Community Health Workers Fighting AIDS

Barrington M. Salmon | 7/12/2012, 2:47 p.m.

"And the laws that criminalize HIV don't inspire people to get tested."

In low-income areas, the pandemic moves unhindered, primarily affecting black women who are uneducated, unaware and who often are so caught up in maintaining households, being a caregiver and dealing with the issues of everyday life, they neglect their own personal care. All too often, people living with the disease are overlooked or don't come to the attention of case managers who are stretched to the limits with their caseloads.

"Ramona" and Jackson said low-income neighborhoods, in Wards 5 through 8, are "ground zero" for the disease, affecting heterosexuals, homosexuals, IV users, women, and members of the transgender community, with Jackson adding his concern about the growing number of young men who engage in homosexual activity but have relationships with women and who are not using adequate safeguards during their sexual activity.

"This should have been in place a long time ago," Jackson said of the program. "We need to have as many community health workers here as they have in Texas, Los Angeles and San Francisco."

Charles said that D.C. has its own unique issues.

"D.C. has such layered determinants of health such as high drug use and no needle exchange, significant poverty, unemployment and violence," said Charles. "... Money for outreach is decreasing and the focus is on high-impact targets such as men having sex with men."

But the District has the best matrix of care in the country which means people come from all over to get care," several of those who discussed the issue said.

Charles said the Positive Pathways was created "based on significant need because of D.C.'s viral load data." The organization, which is funded by AIDS United, has partnered with a number of community organizations. To date, 401 people are clients in the program that began in June 2011.

"We still have a lot of people who don't know their status," she said. "And some men are bitter and have unprotected sex. We need more peer workers because we have an epidemic. We have to be real strategic about how to reach those people and get them into consistent health care."

"Homophobia and the fear of expressing one's sexuality is driving the disease and driving people underground."

Ramona and Jackson shook their heads when they recounted the rigorous coursework they endured before they hit the streets. They received extensive training over the course of eight months, meeting three hours a day, and three days a week.

"There are barriers to access, care and services, systematically or individually," Charles said. "The training is such an asset. They feel the pulse. Workers are employed and placed at different sites such as Unity Health Care, Our Place D.C., the Women's Collective and the Family Medical Counseling Services, D.C. Chartered Health Plan and Whitman-Walker Health."

"We're going to homes, calling people, and going to shelters to get people back into consistent health care."

Banaszak praised Positive Pathways.

"Positive Pathways and the peer navigation model is a big component of many of the organizations we support because it's a very effective way to reach people where they are," he said. "There is an element of trust talking to peers of the same gender and race and they often come from their very own community."

He said he is excited that the District will host its first international AIDS conference in 20 years.

"It gives us the opportunity to keep working on these things and tell the story of what's happening on the ground," he said of the 19th International AIDS Conference, at the Walter E. Washington Convention Center on July 22-27. "And with HIV Awareness Month, we will be able to bring [different] factors to light. A lot of attention has been placed on the global epidemic but what type of society do we see ourselves living in?"