People Who Heal People
With a Nontraditional Approach to Wellness, Health People Uses Proven HIV/AIDS Prevention Principles to Empower a Community
by Chip Alfred
Photographed Exclusively for A&U by Alina Oswald
It all started more than twenty years ago when some courageous women did something to help their neighbors that nobody had ever done before—risking their own lives in the process. In the midst of a violent drug war erupting on their streets, a small group of HIV-positive women set out on a mission to teach people in their community about AIDS. “Thirty people were shot to death within a few months two blocks from our office,” Health People founding executive director Chris Norwood remembers. “I really had to look at the absolute determination of the peer educators. They didn’t stop—even with gunfire all around them. It was really extraordinary for women in 1990 to go out in their own neighborhood and try to get other people into care and support groups because the stigma was huge.”
The organization that began with an office in a single room at Bronx Community College has become a multifaceted, internationally recognized model for training and empowering people in areas overwhelmed by chronic disease. “I’m really proud of not only starting the program,” Norwood says, “but also that I personally have been able to learn from the program and from the peer educators.” Health People: Community Preventive Health Institute addresses health issues in the South Bronx, an area heavily impacted by poverty, with some of the worst health statistics in the state, and sizable immigrant and ex-offender populations. Predominantly Hispanic and African-American, many of the local residents are living with chronic illnesses including HIV/AIDS, hepatitis C, diabetes, heart disease, and asthma.
Over the years, Health People has expanded and evolved to improve the overall health of the community it serves. With about twenty full-time staffers and thirty part-time peer educators, the community-based organization offers outreach, prevention, self-care classes, mentoring and support. “People are very enthusiastic here about saying, ‘Okay, nobody’s helping us. We’ll do it ourselves.’ You have a level of community awareness that is very good for peer programs,” Norwood declares. Along with the physical health issues there are often mental health challenges that compound the problems. This is one of the reasons most of the programs offered by Health People don’t take place in their facility. “If you want to enroll people who are isolated and depressed, you have to go out to where they are.” She believes Health People’s methods are working “for practical and very human reasons. We’re training people to do evidence-based education. The courses are facilitated by people in the community who either themselves have HIV/AIDS or chronic diseases or have family members who do.”
The success stories from HIV/AIDS education are being applied here to prevent and treat other chronic ailments. “What has become the standard education strategy in AIDS, which combines peer education with multi-session prevention or self-care courses, is extraordinarily effective for chronic disease,” Norwood contends. “AIDS organizations as a group—especially community-based organizations—have more experience on a community level than anyone in the country in being able to engage low-income discouraged people in self-care.” At Health People peer educators offer more than just facts and figures. “Classes are very interactive. People don’t just get information; they are supporting each other. People feel comfortable doing this.”
One of those peer educators is Ryziel Wylie, a Bronx native whose focus is mainly HIV and hepatitis C. A mentor for young men on parole, Wylie teaches people about medication and better living, helps citizens returning from prison or jail integrate back into society, and links them to medical services. He also works with HIV-negative populations, teaching them about the importance of safe sex and harm reduction. Wylie has spent time behind bars, abused marijuana and alcohol, and has engaged in risky sexual behavior in the past. Now three years clean and sober, he describes himself as “gracefully recovering” and feels fortunate he’s remained HIV and hepatitis-free. This, he says “allows me to help those who weren’t so lucky. If we’ve experienced what some of these individuals have gone through, we have a better understanding and connection with them.”
“Peers provide the best ‘patient-centered’ information in language that is not only understandable but also most culturally and socially relevant,” states Hal Strelnik, Professor of Family & Social Medicine and Assistant Dean for Community Engagement at Albert Einstein College of Medicine, and chair of Health People’s board of directors. He is a strong advocate for the peer education model because “peer educators have ‘walked in the shoes’ of those they seek to help, bestowing on them a different kind of credibility than health professionals have.” When an effective peer educator speaks, people want to hear what he or she has to say. “They listen because everyone has a story. They may be surprised that the story I have to share is similar to theirs,” says Wylie, adding that educating others has its share of inherent rewards for him as well. “It makes me feel great to know that I have been able to help someone make a better decision or move forward with their life at an integral point in their life. When I was younger I didn’t have this. I see a smile on their face and it puts a smile on mine knowing that I’m doing the right thing.” Strelnik says peer educators serve as role models. “Their very presence and expertise together convey a message that, ‘If I can live and manage this condition, so can you!’ And now there are more and more studies proving that Health People’s pioneering approach was right on target.”
One Health People program that gives Norwood great pride is Kids-Helping-Kids. In its ten years, this peer mentoring program has proven to be one of the most innovative and unique youth programs in the nation. It is specifically designed to help children and teens whose parents have HIV/AIDS or other chronic illnesses. Older teens are trained to become leaders and mentors for younger kids. According to an evaluation by the National Disease Research Interchange funded by the National Institute of Child Health and Human Development, kids in this program are significantly less likely to abuse drugs than similar kids who aren’t in the program. More than that, these teens have shown themselves to be real leaders and inspiring, dedicated mentors for the younger children.
Despite the success of this and other Health People initiatives, Norwood points out that sustaining financial support for her organization and similar programs in underserved communities has been challenging. She claims some funding decision-makers are essentially saying that real people doing community education is offensive. The message, according to Norwood, is that “these people shouldn’t be doing that. It should be done by someone with a master’s degree. Poor communities can’t do this for themselves. It always has to be done from the outside.”
In a research project presented at the 2010 International AIDS Conference in Vienna, Norwood shows that AIDS funding in New York City is being disproportionately distributed by borough. According to data from the New York City Department of Health, a major shift in AIDS funding occurred from 2005 to 2012. The Bloomberg Administration steadily closed community AIDS programs supported with Ryan White funding in the Bronx and Brooklyn and moved some of this funding to Manhattan-based programs. “I think it reflected utter contempt for poor communities,” she tells A&U. In particular, she says peer-educator models and self-care education took a hit. If you follow Norwood’s premise, this reallocation of funding might be having deadly results. In 2005, before the funding shift that favored Manhattan, deaths of people with AIDS in the Bronx, Brooklyn and Manhattan were all virtually equal to each borough’s percentage of HIV/AIDS cases. By 2012, the last year for which city statistics are available, deaths of people with AIDS in both the Bronx and Brooklyn were thirty percent higher than their percentage of city HIV/AIDS cases, while Manhattan’s percentage of HIV/AIDS deaths had decreased to the point that its share of city deaths was twenty-three-percent less than its share of city HIV/AIDS cases. “We can’t show cause and effect,” she acknowledges, “but death shifts like this are unusual and certainly should be examined.”
Due to health reform, however, there may be a light at the end of the tunnel when it comes to financial resources for CBOs. Ultimately, Norwood understands that flexibility and collaboration are two crucial factors affecting the survival of organizations like Health People. “Now community groups can form real alliances with medical centers. You just have to work really hard to get reimbursed for the services you offer. As a nonprofit leader, you have to be a salesperson and an entrepreneur.” The bottom line for Norwood is results, such as witnessing a young man like Wylie turn his own life around and going on to do the same for others. “Health People is a great place to come and learn,” he attests. “I never thought that I would gain from it what I have.”
For more information, visit www.healthpeople.org.
Chip Alfred is an A&U Editor at Large based in Philadelphia.