March 27, 2012
The seventh in a series of articles about the Road to AIDS 2012, a 17-city tour that seeks to define the state of the U.S. epidemic and that leads up to the International AIDS Conference in Washington, D.C., in July 2012. The sixth installment reported on the Fort Lauderdale, Fla., meeting.
The political climate in Texas has made HIV/AIDS-prevention efforts more challenging than in some other states, but participants at a town hall meeting in Houston on March 13 voiced a commitment to stemming the epidemic.
"It can be tough to focus on prevention strategies in Texas," said state Sen. Rodney Ellis, one of the town hall panelists. For example, the state's conservative political leadership often touts abstinence-only sex education as the best way to approach the disease. Campaigns that focus on teaching safer sex practices traditionally don't receive as much support, town hall participants said.
"Texas is very interesting in terms of political landscape," said panelist Marsha Martin, director of the Urban Coalition for HIV/AIDS Prevention Services. "You're often not able to implement programs you'd like to because of political reasons."
Not only are political leaders often hesitant to address the HIV/AIDS epidemic, but medical practitioners in the state are also frequently reticent. "Clinicians are often uncomfortable bringing up the topic of screening for HIV," said panelist Judy Levison, M.D., associate professor in the department of obstetrics and gynecology and the department of family and community medicine at Baylor College of Medicine.
Shame and stigma often keep patients just as tight-lipped, said panelist Ann Robbins, manager of the HIV/STD Prevention and Care Branch at the Texas Department of State Health Services. "About half of gay men in a survey said they hadn't told their primary care physician that they were gay," said Robbins. "How is a physician supposed to care for them?"
Part of the challenge lies in learning how to reframe HIV so that it can be explained to anyone regardless of his or her political or personal views, said panelist A. Toni Young, founder and executive director of Community Education Group.
Coming up with creative strategies to increase HIV screening was another major thrust of the conversation among eight panelists and 63 audience members largely consisting of people living with HIV/AIDS, as well as those who work for community-based organizations and AIDS-service organizations. Other panelists included Steve Walker, deputy national political director for the Democratic National Committee; Donna Crews, director of government affairs for AIDS United; and Phill Wilson, founder and executive director of the Black AIDS Institute.
One audience member suggested that incentives be used to encourage testing. For example, people could be offered $50 to get screened. A show of hands in the audience revealed an even split on whether this was a good idea. "There can be value in incentivizing, but it should break our heart if that's the only conversation we're having," said Wilson. "If you have to incentivize people to save their lives, something is wrong."
The Black MSM community is being particularly hard hit in Houston, participants pointed out. "Most groups are leveling off when it comes to new cases, but not young Black gay men," said Robbins. Another concern voiced at the town hall meeting: Latina women who are not legal citizens face potential disruptions in treatment under health-care reform. "One of my concerns with the Affordable Care Act [ACA] is that many women that I take care of won't be covered because if you're not legal, you cannot be covered," said Dr. Levison. "Probably 40 percent of my patients will fall in that category."
Other town hall participants were also concerned about legal challenges to the ACA. Under the law, "about 37 million more people will have access to health care," said Walker. "We should be mad as hell that someone wants to take away something that is saving people's lives."
The way to express that anger is to vote, not just for president but also for Congress, as well as state and local leaders, participants said. "Think about what's happening locally and what's happening in your state," said Martin. "Get the political leaders out if they don't work for you. Sixty people in local elections change the local landscape."
The entire Road to AIDS 2012 tour is a joint effort between the Washington, D.C.-based Community Education Group, the Urban Coalition for HIV/AIDS Prevention Services, pharmaceutical company Merck and AIDS 2012. The Road to AIDS 2012 will seek community input in cities across the country. That input will be shared at AIDS 2012 in Washington, D.C., when the International AIDS Conference is on American soil for the first time in more than 20 years.
Tamara E. Holmes is a Washington, D.C.-based journalist who writes frequently about emotional health and wellness.