“I need housing and a job. We can talk about that other stuff, but this is what I need.”
—a client at the Youth Empowered Society (YES) Drop-in Center
Homeless, HIV-positive youth (ages 13–29, for the purposes of this article) have their priorities, which don’t always include self-care and treating their HIV. Some are looking for a safe place to sleep. Some want to be gainfully employed. Some are looking for their next fix. Some are looking for something—anything—to eat. Some are running from an abusive home life. Some just want clean socks.
According to the Centers for Disease Control and Prevention (CDC), 39,782 people were diagnosed with HIV in the U.S. in 2016. Shockingly, 8,451 of those newly diagnosed were between the ages of 13 and 24. And nearly half of them were young, African American men who have sex with men (MSM). In 2015, an estimated 60,300 youth were living with HIV, but half of them did not know that they were HIV-positive (and may have been unknowingly passing on the virus to others). In fact, 100 young people died of AIDS in that same year. With all the progress that has been made in HIV prevention (PEP, PrEP, U=U, condom distribution), youth remain highly vulnerable—especially when they are also living on the streets.
The California Homeless Youth Project agrees that homeless and unstably housed youth are highly vulnerable to HIV. Many are involved in survival sex (trading sex for food, money, a place to sleep, or all three). Without regular access to food, shelter or jobs, many homeless youth engage in survival sex in order to get their basic needs met. The survival sex is often condomless. And some are living on the street because they have HIV but no family support. Families of positive youth either kicked them out of the home or stigmatized them to the point where they can no longer live at home. Not being able to share utensils or sheets or towels with your family is emotionally painful.
Many young people use alcohol and other drugs to self-medicate their mental health issues and emotional pain. Substance use also numbs physical pain, hunger, and the challenges of life on the street. And, using uppers (meth, cocaine) can mean more than getting high—these drugs help youth stay up through the night to prevent robbery, physical assault, rape, or other crimes.
It’s been proven that stable housing increases access to medical care, treatment, and continuity of care for HIV-positive youth (and anyone of any age living with HIV). Agencies across the U.S. are trying to get HIV-positive youth into housing, link them to care, and provide them with much needed emotional support.
Spencer not for hire
Spencer is a fierce force to be reckoned with. Six feet three inches of compassion, caring, and straight talk. Even he agrees, “I’m a soldier. And wish I had more soldiers to work with me.” Formerly homeless himself, Spencer currently volunteers for many agencies in Los Angeles, including APLA Health, LA CADA, Black AIDS Institute, AIDS Healthcare Foundation, and Project Engage. But his favorite place to volunteer is Friends La Brea (also known simply as “Friends”). There, he “recruits” people for HIV testing and helps the homeless youth who hang out near Friends in the heart of Hollywood. Many of the youth call him “dad,” and he calls them his “kids, daughters, sons.” He is their unofficial relative, case manager, and counselor. He has been offered positions at many AIDS service organizations (ASOs) around Los Angeles, but doesn’t want to be tied to any one agency. Spencer wants to serve his community his way.
He is a recovering meth addict who has been clean and sober for the past seven years. An out gay man who both sold and shot meth, he did time in prison for dealing. He was also a sex worker, and was a “girl at night and a boy in the daytime.” With his long braids he “looked like Milli Vanilli” walking the streets of L.A. He contracted hepatitis C (and was treated, which was “rough” but he was cured) yet somehow never acquired HIV, even though an ex-boyfriend had AIDS. They had condomless sex and shared needles—both extremely high-risk activities. When asked how he managed to stay HIV-negative, there was a long thoughtful pause in the conversation. He doesn’t know. Luck? A miracle? Both? But he does know that he is grateful and that that his mission is to “give back and help the kids.”
He “hangs with the kids to see what they are doing.” He gets them tested if they need to be. He connects them to services if they want them. And he listens because he has been there. Spencer did not have his own apartment until he was 51 years old, and he tries to inspire others to do the same. “I am in my place. I got my own apartment. You can have a place like mine if you put your mind to it.” And Spencer has ideas about how to get HIV-positive youth successfully housed. “We need classes for them. People have been on the streets so long they don’t know how to live. I know someone who put a tent up inside her new apartment. She was so used to being on the streets. And they need to be taught “how to keep the house up. Tackle it one room at a time. Do one thing for your new place every day.” Who should teach these classes? “Oh, I’d love to teach them!”
The biggest piece of advice he tells his “kids”? “You gotta have patience and follow your dreams. Whatever you want to do. You want to go to school? You can do that. Don’t let nobody tell you that you can’t do that.”
The roots of her forest run deep
Susan Forrest is a true AIDS warrior. She started her career back when the epidemic was raging in the 1990s, when she was the only one out of 20 friends who injected drugs who tested negative for HIV. Her first HIV-related job was TPAN (the publisher of POSITIVELY AWARE) in Chicago, working for the agency’s HIV/AIDS hotline and buddy program. Eventually she moved to Los Angeles and worked for AIDS Project Los Angeles in their housing department and then for 20 years at Behavioral Health Services in Hollywood. Flash forward to 2019 where she now runs the Art House Pasadena (AHP), which provides safe and culturally affirming alcohol- and drug-free housing. AHP is funded by the Los Angeles Housing Authority and is a recovery bridge housing program. AHP links clients to services that assist with the recovery process and uses art as part of that process. Approximately 40–50% of their clients are under the age of 29 and approximately 60–70% are HIV-positive.
AHP can house 20 people at a time. Clients can stay for 90 days with the possibility of an additional 90 days, depending on “forward movement” towards housing. “If there is no movement—then the program is not working for them.” AHP makes use of a van that takes clients to their medical appointments and has a relationship with an HIV specialty pharmacy that delivers HIV medications “directly to the door of AHP.”
Susan freely admits that HIV prevention at AHP is a hard sell. “All of our clients who have found permanent housing were HIV-positive. Our challenge is to get HIV-negative people to stay negative when they see others getting into housing. They have never known anyone to get sick. They haven’t lost 30–40 friends to AIDS. One pill per day, and everyone is healthy. It’s hard to make a case to stay HIV-negative. An HIV diagnosis is like a safety net. They get a gym, housing, benefits, which other people don’t get. ‘What’s so bad about it?’ ”
Angels in the City of the Angels
Andres E. Sanchez Montoya (pronouns: they/them) works in the Division of Adolescent & Young Adult Medicine at Children’s Hospital Los Angeles (CHLA). They work in CHLA’s HIV highly ranked program with HIV-positive youth 16–25 years of age. CHLA is “one of the few adolescent medicine clinics in Los Angeles County,” so, many HIV testing sites refer clients directly to them. They also get word-of-mouth referrals. CHLA’s HIV program currently has 60 clients, 26% of whom are homeless. Most of their current clients are MSM (men who have sex with men) who acquired HIV through sex. Some acquired HIV perinatally, and one was the victim of a sexual assault.
Adhering to an HIV regimen is a challenge for anyone, but especially for young people. To help with adherence, says Montoya, CHLA “works together with the B3 (Become, Believe, Belong) group. They provide assistance with support groups and individual one-on-one meetings that discuss the HIV lifecycle, medical adherence, social support, and an array of topics around their individual HIV care. It is extremely difficult for youth, especially when they are homeless. They report not remembering to take their meds or just being tired of having to take meds on a daily basis. For some, it’s about reliving when they were diagnosed every time they have to take their medication.”
Being homeless is a “huge barrier” to HIV medical care and “no living space means no place to store HIV medication.” Andres’ homeless clients are “couch surfing, living in tents, squatting in abandoned spaces.” Some young MSM “are rejected by their families and kicked out of the house. Or, the family is okay with them being gay, but once they are HIV-positive, that creates another family stressor” and the kids get kicked out at that point. For the youth who go to shelters (mainly the Salvation Army or Covenant House), most “have clients check in their meds and encourage them to take the meds.” However, “things get stolen at shelters,” including HIV medications.
CHLA has a “good success rate for getting people into housing. And having an advocate for each client helps. It’s hard to get a place to live if you don’t have a way for a housing agency to contact you. Clients have different phones and different phone numbers every month. Their contact information changes regularly.”
One young man had “bad experiences at other places. He had medical and institutional mistrust. He had been let down. He didn’t ask for help right away—he waited until things became more complicated and then presented with a challenge. But by then, he had exhausted all his options.” Dealing with both mental health and meth abuse, Andres worked with him six to nine months to get him into housing. They went with the client to all of his housing appointments and were his advocate. “But once he got housing, he became overwhelmed with the responsibilities. He found it hard to deal with and left housing after two months.” Andres searched for him for a long time but contact was lost. The client has yet to return to Andres and their program.
Conversely, another client was a 15–16 years old male immigrant from Central America. At some point he was in the Los Angeles foster care system (as are many CHLA clients) and eventually became homeless. But “he pushed forward in spite of the barriers. He was not afraid of asking for resources. He went to college and graduated, even while dealing with HIV and homelessness.”
Say “yes” to YES!
Blair Franklin works at the Youth Empowered Society (YES) Drop-in Center in Baltimore, MD. Born and raised in the city, “Baltimore flows in his blood.” YES serves young people who are 14–25 years old. Perhaps the epitome of a grassroots organization, YES was founded by homeless queer/trans youth (with some adult allies) who “recognized and named that there was nowhere for youth to feel safe and get services. And no one was thinking about long-term system changes” for youth without housing. Baltimore has limited housing options for youth—only two youth shelters with eight beds each. “Adult shelters aren’t safe for youth,” says Franklin. And YES has an ambitious endgame: to end youth homelessness and put themselves out of business.
YES serves 300 homeless youth per year, an estimated 10% of whom are HIV-positive, although Blair suspects that many clients are not disclosing their HIV status. The youth “still don’t know about PrEP. The young people focus on their surroundings and how to get through tomorrow.” So YES offers sexual health programs, HIV education, harm reduction, and condoms in the bathrooms. Clients “run in, grab condoms, and roll out.”
The agency is “first and foremost a drop-in center for youth who are currently experiencing homelessness. We offer showers, laundry facilities, an address for them to use for mail, a place to charge phones and nap.” YES offers what they call “rapid rehousing” and they “provide rental assistance for 1–2 years.” Their intensive case management helps clients “learn how to sustain an apartment” and provides crucial support during the housing application process.
Jobs are necessary to keep those apartments and YES offers a workforce development program. Most job placement programs don’t offer stipends, so the agency “fundraises to make sure kids get paid.” And their youth often say, “Why do I even engage or bother when I won’t be safe in this [work] environment?” So YES is heavily involved in advocacy and “what it takes to get jobs and equity.” They also work on reducing bias in job interviews and how prospective employers should handle “when a client shows up and looks different [or presents as a different gender] than their identification.”
The demand for services is so great that they have already outgrown their current physical space. “The hallways are narrow and people bump into each other, which creates conflict. There’s no room to breathe.” Blair and YES are looking for a new location, “one that is friendly, affirming, central, and not in street gang territory.” And the hope is, if they “do well and do right, they don’t have to exist.”
Dancing as fast as he can
Twenty-six-year-old Thomas Davis is a Program Coordinator for Prevention and Care at the Black AIDS Institute in Los Angeles and the creator/founder of The Catharsis Project. A talented dancer from Estes Park, Colorado, he moved to Los Angeles to fulfill his dancing dream and was diagnosed with HIV in 2013. The Catharsis Project started as a film but now uses dance and many kinds of art forms to share stories and experiences about the AIDS epidemic.
The Creative Remedy Education Workshop (CREW) is a one of The Catharsis Project’s programs. CREW started in 2017 and is funded by AIDS United and follows the model of Meaningful Involvement of People with AIDS (MIPA). It consists of weekly meetings for HIV-positive millennials (born between 1981 and 1996) of color. CREW is open to anyone, but most members are from the LGBTQ community. Thomas “didn’t want CREW to meet at any of the large ASOs [AIDS service organizations] in Los Angeles. We are oversaturated with their content.” He also wanted CREW members to avoid the stigma of walking into an ASO. Thanks to his connections in the dance community, CREW meets at the venerable Lulu Washington Dance studio in South Los Angeles, which Thomas calls “an untraditional partnership.”
CREW meets every week for two hours. The first hour is full of art and self-expression. Thomas brings in “community professionals” for dance, creative writing, drama, photography, etc. The art hour “creates a safe space and loosens up the group.” The outside speakers “offer insight and expertise.” The second hour involves food and fellowship. They talk about issues—“sometimes whatever comes up, sometimes the topic is planned.” But no matter what they talk about, “HIV always comes up. It is always part of the conversation.” CREW usually has 10–15 people at their weekly gatherings and each person has “come more than once. No one-offs, which is big for Los Angeles!” Unfortunately, most CREW clients are homeless or unstably housed.
Although passionate about HIV/AIDS, dance is his true love “and a career in the arts takes some sacrifices. Arts don’t pay the most.” Thomas is no stranger to homelessness himself and has “experienced homelessness several times, although it is not a regular thing.” He has couch surfed and slept in his car. Thomas talks about presenting at a national HIV conference and then flying back to Los Angeles to sleep in his car. Again. Everyone told him he did a “great job” with his presentation, but no one knew where he was actually sleeping.
Now open about his addictions to meth and sex (although Thomas “identifies more as a sex addict” and is “trying to figure out what recovery from sex addiction looks like” for him), he “previously didn’t have the vocabulary to deal” with his issues. He had no access to mental health services and “no energy to deal with them.” After losing an apartment, he found himself in complicated living situations with so-called “friends.” One “friend,” who proved to be a predator, let him stay on the couch in the living room. Thomas “woke up with him naked over me one night.” He was pressured into survival sex for a place to stay. “I did things I did not want to do.” One night he “had it” and moved in with “another friend who was not a friend” and had a meth problem, which was not helpful for Thomas. Fortunately, he has had a safe and stable place to live for the past three years.
Once he started CREW, Thomas realized that “I was not the only one who went through this [homelessness]. It’s more common than I thought. It’s both comforting and upsetting how common it is.” CREW clients talk about housing a lot and about how much harder it was to get housing before their HIV diagnosis. “It’s like their diagnosis helped them. Hey! There are programs! What a ‘cool’ irony!”
CREW’s current AIDS United funding ends this October but he is hoping that he will either get refunded or find a grant somewhere else. He is “always looking for ways to keep it going.” His dream is to make The Catharsis Project a full-time job for him. That, and to dance.
The tale end
How to end HIV and homelessness in the youth community? Let’s follow the example of YES and try to truly end homelessness and not just use Band-Aids. Let’s follow CREW’s MIPA (Meaningful Involvement of People with AIDS) model and talk about HIV together. Let’s get people sober, like Pasadena Art House does, or help create any positive change. Let’s create a safe medical home for youth who are HIV-positive, like CHLA. Let’s be soldiers like Spencer. With over 8,000 youth acquiring HIV each year, we can’t afford not to do this. It’s time to bring these tales to an end.
Michelle Simek has worked in HIV/AIDS for over 20 years. She currently works at an HIV clinic in Los Angeles, and is a popular AIDS educator/public speaker both locally and nationally. When not writing for POSITIVELY AWARE, she likes to binge watch BBC shows on Netflix, thrash around while watching punk rock bands, go to the beach under the protection of SPF 4,000, and cuddle with Baxter, her cat and BFF.