September 25, 2012
This is the fourth in a series of conversations about ending the AIDS epidemic in Black America. We began with a conversation about why the Affordable Care Act (Obamacare) is critically important to Black people and why we need to be at the forefront of its full implementation. We then talked about people with HIV coming out and how important it is to create an environment where people with HIV can easily live full and open lives. We condemn the brutal murder of Cicely Bolden, a young HIV-positive mother of two killed in a domestic violence case in Dallas This tragedy once again reveals the potential horrific consequences of HIV-related stigma and how vulnerable some people living with HIV can be. It also underscores the need for increased education about HIV -- and HIV transmission, in particular. Last week we talked about increasing demand for treatment -- "if we come, they will build it!"
This week I want to talk about integrating biomedical and behavioral interventions in both our prevention and treatment efforts. Some people in the AIDS field continue to resist the so-called "medicalization" of AIDS, while others promote these new biomedical tools as a panacea. Neither perspective is correct. These new biomedical strategies -- treatment as prevention, PrEP, and others still to be developed -- are more powerful than anything we've ever had in our AIDS toolkit. But to work, these powerful tools will need to connect with actual people -- those who deliver them and those who use them.
Biomedical interventions won't be effective if people are so frustrated by the complexity of our service systems that they simply give up, if they don't understand the importance of adhering to prescribed regimens, or if their providers are judgmental or display no understanding of their life conditions. Over the course of this epidemic, we've learned a lot about how to influence human behavior and we need to apply those lessons as we put the new tools into practice.
Biomedical and behavioral strategies are not an "either/or" but a "both/and" approaches. The biomedical model only works when education, counseling, behavior change, adherence and support, are all there. The history of the epidemic has shown that while education, social, and behavioral interventions are absolutely necessary, they absolutely are not sufficient. If they were the epidemic would already be over. It's the addition of these new biomedical interventions that can lead us to the promise of ending AIDS. And it will take scientists, clinicians, activists, industry, community and people living with HIV/AIDS working together to make it happen.
One of the most first things that we need to do to integrate biomedical interventions with behavior interventions is to assess the baseline knowledge of the HIV/AIDS community. There has not really been a coordinated, concerted effort to educate the HIV/AIDS community or even to do a quality assurance assessment in the last 15 years. As a result we don't know what our workforce knows or what they don't know. What we do know is that the efficacy of biomedical interventions will depend on a highly trained HIV/AIDS workforce. To fill that gap the Black AIDS Institute, in partnership with industry, researchers, health departments and community, is launching a national knowledge, attitude and behavioral survey of America's AIDS workforce at the 2012 US Conference on AIDS in Las Vegas. If you are at the conference, please stop by our booth #203 and fill out a survey.