Julie Davids Reflects on CHAMP and the Future of HIV Prevention Justice
Interview With Veteran HIV Prevention and Social Justice Activist Julie Davids
TAGline: So what do we do now?
JD: We continue the fight.
Looking at the successes and failures of CHAMP and other efforts, I've learned that this fight must not be limited to one-time or short-term trainings, small-scale technical assistance, capacity building, and/or online organizing. For those who have noted and respected our work, I'd ask you to look at our capacity struggles as well as our successes as useful data about the need to have strategic alliances and resources to stabilize efforts over the course of years, allowing activists to work together with support and a sustainable home for ongoing campaigns and flexible networks.
In the near term, state-level and regional efforts -- providing training and support for new and longtime leaders -- need to be scaled up in partnership with national initiatives. We can leverage interest in the 2012 International AIDS Conference (AIDS 2012) in Washington, D.C., and the presidential election of that year into resources for leadership development, political education, and on-the-ground field organizing. But we also should reap the benefit of skilled facilitation and strategic support for healthy collaboration to ensure that passionate and opinionated individuals and organizations in our movement are best able to build our collective power in the coming years, and to allow new leaders to emerge for the fight that will continue long past the conference and election.
And fundamentally, we need to continue the fight for the very basics of HIV prevention, such as condom access and funding for syringe exchange, that remain out of reach for many.
We must amplify the fight against the social drivers of HIV in our country, like mass imprisonment, lack of safe and affordable housing, and LGBTQ marginalization.
And we should challenge ourselves across and beyond the HIV sector -- whether people living with HIV, prevention providers, public health advocates, funders or cogs in the wheels of struggling public systems -- to bridge the now-artificial distinction between treatment and prevention and aim higher for cross-cutting efforts that have a shot at reaching population-level success to reduce HIV incidence and health inequities.
We must also use the momentum of the NHAS and the upcoming spotlight on the U.S. epidemic at AIDS 2012 to ensure that more and better coordinated resources reach, and are accountable to, the populations most affected by HIV in our country: gay men, other MSM, and transgender people of all races and ethnicities; and people of color of all sexual orientations.
We need to continue the fight because HIV prevention does work.
The basic HIV prevention package -- including counseling, access to condoms and sterile syringes, and STD treatment -- has helped and continues to help many people avoid infection. Its success has actually made it harder to get results from efficacy studies of additional or alternative prevention interventions, since the systematic inclusion of the basics in the placebo arms has often meant the overall infection rate in trial participants declined substantially.
We have never had a basic, solid, comprehensive foundation of HIV prevention in our country upon which to build more innovative solutions or combination approaches. Notably, it was just this past year that the CDC released a powerful and clear set of data and recommendations on condoms as a structural intervention in HIV prevention. Not just an individual intervention, where one person chooses or is able to use a condom, but a structural intervention, meaning that overarching civic structures can and should make condom access a priority (as has been done in New York City).
In addition, most students and young people never get fully comprehensive sexuality education. There is still no data at all about whether or how sex ed is protective or helpful for LGBTQ youth, and abstinence-only programs still spread misinformation on the public's dime.
These days, the basic prevention package should also include seamless access to postexposure prophylaxis (PEP) for serodiscordant couples and those who have a risky encounter and/or self-identify as at high risk for HIV acquisition, even as we puzzle out how to best move forward on interpreting and implementing initial PrEP results. While there are longstanding public health service guidelines on PEP, actual local programs to get it quickly into the hands of those who need it are rare.
That's why it's encouraging to see that a 12-city expanded HIV planning initiative that's one of the first cross-agency offerings out of the NHAS box -- Enhanced Comprehensive HIV Prevention Planning and Implementation for Metropolitan Statistical Areas Most Affected by HIV/AIDS (ECHPP) -- mandates "PEP access for populations at greatest risk" as one of the required interventions.
Of course, we could hope that syringe access could become more reliably a part of the basic package, now that the federal funding ban has finally been lifted. But two major barriers remain.
Sadly, the NHASperpetuates Bush-era bias against harm reduction, in a time in which those on the front lines believe we could virtually eliminate HIV in injection drug users through concerted, systemic efforts. For example, the ECHPP doesn't even list sterile syringe provision as a "recommended" intervention, much less require it (though it notably highlights a brief alcohol screening/intervention for HIV positive and high-risk people that's seen some success in New York). Even if many of these municipalities are already committed to sustaining syringe exchange (which we cannot count on in this economic climate), the absence of these words in the intervention list of this much-publicized new initiative is chilling.
And there's just not likely to be new money for HIV prevention federally (and much less money given recent and pending cuts at the state and local levels.) This probably means that federal funds must be taken from something else in HIV prevention in order to be redirected to syringe access, setting up competition between different camps or constituents in HIV prevention. While this could and should provoke healthy conversations about the most vital interventions in the current era, it's not an easy process, especially while our organizations and constituents are battered by economic challenges.
Clearly, it's not just syringe access that's threatened by budget woes. The now-worldwide recession is not likely to disappear any time soon -- and if/when it does, there's nothing guaranteeing that funds will flow into the path of justice and public health rather than into the pockets of the banks and corporations that are steering much of the decision making around the U.S. economy.
This is a challenge to us on multiple levels. It's not only harder to find the city, state, federal, and private funds to implement the best strategies of the NHAS and push for much needed investments in HIV prevention, treatment and care. Those hardest hit by economic turmoil are those who are or will be put in harm's way and made more vulnerable to HIV. The CDC has now acknowledged that poverty is a major driver of HIV in heterosexuals, and as the number of impoverished people goes up, we could guess that HIV incidence will as well -- and not just in straight people; poverty jeopardizes the health of all.
Even in this economic downturn we are finding potential innovations in prevention, like PrEP. But we must use these breakthroughs to inspire us to find ways to confront and overcome, rather than reenforce, longtime and persistent health disparities based in economic, racial, and social injustice in order to ensure that interventions reach all people who could use them.
So we need to also continue the fight because in order to prevent HIV; we need prevention justice.
During CHAMP's lifetime, we launched and promoted an HIV prevention justice movement -- one that will be sustained and expanded, in part, through the HIV Prevention Justice Alliance (HIV PJA) as it moves forward with its two other cofounders, the AIDS Foundation of Chicago and SisterLove. Prevention justice asserts that advocates for HIV prevention must join in common-cause struggles for social, racial, and economic justice, and that human rights are essential in furthering our fight against HIV.
This article was provided by Treatment Action Group. It is a part of the publication TAGline.
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