Bay Windows - May 24, 2007
Ethan Jacobs, ejacobs@baywindows.com

"I have a newly diagnosed HIV patient whose T-cells have quickly fallen, and I want him to start up [taking HIV medication], but he disappeared for two-and-a-half months. I couldn't get a letter to him, I couldn't get a phone to him, no one could get a hold of him," said Vetters. "I thought, do I have to stalk him? But at a certain point, there's a difference between what they care about and what I care about. I may care about that a whole lot, they don't care about it, and until they care about it nothing I'm going to do is going to make a difference. In fact the harder I push, the further they'll run away. So I stop pushing."

Vetters said for the Borum's young patients (the clinic serves youth between the ages of 13 and 29, and last year more than 1500 clients accessed the center's services) the worst days of the AIDS epidemic when people were dying left and right are ancient history. The epidemic has become nearly invisible, and for many of the young people who test positive for HIV the daily medication regimen is a grim reminder of their infection. For many of them it takes time before they are finally ready to begin taking meds, and Vetters has learned to take a careful, diplomatic approach to urging his patients to begin, easing them into the discussion.

"Finally when this other kid did show up it was like, 'Hi, how are you,' and we dealt with the acute problem, and then I was able to say, 'Let me tell you what I'm worried about,'" said Vitters.

For more than 10 years, many of the Borum's clients have been either youth living with HIV or those at high risk for infection, but the shape of the epidemic was much different when the health center, a program of JRI Health, first opened in 1994. Bob Garcia, the clinic's director of operations and one of its original staff members, said that JRI's corporate offices were originally located right next to the present site of the Borum, and he said Michael Cronin, former JRI vice president for developmental disabilities, was inspired to open the center after talking with some of the homeless youth he saw living on the Common and doing drugs on his way to work each day. Garcia said he asked them what needs they had that were not being met, and their top concern was health care.

The center is named after Sydney Borum, Jr., an HIV/AIDS educator who worked for the Department of Public Health, visiting schools in the Boston area and teaching young people about HIV prevention. Garcia said that Borum, who was himself HIV-positive, had a message for the youth that went beyond simple prevention messages.

"While he started off talking about HIV, underneath and around the prevention messages that Sydney would talk about HIV were messages about health promotion and how to take care of yourself and value yourself as a human being," said Garcia. "He died a year before the clinic opened, and it was really in a testament to his incredible work with young people in prevention and testing and getting into treatment for HIV that JRI Health named the clinic in his honor and continues to honor his memory."

The center's focus on HIV/AIDS and LGBT youth evolved naturally from the original mission of serving homeless youth on the Common. Garcia said in working with the youth they discovered that about a third of them were LGBT-identified, many of them kicked out of their homes after their parents discovered their sexuality or gender identity. That prompted JRI to work to make the center welcoming to LGBT youth, and it also led JRI to launch the LGBT youth program Boston GLASS.

Soon after the center opened Garcia said staff found that they were also getting a sizable transgender population among their clients, including many young MTFs who were working as prostitutes. The center worked to make sure it was equipped to handle the health needs of its transgender patients.

The other major issue facing many of their patients in the early days of the clinic was HIV/AIDS. Garcia said at the time the treatments available for HIV were much less effective, and many of the youth coming to the center were suffering from opportunistic infections like pneumocystis pneumonia.

"Back then the young people that came to us were more desperate, and definitely sicker," said Garcia.

HIV has remained one of the top issues the health center deals with among its clients. Ariel Persing, coordinator of family planning and counseling and testing at the Borum, said that in any given week between 10 and 15 young people come to the center to get an HIV rapid test, and about two-thirds of them are LGBT. Persing said the center takes a harm reduction approach to trying to help the youth who test negative stay negative.

"The idea is that you are learning from someone things they are doing that they may or may not be okay with. If someone presents as high risk and they don't care, there's not a lot that's going to change in that one session or in a couple sessions, but if someone comes in and you ask, 'How does that make you feel when that happens,' and they present wanting to change, you come up with different ideas for them to do that," said Persing. "So if it's something as simple as, 'I get drunk every weekend and I hook up,' what is one thing that you can change in that scenario? Can you drink less? 'No.' Okay, if you're going to hook up, what can you do to limit exposure? 'Have a condom on me.' Awesome. Take the condom with you ... So it's looking at realistic changes that they can do."

But in recent years it has been harder and harder to get young people to take messages about reducing risky behavior to heart, said Vitters.

"It's not a lack of information. In some sense it's an over saturation of information. It's just a constant background noise. It doesn't seem any more important than when we talk about, 'You should stop smoking,'" said Vitters. "In some sense I think that's it. It's been such this consistent, persistent message that it has no more energy to it, no more zing to get through everything than the stop smoking and get more exercise and eat your fruits and vegetables [messages]. It's all the same, and the urgency isn't there anymore because it's all part of the same message. 'Use condoms, eat more fruits and vegetables,' it's all the same."

The care provided by the Borum center is not limited to HIV/AIDS and STDs. For young people without any other options for health care they can receive free primary care at the Borum. Transgender patients can get access to hormones, mental health services and other services to help them transition. Vitters said trans youth who are getting their hormones on the black market can come to the center to make sure that they are safe by monitoring their hormone levels.

The center also provides services targeted to homeless youth, including basic services like a shower that is available for clients to use weekday mornings. In the run-up to Boston Pride the Beth Israel Deaconess Medical Center, which counts the Borum as one of its seven affiliates, is hosting a drive among its employees for donated hotel toiletries like soap and shampoo specifically for the Borum's homeless clients. Ediss Gandelman, Beth Israel's director of community benefits, said there will be donation boxes and displays explaining the Borum's work in the cafeterias on its east and west campuses, and there will also be a display and donation box at Beth Israel's June 6 Pride awards ceremony, which is open to employees and board members.

Gandelman said Beth Israel is proud of the work the Borum does with reaching youth at the margins.

"We really do think that the Borum is a gem," said Gandelman. "Of our seven health centers they really embody the spirit of taking care of those who are disenfranchised and really offering culturally responsive care. All of our health centers do that, but they do it with flair."

Vitters said while many of the clients come to the Borum for specific concerns such as STD screenings and birth control, the center takes a broader view to try to improve their long-term health.

"I kind of think of those issues as the sort of entree, that's how we get them in, because they're interested in knowing what their HIV status is, what their STD status is, getting tested and treated for itchy genitals," said Vitters. "And then once we get them in there are issues of, we are also believer of the package issues, so it's smoking, it's obesity, it's risk for violence, it's vaccination, it's some of the large primary care questions. What are the risks for elevated cholesterol and diabetes, heart disease and all the sort of things that if we are able to get them to moderately change behavior in certain ways then we can actually make them healthier 10 years or 30 years from now?"

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