Taking It to the Streets

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Science  28 Jul 2006:
Vol. 313, Issue 5786, pp. 483
DOI: 10.1126/science.313.5786.483

An unusual prevention program targets gang members, who are seen as particularly vulnerable to HIV

BELIZE CITY, BELIZE—Shortly after Douglas Hyde started working 4 years ago doing HIV/AIDS prevention work with gang members, he was welcomed with a “pint bottle” to his face that left a nasty scar above one eye. Today, Hyde, a former gang member, continues the work through a multipronged government program called Youth for the Future that attempts to link violence reduction with HIV/AIDS education.

As Hyde drives around the rough South Side streets where he grew up, he repeatedly toots the horn of his van at gang members. “What's up, fam?” he asks a group of men and boys hanging out on one street who don't exactly look like his family. The group gives a warm “Ya ya” to “Dougie,” who has o-n-e l-o-v-e inked across his fingers and barbed wire tattooed on a bicep. Several of the men wonder whether he has leads on any jobs. “I have become the job god in the street,” says Hyde.

This is Blood territory, the gang that Hyde used to run with until a showdown with the rival Crips scared him straight, and he notices the finer details of the street. The pile of used clothing for sale on the sidewalk is a front for dealing drugs. Most of the guys in this group are “strapped” with pistols. “Scopes” at second-story windows of the incongruously colorful clapboard homes are monitoring his every move. And he sees something else that may be less than obvious to outsiders: a strong link between the gang lifestyle and Belize's high prevalence of HIV, which at the end of 2005 had infected 2.5% of adults. That's why Youth for the Future believes that finding people legitimate jobs and encouraging them to quit gangs is a potentially powerful HIV prevention strategy.

Although many Latin American countries have problems with gangs, a 2005 report by the nonpartisan U.S. Congressional Research Service said “the largest and most violent” ones are in Central America and Mexico. According to the report, several factors have led to an increase in gangs: weapons left over from the many civil wars in the region, the stepped-up U.S. deportation of law-breaking immigrants, and staggering income inequalities in Belize and its neighbors. Youth for the Future is one of the few efforts that explicitly targets gang members as “at-risk youths” for HIV infection.

Ganging up on HIV.

Youth for the Future's Douglas Hyde (right) found these former gang members jobs with a company that's clearing this junkyard.

Not only do gang members often share one woman, Hyde says, but “transactional sex” for a meal or protection is also the norm. “Give some, get some,” says Hyde. Condom use is also low. “And some guys in the street, especially the leaders, believe that they don't need to take the HIV test,” says Hyde. “They believe they just need to send their girls or wives to take the test to know their status. We're telling them that's not true.”

Supported by the United Nations Population Fund and a grant from the OPEC Fund, Youth for the Future maintains a resource center that's essentially a hangout for anyone, and gang members are welcome. It stages frequent HIV/AIDS prevention education sessions and has a big bowl filled with free male and female condoms, free pamphlets on HIV/AIDS prevention, and Internet access for a small fee (free to students). “They have done tremendous work,” says epidemiologist Paul Edwards, head of the Ministry of Health's National AIDS Program. “These kids have a lack of education and don't make the best decisions possible.”

No study has ever assessed HIV prevalence in gang members in Belize, which has a tiny population of 280,000 people. A study done in the country's one prison—which almost every longtime gang member knows intimately—found an HIV prevalence of 4.6%. Youth for the Future plans to start offering HIV counseling and testing, and Hyde hopes to recruit gang members to participate in a prevalence study. Meanwhile, he's become increasingly cautious about how he conducts his business. “I'm good with everyone,” says Hyde. “But I'm very smart now to recognize when I shouldn't be around.”

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