Some CDC grant money unspent by Latino clinic
By JOEY DiGUGLIELMO
The Washington Blade
May 9, 2008
A Washington clinic that provides free health services for the Latino community has spent only a fraction of the funds it received through two unprecedented 2006 Centers for Disease Control & Prevention grants, raising concerns among some local trans activists that the money is being mismanaged.
La Clinica Del Pueblo, located on 15th Street N.W., was one of 23 organizations around the country that received a grant to establish behavioral interventions for high-risk young men of color who have sex with men.
Amounts varied among the organizations awarded grants but funds for each will be doled out in equal amounts annually for five years. La Clinica was allotted $198,939 the first year, one-fifth of the $994,695 that will be available to the organization by the time the five-year period ends in 2011 (years run September to September; grantees were announced in September, 2006).
La Clinica received another CDC grant that, over the course of the same five-year period, will be worth $991,605. This grant was awarded to implement behavioral interventions for high-risk young transgender women of color. La Clinica was one of only five organizations that successfully applied in that grant category.
But the delay in opening a transgender youth outreach center has given some in the Washington Latina trans community the impression that La Clinica staff is either wasting a rare opportunity or misusing the funds.
Long-time Latino activist Ruby Corado, who’s transgender and claims to have urged La Clinica to apply for the funds, is the most vocal.
“I really don’t think there’s any corruption, but I mean, come on — this is only a five-year program,” Corado said. “We’re two years into it and nothing. Can’t they at least hand out some condoms or something? What are they doing with this money?”
Corado alleges that several e-mails and meetings she’s had with involved parties — including CDC Project Officer Janice Norwood — have not resulted in action and she’s alarmed.
Of a December meeting Corado had with Norwood, Corado said the CDC officer “didn’t seem too interested in hearing a lot of it.”
Norwood directed Blade calls seeking comment to the CDC’s media relations department. Several messages left with the CDC were not returned.
Catalina Sol, HIV/AIDS department director for La Clinica, said she understands the frustration some in the local trans community feel about the project’s status but said several factors have led to delays beyond her organization’s control.
“We were ecstatic to be awarded these funds,” Sol said. “But there’ve been a number of factors for the delays. It’s no secret to us or to the participants that this has been much slower than we’d hoped and that some people are frustrated. But we’re working hard to be transparent and we’re always looking for opportunities to get the word out.”
Sol, who’s straight, cited challenges with the facility, age restrictions on the grant and staffing as the main obstacles to getting the trans program running.
La Clinica signed a lease agreement for a site on Mt. Pleasant Road to house the youth trans program but said renovations there have been more extensive than anticipated.
“It’s just a different level of renovation than we realized,” Sol said. “We expect to be in the site, with God’s blessing, by June.”
La Clinica forged ahead with that location because it’s “the most suitable site” and “prime space,” Sol said.
“We thought it was worth the effort,” she said.
Some of the grant money can be used for site renovations.
There’s also been some confusion within the trans community about the age stipulations included in the CDC grant, which limit the resources to benefiting those between ages 13 and 24. La Clinica is targeting young people between ages 18 and 24 for both the trans grant and the one for young men who have sex with men.
Most trans La Clinica regulars are active in a support group called Mariposas (butterflies in Spanish). One trans woman from New York, who was hired to coordinate the program, said she, like the support group members, misunderstood the terms of the grant.
Natalie Isaaz moved to Washington in January to oversee the program but said important information was not conveyed to her when she interviewed for the $34,000-per-year position.
“I got there and they said it was only for 24 and under,” Isaaz said. “But most of the transgenders in the program are over 25. They’re older. I’m not expecting to work for one community and leave most of them behind.”
Isaaz, who is friends with Corado, left the job after only two months.
Isaaz, 52, said she, like Corado, questioned what was being done with the CDC money.
“Just tell the truth,” she said. “This is a community with a lot of need. What happened with that cash? What are they using that money for?”
Sol declined to discuss personnel issues but said two people had been in the coordinator position at different times but that it’s currently open. Using CDC grant money, La Clinica hired three full-time employees and a few part-timers to staff the young men’s program though some, such as a project manager, will oversee both the young men’s and trans women’s groups.
A 28-year-old Latina transgender woman in Washington, who spoke on condition of anonymity, said members of Mariposas don’t understand the restrictions.
“There’s only three or four who are under 24,” the woman said via a translator. “They didn’t tell us that (when the grant money was announced).”
According to CDC paperwork that explains the grants, the age restriction was implemented because young men of color who have sex with men are the largest group of young people infected with HIV, accounting for 56 percent of HIV infections ever reported among those aged 13 to 24 in the 33 states that have HIV name-based reporting.
CDC also cited a study that showed male-to-female transgender youths as accounting for 35 percent of HIV infections. Trans/HIV research from other sources confirms that it’s a significant public health problem.
Sol said research data indicated youths were especially at risk for contracting HIV and that’s why the grants came with strict age restrictions. Trans women older than 24 are more likely to have been informed of HIV risk factors, Sol said.
Sol also said some who’ve criticized La Clinica may not be aware of how the grants work. She said the CDC doesn’t simply write La Clinica checks each year for the nearly $400,000 it’s eligible for annually from the combined grants.
La Clinica employees, Sol said, have to submit expenditures to the CDC for reimbursement. Unspent money from year one was given “carryover” status, which La Clinica had to apply for. If La Clinica doesn’t use the money by September 2011, it can’t be received.
In the grant application, the CDC outlines its monitoring procedures.
“CDC requires HIV prevention grantees to demonstrate that the programs they support and implement are capable of meeting their states’ goals,” the paperwork says. “[Grantees] … need data to … demonstrate prudent stewardship of funds.”
It could not be determined by press time if the CDC was properly monitoring La Clinica’s use of the funds because the CDC didn’t return calls, but Sol said there are “multiple layers of accountability” in place.
Joe Hollendoner is director of a comparable program in Chicago that also received a CDC grant for young trans women of color. Hollendoner, who’s gay, said CDC’s involvement in his work at the Broadway Youth Center, a division of Chicago’s Howard Brown Health Center, has been of a collaborative nature.
“I’ve never felt the CDC was judging us in a harsh light,” he said. “They realize this is the first time any of us have done this so there’s a learning curve there for both parties. I’ve never felt we were in hot water with them.”
The Broadway Center’s trans youth program, though, is much further along than its Washington counterpart. Three classes of young trans women there have graduated its six-session education course.
But the Brown Center had more infrastructure in place initially than La Clinica. The Broadway Center was already in existence providing a handy facility and Chicago Department of Health has other programs available for older trans women, Hollendoner said.
Susan Kegeles, professor and coordinator of the Center for AIDS Prevention Studies (CAPS) in San Francisco, plans to work with La Clinica on implementing programming when it has facility and staffing issues settled. CDC uses agencies like CAPS to help ensure proper implementation of grant money.
“I have no idea what’s caused the delays,” Kegeles said. “[The CDC] has told us just to stand by. We wondered if we should start badgering them but we’ve been told they’d call us when they needed us.”
But Kegeles also said the delays shouldn’t be cause for alarm and cited research by Dean Fixsen of the National Implementation Research Network that found it can often take two to three years to get new programs up and running.
“There’s a whole bunch of research on this,” Kegeles said. “I’ve seen this time and time again — it really takes a substantial amount of time to implement something from training and staffing on down. I kind of picture it like a huge locomotive moving downhill. It takes a lot of work to get a train to a halt and get it turned around in another direction.”
Sol said La Clinica is doing some youth prevention outreach now through its 15th Street location. She pointed to condom distribution, HIV testing, movie nights, participation in Youth Pride and last year’s Capital Pride, peer education visits in homes, a Christmas dinner and more as evidence that the work has begun.
“We’ve actually got a lot going on despite this cramped site,” she said.
She also said the programs are “much closer to being visible” and that she welcomes questions and concerns.
“We feel we have a huge responsibility with this,” she said. “The delays haven’t been for lack of attention or lack of importance.”
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