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The other age group that has recently had an increase in HIV contractions is young adults ranging from teenagers to mid twenties (8). The State of New York is required to inform students about HIV/AIDS through the educational system. The amount of money designated for schools to teach sex education is determined by the school districts. In 2005, the state gave $10.6 million in funding for abstinence only education. This form of sex education only tells students that maintaining their virginity is the best way to avoid unwanted pregnancies and sexually transmitted disease contractions. No other forms of protection are discussed, because of the lack of sufficient funding. There is another program called comprehensive sex education that informs students about abstinence, contraception and sexually transmitted diseases and other methods to avoid unwanted situations; however, there is not enough funding designated for this program. When President Bush proposed an increase of funding to $141 million for comprehensive sex education, his proposal was rejected by the Senate Appropriations. When surveyed, many parents said that they do not know how to confront their children about their sexual activities, and most are just uncomfortable raising the subject (5). This shows that the city needs to put more emphasis on the importance of these programs, because students are not well informed on the severity of HIV/AIDS, how high their chances are of contracting it and how it affects lives.
Although the importance of sex education programs in schools has been overlooked, the city has made efforts to promote “safe sex” practices outside of the classroom. In February of 2007, the Department of Health launched a program to distribute free condoms in New York City (13). Approximately 1,600 organizations such as community centers, health care groups, bars, and clubs ordered condoms, and by June, 10 million condoms were distributed (4). During the beginning of my summer break, I made a visit to the doctor’s office, and I actually saw the condoms in a small box on top of a table. I wondered if people were embarrassed to take them, but just a few minutes after this thought crossed my mind, a man walked in and grabbed a handful of the colorfully wrapped MTA Subway condoms. Minutes later, a woman came in, counted about three or four, and walked out of the doors. Hopefully city officials will continue to support this effort, because it seems to be successful thus far. Many teen pregnancies have been prevented; however, the program’s affect on the spread of HIV has not been reported as the project is fairly new.
State efforts are not the only being made to reduce the spread of HIV. Many organizations have devoted time and money to promote awareness in various neighborhoods throughout Brooklyn. One of these organizations is the Lutheran Medical Center. In conjunction with the Caribbean Women’s Health Association, the Lutheran Caribbean American Family Health Center has addressed the drastic increase in HIV infection among Caribbean communities in Brooklyn and abroad according to Joyce Shelby’s Daily News article, and there has been a steady increase of migration from the Caribbean to Brooklyn. In an effort to provide support for both citizens and immigrants, both organizations raised 2 million dollars to train health workers. These health workers were trained to give lectures, lead support groups and conduct classes in order to increase awareness throughout the borough (2). Another organization that contributed to the availability of information concerning AIDS was the Gay Men’s Health Crisis. In 2006 members placed poster on Subway walls throughout Brooklyn. They also distributed 5,000 post cards in various neighborhoods. Other examples of people trying to promote awareness are the individual contributions. A 22 year old woman named Starkima Fleming conducts counseling sessions for teenage girls. According to the article written by Joyce Shelby of the Daily News, “Among New York City women who tested positive for HIV, 71% were black, 24% were Hispanic and 35%of them lived in Brooklyn. Starkima uses her ability to relate to the teenagers to make them aware of these statistics and about ways to avoid becoming one (8). Articles discussing these attempts at making people aware of the disease and how it affects their communities are minimal. While searching for articles specifically about Brooklyn, numerous articles about the HIV/AIDS crisis in Africa appeared, which makes it seem like people are devoting more time to HIV/AIDS awareness abroad.
Essay # 3:
The HIV/AIDS epidemic is spreading fastest among African American women (1). As of the year 2003, approximately 69% of women’s HIV/AIDS cases in America were among African American women. Furthermore, in New York State, AIDS is one of the leading causes of death in African American women from ages 15 to 44 (2). As of 2006, one third of the newly diagnosed women with HIV in New York City were from Brooklyn (3). Among women who tested positive for HIV in New York City, 71% of the women were African American, 24% of them were Hispanic, and 35% of these women lived in Brooklyn (4). The largest percentage obviously precedes African American women.
Although there is more than one ethnic group and gender group that are suffering the brunt of the epidemic, African American women in particular are contracting the disease at an alarmingly high rate (1). The fact that social standing has an effect on the rapid transmission of HIV is reflected in the statistics mentioned previously. One of the major reasons for this is that they are living in neighborhoods of lower socioeconomic standing (1). The main reason for the concentration of HIV/AIDS in these areas is a lack of awareness on part of women; however, they are not entirely to blame, because some have not been properly notified about the disease and resources available to them. This essay will address the factors that lead to infection, and it will also address modifications that can be made to already existing programs in the East New York area to improve awareness and prevention methods.
The neighborhood of focus in this essay is East New York, because as shown in the previous two research papers, it is one of the areas in Brooklyn that has been significantly affected by the HIV/AIDS epidemic. From 1991 to 1999, the number of AIDS diagnoses of women living in Brooklyn rose from 27.4% to 35.4% of the total number of AIDS cases (5). According to tests conducted specifically in Brownsville/East New York by the group Life Force Women Fighting AIDS, 4% of approximately 300 women were HIV positive (3). Not only is HIV infection on the rise in women, but there has been a drastic increase in African American teenage girls as well (4). In comparison to Hispanic and white teenage girls, African American girls are more likely to engage in sexual intercourse before the age of thirteen, which places them at risk for infection (6). The high rate of infection in African American women is mainly due to heterosexual transmission. It is the second leading cause of infection among women in the borough, but it is about to surpass IDU as the fastest mode of transmission (5).
A major problem that indirectly contributes to the spread of the disease is poverty. Many urban areas across the country like New York City have large minority populations. Minorities generally have lower economic status compared to other areas in large cities where the typically wealthier white population resides (7). They also tend to live in less developed areas such as East New York and often have limited resources at their disposable such as adequate schooling, employment opportunities and adequate housing space (8). Many people do not have high expectations for themselves so dropout rates in these neighborhoods tend to be higher than in others; this leaves people uneducated about STDs and prevention methods. Studies have indicated that African American high school dropouts are about 2.5 times more likely to resort to drug use, and many people use drugs as a stress reliever (9). Since the IDU rate among black males is so high, especially in East New York, it is more likely that HIV is contracted from contaminated needles. When they have intercourse with females they do not use condoms to prevent transmission, so the virus is spread rapidly through the African American female population.
The misunderstanding of safe sex practices and a lack of communication between partners in relationships, especially in the African American community, can lead to unsafe sex practices and more frequent transmission of HIV to women (10). Lack of communication makes it difficult for women to express their views. They find it difficult to refuse sex when confronted with the subject, to initiate condom usage and to determine when to have sex. Some engage in sexual acts because there are fewer available men due to incarceration and murder rates (11). Some even subject themselves to physical, sexual and mental abuse because they want to remain in some type of relationship (12). A relation has been discovered by researchers between gender based violence and HIV infection because safe sex practices are neglected (13 & 12).
Other women remain in unsafe sexual relationships because they feel like they have no one else to turn to for support; this is known as survival sex. Survival sex is the practice of remaining in an abusive relationship because of dependence instead of an emotional connection with one’s partner. Unlike prostitution, survival sex occurs within relationships, and women perform unsafe sexual acts to please their partner. They feel that if they do not submit to their partner’s demands, they will be thrown into the street with no one to provide shelter for them. (14). The practice is dangerous because many women who want stable relationships are often infected by men who are intravenous drug users who contract the virus and pass it on (5), and women who are substance abusers themselves are often times more vulnerable for victimization (15). Survival sex is not only practiced by older women; it is also a practice of homeless youth and various other adolescents (16). Many girls who have experienced violence in the past are more susceptible to future violence because of lower self esteem (17). Although violence in relationships is a large factor, sometimes it is just a matter of men not wanting to wear condoms.
A recent study which included surveying 500 African Americans by phone shows that many African Americans have conspiracy beliefs concerning the government. There are some people who do not believe the government is informing people about HIV, consequently, this same group also seems to distrust the government’s advice about condom usage. Some men believe that the government is actually putting strains of the virus into condoms in order to infect African Americans. These negative views developed because of the scandal surrounding the Tuskegee syphilis study. African American men who harbor conspiracy beliefs are less likely to use condoms consistently, and this ultimately affects their female partners (18). If men decide not to use condoms, they are more susceptible to contracting HIV and also transmitting it to their partners. Men ultimately control the use of condoms in sexual encounters, but women have the ability to refuse sex when faced with the decision of having it or not. At this point for women, it becomes a matter of self esteem, in depth knowledge of safe sex practices and adequate knowledge of HIV in order for them to make the right decisions.
Awareness begins at a young age, if a community waits too long to educate adolescents about risks and also precautions also educates them about that can be taken to avoid risks their lives are put at stake. In the case of people living in East New York, this is evident. The main preventative force in these girls lives are their mothers. Parents often have more influence over their children’s behavior than most people believe. Discussions that parents have with their children often leave lasting impressions on their children’s decisions (19). A study that was conducted on mothers and daughters relationships has demonstrated that when mothers talk to their daughters, they have a great deal of influence on the choices their daughters make when confronted with sex (20). As a result of parental discussion, many children are often more likely to participate in sexual activities at a later age because they are more aware of risks that are involved with their actions (21). Studies show that many African American mothers actually want to be proactive in their daughter’s lives, but they are unsure how to confront their daughters about sex and HIV. Researchers believe that there is hope, because mothers actually want to play a role in educating their children shows that they just need to be taught techniques to address the issue (22).
The Health Department can sponsor sessions at community schools to inform mothers about how they can raise the subject with their daughters and how they can discuss the risk that sex entails. We can also find volunteers like Starkima Fleming who gives informative lectures about HIV/AIDS to teenage girls in school auditoriums and classrooms. Her intentions are to begin prevention at a young age. (23) We can also have educators gradually instill a sense of pride and self respect in young women in hopes of decreasing the number of them who end up in abusive relationships. Mothers who are not comfortable having discussions with their daughters can use this as an alternative. Eventually, if the sessions prove to be successful, a program can be established, and educators can be paid. One type of program that is already funded by the Health Department is the STD clinic.
The Health Department provides free confidential STD clinics. Adolescents are not required to have parental consent, and this means that teenagers at risk will feel less pressure when faced with the decision of testing. There are two clinics available in Brooklyn, and both are accessible to East New Yorkers through public transportation. One is located in Crown Heights and the other is located in Bushwick. (24). For people who have already contracted the disease, there are numerous organizations that provide health care services to them that are located within close proximity to East New York.
One such organization is The Access Project which provides information about Medicaid, Medicare, and Insurance plans to make people aware of treatment available to them at lower costs. There is a network that works in conjunction with The Access Project called The East New York Brownsville HIV Care Network Miracle Makers, Inc. It is easily accessible by public transportation. The B25, B83, B60 and a few other buses pass through the area regularly. Organizations like this one either provide visitors with a health care provider or refer patients to organizations with health care providers. The staff also has a policy that if a person is having a difficult time finding health insurance, they make calls on behalf of the patient and inquire about the plans mentioned above. If people prefer to keep their affairs secret, there is an alternative center in Bedford-Stuyvesant/Crown Heights by the name of Bedford-Stuyvesant/ Crown Heights HIV Care Network that can be accessed just as easily by public bus transportation or the A or C trains (25).
Other organizations like the Caribbean Women’s Health Association and the Lutheran Medical Center provide support groups, personal advisors, educators and activities for people who have already been affected by the HIV/AIDS. Over 100,000 people have relied on CWHA’s services, and more can use it as a resource to find other modes of treatment. There are three locations in Brooklyn, and there are two that are within close proximity to East New York (26). The Lutheran Medical Center also does a great deal for people who are not stricken with HIV/AIDS. It focuses mainly on prevention by training community health workers to educate people about the HIV/AIDS before contraction, which is vital to preventing further spread of the virus (27).
Syringe exchange can also help to prevent HIV contraction and it also addresses the problem of IDU among men, which will indirectly decrease the HIV rate among African American women. There are SEP’s that are actually located in Bushwick and East New York to minimize contraction by needle use; however, people still might not be knowledgeable about its existence (28). The SEP in East New York is situated between the two neighborhoods on a road that is accessible by public transportation.
The task at hand is not necessarily to develop new methods of prevention, because they already exist. Our task as Health officials is to help expand the potential of these programs, and it is also our task to inform people about those programs that are available. In 2007, Gay Men’s Health Crisis launched a campaign in subways to make people more aware of HIV/AIDS. Members placed posters in numerous train stations (29). A similar tactic of putting posters up in train stations and on buses could be used to make people aware of testing centers and reasons for getting tested frequently. Other posters can serve as reminders for the importance of safe sex practices. They can also be used to inform people about the locations and availability of SEPs.
There are other methods as well; we can inform pastors at various churches of the problem among African American women in the East New York community. Churches that have not already done so can develop age groups sessions in which they address the problem with a certain age group. Young educators can speak to teenage girls at risk, and older educators can inform age groups from 20-30, 30-40 and 40-50 years of age to address the problem in each specific group.
Another method that can be utilized is pamphlets. They can be distributed in clinics to serve as a reminder to women in the community of the statistics attributed to the epidemic. If they see numbers, maybe they will actually understand the true impact that it has had on their community. These pamphlets can be created easily with Microsoft Publisher and printed in the clinic, or the Health Department can provide them. Another method that can be implemented in the clinics is the use of televisions to increase awareness while people are in the waiting rooms. Since many clinics show educational films pertaining to disease, DVDs can be used to inform people about the virus, provide transmission prevention techniques and inform people about organizations that they can turn to for more information.
There is one other method that can be potentially useful. There are many concerts during the summer at large public parks such as Prospect Park and Sunrise Park. Health Department officials can work with organizers of those events to incorporate two minute educational speakers when the sets are being changed for bands/artists. The speeches do not have to be long, but they must convey powerful messages. All of the previously mentioned methods can be implemented and successful with the cooperation of those whom we ask.
“To succeed at risk reduction, the intervention, education and counseling need communitywide support. The African American religious community, business community, political community and social community should be actively involved…” (30) There has to be a collective effort on part of everyone in the community to halt the spread of HIV/AIDS in African American women who live in East New York and other groups that are affected by the pandemic. I believe that as public health officials, we must not only provide them with money, but me must also be the driving force that propels the efforts until we finally see a significant decrease in the number of African American women being afflicted with the disease.