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Living Classrooms (continued)

By Mat Edelson

Green, chair of the Greater Baltimore HIV Health Services Planning Council, helped oversee some $20 million in federal and state funding aimed at HIV programs, including education. He's studied several well-respected HIV peer-education models and adapted them to his work to create a culturally appropriate curriculum for African-American MSM.

The result of Green's efforts is a peer educational curriculum that goes way beyond HIV 101 and showing men how to put a condom on a banana. He challenges the men before him to think not only about a disease but also about their own mind-sets, how their often negative self-images came to be, and elevating self-esteem beyond internalized limitations. The goal is for each man in the room to feel as comfortable as he can in his own skin and with his own HIV treatment plan, and then, if he should so choose, to share what he has learned with others in their at-risk communities.

Over the 12 sessions, Green will take them where they want to go—the men set their own agenda and schedule. Under Green's tutelage, a question about the right to challenge a doctor's HIV drug regimen turns into a discussion regarding slavery and centuries of having to accept what was given without question. Issues of masculinity—how to ask a partner or a pick-up to put on a condom—similarly are answered with an eye to historical context and culture.

The conversations may range widely but always have a point, Green notes. Many of the physicians these men and their friends encounter in HIV testing and treatment are foreign; fear or distrust of these doctors, seeing them as different and apart, dampens enthusiasm to interact with the medical community. By helping them recognize their own prejudices, Green hopes to make these men less judgmental of others—and ultimately build their own self-respect.

"You have to be so cautious, so sensitive to how people receive [messages]," observes one of the men known as Danny (he asked that his real name not be used), who says he "didn't pay attention to anything that was going on in [his] life" until he "became deathly ill." Diagnosed in 2006 at age 40 with HIV—the result, he says, of drug use with his long-time male partner that led to reckless sexual behavior outside the relationship—Danny has spoken about his disease before more than a hundred inmates at the Maryland House of Corrections. He's also begun an HIV/AIDS ministry in his church.

Danny says Green's sessions have helped raise his level of conscious behavior and to see the world through other's eyes. "People are not mindful of being considerate—considerate for themselves and for other people. If I would have been considerate of my life, myself, and the way I was doing things, I probably wouldn't be in this predicament," he says.

Similarly, Tyrone James, 37, who formerly acted as a male sex worker to provide money for his since-kicked drug addiction, has discovered that he has to deliver any educational message at his client's pace, not his own. (See sidebar.) "I've learned how to present what I want to say, how to say it, and when to say it. And when not to say something. Then it's up to the person to take it in, digest it, and not feel like I'm force-feeding them something, but rather caring about them."

Ultimately, Sifakis expects some 60 African-American men in Baltimore, perhaps more, to take part in the peer education training over the next year. He wants to follow up with the participants through questionnaires and interviews, six months to a year after they've completed the program, to see "if they really are implementing the skills they've learned during the intervention." But funding is not yet in place for that.

For Green, whatever the scientific data conclude, it's this one-on-one connection in the community that is so rewarding, both for himself and these future peer educators. "It's that 'Aha!' moment you see when you look back in someone's eyes, and you know you're making a difference," says Green. "Because they have said something to you and your response is something they can immediately identify with, in the throes of their anxiety, or their pain, or their discomfort."

It's a moment and a model that Lennie Green and Frangiscos Sifakis hope is both personal and universal—utilizing the power of one to reach the many who still desperately need to hear and heed the risk-reduction message.

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