Dr. Ronald Valdiserri.
This article was cross-posted from the AIDS.gov blog.
This is the final in our series of daily highlights from the National HIV Prevention Conference which wrapped up yesterday in Atlanta.
Focus on Reducing HIV-Related Disparities
The first of Wednesday's two plenary sessions addressed the National HIV/AIDS Strategy (NHAS) goal of reducing HIV-related health disparities and health inequities. Three panelists offered perspectives on the current state of HIV-related disparities in the United States including differences related to the geographic and population based distribution of disease, incidence of new infections, health outcomes and mortality. They also explored the role of social determinants in creating, perpetuating or combating HIV-related disparities and inequality. The panelists reviewed some of the promising interventions, policy changes and partnerships that can be adopted to narrow persistent HIV-related inequities.
- Ms. Tiffany L. West-Ojo, Chief of the Strategic HIV/AIDS Information Bureau, District of Columbia Department of Health, highlighted how the epidemic in Washington, D.C., varies from the picture painted by national data, reminding all of us that local surveillance must be used to target and scale programs that reflect local need. She offered examples of how her agency is using community viral load (CVL) to assess differential health outcomes by race/ethnicity. Tiffany stated that the philosophy of her office is one of "customer service" and that surveillance and other data must be used to improve HIV prevention, care and treatment services for the men, women, and children who live in Washington, D.C. As examples of D.C.'s ongoing efforts to "unlock data and use it in innovative ways," Tiffany cited several data analysis projects undertaken in her office. One innovative example involved obtaining drug arrest data from the police department and mapping it by Census tract along with HIV prevalence so as to better target syringe services programs. In another example, Tiffany's office obtained data from the District's licensing agency about the exact location of beauty shops, nail salons, barber shops, liquor stores, and check cashing services. They then mapped those by neighborhood along with HIV prevalence and targeted certain businesses for active involvement in the jurisdiction's extensive condom distribution program.
- Dr. George Ayala, Executive Officer, The Global Forum on MSM & HIV, discussed the role of social determinants in creating, perpetuating or combating HIV-related health disparities and inequities among men who have sex with men in the United States and around the world. He highlighted literature addressing the influence of stigma, discrimination and lack of social support on gay men's sexual risks behaviors. George also shared results from a global assessment of HIV prevention, care and treatment services for gay and bisexual men, which were, sadly, found to be lacking.
- Mr. Chip Allen, Health Equity Coordinator at the Ohio Department of Health, highlighted some recent promising national advances in addressing health disparities and inequities including the HHS Action Plan to Reduce Racial and Ethnic Health Disparities and CDC's 2011 Health Disparities and Inequalities Report. He echoed Ms. West's call for better use of data to examine social determinants of health and inform public health decision-making. Mr. Allen then shared some examples of how his office has used various data sources and mapping methods -- especially those from commercial marketing sources -- to analyze disparities, explore their social determinants, and pursue remedies with public health colleagues. Finally, he highlighted the Ohio Department of Health's recent policy decision that all requests for proposals include a requirement to address health equity and described a comprehensive system to monitor and evaluate the state's efforts to reduce health inequalities.
Lessons for the Road Ahead from 30 Years of HIV/AIDS Advocacy
Phill Wilson of the Black AIDS Institute addresses the closing plenary. Listening are (l-r) CDC's Dr. Rich Wolitski, Dr. Marjorie Hill of GMHC, Michelle Lopez of NAPWA, and Dr. Ron Valdiserri of HHS. Photo credit: Larry Bryant, Housing Works.
The conference's closing plenary featured stirring reflections on 30 years of community leadership, advocacy and activism from three distinguished, longtime leaders from the community: Ms. Michelle Lopez, Chair of the Board of Directors of the National Association of People With AIDS (NAPWA); Mr. Phill Wilson, Executive Director, Black AIDS Institute; and Dr. Marjorie Hill, Chief Executive Offer, Gay Men's Health Crisis in New York City.
- Michelle spoke of the power and passion of the many communities in which she works, including the Latino community, African American, women, mothers, and persons living with HIV, and she urged the continued cooperation and collaboration among all of them and the rest of the advocacy community. She also commended CDC's prioritization of prevention with HIV-positive individuals -- helping people living with HIV reduce their risk of transmitting HIV to others -- as part of its commitment to "High-Impact Prevention." Finally, she urged the audience -- including federal agency officials -- to remember the special needs of women who are infected or affected by HIV/AIDS.
- Phill challenged the audience by stating that we now have the tools "to end the HIV/AIDS epidemic in America" and wondered aloud if we have the will to do so. In passionate words, he talked about his own experience living with HIV and reminded conference attendees that what enabled communities to survive in the early, bleak days of the epidemic endures today: the fact that we have each other. That, despite our differences, we are a family committed to the shared goal of stopping the spread of HIV.
- Marjorie reflected on lessons from the experience of GMHC, the nation's first and oldest HIV/AIDS care and advocacy organization. As we look to the future, she urged participants to enlist new partners and allies to help us achieve our goals, citing new GMHC collaborations with Black churches and AARP as promising examples. She also urged everyone to remember the powerful personal reasons for our advocacy and work, especially as agencies, organizations and programs struggle to align their efforts with the vision and goals of the NHAS.
Closing Thoughts on the Road Ahead
Finally, I was honored to offer some reflections to close the plenary and the conference. I focused on moving forward in our collective efforts to implement the National HIV/AIDS Strategy. My four parting thoughts for the participants were:
- After four days of informative sessions, information sharing, and often impassioned discussion, I appealed to the participants to remember that while we may not always agree on how best to get there, we all share the same goal: realizing the vision of the National HIV/AIDS Strategy.
- It is also clear that we will continue to grapple with the issue of unmet HIV prevention, care and treatment needs. But, as we move forward, we all need to do a better job of sharing the resources that are available -- using what we have to get what we want. In some instances, this will entail redirection of resources by geography or population. It also means that we must scale up priority programs -- and scale back programs that are not having sufficient impact in terms of health outcomes. I reminded participants that as resources are redirected we must carefully consider the impacts of such redirection and plan for them accordingly.
- We all have to use data more wisely to make decisions that better serve our clients and communities. HIV surveillance and other data that we collect must be used to take actions that will improve the health and well being of communities suffering from HIV. At the federal level, we have to start asking for data in ways that are consistent across agencies and programs as well as be reasonable regarding the number of data elements requested from our grantees. I made a commitment to continue to work to reduce reporting burden among health departments and other organizations receiving federal HIV/AIDS funds.
- Finally, we all have to continue to communicate, even when we don't agree. Meetings such as the National HIV Prevention Conference serve as an important forum for sharing our different ideas, perspectives and experiences.
Ronald Valdiserri, M.D., M.P.H., is the Deputy Assistant Secretary for Health, Infectious Diseases, U.S. Department of Health and Human Services. (Cross-posted from White House Office of National AIDS Policy Blog.)
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