By Barrett White
Over the past week, the CDC hosted the annual National HIV Prevention Conference in Atlanta. At the podium were familiar faces such as Drs. Anthony Fauci, David Malebranche and the director of the CDC, Bob Redfield. Over the course of the conference, panelists tackled tough topics like HIV stigma, PrEP access for underprivileged communities, and what it means to navigate HIV care as a married, heterosexual Black woman.
In his presentation, “Ending the HIV Epidemic: Seeing the Possible at the CDC”, part of the Getting to No New HIV Infections session, Redfield outlined stark truths for those of us combatting HIV in the South: The most recent data show that nearly 50% of new infections are confined to the nation’s largest counties and San Juan, Puerto Rico. Most of those new infections are found in the southern states. The states with the highest concentrations of new infections are Alabama, Arkansas, Kentucky, Mississippi, Missouri, Oklahoma, and South Carolina—Harris County made the list of counties with the highest rates of infection.
Tony Christon-Walker, Director of Prevention and Community Partnerships at AIDS Alabama, spoke about the challenges of reaching the Black community in the South.
“One of the hardest things to do is to find a population that doesn’t want to be found,” he said. “Stigma affects every part of our work. One thing we noticed is that the people who need to be tested the most, are the people who avoid us the most.”
In a focus group in Birmingham, AIDS Alabama discovered that much of the resistance to outreach came from a rejection of the marketing of the outreach campaign.
“The ads were too sexy—just give us the information. Don’t make it look glamorous; and we hate the term ‘men who have sex with men’ because it reduces us to an action.” AIDS Alabama also discovered that advertisements on hookup apps missed the mark. “These men are on the app for one reason and one reason only. They don’t want to see that there.”
So the group, in its campaign, targeted at-risk men of color by running ads in the city featuring people of color—not just men—who are both in treatment for HIV, and who are in preventative care. The effort in Birmingham featured real people, their status, their treatment choice (ART, treatment as prevention, etc.), and discovered that the number of HIV tests increased to 2,200 appointments, 90% of whom showed up for their test.
The sentiment of low medicinal adherence and outreach was echoed in the transgender community by Christon-Walker’s fellow panelist Sophia Kass of the Transgender Law Center. The crux of the issue she says is “social determinants of health”, a term that refers to your quality of life and how that impacts your health. Someone with low-income or unstable housing, for example, may have poorer health than someone who is financially better off due to lack of healthy food or access to preventative care.
To combat the virus, “there is a lot of emphasis on viral suppression. But we know that quality of life is equally as important, because someone can fall off of viral suppression of their quality of life does not support him or her staying in care,” she said.
A study conducted by the Transgender Law Center in Detroit, Fort Lauderdale, and Miami among mostly Latino and Black trans individuals suggested that stable income and employment was the largest barrier to care for trans people of color. From 2015 to 2018, numbers have remained stagnate. “How am I supposed to remain virally suppressed without stable employment or housing?” she asked.
Gina Brown, MSW, of the Southern AIDS Coalition, brought levity to her panel with her personal narrative. While she kept the ballroom smiling with her sense of humor, her story was, after all, a sobering account of what it meant to be straight Black woman with HIV in the ‘90s, and what that continues to look like today. Now living with HIV for 22 years, she recalled her early days of infection, unable to see herself in the fight against HIV during its heyday. While the focus of treatment was on white gay men, she thought it was impossible—a fluke—that she could have contracted it.
When she discovered she was pregnant, she knew she had to be proactive about not only her own health, but that of her unborn child. She entered a study on women living with HIV and was able to give birth without transmitting the virus to her son.
“We are not going to test our way out of this epidemic,” she repeated, stressing the importance of reaching out to marginalized communities that don’t see themselves represented, and who therefore won’t show up to be tested.
“Why would I get tested? Why would I change anything?” she asks, repeating the mindset that she and others live in when they don’t know that the effects of the virus are in their own community. “We hear a lot about same-gender loving gay and bisexual men, but we don’t hear anything about black women,” she stressed, “but we are [nearly] 50% of all new infections.”
By listening to community members and experts in the field of HIV prevention and care from a vast array of cultural and socio-economic backgrounds, we can help to bring and end to HIV.