This weekend, Harlem United is hosting a viewing of The Other City at the Clearview Chelsea Cinema. This incredible documentary profiles the lives of people living with HIV amidst a staggering epidemic in Washington, D.C.
I'm amazed by the invisibility of poor people with AIDS, the stigma associated with this disease and the tolerance for the disproportionate impact on the poor, people of color, women, drug users, people of trans-experience and young gay men. Yet every day people hold on to their dignity and humanity in the face of poverty, racism, homophobia and criminalization. Poverty limits the opportunities people have to avoid HIV, and restricts access to quality care and treatment for those who are infected. It's hard to safeguard your health when confronted with so many barriers day in and day out.
When you look at the way HIV lives in New York City neighborhoods, it becomes clear that we have two epidemics: one concentrated among men who have sex with men (MSM), increasingly among young Black and Latino MSM, and one generalized across poor and working class communities of color. For example, Chelsea lives a concentrated epidemic among MSM with the highest HIV prevalence rate in the city at 4.8%, but a death rate of 1 per 100 people living with HIV/AIDS. The generalized epidemic in East and Central Harlem created a prevalence rate of almost 3%, but a death rate of almost 3 per 100 people living with HIV/AIDS. This isn't just The Other City -- it's a Tale of Two Cities.
People in Upper Manhattan are not using condoms any less than their Chelsea counterparts. In fact more people in Central Harlem use condoms more frequently than people in Chelsea. But in high prevalence communities where people have less access to testing and treatment, one encounter without a condom has a higher probability that HIV will be transmitted. It's the luck of the draw, and that's just wrong. Add to that the 20% of HIV positive people who don't know their HIV status but drive more than 50% of the new infections, and you stack the deck against the poor and marginalized so that even one supposedly low risk encounter becomes high risk.
HIV-positive people on treatment can reduce the HIV in their blood to levels that practically prevent HIV transmission, and these treatments extend a person's lifespan to be consistent with non-HIV'ers. The evidence is in. Annual screening for HIV and access to treatment in a quality healthcare environment is what can stop this virus in its tracks. We need to help poor people across the country exercise their right to access testing and healthcare, eliminating the disparities in infection and death.
Testing and treatment should be the cornerstone of a comprehensive approach that also includes syringe services, female-controlled methods of HIV prevention, and safer sex strategies for MSM that can be adapted across a person's lifetime. Besides reducing community viral load, routine HIV testing and treatment ensures all people infected with HIV have an equal opportunity for their infection to become a chronic condition, not as a terminal illness. This comprehensive strategy provides a short term impact that opens an opportunity to get at the structural root of HIV -- poverty, racism, homophobia, criminalization of drug users and HIV'ers, and violence against women, which unfortunately will take longer to change.
Harlem United has a limited number of free tickets to the screening. I recommend that anyone who cares about the way this epidemic affects our NYC neighborhoods e-mail Kitty Chan at firstname.lastname@example.org.