Sharen Duke, MPH, is executive director and chief executive officer of AIDS Service Center New York City (ASCNYC). Founded in 1990 as an HIV services group, ASCNYC has grown into a multiservice community-based organization, with four locations in Manhattan and one in the Bronx that help people living with HIV and other chronic conditions. “Helping many, one by one,” is its mission.

“Positive Change” is the slogan ASCNYC uses to describe the outcomes it seeks for its clients. Those outcomes can include accessing medical care, escaping homelessness, overcoming addiction, rejoining the workplace, creating community, living healthier and being more self-sufficient. For many ASCNYC clients, an additional outcome is the chance to give back to the organization by joining the staff.

Duke, who received her master of public health degree from Columbia University, has led ASCNYC since the beginning. From a staff of three and a budget of $170,000, today the group has more than 100 staff members and nearly as many peer educators with a budget of over $10 million. ASCNYC serves over 5,000 clients a year and reaches over 17,000 people a year through peer education and community outreach.

 

Tell us about your peer program.

In general, it’s been really exciting to have the opportunity to create programs that can help people achieve their goals. That’s what I love about our peer program. Once folks achieve a level of stability in their lives, we provide training, information and support for those who choose to give back and pass it forward.

Our peer program has multiple components. There’s a training component, where we provide knowledge and skills for graduates to become health educators and peer navigators. A mandatory support group is a part of the training.

We do placements for peers into part-time internships, which function as job readiness and skills development. Many peers go on to become full-time employees at these placements.

We offer care management to all of the peers, and we ensure that they remain connected to medical care and get their personal needs met while they are giving back and acting as role models.

We started the peer program in 1992 as a collaboration with the now-defunct group Body Positive. The first training cycle was called the peer leadership training program. The graduates did so wonderfully that we gave them internships to practice the skills they developed during their training.

There were instances of relapse among some folks after they left training. We needed to address recovery, so the peer leadership training program became the peer recovery and education program (PREP). In 2014, we had 93 graduates with 98 percent in sustained recovery.

Your peer program itself has become a role model, hasn’t it?

ASCNYC was one of the organizations that participated in Governor Andrew Cuomo’s taskforce to end the AIDS epidemic in New York. As a participant, I was one of the folks to write the recommendation to create a peer workforce as a strategy to help achieve that end.

Based on that recommendation, the state has created certification criteria. ASCNYC is very proud to say we are one of the authorized training centers of certification training for the peer educators. We’re still going to continue to do what the state calls our foundational training, which is our PREP training.

Now with additional resources committed by both the state and the city, there’s funding for expanding the peer workforce. We’re creating a Peer Training Institute to expand training opportunities for peer educators and to expand peer placements.

Our peers are part of what makes ASCNYC unique. They are our point of difference. The peers are integrated into every aspect of our work. The way that we approach that work is like a tapestry of people and of service.

You have such an animated culture at ASCNYC. How did that come about?

Our culture is based on a belief that everyone has the capacity to make positive changes in their lives. Just because you did something one way yesterday doesn’t mean you don’t have the opportunity to do it differently tomorrow.

When people come to ASCNYC, I see them as being brave and courageous in taking that first step to say, “I need help.” We are providing the environment and the safety and the support for them, but they’re the ones who do that hard work.

Apart from hope as a central tenet of our culture, another incredibly important piece is respect, cherishing diversity and celebrating differences between us that do not have to separate us.

Frankly, as a white woman running an organization where a majority of the people we serve are people of color—and the majority of the people who serve them are people of color—I am a part of the solution because I cherish and respect their life experiences.

What I have also learned in doing this work for 25 years is that you cannot look at someone and presume to know who they are or where they come from. I’m the daughter of a Holocaust survivor, and my late father was the sole survivor of his family; his entire family was wiped out. So I’m first generation. He came to the United States during McCarthyism.

He was a Russian partizan, and he burned his uniforms; he didn’t want to be sent back. He taught me that you have to stand up and do what is right, even if it is not easy. His legacy of hope and survival is what I think I have tried to bring to ASCNYC and foster that through the services that we provide.

Tell us about some of your services.

We provide care management. Some of the things that make us so successful are our community medical partnerships. We have meaningful and financial relationships with leading medical facilities like New York–Presbyterian Hospital, Mount Sinai and others. We’ve been working with these health systems to replicate and scale our models.

The care management is one of the important pieces because it’s an individualized, tailored plan to help people living with HIV or other chronic conditions to access all of the services that they need to be healthy and to remain in the community as long as possible.

For New York State, about 50 percent of people living with the virus are virally suppressed, so our work is to find and engage that other 50 percent and ensure that they get connected to care and to treatments and to medications. It’s been exciting and expanding.

Related to that, we have a pharmacy access program where we partner with mail-order pharmacies. Our clients can get their medications delivered to ASCNYC locations in Herald Square and our Casa Washington Heights community center, which is just blocks from New York–Presbyterian.

We’ve also started a supportive housing program in the Bronx and we’re opening up a pharmacy access center there. We’re going to augment it with treatment adherence counseling and support groups and participant incentives, all with the goal of connecting to care and viral suppression.

We also have a creative writing workshop that has been meeting once a week for over a decade. It’s a support group for treatment adherence and sustained recovery using poetry. They read poems together out loud and discuss them. Part of the class time is spent writing poetry, which we publish annually in a magazine.

What keeps you motivated?

Believe me, there are days—between government funding and politics, there are tons of headaches and challenges. But being able to participate in the conversation in moving progress forward is a very exciting thing. I’ve seen that one person can make a difference, and one person in a group can make more.

Twenty-five percent of our staff are graduates of the peer program. Seeing the peers turn their lives around and pay it forward and teach others is really what keeps me motivated to do the work.