by Suzy Subways
APRIL 2007 • Issue 4
A disaster that uproots large numbers of people causes an immediate public health emergency, and the effects continue to be felt if the damage isn’t quickly repaired. Soon after the hurricane, P. Gregg Greenough, MD, MPH and Thomas D. Kirsch, MD, MPH went a step further in an October 2005 New England Journal of Medicine commentary, observing that, “Given the ineffective response mechanisms that were in place, Katrina could become a public health catastrophe.” They cited potentially devastating sanitation and immunization problems, among other concerns. “The biggest health issue, however, was and will continue to be the inability of the displaced population to manage their chronic diseases,” they argued. “Katrina disproportionately affected the poorest residents of New Orleans, who did not have the health reserve or the access to care needed to absorb the blow of a breakdown of the local public health system. In the long run, the destruction of the public health and medical care infrastructure has the potential to be more devastating to the health of the population than the event itself.”
Before the hurricane, Charity Hospital’s respected HIV Outpatient (HOP) Clinic served about half of New Orleans’ 7,000 HIV-positive patients. Severely damaged by Katrina, the clinic closed for two months, then operated out of several temporary facilities. Rebecca Clark, MD, says, “Seventy percent of our patients experienced disruptions in their medications for a month or two.” This is far more than a temporary inconvenience, since it can lead to HIV drug resistance and dangerously weakened immune systems, increasing the risk of serious illness and death.
In its 2006 report Voices of the Storm: Health Experiences of Low-Income Katrina Survivors, the Kaiser Family Foundation, documented cases of lower CD4 cell counts due to medication disruptions. One resident of a group home said that her facility gave her only a three-day supply of her HIV medications when she was evacuated. An incarcerated man with HIV missed his medications when he was moved to another prison. An HIV-positive man with severe mental health needs lived on the streets for weeks after evacuation from his group home. These incidents illustrate what many people with HIV experienced when a major natural disaster was combined with a callous and inept government response.
Charity Hospital is now permanently closed. The HOP Clinic is back in its original location but shares the space with other clinics—and only half of its former patients have returned. Many no longer have homes to come back to.
Housing Crisis Increases HIV Risk
Following the hurricane, serious barriers made it difficult or impossible for people to return to their homes or obtain new housing. The lack of affordable housing in New Orleans has created new gaps in HIV prevention services, as many providers themselves haven’t come back. Five of the city’s ten community-based HIV prevention contractors went under in the wake of the storm due to the hurricane’s destruction and to staff not returning. Residents who have made it back are dealing with housing instability and stress, heightening their HIV risk, says Noel Twilbeck, co-chair of the Louisiana AIDS Advocacy Network and executive director of NO/AIDS Task Force. “When people are living in stressful situations, they have a tendency to engage in risky activities,” he says. “There are people living in houses that still don’t have walls up, waiting for repairs.”
HIV prevention worker Tamachia Davenport of St. John #5 Faith Church agrees: “Since Katrina, we’re seeing more high-risk behavior, people in recovery relapsing, doing things to pay their bills—they’re in survival mode, and that puts them at risk for HIV.” (Click here to read a recent interview with her father, Pastor Bruce Davenport, about the church’s efforts against HIV in post-Katrina New Orleans.)
For ten years, Tamachia Davenport has been handing out condoms in housing projects in the 7th ward, one of the neighborhoods most damaged by the hurricane. “Some people evacuated to the projects because they were some of the strongest buildings in the city—they’re made of stone and bricks,” she says. Yet the city has kept them fenced off and plans to tear down four of them, replacing them with “mixed income” housing. Davenport says, “People who were paying $100 or $200 a month, will now have to pay $600.” And most people can’t afford that monthly $600.
Housing activists have launched tent cities and building takeovers in protest. To many people from New Orleans, the government’s housing policies seem designed to keep low-income people from remaining in or returning to the city. New Orleans Times-Picayune columnist Lolis Elie, in a January 5, 2007, interview with psychiatrist and Root Shock author Mindy Fullilove, argues that his hometown is intentionally keeping poor people from coming home. Fullilove agrees. “There is definitely an attempt in New Orleans to label this as a moment of progress, meaning you can bar the poor from returning,” she told Elie. “I read this as a message of how society feels about people… It is a betrayal of a fundamental contract, as if your mother wanted to murder you.”