Sunday, 28 December 2008

HIV among New York's African immigrants

Le Griot – April 2006

(Article published in French in Le Griot “Le Journal de la Diaspora” - a community newspaper for francophone West African immigrants in the Unites States.)

By Ann Tornkvst

A knocked-over One Way sign lies in the litter on 127th street in Harlem. A fleet of yellow cabs lined up outside an auto repair shop break up the monotonous browns and dirty grays of warehouse fronts. Another dash of color hangs from a large building’s bare brick façade: a yellow flag adorned with the green outline of the African continent, announcing 'The African Services Committee."

The name is also spray-painted in simple letters onto the heavy entrance door. Around one of the intercom's four black buttons, the grime on the metal has been worn away by frequent use, a fingerprint of clean steel surrounding buzzer number two. Inside, a polyglot health service targeting a specific population nestles quietly on the second floor.

In an attempt to encourage HIV-testing among New York’s Africans immigrants, the African Services Committee (ASC) guarantees it will not check clients’ immigration status. It also gives out groceries and metro cards. As visitors climb the lipstick-red, industrial stair-case leading to the modern health centre whose simple walls display carved African masks, a painting hangs opposite the entrance. It welcomes visitors with an odd motif. A man wearing a Western suit stands on a desert road. His open arms welcome a family dressed in Sahel robes.

The ASC tests 50 people for HIV every month, says Martha Kahirimbanyi, the Testing Center Manager. Among West African immigrants, who comprise the majority of African immigrants to the city, Kahirimbanyi estimates that five percent of the population is HIV positive. Citywide the figure is around two percent. One out of three patients from Southern Africa who are tested at the clinic is positive, the highest infection rate seen at the ASC.

The African immigrants in the greater New York area, estimated at 450,000 by the 2000 Census, face not only legal but also linguistic barriers to accessing health care. In April, NY Attorney General Eliot Spitzer announced that New York hospitals did not provide the basic translation services required by law.

Among 35 staff, Kahirimbanyi is a typical example. Originally from Uganda, she is fluent in Luganda and Rokiga. Her colleagues speak Kiswahili, Wolof and a host of other African languages. A young man walks into the waiting room greeting the receptionist with a big smile as he pulls of his gloves. "Ca va?" he queries. The 2000
Census indicated that 50,000 of the city’s African immigrants come from West Africa where French is a post-colonial lingua franca.

Efforts to improve translation services in health care are underway and Harlem Hospital is at the forefront of developments. A month after Spitzer’s damning report, Harlem Hospital collaborated with community-based organization African Hope and visited one of the West African mosques at the center of Harlem’s African community. The area around 116th Street is known as “Le Petit Senegal” and houses the majority of African immigrants to the city.

The ASC has similar initiatives. “We have two outreach workers who go out into the community to let people know about our services and also about HIV prevention,” said Salem Fisseha, Assistant Director of Health Services.

To improve its outreach and services, Harlem Hospital is recruiting volunteer translators and has invested $450,000 from the federal Office of Minority Health to assess employees’ language skills. “They are beginning to understand the needs of this group,” said Clarisse Mefotso Fall, the founder of Harlem-based health advocacy group African Hope, in an article published in Crain’s Business New York in June.

Although the 2003 Community Health Profile of Central Harlem reports that one in five of the neighborhood’s residents are immigrants, the report did not discuss that community’s specific problems and needs. In the HIV/Aids Surveillance Statistics published annually by New York City, figures are broken down by race, thus African immigrants and African-Americans are lumped together under the category “black.”

“The trend of the epidemic in NYC has shifted to communities of color and women in particular,” said Fisseha. In 2003, 806 black males died from AIDS in Manhattan. The equivalent figure for white males was 288. Black female deaths were 422, white female deaths were 64.

The virus was transmitted through homosexual intercourse among 15 percent of black males, compared to 42 percent among white males. The primary risk factor in Harlem is intravenous drug use according to the community health profile. Almost 40 percent of black males in Manhattan who died of AIDS were infected through intravenous drug use. Among white males, the figure is 35 percent.

It is extremely difficult to assess to what extent African immigrants are at risk of infection because of homosexual intercourse and intravenous drug use. Both practices are forbidden by Islam and most West African immigrants are Muslim. Iman Omar Diaby, at the 116th Street mosque, also believes that the family support structure is more solid among Africans immigrants than among Harlem’s majority African-American population, something which he believes prevents certain behaviors.

In terms of diagnosis and treatment, the population most at risk are illegal immigrants who fear, whether justified or not, to be deported. The 2000 Census points out that the real size of the African immigrant population cannot be determined because it is
believed many are here illegally.

"It's a reason why so many people don't access health care," said Kahirimbanyi. "They're scared they'll get into trouble." Thus at the ASC, the greatest incentive is neither linguistic diversity nor free metro cards, but that it does not check immigration status.

The center is independent from the NYC Dept. of Health although it receives grants from various state and federal agencies. Along 116th Street, businesses and non-profit organizations offer aid with applying for green cards that would qualify low-income immigrants for Medicaid. "You DON'T need a Green Card," announce the ASC's advertisements bluntly, a French translation next to the English text.

They are published in newspapers across the city, for example the Caribbean Sun Times, a local immigrant paper. The leaflet displays a photograph of a young woman, wearing a traditional African head piece and large gold hoop earrings, leaning her chin on her fist in an attentive pose.

The ASC also do not require to see a work permit or a social security number needed. At the center, staff doesn’t even ask for an ID, said Kahirimbanyi.

Due to patient confidentiality, Communications Director Catharine Bufalino denied access to the center’s clients, instead forwarding a document with a patient’s story. It highlights that the man was turned away from several city offices because of his immigration status. It also briefly mentions the stigma of HIV and Aids and the patient stated that he was “too ashamed to ask for the assistance of the immigrant Togolese community.” The ASC now supplies the patient’s anti-retroviral drugs.

The center also regularly offers wider health services, including tests for diabetes, blood pressure and tuberculosis. These screenings, says Kahirimbanyi, usually brings in even more clients. She reiterates that for many of the Africans, not having their immigration status questioned is far more important than the free metro cards and the groceries. Instead, the incentives have “brought in a whole new clientele,” older African-Americans
resident in Harlem.

Harlem is one of Manhattan's poorest neighborhoods despite rapid gentrification. According to the 2000 Census, 36 percent of the community lived in poverty. Providing health care in impoverished neighborhoods is challenging: Harlem Hospital has a HIV testing center, and there are community-based organizations working with HIV prevention, such as Harlem United that offers treatment and services to Harlemites struggling with the dual burden of HIV and drug addiction.

In the rest rooms of the ACS, magenta slips of paper are taped to the cubicle doors to inform clients that substance abuse on the premises will be prosecuted. In the staff kitchen, the October sun floods through the narrow windows that crown the building. “Someone is using something illegal in our bathroom,” says a white female staff member in her 40s as she holds up a tiny transparent plastic pocket, the traces of white powder inside it picking up the rays of afternoon sun.

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