Browsing Category: Access2Care

Addressing the Issues of Women, HIV and Violence Together, Today and Every Day

MDonze headshotBy Melissa Donze, Program Associate, AIDS United

Every year on March 10, National Women and Girls HIV/AIDS Awareness Day gives us the opportunity to raise awareness and bring attention to the continued impact HIV has on the lives of women across the country. Women and girls make up about one in four of the 1.1 million people living with HIV in the United States, and a majority of these are women and girls of color. These women face barriers to accessing and staying in care, which is critical to their continued health and viral suppression.

When we talk about women’s health, however, talking about HIV alone isn’t enough; we must talk about violence too. Experiences of violence and resultant trauma have a significant impact on women’s health, especially for women living with HIV. Women living with HIV experience highly disproportionate rates of trauma and post-traumatic stress disorder (PTSD) compared to the general population of women: 55% have experienced intimate partner violence (IPV), twice the national rate; over 60% have been sexually abused, five times the national rate; and 30% have PTSD, six times the national rate. Trauma and PTSD are associated with poor health outcomes at each stage of the HIV care continuum, including disengagement from care, medication non-adherence and medication failure. Recent trauma is also linked with almost twice the rate of death among HIV-positive women.

In September 2013, we took a huge step forward in addressing these issues. The President’s Working Group on the Intersection of HIV/AIDS, Violence against Women and Girls, and Gender-Related Health Disparities, formed in March 2012, released a report that identified five objectives and recommended actions for federal agencies to increase interventions to link women living with HIV and affected by violence to much-needed services and care, as well as encourage broader prevention efforts and research. In response to this report, AIDS United, with generous support from AbbVie, convened a Summit with an interdisciplinary group of activists, thought leaders, academics, women living with HIV and federal partners to provide commentary and develop innovative community-driven advocacy and implementation strategies to address the intersection of women, HIV and violence. The strategies developed throughout the two-day meeting, summarized here, provide tangible steps we can take to ensure that the issues of women, HIV and violence are addressed together.

These experiences are lived by women and girls across the country every day, so while a single day to highlight the impact of HIV on women and girls is important, it simply isn’t enough. We must continue to have these conversations every day because violence is real and affects every aspect of women’s health, especially for women living with HIV, and it won’t go away tomorrow. Let’s use National Women and Girls HIV/AIDS Awareness Day to recommit ourselves to addressing HIV and violence together, for all the women in our lives.

Click here to view photos from the summit.

The Personal is Political: National Women and Girls HIV/AIDS Awareness Day

By Liz Brosnan, Executive Director, Christie’s Place

The HIV/AIDS epidemic is a formidable health threat to women in the United States, particularly young women and women of color. As Executive Director of a women-serving organization founded eighteen years ago in memory of Christie Milton-Torres, the first woman to unabashedly share her life and struggles of living with HIV in San Diego, National Women and Girls HIV/AIDS Awareness Day (NWGHAAD) plays a critical role in bringing much needed attention to the impact HIV has on women and girls. I’ve had the honor to serve as Executive Director of Christie’s Place for the past twelve years and sadly the struggle to have women count – to ensure that they have the resources and care they need to survive – has not lessened. As an activist for the past 16 years, this day represents much more than raising awareness. It represents a synergy of efforts to offer support, encourage discussion, teach prevention and the importance of getting tested, as well as how to live with and manage HIV.

Over the past year it seems to me that the national discourse is minimizing the impact of the epidemic amongst women. It is my hope that NWGHAAD will reinforce that there is an ongoing need to address HIV/AIDS among women and girls domestically. The theme, “Share Knowledge – Take Action”, is important now more than ever. We need to raise the collective consciousness that HIV affects women and girls in complex ways along the care continuum and take action to ensure their needs are adequately addressed.

Last summer Christie’s Place joined the AIDS United Public Policy Committee (PPC). Like many of my sister organizations, we don’t have a budget for advocacy work. A colleague, Doug Wirth, was visiting our agency and when I shared that as much as I would like to join the PPC, membership dues weren’t in our budget. Without blinking, he took out his checkbook and gave Christie’s Place a donation to sponsor our membership. He shared in my belief that it was important for a women-centered community based organization to be involved because we would offer a unique perspective. I was honored and humbled, and after I wiped the tears from eyes I joined that afternoon. It’s important for organizations like Christie’s Place to be at that table because we provide a grassroots and grasstop perspective about how policy impacts organizations and women we serve on the ground. Being part of the PPC emphasizes the importance of solidarity – not just in sisterhood but with our brothers who are in this struggle with us and for us.

The role of policy is vital in our local response to serving women. It is a bidirectional process where we lift up the lived experiences of women as well as advocate at the national level for policy, funding and services that fully address their needs. Social determinants, gender inequalities along with the pervasive intersections of violence and trauma all fuel women’s health disparities. Violence and trauma are deeply interwoven in women’s lives. In order to “get to zero” our public health, healthcare and social service systems need to be trauma-informed and trauma-responsive. Christie’s Place and others across this country have been working to this end over the past year. The White House Interagency Federal Working Group Report on the Intersections of HIV/AIDS, Violence Against Women and Girls, and Gender-Related Health Disparities is a much needed first step in addressing the need for a coordinated, integrated and holistic approach to caring for women and girls within this context.

As a woman, the personal is political. Stigma, shame and fear fuel this epidemic. This past year has been one of great reflection. I am a survivor of childhood sexual abuse, violence and trauma. I have lived in silence with this stigma for most of my life. NWGHAAD is a call to action, so how can I expect women to share their status to combat stigma, to share their resilience in surviving trauma to inspire hopefulness, to turn the tide on AIDS by speaking out when I have concealed my own lived experiences crippled by shame and fear? I’ve been a hypocrite, but that ends today. In honor of NWGHAAD, I lift my cone of silence in solidarity and to speak truth to power.

I Am My Brother’s and Sister’s Keeper. Fight HIV/AIDS!

gina-brown-web

By Gina Brown, Program Manager, AIDS United

“I Am My Brother’s and Sister’s Keeper. Fight HIV/AIDS!” This is the 2014 theme for National Black HIV/AIDS Awareness Day. National Black HIV/AIDS Awareness Day was first observed in 1999, and since then, advocates, allies and people living with HIV/AIDS in the Black community have worked hard to be “Our Brother’s and Sister’s Keeper”. We’ve organized, united, strategized, articulated and advocated for the need to be our brother’s and sister’s keeper, as we remain dedicated to fighting HIV/AIDS in the Black community.

HIV/AIDS continues to disproportionately affect Black America. Currently, three in five Black Americans know someone living with or who has died from HIV/AIDS. Although we account for less than 14% of the U.S. population, Black America represented 44% of all new HIV infections in 2010, according to the Centers for Disease Control and Prevention (CDC). Men who have sex with Men (MSM) remain the group most heavily affected by HIV, while young Black MSM continue to account for more than half of new infections among young MSM. The CDC reports a 21% decline in new HIV infections among women overall, however the new data shows that black women continue to be far more affected by HIV than women of other races/ethnicities. Of all the women living with HIV in the United States, approximately 66% are African American.

According to the Southern AIDS Strategy Initiative (SASI), in 2010, 46% of all new diagnosis of HIV infection occurred in the South. Compared to other regions, a higher percentage of diagnoses in the South were among women (23.8%), Blacks/African Americans (57.2%). With numbers this high, it is crucial to expand Medicaid in the South, since Medicaid Expansion would allow greater access to care and treatment for HIV positive individuals.

What does it mean to be “Our Brother’s and Sister’s Keeper?” One way this can be interpreted is that a sister or brother takes responsibility for the others behavior. It means taking care of them and not ignoring their problem, it also means being concerned with someone else besides you. You keep him or her from harm. As a woman living with HIV, the way I do my sisterly duty is by speaking for those women who have yet to find their voices. I take this charge seriously because I AM my Sister’s Keeper!

So looking forward, how do we take greater responsibility for one another in the Black community, as we recommit to ending the HIV/AIDS epidemic? First, EVERY Black American must know his or her HIV status. Second, every person who tests HIV positive must have access and be linked to care, which helps to improve their health outcomes. Third, partners and allies must work to ensure that all groups and individuals who are challenged by social determinants work to keep the Black community within reach of access to opportunities that limit poverty and social exclusion. This focus is critical as we work together to end the HIV/AIDS epidemic. Since its inception, National Black HIV/AIDS Awareness Day provides a heightened opportunity for Black Americans to come together for education, testing, involvement and treatment, if necessary.

As our Brother’s and Sister’s Keeper in the Black community, on this National Black HIV/AIDS Awareness Day, we are dedicated to ending the HIV/AIDS epidemic in America.

Lost and Found

Author-webBy Nucrisha Stone Plowden
Health Navigator,  Amida Care

I was recently asked to write about my experiences as a Health Navigator for Amida Care.  Amida Care, a grantee of AIDS United’s Access to Care Initiative, is a Medicaid health plan specifically designed for people living with HIV/AIDS in Manhattan, Brooklyn, the Bronx, and Staten Island, New York.  Amida Care’s “Live Life Plus” mission is to provide access to comprehensive care and coordinated services that facilitate positive health outcomes and general well-being for its members.

The Health Navigator is a key component of Amida Care’s access to care work.   Because of the success of our Health Navigator Program, we have been able to expand the number of Health Navigators from three to seven, giving us even greater capacity to help our members get reconnected to the care they need.  This can still be a bit of a challenge, though, as shown through a recent experience with one of our members.

First appearing on my “lost-to-care”  list (meaning I had to search for him), this member was a young man of 22 who had little knowledge of the HIV virus that he had been infected with. Having been diagnosed at age 15, he admitted he had never taken any of the medications prescribed. Because of the resistance he was developing to treatment, he began to experience early stages of renal disease, along with a low CD4 count and high viral load.  He had only kept a few appointments throughout the year, but not enough to maintain his health. I educated him on some basic facts about disease and treatment and explained how crucial it was for him to visit with his doctor regularly and to take his medication.  He expressed he wasn’t sure if he wanted to get care in a hospital because the setting was so overwhelming to him. He felt he wanted to experience something new, maybe some place smaller. I asked him to revisit the clinic and assured him that I would escort him and advocate for him. I just wanted him to be sure of any decision that he made.

Access-to-Care-Team--NYC-webThe clinic staff was surprised to see him return for an appointment, as this patient has been hard to engage. Fortunately, as a Navigator, I had the time to look for him. Not only did I have the time, but I refused to give up.  After a few more visits he made up his mind to transfer his care to another facility. He wanted to see what it would be like to have care in a private setting as opposed to a large hospital.  He made the decision and I was proud that he was being accountable for his health care.

My intention is to do what is best for the patients, and to respect their wishes.  We work to empower our members — mentally, emotionally and physically — to educate them about their health and all available health services and connect them with community services to enhance their overall functioning.

In the end, this member learned self-preservation, obtained a greater sense of self-esteem and was able to tap into personal strengths that he had been unaware of. He took charge of his health and is taking his medication as prescribed daily and is working on getting his renal disease under control.

Many times I feel like I’m chasing ghosts and I beat myself up when I can’t find people, but cases like this make it all worth it and I am reminded that the work we do is impacting lives.

 Amida Care is a grantee of AIDS United’s Access to Care (A2C) Initiative

 

One City, Two Access to Care Interventions

BrianRisley-webBy Brian Risley, 
Manager, Treatment Education Program
AIDS Project Los Angeles

People living with HIV/AIDS in Los Angeles can face numerous barriers – including systems, structural and social barriers — to accessing the life-saving, HIV-focused care they need. Some may lead to people already falling through cracks in the system, and some may inhibit people from seeking care at all. AIDS Project Los Angeles (APLA), with support of AIDS United’s Access to Care (A2C) initiative, has set out to tackle these barriers by creating the Care & Access Network. The Care and Access Network is a partnership with Northeast Valley Health Corporation, REACH LA and the Los Angeles County Division of HIV & STD Programs, and uses a variety of intervention protocols to get HIV-positive Los Angeles area residents into care and to keep them there.

Baby Steps

One intervention example in which we are starting to see success involves a culture change — not a seismic shift, but a discernible change — in the way one Ryan White-funded HIV care clinic in the Los Angeles County – University of Southern California medical system now addresses systems barriers. The catalyst occurred once our County patient navigators (NAVS) went to work in the clinic to help reach a long list of patients who had fallen out of care. The NAVs locate and contact out of care patients though multiple people-finding resources, and upon consent, work with the client using to address barriers to care and connect them back into HIV care. The County NAVs have gradually assimilated into the clinic culture and have been resourceful enough to try to amend some of the structural barriers they faced: out-of-date patient contact information, expired medical consents, insufficient reminder calls to patients by clinic staff, no electronic medical record keeping and limited access to computers and databases. To date, the County NAVs have been providing helpful feedback to the Medical Director or the head administrative RN, who then have taken appropriate action to resolve the issues. The result has been improved documentation of new patient contact information, increased appointment reminders to patients from clinic staff, and more mindful attention to create patient-centered conversations.

APLA-CAN-blog-photo-web

The Care & Access Network team discusses strategies for keeping a client in care.

Safe Spaces

Another example of early success involves a newly diagnosed client who came into the other arm of the Care & Access Network, located at APLA’s Geffen Center, through a support group of newly-diagnosed HIV-positive people. The client became comfortable enough to disclose that he recently relocated to Los Angeles and learned through an emergency room visit that he was HIV-positive. His viral load was sky high, (over a million copies/ml), he had no HIV
medical care outside the ER, and no health insurance. Because he was employed by the adult film and escort industry, he was fearful production companies and clients would shun him if they found out about his HIV diagnosis. Uninsured and depressed, the client was happy to receive help. APLA’s patient navigator linked the client to a Ryan White-funded HIV clinic, and he became virally undetectable within eight weeks on antiretroviral treatment. He also gained skills about disclosure and negotiating boundaries, which would come in helpful when faced with the lure of lots of money to engage in risky sex practices. The client’s most pointed crisis was to risk telling employers about his HIV status and suffer a major loss of income, especially when living in a new city with no family or friends. Together, navigator and client addressed the fear of loss of health, income and stigma and found a talent manager who works with other HIV-positive adult film stars. The client signed with the manager and met others who were going through similar health challenges. Today, the client is starring in a new DVD release where his knowledge of treatment as prevention, condom use and boundary negotiation has brought back real confidence. He sort of has a boyfriend, has cut down on his “overnights” to attend his support group meetings and doctor appointments, and is grateful for
the advice and safety of the Care & Access Network.

APLA is a grantee of AIDS United’s Social Innovation Fund-supported Access to Care Initiative

The Telemedicine Link to HIV Care

by Sandra Percival, Program Director, Telemedicine and Distance Learning Initiatives
Medical AIDS Outreach of Alabama

Reashanda's-photo - MAOReashanda White, access and retention liaison for Medical AIDS Outreach of Alabama, Inc., makes frequent trips to Selma, where more than 39% of residents live below the federal poverty line.  Reashanda (pictured right) recently visited a drug treatment center there that serves young adults.  Because the center’s clients are considered at increased risk of HIV infection, Reashanda wanted to raise awareness of HIV/AIDS and the services MAO provides.

This initial visit led to a partnership with the treatment facility that enables Reashanda to give bi-monthly presentations to these high-risk individuals.  At her first presentation, she was pulled aside by the center director who had several questions about how to get a new resident, who is HIV positive, into treatment.

Thanks to the Social Innovation Fund grant from AIDS United, Reashanda was able to direct him to MAO’s ground-breaking telemedicine clinic in Selma, just around the corner from the drug treatment center. Without the telemedicine clinic, this resident would have had to drive more than an hour away to get to MAO’s Montgomery clinic, or worse,  risk falling out of care.  Thanks to the telemedicine clinic, the Selma patient has a local, full-service treatment center.

Thanks to Reashanda’s proactive approach to outreach, the Selma drug rehabilitation center now refers its residents needing HIV care to the telemedicine clinic.

In rural areas like Selma, poverty and transportation are the two biggest barriers to care for persons living with HIV/AIDS.  Without personal vehicles, many PLWH/A risk disclosing their status in order to find a ride to a treatment center in an urban area.

Telemedicine allows doctors to see patients without the need for travel.  It’s just like being in the room with the provider, but at a much lower cost.

Today, the drug treatment center’s HIV-positive resident is enrolled in care and, with telemedicine, he does not have to travel to Montgomery for his appointments.