HIV: The New and the Now
In my eight years at ACRIA, I have given workshops on topics ranging from the immune system to domestic violence. But "What's New in HIV?" is definitely one of my favorites, because I never know exactly what I want to focus on until just before the training.
To me, this topic is always evolving. A few days before, and even up to the day I present, I look for new, cutting-edge, and interesting HIV-related topics, whether clinical or social. I reach out to other ACRIA staff to see if they've come across anything new in their research. I want my participants to walk away with information they didn't have walking in.
I also want them to understand how our knowledge of HIV has changed over the years, so I begin by asking them to tell the group the number of years they have worked in HIV. There's always a wide range in the room -- from five days to 15 years -- which is great for what I want to get across. The number of years a provider has worked in the field is important. When I began in this field twelve years ago, my clients were often dying. I can remember attending three funerals in one week. Things are so different now, and I want them to feel that.
I begin with an exercise called "Then, Present, Future." The participants are broken into groups, and each group shares what was happening in HIV ten years ago, what's going on now, and what they think HIV will look like ten years from now. It helps if they understand how things have changed over time. One recent participant, for example, brought up the fact that she and her colleagues always discuss sexual practices and risk reduction with their clients, and those in the room who were doing HIV work 15 years ago admitted, "We never went there." Today's providers have that conversation more often and are able to tell the room a thing or two about sexual risk reduction -- and usually do! Some participants report that they even take notes.
Clients' needs have also changed. It's important for service providers to realize that the services we provided a decade ago are not the same ones that are needed today -- it's a new day.
Clients' needs have also changed. For example, we've come a long way, especially in communities of color, on how we view mental health services. It's important for service providers to realize that the services we provided a decade ago are not the same ones that are needed today -- it's a new day.
In every "What's New?," I talk about microbicides (topical products being studied to reduce sexually transmitted infections, including HIV). What I say about them depends on what the latest research shows, but I always include the topic. And every time, the majority of people in the room have never heard of microbicides. I usually ask, "So why do you think it's been so hard finding one that works?" One man in a recent workshop replied, "Well you know how women are -- everything just hurts them down there." Before I could respond five women snapped back, "Oh, no, he didn't!" I did damage control and explained that early trials had not found the first candidates to be effective (see "HIV Prevention: A Changing Outlook"). We all laughed and moved on. Microbicides are a great topic and everyone leaves with plans to keep their eye out on "what's next" with microbicides.
Another topic that I find of great interest is the ever-changing guidelines on when to start HIV medications. Everyone chimes in on this one, since no matter how long you've been doing this work, when people should start HIV meds is a constant discussion. People share stories about clients who took part in the first trials of AZT and those who are only taking one pill a day now. Still, someone always seems to say, "Yeah, that AZT is a killer." Teaching point! We then look at the history of AZT -- how it was used at very high doses back in the '80s, how it is used now, and how successful it has been in preventing HIV transmission during childbirth.
I always include epidemiology so we can see the change in the who, what and where of the epidemic. When I show the change in AIDS cases for African-American women, it always leads into an in-depth conversation on why the face of HIV has changed so drastically over the years. It's an interesting but sometimes disturbing conversation.
During one training, someone told us about a client who said he would never use AZT, ever. When asked what regimen he was on, he responded "Trizivir," which actually contains AZT! The counselor just didn't have the heart to tell him. The guidelines are a great "What's New?" topic because it not only increases participants' understanding of HIV meds, but also shows how even the experts are constantly debating this topic.
In a recent training we talked about HIV vaccine research, which always brings up opposing views. I shared the latest developments in vaccine research, and the room was divided as to the hope of finding a vaccine or cure. One woman spoke eloquently of her hopes and prayers for a vaccine so that her children and grandchildren could be free from the risk of an infection that would change their lives forever.
Vaccines and a cure can be emotional topics, and there are always those who express the belief that they will never be available because "they" (those in power) don't want them to. Conspiracy theories are still alive in some communities.
Vaccines and a cure can be emotional topics, and there are always those who express the belief that they will never be available because "they" (those in power) don't want them to. Conspiracy theories are still alive in some communities, and we discuss this. I never let it consume the training but it is an important topic, since anything that is a force in the community should be addressed. We talk candidly and discuss ways to approach it so that these suspicions don't hinder clients' efforts to stay healthy. I always end the discussion by sharing that we continue to learn from vaccine research -- even its failures -- and that in order to find a vaccine, we actually need to learn something we don't know yet. I urge them to stay hopeful as research for therapeutic as well as preventive vaccines continues.
I also feel it's important to include social issues in this workshop. We often talk about how HIV stigma has stayed the same in some ways and changed in others. During one training I pointed out that there were a lot of Gay Pride events happening in Harlem that year, and that got a lot of reaction from the room. Some people said, "It's about time!" but others said, "Watch out -- it's a trap to get us all in one place!" We all laughed, but then we talked seriously about stigma and cultural competence. This led to a deep conversation about how different social, racial, and ethnic groups view and experience HIV stigma. These are often new conversations for participants and give service providers a different perspective when offering services to their diverse clients.
I always look forward to conducting "What's New in HIV?" because along with the participants I learn new things every time.
This article was provided by ACRIA and GMHC. It is a part of the publication Achieve. Visit ACRIA's website and GMHC's website to find out more about their activities, publications and services.
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