Every hour, two more young people in the United States are infected with HIV. Many live in New York, which has more HIV cases than Los Angeles, Miami and Chicago combined. The risks are even greater in poor neighborhoods and communities of color.
This grim reality is complicated by a simple fact. Young people see a doctor less often than any other age group. “They haven’t had good experiences with health care providers,” says Dr. Alwyn Cohall, director of the Harlem Health Promotion Center and its Project STAY at Columbia’s Mailman School of Public Health.
For more than 20 years, Cohall, a pediatrician and specialist in adolescent medicine, has bridged that gap by partnering with young people to prevent HIV and other sexually transmitted infections, and care for those already infected.
As part of Project STAY, which stands for Services to Assist Youth, he and his staff travel to high schools, vocational schools and juvenile justice centers in all five boroughs to make presentations about sexual health and encourage young people to be screened. Nearly 10 percent test positive for one or more sexually transmitted infections.
Anyone ages 14 to 24 is welcome at two Washington Heights clinics operated by Project STAY with the Comprehensive Health Program at NewYork-Presbyterian Hospital—a New York state designated AIDS Center. Services are confidential and of the 1,500 youth seen in a year, many are regulars. They come back to renew a birth control prescription, get retested, apply for food stamps or deal with any number of other health issues. Occasionally a patient will come to the clinic with a family member. More often, they are on their own. “We give young people a place where they can feel safe,” says Cohall. “We become a kind of family for them.”
Cohall, who was born in Jamaica and grew up in Harlem near City College, was inspired to become a doctor after seeing firsthand how medical services were stretched thin in the community. He once injured himself playing football and spent most of the day in the emergency room.
He studied anthropology at Wesleyan University in Connecticut before getting his medical degree at University of Medicine and Dentistry in Newark, N.J. During his residency in pediatrics at Montefiore Medical Center in the Bronx, he came to enjoy working with vulnerable youth, which led to a fellowship in adolescent medicine at Mount Sinai Hospital in Manhattan.
In the late 1980s and early ’90s, while on staff at St. Luke’s-Roosevelt Hospital Center, Cohall was among the first to create health clinics within New York City public high schools. After encountering several cases of sexually transmitted infections, he began testing students for HIV. Out of the first 10 people tested, four were HIV positive. None was symptomatic or knew they had the disease.
“The conventional wisdom at the time was that young people who were HIV positive were prostitutes or IV drug users or were somehow disconnected from mainstream activities,” he remembers. “The young people we found were in high school. In one period they were going to English class, and the next period they were finding out that they had a life-altering infection.”
At the time, there was no place for young people with HIV to call their own. With a grant from New York state, Cohall created Project STAY in 1991.
The early years were rough. “We went to an awful lot of funerals,” he remembers. By the late ’90s, antiretroviral therapy began transforming HIV into a chronic disease instead of a death sentence. One patient went on to pursue a law degree at Columbia. Another is married and has three children. Remarkably, of every baby born to Project STAY patients, none has been infected with the disease.
Cohall’s work at the Harlem Health Promotion Center, which is funded by the Centers for Disease Control and Prevention to address health disparities in Harlem, complements other anti-AIDS initiatives at Columbia, including at ICAP, part of Mailman’s Global Health Initiative, and at the College of Physicians and Surgeons, where scientists are working on a vaccine. “We are fortunate to be in an institution that considers HIV a high priority,” Cohall says.
On World AIDS Day this past December, the New York City Department of Health honored Cohall’s work. The recognition was gratifying, but reminded him that more needs to be done. Project STAY has about 80 HIV patients and the number of cases has been increasing by 20 percent every year. Despite the growing demand, finding financial support has been a challenge. “Teenagers aren’t cute or cuddly,” observes Cohall. “It’s a tough sell.”
For youth with few options, Project STAY continues to be an essential lifeline. “It’s tough enough being a young person in NYC, let alone with HIV,” he says. “We try to normalize their existence and help them get to where they want to go.”
—by Tim Paul, Mailman School News