Turning the tide of AIDS in New Haven, in a collaborative style

When Yale College turned him away as an applicant in 1961, it came as a shock to Matthew F. Lopes Jr., M.P.H. ’77. He’d grown up at Yale, living at the Elizabethan Club on College Street, where his father was the steward. Lopes naively assumed that Yale, the only school he’d applied to, would accept him.

He applied again to Yale College after a stint as an Army cryptographer during the Vietnam War. After another rejection, he argued his case at the admissions office and ultimately was accepted.

Today, Lopes is the coordinator for AIDS services for the New Haven Health Department, where he oversees a staff of 17 who deliver education, outreach and care to New Haven’s HIV-positive community. He chose a career in public health after his plans to become a physician didn’t pan out. Nearing graduation from the combined M.D./M.P.H. program at the medical school in 1977, he had written his thesis on Reye syndrome, completed his course work for his M.P.H. and finished all but two semesters of medical school. After several attempts and near misses, however, he failed to pass his medical boards. He graduated from Yale with an M.P.H.

“The world doesn’t necessarily stop because you don’t get everything you want,” he said. “I’m living testimony to the fact that you can survive not passing your boards and still be involved in medicine or practice public health.”

Lopes had chosen the combined program because he wanted to practice medicine in an urban environment and he felt he would need a public health background. As it turned out, public health was probably the better choice for him, because it gives him the opportunity to deliver health care to a larger segment of the population than he could were he in private medicine. “In public health we see a lot more people and have a better impact in some respects,” he said. “A lot of people with HIV/AIDS need primary care and supportive services, and we have the models to make it work.”

Lopes came to the city’s health department after working as an epidemiology consultant at the state health department, a hospital administrative intern at the state’s Department of Mental Health and a minority recruiter at the School of Public Health. He joined the city’s AIDS division in 1993, about three years after the city initiated its groundbreaking needle exchange program. Lopes has kept the program going, sending a van out five days a week to sites around the city where people can exchange used syringes for new ones and receive support services such as drug treatment referrals and HIV counseling and testing. With intravenous drug users accounting for 48 percent of New Haven’s AIDS cases, Lopes believes the program is essential to fighting the spread of HIV/AIDS. He shuffles resources to fund it, since federal support is not available. “We try to meet people where they are and bring them to where we want them to be, without being judgmental,” he said.

When Lopes joined the health department at the height of the AIDS epidemic, there were almost 280 new cases reported that year in New Haven; today there are about 80. But there are 680 HIV/AIDS patients and their families in New Haven who receive care through the New Haven HIV/AIDS Case Management Consortium, and delivering that care can be complicated. Lopes, with the support of community-based organizations, has built an infrastructure with funds from the Ryan White care Act, a federal program designed to help provide care for HIV/AIDS patients and their families. He coordinates HIV/AIDS case management for the city of New Haven through another consortium of five community agencies (including the AIDS Interfaith Network and Hill Health Center), and oversees the health department’s outreach and education efforts, HIV counseling and testing, and drug treatment referral. He is also the coordinator of the Mayor’s Task Force on AIDS, whose mission is to foster community response to the HIV epidemic and raise awareness of AIDS at the local, state and federal levels. “We’ve built a huge network of collaboration,” he said, referring to the myriad agencies and officials involved in the fight against AIDS.

Although the number of new cases of HIV continues to decline, the Centers for Disease Control and Prevention estimates that 25 percent of those infected may not know they harbor the virus. Lopes sees his mission as finding those people and getting them tested and into treatment. To do that, he has looked at new ways of reaching people who are at risk, those who engage in intravenous drug use and unprotected sex. In an effort to address New Haven’s needs, Lopes has introduced flex hours so that his staff can start and end their day later, when they have a better chance of connecting with residents who need services; some of the agencies in the consortium have extended their hours as well. His department’s outreach efforts include visiting drug sites, beauty parlors and even soccer fields on the weekends to help disseminate information, as well as running peer education groups with teens and going into schools to promote harm reduction. In addition, Lopes organizes community-level interventions, such as World AIDS Day, which took place at Center Church on the Green on December 1 last year.

At 61, Lopes shows no signs of slowing down, although retirement isn’t far off. He and his wife, Evelyn, an artist, plan to retire to either Brazil or Costa Rica in about four years. Lopes is undaunted at the prospect of picking up and starting over in a foreign country; over the course of his lifetime he has learned Spanish, Portuguese, French, Japanese and German. “I’m nosy and I like languages,” he said, “so I could live anywhere.”