Tonight, I had to speak in front of the City Council. Only for 3 minutes, but still enough to scare the crap out of me. I am somewhat averse to this sort public speaking, as it involves being looked at by a bunch of strangers, being judged by people who don’t know you, and explaining something badly that I could have explained in careful detail via email or some sort of public message board. I hate all three of the aforementioned things.
Alas, my Executive Director and her Deputy Director are out of town all week. They are two of the three people who designed the program for which we are seeking funding. Guess who was number three?
Here’s the back-story:
A couple of years ago, my boss and I had some conversations with some of our social workers and began to get a sense of a certain pattern in the lives of many of our female clients who are newly diagnosed, as well as in the lives of high-risk HIV- women being engaged through prevention outreach. It goes something like this: poverty leads to substance abuse, or substance abuse leads to poverty. Either way, the result is desperation, and there are usually one or more asshole guys in these stories. Anyway, for a lot of these women, desperation leads to prostitution. So now they’re hooking and shooting up, and those are both illegal, so they usually end up in jail. If you’ve ever been in jail (or worse, actual prison), you know what an uplifting and rehabilitative experience that is. Our county jail likes to do cute things like keep the women until just after midnight so they’ll get the state money for that prisoner for one more day, and then release the women onto the streets at 1AM. They have nothing and nowhere to go, and so are easy prey for the pimps who come cruising around the women’s jail like jackals. And so the cycle begins all over again.
While this cycle is bad enough just on its face, the deeper problem is that each point in that cycle represents high risk for contracting HIV (or, in the cases of those women who may already be infected, transmitting the virus). The seroprevalence rate of incarcerated women is significantly higher than that of any non-incarcerated American female population. Between the time she becomes infected and eventually learns of her serostatus, an injection-drug using sex worker could infect a lot of people. Each one of those infections, including hers, represents not only a loss to the community – the loss of someone’s daughter or son, someone’s mother or father – but also the loss of a productive citizen and the expenditure of hundreds of thousands of scarce public dollars for health care.
But risk reduction with these women requires a lot more than a risk-reduction plan, a packet of condoms and a fare-thee-well. Their risk of HIV is intimately bound up with their poverty, their chemical dependencies, their mental health problems and histories of abuse and exploitation, their lack of marketable skills, their homelessness, and on and on. For the women who come to us as newly-diagnosed, their HIV infection is merely the latest catastrophe in lives that seem to consist little more than disasters strung together on the thread of time.
So we screwed on our thinking caps and got out the white-board markers and went to work. Basically, we decided that poverty, unemployability, self-esteem issues, mental health problems, recidivism and substance abuse are all pretty much synergistic with each other, so to solve any one of them, you have to take them all on at once.
What we ultimately came up with was a transitional housing facility where women would come straight from prison. They would be screened and recruited for the program while still in prison, with the help of the probation and parole offices. They would come to live at our facility, and pursue a course of activities based on the goals each woman would set for herself in consultation with her program director. In short, these women would get lifted directly out of the whole drugs-crime-jail cycle and placed in a completely different environment where they can work on simultaneously in a supportive environment. We eventually envision providing everything from substance abuse counseling to helping women learn how to dress of a job interview. This transitional period would last from one to two years for each woman, depending on her goals and the challenges she’s facing. We would be working with 26 – 28 women at any given time, with an additional 4-bed short-term homeless shelter and 2 badly needed detox beds. These would be ways for women to get connected with the center even though they might not be ready to enter to primary transitional-living program.
The long-term goal is for these women to be healthy, safe, financially- and housing-independent, and to stay free from both the literal bars of a jail cell and the figurative chains of addiction and exploitation. We set these goals not just because they’re good in themselves (although they certainly are), but because we know that homelessness, substance abuse, and repeated incarceration correlate very highly with risk for HIV.
This is an ambitious idea, and it’s expensive. The cost per client served is pretty high compared to the homeless shelters and after-school programs that were down at the convention center tonight to ask City Council for a little of the CDBG bread.
Also, to be fair, it’s not a particularly attractive target population. I sat there and listened to all of these people from all of these amazing organizations describe the projects that they’re seeking funding for. These meetings always leave me amazed at the good-heartedness and sheer creativity that exists in the non-profit sector. It’s heartening for me because, to be perfectly honest, the world of AIDS service organizations is a seething nest of dysfunction, psychopathology, resentment and petty quarreling. It is probably the crappiest part of the entire non-profit world. So it’s really nice to hear the lady from YMCA stand up and talk about the great work they do with youth and families (and NOT make a subtle jab at the work other organizations do with the same target populations, the kind of brutal competitiveness that infests the ASO world). I’m a big fan of the Y anyway, since they do absolutely amazing work in my community, but I was impressed with every single presentation. People working with troubled youth, people teaching adults how to read, people helping the poor and elderly prepare their taxes, people helping abused and neglected kids navigate their way through the legal system, people lifting up battered women and giving them hope. Even the faith-based projects sounded decent, and I’m pretty opposed to that sort of thing. But who doesn’t support helping kids who are in trouble? Who is against teaching adults to read so they can become full participants in our democracy? Who doesn’t think that poor kids should have a decent athletics program like rich kids do?
And then I get to get up and talk about our plan to help out criminals, hookers and junkies. I doubt it filled anyone’s heart with a warm glow.
But here’s the deal – and I wish to God I was a better speaker, so I could make them understand. Let’s momentarily set aside any purely ethical argument that the simple fact of their humanity makes these women worth helping. Maybe you think they’re irresponsible and deserve whatever happens to them. For the moment, I won’t argue with that. Let’s also set aside the enormous cost in public health dollars and lost economic productivity represented by every infected individual.
Consider this: we live in a world of connections that bind us to one another more closely than we generally suspect. HIV can very easily work its way along the chain of six links between Stockard Channing and that common street hustler. So if you are a middle-class white woman, you may never know the sex worker who we’re targeting with our project. But your husband might, because the big secret about prostitution is that there are plenty of middle-class suburban dads taking advantages of the “services” of these brutally exploited women. How many of them are bringing HIV home for dinner? (Let me add that I don’t mean to suggest that the life of Suburban Dad is somehow more valuable or of more social concern than the life of Junkie Hooker – only that their respective worlds may have fewer degrees of separation between them than most suspect.)
Then too, it’s worth considering that people can and do change, and they are not always what they seem to be. In 2002, I was a semi-homeless cocaine addict. In 2002, my dealings with local government consisted primarily of occasional visits to the county jail and peeing in a cup for my probation officer. I was not a likeable person. I had no self-esteem, which was logical, since I had not behaved in a consistently estimable fashion for some time. My sexual behaviors were such that I will never understand by what grace or sheer chance it is that I am HIV- today.
Seeing me today, you’d never know all of that. Today, I am pretty boring. I have a boyfriend, a cat, and a nerdy job. I get my kicks from buying square dishes. My interactions with local government consist of speaking before City Council and occasionally meeting with the Dept. of Community Initiatives. The only thing “2002” in my life today is the merlot I’m enjoying this evening. People can change, and do. Not always, but sometimes, and the possibility is worth the second and third chances. I got those chances from a family that loved me, but not everyone is so lucky.
I’d never in a million years want to take away some kid’s after-school program, but I hope the councilwomen and men got my message. Every junkie, hooker and ex-con is somebody’s son or daughter. A lot of them are someone’s mom and dad. We are all connected. If we let too many of us fail and fall, it drags us all down. If we help each other grow, we all can rise. In that rising, we may be changed.
“In a moment, in the twinkling of an eye, at the last trump: for the trumpet shall sound, and the dead shall be raised incorruptible, and we shall be changed.”
-1 Corinthians 15:52
Sounds like heaven to me.
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