HIV Prevention Justice Blog

White House Announces Tentative Dates for Community Discussions on the National HIV/AIDS Strategy

David Ernesto Munar — Wed, 23 Sep 2009 16:42:26 +0000

White House officials have announced the tentative dates for community discussions to gather recommendations and input for the creation of the National HIV/AIDS Strategy. The tentative dates and communities where these meeting will occur are listed below:

District of Columbia -- Monday, September 21
Minneapolis, MN -- Friday, October 2
Albuquerque, NM -- Friday, October 9
Houston, TX -- Saturday, October 10
San Francisco, CA -- Friday, October 16
Oakland, CA -- Saturday, October 17
Los Angeles, CA -- Sunday, October 18
Columbia, SC -- Monday, October 26
Puerto Rico -- Friday, November 6
Virgin Islands -- Monday, November 9
Jackson, MS -- Monday, November 16
Ft. Lauderdale, FL -- Friday, November 20
New York, NY -- Friday, December 4

The HIV Prevention Justice Alliance will continue to update readers about these meetings and any changes as they are announced.

Registration Details for the 9/21/09 Washington DC ONAP-Sponsored National HIV/AIDS Strategy town meeting

Julie Davids — Fri, 18 Sep 2009 09:53:18 +0000

Dear Planning Committee,

Thank you for your input concerning selecting a date, location, and meeting format for the September 21 HIV/AIDS Community Discussion in Washington, D.C. Please note the following confirmed details for your planning purposes:

Location:

The University of the District of Columbia Auditorium (building #46 on campus map)

http://www.udc.edu/campus_map.htm#directions

4200 Connecticut Avenue, NW

Washington, DC 20008

Date and Time:

Monday, September 21, 2009 from 6:00 pm-8:00 pm.

Registration:

Individuals interested in attending the Community Discussion may RSVP online at: https://www.cmpinc.net/ONAP. Please feel free to add this link to your website and distribute it widely to others who may be interested.

Regards,

Marjorie Burdetsky

Capital Meeting Planning, Inc.

Marjorie Burdetsky

Capital Meeting Planning, Inc.

6521 Arlington Blvd., Suite 505

Falls Church, VA 22042

Phone: (703) 536-4995

Fax: (703) 536-4991

Email: mab@cmpinc.net

National HIV/AIDS Strategy Town Meeting: Voices from the Community!

Ebony Johnson — Wed, 26 Aug 2009 19:54:40 +0000

Last night at the first town meeting on the National HIV/AIDS Strategy (held at the National HIV Prevention Conference), the community spoke out!!! Here's some quotes:

"We need to stop being the gender police, start asking the right questions & stop expecting communities to do their own research!"

"Lack of integration of departments of Labor, HUD and education... We need housing, employment, education to change the direct of HIV..."

"Expand Ryan White Services to persons in jail... They are elgible before and after incarceration.."

"Remove barriers that do not allow nurses to practice HIV Care to their full capacity. Tell President Obama will need to expand nurse's power to treat and care for persons living with HIV"

"We need to reduce the number of babies born with HIV. We have empower women to be included in their healthcare .. To know their HIV staus, to have access to have healthy babies and to be treated woth respect by their healthcare providers... Women living with HIV have the right to have healthy babies."

"If I wanted to bring culturally relevant posters, I would have to get them outside of the Uinted States. We need to remove the barries for communities to create culturally relavant prevention materials."

"We are our own healers... I would like to see more fnding into holistic health, tai chi, stress maagement and wellness."

"As a transgender women their is often no box for me so I am left to check other or even worsethere is no box to check... We need services for the transgender community."

"A sustainable HIV work force requires a workforce under 30.. We need new leadership, mentorship... I need this to happen before I die with no HIV strategy that includes me..."

"Continued disregard for the tansgender community will leave a hole in HIV prevention.."

"Healthcare is a RIGHT not a privilege"

"Sexually active men should be treated like sexually active women -- should be expected to been s.een every year by a doctor"

"We must decriminalize homless and make housing available... Decriminalize the sexual activites of people who are HIV positive and engaged in consensual sex..."

"We need comprehensive HIV education in all school - public, private and otherwise"

Six Months Into New Admin, Fed HIV Prevention Officials Speak More Freely of Science, Marginalized Groups, Need for Funding

Julie Davids — Wed, 26 Aug 2009 19:39:30 +0000

Economic recession threatens to relegate bolder talk to merely good intentions as White House Embarks on Development of a National HIV/AIDS Strategy

By Julie Davids and David Ernesto Munar

ATLANTA (Aug 25)—Speaking at the Obama Administration’s first national HIV summit, top public health leaders and community activists agree that a paradigm shift in HIV prevention approaches is needed to make progress reducing HIV transmission in the U.S.

According to advocates and other experts, the U.S. Centers for Disease Control and Prevention (CDC) must work with partners to develop and implement a strategic scale-up of comprehensive, combination HIV prevention strategies in order to achieve population-level decreases in HIV transmission. The aims of a new approach must focus on averting as many HIV infections as possible. And it must expand successful interventions, invest in research and evaluation, and address social drivers such as lack of housing, mass imprisonment, poverty and marginalization.

There were tantalizing hints at this week’s conference that CDC may be ready to seek significant changes in federal prevention policy and programs, a shift that would require strong leadership to inspire political buy-in and increased resources. Meanwhile, the new leadership at CDC faces steep challenges contending with an unprecedented economic crisis and competing national priorities that could jeopardize progress to slow the spread of HIV in the U.S.

In a seven-page booklet, distributed to all delegates attending the 2009 National HIV Prevention Conference but not yet available online, CDC asserts that “the science is clear: HIV prevention can and does save lives.” The document, entitled HIV Prevention in the United States: At a Critical Crossroads, makes the case for HIV prevention and articulates CDC’s vision for leading the fight.

The arguments in the report are not entirely new. As in past reports, CDC describes the dire nature of the epidemic in the United States and asserts CDC’s vigilance tackling HIV incidence.

However, some participants at the conference noted new, refreshing areas of emphasis. CDC’s report, which is going through the government process for online publication in the next few weeks, describes the hundreds of thousands of infections—and millions of health expenditures—averted to date. The report describes the diverse and complex distribution of the epidemic and the many critical issues a more robust approach will need to include.

“People don’t know what prevention is, what they’re getting for their dollar, and why we need to do more,” explained Terry Butler, a communications specialist with the CDC. “While we know the value of prevention, there’s a lot of misperception that prevention is not making a difference—the value of prevention in terms of lives and dollars saved.”

AIDS advocates attending the conference observed that the new report comes on the heels of CDC’s significant set-back in not securing one-time HIV and STD prevention funding in the economic recovery plan passed by Congress earlier this year. Despite a proposal by the U.S. House of Representatives to invest $335 million in HIV and STD prevention work, conservative media pundits ridiculed the proposal and Senate members removed the allocation from the final spending package.

Meanwhile, struggling state economies have triggered deep budget cuts for public health and HIV prevention programs across the country. Several speakers at this four-day conference—presenting innovative HIV prevention activities— acknowledged fear their programs and jobs will not be sustained in the weeks and months ahead.

In his opening remarks, the new Division of HIV/AIDS Prevention (DHAP) Director Dr. Jonathan Mermin didn’t shrink from describing the challenges posed by the nation’s economic recession. He described data compiled by the National Alliance of State and Territorial AIDS Directors (NASTAD) showing $84 million in HIV-related funding cuts among states surveyed. A total of 55% of health departments reported funding reductions for HIV prevention. Importantly, the survey conducted earlier this year does not even include the estimated $31 million in cuts resulting from California’s state budget crisis.

CDC’s new booklet details the widening funding gap at the federal level. While CDC’s HIV prevention budget has remained relatively stable since 2002, at $750 million annually, the purchasing power of the budget has declined by nearly 20 percent as a result of inflation. Additionally, the report describes the CDC’s professional assessment, calculated in 2008, that an additional $877 million (a greater than 100 percent increase) is needed annually to achieve a 50 percent reduction in yearly HIV infections in the U.S.

Mermin, a long-time AIDS clinician and CDC staffer who spent the length of the Bush Administration in Uganda and Kenya, has pledged to launch a new strategic planning process for CDC’s Division of HIV/AIDS Prevention (DHAP) this fall as a component of the National HIV/AIDS Strategy. He said it will draw upon the work of the External Peer Review of DHAP’s programs and structure initiated this Spring. Individuals involved with the external review say they already see evidence of their recommendations integrated into Mermin’s remarks defending the cost-benefits of HIV preventions and justification for a larger investment in HIV prevention.

For example, Dr. Mermin expressed in his welcoming remarks the need to look at the “social context, including where people living, poverty, homophobia, race/ethnic bias, gender inequality, housing status, and HIV stigma,” all factors believed to contribute to elevated risk for HIV acquisition. He also called for a deeper investment in combination HIV prevention strategies to bridge different approaches “in multiple disciplines, including biomedical, behavioral, and community and structural interventions.”

The HIV Prevention Justice Alliance (HIV PJA) secured a meeting with Dr. Mermin on the closing day of the conference to discuss ways to collaborate with CDC on efforts to mitigate HIV-related social determinants. Among the HIV PJA’s demands is CDC’s commitment to develop a framework that begins to shift the focus of federal HIV prevention from predominantly individual, behavior-change models to interventions addressing the social and structural components fueling HIV transmission for entire groups of people.

But beyond the mere complexity of such an ambitious undertaking, HIV PJA fears current economic conditions will undermine even core public health functions from being delivered, much less new forward-looking plans on root drivers of risk and HIV acquisition.

Graphically Simplifying a Complex Epidemic

HIV Prevention in the United States includes just two graphs, but they both speak volumes about how CDC may hope to inspire an increased investment and focus on HIV prevention. One charts the growing numbers of people living with HIV during a period of relatively stable HIV incidence (albeit at a rate that we learned a year ago is much higher than previously thought).

According to Rich Wolitski, Deputy Director of DHAP, the chart “encapsulates a lot of challenges and tough decisions facing us,” as it indicates that more HIV-positive people are in need of prevention resources even as the need for primary HIV prevention for those who are negative remains.

The second breaks down the 2006 incidence estimate by race/ethnicity, risk group and gender for the most affected subpopulations, and thus has distinct, descending bars for white men who have sex with men (MSM), Black MSM, Black heterosexual women, and so on. As explained by CDC spokesperson Terry Butler, this breakdown is part of an effort to “better communicate where we are in the epidemic. The data’s been out there but it’s clearer this way.”

After years of euphemistic coding and strategic de-linking of information on different populations (for example, much talk of “African American and gay men” but little of “African American gay men”), these analyses are helpful tools even in clarifying the realities of the epidemic for conference attendees in the thick of prevention work. Throughout the conference, CDC has also been gathering feedback on a possible online tool that will also help a broad range of people visualize the incidence data broken down to this level of detail.

The Need for a Big, Good Idea

On Monday, HHS Secretary Kathleen Sebelius spoke boldly about the need for an emergency response to the epidemic:

“In 2005, the CDC reported that in five major cities, almost half of all African-American gay men were HIV-positive… Think about that. Imagine if it were half the straight white women in Atlanta. Wouldn’t we be calling this a national emergency? Shouldn’t we be? That’s how we at HHS are treating it. So we’re experimenting with innovative new ways to reach these groups – from a new online banner campaign that targets gay African-American men to partnering with groups like the Black Women’s HIV/AIDS network.”

While greeted by loud applause for her recognition of the racial and social injustices, the Secretary’s examples of innovation under-emphasize the many activities at the federal, state, and local levels needed to heighten the response to HIV/AIDS among gay men of color. Thankfully, in dozens of presentations and a CDC listening session on responding to HIV among Men who Have Sex with Men, participants described the need for programs and services designed to address the diversity of gay men at risk for HIV. A speaker from Massachusetts, for example, described the disproportionate number of HIV-positive gay men who have spent time incarcerated.

The discrepancy between the progressive analysis and rather standard actions (online banner ads? Partnering with community networks?”) is reflective of some of the post-Bush CDC initiatives in which long-awaited core activities are perhaps over-lauded for lack of more radical approaches.

For example, conference participants spoke of CDC’s new “Act against AIDS” advertising initiative as a decent start to spark a national dialogue about HIV/AIDS but cautioned, however, that the campaign cannot be viewed as taking the place of expanded HIV prevention services needed by people at risk and living with HIV or strategic structural interventions.

Treatment and prevention integration dominated many of the discussions this week with advocates and federal officials anticipating clinical trials will likely show that pre-exposure prophylaxis with HIV medications can effectively, though not completely, prevent HIV acquisition. However, the health education, medical and social systems implementation and financial challenges that would come with such a breakthrough would be formidable, and comprised the subject of a day-long meeting here on Sunday.

The concept of reduced “community viral load” as population-based HIV prevention (where greater numbers of HIV-positive people on treatment achieve undetectable viral load and are rendered significantly less infectious) is another bold idea gaining prominence. Implementing greater treatment and prevention integration on a large scale, and in the face of significant budget reductions, remains a daunting task and will likely require greater coordination and collaboration between different government departments and agencies to, among other things, pool resources.

Tough Choices, But New Opportunities?

The new booklet speaks quite plainly about the need to prioritize prevention work.

Advocates and Congress alike have criticized CDC officials for a lack of transparency and a reluctance or inability to provide clear and timely information about how they set priorities and spend the agency’s funding.

In one of the final conference sessions, CDC will unveil a new resource allocations model that is being designed and tested to better determine program priorities. And the booklet makes it quite plain that “difficult choices” will have to be made, with “resources… directed to the populations at the highest risk and to the strategies that are the most cost-effective in reducing HIV transmission.”

As explained by Wolitski, the “crossroads” referred to in the publication’s title (“At a Critical Crossroads”) alludes to the imperative to make difficult, strategic choices in an era of increased need and diminished resources.

“We’re at a point of having to ask these questions. We are doing the external review, a strategic plan, there’s the national HIV/AIDS strategy and health care reform. A lot of things today are changing. We have to look at the data and variables, and assess how what CDC does fits in a broader framework of providers, private insurance, medical care systems and so on. That’s why the tough choices are now so salient.”

New CDC Director Thomas Frieden, former commissioner of New York City’s health department, is no stranger to embracing controversy in the face of what he feels is in the best interests of public health. Advocates note his past efforts supporting access to condoms, syringe exchange and – incurring the wrath of some advocates -- pushing for legislative changes to allow for HIV testing without written informed consent or counseling. But his presence at the podium was limited to an introduction of HHS Secretary Sebelius, far from showing his hand or sketching out a vision of change.

Last year, the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention held a consultation to consider the adoption of a social-determinants framework. While its Director, Dr. Kevin Fenton, has pushed for such a framework, it remains unclear whether new leadership at CDC will embrace a model that posits factors such as poverty, homophobia and mass imprisonment of African Americans and Latinos as likely drivers of the epidemic – or if they would actually move from a modeling to significant action.

It’s widely speculated that any re-thinking of CDC policy must reduce dependence on pre-packaged “boxed interventions,” which have failed to meet the nation’s HIV prevention needs but been the mainstay of funded programs. Thus, some speculate that community-rooted prevention workers could be shunted aside rather than retrained under a new vision of comprehensive HIV prevention. Advocates have begun to speak out to demand that, if changes do come, those leading HIV prevention efforts in our communities will be given the opportunity for training and support to integrate and bolster new efforts, but this was not addressed in Atlanta this week.

The National AIDS Strategy to the Rescue?

Throughout the conference, there was much talk of the potential capacity of the National HIV/AIDS Strategy (NHAS) being coordinated by the White House Office of National AIDS Policy as a tool for turning tough choices into big, new ideas for prevention progress and inspiring re-investment in reducing incidence.

The placement of noted CDC researcher Greg Millett as a Senior Policy Advisory for the NHAS has been lauded as a step in the right direction. ONAP held a well-attended input session at the conference to launch development of the NHAS, with dozens of people testifying on their priorities for the plan, and Mr. Crowley spoke on a plenary session devoted to inter-governmental collaboration.

The NHAS is, in and of itself, a big, new idea in the domestic epidemic. The challenges of a truly implementable strategy are formidable, but fully consistent with the need for CDC to devise a more strategic and rigorous approach. Only through bold, new leadership to chart a new, strategic path is there any chance to confront stubbornly persistent HIV incidence in our country.

Waters Rallies for Health Care Reform

David Ernesto Munar — Wed, 26 Aug 2009 16:03:23 +0000

In the closing panel at the 2009 National HIV Prevention Conference, Congresswoman Maxine Waters (D-CA) delivered a stirring presentation about the centrality of healthcare reform to achieve better results in the fight against HIV/AIDS, including efforts to reduce new HIV infections.

Brief Thoughts on NHPC Tuesday Morning

Ebony Johnson — Tue, 25 Aug 2009 17:56:31 +0000

"Women need to have a certain set of ideas, values & belief systems about condoms to use condoms."

"Globally, women account for more than half of the 33 million people living with HIV."

"The institution of marriage itself is not set up to empower women's... sexual and reproductive choices and power - women need to be more responsible and intentional. This is not your grandmother's marriage."
Dazon Dixon Dialo, MPH

"Women love the skills and love the tranings, but at the end of the day women really want to be told that their relationship is different and that their man doesn't cheat.. We have to get women to the place wherein they can make good and healthy decisions in ANY type of relationship"
Dazon Dixon Dialo, MPH

Three decades into the HIV pandemic, millions of anecdotal lessons and a plethora of data on stigma... Still these statement are ground breaking!

Each component of women's services must be actively engaged in women's health and wellness. There needs to be a repetitive and unifed effort from every service provider across the spectrum (medical, beauty technicians, medicaid, domestic violence services, housing providers, sororities, civic groups, community collaboratives, etc. etc.).

Condoms (both males and the under-represented female condom) are the least expensive and most effective tools we have to fight against HIV (unwanted preganacy, STIs, HIV re-infection/new infection)

Yet, we are still livng in a place where saying condom, offering condoms and addressing the sexual and reproductive health and desires of women is still taboo and riddled with stigma.

Women need more healthy and transpearant messages that affirm women's power over the direction of their health. Hiding information and flattering* women by not offering resources like condoms (with condom education), communication skill building, self-esteem building, HIV testing and STI screening only expands gaps and limits women's ability to make informed decisions.

HIV prevention and education can not happen in a silo. We must increasingly become a society of cross-training. Session after session we hear the indicator buzz words: poverty, low-literacy, stigma, gender/power imbalance, transient/homeless and not in healthcare. We have figured out that many women have competing soci-economic factors that limit their engament in healthcare.

Each person who works with women is an intervention within themselves. We have to be comfortable and willing to give women a broad range of options around HIV, safer sex, family planning and reproductive health.

"Talking to women and taking time to follow-up took a lot but the change we saw made it worth it"

The CDC (Finally) Makes It Official: Gays and Other MSM Are 50 Times Likelier to Have HIV Than Women Or Straight Men

Walt Senterfitt — Tue, 25 Aug 2009 02:54:11 +0000

CDC official Dr. Amy Lansky announced today at a plenary session of the National HIV Prevention Conference the CDC's finding that gay men and other MSM have AIDS at a rate more than 50 times (that's right, FIFTY TIMES) greater than women and non-gay/bi men. This confirms in emphatic terms that of all the disparities and disproportionate impacts in the HIV/AIDS epidemic, the greatest one is the extraordinarily disproportionate impact on gay and bisexual men (MSM) -- of all races and ethnicities, though the most disproportionate impact is on African American gay, bi and other MSM.

As the CDC 's incidence estimates released last year revealed, MSM constitute more than half of all new cases of HIV and are the group in which the number of new cases each continues to slowly increase. What's new today is that the CDC has calculated *rates* of HIV/AIDS prevalence among MSM, not just raw numbers. Lansky says the CDC estimates that there were 692.2 new HIV cases in 2007 per 100,000 MSM. Having a rate as well as the raw numbers allows comparisons for the first time to other population groups at risk, such as women and heterosexual men.

In turn, to calculate a rate, one must be able to know or estimate the size of the underlying population. It's fairly easy to know how many women or African Americans or Latinas/os there are in the country or a state or a community. It's not so easy to know how many gay men there are, especially since many gay and bi men have reasons not to disclose their sexual orientation and since the government has not been especially interested in accurately counting us. The CDC took a range of estimates from several nationally representative surveys and studies and decided to use the figure of 4.0%, representing the median estimate of the proportion of adolescent and adult men who acknowledge having had sex with another man in the past five years.

Why has it taken so long to make this estimate, which in turn allows population comparisons and impact assessments? Maybe part of it is due to natural scientific reluctance to make guesses about things they cannot accurately measure. But that doesn't really was, because policy makers push scientists all the time to make estimates about hard-to-measure phenomena affecting public policy. Seems clear to me that this was at least an indirect effect of the pervasive homophobia still affecting much of government, public policy, media and societal norms in this country.

At the same time we applaud this newly honest statement and comparison, and what it means about the continuing devastating impact on MSM communities and populations, most especially on MSM of color, it is equally important to reaffirm the devastating and disproportionate impact that HIV has as well on other populations and communities, particularly women of color in the South and elsewhere and on transgender women in urban areas throughout the country.

We must fight for funding and adequate social investment to end HIV/AIDS wherever it continues to persist and thrive, which is almost always where concentrated social injustice also thrives. We will not decisively end AIDS anywhere unless we end it everywhere.

Obama Administration Announces Another Top AIDS Advisor

David Ernesto Munar — Mon, 24 Aug 2009 21:07:04 +0000

U.S. Secretary of Health and Human Services Kathleen Sebelius announced the appointment of Dr. Helene Gayle, currently Presdient and CEO of CARE, and a former Director of CDC's National Center for HIV, STD, and TB Prevention, as the incoming Chairperson of the Presdiental Advisory Council on HIV and AIDS (PACHA). The announcement marks the first appointment to PACHA under the Obama Administration and more appointments are expected soon. According to Jeff Crowley, Director of the White House Office of National AIDS Policy, PACHA will play a role in advising the Administration in the development of the National HIV/AIDS Strategy.

Standing Up for Healthcare Reform

David Ernesto Munar — Mon, 24 Aug 2009 20:48:31 +0000

Advocates for healthcare reform surrounded the stage when Kathleen Sebelius, Secretary of the U.S. Department of Health and Human Services, took the stage at this afternoon's plenary session. Amid chanting for better health and preventative care options in the U.S., advocates distributed this flyer:

PEOPLE WITH HIV/AIDS NEED HEALTH CARE REFORM NOW

Be part of the solution. Call your legislators today and tell them health reform cannot wait. We need quality, affordable health care for all Americans.

Contact Lawmakers Today!
1-800-828-0498
http//tinyurl.com/pass-reform

National healthcare reform will transform the fight against HIV/AIDS in the U.S., making long-term reductions in deaths and fewer infections possible.

http://tinyurl.com/HIV-and-healthreform

Also visit the Treatment Access Expansion Project, which is working with the HIV Health Care Working Group, on advocacy and anaylsis of health reform legislation from the HIV perspective.

Voices from the Prevention Conference

Julie Davids — Mon, 24 Aug 2009 20:01:12 +0000

Today, I had the opportunity to chat with some of the delegates at the National HIV Prevention Conference about their hopes for their time here. Be sure to click through to see the whole post with all 4 clips...