The Southern HIV/AIDS Strategic Strategy Initiative called for a “holistic approach” in its 2014 report HIV/AIDS in the Southern U.S.: Trends from 2008-2011 Show Consistent, Disproportionate Epidemic. Such an approach, it says, must “address the multiple factors that contribute to the disproportionate epidemic in the South, such as lack of resources and regional resource inequalities as well as stigma and high STI rates.” As part of our larger feature on HIV and AIDS in the South, we looked at five ways people are combatting the spread of HIV right now in the region.
Meet Them Where They Are
Connecting Resources for Urban Sexual Health, better known among activists as CRUSH, is a consortium of agencies and organizations in Alameda County, Calif., on the verge of issuing similar recommendations based on its study and treatment program for young men of color who have sex with men. Its study concluded that many young gay and bi men of color could benefit from mental health counseling, that money is still a barrier to medication, and that those agencies serving people of color need to meet their clients where they are. For example, when the member agencies learned that many of their clients had no stable address or phone number, they relied on email communications (because most clients were accessing free email via friends or public libraries). And when several clients admitted they had skipped pills when out partying or spending the night away from home, CRUSH began distributing a keychain capable of discreetly carrying their medication.
Some young black gay men have other ideas for how to stem the tide of HIV infections and how to get those who are poz into treatment. One popular idea is fighting for greater adoption of the “opt-out” HIV testing model that the CDC recommended in 2006, where doctors routinely offer HIV testing to all their patients at each contact, so that the client has to actively choose not to get the screening.
A 2010 study found that the model had met with only moderate success when it was adopted by a large emergency medicine department. In fact, 75 percent of the patients chose not to get the test, probably because they did not think they were at risk for HIV, said Jason Haukoos, MD, of Denver Health Medical Center.
However, the model has not been given a fair trial in primary care environments where a patient might feel more comfortable and the doctor could explain the rationale for everyone to have the test just as they would a pap smear or prostate exam—neither of which anyone particularly enjoys, but which most patients still do.
But activists like Kenyon Farrow, former executive director of Queers for Economic Justice, maintains that testing is just one aspect of a broken system. “Testing is great, but what about voter registration, electoral politics?” he says. Farrow argues that HIV infection rates in the South cannot be adequately attacked without addressing other social justice and economic inequality issues. He and other activists argue that organizations addressing HIV need to be “reimagined” as broader social justice agencies aiming to address deeper sociocultural issues.
Telemedicine in Rural Communities
HIV-positive residents in the rural south may benefit from strategies like the telemedicine program from Medical AIDS Outreach of Alabama. As part of AIDS United’s Access to Care initiative under the Social Innovation Fund, MAO set up locations in rural Alabama where patients with no HIV medicine providers nearby can talk with doctors via high-definition video screens. So far the program has a 92 percent patient retention rate, and it has received recognition at several White House events in the past year. Since it was launched in 2011, the program has proven a cost-effective way of giving rural populations access to HIV care.
According to an article in Positively Aware, some of the telemedicine patients eagerly await their appointments. “We have several clients who always dress up for the camera. … They love being on camera,” Michael Murphree, the CEO of MAO told the magazine. “One of the guys admits that for him, it’s his American Idol moment. He never misses an appointment.”
Now the agency has received a $1.2 million grant to establish more telemedicine connections in remote areas of Alabama hardest hit by HIV. (The group used AIDS Vu maps to pinpoint prime locations.) This program could be adapted to other states and regions, though Medical AIDS United staffers warn they had to first convince the Alabama Board of Medical Examiners to accept telemedicine as a viable method of providing care.
Faith Leaders Combating Stigma & Misinformation
A study by the HIV Vaccine Research Initiative determined that many African-Americans are hesitant to participate in vaccine trials for three reasons: Some believe that an HIV cure or vaccine already exists but is being withheld from their population; others fear stigma and discrimination if they were known to be participating in a vaccine trial; and still others are concerned about whether blacks would even have access to a vaccine if one was were developed.
Since the study also found that African-Americans are more likely than other groups to see faith leaders as advisers whose guidance and information can be trusted, it recommends building collaborations with clergy and other religious leaders who provide information, inspiration, and mobilization within the black community.
HIV activist—and trained preacher—Aquarius Gilmer agrees. A regional affiliate coordinator at the National Black Leadership Commission on AIDS, Gilmer says his organization is just starting to work closely with seminaries to that end: “We’re working with seminaries around the country to educate this next generation of black pastors to not only talk about HIV and stigma but…to be advocates from behind the pulpit, and also to equip their congregations to be advocates for their own family members, or their own neighbors.”
Although Gilmer says the program is just in the planning stage (and is still seeking financial support), his group hopes to roll it out next year by attending several black church studies conferences.
Engage People Who Are HIV-Negative in the Conversation
Gilmer also says that engaging HIV-negative people in the conversation about ending HIV is essential, “particularly because they can help us tremendously in curbing stigma. We know stigma really fuels this epidemic, so if we had more allies, that would really help our cause.” He adds, “And vice versa, if people who are in HIV policy could think about how to provide people services who are HIV-negative. Because we are also hearing about men who are HIV-negative feeling stigma for being negative but who also don’t have access to services because they are negative.”
PrEP could play a role in this too. After all, Gilmer reasons, if HIV-positive and HIV-negative are both taking a daily pill to retain their health, it would reduce stigma around HIV care.
Meanwhile, Farrow calls on the residents of Southern states to push for Medicaid expansion and demand to be enrolled because they are already paying for the federal programs. Of course, Gilmer adds, African-Americans are still trying to figure out how to protest in “a police state where you can get shot with your hands up.”
Mental health issues of African-Americans—especially those who are gay or HIV-positive—also need to be addressed. According to the Suicide Prevention Resource Center, suicide is the third leading cause of death among young black men.
CRUSH studied young gay and bisexual men of color in Alameda County and discovered that many of its member agencies’ clients—who were generally HIV-negative—could benefit from counseling for the stigma they’d been subjected to simply for having sex with men.
Atlanta’s Men’s Information Services: Testing, Empowerment, Resources has taken the “holistic” strategy to heart, implementing a program that offers a variety of free services to gay and bi men, including STI testing, meditation, yoga, sexual health education, support groups, and a year of free mental health counseling for any issue.