Pathways Spring 2014

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pathways VOLUME 18 ISSUE 1

Published by Evergreen Health Services

from the editor

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PRESIDENT & CEO / Ronald T. Silverio EDITOR/ART DIRECTOR / John Carocci COPY EDITOR / Theresa Woehrel CONTRIBUTING WRITERS John Carocci, Shannon Curry Christopher Reybrouck, Cord Stone CONTRIBUTING PHOTOGRAPHER John Carocci ____________________________________________________

EDITORIAL & ADVERTISING / 716-847-0315 FACSIMILE / 716-847-0418 E-MAIL / publications@evergreenhs.org ON THE WEB / www.evergreenhs.org _________________________________________________

Copyright 2014 by Pathways, all rights reserved. Published by Evergreen Health Services, 206 South Elmwood Avenue, Buffalo, New York 14201. Pathways circulation is 5,000. Pathways is received by request by donors and supporters. Distribution is by mailing list and placement. Views expressed herein are not necessarily the views of the publisher. Publication of any person or organization in articles, advertising or listings in Pathways is not to be construed as any indication of the sexual orientation or HIV status of such person or members of such organizations. Pathways cannot acknowledge or return unsolicited manuscripts unless they are accompanied by a self-addressed stamped envelope. Pathways’ mailing list is never shared. Pathways urges readers to consult their medical practitioners about any therapies or treatment strategies in this publication. To be put on the Pathways mailing list call 847-0340 or email smalyszka@ evergreenhs.org.

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inside this issue From the Editor / 3 Pathways Profile: Laurie Abbatessa / 4 Evergreen Medical Group Faces the Future / 5 Hope Behind Bars: the CJI / 6 PrEP: the Latest Prevention Tool / 8 Introducing Team Evergreen Outreach / 11 AIDS Walk 2014: We're All Pals of Pannozzo / 12 Syringe Exchange Successes & Challenges / 16 Art Therapy at the Wellness Center / 20 Red Ribbon Week / 22 ON THE COVER

Vision without action is merely a dream. Action without vision just passes the time. Vision with action can change the world. – Joel Barker At this point it's cliche — the observation that the world of HIV/AIDS care is ever-changing, and that we must constantly adapt in order to continue meeting the needs of our patients and clients. It can feel like a game of Whack-A-Mole, with a new problem (or three) popping up before we've managed to hammer the current crisis back into the ground. But that image, while entertaining, doesn't tell the whole story. Yes, we often find ourselves responding to changes that seem to come out of nowhere, but, just as often, our leadership (Management Team and Boards of Trustees) anticipates those changes, and we deal with them proactively.

That's vision, and we've been fortunate to have a visionary at the helm for the last 25 years.  At the Evergreen Association's recent annual meeting, the carefully planned agenda was discarded and replaced with a tribute to our President and CEO, Ron Silverio, in honor of his 25th anniversary with the agency. We laughed and cried as we watched a video featuring Ron's memories of the early days. Staff and Board members (past and present) spoke of the impact Ron has had on all our lives, and as I looked around the room I couldn't help but be amazed at how everything has turned out. The Evergreen Association of today would be inconceivable to an AIDS Community Services employee or client of the 1980s or 1990s. Our comprehensive array of services, our facilities, our nearly 200 employees, our family of affiliate organizations, our expanded medical practice, our on-site pharmacy, our research collaborations, the list goes on and on. Of course, this isn't to say that the fight against HIV/AIDS is over, or that the challenges our clients face every day have gone away or even diminished. They haven't. But thanks to the vision and leadership of Ron Silverio, our Management Team, and our Boards of Trustees, we're prepared to meet the challenges of the future head on. On behalf of the Evergreen Association's clients, patients, Board members, volunteers, staff and supporters, along with anyone in Western New York who has been affected by HIV or AIDS, thank you Ron! — John Carocci

A guitar autographed by members of the band Styx will be auctioned off at AIDS Walk 2014!

Photo: Evergreen Association President & CEO Ron Silverio with Association Board Chair Joy Feldman

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PATHWAYS PROFILE

SPRING 2014

Laurie I've always loved the saying "Life is like a camera.

Focus on what's important, capture the good times, develop from the negatives, and if things don't work out, take another shot!" - Laurie Abbatessa

T

hese aren't just empty words. Laurie, a Nurse Practitioner at Evergreen Medical Group, has committed herself to making a difference in the lives of her patients. Laurie's medical skill, experience, compassionate nature, and passion for learning make her a perfect fit for Evergreen, where she has already made her mark in a relatively short period of time.

Laurie grew up in Fillmore, New York, a town in Alleghany County.

"I come from a long line of nurses," says Laurie, laughing. "Everyone in my family was always telling me to go to nursing school, so I wanted to avoid that at all costs. But when I got my first degree in psychology I started to think, maybe I can do both."

Laurie's education was extensive. She has degrees in math/science, psychology, and nursing under her belt. Laurie's post-grad research work is what got her involved with HIV/AIDS care, though she put up a bit of a fight.

"I was working with Dr. Chiu-Bin Hsiao as his Research Coordinator, and in 2003 he was sent over to ECMC to become Research Director of Immunodeficiency," says Laurie. "He asked me to come with him to help get things up and running.

I really wasn't interested. At that time there wasn't a lot of information about HIV/AIDS work in the schools. There still isn't. But he convinced me to help out, if only temporarily."

Laurie met a patient through her research interviews who was not only HIV positive, but his CD4 count was less than 5, and he was out of options. Despite his desperate situation, his courage and attitude had an impact on Laurie.

"His spirit and drive was so strong and so contagious," Laurie recalls. "He was an absolutely amazing man. Through him, I saw what HIV care meant, and it was a force that pulled at my heart. I went to Dr. Hsiao and said all right, I'm here, let's get this thing going."

Laurie's position with Dr. Hsiao became permanent, and soon they were busy with studies

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e Abbatessa for medications. Laurie found it spellbinding to watch people go from having no options in treatment to having fully suppressed viral loads.

Soon after, during the last semester of her masters in nursing, she had the opportunity to start a two year post grad fellowship with the AIDS Institute to train throughout the state and become an HIV specialist. This time Laurie took the position with no hesitation. After completion, the program rolled into an attending position at ECMC, where Laurie provided care to HIV positive patients for the next five years. She describes the experience as follows: "Meeting amazing people and having a brilliant collaborating physician has enriched the last five years so much."

Laurie's background in HIV care led her to Evergreen Medical Group, where she is able to provide care to HIV positive individuals and still

be involved with some exciting new programs.

She has been a driving force behind EMG's new Hepatitis C treatment program, along with the new PrEP program (a treatment regimen designed to prevent HIV negative individuals from becoming positive — see the full story on page 6), which already has five patients enrolled.

"One of the many things that drew me to Evergreen was that I wanted a place where the relationships with my patients and co-workers are more personal. Evergreen is a great place to be doing this kind of work."

Laurie told the story of a man who had asked his doctor about the PrEP program, only to be told "that's not for you, you're not at risk for HIV." "This doctor had no idea what his patient's risk really was, and no interest in finding out," says Laurie.

"At Evergreen we look at each patient's unique

situation, even – especially – things other providers might be uncomfortable discussing." Laurie admits this aspect of the job has been a challenge, because as the "new girl" she's still getting to know her patients, a process that simply can't be rushed. Finally, I asked Laurie her views on the current state of HIV care, and what she thinks the future holds for Evergreen.

"We're in a good position here. Treatments are advancing. Medications are easier to take and easier to tolerate. And, as the state shifts AIDS funding from prevention to primary care, Evergreen is exactly where we need to be. We can provide excellent medical care, along with care coordination and even prevention work through the Health Home system."

And the future?

"We're moving so fast, I can't begin to predict where we'll be in 10, 5 or even 1 year. But we're definitely heading in the right direction."

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Evergreen Medical Group Poised to Take on the Future In January of 1997, the premiere issue of Pathways featured a cover story about the new primary care facility at Evergreen Health Services (then known as AIDS Community Services). Evergreen Medical Group was a direct response to the lack of comprehensive, affordable health care available to HIV positive people in Western New York. Factors such as lack of transportation, poverty, mental illness, substance use, and the stigma surrounding HIV/AIDS combined to prevent many of our clients from getting the health care they needed.

The addition of primary medical care to our array of supportive services was an important step in our quest to offer "one stop shopping" under one roof, but there were other benefits besides convenience and easy access. Case managers (now care coordinators) and counselors were now able to work closely with medical providers, to identify potential problems and address ongoing challenges proactively. That led to better overall care for the client. It also allowed people who tested positive for HIV to be linked to medical services almost immediately, improving their chances of living a healthier, longer life.

Evergreen Medical Group is free of the stigma that — decades into this epidemic — people living

with HIV/AIDS or LGBT individuals continue to experience daily, even from well-educated medical professionals. EMG staff routinely hear accounts from patients about experiences with other medical providers, ranging from good to very bad. Addressing the unique health care needs of gay, lesbian, bisexual and transgendered people along with specialized HIV care has been a priority at Evergreen Medical Group since the beginning. As the 1997 Pathways article put it, "we want to create a safe space to address their (LGBT) health concerns," and that commitment remains in place nearly 20 years later.

Not everything has remained so constant in the world of HIV/AIDS and healthcare in general since Evergreen Medical Group opened its doors for the first time. Near miraculous advances in treatment and testing are helping HIV positive people live longer, healthier lives, and as a result we are seeing more and more older, positive individuals with increasingly complex medical needs. AIDS care will have to shift part of its focus to address the needs of an aging population.

Evergreen Medical Group has responded to these myriad changes and not only survived, but thrived in the new world of health care. The numbers speak for themselves. In 2013, the number of active

patients increased by 45%, to 1307. As of March 1, 2014 that number had already grown to 1400. The number of HIV positive patients grew by 22% in 2013; the number of HIV negative patients grew by 86% during the same period; and the number of transgendered patients increased by 51%. The staff is growing, as well, to accommodate the rapidly growing patient base. EMG added 13 staff members in 2013 and 2014, bringing the total roster to 25, including 2 Medical Doctors, 4 Nurse Practitioners, 4 Registered Nurses, 2 Licensed Practical Nurses, 2 Phlebotomists, a Medical Technician, 2 Medical Care Coordinators, and more. Evergreen Medical Group is a professional, fully-formed medical practice that is at the cutting edge of medical technology. Our state of the art Anal Health Program is providing a much needed service to individuals at risk of developing anal cancer or who have other common complaints such as anal warts, rectal itching, anal pain, fissures, infection and/or discharge — a service few other providers are able to offer. But EMG has not — and will not — lose sight of its original mission, which is to provide quality, compassionate health care services to everyone, including those who, for whatever reason, may feel they've been left behind by other health care professionals.

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"MANY PRISONERS ASSUME THEY'VE BEEN TESTED FOR SEXUALLY TRANSMITTED DISEASES INCLUDING HIV"

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n estimated 1 in 7 persons living with HIV pass through a correctional facility at some point in their life, and while most of them acquire HIV outside prison walls, inside is where the initial diagnosis is often made and treatment begun. Incarcerated populations are more likely to face many of the risk factors associated with acquiring and transmitting HIV: injection or other recreational drug use, commercial sex work, untreated mental illness, and lower socio-economic status among them. Many enter the prison system with a history of activities increasing the risk of exposure to a variety of sexual and blood borne infections. Some have even deliberately used prison as an alternative to secure food, housing, and healthcare due to the multitude of psychosocial barriers they face in their lives.

As of 2011, there were 5,899 people in upstate New York prisons living with HIV and AIDS. 41 of those were newly diagnosed with HIV, and 60 were newly diagnosed with AIDS. This is an indication that New York State has work to do to educate the inmate population about HIV/AIDS and other infections. Many prisoners assume they've been tested for sexually transmitted diseases, including HIV and HCV, because blood was taken upon their arrival.

In reality, only routine blood tests, Syphilis and Hepatitis B tests are being conducted at intake.

As a result, prisoners often engage in risky behaviors with other prisoners (and with spouses during conjugal visits) without knowing their true status, putting the community at risk.

Evergreen Health Services implemented the Criminal Justice Initiative (CJI) in March 2011. Since then, we have provided educational and supportive services to more than 1,500 inmates at the Collins, Gowanda, and Wende Correctional Facilities. Our primary goal is to reduce the number of new HIV, HCV, and STI infections among New York State's prison populations, but we also provide inmates with a continuum of HIV education and supportive services, especially for those affected or infected

by HIV and those who are returning to their home communities. These services are designed to diminish HIV transmission, create awareness of HIV, STIs and Hepatitis, and improve the health and well-being of those who are

incarcerated, both now and after their release from prison. The CJI at Evergreen Health Services uses three strategies to ensure effective service delivery, described below.

Video Opportunities for Innovative Condom Education and Safe Sex (VOICES) is a program using video and facilitated discussion to educate inmates about how to use condoms safely and effectively. Discussions focus on how to negotiate safe sex decisions with sexual partners. Since many program participants have been incarcerated for years or even decades, it's not unusual for someone to be unaware of the proper way to use a condom or the basics of how to protect themselves from sexually transmitted diseases. Understanding safe sex options is essential for those who are re-entering society, particularly those who were not eligible for conjugal visits (usually intimate or sexual contact with a spouse) and have not been sexually active for years.

CJI also oversees a Peer Facilitator Training program, which provides information about HIV, STIs, and Hepatitis to inmates. This program uses a combination of abstinence, prevention, and harm reduction based approaches.

Participants who complete the Peer Facilitator Training program leave with the knowledge and presentation skills necessary to not only advocate for themselves and apply these skills to their own personal lives, but to educate others on how to do the same. This program gives inmates a sense of accomplishment and can also potentially fulfill future academic programming requirements.

One challenge faced by our prison system is the high rate of recidivism, especially among those who are on parole. CJI addresses this by providing linkage to medical care, housing, case management, evaluations for alcohol, drugs, and mental health, education and employment services, and other supportive services to HIV positive inmates who are being released. These services help people make the transition from prison to community, become more selfsufficient, and at the same time reduce or even eliminate the factors leading to recidivism.

In addition to the interventions and services that the Criminal Justice Initiative provides, there is a Prisoners for AIDS Counseling

and Education (PACE) program in two of CJI’s three targeted correctional facilities. The goal of the PACE program is for inmates to provide assistance, support, and education to those who are infected or affected by HIV or other sexual and health related infections. Inmates who have graduated from CJI's peer training program are encouraged to participate in PACE and facilitate HIV 101 sessions to members of their program.

CJI has a close relationship with PACE, and we utilize these members during new inmate orientation to inform new arrivals of our services. We also utilize PACE as a referral source to recruit eligible prisoners for our transitional services.

A group of peer training graduates who are also members of the Latinos In Progress, Positive Change Organization and Inmate Liaison Committee groups established the first annual AIDS Awareness Day at Gowanda Correctional Facility. Evergreen Health Services had an opportunity to speak to a group of over 100 inmates who have been involved with HIV/AIDS awareness, and those who want to fight the epidemic inside of the prison population as well as in their communities. I had the opportunity to speak at this event about the basics of HIV, how statistics relate to their prison and outside communities, programs and services which combat the epidemic inside and outside the facilities, High Impact Prevention, HIV testing, and pre- and post- prophylaxis. Lisa Schult (Correctional Services Specialist) and I also had the opportunity to see the prison's civilian staff, who are very supportive of our HIV education and interventions within the facilities. Inmates who are in medium and maximum security facilities have to overcome many challenges to get educational events like AIDS Awareness Day into their facilities. It took this dedicated group of inmates about two years to make the event happen. In addition, the programs raised a total of $300, which will be donated to Evergreen Health Services to honor all of the lives that have been touched by our services over the years. Sexual health may be the least of the many worries a prisoner has, but the level of care we give to our clients and participants makes it easier for them to make it a priority and keep themselves safe and healthy.

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At Evergreen Health Services, our goal is to provide the tools clients need to live healthy, happy lives.

This often includes sharing information about new medication and therapies available for treating chronic illness. Recently, the FDA approved a once-a-day pill for preventing HIV infection among those at high risk for contracting the disease. The pill is called Truvada, and the strategy is called PreExposure Prophylaxis, or PrEP for short. It’s one of the new tools in Evergreen’s risk reduction toolbox, and our healthcare providers have been trained to help you assess if PrEP is right for you. If taken

properly every day, PrEP can largely prevent HIV negative individuals from becoming HIV positive.

It has been approved by the FDA for use by HIV negative individuals who are considered at high risk of HIV infection. Who is considered at “high-risk” for HIV infection? Individuals who…

• • • • •

have unprotected anal sex have multiple sexual partners have a sexual partner who is HIV positive do not actively use condoms have a history of sexually transmitted disease

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PrEP takes about seven days to become fully active and offer maximum (99%) protection against HIV • •

use injection drugs have a history of sex work

If you fall into one or more of the above risk categories, and are currently HIV negative, you may be a good candidate for PrEP. It is important to know your own sexual behaviors, take control and have a frank conversation with a healthcare provider to discuss if PrEP is right for you.

PrEP Must be Taken Regularly Research has proven that PrEP is 99% effective at preventing HIV if treatment is taken every day. However, like any medication, PrEP is only effective if taken exactly as prescribed. The less it is taken, the less protection it will offer. Other important facts about PrEP: •

• •

•

• •

PrEP is only for HIV negative individuals.

HIV positive individuals need more than just Truvada to control their HIV. PrEP only prevents HIV, not other STDs. Taking PrEP requires initial blood tests and HIV screening. After being approved by a medical provider, follow-up to renew the Truvada prescription is every 90 days and includes continued HIV screening.

PrEP takes about seven days to become fully active and offer the maximum (99%) protection against HIV. PrEP is not a cure for HIV. When on PrEP, it’s important clients take it every day, and not just when they anticipate sexual or non-sexual risks.

PrEP has the potential to greatly reduce HIV transmission. We have to start including PrEP in the conversation, be willing to openly address sexual behaviors, and champion people to take control of their sexual health. We encourage you to speak to your healthcare provider about PrEP, or contact Evergreen Medical Group at 716-847-0328 for P more information about PrEP.

10 SPRING 2014

Volunteers Needed!

As an agency founded on the hard work and commitment of five volunteers, our appreciation of your willingness to serve the community is immeasurable.

Visit our website today to learn more about the volunteer opportunities available at the Evergreen Association!

www.EvergreenHS.org Evergreen Health Services - Benedict House - Pride Center - Community Access Services

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It

all started when Evergreen Executive Vice President Ray Ganoe attended a lunch meeting at one of Buffalo's LGBT bars. Over the course of the meeting, he was approached several times by staff and other patrons who had questions about Evergreen Health Services.

When Ray noticed the bar's condom dispenser was empty, the bartender confessed that he went to the Evergreen Center on a regular basis to get stashes of condoms to give out at the bar.

These conversations struck a chord with Ray, and the seed was planted for the agency's new Team Evergreen outreach program.  Evergreen has always had good lines of communications with Buffalo's LGBT bars and clubs, but Team Evergreen takes a more direct approach and formalizes that connection. Every 6 weeks, an outreach team comprised of staff and volunteers will make the rounds of the bars dressed in special outreach t-shirts, handing out condoms, engaging patrons in conversation about sexual health issues, and getting the word out about the services available at the Evergreen Center.  Each of the outreach sessions will focus on a theme relevent to LGBT health (the Anal Health

Program at Evergreen Medical Group, the PrEP program, home HIV testing, etc.) but condom distribution will be constant, and a tool team members can use to break the ice with bar patrons.  The outreach program made its debut in March with a "Grab a Handful" poster campaign in the bars, designed to encourage condom use among MSMs (men who have sex with men). Posters identified locations in the bar where condoms are available, and featured contact information for Evergreen Health Services. Response from the bars was uniformly positive, and two of them even called to request more condoms. April 12 marked the first public appearance of the Team itself, armed with even more condoms and information about the Anal Health Program.  The Team has just gotten started, but organizers are already looking ahead. "It takes time for our presence to really sink in with the public," says Christopher Reybrouck. "But once that happens, and people become comfortable with us, we can be present without being intrusive. Eventually, people will see our Team Evergreen t-shirts, and know they can approach us with any of their sexual health questions."

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12 SPRING 2014

Now We

AIDS Walk has always been more than just another fundraising event. Sure, the money we raise each spring is vital, helping support the programs and services our clients and patients depend on every day. But AIDS Walk is also about coming together as a community, to remember those we've lost to this terrible disease, to honor and support those who continue to struggle today, and to send a message, loud and clear, to the rest of the world: AIDS is still here. The Walk has been going strong for over twenty years, and it can be a challenge to keep the day fresh and interesting without changing the things people really like. Sometimes we miss the mark, like the year we traded spring sunshine for autumn breezes. Other changes have been more successful, like the flower launch which quickly became a highlight of the day for many walkers. But these details are ultimately just that: details. The real vitality, the real energy comes from the people who take that first critical step — deciding to get involved to make a difference in our community. It's the most important step of all, and we hope you'll take it with us on May 10.

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facebook.com/aidswalkbuffalo

e'reAll Pals of Panozzo!

THEBIGNEWSÂ

for AIDS Walk 2014 is our Celebrity Chairman Chuck Panozzo, bass player and founding member of the legendary rock group Styx. Styx was a fixture on the charts in the 70s and 80s, with 16 top 40 singles in the United States, including the smash hit Babe. In 1991, Chuck found out that he is HIV+.

He didn't seek treatment, and was symptom free for years. Then in 1997, the disease struck hard.

"I had every condition that comes with advanced HIV," recalls Chuck. "I lost fifty pounds, and I had terrible anemia." As Chuck lay at home, seriously ill, he made himself some promises. One was to get well, another was to go public with his condition, and the third was to perform on stage with Styx

once again. Chuck kept all of those promises.

In 2001, speaking at a Human Rights Campaign dinner in his hometown of Chicago, Chuck came out as a gay man living with HIV, and since then he has used his celebrity influence to promote AIDS awareness and support a variety of gay rights causes, including HRC's Coming Out Project. Chuck considers this new role one of his most important.

"I feel I can help with equal rights, stand against hate and violence, and do everything I can to make this a better world for the next generation" says Chuck. Meanwhile, here in Buffalo, a group of Chuck's loyal fans (Pals of Panozzo) has walked in the AIDS Walk for the past several years. Chuck himself has supported the team that bears his name,

giving guitar picks and autographs to the Pals of Panozzo's supporters. This year Chuck and the Pals are taking it to a whole new level. Not only has Chuck agreed to be the Celebrity Chairman for our 2014 Walk, he has donated a Fender electric guitar, autographed by his Styx bandmates, to be raffled off at the Walk! The Pals of Panozzo are stepping it up as well, using social media to expand their fundraising and awareness efforts to Styx fans all over the world. Since Pathways doesn't get to do many celebrity interviews (total so far: 0) we pulled out our Paradise Theater CD and asked Chuck Panozzo a few questions. Q: Is HIV something you thought about before you knew you were HIV+? (continued on next page)

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(Chuck Panozzo, continued from previous page) Chuck: No. I'm from the Midwest and the Harvey Milk generation. It wasn't until friends started to get sick and die that I realized the beginning of an illness was taking place; one that progressed from a gay disease to a global epidemic. Q: How has HIV changed your life? What do you do to counter its impact, especially when you’re on a grueling tour schedule? Chuck: It's been a life changing experience. 30 years into this, and it's now a chronic illness instead of a death sentence.

Thank you protease inhibitors, research, and the men, woman and children whose names on the AIDS Quilt give testimony to the most politicized illness. Q: Have bandmates/fans/colleagues in the music business been supportive? Chuck: Yes. After recovering from full blown AIDS, I returned to Styx on a limited touring schedule. Fans embraced my return. I returned to the stage on September 11, 1999 in Las Vegas. Tommy introduced me, and when I walked out on stage the crowd was chanting my name. I could see the joy on everyone's face that I was back on stage. Once I accepted myself, Chuck, being gay or HIV+ became a non-issue. Q: Pals of Panozzo team is one of our most enthusiastic teams. How did you meet them?

Chuck: Michele sent me a beautiful email expressing her support following the HRC dinner. She asked me if I had thought of doing a website, and offered to set one up for me. I was touched, and accepted her offer.

I met her sister, Mary Jean, through Michele and we've all been friends for over 10 years. Q: Is there anything else you want to say? Chuck: I've been given a unique opportunity to make a difference, and I don't take that opportunity lightly. My commitment to equal rights for all is as important to me as any work I've ever done on stage. And so my work continues. My wish is to inspire others, gay or straight, to live a proud, truthful life.

If I can help just one person to follow his bliss, I have changed the future.

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Above: Chuck Panozzo back on stage with Styx; Below: the Pals of Panozzo at AIDS Walk.

Opposite: this Fender guitar autographed by members of Styx will be raffled off at AIDS Walk.

Raffle ckets can be purchased at the official AIDS Walk website: www.AIDSWalkBuffalo.org

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17 SPRING 2014

HIV Rates Among Injection Drug Users Continue to Fall While Overdose and HCV Are Growing Concerns In 2009, the United States House of Representatives passed a bill ending the ban on federal funding of syringe exchange programs (SEPs). This was an important step in the fight against HIV and AIDS in America. Federal funding of SEPs had been prohibited since 1988, despite overwhelming evidence that these programs help significantly slow the spread of HIV and other blood-borne diseases among injection drug users. Buffalo's syringe exchange program, known as Project REACH, was started in 1992 in response to the high rate of HIV infection among this population. It has been a resounding success. HIV infection rates among injection drug users in Western New York have fallen, from approximately 35% early in the epidemic to under 7% today. In 2007, Project Reach became part of Evergreen Health Services (then AIDS Community Services) and was renamed Project SAFE (Syringes Available for Everyone).

Project SAFE currently operates on the first floor of the Evergreen Center in downtown Buffalo.

MANY

of us born in the 1970’s or 1980’s were blissfully unaware of what a horrific me it was for millions of individuals. People waited weeks for HIV test results and prepared for death, became sick on medica ons and became sick without them. Fear of the virus perpetuated hateful s gmas, and ignorance about HIV transmission and risk factors encouraged the mistaken belief that it was not something a straight person needed to be concerned with. Except it was, and it absolutely s ll is.

HIV and AIDS may s ll be most commonly associated with unprotected sex, but it was injec on drug users that accounted for nearly 36% of all new HIV and AIDS cases when the epidemic began. This quickly forced government agencies and health care providers to consider a paradigm shi that would later prove to have a revolu onary impact on the drug community: Syringe Exchange Programs (SEPs). Recent sta s cs es mate HIV infec on through sharing needles during injec on drug use to have fallen by 80% since the incep on of SEPs. With an es mated life me cost of treatment for an HIV posi ve person between $385,200 and $618,900, SEPs have not only saved millions of lives, but saved billions of dollars. At an average annual cost of opera on around $169,000, SEPs are extremely cost-effec ve and essen al to both drug users and non-users alike. In areas of Eastern Europe and Asia that do not permit SEPs, nearly 83% of all HIV cases are due to injec on drug use. This highlights just how quickly and effec vely the virus can be transmi ed when injec on drug users don't have access to sterile

syringes. Project SAFE (Syringes Available For Everyone) staff con nues to remind our par cipants that although HIV infec on has dropped dras cally it has not disappeared completely. Using a new, sterile syringe for each injec on is the safest way to prevent transmission, but discussing how to properly use bleach to disinfect is an integral part of harm reduc on as well. To date, there have been only 13 reported cases of HIV by injec on drug use since Evergreen began offering tes ng in 2004, with the most recent case iden fied in 2011.

Project SAFE sees ever-increasing numbers of younger individuals that never lived through the HIV/AIDS epidemic, and so our message of safe injec on has never been more important.

Photographs of emaciated AIDS pa ents slowly dying in a hospital bed have been replaced with images of athletes and smiling faces. The fis uls of medica on have been replaced with two or three pills. The message is clear: this is not the 1980’s anymore, and there is life a er HIV. While this is a message of hope and encouragement, we must never become complacent and lose sight of how our program came to be, or forget the people who lost their lives and loved ones due to one used syringe.

Increased rates of infec on are also being seen among demographics that were previously rela vely unaffected, such as white males and females that reside in suburban or rural areas, and fall into the 15-24 age group. The Massachuse s Department of Health reported a 74% increase in HIV infec on between 2002 and 2009 among individuals seeking treatment for chronic HCV infec on. Soon the rest of the

country, including Buffalo, began no cing and repor ng similar increases.

It can be difficult for people to really understand how HIV and HCV differ. Some believe that since HIV infec on rates have been so dras cally reduced by using new syringes or never sharing with another person, then they have taken all the necessary precau ons to keep themselves safe. Not so. HCV has thrived in the shadow of HIV. As we began to be er understand HIV and its transmission, SEPs provided the best way for injec on drug users to protect themselves against infec on; new, sterile syringes. But while HIV rates have fallen, HCV rates showed alarming increases due to its resiliency and ability to live outside of the body for several days – typically in the co ons, cookers and other works injec on drug users use. Many Project SAFE clients are aware of why it is necessary to use new syringes for HIV preven on, but have limited knowledge about HCV and how to protect themselves. This is especially dangerous, as HCV morbidity has surpassed that of HIV in recent years.

While some individuals who do not use drugs may have li le concern about the HCV epidemic sweeping the injec on drug using community, they should. Intravenous drug use is the core method of transmission. However, HCV is a blood-borne pathogen so the possibility of being infected goes well beyond sharing needles. An es mated 50-75% of all individuals infected with HCV are unaware of their status. A 2006 California study found the hospital costs of trea ng liver disease in people with HCV to be almost 1.4 billion dollars over just one year, in California alone. Early diagnosis and consistent viral load monitoring can dras cally reduce the chance of HCV progressing to a chronic state, and new non-Interferon based treatments have shown promising results in eradica ng the virus en rely.

At Project SAFE, we are thrilled that not only are we able to provide on-site tes ng, but can now refer clients to Evergreen Medical Group for treatment. People o en report poor treatment at other prac ces due to the s gma za on of (con nued on next page)

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Project SAFE is a beautiful example of the community taking care of the community in a world where addiction and those who suffer from it are gravely misunderstood

(SEP con nued from previous page) drug use. However, the ability to seek treatment from within an organiza on they already trust has encouraged many clients to face the virus by ge ng tested or finally seeking help. These brave steps can be very empowering, and have led to increased numbers of our par cipants taking control over their health and wellness.

SEPs have helped reduce the rates of HCV, but with injec on drug use star ng at a younger age the amount of new cases (diagnosed and unknown) versus the amount prevented are showing signs of poten al overlap.

According to the Massachuse s study the length of me it took the average injec on drug user in the 15-24 age range to transi on from taking prescrip on pills to injec ng heroin was only 1-1.5 years. Educa on about HCV preven on during this short but cri cal me period can be extremely difficult when many individuals who reside in suburban or rural areas o en rely on others with easier access to the city for supplies, or simply go without. Community outreach can be equally difficult, but may have go en a li le easier for one unfortunate reason: publicity surrounding recent overdose deaths.

Research has proven me and again that

SEPs benefit the community as a whole. Not only have they helped to reduce the incidence of HIV and HCV infec on, SEPs are a place for par cipants to receive other life saving informa on, training, and links to health care or even treatment for addic on. Project SAFE offers free Narcan (naloxone) training – the “an dote” as referenced in some news ar cles.

Since Project SAFE began offering the training in February of 2008, 545 people have been cer fied to administer Narcan, and over 200 lives have been saved, with a notable increase over the past 6 months. Mayor Byron Brown’s recent announcement that Buffalo Police will begin to carry intranasal Narcan marks a monumental advancement for harm reduc on in Buffalo and a renewed commitment to protect all members of the community. Project SAFE along with the New York State AIDS Ins tute will be in collabora on with the Buffalo Police Department (and, poten ally, other first responders who par cipate in the program) to ensure that their Narcan programs are successful. With the recent publicity surrounding deaths due to overdose, staff at Project SAFE have been approached by many members of the community seeking informa on about Narcan and other services.

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What has been an incredibly diďŹƒcult me for our community has also helped spark meaningful dialogue about harm reduc on and addic on.

In addi on, this allowed us to be received by other agencies such as the Jamestown Mental Health Associa on, schools, halfway houses, and other community based organiza ons. The heroin-fentanyl mix that has been the cause for many of the deaths reported in the media have also inspired a new wave of SEP par cipants to become trained. The conversa ons taking place within the program between par cipants have been increasingly suppor ve as strangers urge other strangers to be trained, stories of the success of Narcan are exchanged, love and condolences are given to those who have lost someone‌ Project SAFE is a beau ful example of the community taking care of the community.

In a world where addic on and those who suer from it are s ll gravely misunderstood, this program exists to provide a safe haven for each and every par cipant. They will never be judged by their HIV or HCV status, age, race or sexual orienta on. Instead, they will always be celebrated for their commitment to keeping themselves and others safe.

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Tezozomoc Raul Campillo Chavez, a member of the Wellness Center's Art Therapy group at Evergreen Health Services, creates vibrant, colorful images in pencil and watercolor. Chavez says Scratchliquatl (above) represents the intersection of his Chicano heritage and interest in hip-hop culture. The untitled image detail at left, also by Chavez, features glyphs which translate to "West Side Buffalo". Watch for more artwork from the Wellness Center's Art Therapy group in future issues of Pathways.

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22 SPRING 2014

The Red Ribbon is Back!

by Christopher Reybrouck

Are you interested in selling Red Ribbons or getting involved with World AIDS Day 2014?

Contact Event Coordinator Christopher Reybrouck at 716-847-0212 or via email at creybrouck@evergreenhs.org.

World AIDS Day is observed on December 1st each year, in order to raise awareness and focus a en on on a global epidemic that con nues to affect millions of people. It is an opportunity for businesses, community organiza ons and individuals to promote preven on educa on, while suppor ng those who are living with HIV/AIDS and commemora ng those we have lost. Evergreen Health Services expanded the push for awareness and remembrance with Red Ribbon Week, and asked Western New Yorkers to wear the Red Ribbon from December 2 - 6, 2013 to show their support for HIV/AIDS awareness. Ribbons were available at Evergreen Health Services, SPoT Coffee on Hertel Ave, and Buffalo Fleece and Outerwear for a suggested dona on of $2 - $5. Independent Health created a fun awareness promo on; employees were asked to donate $2 for a Red Ribbon, and in return they were able to dress down at work and wear the Ribbon. Pictured above is Dr. Thomas Foels, Execu ve Vice President & Chief Medical Officer of Independent Health presen ng a check for $1056.50 from their Red Ribbon sales to Evergreen Health Services Execu ve Vice President Ray Ganoe.

Red Ribbons were a buzz around town in December, with not only all employees of Evergreen Health Services and many local HIV/AIDS advocates wearing them, but also all on-air news personali es on WKBW Channel 7 in support of World AIDS Day. The awareness effort was also a financial success, raising over $3,100 in just a week for Evergreen Health Services and Benedict House in honor of World AIDS Day and Red Ribbon Week.

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