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“The only thing necessary for these diseases to the triumph is for good people and governments to do nothing.”


 
  


 

In Arizona, 3 programs point to hope

Judy Nichols
The Arizona Republic
Jul. 3, 2005 12:00 AM

http://www.azcentral.com/

 

The sun had set when Melvin Harrison walked up to a grocery store on the Navajo Reservation. Word was getting around that Harrison was trying to get help for sick people. A young man, very thin, touched him on the arm and asked for a hug. He wouldn't let go. "I have AIDS," he said."OK," Harrison said. "That's OK." Harrison shivered. "I hadn't seen one of my own people like this. I hadn't been so close to someone. It was shocking to me." It was 1988.

Arizona, with the largest Indian reservations in the country, is home to more than 250,000 Native Americans. It ranks third in the number of cases of Native Americans with AIDS: 289 by the end of 2003. And it has some of the oldest and most innovative AIDS programs for Native Americans. Harrison started one of the first grass-roots organizations.  The Navajo Nation had one of the first tribal programs. And today, that fight continues with an HIV Center of Excellence at the Phoenix Indian Medical Center, the largest program serving Native Americans with AIDS in the country.  Still, the feared explosion of cases could overwhelm them.

 

  


Harrison is neither gay nor HIV positive. He served in the military and thought about becoming a lawyer until alcohol and drugs took hold of him.  He first heard about HIV and AIDS in rehab in 1987.  "It scared the heck out of me," he said. "I asked who was doing the work out here on the reservation.  "They told me, 'It will never get here. It's a White man's disease.'  "But there were already four cases of HIV on the reservation." Harrison took his son to the edge of Canyon de Chelly, a place sacred to Native Americans. "I asked the Creator to give me something to do. I hurt lots of people when I was on drugs. I wanted to give something back."  He helped found the Navajo AIDS Network. In the beginning, no one wanted to hear about AIDS. "Elders here were telling me not to talk about it. They said, 'You're wishing it on us.'  "I was chased out of buildings. But I kept at it."  Today, the organization has a budget of $250,000, less than it used to have, and a staff of five. It provides case management to about 60 clients across miles of open reservation with no phone or mass transportation.

Concerns about AIDS increased in 2003, when Dr. Jonathan Iralu, infectious-disease consultant for the Navajo Area Indian Health Service in Gallup, N.M., found the first cases of transmission on the reservation.  He sounded the alarm again when he saw an epidemic of syphilis cases, indicating unprotected sex that could spread HIV.  In 1999, there were two syphilis cases; in 2003, a staggering 93.  That year also saw 24 new HIV/AIDS cases. The Navajo Nation declared a public health emergency. After a brief foray into treatment programs in the 1980s, the Navajo Nation now concentrates on prevention, with five health educators. "If you look at it as a war, we're not winning or losing," said Darrell Joe, acting coordinator of the HIV Prevention Program. "We're strategizing, planning, figuring out ways for effective combat as opposed to just running out there and shooting randomly." The program now spends about $200,000 a year.
 They are working with a meth task force in the Fort Defiance area, targeting at-risk groups, planning screening programs for hospital and jail populations and doing general education.

The HIV Center of Excellence in Phoenix serves 117 patients, more than twice the 53 it had when it opened in 1996. But the challenge is not just more patients but more long-term, complex care, said Dr. Charlton Wilson, who worked as a physician for the Indian Health Service for years before helping found the center. "Before 1996, the typical AIDS case came in at a very late stage," Wilson said. "It didn't require much in the way of resources because people didn't live very long."  Now, with new drugs, people are living much longer.  "We're providing ongoing chronic care to patients with multiple medical needs, multiple social and behavioral needs," he said. The center, which has a budget of about $1.75 million a year, provides outpatient care, drugs and case management. It also consults with clinics across the Southwest. "This is about ongoing chronic need," Wilson said. "And if it continues to grow as it has been, doubling in a four- to five-year period, we're way under-resourced to provide that care."

 

  


The man who first walked up to Melvin Harrison at the grocery store lived only 10 more months.  Harrison drove him to doctor's appointments and sat by his bedside.  One night, the man held Harrison's hand. "Melvin, it's time for me to check out," he said. Tears were running down his face.  "I'll get a medicine man," Harrison told him. "We'll go to church." "No," he said, gripping his hand. "Keep doing what you're doing. Navajo people need you" Harrison didn't believe the man would die. "I'll see you tomorrow," Harrison said. "You're not going to check out." He pointed at him and left.  The man died that night. He never told his family he had AIDS; his death certificate said cancer.