"Research shows that without stable housing, access to mental health services and affirming environments, LGBTQ youth are more likely to engage in risky behaviors."
– Mark Erwin, Ruth Ellis Center director of operations
With some zip codes in the city of Detroit registering three times the national prevalence of HIV, city and state officials say the disease is absolutely a crisis in the city.
"We believe that any time when a disease disproportionately impacts any race, group, or community, there is a crisis," wrote Loretta Davis, Department of Health & Wellness Promotion Director and Public Health Officer, in response to a series of questions posed by The American Independent and BTL. "Yes, there is a 'crisis.'"
The overall rate in the city is .6 percent, on par with the U.S. prevalence of the infection. But some of the zip codes in the city have a prevalence rate up to 1.88 percent, three times the national average. The disease is disproportionately impacting African American men who have sex with men.
In response to the question "Does Detroit have a crisis with HIV?" Angela Minicucci, spokesperson for the Michigan Department of Community Health, responded by email, "National investments in HIV have contributed to dramatic reductions in the annual number of new infections since the peak of the epidemic in the mid-1980s. However, the HIV crisis in America is far from over, this is not something that is unique to any one city. HIV is distributed disproportionately in Michigan. The city of Detroit has 37 percent of those living with HIV but only 9 percent of the general population."
In a follow-up, Minicucci wrote, "MDCH does believe that the HIV rates in Detroit are a continuing crisis, however, it's important to note that this crisis has been ongoing since the mid-1980s and has decreased since that point. The situation in Detroit is a not an issue that is unique to just that city as this crisis is one that can be seen across America."
HIV and homelessness
Michigan, like other parts of the nation, is actually seeing increases in number of new cases in at least one demographic — young people. The Michigan Department of Community Health reported (PDF) last year that the state had seen "a significant increase in rates of HIV infections in 13-19 year olds, the majority of whom are black" men who have sex with men. And on Wednesday, the CDC released the 2010 HIV Surveillance Report. In a news release, officials highlighted the fact that the report "shows a 10% increase in the number of HIV diagnoses among persons aged 15-19 years and a 33 percent increase among persons aged 20-24 years."
Ruth Ellis Center staff say that 40 percent of the youth they work with — who are mostly African American LGBT youth — self-identify as HIV positive. Ruth Ellis Center is located in Detroit and served over 4,300 youth last year.
"The youth at Ruth Ellis Center know more about HIV/AIDS and how it is contracted in addition to harm reduction best practices than probably the vast majority of people living in Detroit and Southeast, Michigan," said Mark Erwin, director of operations at Ruth Ellis. "The problem lies within the fact that there isn't enough emergency, transitional and affordable housing for literally hundreds of LGBTQ youth in our community alone. Research shows that without stable housing, access to mental health services and affirming environments, LGBTQ youth are more likely to engage in risky behaviors."
Erwin says hundreds of LGBT youth are homeless on any given night in Detroit. This lack of housing leads to survival sex — in many instances trading sex for food or a place to sleep. This puts many youth at high risk for HIV because they are unable to negotiate safer behaviors.
Advocates for those living with HIV say the crisis is exacerbated by a combination of economic realities and budget cuts.
Shrinking resources
Mark Peterson, a director of Michigan Positive Action Coalition, said Detroit has been disproportionately impacted by the epidemic since the beginning.
"There is no doubt that we contine to be in a state of crisis here," Peterson said, adding, "Without a more concerted effort to ensure the most effective prevention interventions and continued access to high quality care, the situation can only get worse and the outcomes will be seen on the individual and community level."
Barbara Murray, executive director of AIDS Partnership Michigan, also said shrinking resources are a growing concern for addressing the crisis in the city.
"The state is going to be hampered by expected cuts in CDC prevention funding," said Murray. "I believe the awards have been made, but do not know what the game plan is. Providers have been hampered by 3 month prevention contracts — which have just been increased to 6 months. It is very hard to plan and operate in such short chunks of time. Twelve month contracts are best … 24 month contracts are even better."
Due to a realignment of the federal resources directed at the epidemic, the state stands to lose 33 percent of its annual funding by 2014. The federal government is moving resources to cities — such as Washington, D.C. — and regions — such as the south — that are being hardest hit by the epidemic. Federal HIV dollars used to be distributed based on the cumulative number of HIV/AIDS cases in a state — meaning places like California and New York received significantly more funding even as new infection rates decreased.
Ultimately, says HIV activist Peterson, officials will need to become more nimble and effective in addressing the crisis.
"It is our hope that both at the state and local level, those entrusted to manage these resources find new, more effective and more impactful activities both in care and prevention," says Peterson. "The time of operating in silos and seeing arbitrary jurisdictional issues as more important politically then providng the the best care and prevention services is long since over. We hope that the state and city can begin to apply resource-sharing practices that can overcome the current econmomic barriers we face. We can no longer afford to continue funding activities which do not address our highest impacted populations in prevention and we must ensure we do all we can to see that all people living with HIV in the Detroit area are supported to maintain consistant utilization of care services."
