Witness to History (Again): Inauguration 2013

January 25, 2013 in Elections 2012, Policy/Advocacy, Uncategorized

head shot, Melissa

By Melissa Donze, Zamora Fellow, AIDS United

Six hours of freezing cold temperatures; six hours of standing in the same place, watching the sun rise over the Capitol; six hours of waiting to hear a single person speak; and it was worth every single second.

Four years ago, I drove to Washington, D.C., with some of my college friends so I could be witness to the historic inauguration of the man who renewed my hope in the collective power of individuals. Being a part of President Obama’s first inauguration is one of my most treasured memories; for the first time in my life, I was part of something bigger than myself, something that we have only begun to understand within the context of history.

Four years later, I found myself in D.C. again, this time as a resident and an advocate for people living with HIV. When the opportunity to attend President Obama’s second inauguration presented itself, I couldn’t say no; I wanted to be a part of history again. This time, the crowd looked different. It was smaller, but hopeful; enthusiastic, but resilient. The past four years had changed all of us in one way or another. I was older, and maybe a little bit wiser. I went abroad and returned home with an altered perspective of the world every time. I graduated from college and got my first taste of the “real world.”

I wasn’t the only one who had changed. President Obama was noticeably greyer this time. Realistic expectations and principles had replaced the unbridled idealism of four years ago. The most noticeable changes, however, were found in his inaugural address. While his first inaugural address was good, it was full of lofty messages and metaphorical abstractions that could have been applied to any time period. This second address, however, was grounded in our time and the struggles we face today. It was guided by the principles of our founding documents and still managed to be forward-moving and progressive. Its premise of equality, the most evident of truths, allowed him to address fair wages for women, gay marriage, voter suppression, immigration, and second amendment controversies. Although he did not directly mention HIV, his address spoke to many of the issues people living with HIV face.

As I stood there and listened to President Obama say the words “Stonewall” and “Newtown,” among many others, my eyes filled with tears. I am so proud that the President will be leading us down the path to ensuring life, liberty and the pursuit of happiness for all Americans. It truly feels to me like we are now on the path to equality.

Remembering Our Friend Dave Purchase

January 23, 2013 in Syringe Services Advocacy

Dave Purchase and syringe services advocates on the day the ban using federal funds for syringe services programs was lifted.

Dave Purchase and syringe services advocates on the day the ban using federal funds for syringe services programs was lifted.

By William McColl, Director of Political Affairs, AIDS United

Dave Purchase, the Executive Director of the North American Syringe Exchange Network passed away on Monday, January 21st. He will be remembered for inspiring, tireless advocacy on syringe. As he always said, “the point is the point!”

Dave Purchase was my friend and my mentor. I will always choose to remember him at a moment of triumph; his visit to the U.S. Capitol in May of 2010 to receive a “Champion of Public Health Awards” at the victory celebration for overturning the ban on the use of federal and local Washington DC funds for syringe exchange in 2009. In a place where Members of Congress address each other as “my friend” and “the honorable member,” Dave used his speech to directly bring in the view from the harm reduction street to Congress. He spoke simply and eloquently about the value and cost effectiveness of syringe exchange programs, but he reminded folks of the extreme cost in lives and money of the 20 years it took to change ignorant laws. I am pretty sure Dave is the only person I’ve heard use the f-word 3 times in a speech at the Capitol. I’m still smiling and I think he was pleased with that – I think he’d enjoy that I’m sharing that with you.

He was right to bring in that viewpoint and right to remind us about the costs because just two years later, the extreme conservative Congress elected in 2010 reinstated the federal ban. That they left the local Washington D.C. ban alone was a small but precious victory that we will work to maintain. Dave was always clear with me that our community will eventually end this horrible policy and we traded thoughts about how to do it relatively frequently. So Dave and I (and each of you too) have unfinished business. All of us will miss Dave’s wise counsel, his incredible wit and common sense; and our journey won’t be quite as fun without him, but it is our promise to Dave that we will eventually end the ban on the use of funds for syringe exchange.

Dave was also a dear friend and colleague of several other AIDS United staff members, who have also shared their memories below. He is irreplaceable. His contributions include saving thousands of people from HIV and in many ways creating the very concept of a harm reduction community and his legacy will live on in the courageous work of others. His loss will be felt throughout the community, as well as here at AIDS United, for many years to come. Dave, we miss you already!

Monique Tula, Director of Access
“Dave Purchase was a man of few, but mighty words. He defied conventional wisdom when he set up his card table and folding chair where he distributed-yes, damn it distributed! – clean sets to people who needed them. He did this quietly, without a lot of fanfare. He didn’t expect to be honored, or revered. He’d likely cringe at the thought being called a legend. And yet he was legendary. Many of us wouldn’t be able to do the work we do if it weren’t for Dave and the legacy he leaves in the form of Point Defiance. Rest now and let us continue what you started so many years ago. Oh, and save a dance for me.”

Shannon Wyss, Grants Manager
“When I started working with the Syringe Access Fund in 2009, I very quickly learned Dave’s name. But it wasn’t until the reception where we all celebrated the (short-lived) lifting of the federal ban that I met him in person. I remember being incredibly impressed with this super-friendly, affable individual and liking him immediately. And I was even more impressed later when such an important figure in the harm reduction community actually remembered my name and where I worked. I always looked forward to his calls, which would invariably start out with, “Shannon, this is Purchase!,” and would be characterized by a little bit of business and a whole lot of friendly back-and-forth, usually with more than a little joking thrown in. There is no one who can match his personality, friendliness, and humor.”

Vignetta Charles, Senior Vice President
“Purchase, to me, represented wisdom and joy. I turned to him for advice for new exchanges who wanted to get off the ground (or go underground, if necessary). I was inspired by how fervently he worked to lift the federal ban. I admired the strategy of the Buyers Club to ensure co-op buying power of low cost syringes. And I relied on the data from his team on the 203 programs operating exchange sites in 34 states, the District of Columbia, Puerto Rico, and the Indian Nations.

Most importantly, Purchase was just a really good man who brought joy and light to my days. Every phone call we had involved more than a few laughs. And every time we were in the same room, he would find a way to dance with me. The field has lost a warrior, and many of us lost a friend. There is no replacement. But we will all carry on his legacy.”

Other information:

PEPFAR, Prostitution Policy, and the First Amendment

January 18, 2013 in Policy/Advocacy

By Sarah E. Fay, J.D,
Zamora Fellow 2009

This spring, the Supreme Court of the United States (SCOTUS) will decide whether the government can condition PEPFAR funds on the adoption of an explicit anti-prostitution policy.

On January 11 2013, SCOTUS granted a petition for writ of certiorari in the matter of United States Agency for International Development, et al. v. Alliance for Open Society International, Inc., et al(1)

Specifically, the Court will determine whether a federal conditional spending statute predicated on adoption of a policy explicitly opposing prostitution and sex trafficking violates the First Amendment. The outcome of this case will have far reaching effects throughout the HIV/AIDS community, as two of the respondents collectively include most of the organizations receiving Leadership Act funding in the U.S.

The U.S. Leadership Against HIV/AIDS, Tuberculosis and Malaria Act of 2003 (” Leadership Act“) is at the heart of this debate, and it is the primary vehicle for distributing funds for the President’s Emergency Plan for AIDS Relief (“PEPFAR”). The Leadership Act requires organizations receiving funds to have policies affirmatively opposing prostitution and sex trafficking:

No funds made available to carry out this chapter, or any amendment made by this chapter, may be used to provide assistance to any group or organization
that does not have a policy explicitly opposing prostitution and sex trafficking, except that this subsection shall not apply to the Global Fund to Fight
AIDS, Tuberculosis and Malaria, the World Health Organization, the International AIDS Vaccine Initiative or to any United Nations agency. 22 U.S.C. §

The Alliance for Open Society International (“AOSI”) claims that the Leadership Act’s Policy Requirement violates First Amendment guarantees by requiring grantee organizations to adopt as their own the government’s viewpoint on prostitution. Moreover, grantees’ First Amendment rights are further offended by the Policy Requirement’s application to grantees’ alternatively funded, private speech. With regard to the substance of anti-prostitution policies, AOSI states that the Policy Requirement impedes its ability to work to fight HIV/AIDS by prohibiting from discussing its work and research at “public health conferences, in publications, and on websites.”(2)

USAID asserts that congressional Spending Power permits Congress to use federal funding to further a government purpose. Here, Congress intended for the Leadership Act to include efforts to prevent the spread of HIV and alter high-risk behaviors associated with spreading the disease. Congressional findings linking prostitution and the spread of HIV serves as a strong foundation for the Policy Requirement’s focus on deterring behavior associated with prostitution. USAID claims that enlisting NGOs to spread a message aimed at preventative measures falls within the purview of SCOTUS precedent and is constitutional. Additionally, USAID notes that organizations are not required to accept the funding if they do not wish to adopt an explicit anti-prostitution policy. In the alternative, the Department of Health and Human Services and USAID, the two agencies tasked with disbursement of Leadership Act funds, have issued nearly identical guidelines allowing grantees to create or work with non-recipient organizations to engage in activities contrary to the Policy Requirement. In its petition, USAID states that this dual structure approach for affiliates “cabin[s] the effects of a restriction on speech,” thereby “cur[ing] any constitutional difficulty” relating to alternatively-funded, private speech.(3)

Aside of First Amendment implications, what is clear here is that organizations focused on HIV/AIDS issues need to be empowered to meet the needs of their communities. The sooner those organizations are able to carry out their work uninhibited, the better.

For a full discussion of the additional issues addressed in this case, please see SCOTUSblog.

The petition was made on appeal of a United State Federal Court of Appeals Second Circuit decision that affirmed
the SDNY District Court’s decision to grant a preliminary injunction against
enforcement of the Leadership Act’s pledge requirement. The case is likely to be heard during the upcoming April sitting of SCOTUS.

Brief in Opposition, p7. The Policy Requirement’s exemption of specific international organizations – such as WHO and UN – that have made statements in direct
opposition to the anti-prostitution approach underscores AOSI’s assertion.

Reflections on World AIDS Day in D.C.

December 6, 2012 in HIV/AIDS Awareness Days, Policy/Advocacy, World AIDS Day

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

in HIV/AIDS Awareness Days, World AIDS Day

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

December 4, 2012 in Harm Reduction

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


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.