Syndemics Theory

Creating a culture

Now Halkitis merges his own work with mentoring the next generation of researchers. Daniel Siconolfi, an assistant project director at Halkitis’s research center, says he started there as an undergraduate looking for a five-hour-per-week volunteer job. Five years and a master’s degree in public health later, he is still there. “If you put in the work, Perry really takes you under his wing and nurtures you as a professional,” he says. “It’s a great experience.”

There is much talk of the culture that Halkitis has created at CHIBPS, where the potentially intense job of interviewing hundreds of at-risk and HIV-positive individuals can explode at any moment. The man who tested positive last summer, spawning the “research 9-1-1” emergency, is one such example; Moeller, the associate research scientist at CHIBPS, says they continue to work with the man almost a year later, and that he is doing substantially better.

Sandy Kupprat, who is working at CHIBPS on improving HIV testing rates in African-American gay and bisexual men, says the familial atmosphere that Halkitis has nurtured helped them help someone else that night. “It was scary, and yet also good at the same time, for us as a team.”

Halkitis’s desire to focus on the protective behaviors that people have is a departure from the risk-centered research that is most often conducted surrounding HIV and drug use. Barbara Warren, the former director of planning and research at the New York City Lesbian, Gay, Bisexual and Transgender Community Center, says that obtaining a recent National Institutes of Health grant to study that positive behavior was a “big coup.” She adds that, “Perry has a really unique ability to translate research findings into the vernacular for communities.”

Warren, who has worked with Halkitis on a number of projects over the years, says that academic researchers often don’t consult with the communities they aim to serve about their work. In contrast, Halkitis is actively involved with community centers and organizations from the beginning to the end of any project he does. “Along with that, he’s an incredible mentor to a lot of researchers,” she says.

Ignored is not defeated

Halkitis speaks glowingly about being a mentor of his team, but when the field’s lack of progress comes up his frustration is apparent.

“Here we are in 2009 and I think, really we haven’t gotten anywhere.” Halkitis speaks quickly, impatient with the status quo, where efforts to curb the HIV/AIDS epidemic focus on the wrong ideas. “Use a condom every time? Really? Do we really think that message is working anymore? It’s clearly not working.”

It had its flaws in the previous era as well. Gay men of his age — he turned 46 in February — who survived through the 1980s and early 1990s often have mind-numbing stories to tell. “All of my friends, or people I was friendly with in college, who were gay men, they all disappeared,” Halkitis says, slowly now. “I would say that between 1986 and 1995, I went to close to 100 funerals and memorial services.”

Soon afterward, the advent of HAART — highly active antiretroviral therapy — in 1996 coincided closely with the start of Halkitis’ research career, and it also changed the landscape of HIV work. Some thought the epidemic would decline in this country, but studies recently showed that rates of new infections among New York City men under 30 who have sex with men rose 32 percent between 2001 and 2006. Over the same period, the overall New York City rate dropped by 22 percent, according to a January 2008 New York Times article. The drugs have made HIV a chronic disease rather than a death sentence, but they also serve to push the issue from the forefront of consciousness.

“When I was 18 or 19, everybody was dying, and we knew what we had to do: stay alive,” Halkitis says. “If I was 18 years old now, in 2009, would HIV be the primary presenting problem in my mind? Probably not. So why do we think that approaches we used 28 years ago are relevant now? They’re not relevant. It’s a whole new generation, and it’s a different epidemic.”

Syndemics, personified

In the tranquility of Halkitis’ office, it is difficult to imagine his decidedly non-academic battles against that older, original epidemic, of protests in the street, or even of a hysterical young man being taken to a psychiatric hospital last summer. Halkitis carries the weightiness of his work easily, with passion but not anger. As he speaks of how to fight the new HIV epidemic, huge corner windows behind him reveal a serene Washington Square Park, and from the fifth floor the harried students on the streets below barely exist.

There is also little movement inside the office, save for a lone birthday balloon tied to his desk, swaying languidly. It’s from my mother, he says, and smiles. Having just described the experience of attending 100 funerals in a decade, he seems amazed to even say the words “I just turned 46 years old.”

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