As the rents in New Haven rose, so did HIV diagnoses among gay men, especially in communities of color.That rise isn’t happening just in New Haven, learned AIDS Project New Haven (APNH) Director Chris Cole. It’s a national problem, and it’s not showing signs of going away.
On the eve of APNH’s annual fundraiser Dining Out for Life and the 20th anniversary tour of the groundbreaking musical Rent at the Shubert this weekend, Cole and APNH Events and Volunteer Coordinator Fran McMullen sat down to discuss the rising number of HIV cases — and the ways APNH is changing its outreach efforts to combat it.
The 1997 hit Rent was written by Jonathan Larson, who died unexpectedly on the day the show was set to start its previews on Broadway. A riff on Giacomo Puccini’s La Bohème, the musical depicts a group of eight 20-something musicians, actors, and artists trying to make ends meet in New York’s East Village.
All the characters in Rent are living on the edge of something transgressive. Angel thrives on the drag scene. Maureen is a hip, punk-edged bisexual who does zoning protests and performance art. Roger is a musician with a junkie past. His siren, Mimi, is a junkie herself. Several of the characters struggle with HIV and AIDS, and their daily battles with the virus become part of the musical’s plot and score.
By the time Rent premiered in 1997, APNH had already been offering testing, treatment and prevention services across New Haven for 14 years. In 1988, it added a Caring Cuisine component to its list of programs, shuttling meals and groceries to HIV-infected patients who were homebound or too ill to shop for groceries or cook for themselves or their families. During those years, there was a national demographic shift in those infected with HIV. The majority of patients, who had been white men in the 1980s through the mid-1990s, were now men of color. As overall incidences were decreasing — “We saw what happened in the 1980s, and people were using much more protection,” Cole said — those numbers were rising.By the early 2000s, the demographic shift pointed to a larger national trend — an increase in the number of new HIV diagnoses among gay men, and especially gay men in the black and Latino communities. In 2015, 277 new HIV cases were diagnosed in Connecticut. Of those cases, 48 percent who contracted the virus were men who have sex with men, 36 percent were black and 29 percent were Hispanic or Latino, according to the state’s Department of Public Health. Cole attributed part of that to higher methamphetamine use — as a party drug (such as MDMA) rather than injected form — in the gay community, which reduces inhibitions and increases sex drive, and a growing sense that HIV is no longer a death sentence.
“HIV is viewed as a manageable disease,” Cole said. “Now that it is not a life-ending disease, and even less of a life-changing disease as it was at one point, I think people are looking at it as: This is treatable. It’s not the best thing, but I’m not going to die. In the late 80s, early 90s, you didn’t have sex without using protection, especially if you were a gay man. Now, that’s not the case.”“I’ve heard people actually say that,” said McMullen. “Oh, I just take a pill. It’s no big deal.”
But there “is still an enormous amount of stigma around the infection,” McMullen added. “I hear that from clients a lot — especially around disclosure … even [to] their own family for fear of how they would be treated afterwards. So that is still something that we work on educating people constantly and working with our clients to feel empowered that they are not their disease.”
One way in which McMullen and Cole do that is to make sure more people know about pre-exposure prophylaxis (PrEP), a new, daily regimen that has become FDA approved and on the market in the last three years. On PrEP, people who are not HIV-positive but are at risk of becoming HIV-positive — for instance, someone whose sexual partner is HIV-positive, or someone who has a lot of unprotected sex — take daily doses of medication to act as a firewall against HIV. That’s in addition to extensive efforts APNH has taken to keep those who are already HIV-positive on the correct antiretroviral drugs.
So far, the Centers for Disease Control report that the PrEP drug “reduces the risk of getting HIV from sex by more than 90 percent.” As a result, Cole and others at APNH are now working “to get the word out and get as many people on PrEP as possible,” he said.
The organization’s outreach efforts have also changed with the growth of social media, Cole said. While APNH still sends out outreach workers to do on-site testing, flyering, and speaking at events like last week’s AIDS Walk New Haven, the organization has realized that a dedicated online presence may lead to greater statewide prevention, and people learning about APNH’s testing services.Two floor below Cole’s office, Outreach, Testing & Linkage Manager Barry Walters was hard at work on some of APNH’s online efforts. Walters mans APNH’s two Facebook accounts, devising advertisements for testing and prevention while also posting to keep people interested. Recent postings included a jockstrap debate, a clip from Cartoon Called Life, and a profile of Shawn Barber, the British pole vaulter who recently came out as gay.
Walters also visits sites that he described as “pretty hardcore” — the dating site Adam4Adam or Bareback RT, for people who specifically want to have unprotected sex with men. APNH is opening a new, unexpected frontier for prevention there, Walters said. On Adam4Adam, guys can see when you’ve checked out their profile, and engage you back if they want to. Many of them do. Walters recalled how one such interaction led to a six-month chat exchange, at the end of which the guy agreed to come in for testing in late April. Other interactions are quicker. People message Walters asking if they can get HIV from kissing, or about the importance of using PrEP if they only have unprotected sex occasionally. For those with more serious questions about testing, treatment, and taking PrEP, Walters offers to call an area clinic with them (Nathan Smith Outpatient Clinic is the one APNH uses most frequently).
“It’s funny how it all plays out, but we’re able to educate,” he said. “You got to meet people where they’re at.” Sometimes, that’s on the street. Sometimes, it’s online.
Author: LUCY GELLMAN