2008

Making Testing Accessible

Zachary Westcott knows that he should get tested for HIV. As a 27-year-old sex worker who serves both women and men, he is especially at risk. But the lines at clinics are long and the staff can be callous, so he tends to put it off.

Originally published in Gay City News, April 17, 2008

Zachary Westcott knows that he should get tested for HIV. As a 27-year-old sex worker who serves both women and men, he is especially at risk. But the lines at clinics are long and the staff can be callous, so he tends to put it off. On a recent afternoon in Greenwich Village, however, Westcott ran into a man offering free HIV tests who wouldn’t take no for an answer.

“It’ll only take 20 minutes, scout’s honor,” said Craig Gibson, an outreach worker for the Harlem-based group Gay Men of African Descent (GMAD). “This way you can go tell whoever you’re vibing with that you’re negative.”

Westcott agreed to get tested, and followed Gibson back to GMAD’s mobile testing van, parked near the intersection of Christopher and Washington Streets in the West Village, just a block from the piers. A tall, burly man in gray and white army fatigues, Gibson enjoys bantering with his clients on the way back to the van, often complimenting their fashion choices. It’s his way of establishing a rapport and putting them at ease.

“It caught me off guard,” said Westcott, who wore a nose ring and a black newsboy cap. “Somebody cares about you, and they don’t even know you.”

Inside the van, Westcott was greeted by Columbus Gaskins, a soft-spoken man with a salt-and-pepper mustache, who helped him fill out the necessary, pre-testing paperwork. The forms include a portion for sexual history, with questions like, “Have you ever had sex for drugs or money?” Then Gaskins led Westcott into a private room, where he scraped some cells from the inside of his cheek with a plastic stick, and inserted it into the testing device, which resembles a digital thermometer. Twenty minutes later, if the screen on the device showed a pink strip, the test would be positive.

In addition to his work as a prostitute, the fact that Westcott is young, black, and gay places him at particular risk for HIV. A recent New York City Department of Health study found that incidence of HIV in gay men under 30 increased by 33 percent from 2001 to 2006, with African Americans and Latinos especially hard hit.

Other studies have shown that people who know their status are less likely to infect others. For this reason, the DOH funds groups like GMAD to provide free, anonymous testing. The purpose of the mobile van is to catch people, like Westcott, who are unlikely to get tested at clinics.

Although groups like the Harlem United Community AIDS Center and the William F. Ryan Community Health Center also have HIV testing vans, GMAD’s is the only one to focus solely on gay, African-American men. In addition to Christopher Street, GMAD’s van visits Hell’s Kitchen, Central Park North, and East 125th Street. The group has tested around 240 people in the past six months, 17 of whom came back positive.

Gaskins’ high-risk clients are often not surprised when they learn they have HIV, but those who have largely abstained from risky behavior can be devastated. Gaskins remembers one man in his 20s who fell on the floor in shock when he learned he was positive, having had only one sexual partner from his telling.

Mobile testing vans are necessary, according to Columbia University’s Dr. Robert E. Fullilove, because many people are reluctant to seek testing on their own.

“A lot of people who think they have some disease are reluctant to get bad news, especially if they have to travel to a community that’s far away, and doesn’t share the same culture,” said Fullilove, the associate dean of Community and Minority Affairs and professor of Clinical Sociomedical Sciences at Columbia’s Mailman School of Public Health. “Many people are not even remotely motivated to do that. But lots of people will accept something that’s in their own neighborhood.”

Sitting in GMAD’s van, Westcott compared his experience there to other testing facilities.

“This is the first time I’ve felt like somebody actually cares,” he said. “In different vans you get treated like crap. That’s why a lot of kids don’t want to be bothered with getting tested.”

Of all the hard-to-reach groups, adolescents may be the toughest. They often see the risks of getting tested or treated for HIV, such as being stigmatized by their parents or peers, as outweighing the risks of getting a sexually transmitted disease, studies have shown. Yet the worst barriers may be psychological, according to John Nelson, a nurse practitioner and Ph.D. who works with HIV-positive youth at Harlem’s Project STAY, which provides counseling and medical care. Nelson notes a sense of hopelessness and abandonment amongst his clients, citing everything from increased rates of adolescent incarceration, to decreased funding for alterative high schools that serve at-risk youth.

“Among youth of color in New York City, the leading cause of death is homicide,” he said. “To worry about a virus that might kill them 15 years from now if they don’t get treatment isn’t as much of an issue.”

On a recent night in Hell’s Kitchen, GMAD’s Gibson approached a group of three teenagers dressed in baggy jeans and flat-brimmed caps on their way to the Port Authority. They hesitated at first, but eventually surrendered to Gibson’s forceful pitch. The youngest of the group was 16 years old and had a ten-month-old son. The oldest, Juan Miranda, 20, had a cousin who learned he was HIV-positive this past summer. The third had spent two years in prison on Riker’s Island.

“I’m nervous, and I’m not,” Miranda said as he waited for his results. “I’ve done risky things, but I trust the people I do it with. Still, there’s always that thought in the back of your mind.”

When the tests came back negative for all three, they jumped with excitement and joked about putting the results on their MySpace pages. One called a friend to share the good news.

Back in the West Village, Westcott had a similar reaction. “I ought to get this laminated,” he said when he received his negative result. “What’s the name of this group again?”

“It’s GMAD-Gay Men of African Descent,” Gaskins replied.

“Ah, wicked!” Westcott said.

Gaskins has mixed feelings about seeing positive test results. While he is sorry for the individual learning the news, he also feels good about identifying a new case, thereby fighting the spread of AIDS. But on Christopher Street, he is less stoic.

“Down here, where the average age is 16 or 17, I’m very happy if we can go all night and get no positives,” he said.

Before he left the van, Westcott reached into his canvas satchel for a photograph of his best friend, Antonio, who has an AIDS diagnosis. It was the last picture Westcott took of him before learning he was sick, snapped in front of a barn in Providence, Rhode Island, which they stumbled upon one afternoon wandering through the woods.

Westcott also pointed out the three Japanese-letter tattoos on his arm that symbolize his brushes with death - one for when he was shot, one for the time he almost drove a motorcycle into a ravine, and one for when he overdosed on Ecstasy. He says that he always uses protection with clients, but doesn’t plan on changing his vocation anytime soon.

That night on Christopher Street, Gaskins gave ten tests and returned one positive. As his clients waited for their results, he often took the opportunity to advise them about safe sex. But with only 20 minutes, he stopped short of pestering them to change their lifestyles, or, where it was relevant, give up prostitution.

“Even if we had two hours we couldn’t do that,” he said. “All we can do is give them the info and let them go home and think about it.”