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The Allentown Morning Call
For Latino Community, AIDS Comes By Way Of Heroin
In The Region, Hispanics Make Up 7.5% Of The Population But Account For 43% Of People Living With AIDS. Miguel Nieves Tells His Story.
By Jose Cardenas Of the Morning Call
28 December 2004
After Miguel Nieves found his 26-year-old son, Miguel Jr., dead from brain cancer in their south Bethlehem home, doctors informed him that the young man was also carrying the HIV virus.
Long before the death seven months ago, Nieves suspected his son, who had dabbled in the South Side heroin scene, could be infected with the disease that the father knew all too well.
Nieves, 48, contracted HIV about two decades ago, when he was a heroin user fresh from Puerto Rico, swapping needles with other addicts on the streets of Brooklyn, N.Y.
In Bethlehem, his son fell into the same cycle that Nieves left behind 13 years before. "He started using here, on the streets," said Nieves at his home in the Lynfield housing development. "His friends got him involved, lamentably."
For too many Latino men, whether originally from Bethlehem or Allentown or transplants from New York, New Jersey or Puerto Rico, the story of heroin use that leads to HIV infection remains a common one. The lingering heroin problem in the Latino community is largely responsible for the group's disproportionate representation on Bethlehem's toll of HIV/AIDS cases, according to statistics from the city's health bureau and health workers.
In Bethlehem, Latinos make up about 18 percent of the population, but even in years past when their numbers were smaller, they accounted for as many as 70 percent of the city's HIV/AIDS cases.
Since 1982, Bethlehem has recorded 315 HIV/AIDS cases, 208 of whom have been Latinos.
Bethlehem's numbers are part of the statistics for Berks, Carbon, Lehigh, Monroe, Northampton and Schuylkill counties -- the six area counties covered by AIDSNET. The nonprofit group is charged with disbursing state and federal funds to service providers and its statistics show that, as in the rest of the country, blacks and Latinos here are disproportionately affected by HIV/AIDS. Here, though, the numbers are even more dramatic.
Heroin use plays a big part
The statistics also show that heroin use, which is the main mode of HIV transmission in the region, remains a significant health problem for Latinos and others.
Nationally, blacks make up about 13 percent of the population and 42 percent of people living with AIDS, according to federal statistics. Latinos make up 15 percent of the population and 20 percent of the cases.
In Lehigh, Northampton, Berks, Carbon, Monroe and Schuylkill counties, Latinos make up only 7.5 percent of the population but 43 percent of the 1,182 people living with AIDS, according to statistics from the state Health Department. Blacks make up only 3.4 percent of the population but represent 21 percent of the cases.
The state statistics are tallies of full-blown AIDS cases, however, often reflective of people's behavior years ago when they originally contracted the disease.
Pennsylvania began collecting data on new HIV-infections only two years ago. The commonwealth has not yet released data that will show on a state level whether HIV cases are increasing, what populations are being affected and how the disease is being passed on.
The number of full-blown AIDS cases has gone down in the last few years in the Lehigh Valley because better AIDS drugs are keeping people healthy longer, said Ross Marcus, executive director of AIDSNET. Also, he said, sample data of new HIV infections from publicly funded clinics and other testing facilities in 2002 in the Lehigh Valley showed that new infections continued to affect minorities disproportionately.
AIDS in the Lehigh Valley also differs in the way the disease is most often passed on.
Nationally, men who have sex with men still account for 45 percent of HIV/AIDS cases, followed by intravenous drug use, 26 percent, and heterosexual sex, 21 percent.
In the six counties, intravenous drug use accounts for 46 percent of the AIDS cases while men having sex with men accounts for 19 percent and heterosexual sex accounts for 16 percent.
The intravenous drug problem accounts for a local trend: the growth in the number of women who are contracting the disease through men who use drugs, according to AIDSNET.
The trend in the Bethlehem- and Allentown-area Latino communities also serves to show how the disease has affected Puerto Ricans in northeastern United States cities and Puerto Rico more heavily than other Latino groups around the country.
According to statistics by the Kaiser Family Foundation, Latinos in the Northeast, who are predominantly Puerto Ricans, have up to four times the incidence of AIDS as Latinos in some western states, where the much larger Latino communities are predominantly composed of Mexican-Americans.
And while Latino men in the West fall into the national trend by contracting HIV predominantly through homosexual sex, Puerto Ricans on the East Coast, according to Centers for Disease Control statistics, contract the disease predominantly through intravenous drug use.
Nieves started experimenting
In Bethlehem, the story of Miguel Nieves Sr. is a case in point. He started using drugs as a teenager in Catano, Puerto Rico, where he and 10 other siblings and cousins were raised by his grandparents in a small house.
He skipped school as a teenager and used marijuana in a drug-infested neighborhood called Juan Amatos.
Nieves only finished seventh grade. At 17, a friend offered him heroin. In those days, peddlers first sold heroin in capsules, each worth one peso, a Puerto Rican dollar.
"That's the way I started," he said. "Little, by little, by little, experimenting, experimenting, experimenting, until I tried heroin and that's where I got trapped in the web."
Even with his drug use, he was able to function enough to get married and father four children.
He moved to Brooklyn in 1979 with his wife and four young children, got an apartment and a job at a factory.
But with the $300-a-day heroin habit that gripped him, he lost his job as he took to injecting drugs with other addicts on the streets or hiding from his wife in a room in their home.
He got tested for HIV in 1987 at a Brooklyn hospital. "When I heard the news, my world fell," he said. "I was young and I said, "Now I really ruined myself.' "
He and his family went back to Puerto Rico where he kept using. One day, alone in a room in their apartment, he got down on his knees.
"I gave my life to the Lord," he said. "I abandoned the habit and God set me free."
Nieves moved to Bethlehem in 1992, where his son, Miguel Jr., eventually also picked up the needle.
The elder Nieves has managed to stay alive by taking three different medications every 12 hours. With help he got at the Community Action Committee of the Lehigh Valley, Nieves started an office-cleaning business that he runs from home.
He said he doesn't mind telling his story publicly in the hope it might prevent some young man from suffering his fate.
"If it helps somebody, it's worth it," he said. "Drugs don't leave you anything but destruction. It breaks your marriage, breaks your health. What it leaves is death."
Latinos for Healthy Communities on Chew Street in Allentown has a waiting list of addicts, some of whom walk up to outreach workers on the street, asking to be admitted into a program where methadone medication is used to help people get off heroin.
The lucky ones are sent to New Directions Treatment Services in Bethlehem, which operates the clinic.
An indicator that heroin is a growing threat is the fact that New Directions and the other methadone clinic in the region, which is in Phillipsburg, N.J., together had 160 patients eight years ago and now they have 500.
Latinos represent about 45 percent of those in the program at New Directions, said Glenn Cooper, the executive director.
Why Latino men?
No one can pinpoint for sure why intravenous drug use is more prevalent among Latino men. Cooper points out that intravenous drug use as a mode of HIV transmission historically has always been higher in the region between Philadelphia and New York than other parts of the country.
The fact that Latino men are over-represented in the methadone programs and AIDS statistics doesn't mean that they use drugs at higher rates than other groups, Cooper said, only that they inject heroin more than they use other drugs.
"White people use alcohol but it doesn't mean there aren't any Hispanic alcoholics," Cooper said.
Some Latino community leaders caution that heroin use is a problem for all races. Others say that Latinos have a particularly serious problem with heroin, as well as other drugs and alcohol that cause people to engage in risky behavior.
"Our community is in bad shape. We have to face it," said Elsa Vazquez, a psychotherapist who works in St. Luke's Hospital's HIV/AIDS programs, where Latinos account for 90 percent of patients.
Vazquez thinks Latinos, in part, use heroin to deal with a host of problems, from poverty to trouble assimilating into mainstream society.
"You look at the methadone clinic, we are over-represented there," she said. "You look at the prisons, a great number of Latinos are jailed for drug-related charges. We have a lot of mental health problems."
At establishments where HIV care is given, such as St. Luke's, the patients showing up increasingly are women, Vazquez said.
In her row house in South Bethlehem, 42-year-old Flor, who has full-blown AIDS, tried to keep herself warm on a recent cold day. Flor, who asked that her last name not be used because she fears discrimination, said she doesn't know whether she got HIV from her ex-husband in Allentown or whether she got it from someone else before they married and gave it to him.
Even though she has to go to St. Luke's for treatment every day, she thinks her ex-husband must be in worse shape because people tell her that he's bed-ridden in Texas.
Two years ago when she developed a rash, she feared she would die within a year. "I know how people get when they're going to die," she said.
A few years ago, she saw her brother-in-law, a heroin user in Boston, shrink down to little more than a skeleton before he died. Flor thinks her brother-in-law's wife, also a heroin user, might be dead now, too, because she was also infected.
In Flor's case, the energy she spent being angry at her ex-husband when she was first diagnosed, she now spends trying to keep herself well.
"Like I told my family, if it's me who got it, or he who got it, I'm not going to lie in bed to die, blaming him," she said "I have to find peace."
Some Latino leaders say that as the heroinand AIDS problems have lingered over the years, there's been a long-standing needfor culturally sensitive outreach workers to canvass Latino neighborhoods.
"In the Latino community people need to understand that we need to see people, contact people," said Lissette Lahoz, program director of Latinos for Healthy Communities, which has two Latino outreach workers who target heroin users on the streets of Allentown, Bethlehem and Reading. "Just making contacts or giving them a brochure, that doesn't work."
Don Jackson, director of Lifespan Religious Education at Unitarian Universalist Church of the Lehigh Valley, points out that most outreach efforts are targeted toward Latinos and not enough is done to reach African-Americans.
Sara Steiger, project irector at Echo Clinic in Easton, where blacks, not Latinos, account for most AIDS cases, also said her area suffers from a disparity in funding for outreach.
Though more outreach efforts are needed, AIDSNET will spread almost $459,000 in state aid among eight community organizations, said Marcus. That's almost all of the money available for outreach.
When it comes to drug-users, they are inherently difficult to reach, Marcus said, because they are high or out of sight much of the time.
"That's a very difficult population to reach," he said. "But according to our data, we need to reach them."