Fighting HIV on the Frontier

I am still surprised after six years of living in Alaska at how many people ask me the same question: 'How do you survive living in 24 hours of darkness?' To survive in Alaska, one has to look beyond its shortcomings and find the beauty that lies within our great state. And like anywhere else in the world, Alaska has unique obstacles when it comes to HIV prevention and in providing services to HIV-positive people. But instead of focusing on the 'darkness' of those obstacles, I like to look at them as positive challenges. So my answer to that question I'm so often asked reflects that same optimistic approach: 'We get 24 hours of light as well.' Two of the unique challenges we face are related to the sheer size of the state and the stigma still attached to HIV. I recently met with 30 AIDS case workers who all say reaching out to rural communities in the state is particularly difficult. In Alaska much of the state's population is spread out over hundreds and hundreds of miles in about 200 small communities. Most of these villages are accessible only by plane and'depending on the time of the year'perhaps by boat or snow machine. A trip to one of these communities can take an entire day and can cost more than traveling to Europe. And with the population so scattered, high-risk groups can easily become hidden, making outreach even more challenging. But these obstacles do not prevent us or our vital information from reaching the people in these remote locations. Through collaborative efforts, agencies of all types throughout the state pool resources so that cost-effective outreach programs can be implemented. Technology is used to bring providers together and share information and ideas. We also actively work to connect HIV-positive people to their peers through the Internet so that support systems and friendships can be discovered. And yet HIV's stigma remains strong because of our remoteness. Many communities continue to deny the existence of the disease. And having grown up in a small community, I understand some of the reasons for that silence, including the sense of 'one degree of separation' that permeates the community. The fear of being publicly identified as being HIV-positive and the associated fears of being ostracized from one's home or way of life causes many to forgo HIV antibody testing and entire communities to deny that they're at risk for infection. Fortunately, people like Selina Moose, an Alaskan native who lost her brother to AIDS, are beginning to chip away at that denial. Moose was enraged at the silence among native Alaskans about AIDS and began to publicly challenge her peers to speak openly about the disease and HIV prevention. Because traditional media campaigns often go unnoticed among Alaskan natives, AIDS activists helped foster the development of culturally relevant educational materials. Relationships between community leaders and AIDS groups are being formed to pave the way for even more extensive outreach. While challenges remain, dedicated activists like Moose and countless other men, women, and youth in the state have helped us make great strides in fighting AIDS on the last frontier. We continue to confront the obstacles facing us and are constantly finding new and better ways to overcome them. And we will continue to see the light rather than the darkness. Storrs is the executive director of the Alaskan AIDS Assistance Association, the largest AIDS service organization in Alaska.