Julie Davids Reflects on CHAMP and the Future of HIV Prevention Justice
Interview With Veteran HIV Prevention and Social Justice Activist Julie Davids
The HIV PJA has identified three key social drivers as major contributors to stubbornly high HIV incidence rates in the United States: shortage of stable, safe housing access (which is a marker of economic injustice), mass imprisonment (particularly of people of color), and the marginalization of LGBTQ people.
As we move forward in coming generations, we must twin our efforts to combat the proximate, or immediate, causes of HIV, such as sex without condoms or syringe sharing, with an ongoing commitment to the distal causes that determine relative vulnerability or resiliency against HIV, such as poverty and discriminatory policies, that are the focus of HIV prevention justice.
For example, by joining efforts to fight for fair housing for all people at the local level, we bring the strength and passion of the HIV/AIDS community to a human rights struggle that is concretely tied to HIV prevention, treatment, and care. And when we do so as people openly living with HIV and their allies, we create visible space for others to come out, and that's also a good, grassroots way to combat HIV stigma.
CHAMP and others have worked assiduously to draw attention to the reality that gay men of all races and ethnicities are the largest group of those infected in the United States, with the highest rates in black gay men, and the only group in which incidence rates continue to increase. Thus it can come as a shock to some that efforts to end LGBTQ marginalization are often at a distance from the HIV/AIDS community.
Data keep coming out about how events early in the lives of queer people -- like whether or not we are accepted by our parents, or to what degree we are targeted for bullying in schools -- are formative issues that set in place a cascade of vulnerability or resiliency for a lifetime of health issues, including substance abuse and intimate partner violence as well as HIV/AIDS. And groups like Queers for Economic Justice have challenged the AIDS community to recognize the distinct and compelling challenges faced by low-income and poor LGBTQ people that draw our attention right back to core social drivers like poverty, housing, imprisonment, and immigrant issues.
Fortunately, the NHAS explicitly states that we will never overcome HIV in the United States if we do not deal with the epidemic in gay men. But it remains to be seen if resources truly shift in a smart and sustained way to address the prevention needs of gay men (both HIV-positive and HIV-negative) across the lifespan -- and if the HIV/AIDS community will bolster important justice efforts for the liberation of LGBTQ youth and adults that need to go way past issues of marriage.
We know that success in struggles for true justice and human rights do not happen overnight. These sorts of realities -- despite encouraging news on the biomedical prevention front -- make it clear that HIV will probably be a health and political challenge well beyond our lifetimes.
Moving forward, I think we should be honest that it's very likely that we are talking about a fight that will last multiple generations. While we may be able to drastically decrease HIV rates, we are likely to see sustained transmission in marginalized communities as well as the need for care and treatment in the absence of a cure for some time to come. (As an aside, the reemergence of campaigns to fight for a true cure for HIV are encouraging and vital as a counter to any belief that its acceptable to assign people with HIV to a lifetime of expensive and non-benign treatment.)
It seems increasingly disingenuous to state that the epidemic is fueled by longstanding, complex problems like racial injustice, homophobia, gender bias, and poverty, but then also assert that we could "end AIDS" in five or ten years if we just had enough funding.
We might want to look at the vision of groups like Generation Five, an Oakland-based initiative whose mission is to end childhood sexual abuse in five generations, and consider the following challenge: How would we fight HIV/AIDS in the current time if we both want to move forward to improve things today, and put things in place so our descendants can further the fight in their lifetimes?
The provisions of the Affordable Care Act do hold some promise for near-term resources for HIV prevention. The act's Prevention and Public Health Fund contributed some $30 million to HIV research and prevention in fiscal year 2011, and is (hopefully) the source to pay for the implementation of the 12-city plans in fiscal year 2012, if it survives conservative attack. And the fund is slated to grow each year, without the need for annual appropriation battles.
In addition, the planned massive expansion of health care and medication access as many of the major provisions of the Affordable Care Act roll out in 2014 will increase access to care for many people living with HIV. This should spur innovative and collaborative planning to scale up prevention resources for people living with HIV, and the integration of PEP, PrEP, and testing into a more holistic vision of HIV prevention efforts that bridge behavioral support with treatment and biomedical approaches.
But it's not 2014 yet, and problems abound as AIDS drug assistance program waiting lists grow, immigrant populations are increasingly distanced from care with little hope of abatement from anything in health care reform, and the Affordable Care Act remains a big target for old-school conservatives and Tea Party leaders alike.
As we seek to survive to 2014 and beyond, we can acknowledge that this is a long-term struggle and bolster our strategies for furthering HIV-specific advocacy, marshaling the passion of the HIV/AIDS community as a powerful part of broader coalitions and collaborations to confront the social drivers of the epidemic while we confront HIV stigma through our very participation in these broader campaigns.
Despite cuts that are slimming the HIV sector and public health infrastructure, there are people ready to join and sustain the fight for HIV prevention justice.
We can and must usher in a next-generation approach to prevention that breaks down silos of treatment, care, behavioral interventions, mobilization, and research in order to innovate, evaluate, and expand combination interventions deeply rooted in community that marshals the strengths of large health care and public systems.
We can and should move forward on initiating no-cost, low-cost, or independently funded DIY and grassroots sex ed and HIV prevention that can be as down and dirty and explicit as it needs to be -- without worrying about the political climate that can make funders balk.
Oh, there's so much we can and should do. But no matter what, we need strategic approaches that bring our best ideas together to give us a shot at succeeding. I feel lucky to have been able to be a part of CHAMP, which helped so many people turn frustration into power, and hope that the ideas, actions, and national activist networks that we helped to inspire will resonate for some time to come.
This article was provided by Treatment Action Group. It is a part of the publication TAGline.
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