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Reflections on World AIDS Day in D.C.

By Melissa Donze, Zamora Fellow

On the evening before World AIDS Day, I took a walk down to the White House after work. As a recent transplant to D.C., the sight of the White House, the Washington Monument, and the Capitol still make me smile like a tourist. But this time, as I turned the corner and crossed through Lafayette Square, the sight of the White House took my breath away.

Draped across the North Portico was a big, red ribbon. It stood out so vividly against the white backdrop, and for a moment I stood there, frozen, completely entranced. It was an incredibly beautiful sight.

It’s been seven years since I first became actively involved in the fight against HIV/AIDS; seven years since I first started informing my high school peers about HIV; seven years since I found out that most people in my small hometown didn’t want to talk about sex or drugs or race or poverty because HIV “didn’t affect them.”

Admittedly, I was one of those people. I thought I was invincible, untouchable, unaffected. That all changed at the age of eleven, when I was diagnosed with Latent Tuberculosis. Nine months of medication, blood tests and doctor’s visits later, I stand here at the age of 22, happier and healthier than ever. I knew that the reason for my good health was the medicine I was taking, and despite financial struggles, there was never any question about affording my medication. I knew that in some way, I wanted to help those who weren’t given the chance to live, a chance I had been given without restriction or hesitation. It was a few years later on World AIDS Day 2005 that I learned about HIV through an amazing documentary, and it struck me like no other issue has struck me before; it is so incredibly preventable, yet there are still 30 million people living with HIV/AIDS today, over 1 million of which are in the United States.

Despite the fact that I had been commemorating World AIDS Day for years, this time felt different. It felt exhilarating. As I stood in front of the White House that night and gathered with strangers for a candlelight vigil the next day, I felt empowered in a way I had never felt before. There I was, standing in our nation’s capital, witnessing a fight that has always been so personal converging with the work I do daily in an incredibly powerful way. I am grateful every single day that I work at AIDS United as the Zamora Fellow, an opportunity that allows me to channel my truest passion into real, tangible progress and policy.

Just in the seven years that I have been involved in this fight, I have witnessed enormous progress. I have seen the advent of new science provide breakthrough methods of treatment and prevention. I have seen declines in transmission rates in many countries around the world. I have seen community-based organizations take innovative approaches to encourage testing and disseminate awareness about HIV-related issues. I have seen President Obama release the first ever National HIV/AIDS Strategy, which aims to reduce new HIV infections, increase access to care, reduce health inequities and HIV-related disparities, and coordinate a more effective response to the national epidemic.

At the same time, however, I see that incidence rates in the United States remain at around 50,000 new infections per year despite an abundance of information and resources to actually reduce the number of new infections. I see a huge disconnect in the number of people diagnosed with HIV and the number of people who have regular access to care and treatment. I see certain groups, especially young, African-American men who have sex with men (MSM), disproportionately affected by HIV. I see outdated policies and misguided notions perpetuate stigma and discrimination. I see newspaper columnists and government officials talk about the “global AIDS epidemic,” yet fail to consider HIV in the United States as part of this epidemic. I see an increasingly disillusioned population, in particular the youth, who do not care about HIV, who believe HIV doesn’t impact their lives in any way.

To them, I ask: Do you have sex? Do you have friends who have sex? If the answer is yes, then HIV has an impact on your life. Are you between the ages of 13-24? If the answer is yes, you are a part of the population that accounts for 25% of new HIV infections. HIV has an impact on your life. Do you live in an urban area or in the South, areas in which rates of HIV tend to be higher? If the answer is yes, HIV has an impact on your life. Do you have friends who have been tested for HIV? Have you yourself been tested for HIV? Regardless of your answer, HIV has an impact on your life.

This World AIDS Day, I remembered those we have lost, celebrated those still with us and reflected on the great strides we have made. In the face of the many challenges that confront us, I renewed my commitment to end this epidemic. We have come so far, and our success should be recognized. But we can’t let our past success preclude us from taking action today. We are at a crossroads in history; we have the science, political momentum and expertise to actually see the end of AIDS, but it requires us to take aggressive and coordinated action now.

I truly believe I will see the end of AIDS in my lifetime. Today, more than anything else, I have hope. And it is this hope that keeps me fighting every day.

A View of HIV from Kenya

by Julia Cheng, former AIDS United Zamora Fellow

Hello and habari zenu!

On this World AIDS Day, I greet you from Kenya.  I’m a Peace Corps volunteer working as a science teacher at a secondary school about 22 kilometers (about 14 miles) from the nearest paved road.  Two years ago, I was at AIDS United in the policy department as a Pedro Zamora fellow.

Today I’m Kisumu.  I’m running a half-marathon for Worlds AIDS Day.  Running this half marathon has got me thinking about the parallels between Kenya and in the U.S.   AU is finishing up its second year of the Team to End AIDS endurance training program.  That’s one similarity between the U.S. and Kenya.  But there are just as many differences for all the similarities.  In the year I’ve been here I’ve learned and experienced many things, some of which I wanted to share with you.

It might go without saying that my jobs in Kenya and in Washington, D.C. have been very different.  At AU, everyday, my work directly revolved around HIV and AIDS  and working on big picture issues.  As a teacher, my work has almost been the opposite.  Most of the time, I teach biology and physics which usually have little relevance to HIV.  But, once a week for each form (grade) I teach a life skills class where I get to talk about HIV, sex, goals, decision making, and all those unique challenges that teenagers and young adults face.  As a teacher, I work directly with students.

HIV in Kenya and the U.S. is very different.  Just by the statistics, Kenya differs from the U.S. by having a higher prevalence rate, around six percent.  Like other African countries, here the epidemic is generalized among the population.  But, attitudes to the virus are different too.  Ask any school age child what HIV or AIDS is and they’ll be able to tell you what it stands for, how you get it, and they might even be able to sing a song about it.  Yet, how well have they absorbed this information?  And of course, misinformation still abounds.

The biggest difference to me is not the misinformation–the things I heard growing up in Mississippi don’t always sound too different from here.  The major difference is comprehension and accesibility to alternative information.  In the U.S., there are books, libraries, the internet, or a trusted adult that a student can ask sensitive questions to.  In Kenya, that is not necessarily the case.  Access to books is lacking, at my school, students share the text books.  A few subjects have only three or four books for a classroom of forty.  Books outside of the required texts are rare and highly valued.  Students lack access to computers, the internet, and most importantly lack computer literacy.  The adult they may ask might have the same access or even less access to information as the student.  For those adults with information, the student may be too intimidated to ask.

Like all misinformation, some is obvious to students.  For example, during a model school exercise, I and other current volunteers asked students to play a game of “fact or myth.”  We had students write things they had heard about HIV and together, decided if they were facts or myths.  Some concepts, like “albino’s can’t get HIV,” students instinctively knew as a myth.  However, ideas like “condoms do not prevent against HIV” were more confusing.  My students and others across the country have heard both that condoms can protect them and that condoms are not 100% effective from veritable sources.  Which are they to believe?  Explaining why they might have heard both things and how both are true is where most of my work comes in.

Another big difference–that, to be honest, I haven’t quite yet figured out yet–are attitudes to testing.  For example, one life skills class, I decided to take my students to the local dispensary.  I wanted to expose them to where they could be tested and to show them what the process of testing and counseling looked like.  One of the clincians suggested that after the demonstration, students that wanted to be tested could do so.  I agreed, but expressed skepticism.  Yet, to my surprise, each and every student that I brought wanted to get tested.  This, despite my repeated assurances that they did not have to and were not expected to. In all, three fourths of the school (~160 students) were tested, the limiting factor become the number of available tests.

Attitudes and reactions to HIV are different everywhere.  Even attitudes and reactions to running are different everywhere.  In training for this half marathon, sometimes I’d have to explain myself.  In Kenya though, it’s easy for me to explain. Everyone here knows the word marathon since some of the top marathon runners in the world come from Kenya.  In some other places though, I don’t doubt most people would be craning their necks to see what I was running from.  In the U.S., attitudes to running and HIV can be highly geographic.  For HIV, this makes our job more difficult.  There’s no one method that we can use to tackle the epidemic.  But it can also help us.  Part of the reason I came here is that I’ve always appreciated learning from people different from me.  Learning how to live in a different country, run in a different country, and address HIV issues in a different country has made me a more capable person.  In a similar way, learning and experiencing other attitudes and ways of addressing HIV, we can become more capable at dealing with the full spectrum and diversity of our world and our country.

Why Overdose Prevention Matters for People Living with HIV/AIDS

by Leilani Attilio, MPH, RN
Overdose Prevention Coordinator
North Carolina Harm Reduction Coalition

Prescription drug overdoses (OD) have reached epidemic proportions1, 2 and is the fastest growing drug problem in the United States1.  OD deaths are the second leading cause of unintentional injury3.  Among rural states, North Carolina, has one of the highest percentage increases of unintentional OD deaths from opiate drugs2.  In the most recent issue of the New England Journal of Medicine, a research study found that abuse-deterrent formulations of OxyContin, an opiate, has generated unintended negative outcomes4.  Although there has been a significant decrease in OxyContin use, heroin use nearly doubled simultaneously4.  Heroin use poses dangerous consequences to include contracting the Hepatitis C Virus and HIV due to high-risk drug behaviors such as needle sharing5.  As a result, harm reduction organizations, drug treatment centers, and AIDS groups understand the importance of a comprehensive program planning in HIV/AIDS treatment, which includes OD prevention for people living with HIV/AIDS.

OD prevention encompasses rescue breathing and the distribution of naloxone, which is a highly effective antidote to an opioid OD.  Naloxone is not a controlled substance, nor can a person become high and thus, has no potential for abuse.  It can be safely administered to clients as a rescue medication in the event of a respiratory arrest6.  Outlined are several reasons OD prevention is an important topic among people living with HIV/AIDS.

1.) OD prevention services act as a bridge between people who use drugs and HIV prevention, drug treatment, and primary healthcare8.  Globally these programs draw new clients into their HIV prevention services and thereby, enabling HIV prevention to expand beyond traditional services in order to mitigate the HIV epidemic.

2.) Nonfatal overdose outcomes (e.g., pneumonia, acute renal failure) can be worse in people living with HIV8.  Hospitalizations can interrupt the HIV treatment regimen and may induce HIV-related diseases such as tuberculosis and bacterial pneumonia.

3.) HIV drug regimens may block the breakdown of opioids in the system and ultimately, putting the client at risk for an overdose8.  Opioid medications are routinely administered for their analgesic effects to people living with HIV/tuberculosis co-infection.   Many of these people also have a substance use disorder and would benefit from overdose prevention education.

4.) There is a disproportionate number of overdoses among HIV positive injection drug users8.  Since injection drug use is a the third leading cause of HIV in North Carolina7, HIV services should prioritize overdose prevention support to their clients who are using drugs.

5.) Overdose prevention empowers people that use drugs who are at-risk for acquiring HIV8.  Research suggests that people who use drugs are as skilled as medical providers in correctly recognizing overdose and determining appropriate use of naloxone9.

6.) Policies that increase HIV infection risk among people who inject drugs also increase the risk of overdose8.  For example, the release from prison greatly increases the risk of overdose for people who inject drugs10.  Health and social programs who serve inmates inside or exiting from these settings are in an opportune position to support those at greatest risk for overdoses.

7.) People living with HIV and use drugs are concerned about overdose8.  In a study among people who inject drugs in the United States, almost all (87%) were strongly in favor of participating in overdose prevention education and training in resuscitation techniques11.

OD deaths are a major public health issue.  By bridging people who use drugs to necessary social services and empowering the most vulnerable, OD prevention not only is effective and feasible, but most importantly humane piece in HIV/AIDS programming.

The North Carolina Harm Reduction Coalition is a grantee of AIDS United

References:

1. Paulozzi L, Baldwin G, Franklin G, et al. CDC Grand Rounds: Prescription Drug Overdoses-A U.S. Epidemic. Atlanta: Centers for Disease Control and Prevention; January 13 2012.

2. Sanford K. An Unrelenting Epidemic of Deaths from Prescription Drugs in North Carolina. 2008; http://www.ncmedboard.org/articles/detail/an_unrelenting_epidemic_of_deaths_from_prescription_drugs_in_north_carolina/. Accessed July 16, 2012.

3. Paulozzi L, Annest J. Unintentional Posoning Deaths-United States 1999-2004. Atlanta: Centers for Disease Control and Prevention; March 28 2007.

4. Cicero TJ, Ellis MS, Surratt HL. Effect of abuse-deterrent formulation of OxyContin. N Engl J Med. Jul 12 2012;367(2):187-189.

5. CDC. Hepatitis C Information for Health Professionals. 2011; http://www.cdc.gov/hepatitis/HCV/index.htm. Accessed July 16, 2012.

6. Tobin KE, Sherman SG, Beilenson P, Welsh C, Latkin CA. Evaluation of the Staying Alive programme: training injection drug users to properly administer naloxone and save lives. Int J Drug Policy. Mar 2009;20(2):131-136.

7. Foust E, Clymore J. Epidemiologic Profile for HIV/STD Prevention & Care Planning. Raleigh: State of North Carolina Department of Health & Human Services;2011.

8. Curtis M, Dasgupta N. Why Overdose Matters for HIV. 2010; http://www.soros.org/publications/why-overdose-matters-hiv. Accessed July 16, 2012.

9. Green TC, Heimer R, Grau LE. Distinguishing signs of opioid overdose and indication for naloxone: an evaluation of six overdose training and naloxone distribution programs in the United States. Addiction. Jun 2008;103(6):979-989.

10. Binswanger IA, Stern MF, Deyo RA, et al. Release from prison–a high risk of death for former inmates. N Engl J Med. Jan 11 2007;356(2):157-165.

11. Seal KH, Downing M, Kral AH, et al. Attitudes about prescribing take-home naloxone to injection drug users for the management of heroin overdose: a survey of street-recruited injectors in the San Francisco Bay Area. J Urban Health. Jun 2003;80(2):291-301.

“This Is the New War on Drugs!”

By Shannon Wyss, AIDS United Grants Manager

What are the intersections between harm reduction and sex work?  Should the harm reduction community get involved in the struggle for or against sex trafficking?    These were a few of many questions addressed by one of the panels during the 2012 Harm Reduction Conference in Portland, OR.

“Trafficking Wars,” held on the conference’s second day, addressed many of the issues raised by the fight against sex trafficking and examined how this fight affects sex workers, men of color, and youth. Two of the four panelists declared the anti-sex trafficking movement “the new war on drugs,” and the arguments presented by the four panelists and the moderator stemmed from independent research, work with clients in non-profit organizations, and studies into the potential impact of the newly-passed anti-trafficking Proposition 35 in California, as well as similar, already-implemented laws in Illinois and Washington, DC.

Why anyone would be “for” sex trafficking was not, of course, the crux of the discussion. No one on the panel argued that individuals who are forced into sex work against their will should be left unaided. The first panelist, however, did offer a detailed analysis of how and why many estimates of persons trafficked are wildly overblown.

Rather than supporting trafficking, the panel’s focus came from a critical feminist analysis of anti-trafficking work – work that, they acknowledged, has involved many other feminists who come from a very different perspective. Using a specifically anti-racist, anti-ageist framework, the panel’s conclusion was clear:  harm reduction work is under attack through the fight against sex trafficking.

The panelists pointed out that, while feminists have spent decades fighting for women’s reproductive rights and the right of teenagers to access abortion services without parental consent, anti-trafficking statutes take direct aim at these hard-fought victories. By denying youth the capacity to consent to selling sex under any circumstances, young people are disempowered and infantilized.

Furthermore, teens who are caught up in anti-trafficking sex stings are often placed under the surveillance of family courts until the age of twenty-one and may be forced back into the unsafe family or foster care situations from which they had originally escaped.

Organizations that take a harm reduction approach to working with youth on the streets are also directly impacted. For example, anyone caught working with a young person who is engaging in sex work can be charged as a trafficker.  This includes harm reduction workers who give their clients meals, rides home, bus tokens, or clothing. It also includes youth who assist other youth on the streets, whether by merely hanging out together or by helping each other find clients. And yet one of the first harm reduction methods taught to young sex workers is to work in pairs. So any caseworker who helps a teenage sex worker – or any young person who aids another – can potentially be arrested, charged, and imprisoned as a sex trafficker.

Anti-sex trafficking laws also feed directly into the racist prison industrial complex, according to the panelists.  Not only do police departments receive increased funding for anti-sex trafficking work, but these statutes empower police to increase their surveillance and targeting of men of color for arrest; similar actions have not been concentrated in white communities.  Furthermore, many of these laws have increased the severity of related crimes:  what used to be misdemeanors are now felonies.  So men of color are being targeted by police, arrested more frequently, and convicted of more severe charges with more required time behind bars, thereby exacerbating a system that is already stacked against non-white men.

And, of course, from a harm reduction perspective, prison is not a safe place for anyone. Being stuck in a system where inmates face increased risk for HIV, hepatitis, harassment, and rape is hardly an environment in which an individual can easily reduce her/his risks and stay healthy.

All the panelists agreed that the harm reduction community has not been fully engaged in the fight to end anti-sex trafficking statutes and the deleterious impact that they have on so many individuals.

By extension, the HIV community stands to benefit from the end of anti-sex trafficking laws:  the amazing organizations that do such critical HIV outreach and prevention work will be able to continue fully engaging youth and others involved in sex work; men of color, already at astronomically increased risk for HIV, will be less likely to end up in prison; and we can continue to make inroads in stopping the spread of AIDS and keeping those who already are infected healthy and in care.

To get involved, contact your local sex workers’ rights organization or an agency that provides supportive, non-judgmental, harm reduction-based services to individuals involved in commercial sex work.

AIDS United Field Team Hosts Medicaid Advocacy Training in South Carolina

By Charles Stephens, Regional Organizer

One of the more optimal paths to achieving an end to the HIV/AIDS epidemic as we know it is through the full implementation of the Affordable Care Act in this country. We are presented with a critical opportunity, particularly through the expansion of Medicaid, to increase access to HIV prevention, care and treatment. The evidence suggests this will reduce the number of new HIV infections and improve health outcomes for those living with HIV. This approach would also move the needle in creating greater parity in healthcare access, and improve the overall health outcomes for people living with HIV. In the U.S. South this change would quite literally save lives. Unfortunately, the southern region far too often lags behind the rest of the country on healthcare issues and certainly in HIV/AIDS treatment and care.  Click here

To assist our grantees and partners in their advocacy efforts for Medicaid expansion, the AIDS United Field Organizing team is hosting a series of trainings. I led the first of these events in South Carolina with the South Carolina HIV/AIDS Care Crisis Task Force (SCHACCTF). SCHACCTF is a statewide coalition of individuals, organizations, and other stakeholders committed to HIV/AIDS advocacy in South Carolina.  The goal of the training was skills building among our stakeholders on how to educate their constituency and plan their advocacy efforts in the state.

The training began with a general overview of the Affordable Care Act and how it would impact the HIV/AIDS community in South Carolina. I shared with the group how the majority of HIV/AIDS care and treatment funding is currently through Medicaid. We talked about the relationship between the Ryan White CARE Act (RWCA) and Medicaid.  I explained the RWCA is scheduled to be reauthorized before September 30, 2013. We discussed how implementation of the Affordable Care Act, especially Medicaid expansion, would impact the RWCA reauthorization potentially helping reduce the strain on RWCA funding. Whereas, the Ryan White CARE Act has to be reauthorized every 3 – 5 years, the benefit of Medicaid expansion, if fully implemented, is a permanent solution. This would create a more sustainable solution for access to healthcare for people with HIV.

We discussed the potential if Medicaid expansion is fully implemented we could end the HIV/AIDS epidemic in the United States. Greater access to HIV care and treatment would reduce the number of new infections each year and create better health outcomes for people living with HIV. Ensuring HIV positive people receive an early diagnosis, get linked to care, have access to drugs and receive assistance in managing adherence and sustaining their health and the health of their partners will lead to an AIDS free generation.

I also provided an overview of the Essential Health Benefits component of the Affordable Care Act.  States will have wide latitude in choosing 10 Essential Health Benefits categories so the minimum benefits provided from state to state will look different. Thus, the minimum benefits in California might look different than the minimum benefits in Georgia.

Developing an educational public message was an important part of the training. Participants worked together in small groups and developed messages related to Medicaid expansion advocacy. The cost effectiveness of Medicaid expansion both in terms of the federal resources that would be used to support implementation and cost effectiveness of keeping people healthier resonated most with the group. Several participants volunteered to share their messaging with the group.

Moving forward with advocacy in the state, the South Carolina HIV/AIDS Care/Crisis Task Force is hosting an Advocacy Day breakfast early next year. The group will continue advocating elected officials and key figures on the expansion of Medicaid in South Carolina. The AIDS United Field Team will continue hosting Medicaid expansion trainings over the next year. In December we are hosting events in Louisiana and Virginia.

So Many Issues, So Little Time for Lame Duck Session

by Donna Crews, Director of Government Affairs

On Tuesday, November 13 the House and Senate will convene for the “lame duck” session of the 112th Congress, which will run through the end of December. The list of legislative priorities far outweighs the six-week timeframe that Members of Congress have to address those issues. The timeframe offers less than 20 possible legislative days working 4 day weeks each week except Thanksgiving and Christmas week.

The issues that must be addressed prior to New Year’s are:

  1. Sequestration with a January 2 start date without change in legislation.
  2. Expiration of the Bush era tax cuts December 31 without an extension
  3. Expiration of long-term unemployment insurance benefits December 31
  4. Expiration of payroll and alternative minimum tax credits (AMT) December 31
  5. Decrease in the payment amount to doctors who care for Medicare patients (SGR)
  6. Emergency appropriations package for FEMA in light of Hurricane Sandy
  7. Various reauthorizations including the Farm Bill (which expired 9/30/12). This bill includes the Supplemental Nutrition Assistance Program
    (SNAP)

Other issues that will need resolution include:

  1. Possible increase in the debt limit by February
  2. Completion of Fiscal Year 2013 appropriations prior to March 27, 2013

Each one of these issues could take the complete lame duck session to debate and pass. It is expected that the Congress will come up with a legislative fix to delay or punt the first year of the $1.2 trillion sequestration plan and stop the 8.2 % cuts to non-defense discretionary. Neither Democrats nor Republicans want sequestration. When passed into law as part of the Budget Control Act in 2011, sequestration was never intended to take effect. It was included as an enforcement mechanism to encourage the bipartisan Joint Committee to come to agreement a year ago. Since that did not occur Congress and the White House must determine a way to avert the devastating impact of these possible cuts. Thus far the only budget savings have been $1.5 trillion in cuts to discretionary programs.

Now that the election is over Members of Congress may be able to debate and discuss a balanced compromise to this situation that includes revenue in addition to cuts. Thus far, Republican Members have been adamant about only including cuts to programs and the Democrats and the President have explained another deal will not be on the table without a balanced approach that includes revenue.

It is expected that President Obama will unveil his “Grand Bargain” plan to address sequestration next week. His plan likely will be based closely on his FY 2013 budget proposal, which adverted sequestration with revenue increases as well as defense and non-defense discretionary cuts. The President will give a preview of his thinking in a speech scheduled for 1 p.m. EST today (Friday, November 9). It has been reported that the bipartisan Senate “Gang of Eight,” the group of Senators charged with creating a deficit-reduction deal, has been meeting for some time but does not yet have a viable plan to avert sequestration.

AIDS United believes the most likely way forward will be a date change to the sequester of six months to a year that includes instructions for relevant committees to make changes in the tax code and determine spending cut targets. On Wednesday, November 7th, Speaker John Boehner held a press conference where he stated that Republicans are willing to discuss revenue and they await the President’s “leadership” on the fiscal concerns facing the nation.

It is not clear how much more of the lame duck issues will be resolved prior to adjournment. Those issues not addressed will have to be addressed by the 113th Congress, which convenes January 3, 2013.