English: Part of a project documenting the HIV community in Portland, ME.

Interview with George Friou January 4, 2002

I’m the executive director. It’s an administrative job- I supervise the managers here running the programs, I also write the grants, go out into the community and become a known entity to people. Mainly, I over see all the programs at the AIDS Project.

I started in this work about twenty years ago, I was a Peace Corps volunteer in Gabon, Central Africa and working in some of the local rural health clinics there. We had a lot of people, normally, dying of tuberculosis over there, it was pretty common. But there was an extraordinary high amount. That was the year that we all became aware of this virus. We put out flyers that there was an unknown virus causing all the deaths. It turned out that the population we were serving was heavily infected with the epidemic. That was the beginning of my work with the HIV world.

It was scary. We were using precautions, gloving up, etc. The blood exposure I had there, car accidents, that kind of thing, was nerve racking because I was constantly exposed. I thought for sure I was finished. Somehow I wasn’t. It took us a long time to educate that population about what was happening. Even today I think they are having a hard time understanding it. Why? Cultural difference, sexual practices, circumcision- the way it’s all done is not exactly the healthiest in the world. That’s how the virus is transmitted, not just through sexual contact- it’s more built into the culture there. It was difficult for them to understand that they needed to stop doing some things that they’ve been doing for generations. It was scary for them, and for me at the time.

Unfortunately, It hasn’t changed much. I still have some friends there that I correspond with. A lot of their families are gone- they aren’t alive anymore. The underlying message to me is ‘George, what you’re trying to do here, twenty years ago, it’s still not being done.’ So, it’s going to be a hard nut to crack. On top of that, they have the Ebola virus that’s popping up in different parts of Central and Western Africa. It’s a scary thing.

I left Africa in 1984, came back to the States and went to graduate school at Boston University and got a Master’s in public health. I worked in Boston in several health clinics- at this point the epidemic was very well known and spreading all over the community. I became more involved in the Outreach aspect of maintaining unexposure to the virus. In 1991 and worked in San Francisco at a homeless health clinic, and then moved to Maine in 1998. I have been working at the AIDS Project ever since.

I found that coming from California to Maine was a big change. I consider the state of Maine a rural state- getting at people and trying to educate people is difficult. Even trying to reeducate someone who is already infected to not continue to transmit the virus is very difficult here. You have less exposure to education in general. People who live in the rural areas of Maine don’t get the constant flow of information that they need about how this virus is transmitted. I’ve learned that, I’ve seen that.

Plus, here we have a big closeted community- people are afraid to come out and discuss their sexual orientation. I think this [discussion] leads to discussions about the virus. It’s not a very open society here. It’s probably one of the most difficult parts of it, because you need to be very open and be able to talk about who you are and not worry about it. You must have enough self confidence in yourself no matter what you do in life, and not be intimidated to say that ‘I’m a gay man’ or ‘I’m a lesbian woman’- I mean, ‘So what?’ That kind of attitude is not evident here. We have pockets of people who can [be open], but it’s very limited. I think if you’re going to get at this epidemic and change it, that [silence] has got to go away.

Look at the younger population here. I can’t get into the schools here for a couple of reasons. One is a political reason that’s not really worth talking about. The other reason is that the community is afraid to talk about the sexual aspects of this epidemic. They say “My child is not having sex, anyway. If they are, I know they’re doing it safely.” But I know they’re not, because the kids tell me that.

If you look at the chlamydia spike in infection rates here, that tells me that high school kids are unprotected. That will lead to a problem. But I can’t get into schools. It’s something that administrations are nervous about. They have very limited AIDS education- they lump it in with basic sex education. It’s not really as much of a topic as it should be. Everybody is having sexual encounters younger and younger- it’s a matter of time before this all bites us in the back.

We have a couple of schools who have asked us to come in. Some in Scarbourough, but none in Portland. Every opportunity I have I try and open up the door so I can get in. We’re in the middle of writing a grant right now for someone who is more or less around their peer group to be able to get in there.

This is an epidemic that you need to be fully aware of. Since we are human, we are very exposed to this. Here are the ways that you are exposed, and here are the ways that you can prevent becoming infected. Those are messages that have to be constantly engaging people. You have a new generation coming up now who doesn’t know a thing about it. There’s less and less money out there to teach them about it.

We are starting to experience a different kind of a client, since people are living longer with the disease. I think a much more complicated one, because we didn’t know what the effects of the medication have been up until recently, and they are very bad. A lot of substance abuse is being mixed in now – it’s a dual diagnosis. The issues that come up with being positive, having an alcohol problem and putting those two together, you get a client that many people can’t take care of. We do. One of our clients has HIV and severe dementia. You can’t house them anywhere. Even in the Alzheimer’s units. They can’t put that combination in there because of the danger of the virus being transmitted. That’s a huge change. Before you didn’t have that, because people weren’t living that long. You didn’t have that issue. Now we are going to have a large population of people experiencing all sorts of adverse reactions to medications and who are mentally incapable of taking care of themselves. It’s going to be a real drain on the system to take care of people. I think housing is going to be one of the biggest issues.

What we are going to fight for is capacity. Presently we are housing six people at Peabody House. That’s not enough- we need to have a larger facility that can house people, as well as staff it appropriately to take care of some of the dual-diagnosis problems. We need to seek out the dollars to do that, and that’s very hard to come by. Less and less dollars are available. It’s a little frustrating, but again it’s going to hit this crunch period where we are going to have a large infection rate again and a large amount of people who are going to die again and more money will swing around and come back and we’ll have that capacity again. I call it the street light syndrome. You don’t have a street light on a corner until X amount of people die, then eventually they put a street light up.

It’s hitting the lower-income inner city communities. That’s what I mean by a burden on the system- the Medicaid system is going to be taxed to the limit and you’re not going to have the money for somebody to go out and get their medication. It’s just not going to be there anymore. It’s going to hit us- we’re going to have a problem here pretty soon. It’s going to get really big as time goes on. We all know that, looking at the infection rates everywhere in the states.

Let’s say right now that you have a symptom of something, or you aren’t feeling well. You’re not getting tested. So you really think, oh, it’s the flu or something, and you let it go on. Periodically you get sick, and then you get sicker and several years go by and finally you go in and get tested and you’re at the latter part of the disease. This is where it costs more. You’re also ten years older, so you’re in your early thirties- the doctor is going to say you’ve probably had this for eight or ten years. You were probably infected in your early twenties or late teens. That’s what we are seeing. That is why the younger population is important to get at. In fact, infection is starting then. The majority, I believe of infections, is people in their mid-thirties. That’s late, it’s in the latter part of the disease. So that tells us something big.

What I’m trying to do here is just build the capacity to take care of more people, because all we are getting is more people coming in. We don’t have the capacity right now to deal with it. Waiting lists are longer, the type of client is more difficult, we don’t have enough people trained to take care of some of these very complicated situations.

The hardest part that I’m having is getting unrestricted grants or unrestricted dollars. If you send me a check for $100, I can spend that on anything. If I write a hundred dollar grant, I can’t [spend it on anything]- it’s going to go for specifically whatever I write it for. The hardest money to come by is the money to pick up the pieces here and there. When you write a grant and get a million dollars, people think you’re rich, but in fact it’s costing me twenty or thirty thousand to run it. So I need to find that twenty thousand from somebody like you and I who will send dollars in to help pay for it. That’s the hard part, and that’s what’s going down. Especially after the buildings went down. We received less donations since that episode. Our annual is down several thousand dollars. You add all of those up and you start to fall short, eventually it effects programs and the clients aren’t getting the best services that they should. That’s what we are experiencing now.

I think the biggest vision is to be become more diverse. We need to have larger prevention programs, larger case management capabilities, better housing. Those are the three components. They need to be bigger. So my vision is to increase the capacity here. That’s not going to come through donations, it’s going to come through a grant writing process where we can try and cover some of our expenses with the grants, but the main thing is to write them in such a way that it would appeal to the federal government. ‘Let’s let the AIDS Project try this model and see how they do.’

The housing program we have here, Housing Opportunities for People living with AIDS (HOPWA), took us six years to get there. Now it’s being used all over the country and successfully housing people who are living with the disease. We should be able to do that with prevention activities as well.

HOPWA- Housing Opportunities for People Living With AIDS. That’s a grant that allows us to have subsidies for people- we subsidize their living and apartments and emergency money for heating and phone and that kind of thing. It’s very popular. We’re housing hundreds of people. Instead of going out and buying a place and housing people, this is more of an apartment subsidization that turned out to be very successful. They have to be clients here, or at Shalom House or AIDS Lodging House or Peabody House. They have their case management services, their medical services at Maine Med. It’s a really comprehensive model.

Over the years here we’ve had some specific models that the state has been dictating to us, how to educate in the prevention world, how to educate people on how not to get infected. That’s changing now- it hasn’t been very successful. The Center for Disease Control went from concentrating on people who are negative to focusing on people that are positive- because that’s how it’s being transmitted. The biggest question here is testing- you’ve got to know your status. Once you know that, whether you’re negative or positive, there’s evidence showing that you will become more aware of your sexual activity and a little bit safer. If I’m positive and I didn’t know it, the goal here is to make sure that I know. We as a team here at the AIDS Project have decided to focus a lot of our work on getting people tested, and then to work with the people who are positive to educate people who are negative not to become positive. Different approach- I think it will be more successful.

The big problem is, I don’t really know whether you’re listening to me or not. You can come in here and say ‘sure, I’ve been listening for the last half hour, and I’m going to use condoms every single time I do any kind of sexual activity.’ You come back in six months and I will ask you the same question- it’s only on your trust that you actually did that. You can’t measure the success at all. The only way I would be able to measure that is to test you.

We advertise for testing, and we have a hotline here as well. People call all the time. There are posters around the city. But we can’t get into the schools. Some of the more progressive schools allow us to do that, but the majority of the schools, we can’t do that. We’re going to get there though. You have to have pretty progressive principals and teachers who are willing to take that leap toward being able to openly talk about the potential for high school kids being positive, or having sexual activity- a lot of people think they’re not.

We had an in-service with the staff at Scarborough Middle School- there was about forty teachers there ranging from about twenty-two to sixty in age. I would say that the majority of them really had no idea even what chlamydia was, how the virus is transmitted, why is it easier to transmit HIV when you are infected with chlamydia or another type of venereal disease- nobody knew anything at the staff level, so that tells me what’s going on at the student level.

I think it’s a responsibility to look at our educators and make sure they are up to speed with what they are trying to teach. If a young woman who is fifteen years old says she wants to talk to you about HIV and you can’t, that’s an alarming problem.

The Scarborough Middle School loved the in-service. It went a lot further, we went back and we brought some clients as well as some staff and we have in-service with the kids now. We’ve gotten really good feedback. You know, we’re going to have some parents who are going to call us and ask what’s going on, but that’s OK. To me, I’ve turned the stone here, and got the fire burning. I’d rather have sort of focus groups with parents and the kids together. If you can’t go home, sit down with your child and talk about this openly and have condoms in your house, and if you don’t because of religious reasons or whatever, you know, we’ve got a problem. In my house, with my kids, when they grow up they’re not going to have to go to the grocery store like I did- hide and spend twelve dollars on four condoms and hurry up because my mother might see me kind of a thing. (laughs) I don’t know if you ever went through that, but I did. It’s embarrassing. That’s got to go away. We have to just be able to go out and get condoms when we want them and say yes, I’m having sex, and I’m doing it right! (laughs).

I think it’s important for the community to become more aware and involved with the global aspect of the epidemic as well. I would love to start some kind of sister non-profit program in a Southern African country, where we could exchange people or fundraising activities. That would be a real eye-opener for people, because if you look at the latest statistics for Southern Africa it’s alarming. We’re losing a generation over there. That’s hundreds of thousands of people in ten years that are gone. I don’t think people are aware of that here. We have our little Maine, we have a couple thousand potential people that are infected here that are really important for us to take care of, but I would like to make that jump to what the epidemic means at the global perspective. We need to be aware of it. It’s a plane ride away now, it’s not someplace that takes forever to go. If somebody comes over from an infected part of the world, it could just be instantly transmitted here too.

I’d love to get a couple media channels to go over with me and make a documentary. Back in the eighties, that was how people became aware of it. Documentation of the effects of the disease- people were becoming infected and dying in a year, at a huge level. Hundreds of people were passing away in San Francisco. We need to get that exposure again, people aren’t seeing that anymore. It’s becoming a so-called livable chronic disease and that’s not the truth.