UPTOWN vs. DOWNTOWN:

Where should the resources be allocated?

       In order to figure out the most comprehensive and effective use of resources by the city for both treatment and prevention it is necessary to breakdown the HIV/AIDS issue into two different groups, Downtown and Uptown, which will referenced throughout this paper.  While both of these groups carry over from my AIDS data analysis some changes have been made with Downtown now referring to the general gay population of Manhattan, and Uptown referring to low income minorities of both sexes.  These two different groups bring up a series of questions that need to be considered when allocating resources: Which group needs more attention? What programs should be created/funded?

            The first cases of HIV/AIDS in New York occurred mostly within the gay community before spreading to IDU users, creating an image of HIV/AIDS as a primarily MSM and IDU issue. However the face of HIV/AIDS has begun to change, now including the Uptown group in large numbers. Blacks and Hispanics constituted 81% of HIV diagnoses in 2005, and among women black and Hispanic women accounted for 92% of HIV diagnoses in 2005.[i]  As more and more people of minority ethnicities are diagnosed with AIDS it is necessary to the note the strong stigmas in minority communities towards AIDS, especially the idea of MSM transmission. Also the minority community has extremely limited financial resources as the median household income of black and Hispanic households are, respectively, $23,813 and $24,766 – less then half of the median household income for white households.[ii]

            The Downtown community continues to face issues of the HIV/AIDS crisis: new diagnoses, many patients in need of treatment, and social stigma. In 2005 MSM transmission still accounted for 51.5% of male HIV diagnoses, and 41.8% of men still living with HIV/AIDS.[iii] Crystal methamphetamine use has recently arisen as an issue in the gay community, as its use increases the chances of unprotected sex, greatly increasing the chance of HIV transmission.[iv] In the face of HIV/AIDS many organizations have arisen in support of the downtown group. By building a strong base of public and private support and intense fundraising gay-focused HIV/AIDS organizations have managed to establish a strong support system for the downtown group.

            Organizations appeared in the late 1970s and early 1980s in response to the slow political and public health response to HIV/AIDS, often beginning as fund strapped grassroots attempts to help those who were dying. Twenty years later organizations such as the Gay Men’s Health Crisis continue to provide support to the downtown community. With assets topping $17,000,000 and an annual budget over $25,000,000 the GMHC provides prevention services, HIV testing, community outreach, treatment connection, legal services and patient counseling.[v] With established, private organizations providing so many services to the downtown group more attention should be paid to a new group of HIV/AIDS patients—the uptown group.