AIDS Has Not Disappeared

Neither of the outreach workers say it, but the woman looks like a hooker. It's 6:45 p.m. on a Thursday, and Fremont Street is a few hours away from morphing into the open-air drug and sex market that's bedeviled cops for the better part of two decades. Dressed in all pink, the woman isn't the steadiest person to ever don high heels. She's "switching"—seductively thrusting her hips as she walks, each step challenging the dexterity of her ankles and pushing her loose-fitting, ponytailed weave into a side-to-side sway. As she approaches, Nicole Rogers readies a small blue bag.

"Want some condoms?"

"Yeah, I'll take some," pink-clothes lady responds, sizing up Rogers' companion, Frank Byndloss.

As if.

On many Thursday evenings Rogers, a specialist in human trafficking at the Westcare social service agency, Byndloss, an educational coordinator for Aid for AIDS of Nevada, the state's largest AIDS service organization, and other outreach professionals travel Fremont Street from 15th Street to Las Vegas Boulevard talking to people about the dangers of drug use and unsafe sex, passing out condoms, educational pamphlets and bleach kits (to clean syringes and needles).

Some folks snatch the condoms like they're manna from heaven. Others decline. "No thanks," says one couple in front of El Cortez. "We're married." Some ask questions—"Do female condoms really work?"—and heed the advice. For others, it's in one ear ...

Like today. Though their backs are turned, Rogers is sure one of the two women that cops have cuffed and spread-eagled at the southeast corner of Fremont and 11th Street is a client.

Near Ninth Street, Rogers chats up a mother and her two daughters. After Mom declines the goody bag, little sister rats out big sis: "She needs some (birth control) pills." Mom takes the condoms.

Inching toward Seventh Street, Byndloss points to apartments above a corner store that purportedly double as brothels.

In front of the Western hotel-casino, Rogers stares at certain cars and specific men; the teenage prostitutes she works with have taught her how to recognize pimps and johns.

From its earliest days as a pit stop between Salt Lake City and Los Angeles (Block 16, from First Street to Ogden Avenue, served as the city's tenderloin in the early 1900s) to now, Las Vegas has trafficked in sex. Home of showgirls and call girls. Street walkers and high-priced hookers. Juvenile prostitutes and women smuggled in as sex slaves. Sidewalk smut racks and billboards promising strippers "direct to you." Spurious massage parlors and thinly veiled escort services.

And what's happening here—young girls turning tricks in motels; strippers selling their bodies on the side; the "down-low" phenomenon of heterosexual men secretly sleeping with men—is staying here ...

... In the form of climbing HIV/AIDS rates.

According to the Henry J. Kaiser Family Foundation, Nevada's AIDS rate (12.4 per 100,000) trails only California (16.6 per 100,000) among Western states. From 1999 to 2003, the number of people living with AIDS jumped from 5,474 to 7,472, a 7 percent increase year over year, according to a state epidemiological profile compiled by the Nevada State Health Division. And in 2003, Nevada's Asian/Pacific Islanders had the nation's sixth-highest rate of adult/adolescent AIDS cases; whites the 11th highest and blacks the 12th.

Guess where the bulk of those cases emanate?

Home sweet Clark County.

The Clark County Coalition of HIV/AIDS Services Providers reports 7,154 cases in the last 13 years.

According to the state epidemiological profile, since 1992 there have been more AIDS-related deaths in Clark County (2,604; enough bodies to fill a local high school) than the number of AIDS cases it takes to qualify for federal Ryan White funding (2,000 cases over a five-year period).

Prior to 1999, the county accounted for 78 percent to 84 percent of Nevada's AIDS cases; that number jumped to 91 percent from 1999 to 2003. In the same four-year period, the county recorded the state's highest HIV contraction rate among men, minorities (particularly blacks and Hispanics), 13- to 24-year-olds and MSMs (men who have sex with men). Two years ago, the county experienced a 66 percent increase in the number of people living with HIV and a 30 percent jump in those living with AIDS.

Since Clark County is the state's growth center, it makes sense that it dominates the charts. Among the thousands moving here each month, someone's bound to be infected. But it's the preventable triggers that worry health officials. Apathy. Ignorance. Cultural barriers. Drug use, which lowers inhibitions. If not adequately addressed, they fear we could be building the framework for a future crisis.

Over two days in August, dozens of social service professionals met at Doolittle Community Center for the fifth annual Community Empowerment Summit put on by the Ryan White Comprehensive AIDS Resources Emergency Planning Council. The goal: Decide how to allocate $4.5 million in federal funding for HIV/AIDS services in Clark and Nye counties and Mohave County, Arizona. Propped up throughout the main conference room were several cardboard posters, each with varying themes on addressing HIV: "No man is an island. Don't let HIV isolate you."

The room starts to fill as Rick Reich, communicable diseases/AIDS services supervisor for the Clark County Health District, presents state and local HIV/AIDS data. An affable man with a folksy demeanor, Reich is like a human version of Google when it comes to data on sexually transmitted diseases. His was a Greenspan-ian role in the summit: present the numbers, provide context for the 78-page epidemiological profile.

Some of the numbers were sobering:

Four hundred and sixty four: AIDS deaths statewide since 2003.

Seventh: Rank of HIV/AIDS as a cause of death in 25- to 44-year-olds in 2003; there were 93 deaths (heart disease was tops, killing 195).

Five to 10 times higher: Nevada's prison HIV infection rate as compared to the national average.

He's just getting started.

From 1999 to 2003, HIV cases in Clark County jumped from 1,186 to 1,973, while AIDS cases rose from 2,964 to 3,859. Black men figured heavily in this surge. In 2003, they comprised 81 percent of HIV cases and 89 percent of AIDS cases, had the highest rate of HIV/AIDS-related deaths (18 per 100,000) and were five times more likely to contract HIV (74 per 100,000) than white men (14.8 per 100,000), a situation that Reich says must be addressed, pronto. "This is going off the chart."

Most everywhere there was good news—a reduction here, no movement there—but bad news pulled up the rear: A 7.1 percent drop in HIV/AIDS incidence rates among 25- to 44-year-olds from 1999 to 2003 is leavened by an 82 percent jump among 13- to 24-year-olds and a 32 percent leap in MSMs. Among the latter group, Reich says risky sexual behavior is on the rise, particularly men going into nightclubs, coming out to have sex in parking lots and then going back in.

"In the Fruit Loop [a conglomeration of gay bars and businesses near Tropicana Avenue and Paradise Road] you are seeing a resurgence of this," he says. "There is a large consequence in terms of the role this is playing in other STDs (sexually transmitted diseases)."

Equally troubling, Reich says, is news that only 57 percent of people with HIV/AIDS are receiving primary medical care and that 75 percent of those ages 20 to 39 have gone without medication, lab work or doctor visits for a year. Of the 6,981 HIV/AIDS-related hospitalizations in 2003, 72 percent to 79 percent resulted in emergency room visits; 30 percent of those ER patients had infections or parasitic diseases.

"Someone has to pay for this," he says, i.e., taxpayers.

The 813 enrollees in the AIDS Drug Assistance Program, which helps poor patients get medicines, is another of those good news-bad news tidbits. On the one hand, people are getting treatment; on the other, some are neglecting other health issues. Reich recently lost an HIV-positive friend to colon cancer. And he says all the data in the epidemiology report might actually understate the problem. Not factored in, he says, are the 100,000-plus tourists here on any given day.

"We may have 90 percent of the people diagnosed who are already here, but there are lots more people coming here who were not diagnosed here," Reich says. "Every report of HIV/AIDS comes through the county health district. After a lab analysis is done and comes back confirmed, then the case registers here. But if a guy comes from Chicago and gets care there, then he moves to Vegas, it doesn't register here as a case, which can affect funding (for HIV/AIDS services)."

Tall, angular and refined—basically a smoother version of former NBA star Julius "Dr. J." Erving—Arthur McCoy mans the check-in center at AFAN, charming and disarming as clients come for food, nutritional supplements or just to see his smile.

"I see people from all walks of life. I want to make sure they're comfortable," he says. "When it comes to HIV/AIDS, stress can be the biggest killer."

McCoy, 53, should know. He's been living with HIV for at least 15 years, maybe longer. Figures he contracted the disease during one of his periodic stints in jail for selling drugs, pimping and gang-banging with the Vicelords in Chicago. Flashes a timeworn tattoo to prove allegiance. "I was in Cook County jail in 1988," he says. "About 10 of us (fellow gang members) were using the same needle and ink to get tattoos."

McCoy tested positive in 1990. Clueless about HIV, AIDS or what came next—sickness? death?—he started taking medicines to fortify his T-cells and began praying. Soon, he got a job at a car-detail shop, a car, a condo, even a wife. As quickly as he rose, he fell. His wife got hooked on crack cocaine and began disappearing for days on end. Chasing her sapped his energy. His mother, who lived in Vegas, figured a change of scenery would do him good.

Once here, McCoy found F.A.C.T (Fighting AIDS in our Community Today), which directed him to AFAN, where he learned about Project Upfront, a three-day training program for HIV positive speakers. Working in the center, he gets to put his street pedigree to good use.

"Clients will sell food from the pantry for drugs. I can tell by the weight loss if they are selling their food," he told the gay-focused magazine QVegas. "I talk with them and encourage them to change. If a person is living in the gutter and doesn't know anything else, don't kick him when he's down, but help him up, love him. Everybody deserves a chance."

"The problem," McCoy tells the Weekly, "is that when people get HIV, they stop caring about themselves and the world stops caring about them. People only start caring when someone close to them gets HIV or AIDS. To see a child wither away, that does something to a parent. This is not a disease you can call a time-out on. Once you get it, that's it. You just have to learn to live with it. You have to surround yourself with positive people."

McCoy is the exception. Nationally, HIV/AIDS has cut a wide swath in the black community, leaving devastated families and communities in its wake. Only recently has the issue made its way into pulpits (a few), community groups and African-American dialogue.

HIV/AIDS isn't some new-kid-on-the-block epidemic. In 2001, it was among the top three causes of death for black men ages 25–54, the top four causes of death for black women 20-54 and the top killer of black women 25-34, according to federal Centers for Disease Control and Prevention. Generally the same story here. Blacks comprised 7 percent of the state's population in 2003, but accounted for 27 percent of new HIV/AIDS cases and 22 percent of people living with HIV/AIDS.

Says Byndloss: ‘"We don't have the numbers to qualify for an epidemic, but there's definitely a problem, especially in impoverished black communities."

Take West Las Vegas. Officials with F.A.C.T., established in 1998 to address the issue, say incidence rates are trending upward. In 2004, after six years at University Medical Center, the group moved into a 3,800-square-foot center adjacent to the UMC Quick Care in Wheeler Peak, just west of Martin Luther King Boulevard—the heart of predominantly black West Las Vegas. Good move. More than 1,500 people have been tested for HIV, counseled and educated in the last 12 months.

F.A.C.T.'s interim executive director, Eileen Mason, speaks in measured, evenly spaced breaths—like talking is a marathon and she needs to conserve her energy for the long haul. Fits with her approach to fighting HIV/AIDS: Miracles won't happen overnight. F.A.C.T.'s smorgasbord of programs for black youth and adults can only do so much. Eventually, someone or something will have to convince the black community that HIV/AIDS is as big a threat as gangs and drugs. The attack's centerpiece must address misperception, ignorance and fear. Decades after HIV/AIDS' arrival on the scene, Mason says, people still think they can get it from casual contact—a handshake or hug—or that they can tell if someone is infected just by looking. While What Happens Here, Stays Here keeps tourists coming, she says, it also gives people a false sense of security, like they can do anything they want—with no repercussions. As problems go, fear is the biggie.

"People fear being stigmatized. This is still very much a taboo topic in the black community and especially in the black church," she says. "Some churches do outreach—Victory (Missionary Baptist) does—but not enough of them do. For so long, the focus in the black community has been on gay men (as the problem), when the problem is more widespread."

Nothing like a little street evangelism to get the word out. Three times a week, F.A.CT. workers hit up recreation centers, parks, basketball courts, barbershops and athletic fields in West Las Vegas—anywhere they can bring the message to people's faces. With its steady stream of customers and catfish that attracts folks from Summerlin to Henderson, Mario's West Side Meat Market is as good a place as any. Outside the door, an elderly lady sits next to table stacked high with pink boxes—pies for sale. In front of her, a lanky man who's scraping 40 hawks baubles with Christian sayings.

Mason and four F.A.C.T. employees work the crowd like pros, convincing some to take red bags filled with condoms and pamphlets. She chats up three snazzily dressed men who say they've just come from a funeral. The chubby one declines condoms; says his girlfriend will think he's cheating if she finds them. Another F.A.C.T. worker has developed a new appendage, in the form of a short, darker-skinned man who's asking more questions than a prosecutor—interested in effectiveness of female condoms.

Relocated a few blocks over to the Nucleus Plaza on Owens Avenue and H Street, Mason and her crew blanket the commercial center, dipping in and out of barbershops and social service agencies. The welfare office is off limits—government rules. Once outside, a Hispanic family listens to the pitch. Mom promises she'll stay in touch. Back at F.A.C.T, client services liaison Tony Dorsey concedes that street outreach can only do so much.

"There are a lot of challenges in this area ... we're playing catch-up across the board in terms of social services over here, but particularly with HIV/AIDS; medicine can be very expensive and many people over here have scant resources," Dorsey says.

He adds a fifth head to the monster: confusion. Segments of the black population think HIV and AIDS is an automatic death sentence: Get it and you're a goner. Other view it as mostly hype: Former NBA star Earvin "Magic" Johnson has HIV and he's cool.

"People don't know what to think."

"The community has blinders on," says Jennifer Roberts, director of programs for AFAN. "We have a section of people who don't care because the symptoms haven't surfaced, and we have a section of people who are oblivious and willfully ignorant of the dangers."

We're in AFAN's cramped Rancho Road offices. Executive digs are on the second floor. Outreach coordinator Sybrina Bernabei has the jazziest room, filled with colorfully packaged condoms and flavored lubricants. After Oprah Winfrey aired a show last year on men who secretly have sex with men, Bernabei says black women in area churches flooded AFAN with calls.

Command Central is downstairs, a place called "the center"—where Arthur McCoy signs up new clients and keeps a database on old ones. Head through a nearby doorway and you're in the pantry. Fruits, vegetables and breads line the shelves. Clients are allowed one bag of groceries per week. More than 800 bags are dispensed monthly. Across the hall is the UMC Wellness Center, where the HIV-positive can get medicine.

Much like F.A.C.T., AFAN puts a premium on community outreach. "Anywhere where it's high risk, we go," Bernabei says, citing West Las Vegas, the Cambridge Area (near the Boulevard Mall), gay bars and Downtown.

"In any other major city, downtown is often the place where you'll find drug addicts and sex workers," Bernabei says. AFAN officials estimate there are at least 600 HIV-positive prostitutes plying their trade. "Some of the sex workers want to get off the streets and into a ranch (brothel) but can't because they are HIV positive."

In recent years, AFAN has targeted its resources even more acutely, focusing on geographical pockets. Says Roberts: "It's hard to do outreach because things are so spread out. This is not a concentrated community. We will go to areas if we're given enough information about the issues in the area. For example, there are a lot of sex workers near Nellis Air Force Base and in Naked City [behind the Stratosphere], but we need data to back up claims that there are problems. We have to do a cost-benefit analysis. Funding sources want to know that behaviors are changing (in the client populations)."

Big as AFAN is—14 full-time staff, $1.5 million annual budget, cadre of volunteers—it's still small. Three care coordinators (funding was recently approved for a fourth) work with upwards of 600 clients. One month earlier this year, they handled 1,409 client interactions. That's everything from arranging transportation and mental health care to securing housing assistance. From scheduling free haircuts, massages and reflexology treatments to helping clients find a job, a religious sanctuary or a social outlet.

"We never turned down a phone call," Roberts says.

Care coordinator Fabian Mera says the long hours are worth it. He has a good story: A 60-year-old HIV-positive cancer survivor came to AFAN three years ago. No job and pulling in $574 in monthly Social Security income—and wanting a new place to live. Over the past three years, he helped her manage her money, find medical services (the cancer is in remission) and win entry (via lottery) into a property run by the North Las Vegas Housing Authority. Make that two good stories: AFAN threw a pizza party for a mother of five who was recently diagnosed with HIV. "We told the kids about HIV, what to expect and what they can do to help their mom."

There have been bad experiences, too. The Hispanic community's been a particularly tough nut to crack. Deportation fears play a role. So does an insular, patriarchal culture. Mera says clients usually come in when they're at the end of the rope financially and medically.

In 1999, HIV was the second leading cause of death for Latino men ages 35 to 44 and the third leading cause of death for Latinas in the same age bracket. Three years later, Hispanics accounted for more than 8,000, or 20 percent, of the more than 42,000 new AIDS diagnoses in the United States, according to the CDC. The joint United Nations program UNAIDS reports that more than 1.7 million people are living with HIV in Latin America—which supplies a steady stream of migrants to Vegas. Last year, there were 95,000 AIDS-related deaths and 240,000 new infections in Latin America. Far from dire, Latino activists say local numbers (an incidence rate of 18.7 per 100,000 for Latin men) are still cause for worry.

The Nevada Association of Latin Americans is on Maryland Parkway, across the street from the adobe-styled Arturo Cambiero Senior Center and the Latin Chamber of Commerce's modern digs. Around since 1969, NALA is in its fifth year offering HIV/AIDS service—about 100 active clients. As care coordinator, Keanu Medina sees the obstacles on a regular basis. Sure, fears of deportation exist, but fear of embarrassment is more paralyzing. "Latin families are traditionally secretive," he says.

Hispanics who admit to being HIV positive often face a strand of ostracism more virulent than in the black community. Medina recalls a client who was kicked out of his parents' house. Louise Zuniga, an immigration/HIV outreach coordinator, says women who ask the boyfriends and/or husbands to use condoms risk humiliation or worse.

"The men might accuse them of fooling around. This is a very macho culture," Zuniga says. "Since this culture has a stigma of machismo, and females are viewed as being docile and domesticated, the men don't open up about sex to me like they do with Keanu. But Keanu has had little success in talking to women about sex. It's also a culture where there is a lot of pure ignorance about what HIV/AIDS is. People go from asking, ‘What is it?' to ‘If you get it, you're going to die'."

Hispanic teens are the great exception, Medina and Zuniga say. They're more receptive to using condoms. Giggles are guaranteed whenever Zuniga teaches teenage girls how to use a female condom. Teenage boys will endure any kind of lecture, so long as they get some condoms. "Many Hispanic kids are Americanized," Zuniga says.

Cultural assimilation also causes problems. Things their parents would frown on—drinking, drugs, tattoos, body piercings, promiscuity—some Hispanic youth embrace.

"You see it in a lot of the kids. They are different when they drink. Drinking eventually leads to drugs. Cocaine is big among our clients. It usually leads to crystal methamphetamine. Some clients refuse to have sex unless they're tweaking (high on meth)," Zuniga says. Earlier this year, a three-person team from the CDC visited and confirmed a syphilis outbreak.

Packaging services, a la AFAN, has met with muted success. You could hear a bird chirp when pharmaceutical companies put on informational workshops on HIV/AIDS—it was that empty. When NALA offers food vouchers, the place turns into a mini Vons. Occasionally, they run up against parents and old-timers who say they're promoting drug use and unsafe sex by giving out clean needles and condoms.

Medina says he tells them, "It's about risk reduction, harm reduction."

On Desert Inn Road, just east of the Boulevard Mall, sits the 2 12-year-old Medicine Cabinet, looking nothing like it sounds. Except for maybe the cabinet part. It's small; there are no medicines. Janis Brooks started the business to target uninsured blacks and Hispanics. According to the 2004 Families USA report, "One in Three: Non-Elderly Americans Without Health Insurance," there were 700,000 uninsured Nevadans in 2003. Nearly 58 percent of Hispanics lacked coverage, while 42 percent of blacks didn't have insurance. Brooks had witnessed her diabetic father's struggle with obtaining prescription drug insurance and read about the plight of seasonal workers in Nevada who don't work enough to earn prescription coverage and those who've exhausted their Medicare and Medicaid benefits. "I wanted to help," she says.

So she began establishing relationships with pharmaceutical companies (up to 240 now). Most companies readily agreed to provide drugs. Helps people, but more importantly, it looks good for the pharmaceutical industry. The Medicine Cabinet now provides access to more than 1,800 medications, from Allegra to Viagra, as well as 23 of 24 medicines commonly prescribed for HIV/AIDS, including Sustiva (which helps keep viral counts low).

"It costs $1,300 a month normally, but people can get it for free here."

It works like this: Clients pay a one-time $25 fee, then $10 for each 90-day supply of medication. Brooks says the company's role in the fight against HIV/AIDS is more than just providing drugs.

"People like coming here because it's a more discreet location (than a testing center)," Brooks says. "They don't have to feel guilty by association."

Back at the 7-Eleven on Fremont and 15th Street, things are winding down. More questionable characters are starting to surface. The same white Cadillac makes at least four trips back and fourth on Fremont. More women appear, too. Even a young girl or two. Of late, a few juvenile prostitutes have tested positive for HIV, says Kevin Morss, Westcare's outreach coordinator. "When they're working for pimps, getting tested isn't a high job priority. Some don't know anything about HIV or AIDS."

A group of kids that arrived early for the outreach—including two young boys who tease each other endlessly; the smaller one gets the best of the exchange, running out to the curb and yelling that his friend "sucks cocks and sucks dick"—are still there. Like the other kids, they've come to relish this weekly respite from their lives. The adults here listen, they care and, most importantly, they come bearing gifts. This week it was hats.

Byndloss says the kids offer the most promising inroads into battling HIV/AIDS. The ones that come out each week are knowledgeable beyond their years, forced to grow up faster because Mom or Dad, brother or sister or guardian, can't stay on track.

"These kids are on point," he says. "They know what the bleach kits are and how they work. They know about condoms. They take them and give them to the adults to use."

As the outreach winds up, a disheveled man walks up, his belongings in a plastic sack. From the looks of it, he's either homeless, recently released from county jail or both. He turns the blue bag upside down. Out falls a condom; his cheeks upturn, forming a smile.

"Thank you for giving this out in this area. You are saving lives."