"We’re at the apex of the AIDS and HIV infection problem in Central Pennsylvania," says AIDS Community Alliance (ACA) executive director Phil Goropoulos. His agency provides services to individuals with HIV disease and clinical AIDS in Dauphin, Cumberland, Perry, Lebanon, Lancaster, Juniata, and Mifflin Counties.

During the past 10 months the Agency has conducted over 110 intakes of individual accessing services for the first time and all indications that client numbers will continue to grow as more learn of the services offered by ACA. "We’ve responded rapidly and aggressively to the changing needs of people with HIV disease," Goropoulos says. His organization’s administrative unit recently relocated from Lancaster to Harrisburg and "mobilized" 12 case managers to 21 different sites throughout their seven county service area in order to be more accessible to clients.

"ACA services are as spread out and accessible as they’ve ever been. We send case managers at locations ranging from PinnacleHealth, Central Allison Hill, Hamilton Health, and the Discovery House in Harrisburg to locations such as Southeast Lancaster Health Services, the Spanish American Civic Association and St. James Episcopal Church in the Lancaster area. We’re where the clients are daily," he says. Clients no longer have to make a "separate" trip to ACA service sites for help. Goropoulos has fashioned a "one-stop-shopping" delivery system.

Being available to clients is important as the demographics of the disease shift from gay white males to other communities historically resistant to facing the problem. "Nationwide, and in Central Pennsylvania, women and men from communities of color are increasingly at risk for HIV infection. We’ve joined shoulder-to-shoulder with the African American Initiative on HIV and AIDS to make a difference," Goropoulos points out. In Dauphin County, for example, about two-thirds of the people with HIV disease accessing ACA services are African American individuals. Within that 60% of the whole, about two-thirds are African American men, Goropoulos explains.

Rising to the challenge within the African American community with other organizations, ACA’s Reverend Lawrence Henryhand, a well-respected Carlisle pastor recently honored at a public dinner, chairs the Initiative’s Faith-Based Committee. The group of concerned individuals was convened by the Greater Harrisburg Foundation to begin working on the problem at street level. "Faith-based communities are vital to working in the African American community. We recognize this and wholeheartedly collaborate with the Greater Harrisburg Foundation and the African American Initiative to bring our skills, resources, and staff to the effort," Goropoulos says. Renee Hartford, also of ACA staff, chairs the Initiative’s Educating the Community Committee. She also coordinates an ACA program known as STOP or Street Outreach Prevention Project.

As with any public health issue, perceptions play a formative role in how people view an issue. With AIDS, there isn’t "one" perception that clearly describes the different ways the disease affects different communities. Newer HIV drugs, although successful in warding off the type of infections that can be fatal for an HIV infected person, have confused the public into thinking there is a cure. "Although newer drugs have reduced the number of people infected with HIV from progressing onto clinical AIDS, or those with AIDS from getting sicker, the real numbers are revealing. About half the people who take the drugs fail on them. Those who do take them often experience severe side effects. Overall, researchers do not think the newer drug combinations can be taken for a lifetime. Right now, they’re a stop-gap," Goropoulos explains. Comparisons are often made to AIDS as a "chronic" manageable illness, a comparison Goropoulos acknowledges with a caution learned from dealing with HIV infected individuals. "There are no ‘AIDS’ rules about how an individual will or should react to the virus. If you have an HIV-infected family member or friend, remember to view them and their disease on an individual basis. Don’t make them have AIDS as described in a national news weekly," he warns.

Goropoulos also talks about individuals needing to know that they are infected. "Testing remains vitally important," he stresses. Free testing is available by Pennsylvania Department of Health at approved sites throughout the state including four sites managed by ACA. ACA testing days and times include every Tuesday in Lancaster at the Spanish American Civic Association from 1 p.m. to
5 p.m. and in Harrisburg at the ACA office (121 State Street) from 9 a.m. to 8 p.m.; every Thursday at Southeast Lancaster Health Services from 10 a.m. to 7 p.m. Beginning on December 8th, ACA will be offering testing services in Carlisle every Friday at the Carlisle Hospital Sadler Clinic on Hanover Street from 9 a.m. to 4:30 p.m.

The importance of testing raises the issue of "new infections" at a time when knowledge of HIV disease remains, at least in pockets of some communities, an exercise in denial. "In the heterosexual world, the rate at which infection in members of couples where the man is initially positive and the woman negative is near 100%. That is an astounding statement of denial over personal responsibility and risks by both parties. Traditionally, women of color and poor women feel they have little control over sexual practices – and men think they’re in charge. That dynamic makes for lots of newly infected people, and the numbers are there to prove it," Goropoulos observes. Among female AIDS cases reported in 1999, heterosexual contact was the most common risk factor for transmission of HIV, accounting for about 54% of the cases. Heterosexual transmission has now replaced injection drug use, accounting for about 44% of cases reported in 1999, as the most common mode of transmission among women.

Goropoulos makes an observation about the gay community. "Prevention works. We know this. In 1985, three-fourths of the infections were in the gay community, mostly white men. The remaining one-quarter of infections were, mostly, in men of color. By 1990, that number was half and half. By 1995, it was reversed. During those years, gay men launched prevention programs and made headway in the battle against new infections. At that same time, communities of color found it difficult to move from denial to action. Consequently, those numbers are reversed today," Goropoulos explains. He is concerned that within segments of the gay community, including Central Pennsylvania, the fears of AIDS have worn off and prevention messages have begun to fall on deaf ears. "Young gay men haven’t experienced the loss of friends and seen first-hand the devastation AIDS causes. AIDS has become ‘invisible’ to them in many ways, less real, less threatening. We need to be realistic yet honest about sexual practices. At first the almighty ‘Condom Code’ was the rule of the day, or night. That’s not working as well over time. We can’t be in a ‘crisis’ for 15 years. We need new, honest strategies for lowering risk," Goropoulos says.

Goropoulos has been ambitious in developing new programs that reflect the changing face of AIDS. Underway are four new programs known as Gay Men Seeking Health, Brother Coming Together for African American men, and Girlfriend to Girlfriend for women of color and Lesbian Initiative of Good Health and Togetherness (LIGHT). "We are organizing small groups of people to come together and talk about wellness and HIV disease — preventing it, treating it, and living with it. Individuals who get involved will have a great deal of control over the nature, pace, and topics of the program," he explains.

Besides busy with new programs, the folks at ACA do have time for fun. On December 1 — World AIDS Day — they will host Jill Sobule of "I Kissed a Girl" fame at Lancaster’s popular Chameleon Club.