Mary sits calmly. Her jeans are clean and well-made, her hands compact — never fidgeting — and she’s telling anecdotes about all the men she’s dated. She has lots of advice for what to look for in a man, and she can tell you how to leave a man and confidently move on, independently, for yourself. The night before, she broke up with her boyfriend. She’s alert, can take a joke, and holds her ground, and she has lived with HIV for 16 years.

Mary, just by appearances, could be misperceived as uninfected. She goes shopping, meets friends for lunch — she’s even about to go to a recently opened “HIV Only” club downtown, where she can dance and meet other singles. “I haven’t experienced the things people experience,” she says. “I have never been to a hospital.”

She lives in Harlem, a neighborhood sometimes called the United States’ HIV/AIDS epicenter and bellwether. Local HIV/AIDS organizations constantly scramble to anticipate trends and statistics. In the ’90s, the focus was on needle-users and the MSM (men who have sex with men) community. Then there were the rumors. Sixteen years ago, when Mary became infected, she “thought that only gays could get it,” she said. Even today, some residents uptown believe HIV can be transmitted through doorknobs and house flies.

As HIV’s reputation has changed from an unknown virus to a treatable medical condition, Harlem United, Harlem’s leading HIV/AIDS organization, has radically revamped how it fights HIV. In the last two years, instead of targeting groups – even those experiencing startling rises in new infections — Harlem United has taken a more encompassing approach that could reach the whole community.

Harlem United maintains an extensive network. It runs two clinics and multiple housing facilities, and partners with smaller organizations focused more on local populations’ needs. It offers services from art therapy to health care for the homeless and runs the only entirely bilingual Spanish HIV/AIDS clinic in the United States.

In the last few years, HIV has spread in Harlem in various, often troubling, directions. In 2006, the average Harlem resident was six times more likely to receive a new HIV diagnosis than an average American, according to statistics released in 2008 by the Centers for Disease Control and Prevention. Most new infections were among Harlem’s Latinos, who were more than 12 times as likely to receive new HIV diagnoses than other New York City Latinos. In fact, “over the past five years, new HIV infections, and concurrent HIV/AIDS diagnoses have fallen among all race categories, except for Hispanic women,” according to New York City Department of Health evaluation coordinator Chris Williams, commenting on the 2006 statistics.  Health professionals believe that trends like these will eventually spread countrywide.

Harlem United, carefully monitoring the CDC and the NYC health department statistics and compiling its own, decided to retain its existing Latino support and testing programs, rather than launch new ones.

Instead, its Blocks Project, begun in January 2008, sets a broader goal of testing everyone in the area — from women discouraged by a partner to the unsuspecting elderly. For the organization, it’s a new way of thinking about HIV/AIDS testing.

Soraya Elcock, Harlem United’s vice president for policy and public affairs, sits in her office, surrounded by mementos from 20 years in HIV/AIDS work and explains the shift.

Although organizations have changed, one thing hasn’t. People still contract HIV in the same ways: through risky sex, intravenous drug use, or long-term partners who become infected.

“It’s not about whether you’re at risk. What is needed is a neighborhood taking care of its basic health,” Elcock says. Unlike programs that target specific groups, she explains the blocks project treats HIV as a basic community health problem, along with hepatitis C, diabetes and hypertension. That means it’s a treated as a disease no more spectacular than any other and no more applicable to one group than another. Women in particular, “respond to something targeting to a larger community health awareness,” Elcock says.

“You have to create a hothouse effect — or you miss all the small groups,” she explains. Targeting a group — like Latinos or small African immigrant populations — tells a sub-community: There’s a problem among people like you. That breeds fear, Elcock says, which can discourage testing by making people clam up in denial or driving them to disregard the risk.

In taking this approach, the Blocks Project also targets an elusive but crucial body of people: infected people unaware they carry HIV.  Harlem United consider them the most hazardous group.  Last year the rate of HIV transmissions originating from people unaware of their infection was 54 to 70 percent, Elcock points out.

“A lot of them don’t believe they are at risk,” she says. As a result, merely encouraging people to be tested for HIV has had limited success. But Harlem United says the Blocks Project, with its enlarged approach, led to 75 percent more testing its first year.

Since kicking off the Blocks Project’s 2008, it has gone through continual revision based on what has worked and hasn’t.

Jennifer Rodriguez, a Harlem United community outreach coordinator, explained that at first, “Harlem United would have meetings with tenant association presidents. We ask them what would be the best way,” she says. Then Harlem United’s outreach staff would head out to the large buildings in teams. “We would have messages that we would put on every door,” Rodriguez says. “They might say Tuesday or Thursday come to this corner,” where testing vans would be available.

But, “the whole ‘come-to-my-van’ approach doesn’t work,” Rodriguez says.  So this year’s strategies were totally different. “In the last month or two we started getting a more intense outreach focus. We’ll have a five-minute conversation like, ‘Oh, why won’t you use a condom?’” she says. “Now it’s not so concerned with tenants. It’s more zones. It’s wider.”

As Mary sits and talks about her experiences with relationships, she suggests that even as more effective HIV treatments have become widely available, the old rumors and stigmas about HIV still pervade uptown.  Although she feels well, facing the disease’s stigma can be the hardest part. She describes an incident she had one night at a bingo game, when she overheard some players talking.

“The older ladies would gather and say, ‘I don’t want him to get HIV out there,’” she says, referring to married women whose husbands may be having affairs. “I used to go out there and say: This could happen to anybody. Because you don’t know what your husband does when he walks out that door.”