‘Building a Comfort Zone’ With Clients at Risk of HIV

Joe Lopez checks his nails, straightens his nylons, pulls on a little black dress and heads for the Lion’s Den, a Costa Mesa club that caters to a gay and cross-dressing clientele on Friday evenings.

Lopez, who prefers the name Josie when dressing as a woman, is a gay man who often dresses as a member of the opposite sex. But tonight he is not out for a night on the town. Rather, he is one of hundreds of people on the front lines battling AIDS in California, whether that means hanging out at the beach to hand out condoms or talking about safe sex at a local gay club.

Nationwide, AIDS intervention programs are abandoning the one-size-fits-all approach that was popular for years and instead using HIV prevention workers like Lopez to target specific populations.

State and federal officials three years ago began funding such peer-group counselors, who deliver a tailored message designed to win their high-risk clientele’s confidence and change their risky behavior.

“You can’t take the menu that works in the gay white world and roll it out and expect it to work in African American, Latino and Asian-Pacific Islander communities,” said Doug Weiss, executive director of the Center-Orange County, a state- and federally funded nonprofit agency that provides services to gays and lesbians. “That’s why Procter & Gamble has 40 different kinds of soap.”

The message and the messenger need to be culturally sensitive, linguistically compatible and appropriate to the target group to be effective, health officials point out.

“We dress [up] because the transgenders open up to us more when we do,” said Lopez, who identifies himself as transgender--an umbrella term that includes transsexuals and cross-dressers, primarily gay men.

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The new approach stems in part from studies that show HIV infection slowing among the white gay population but still on the increase among blacks, youths, IV drug users and in some parts of the Latino community, said health officials around the state. The idea is to identify people who are HIV-positive and get them help, or find those who test negative and keep them that way.

California’s state Office of AIDS this year will spend $29 million on HIV prevention programs, including outreach, counseling, testing and education.

“It is all about targeting,” said Harold Rasmussen, chief of education and prevention at the state AIDS office. “Earlier in the epidemic, when we lacked knowledge, it was a lot more general-population-oriented. We were trying to test the world.”

California had 6,336 new cases of AIDS in fiscal 1998, according to state statistics. As the epidemic continues, those who have AIDS are getting increasingly younger: 50% of new cases were among people younger than 25. Minorities also are disproportionately affected.

Health officials, including those at Orange County’s Health Care Agency, have targeted all the high-risk groups for outreach, including several segments of the Latino community: transgenders, the gay population, youths and day workers.

Day workers, who gather at street corners and other traditional job solicitation sites, are increasingly at risk for HIV as they solicit sex from men and women who pay them, health officials say. The day workers then carry the infection home, spreading it to their families in Southern California or when they visit them in Mexico.

“We are just becoming aware of this [solicitation], and it is all over,” said Mary Hale of the county Health Care Agency.

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This year, Orange County will spend nearly $1.4 million on AIDS prevention, testing and counseling. The money includes funding for more than a dozen outreach workers, including some who target the Latino community exclusively and others who work with youths, IV drug users and the homeless.

Outreach workers, some of them homeless or former drug users, move among their peers, delivering a safe-sex message, offering condoms, counseling or HIV testing. In some cases, workers carry kits and do HIV testing on the street, returning two weeks later to report results to the clients.

The goal of much of the work is to change behaviors by “making safe sex and condoms cool,” said Diana Meier, who runs youth programs at the Center-Orange County. To get out that message, workers establish a visible presence by becoming regulars at youth and gay hangouts.

The idea is to move from handing out condoms to delivering a safe-sex message to talking with people about why they might fail to use a condom all the time and other issues that make them vulnerable to HIV.

“You move beyond being ‘the condom guy’ and take it to the next level by building a comfort zone with people,” said Anthony Brazier, who runs the African American program at the center.

Outreach workers are paid between $10 and $11 an hour, many working part time.

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During a recent visit to Laguna Beach, Brazier and two outreach staff members passed out several hundred packets containing condoms, lubricants and a safe-sex message during an hour on the sand.

Only one man refused the free condoms among a strand full of vacationers and regulars, including couples both straight and gay, and families.

One Laguna Beach woman with two toddlers insisted on being given an extra packet and asked Brazier if he could wait until “my tenant with the revolving bed” got out of the water “because he really needs to hear what you are saying.”

In addition to these kinds of programs, the county and the center are receiving funding from the federal Centers for Disease Control and Prevention in Atlanta to do more intensive HIV prevention work called prevention case management.

Under this pilot program, being tested in two other states, counselors work closely with a small number of extremely high-risk people. These clients generally have low self-esteem or are alcohol abusers. They often lack stable housing and are in low-paying or temporary jobs.

The typical client could be a young person cruising at night and trading sex for a place to stay, or a transgender, unable to get work, involved in prostitution.

“Case management teaches basic problem-solving and how to make life more manageable,” Meier said. “Someone isn’t going to care about safer sex if they are drinking every night, don’t have a job and are having sex for money.”