keeping up on the medications. Sabrena helped me move into the Fortune dorm, ensured I got the necessary medications, and started preparing me for release. When I got released, Fortune made sure I had a seven-day supply of medication and a doctor’s appointment. They also helped me get housing in a zero-tolerance SRO. With Fortune’s help, I have gotten my life stabilized and on-track. I am waiting to get a hip replacement soon, and in the meantime, we’re looking for permanent housing. After the hip replacement, I will take classes to obtain a Class A Commercial driver’s license -- and I plan to hit the road.
My name is Jahad Robinson. I have been on staff with The Fortune Society for three years. I started at Fortune as a Peer Escort with the Drop-In Center, then moved on JAHAD ROBINSON to being a Case Transitional Manager under Specialist, a program with Drop-In Center a grant from Kaiser Permanente, and now I am a Transitional Specialist continuing on with the Drop-In Center. As a Transitional Specialist, we go onto Rikers Island and, with a referral from the NYC Department of Health and Mental Hygiene (DOHMH), we conduct interviews and intakes with people who are HIV-positive. From there, we may move them into our dorm on Rikers and begin assisting them with their transition back into the community upon release. I myself am 27, grew up in the Bronx, and have two sons, three and 11 years old. I love my job because it involves helping people every day, people who come from the communities that I grew up in and that face the same issues I faced. There are about 15 of us who work in the Drop-In Center which is based in Castle Gardens, Fortune’s affordable and supportive housing facility in Harlem. As a Transitional Specialist, I have a caseload of about 30 people at any given time, but at the Center we work as a team so all our clients are treated with the same respect and care no matter who they see. It’s a fantastic team to work with. I hope to go back to school soon and continue to grow in this field -and at Fortune.
Our group of TTN volunteers is growing each month as the word spreads around our organization. I feel privileged to be a part of this partnership. 4
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On the Record: Notes from Our Founder When Homophobia Took Precedence Over Vital Health Information A few days later, he phoned me, reporting that some wardens were resisting distribution of AIDS pamphlets with the word “gay” in them. about AIDS. One very clear and specific message arrived from Attica informing us that a kitchen worker was identified with this new and mysterious malady. “Panic” was the word put forth to describe the reaction of the men confined in that bastille in New York State.
DAVID ROTHENBERG Founder In the early 1980s, an epidemic was reported, mostly by word-of-mouth. The first group identified were gay men and it was being called Gay-Related Immune Deficiency (GRID). The popular media and most elected officials avoided mention of it. Political activists argued with officials at the Atlanta-based Center for Disease Control (CDC) not to name a disease after any group of people. They warned of the political implications, with the possibility of panic-induced roundups and internments. In fact, as the numbers increased, conservative political pundit William F. Buckley suggested that all gay men be branded, a notion that has echoes of WWII slave camps. It was then determined to label this health invasion “AIDS” (Acquired Immune Deficiency Syndrome). Indeed, other groups were identified as patients, including recipients of blood transfusions, but most notably IV drug users. In the early 1980s, The Fortune Society began receiving letters from concerned and uninformed inmates; rumors were flying
I called Martin Horn, then the New York State Deputy Commissioner of Corrections, a man who consistently responded quickly and with concern. He inquired of me whether there was any literature available to be distributed to the prisons, permitting inmates to separate rumor from reality. The only game in town was the newly formed, now legendary, Gay Men’s Health Crisis. They made available all literature, revealing the medical progression’s up-
Obviously, in some institutions, homophobia took precedence over vital health information. I re-contacted the Gay Men’s Health Crisis, requesting that they print literature which only used their initials (GMHC), enabling New York State prisoners to benefit from their valuable information. That was when I first used the parable: “They drew a circle that shut me out. But love and I hath the wit to win. We drew a larger circle and took them in.” By the end of the decade, nearly every person coming to The Fortune Society was conceived with the possibility of AIDS. The spread of AIDS among former drug users was slow to be diagnosed but was having a devastating impact in the com-
By the end of the decade, nearly every person coming to The Fortune Society was conceived with the possibility of AIDS.The spread of AIDS among former drug users was slow to be diagnosed but was having a devastating impact in the community of formerly incarcerated. to-date data (i.e., that the immune system could be compromised by sexual contact, use of needles, or blood transfusions). It was stressed that a kitchen worker was not a danger to his co-workers. I compiled the literature and sent it to Commissioner Horn in Albany. A few days later, he phoned me, reporting that some wardens were resisting distribution of pamphlets with the word “gay” in them.
munity of formerly incarcerated. We were attending too many funerals and memorial services. Fortune’s response to the needs of the formerly incarcerated has always been determined by those who come in our front door. Counseling, employment, and education were clear and obvious priorities. Then it was necessary for The Fortune So-
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On the Record Continued... ciety to respond to the critical health needs of those in reentry. Continuity of health care was a priority. It was also necessary to have a place where former drug users were comfortable in expressing their health problems. Mainstream clinics were often unable to identify the complex perspective of people who had been in cages.
Transitional Health Care Consortium Helps HIV Patients Live Longer, Healthier Lives If you take medication regularly, pay attention to your overall health, and get blood tests to see how your body is responding to treatment, you can control the disease.
On a much broader level, the AIDS crisis was a painful reminder of how society views some populations. It took nearly half a decade before there was an appropriate political and media response. Gay men and IV drug users in the 1980s were perceived as expendable. It took the death of actor Rock Hudson before President Ronald Reagan could even say the word “AIDS.” Film star Elizabeth Taylor, to her everlasting credit, used her celebrity status to implore the President to respond. It took four years and activist protests to insist that the influential New York Times cover the major health story of the second half of the 20th Century. Today, the White House has no hesitancy in supporting AIDS programs and the New York Times is a leader among media advocates. At The Fortune Society, we were witness to colleagues -- men and women -- who dramatically reclaimed their lives only to succumb to the AIDS virus. It was a painful era! Fortunately, medical advances have made it possible for people with AIDS to live meaningful lives. In the 1980s, AIDS was a death sentence. People fought to create a climate of acceptance. The AIDS story is political as well as medical. People battled ignorance as well as HIV in those crucial days. Today, there are politically under-represented groups, like undocumented immigrants. And men and women in prison are still fighting to have their voices heard. Their humanity acknowledged, we must learn from past battles.
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By Alison Jordan Living with HIV while incarcerated is challenging, however, transitional care services are available at no cost. HIV patients face stigma and physical health issues, but the disease can be successfully treated. Fortunately, HIV treatment and transitional care services are available through Ryan White funding at no cost to patients while incarcerated at the time of release and in the community to facilitate a “warm transition” -- removing barriers and facilitating access to HIV care and treatment. For many folks, housing, income, food and clothes, and reuniting with family are necessary first priorities after incarceration. The NYC Transitional Health Care Consortium (THCC) members work together to address these and other needs so that the goal of maintaining continuity of health care is met. THCC works to address the health care needs of people coming home from NYC jails by identifying gaps in service delivery and working to remove them.
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Living with HIV means taking care of your health -- taking medication on time every day, eating regular meals, sleeping well, and avoiding exposure to diseases that can lead to infections. When you know you’re living with HIV, you can take measures to stay healthier and protect yourself and others. If you take medication regularly, pay attention to your overall health, and get blood tests to see how your body is responding to treatment, you can control the disease. Knowing your status and getting on medication can prevent you from getting really sick. That’s why getting tested for HIV while you feel well is so very important. HIV treatment is extraordinarily effective, and people who know they are living with HIV can get into care earlier, and live longer and healthier lives. If you are arrested and brought into New York City jails -- including Rikers Island -- you will receive an intake medical assessment where everyone is asked if they are living with HIV. If you don’t know your HIV status, you can get tested. Everyone is offered an HIV test at the medical intake in NYC jails (Rikers Island and the borough houses). If you know you are living with HIV, please tell your doctor or nurse in jail right away. The medical team is bound by law to maintain confidentiality and keep your health information private. While the NYC Department of Correction supports the medical team, they do not have access to health information. As soon as we know you are living with HIV, medical care and treatment begin right away. There’s help and we can make sure you get your medication. The health coordinators, as part of the medical team, help HIV patients make a plan for during and after incarceration,
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address HIV care and treatment needs, as well as needs for housing and other services. The Fortune Society is available onsite to help with the warm transition, providing ongoing support services at no cost to clients, with an air-conditioned, wheelchair-accessible van to help link folks to medical care after incarceration. Hundreds of community health, housing, substance use, and mental health treatment providers are affiliated with the Transitional Health Care Consortium. Jail-based health coordinators, Fortune transitions staff, and other community partners work together to meet each patient’s immediate and short-team needs. The health coordinator listens first and then works with the patient, the courts, and others to find the best possible plan for returning home. Acting as Health Liaisons to the courts for our sickest patients, the medical team may provide information with patient consent, and the health coordinators will help identify resources for program placement as a medical alternative to incarceration. Nearly 800 people had health-facilitated court releases last year and were linked to medical care and treatment; some were compassionately released. Ryan White programs, funded by the federal Health Service Resources Administration (HRSA), support this work and HRSA Special Projects of National Significance (SPNS) Jails Initiative funded a five-year evaluation of the NYC HIV Continuum of Care Model (HCCM). Thanks to the 550 people living with HIV in NYC jails who participated in this program evaluation, we know that patients’ health improved, more people had stable housing, and fewer were hungry. People were linked to primary care and reduced their use of Emergency Departments. Now HRSA is looking to replicate the HCCM in other areas throughout the U.S. So, please, say “yes” to the test. If you are living with HIV, tell your health provider. Caring, compassionate people -- including many who were justice-involved -- are available to help you live a longer, healthier life. Alison Jordan is Executive Director, Transitional Health Care Coordination at the NYC Department of Health and Mental Hygiene.
2015 AIDS WALK
On May 17, 2015 the 30th Annual AIDS Walk/New York -- a 10-kilometer (6.2 miles) fundraising walk that started and ended in Central Park -- raised $4.3 million to benefit GMHC and more than 40 tri-state area AIDS service organizations. The Fortune Society team was front-and-center in the 2-1/2-hour benefit.
The Elton John AIDS Foundation (EJAF) (http://newyork.ejaf.org) believes that AIDS can be beaten by raising funds for evidence-based programs and policies, and by speaking out with honesty and compassion about the realities of people’s lives. EJAF has provided $75,000 to Fortune over the past two years. By funding the work of The Fortune Society, EJAF is committed to providing formerly incarcerated people living with HIV/AIDS (PLWHA) with discharge planning to ensure healthy living and successful reentry to society. The Foundation believes this is the type of innovative and sustainable programming necessary to reach its ambitious goal of eradicating HIV/AIDS once and for all.
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Reducing HIV By Lowering Burden of Incarceration A simple expedient would significantly lower risk of infection. Instead, we rely on courts and police to serve as social control vectors, contributing toward bankrupt policies unnecessarily increasing HIV risk. Robert Fullilove in conversation with Cynthia Golembeski
Robert E. Fullilove, EdD Cynthia Golembeski: Your TEDMED talk discusses structural drivers of HIV and incarceration whereas the Blueprint focuses on structural-level barriers and intervention strategies. How important is structurallevel analysis? Bob Fullilove: First and foremost, structural interventions need to be understood as opposed to what exactly? When interventions are directed at changing the knowledge, attitudes, or behaviors of individuals who are largely in control of factors that will expose them to health or disease, then individual-level interventions make sense. However, choices may be severely limited by circumstances beyond the individual’s control, whether related to the built environment, policies that guide what one is able to do in the world, or other key factors, including segregation and racism. Directing the intervention at the individual-level is less effective when what is conditioning available options aren’t found in the individual, but in the social, economic, and built environment. The significance of HIV in Black communities since the 1980s must be understood in relationship to social 8
dynamics surrounding those at particular risk for HIV infection. Certain urban areas are characterized by the degree to which they are affected by racial and socio-economic segregation as well as incarceration rates. The New York Times’ article, “1.5 Million Missing Black Men,” underscores how mass incarceration disproportionately affects Black neighborhoods as well as the presence or absence of men in these communities. My analysis of which factors dramatically influence the HIV epidemic began with what happens in communities with so many missing men. The article states that for every 100 Black women, there are only 83 Black men. In communities where the ratio has become particularly problematic -- such as Ferguson, Missouri, where for every 100 Black women there are only 60 Black men -- racial strife, largely owing to community members’ relationships to the police, is evident.
surrounds efforts to criminalize sexual behavior, particularly when those who will most likely be tried for this are gay men -- very likely gay men of color. This is not about law and this is not about justice. This is about bias, racism, and certainly homophobia, plus the ways in which HIV and its impacts are perceived. Increasingly, social control of poor communities of color is being exorcised via police and courts. This exemplifies the trend to criminalize things seemingly out of touch with mainstream America.
If the loss of men conditions everything from mating rituals to fathering possibilities for young people, clearly communities suffering that kind of loss in education-level and the number of parents in households are also affected by how men and women negotiate sexual relationships. The moment these structural factors affect mating and sexual behaviors, it becomes clear that HIV will be involved. Mass incarceration impacts the community, the rates by which so many men are lost, and changes to that sexual environment.
Fullilove: The fact that in Indiana, of all places, an HIV outbreak occurs in a community that is almost entirely white, but nonetheless rural and very poor, describes the degree to which needlesharing behavior is still an active risk factor for HIV transmission. News accounts are quite shocking. In some instances, folks report using the same needle 15 times or more until it broke off in the user’s arm. A simple expedient would significantly lower risk of infection. Instead, we rely on courts and police to serve as social control vectors, which contributes towards bankrupt policies unnecessarily increasing HIV risk.
Golembeski: A St. Louis jury recommended decades of imprisonment for a college student convicted of “recklessly infecting” another man with HIV and “endangering” four others. The Nation suggests, “Michael Johnson’s trial for HIV exposure is a perfect storm of homophobia, racism, and the criminalization of Black bodies.” Fullilove: A long tradition of protest
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Golembeski: Blueprint recommendations include decriminalizing syringe and condom possession and improving syringe access. Critical of the “drug paraphernalia law,” you have long championed public health approaches that prioritize care, support, and treatment, and also address inequities.
Previously, carrying around drug-use works was a felony. The fact that the criminalization of carrying a syringe without a prescription was a major factor in driving the HIV epidemic became a public policy matter. Shooting galleries allowed users, who may already have a criminal record, to avoid being stopped by
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police and found with drug-use works. The epidemic of drug use facilitated the spread of HIV not only due to individual behavior, but also due to boneheaded public policy. Golembeski: Prevention recommendations focus on insurance and linkage to care; provider competency; PrEP and PEP; harm reduction; targeted testing and screening; condom promotion and distribution; and decriminalizing condom possession, nonviolent drug violations, and adult consensual sex work. “Reducing burden of incarceration for young men” is also listed. Fullilove: Committee deliberations carefully considered reduced life chances that are present upon release from prison. Prominent in these discussions was staff who had dealt with the HIV epidemic’s burden on folks who are homeless, which is often tied to a history of incarceration. Experiencing difficulty finding housing and jobs increases the likelihood of engaging in risk behavior that may contribute to rearrest, mainly due to trying to feed, house, and protect oneself. Particularly upon return, there may be no place to go or anything to do, which places one at risk for incarceration. Reducing the burden of incarceration for young men as an HIV risk-reduction strategy makes sense given the burden communities face with so many young men locked up. Considering incarceration as one of the social drivers of HIV and calling for interventions that will specifically reduce that burden is wise. Golembeski: How do you understand the role of community organizations, leaders, and advocates, which were crucial to drafting the Blueprint, in ending the epidemic? Fullilove: I think it is significant that community-based organizations and Black and Latino communities have increasingly discussed HIV as well as enlarged their discourse to include very thoughtful presentations and analyses of the burdens that incarceration imposes on their communities and constituents. They are not simply able to militate against or protest what is going in these circumstances, but they have the resources to actually solve the problems. For instance, Housing Works’ efforts to house folks living with HIV are important to support.
Golembeski: The Blueprint strongly supports peer-based interventions and programming. Fullilove: My teaching with the Bard Prison Initiative includes a heavy component examining HIV and its impact on the health of the public. Young men and women, trained due to opportunities to earn college credit while incarcerated, are often uniquely able to see to others in everything that we have tried to communicate about HIV -- its dangers and how to mobilize communities. Supporting young people with training is incredible because they speak to larger numbers of folks on the inside and on the outside. Peers are more likely to be heard. Organizations created by formerly incarcerated persons, like the Center for Nu Leadership on Urban Solutions, have specific programs addressing HIV challenges. Such efforts should be highlighted and supported wherever possible. Golembeski: How have you come to understand the significance of individual and collective trauma in relationship to HIV, mass incarceration, and health inequity? Fullilove: During the 1980s, we sought to understand why so many women in the Black community were finding their way to addictive substances. Mindy Fullilove’s pioneering work examines the relationship among trauma, crack use, and related sexual behavior. The more we talked to people in drug treatment programs. it became clear we were not looking at drug-use behaviors motivated by thrill-seeking desires. Many women were dosing to address prior traumas and psychiatric damage by going to a drug that would help them forget. The more we probed, especially with women who were smoking crack to feel better, we learned they were engaging in sexual risk behaviors -- sex work if you will -- to gain access to crack/cocaine. It became clear that we were observing trauma visited on the individual and occasioned by living in the fabric of violent behavior characteristic of communities where the crack wars were being fought over territory. Transactional sex often included violent and infectious risk behaviors, which contributed to sex without regard to barrier protection or health consequences. In the early 1990s,
there were high rates of STIs associated with sex work, including syphilis. Violent life in the community was the occasion for various efforts to escape the psychological impact of that violence and facilitated a ready market for the distribution of drugs, like crack/cocaine. Havoc was wreaked on the community-level public health infrastructure in respect to HIV and many other related, highly problematic behaviors. Golembeski: What are your thoughts regarding Mary Bassett’s article, “Black Lives Matter—A Challenge to the Public Health and Medical Communities” and its call for “critical research, internal reform, and public advocacy”? Fullilove: I am one of many who have widely shared the article. It is not only what she says, because she is one of many Black voices helping people understand that we live in a society that is not living up to its most cherished ideals. What is unique is, first, her position as NYC Health Commissioner. Secondly, she is a physician. And thirdly, she describes herself as a parent. She brings all of her professional identity into what is for many a very personal set of issues, namely how do we perceive life in a nation that adores the process and the idea of democracy, but acts in such a nondemocratic fashion. That racism can exist with that kind of impact on the health of the individual and the community is an anathema. She speaks as someone in a position of authority whose weight also carries with it a certain impact on public health. Robert E. Fullilove, EdD is the Associate Dean for Community and Minority Affairs, Professor of Clinical Sociomedical Sciences, and the codirector of the Cities Research Group at Columbia University’s School of Public Health. Dr. Fullilove is a member of Fortune’s Advisory Board. Cynthia Golembeski, MPH, former health policy researcher and educator at Fortune, has primarily been involved with projects advancing health and social equity in urban areas within New York, California, and Sub-Saharan Africa.
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The Fortune News 9
HIV/AIDS Services At The Fortune Society Fortune’s Drop-In Center provides relevant support services to soon-tobe released/recently released PLWHAs to ensure engagement in ongoing HIV medical care and support services. Inside NYC correctional facilities, Transitional Specialists provide HIV-specific discharge planning and ensure linkages to medical care, mental health services, substanceabuse treatment services, and housing postrelease. Fortune’s Transitional Specialists provide post-release assistance with enrolling in benefits and entitlements, risk reduction counseling, linkages to medical care, referrals, and followup for up to 90days. The Drop-In Center’s Transitional Specialists are also on call 24/7 to provide services, including transportation.
As described in this issue’s introduction by Senior VP Stanley Richards, Fortune has been providing services to people living with HIV/AIDS (PLWHAs) being released from incarceration since the 1990s when Fortune staff would greet people early in the morning at Queens Plaza where buses from Rikers Island would drop them off at 5 AM every morning. Since then, we have significantly expanded and enhanced our HIV/AIDS services to meet the complex needs of PLWHAs, including connection to healthcare, housing, counseling, case management, treatment services, nutritional services, and other essential reentry services and supports.
Drop-In Center We formally launched our “Drop-In Center” for PLWHAs being released from Rikers Island in 2002. Today, the Drop-in Center is one of our most robust HIV/AIDS programs, including both pre-release and 90-day post-release services for PLWHAs, and it continues to strengthen our alreadystrong presence in NYC Department of Corrections (DOC) facilities. 10
health care, social work, integrative health care, and an on-site pharmacy. In addition, SCCH hosts the Coming Home Program which addresses the psychosocial needs of individuals with chronic health conditions returning home from incarceration. In 2012, Fortune was awarded a highly competitive grant from Kaiser Permanente to improve the health of individuals newly diagnosed with HIV in minority communities disproportionately affected by the HIV epidemic. Fortune was one of only seven organizations initially funded (and the only East Coast grantee) to develop innovative approaches to prevent new HIV infections -- identify HIV-positive patients sooner, get them into high-quality HIV care sooner, and ensure that they remain in
In 2012, Fortune was awarded a highly competitive grant from Kaiser Permanente to improve the health of individuals newly diagnosed with HIV in minority communities disproportionately affected by the HIV epidemic. The program is primarily funded by NYC DOHMH which has cited the program as a “top performer” for “having not only met their service targets, but having also excelled in meeting the unique needs of clients.” In early 2015, the Drop-In Center received increased funding following a competitive bid, allowing us to enhance services provided to HIV-positive individuals on Rikers Island. Fortune maintains close relationships with the NYC DOHMH’s Office of Transitional Health Care Coordination (THCC)’s Patient Care Coordinators to identify and address the needs of PLWHA and facilitate linkages to medical care and case management services upon release from jail. Fortune is also closely affiliated with the St. Luke’s and Roosevelt Hospital’s Spencer Cox Center for Healthcare (SCCH) where patients can receive single-site access to outpatient primary care and an array of other services, including specialty HIV medical care, dental care, behavioral
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such care. The project involves a rigorous evaluation component which consists of a control group of Drop-In-Center clients and an intervention group that received food security/nutritional enhancement piece. The study received IRB-approval from the NY Academy of Medicine. The University of California, San Diego (UCSD) is involved in documenting the impact of this unique Kaiser Permanente-funded national Test and Treat Initiative. An interim evaluation of Fortune Society’s model is demonstrating promising social and health benefits for program clients. We recently received additional funding to support the nutrition intervention. Fortune staff recently attended the 2015 KP National HIV/AIDS, Hepatitis and STI Conference in October 2015. For more details on the project, see here: http://centerfortotalhealth.org/supportingcommunities-to-end-an-epidemic/.
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HIV/AIDS Case Management And Health Education Following 90-days post-release, many DropIn Center clients enroll in Fortune’s Health Services, funded by NYS Department of Health (DOH) AIDS Institute, which provides them with HIV/AIDS case management, outreach, education, peer training, and HIV care services for a full year. Daily support groups are also offered to participants, including the Health and Wellness group which helps individuals begin the process of coping with the HIV/AIDS diagnosis; and the Positive Living group which focuses on life after diagnosis, including protecting oneself and others, and acceptance and advocacy. Our skilled Case Managers identify vulnerable PLWHAs coming out of jails/prisons and link them directly to HIV primary care services to maximize virus suppression. Case Managers have close linkages with medical providers allowing us to engage in monthly case conferencing to discuss consumer’s treatment and health outcomes. Case Managers meet weekly with clients to address new barriers as they arise. We offer a multi-pronged approach to address all of the intersecting needs of clients. Through case management and health education, we are able to quickly identify consumer problems and directly provide service or link them to care to meet their needs. We focus on helping clients maintain consistent access to care and obtain housing to stabilize their care. Health education services include both individual and group sessions designed to impart knowledge of HIV, medical care, and daily living skills to participants. Health education services are structured to enhance the knowledge base, health literacy, and self-efficacy of PWLHAs in accessing and maintaining HIV medical services and health. Health education curricula topics include: the importance of viral suppression, health literacy, and HIV-related knowledge; how to interpret laboratory results; effective communication with medical providers; consequences of poor medical adherence; strategies
for treatment adherence; management of symptoms and co-morbidities; risk of transmission and prevention of HIV, STI, and Hepatitis C; as well as daily living skills, including proper HIV nutrition, goalsetting, problem-solving strategies, stress reduction techniques, and strategies to build a support network.
HIV/AIDS Housing Since 2000, Fortune has also provided HIV-specific Scatter-Site Housing for PLWHA with funding from U.S. Housing Urban Development (HUD), Housing Opportunities for People living With AIDS (HOPWA). In 2002, Fortune expanded our housing portfolio with the opening of The Fortune Academy (“the Castle”), a supportive transitional housing residence in West Harlem, which includes 12 beds funded by NYC Human Resources Administration (HRA) HIV AIDS Service Administration (HASA) specifically designated for people living with HIV/AIDS. Fortune operates a total of 54 units dedicated to PLWHAs, including both congregate and scatter-site units. Our Scatter-Site Housing model entails securing apartments, negotiating and developing lease agreements, and ensuring that adequate furnishings are purchased for each newly acquired property. Our property management staff oversees the management of the rental budget (including the tenant’s rental share), negotiation of leases, apartment inspections, and providing specialized assistance as needed. Our Scatter-Site Housing staff also actively participate in advocacy activities to encourage landlords and brokers to work with PLWHAs who have criminal histories and have struggled with chronic homelessness, addiction issues, and/or mental health issues. We place formerly incarcerated PLWHAs into stable housing in the community, linking each of them to case management, a primary health care provider, medical insurance, and steady incomes. In addition, outreach workers travel to prisons and conduct seminars for prisoners nearing their release date. These
seminars provide a wealth of health-related information, including information on HIV/AIDS and Hepatitis C, and describe the services that Fortune offers. Fortune is unique in its ability to provide culturally competent, comprehensive reentry services to a population coping with the combined struggles of homelessness, living with HIV/ AIDS, and reintegrating into society after being released from incarceration. Our Peer Coordinator, supported by the MAC AIDS Fund, plays a key role in our Housing approach -- recruiting new homeless PLWHA with criminal histories, and then providing them intensive support as they move through our program.
FOR MORE INFORMATION ABOUT FORTUNE’S HIV/AIDS SERVICES
please contact Nilda Ricard at nricard@fortunesociety.org or call 646-937-5358.
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Read Client Stories from Fortune’s HIV/ AIDS Services The Fortune News 11
HIV/AIDS Services - Client Stories “If it weren’t for Fortune, I wouldn’t be where I am right now, I’d just be another number. They were with me every step of the way.” KS
Meet KS. He has been incarcerated numerous times throughout his life and lived on the streets in a box for 30 years. He struggled with substance-abuse issues, homelessness, and living with HIV/AIDS until he finally found the care and support he needed at Fortune. “I was a hopeless case, and every time I came out, Fortune would pick me up. I had heard of Fortune in jail and realized their services would be helpful for me.” Now, it has been over two years since KS was last incarcerated. Through Fortune, which doesn’t judge based on crime, KS received the tools he needed to take charge of his life and to set some positive goals. Fortune has helped him to stop using drugs, obtain housing and benefits, and receive essential HIV health care at NY Presbyterian Hospital. “If it weren’t for Fortune, I wouldn’t be where I am right now. I’d just be another number. They were with me every step of the way.”
“One of the best things I experienced at Fortune is the HIV groups. It helped me navigate how HIV treatment works and living with the disease.” GT
Another client, GT, was diagnosed with HIV around the year 2000 -- right before he was sent to prison. The medical staff in the prison told him he was going to die. However, GT learned about Fortune’s programs when he was incarcerated and heard that he could receive help with his HIV. He came to live at our nationally recognized housing facility, Fortune Academy, in Harlem after getting out of prison and we connected him to HIV medical care at St. Luke’s Hospital. “Ruben is my Case Manager and he has been the best. One of the best things I experienced at Fortune is the HIV groups. It helped me navigate how HIV treatment works and living with the disease.” Fortune’s culturally competent staff always go above and beyond for clients, particularly those living with HIV/AIDS. In fact, Ruben is open about his own HIV status which helps the clients feel more comfortable sharing and seeing hope for a positive, healthy life for themselves. “If it weren’t for Fortune, I don’t think I would’ve made it. I’d probably be somewhere on the streets living drug-ridden. Fortune is a rock in the community and helps people live lives that they never thought they would.”
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These are just a few of the many clients living with HIV/AIDS who urgently need Fortune’s support as they struggle with the combined challenges of reintegrating into society after incarceration, managing their HIV/AIDS diagnosis, dealing with substance abuse and/or mental health issues, and focusing on their recovery process -- all while working to find safe, healthy housing and stable income. Many of Fortune’s successful graduates go on to serve as Peer Leaders for new clients:
Mikell Mikell is an example of the extraordinary work that Peer Leaders do on a daily basis. He came to Fortune when he was “living on the edge.” He was in Harlem when he first got diagnosed and had already seen many of his friends in the ‘80s and ‘90s die of HIV/AIDS. Fortunately, he was diagnosed early and was able to get on medication to control it. “David Rothenberg [Fortune’s founder] is my saint. When I was incarcerated, I had listened to David’s radio show on WBAI and I can still remember it. I have seen countless plays thanks to David’s generosity and theater has become a passion of mine. I now help with David’s radio show taking phone calls.” Mikell was a resident of the Fortune Academy (“The Castle”) and has served as a Peer Leader for years. He has helped connect people in desperate need of services to Fortune -- he has reached out to those living on the streets with HIV/AIDS who are not receiving care, support, or any services at all. When one man accepted his help, Mikell asked, “Why have you not reached out for help before?” He replied, “I needed you to reach out to me!” We now call this the “Mikell Method” because his warm, caring, non-judgmental, and supportive approach is so effective in reaching people living with HIV/AIDS who are more difficult to reach.
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Kaiser Permanente: Long-Standing Commitment To Help Stop HIV’s Spread The $2.75-million initiative, funded by the Kaiser Permanente National Community Benefit Fund at the East Bay Community Foundation, is supporting seven organizations working with those disproportionately affected by HIV. history, including food insecurity, poverty, and homelessness. Almost one-fourth of those enrolled in the initiative (23%) are homeless, and more than one-third (37%) struggle with having shelter or sufficient food on a daily or weekly basis.
Alexandra Caraballo
Anita Raj
Incarcerated people in the United States have a rate of HIV five times higher than the non-incarcerated population. More than 20,000 of the people in jail or prison with HIV were infected prior to their incarceration.
Foundation, is supporting seven organizations across the United States working with those disproportionately affected by HIV, including men who have sex with men, transgender women, AfricanAmerican women, and substance-using populations.
To address the health concerns of populations disproportionately at risk for HIV, seven organizations -- including The Fortune Society and Kaiser Permanente -have joined forces in an effort to link people living with HIV (PLWH) to clinical care.
Across each of those seven organizations, 73% of the 461 PLWH clients enrolled thus far have a history of incarceration, with 33% reporting incarceration in the past 12 months.
Kaiser Permanente, one of America’s leading health care providers and notfor-profit health plans, developed the Community-Based HIV Test and Treat Initiative in 2013 to fund and evaluate innovative community-based efforts linking PLWH to clinical care, with an emphasis on socially vulnerable populations at disproportionate risk for HIV, such as those currently or previously incarcerated. The $2.75-million initiative, funded by the Kaiser Permanente National Community Benefit Fund at the East Bay Community
Access to health care in such contexts appears to be a concern, with 33% of participants reporting no acquisition of HIV-related care or services in the past year, and 23% stating that they could not get their medical needs met in the past six months. Eighteen percent of clients who initiated antiretroviral therapy (ART) -- treatment that suppresses or stops a retrovirus -- had ceased taking it prior to the initiative, and 21% have never taken ART, though ART is now being recommended for all PLWH regardless of CD4 count or viral load. While supporting the HIV clinical care needs of PLWH is important, comprehensive health care for these populations is required. Behavioral health issues, such as past-year illicit drug use (reported by 54% of initiative participants) and sexual vulnerabilities, such as past 90-day sextrade involvement (reported by 11% of initiative participants), may compound HIV-related health concerns. Chronic health
Fortune’s innovative approach ensures that these individuals receive a discharge plan, linkage to HIV clinical care, food security, and case management immediately upon reentry into the community. These findings demonstrate that serving people living with HIV requires consideration of incarceration history and the social and welfare issues that place undue burden on those with such a
issues, such as cardiovascular disease and diabetes, may also require consideration, as people with HIV are living longer and the number of older people living with HIV is increasing. Among participants in the initiative, approximately 30% are above the
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The Fortune News 13
age of 50 years. These findings seem to be in line with the national data documenting fewer new diagnoses and more longer-term survivors living with the virus, who are able to lead productive lives with good HIV care. The Fortune Society is using the funding to implement and evaluate their holistic HIV support model for HIV-positive people reentering society from prison in New York. Its innovative approach ensures that these individuals receive a discharge plan, linkage to HIV clinical care, food security, and case management immediately upon reentry into the community to improve social and health functioning of their clients. Addressing food security in their approach was included after learning that clients were unable to get basic nutritional needs met. Kaiser Permanente is working with the University of California at San Diego, Division of Global Public Health, to help
document the impact of the Test and Treat Initiative. This initiative has been undertaken to affect HIV at a population level via community approaches to prevention, intervention, and care in communities most affected by HIV. An interim evaluation of Fortune Society’s model is demonstrating promising social and health benefits for program clients. Should this program demonstrate impact, it will offer a model for reentry programs nationally. Kaiser Permanente has earned a nationwide reputation for HIV care excellence over the past 30 years. Its Care Management Institute developed the first clinical guidelines in the United States for HIV/AIDS treatment and the appropriate use of related drugs. The organization has a long-standing commitment to help stop the spread of HIV and to assist those with the virus to get connected with early, comprehensive care. This commitment continues to manifest through the Kaiser Permanente Community-
Based HIV Test and Treat Initiative, and its work with The Fortune Society and other community service organizations. The innovative interventions stemming from this initiative demonstrate how the needs of PLWH in the U.S. epidemic today remain high, but there is progress. Best efforts moving forward will require holistically supporting individuals living with HIV, recognizing that many contend with a history of incarceration and the social and behavioral vulnerabilities that correspond with such histories. Fortune Society’s innovative and holistic programming not only supports local clients, but may likely serve as a model to programs around the country. Alexandra Caraballo is National Manager, Philanthropy at Kaiser Permanente. Anita Raj, PhD is Professor of Medicine and Global Public Health, and Director, Center on Gender Equity and Health, University of California San Diego.
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Like us on Facebook: The mission of the Keith Haring Foundation (http://www.haring.com/kh_ foundation) is to sustain, expand, and protect the legacy of Keith Haring, his art, and his ideals. In accordance with Keith’s wishes, the Foundation concentrates its giving in two areas: (1) the support of not-for-profit organizations which provide educational opportunities to underprivileged children, and (2) the support of nonprofit organizations which engage in research and care with respect to AIDS and HIV infection. In this capacity, The Foundation has helped to fund The Fortune Society’s discharge planning program for incarcerated people living with HIV/AIDS (PLWHA) on Rikers Island. The Keith Haring Foundation has provided $20,000 to Fortune over the past year. 14
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What Drives HIV Stigma? More Than The Fear Of Contagion
By Sean Strub, Executive Director, the Sero Project
When I assert that HIV-related stigma is worse today than it’s ever been, many are startled or just don’t believe me. They remember the days when none of us knew as much about HIV as we do today; when people were afraid to share a drinking glass, kiss, hug, or even breathe the same air as a Person Living with HIV (PLHIV). Today, we know much more about the real routes, risks, and consequences of HIV transmission, including the fact that none of these examples pose any risk. But casual contagion concerns aren’t the only factor that drives stigma. HIV stigma -- as experienced by the stigmatized, those of us who have HIV -- is much more than simple fear of contagion. HIV stigma is about having our moral worth judged when someone learns we have HIV. It is about having our experiences and opinions devalued or treated as if less important. The result of that prejudgment, marginalization, and devaluation often leads to self-stigmatization. By those measures, most long-term HIV survivors agree that HIV-related stigma is worse today than years ago. What is also different today is the much more limited availability of peer support networks for PLHIV, increasing demonization of PLHIV in the media, as well as a more hostile legal and public health context in which we receive and must live with our diagnoses. Years ago, peer networks were where many PLHIV learned how to disclose their HIV status to others who were dealing with a similar challenge. Disclosure used to be considered a private, personal decision.
Today, there are fewer resources available to the newly diagnosed and many fewer peer networks. Failure to disclose before having sex -- even if there is no risk of HIV transmission -- can lead to decadeslong prison sentences. There is little understanding how disclosure can put a PLHIV at risk of partner violence, or losing their housing or custody of their children.
We also support the creation and strengthening of networks of PLHIV, particularly those comprised of and representing key populations, like transgender women, incarcerated people, HIV criminalization survivors, and Latino immigrants.
Effective public health measures -- like syringe exchange, comprehensive sex education, and harm reduction programs -have themselves been crippled by stigma, which has led to more blame directed toward PLHIV. As the broader society began to understand how effective treatments meant PLHIV could live for many years, the popular perception of what it meant to have HIV changed. We stopped being seen as tragic victims on our way to early and horrific deaths and, instead, were seen as a guilty, dangerous population, people who were living longer and therefore around longer to infect others. With the passage of HIV criminalization laws, we became seen by much of the criminal justice and public health systems as an inherent threat to society, a population that needed to be tracked down, tested, reported, listed, regulated, controlled, and in many cases, criminalized. PLHIV started getting prosecuted for perceived or potential exposure to HIV -including, in many circumstances, where there was no risk of HIV transmission -and receiving decades-long sentences even when there was no HIV transmission. A few years ago, I joined other PLHIV to launch the Sero Project, a national network of PLHIV and allies fighting for freedom from stigma and injustice. We especially focus on educating and mobilizing communities to combat HIV criminalization and work to modernize HIV-related laws.
That led some of us to create “Turn It Up! Staying Strong Inside,” a resource guide for PLHIV and/or hepatitis who are incarcerated. Most of the people who edited or contributed writing for “Turn It Up!” are currently or were formerly incarcerated, and many are living with HIV. We know “Turn It Up!” will help people who have few sources of sympathetic support during their incarceration. The only thing that will prevent “Turn It Up!” from being helpful to people in prison is if they don’t receive it. If you or your agency would like copies, please e-mail us at info@seroproject.com or send a letter to Sero Project, P.O. Box 1233, Milford, PA 18337 and let us know how many you need. Sean Strub is a long-time AIDS activist, HIV survivor, and writer. He is the founder of POZ magazine, executive director of the Sero Project, and the author of “Body Counts: A Memoir of Politics, Sex, AIDS, and Survival” (Scribner 2014).
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The Fortune News 15
HIV RESOURCE GUIDE
After Learning About Living With HIV, He Taught His Prison Doctor How To Treat It By Michael in Kentucky I had been locked up for about six years when I tested positive for HIV in 2005. My T-cell count (a measure of the strength of the immune system) was around 800. At that time, the recommended threshhold for starting HIV drugs was 300 T cells, so I didn’t need to start meds. I did need to educate myself, though. I had my family send me the HIV treatment guidelines from the Department of Health and Human Services (HHS) and a treatment handbook from Johns Hopkins Medical School. I read and re-read them both, then went to the prison library and checked the PDR (Physician’s Desk Reference) for side effects of all the HIV medications. Whenever I saw a magazine or newspaper article about HIV treatment studies, I saved it. I got sick in 2006 (H. Pylori, a common infection that can cause stomach ulcers), and my T-cell count dropped to 400. I had seen studies saying it’s best to start HIV meds when your T cells hit 500 (the recommendation now is to start meds as soon as you test positive). I took them to the prison doctor and argued that I should
start. He knew very little about HIV, but I was able to convince him to let me start medication. But the med regimen he chose was not listed among the top choices by the HHS guidelines -- and it has some pretty bad side effects. So I brought him the guidelines and the side-effect information, and asked for one of the top choices instead. The doctor agreed -- and he let me pick my own regimen! Today, I am on that same regimen, with an undetectable viral load and T cells around 1,400. I always take my meds. Whenever it’s close to time for a refill, I remind the medical department. If they don’t fill my meds on time, I immediately file a medical grievance. The prison will never admit they were wrong, but in short time they will provide the meds, which is all that really matters. Same goes for all the monitoring and blood tests I need. Every time there has been a delay or other problem, I’ve been able to resolve it with a grievance -- I’ve never had to file a state or federal claim.
HIV Crimes? Know the Facts! •
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“HIV criminalization” is the wrongful use of someone’s HIV status in a criminal prosecution. For example, 32 states have special laws to prosecute people with HIV who have sex -- even safe sex, even with a condom -- if they can’t prove they told their sex partner in advance that they were living with HIV. In some states, exposure to “bodily fluids,” like saliva or urine -- which do not transmit HIV -- can result in prosecution. Whether a state has special HIV laws or not, people can be charged with more serious crimes simply because they have HIV. A misdemeanor assault charge, for example, might become felony assault or assault with intent to kill. HIV does not have to be transmitted for charges to be filed; in most cases, no transmission occurs. Scientific facts -- things like how HIV is (and is not) transmitted, that condoms and effective treatment prevent transmission, or that saliva and tears do not transmit HIV -- don’t affect the outcome of the cases.
Because many HIV meds can raise lipids (cholesterol and triglycerides) and can lower levels of vitamin D, I also follow an exercise and nutrition regimen. Many state and federal prisons have kosher diets available, and if you can get on a plan, it’s worth it for the more nutritious food you’ll get. You can also ask medical for supplementary vitamins and other nutritional support they might have. I am open about my HIV status with family and close friends and with other HIV-positive people in here. Beyond that, I always have to think, “What will this disclosure bring me? Benefit? Or harm?” This is not about shame or fear, but about being practical. From “Turn It Up!” -- a resource guide for people with HIV and/or hepatitis who are incarcerated. “Turn It Up!” was created by the Sero Project, a network of people with HIV and allies fighting for freedom from stigma and injustice. For a free issue, write to the Sero Project, P.O. Box 1233, Milford, PA 18337 or e-mail info@seroproject.com.
HIV Criminalization is Discrimination and Bad Public Health Policy •
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People living with HIV/AIDS who are charged with HIV “crimes” get smeared in the media, often receive long prison sentences, and can be required to register as sex offenders even when there was little or no possibility of transmitting HIV (like having safe sex, or biting, scratching, or spitting). HIV criminalization discourages people from getting tested for HIV, for fear of prosecution. HIV criminalization fuels the idea that people with HIV are inherently dangerous, a group that needs to be identified, monitored, controlled, and incarcerated. HIV criminalization undercuts the most basic public health messages about preventing HIV and sexually transmitted infections -- that each person must take responsibility for their sexual health decisions. Forcing people to register as sex offenders brands them as evil and makes it hard to find housing, employment, or basic privacy.
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Countering The HIV Epidemic Among Black Women On Probation: Project E-WORTH By Angela Aifah, Karen Johnson, and Louisa Gilbert To-date, WORTH is the only intervention that has been found to be efficacious in increasing condom use and reducing sexual risks among women in community corrections in the U.S.
HIV is a critical public health issue that disproportionately affects Black women. In the U.S., Black women are 20 times more likely to be infected with HIV than White women, and HIV is the leading cause of death among Black women between the ages of 25-34 years old. Black drug-involved women on probation have been hit especially hard by HIV/STI epidemics. A recent study of 337 druginvolved women on probation, parole, or in other types of community corrections in New York City found that 17% of Black women tested positive for HIV and 30% tested positive for a sexually transmitted infection (STI). The extremely high HIV rate found among Black women in this study is comparable to HIV rates in subSaharan Africa. It underscores the urgent need for effective prevention and treatment strategies that may curb this HIV epidemic among Black women in community corrections. Despite the extremely high rates of HIV and STIs that have been found among women on probation nationwide, few prevention and treatment efforts have focused on this population. The Social Intervention Group at Columbia School of Social Work is partnering with The Fortune Society and New York City Department of Probation to test the effectiveness of an innovative HIV prevention intervention called “E-WORTH.” E-WORTH is a five-session, group-based multimedia intervention that was adapted from an evidence-based HIV prevention intervention called WORTH.
The Social Intervention Group, which has been developing and advancing evidencebased HIV prevention interventions for the past 25 years, designed E-WORTH with the goal of addressing key priorities of the National HIV strategy aimed at reducing HIV disparities. These priorities include strengthening prevention efforts in communities heavily affected by HIV as well as increasing access to a range of evidence-based HIV testing, prevention, and treatment services for women in community correction settings. E-WORTH, which stands for “Empowering African-American Women on the Road to Health,” addresses the unique challenges that Black women on probation face that put them at risk for HIV/STIs. These include their greater likelihood of living in communities heavily affected by poverty, incarceration, violence, and lacking access to health care. E-WORTH focuses on group-based problem-solving and negotiation skills-building to reduce HIV risks using culturally tailored interactive exercises, role-modeling, and role play. E-WORTH employs a tablet-based, selfpaced learning tool which group members use to identify their personal risks for HIV, partner violence, and unsafe drug use; to set individual goals to reduce these risks; and to help them expand their social support networks and access to services to address their risks. As part of the E-WORTH intervention, participants will also receive individual HIV testing and counseling. E-WORTH includes updated HIV/STI information and statistics focused solely on Black women in New York City, uses Black women characters with Afrocentric messages that highlight the resiliency of Black women, and will be delivered by Black female facilitators.
This study, which is funded by the National Institute on Drug Abuse, is designed to extend the reach of HIV/STI interventions to probation as a venue. The primary aim of this study is to test the effectiveness of E-WORTH compared to HIV testing and counseling alone as a control condition. The outcomes we are interested in include decreasing biologically confirmed STIs, increasing condom use, reducing drug use, increasing utilization of drug treatment, linkage to HIV care and ART adherence (for HIV-positive participants), and decreasing partner violence and recidivism. Working with The Fortune Society and the New York City Department of Probation provides a unique opportunity to test the effectiveness and cost-effectiveness of E-WORTH on reducing HIV and STIs in “real world” community correction settings that have traditionally been neglected by past HIV testing and prevention efforts. If E-WORTH is found to be effective, it may be delivered in community correction settings nationwide. Advancing a continuum of effective HIV prevention, testing, and treatment interventions that may be scaled up in probation settings nationwide holds tremendous promise for reaching a large number of Black women who remain at very high risk for HIV and countering the HIV epidemic in this community. Angela Aifah is a PhD Candidate at Columbia School of Social Work and a Graduate Research Assistant at the Social Intervention Group. She is a clinical supervisor for Project E-WORTH. Karen Johnson recently completed her PhD from Columbia School of Social Work and is now serving as the project director for Project E-WORTH at the Social Intervention Group. Louisa Gilbert is an Associate Professor at Columbia School of Social Work and Co-Director of the Social Intervention Group. She is a principal investigator on Project E-WORTH.
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Good Fortune For A Long-time Survivor At 62, Ruben Rodriguez is thriving after prison despite HIV. By Kareema Charles I think of how blessed I am that I am still alive. I count my blessings each day and hope that others would do likewise. Does being a long-term survivor come with any unique challenges and benefits?
Ruben Rodriguez Photo by Bill Wadman
Ruben Rodriguez, 62, is a long-term survivor of HIV. He confirmed his positive status in 1994, but believes he got the virus in the early ’80s when he had shared needles with someone who died from the virus a few years later. Rodriguez spent most of his life in and out of the prison system, staying in at least seven different facilities. After his third strike for attempted burglary, he was sentenced to 15 years to life. He was on parole for work release in 1994 and was discharged in 1996, the same year he began taking HIV meds. Today, Rodriguez lives in Queens, New York, and works for The Fortune Society, a nonprofit organization that helps exoffenders back on their feet through programs and education. Rodriguez shared the June 2001 cover of POZ Magazine with Anthony Salandra and Marsha Burnett who both have passed away. To complement the September 2013 POZ cover story on long-time survivors, we caught up with Rodriguez: Out of the three people on our June 2001 cover, you are the only one remaining. What are your thoughts of being a longterm survivor?
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One benefit is that I am still alive. But the greatest challenges come from the longterm effects of taking the medicine. It really takes a toll on you sometimes. My age could have a lot to do with it, but for the most part, it’s the long-term effects of taking the medicines. I tribute a lot of my weight and muscle loss to that.
Can you tell us more about your work with HIV in prisons? When I was in prison, I founded PACE [Prisoners for AIDS Counseling and Education] and was able to participate in a lot of other programs. When I came home, I knew that I wanted to continue the work. I went to The Fortune Society and was offered a position to be a bilingual counselor.
What has given you encouragement to make it this far? Any advice for others? My attitude in general has helped me through. I don’t let HIV/AIDS bring me down. I am educated and know what I have to do. A positive mental attitude and adherence to the treatment can make for a lot for encouragement. I also do not drink and smoke. As for advice, I would have to say it is best to maintain a positive attitude, attend regular checkups, and just enjoy life while you can. That’s what worked for me all this time. How is your health holding up today? I have good days and then I have better days, but I am still blessed. I have gone through treatment for lymphoma cancer and also prostate cancer. I have hepatitis C but am not doing any treatment for it because my doctor hasn’t found a need to put me on medication for that -- I get my blood work done regularly, and my doctor sees that I can live without the medication. Right now, I have an eye problem and am due for surgery in the beginning of August. But other than that, I am able to get up and get to work every day, so I would say that I am doing pretty good.
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Cover of POZ (June 2001) with Ruben Rodriguez (right). I accepted the position for a year until I decided to move on to the Osborne Association for two years where I supervised the HIV/AIDS hotline. It was a hotline for people with the virus who needed help adjusting to life out of prison. I went to Virginia for a few years, but moved back to New York, where I [am continuing] my work for The Fortune Society, as a peerto-peer supervisor. I like the work I do now because it allows me to help others in a sense of giving back. [From POZ.com, August 2013. Reprinted with permission. Copyright 2013 CDM Publishing, LLC.] www.fortunesociety.org
PrEP PrEP -- or Pre-Exposure Prophylaxis -- is a powerful HIV prevention tool, a pill (brand name Truvada) for people who don’t have HIV but who are at substantial risk of getting it, according to the Centers for Disease Control and Prevention (CDC).
World AIDS Day Health Fair At The Fortune Society
When someone is exposed to HIV through sex or injection drug use, PrEP can work to keep the virus from establishing a permanent infection. When taken consistently -- one pill every day -- PrEP has been shown to reduce the risk of HIV infection in people who are at high risk by up to 92%. But people who use PrEP must commit to taking the drug daily and seeing their health care provider for follow-up every three months. The New York City Department of Health and Mental Hygiene (DOHMH) has developed PrEP and PEP Public Health Action Kits which include provider and patient HIV prevention resources. For more information from the CDC, go here: http://www.cdc.gov/hiv/prevention/research/prep/ For more information from the New York City DOHMH, go here: http://www.nyc.gov/html/doh/html/living/prep-pep.shtml
The North American Housing and HIV/AIDS Research Summit VIII: Tackling The Social Drivers Of HIV Fortune’s Drop-In Center staff made a presentation on “Transitional Health Care Coordination: Linking Incarcerated People Living With HIV/AIDS To Care And Services In The Community” at the North American Housing and HIV/AIDS Research Summit in Washington, D.C. on Sept. 14-16, 2015. As described on page 10, the Drop-In Center works in collaboration with The Department of Health & Mental Hygiene (DOHMH) and the NYC Department of Corrections (DOC) to provide discharge planning to individuals with HIV from all NYC jails. Upon release, said Nilda Ricard, Fortune’s Director of Health Services, Drop-In Center staff will pick up and escort these individuals in an agency van, and connect them to medical care and other ancillary services. Once their immediate needs are met, clients are then referred to Fortune’s other supportive reentry services.
On Monday, December 1, 2015, The Fortune Society will host its second annual mini-conference/health fair in recognition of “World AIDS Day,” an effort to eliminate health and social disparities in New York City. Join us to meet with participants from various agencies from the five boroughs, and to learn about and ask questions about their programs and the resources available in our communities. Break-out sessions and a keynote speaker will be announced soon. In addition, there will be screening, healthy food demonstrations, raffles, prizes, and fun. It’s all happening on December 1, 2015 from10 AM-3 PM at Castle Gardens, 625 West 140th St. between Riverside Drive and Broadway in West Harlem. For more information, contact Thelma Frasier at tfrasier@fortunesociety.org.
The mission of the M·A·C AIDS Fund (MAF) [http://www.macaidsfund.org] is to serve people of all ages, races, and sexes affected by HIV and AIDS. MAF is dedicated to partnering with the bold, the visionary, and the brave who confront the HIV/AIDS epidemic in communities where people are most neglected, off the radar, and at highest risk. The Fortune Society exemplifies MAF’s mission in providing supportive housing to formerly incarcerated New Yorkers living with HIV/AIDS. MAF funds start-up costs to help residents fully establish themselves in their new homes and in their new lives as members of the Fortune “family.” The MAF has provided $265,000 to Fortune over the past five years.
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FROM THE DAVID ROTHENBERG CENTER FOR PUBLIC POLICY (DRCPP)
The Power Of Peer Education In Prison The stigma associated with the disease was profound, as people who showed signs of infection were referred to as having the “monster.” By Ronald F. Day modes of transmission (i.e. unprotected vaginal sex and sharing drug paraphilia) were far less known.
HIV/AIDS hit New York City and other areas with dreadful effect in the early 1980s. Before this disease even had a name, it had wreaked havoc in some urban communities. Thousands of people had essentially withered away, their immune systems severely compromised. People were extremely fearful of getting infected, and at this early stage, there was little evidence of how the disease was transmitted. The story of this insidious disease and its devastating impact has been told in powerful films like “And the Band Played On,” “Philadelphia,” and “Dallas Buyers Club,” to name a few. Millions of people viewed these movies and they have been successful at reducing the stigma of people infected and affected by HIV/AIDS. What the public knows very little about is how the epidemic unfolded inside prisons and other correctional institutions. This story has been told powerfully in books like “Breaking the Walls of Silence: AIDS and Women in a New York State Maximumsecurity Prison” and “Dying Inside: The HIV/AIDS Ward at Limestone Prison.” I entered the prison system more than a decade into the epidemic. Like most people I knew, my knowledge of HIV/AIDS was minimal. I had an idea that the disease could be transmitted by unprotected anal sex, but the perception of it being a gay-related disease was palpable. The other common 20
I heard horrible stories of how people with HIV had their cells torched by others who were afraid that the disease could be transmitted by common contact. Because prison is a closed environment, people felt trapped, which only intensified the anxiety. Even those suspected of being sick with HIV had to suffer from alienation. The stigma associated with the disease was profound, as people who showed signs of infection were referred to as having the “monster.” As the disease ravaged the bodies of those infected, they were often transferred to the prison infirmary. Unlike community-based hospitals, family members could not be by their sides. In prison, people simply died alone. My awareness of this epidemic (which became a pandemic) increased significantly when I took a class offered by a program called Prisoners for AIDS Counseling and Education (PACE). This program was started in 1989 by men incarcerated at Eastern Correctional Facility (the precursor to PACE was ACE -- AIDS Counseling and Education -- which was started a year earlier by women at Bedford Hills Correctional Facility). PACE was fully committed to promoting education about the transmission and prevention of HIV/AIDS -- no matter the age, race, religion, sexual orientation, or cultural persuasion of the people interested in learning. I was so impressed by the mission and practice of the PACE program that I continued for years learning about HIV/ AIDS, how the scourge took root in our communities, and how the onus was on us to play a role in containing the disease. I went on to get involved in an advanced class, a train-the-trainer, and then became a peer educator/facilitator and ultimately a director of the PACE program at Fishkill
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Correctional Facility. One of the most important aspects of PACE is that it addressed the myths associated with transmission. It also taught people that those infected by the virus, who had advanced to AIDS, had more to fear from them than the other way around since a comprised immune system put people at risk for developing potentially deadly opportunistic infections. Moreover, the program unabashedly dealt with the stigma, humanizing people who had been previously ostracized.
People were reminded that none of us are perfect, that we all made poor choices, but that HIV does not discriminate. In fact, within a few hours of the class, it became abundantly clear that transmission was not simply about unprotected anal sex between men. People were reminded that none of us are perfect, that we all made poor choices, but that HIV does not discriminate. In fact, within a few hours of the class, it became abundantly clear that transmission was not simply about unprotected anal sex between men. The virus had begun to spread pervasively through unprotected vaginal sex, intravenous drug use (the sharing of tainted syringes and other paraphernalia), and in some societies through mother-tochild transmission. Although the effectiveness of PACE was never scientifically studied, there is anecdotal evidence that the information, condom and syringe use demonstrations, and other prudent techniques used by the program reduced the likelihood that people engaged in risky behaviors. Peer educators www.fortunesociety.org
were regularly pulled aside and probed about safer sex practices and other practices that had clear potential to spread the disease (e.g. tattooing). Many people discussed what they had learned on visits and during other times when communicating with family and friends. Because individuals were released daily with increased awareness about the transmission and prevention of HIV, along with information about anti-retroviral (HIV) medications, functions of the immune system, and other invaluable information, communities unknowingly benefited from programs like PACE. For those who became peer educators, the benefits were magnified, as the facilitation and leadership skills learned in the program were transferable to employment opportunities in the community. The New York State Department of Health (DOH), AIDS Institute, eventually coordinated with the Department of Labor (DOL) on a HIV/AIDS apprenticeship program which allowed hundreds of men to become DOLcertified HIV/AIDS educators. Indeed, many of the former PACE facilitators that I know currently work for social service organizations. By the time I left prison in 2007, there were PACE programs in at least a dozen facilities. The curriculum had evolved to include education on hepatitis, a liver disease that could go undetected for years. PACE is an effective model of each-one-teach-one and of demonstrating that when given the tools, individuals will devise sensible solutions to complex problems. I credit the PACE program with sharpening my facilitation and networking skills, supporting my postrelease employment, and connecting me to life-long friends who genuinely care about their communities. This article is dedicated to all the people who have succumbed to an AIDS-related illness in prison. Ronald F. Day is Associate Vice President of the David Rothenberg Center for Public Policy (DRCPP) at The Fortune Society where he oversees advocacy efforts to reduce reliance on incarceration, promote model programming for the incarcerated population, change laws and policies that create barriers for successful reintegration, and foster a just and equitable criminal justice system.
Center Stage “My Boy”
The Odyssey
Photo Credit: Joan Marcus, The Public Theatre.
Art created by Guy Woodward using ballpoint pen on paper (2002)
The Door
By Ronnell Brown Have you ever thought of the value of a door? How important it is? What’s behind it? What it was put there for? Not the door, the wall. Holding so strong and the door is the only way through. See, I’ve been focusing on that wall trying to get over it so long. I didn’t think of the possibility of a door. But I walked through one today, they exist. I realized I walked through one just now. You know what’s funny? When I look back all I see is doors, no walls. Now, through my life’s endeavors and struggles, I’ve been enlightened to know that the symbolism of the wall is important, but the simplicity of the door is divine. Now, with love and truth I must tell you that the door is part of the wall. Fortified! Locked! So in acknowledging the door, I do now see the possibility of a key. Imagine that.
Once again, the energy and creativity of the people of New York City were on display at the Delacorte Theater in Central Park as this year’s Public Works production of “The Odyssey” was performed over Labor Day weekend in September 2015. A Community Ensemble of over 100 people -- 14 of whom were connected to The Fortune Society as participants, staff, or volunteers -- filled the stage with energy and talent as they told the story of Odysseus and his ordeals returning home from the Trojan War. This is the third year of Public Works, a partnership between the Public Theater and five social service agencies -- The Fortune Society, Children’s Aid Society, Domestic Workers United, Dreamyard Project, and the Brownsville Recreation Center. In the fall and winter, Public Works teaches classes at the different sites and, in the summer, they all come together along with other performing artists to create a production that epitomizes New York City, bringing together people from all backgrounds in what the Public describes as radically inclusive theater. The performers come from every borough and corner of NYC and range in age from two years old to over 70. However, no matter their age, experience, neighborhood, or background, for five weeks they come together to create a work of theater of the highest quality that not only entertains but demonstrates in living color that when everyone works together with a common purpose, the result is uplifting and truly reflective of the greatness of the people of New York. For more information about Public Works, visit http://www.publictheater.org/ Programs--Events/Public-Works/
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