NYC's NEW AIDS CZAR UNROLLS CONDOM PLAN!
Can distributing condoms slow the spread of HIV?
                                                                              
(Harlem,NY)  In this hot Mayoral election year, a New York City Newspaper reported last week that the Bloomberg Administration is launching a major program to distribute free condoms 'to prevent the spread of HIV'. Back in early January, New York City Health Commissioner Thomas Frieden named Dr. Scott Kellerman as the point man of the newly revamped bureau of HIV and AIDS prevention. "We need to cover this city in latex,' said Kellerman, a noted HIV expert from the federal Centers for Disease Control and Prevention (CDC).  He called it "ridiculous that condoms aren't available in places where alcohol is sold and where people may meet and take drugs before heading off to have sex." I agree with him 100%.  But do we need to blanket the city with condoms? What message will this wide spread condom distribution effort send to our youth? Shouldn't we offer black and Latino youth another choice in addition to safe sex and condoms like abstaining from sex until marriage? I think so.  As a matter of fact, it's strange that President Bush is promoting faith-based abstinence but Kellerman hasn't said much about it.

Is everyone equally at risk to get HIV?  I don't think so. Contrary to popular belief, the populations most at risk for HIV are the same ones who got HIV at the beginning of the epidemic: gay men, poor black and Latino men and women, and drug users. And, let's not forget the high number of Caribbean and Africans at risk for HIV in New York City. I am sure Kellerman knows that many HIV activists including myself have worked in the black and Latino community for years to educate the at risk populations about HIV. We distributed millions of free condoms in our neighborhoods. Nevertheless, the rates of new HIV cases in communities of color continued to climb.

Truth be told, many black men most at risk don't and won't use condoms regardless of their availability. We should keep targeting condoms to at risk people of color but a new and additional approach is needed. What if we focus extra attention on the people living with HIV?  What if we go to the AIDS clinics, AIDS organizations, and drug treatment programs and target prevention education to HIV positive people, educate them to be responsible and teach them how to use condoms? The Center for Disease Control (CDC) has been promoting an initiative to educate positive people about safe sex at the AIDS clinics. Couldn't we also use the 'HIV Stops With Me' project as a model for reaching more HIV positive people?

Kellerman says that the message of safe sex continues to be an important tool. "The messages are pretty simple and always have been," he says, "If you have sex and you don't know the status of your partner use condoms. I think we need to sit back and think why aren't these messages getting through now." I agree but Mr. Kellerman is a gay white man. Does he have a particular insight or marketing strategy for reaching the mostly poor black and Latino heterosexual and homosexual men and women most at risk?  Is he reaching out to the on the ground HIV leaders and minority marketing agencies for help?  I haven't heard he was at community meetings in Harlem, the South Bronx, or Bed-stuy explaining his HIV Prevention strategy to the grass roots folks.

Back in 1998,  Ravinia Hayes-Cozier from the Harlem Directors Group (a past Assistant Commissioner of the NYC Department of Health  HIV and AIDS  Prevention Department), Sunni Rumsey, a prior director of prevention from Health Force, a major peer driven HIV organization in the Bronx,  and  I met with Dr. Neal Cohen,  the Health Commissioner at the time and discussed an media based HIV prevention/health promotion campaign targeting New York City black and Latino communities. The meeting established the need and we gave them general ideas about how to develop a media campaign based on black and Latino cultural and community images. But, the white gay dominated HIV prevention department decided to mostly target the gay community with a media campaign. The ultimate campaign was highlighted by posters in bus stops depicting two gay black men advising the 'straight community' to use condoms. The black community did not like or support the effort.  Was the apparent refocus on targeting the gay community with our media campaign ideas based on HIV surveillance data or the result of the gay communities powerful influence over AIDS prevention policy and their reluctance to relinquish control? Whatever the case, over the following five years, HIV in the black community among heterosexuals has exploded. In 2005, it doesn't look like Kellerman will focus the proper attention and resources on communities of color either.

Kellerman has been talking about HIV in the gay community and not enough about HIV in the black and Latino community. He said at a press conference, "Among gay men there are some alarming trends. The number of infections are starting to go up a little bit because of certain behaviors and the use of crystal meth." He was talking about the use of crystal meth in the downtown Manhattan gay community and unsafe sexual activities (insertive and receptive anal sex without a condom). Kellerman believes meth use is a topic that needs to be discussed more openly. Obviously, the gay community must be included in any citywide HIV prevention effort. But, doesn't crack cocaine and other substances popular in communities of color need to be discussed more openly too?

Marjorie Hill, who is black, was the city's commissioner of AIDS services before Kellerman. Her policies were more of the same failed prevention efforts of the past. Nevertheless, she was a woman of color who was sensitive to issue of HIV and AIDS in communities of color. She resigned in November of last year amid rumors about tension between her and Mayor Bloomberg. At the time, many activists, particularly those working in communities of color, were concerned at her departure. Housing Works, a major HIV housing organization in New York City, said in an open letter to Commissioner Friedman that four white men, HIV status unknown, " serve as the primary decision makers on AIDS policy and funding for a population where over 75 percent of men and 90 percent of women living with AIDS and HIV here in NYC are people of color."  Is Commissioner Friedman aware of the facts? If he is aware, why did he hire a gay white man to head up his HIV prevention effort?

Kellerman also wants to focus some of his $200 million dollar a year budget on people who do not know their HIV status. "About one in four of people are walking around and don't know they are infected," he said. "We would really like to focus in on those people so they can know their health status and get some treatment."  I agree. In 1998, I was a One City Award recipient by the Citizens Committee for New York. I won the award for organizing the first annual 'Staying Alive' HIV test day in the Bronx .We tested hundreds of people of color at risk for HIV. Obviously, New York City can do a better job than me of coordinating a citywide testing day using the rapid HIV test that has become widely available.  We should set aside one day of the month for citywide HIV testing. How about declaring the last Monday of each month HIV testing day?   Will black and Latino political and religious leaders seriously get behind a citywide effort to test as many people as possible for HIV?

Last but certainly not least, shouldn't Kellerman get behind partner notification?  In 1998, the New York legislature submitted a bill I supported to encourage newly diagnosed HIV positive people to notify their sexual partners. The gay community vehemently opposed the bill. Nevertheless, the bill became law. The health department has not put a serious effort behind communicating the importance of partner notification. As a matter of fact, some insiders with personal agenda's at the health department have undermined the partner notification law. Indeed, you don't hear any media effort to educate the public about the partner notification law and the need for people to cooperate. I have said time and time again, we need to design our HIV prevention strategies based on a serious rethinking of the HIV=AIDS=DEATH dogma.  You 'heard'?