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A Vision of a Grim Past and a Hopeful Future
GROWTH Brenda Cyrus, a client and board member, gripping scissors at a ribbon-cutting on Wednesday for the expanded East New York Community Health Center.
By GINIA BELLAFANTE
Published: April 6, 2012
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On a bright morning last week, the East New York Community Health Center celebrated its gleaming expansion, something made possible largely by a $541,000 federal grant of the kind intended to flourish under the imperiled Affordable Care Act.
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Shirlene Cooper, an AIDS activist.
Supported by various public funds, the center is run by Housing Works , the 22-year-old nonprofit organization that acts as a kind of entrepreneurial Robin Hood, collecting the discards of the affluent — the merino wool sweaters, lacquered end tables and Lorrie Moore novels — and selling them to help finance the needs of poor people with H.I.V. and AIDS. The newly refurbished wing functions as a site for primary care, offering patients treatment for virtually any kind of ailment. Everyone is welcome no matter the particulars of insurance or immigration standing.
Death rates from AIDS in East New York are among the highest in the city, a matter that has supplied the center with its irrefutable abiding logic: that the best prevention against the disease is the maintenance of physical and mental well-being generally. To this end, substance-abuse treatment, pediatric care, dental care and counseling are all provided; so too is acupuncture.
According to the most recent municipal health statistics , there are more than 110,000 people living with H.I.V. or AIDS in New York City. In 2010, close to 80 percent of new diagnoses were among blacks and Hispanics, while transmission through heterosexual sex outpaced transmission through intravenous drug use by more than four to one.
Thirty-two thousand of those with clinical symptomatic H.I.V. or AIDS are poor enough to receive assistance — over and above Medicare and Medicaid — from the city's H.I.V./AIDS Services Administration, which despite recent and proposed cuts has an annual budget of more than $400 million. The wisdom of holistic, preventive care would hardly seem to require an ardent defense. The East New York Community Health Center embodies at once the vision of a hopeful, compassionate future and a grim, dismissive past. Adjacent to the new primary-care wing is its longstanding AIDS clinic, whose cafeteria one afternoon last week felt like an alternate final chapter of the story of New York in the 1980s, in which the accepted belief of revival and renewal is undermined by the realities of poverty's physical impact.
Most of the men and women sitting down to lunch were middle-age or older. I initially met Brenda Cyrus, 61, who contracted H.I.V. when she was living in the crime-ridden projects in Red Hook in the early 1980s. Her partner, who eventually died, had gone away to prison on a robbery charge, returned home sick and didn't tell her, Ms. Cyrus said.
For several years she didn't realize she had been infected, and she had two children. They tested negative, but her older son got sick himself and died at 22.
Another woman in the room, Shirlene Cooper, a passionate AIDS activist, embodied the extent to which the poor are susceptible to what doctors describe as problems of co-morbidity, the presence of multiple disorders.
Ms. Cooper, 49, grew up in the Walt Whitman Houses in Fort Greene. When she was young, her 4-year-old nephew was hit in the head by a stray bullet while he was outside playing. He survived, but another nephew was murdered by his girlfriend's son while Ms. Cooper was imprisoned for shoplifting.
"There was nothing for a young girl growing up there," Ms. Cooper told me. "Walking back and forth to school was dangerous; I lost interest." Eventually she turned to crack, marrying a Syrian man, who needed a green card, in exchange for money to support her drug habit.
Poverty and trauma and the courses she pursued as a result seemed to ravage every cell in her body. She received diagnoses not only of H.I.V. but also of cervical cancer, tuberculosis and syphilis. Ms. Cooper did not consider her circumstance particularly unusual. "If you imagine your life as a pie," she said, "half of it is spent in the hospital." Recently she learned that she had oral cancer.
When I introduced myself to Ms. Cooper, who sits on a city AIDS advisory board, she was helping an older man with AIDS, Jerry Adams, try to figure out what to do about housing. The lease was up on his apartment, which had mold and rodent problems.
He paid $40 for a credit check for a new place, but the landlord would not accept the voucher the city's Human Resources Administration is offering in place of security deposits. The use of vouchers is a practice Ms. Cooper and other activists have been seeking to reverse. She has also been working to agitate for a state law that would reduce rent burdens of poor people with AIDS.
The Affordable Care Act allocates $11 billion over five years to community health centers like the Housing Works site in East New York, which thanks to its expansion will be able to see more than twice as many primary-care patients a year — about 2,600 — approximately 80 percent of whom are homeless.
Twenty-six hundred is not an immense number in the skewed scale of New York, but the weight of a story like Ms. Cooper's strains any efforts at measurement. Two days after I met her, and a little over a week after the Supreme Court heard oral arguments pertaining to health care reform , she was admitted to the Memorial Sloan-Kettering Cancer Center.
E-mail: bigcity@nytimes.com
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