PrEP, African-Americans, and the Future of Prevention

by Charles Stephens, Regional Organizer, Southern  Region

African-Americans remain the population most disproportionately impacted by HIV in the United States . Comprising only 14% of the population in 2009, they accounted for 44% of HIV infections that year. Of the 1.1 million people living with HIV in the United States, 545,000 are African-American. In addition, new HIV infections among young African-American men who have sex with me (MSM) increased by 48% from 2006–2009. This suggests the urgency and critical place we find ourselves in as we grapple with the HIV epidemic in African-American communities that are facing the most severe burden of the epidemic.  HIV in the United States will not be eradicated until it’s confronted head on in the African-American community.

Over the past three decades there have been a number of key advances in HIV prevention. Condom education for example, has become an institutionalized part of comprehensive sexual health education. We have also seen the overwhelming success of syringe exchange programs as another critical step in reducing HIV infection among injecting drug users. Over the past few years, the advances in biomedical HIV prevention have offered additional hopeful signs in our HIV prevention efforts. Pre-Exposure Prophylaxis or (PrEP), is one of those advances. PrEP is a strategy in which HIV negative people take HIV medicine (antiretrovirals or ARVs) prior to a possible HIV exposure to reduce  risk of infection. Using ARVs to decrease the risk of HIV transmission has already been successful in reducing transmission in HIV positive mothers to their infants.

Two recent studies make this point even clearer, demonstrating that PrEP can be both safe and effective. The iPrEx study was a multinational randomized controlled study in 2,499 HIV-negative men who have sex with men (MSM) and transgender women who have sex with men. The Partners PrEP study enrolled 4,758 HIV serodiscordant couples, in which one partner has HIV and the other does not, from nine research sites in Kenya and Uganda. Both studies indicated the safety and efficacy of PrEP within their respective populations.

With the proliferation of information about PrEP, especially as information is disseminated into communities, there has been understandable excitement, caution, and in some cases alarm. The Final Call, the newspaper of the Nation of Islam recently published a story about PrEP and black communities. The article highlighted some of the anxieties and concerns that the introduction of PrEP into our national HIV prevention toolbox might create. Understandably the present relationship and history between researchers and marginalized communities have contributed to some of the ambivalence. Any mention of scientific research and African-Americans is usually coupled with reflections of Tuskegee.  Tuskegee refers to the now infamous research conducted from 1932 and 1972 in Tuskegee, Alabama by the U.S. Public Health Service to study syphilis that went untreated in poor black men. The black men in the study thought they were receiving free health care from the government. In the aftermath of Tuskegee there have been a number of precautions taken and policies implemented to ensure the safety and understanding of study participants. There has also been the development of very successful community engagement programs like The Legacy Project. The Legacy Project is an initiative of The Office of HIV/AIDS Network Coordination (HANC), and has sought to remedy the broken relationship with education, and even promote the value of participating and engaging in research to people of color.

Currently, Gilead Sciences Inc. is seeking approval with the US Food and Drug Administration for the HIV drug Truvada to be used as PrEP. And if approved, will present another historical milestone for the history of the HIV epidemic in this country.

Besides effectively engaging communities another challenge is cost. Cost of expensive HIV drugs, staffing support to ensure treatment adherence, and expanded HIV testing and counseling efforts, is a inescapable factor to successful deployment of our HIV prevention toolbox.  As government assisted AIDS Drug Assistance Programs (ADAP) waiting lists grow, what does it mean to provide HIV medications to negative people? There are very tough questions we have to struggle with.

The HIV rates among African-Americans indicate that innovation in prevention is not only a scientific necessity, but a moral one. The implications around PrEP and African-American communities is a highly complex issue that must be examined both with rigor and courage.   One thing is certain, we need more research into how PrEP operates in a real-world context, particularly within the African-American community. This National Black HIV/AIDS Awareness Day provides us an opportunity to acknowledge the challenges such strategies like PrEP, but also the hope of effectively reducing HIV rates in African-American communities.

The King In Our Midst: Team D.C. @ The National Cathedral

It was quite fitting that Team D.C. did its MLK Day of Service at the Washington National Cathedral.  Ironically, a few days before the death of Martin Luther King, Jr., he spoke at the Cathedral’s pulpit on March 31, 1968, which happened to be his final sermon.  The title of his sermon was titled, “Remaining awake through a great revolution.”  To us, this speaks volumes. Right now, the AIDS epidemic is going through many changes and breakthroughs as it works to establish an AIDS-free generation.  It is very important that we continue to fight the fight and “remain awake” throughout what is taking place!  Like Martin Luther King, Jr. it is important to stand boldly and confidently in the things that you believe in if you want change to take place!

Team D.C. members started off their day of service at Soka Gakkai Buddhist Cultural Center, collecting clothing that were dropped off for a clothing drive.  There, we sorted and bagged the clothing that was dropped off by members of the community.

Later on in the day, the rest of the members walked over to the National Cathedral where we talked to high school scholars about the importance of doing community service, especially when applying to college.  Each of us went around and talked about the AmeriCorps and what we did at each of our agencies.  It was exciting to talk with these young people because just a few years ago, we were in their shoes.  It is always good to share insight with youth who want to make a difference in their communities!  From there, we joined forces with the high school scholars and split up into groups.  Some of our team helped with the food drive, some ushered for the ceremony that was taking place in honor of Dr. King, and some helped sort out donated books that would be going to different organizations around D.C. that lacked resources!

The ceremony started off with a processional where I.J., Nia and Ryan were chosen to carry the donated food, clothes, and books to the altar.  Following that, lots of great performances ensued.  Dancers and drummers, gospel choirs, and spoken word artists from all over D.C. performed to give tribute to the legacy of Dr. King.  Through music and dance, each performer brought in a different aspect of the city’s rich heritage.

No matter if you were raking leaves, serving food, or reconstructing homes throughout your city, each service project reflects Dr. Martin Luther King, Jr.’s love for service which promotes and uplifts unity and peace in our communities.  Now we must ask ourselves, what can we do and what must be done to promote HIV/AIDS awareness while still uplifting and uniting the communities that are being overlooked and ignored by society?

World AIDS Day in New Mexico

On this day of worldwide recognition for those living with and those who have already passed from HIV/AIDS, not to mention increasing numbers of HIV infection rates  amongst younger people, Team New Mexico was able to collaborate with the New Mexico Department of Health and the University of New Mexico LGBTQ Resource Center in Albuquerque to provide HIV testing for all students. We split up to administer tests at three locations set up throughout the campus giving students multiple opportunities to get tested during the day - The Student Union Building, El Centro de la Raza (Student Affairs), and the LGBTQ Resource Center. The turnout was great being that the temperature was in the 20s, and wind gusts reached up to 44mph.

Two weeks later, the NMDOH returned for a ”Results Day.”  Out of the 33 tests administered on World AIDS Day, 20 results were given. The response to the event could not have been better.

World AIDS Day 2011 in Tulsa, OK

World AIDS Day was certainly a long one this year, as there were two events going on in Tulsa. Instead of picking one, Team Tulsa decided to do them both! First we attended Tulsa CARES’ annual World AIDS Day Symposium. Tulsa CARES is an HIV/AIDS organization that works with HIV-positive people living in poverty. Then we went to Tulsa’s World AIDS Day program and premiere of “We Were Here,” a documentary about the early days of AIDS epidemic in San Francisco and how the city responded.

At the symposium, we learned about issues from a wide variety of sources facing people living with HIV/AIDS  in Tulsa . The first presenter, Jim Ott, talked to us about the “rush to judgment” that we fight against in our work with HIV. Then we had a panel of health experts talk about current and promising medical advances, including new drugs and trials. It was very informative, especially hearing from our HIV-positive audience members and learning their health concerns.

After lunch, Dr. Timothy Harrison from the  US Department of Health and Human Services explained how the National HIV/AIDS Strategy was created and how it would affect Oklahoma. Christopher Grano from the Northern Colorado AIDS Project talked to us about taking stigma out of our prevention materials. Instead of using scare tactics that make people living with HIV seem evil, negligent, or dangerous, he wants us to put people first and have sex-positive prevention materials that focus on good behaviors (getting tested, wearing condoms, not discriminating against people with HIV, etc). Our last presenter asked us to be mindful of the ethics in how we share information about clients with other agencies. Even though sharing might be legal through releases or lack of laws, it might not be ethical. The whole program helped us professionally and personally and was a good reminder that we have the information and medications to end AIDS.

At the candlelight vigil, we had a chance to remember our co-workers, clients, and friends with HIV who have passed. Then we went inside the independent movie theater to listen to stories from Tulsa’s early response to the HIV epidemic. We had a lot of former AmeriCorps site supervisors and an AmeriCorps member from the first team talk about their experiences at the beginning of the epidemic and their hopes for the future. There were lots of people dying in Oklahoma at the beginning, and Ric Harrison, a former AmeriCorps member, was a part of a VNA hospice group that help ease the passing of Tulsans with AIDS. Janice Nicklas, our city supervisor, talked about founding TCAP, Tulsa Community AIDS Project, and Tulsa CARES. It was good for the AmeriCorps team to hear these stories of the beginning of the epidemic since none of us had been born during that time. Hearing all the stories and hopes for the future made us feel more committed to the cause. We’ve come a long way since the beginning of the epidemic, but there’s still a lot more to do!

Team NOLA on World AIDS Day 2011

Throughout the week of Dec. 1, 2011, New Orleans joined other cities around the world in observing World AIDS Day– a time of remembrance and awareness.

On Nov. 30, Team NOLA volunteered at a screening of “The Other City”– a documentary about the HIV/AIDS epidemic in Washington, D.C. Donations were collected at the door to support a project to make HIV Awareness license plates for Louisiana. Team NOLA helped to promote, set-up, run, and break-down the event.

On Dec. 1, Team NOLA participated in the Facing AIDS project. We walked around parts of New Orleans, asking people if they would like to have their pictures taken with a message about how they are Facing AIDS. We were pleasantly surprised by how many people agreed.

The first part of our mobile photo shoot took place in the French Quarter. Next we went to the AIDS memorial in Washington Square Park where the Louisiana Office of Public Health does a wreath-laying ceremony every year. The last part of our photo shoot took place in the Marigny neighborhood of New Orleans.

We took pictures of ordinary citizens as well as people who have been involved in the fight against HIV/AIDS for many years. Everyone was given red ribbons and a flyer with our facebook page where they could access their photo later.

At night, at the request of the Office of Public Health, the lights on the Superdome were red in honor of World AIDS Day.

For other behind-the-scene shots, check out our facebook album!

World AIDS Day in Detroit – Getting to Zero by Facing AIDS

World AIDS Day in Detroit is a day that does not pass without recognition. Community events are found not just within the city, but across the state at universities, health departments and at the agencies where our AIDS United AmeriCorps m members serve. This year a new event looked to honor those efforts in a collaborative event that not only set high standards for the future but reinforced our ties with the past. World AIDS Day Detroit (WADD) set out with the goal of raising awareness, battling stigma and remembering where we have been. “Zero new infections, Zero AIDS-related deaths, Zero discrimination.” Getting to zero, a goal that sets the bar high yet seems to make sense and a goal that Team Detroit looks to back each and every day we head out to service.

Collaboration is strength. Organizers of World AIDS Day Detroit understood and capitalized on this fact. Wayne State University School of Medicine, The Hemophilia Foundation of Michigan, The World Federation of Hemophilia, community based organizations such as AIDS Partnership Michigan, Affirmations and Michigan AIDS Coalition and others from across the city of Detroit combined efforts and embarked on what became a truly remarkable event. Major highlights of the day included speaker Jeanne White-Ginder (the mother of Ryan White), the gathering of south east Michigan mayors and officials in an effort to educate and address issues surrounding HIV/AIDS, the screening of the documentary “Bad Blood,” and a NoH8 photo shoot. Members of the community flocked to the event and partner activities across the state were publicized through WADD as it acted as a hub for World AIDS Day information.

Team Detroit’s role in this event focused on facing stigma by joining in the efforts of AIDS.gov and its campaign “Facing AIDS.” The campaign addresses stigma and promotes HIV testing by “putting a face on AIDS.” Individuals or groups take a picture while holding up a sign stating how or why they are Facing AIDS; the photos are then highlighted on AIDS.gov with others from across the country. Our shoot was popular amongst the array of activities at the event and the emotions behind the messages show the strength and resolve of those battling HIV. From those in the new generation inheriting the fight, to the veterans who already left their mark and look to see it out to the end, to the people we serve in our community who depend on us, all of their messages give meaning to why we do what we do.

“I am Facing AIDS because of all the friends and clients I have lost.”

“We are Facing AIDS so nobody else has to surrender their loved ones to this disease.”

“We are Facing AIDS to build a stronger community.”

Messages like these are often drowned out by stigma’s shout. We must highlight the good in what we do, in who we work with and in why we do it. Allowing these thoughts, feelings and aspirations to go without mention is to allow defeat. The day we allow stigma to overtake our efforts is the day we all lose. The Facing AIDS campaign has grown over the years and Team Detroit was proud to once again take part and allow the community we serve and those we work with each day to have a voice and spread their message of hope and perseverance.

For more info on World AIDS Day Detroit – http://www.worldaidsdaydetroit.com/

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