If we are serious about ending the HIV/AIDS pandemic, then it is time that we look at the whole picture. Each of us are the sum of everything that makes us who we are. HIV is merely one tiny piece of the lives that consumers have to deal with. For some it is a tiny piece, while for others it is a gigantic piece that is all-consuming. While we are focusing on prevention strategies, we must also turn our eyes towards the whole person -- and this should include more education and robust strategies to end poverty, not only for those of us living with HIV/AIDS, but also for those at risk of acquiring HIV.
The consumers that I see every day come to me not with one problem or even just two, but countless problems that have contributed to their HIV status and other sexual health issues. The answer I propose starts with working to solve the very tenets of poverty.
In many communities, HIV is a collateral cost rooted in poverty. In order to be effective and to bring about real multigenerational change, each of us need to examine the role that we can play in ending poverty and the collateral damage it causes.
Support for this can be seen with Ryan White Care, which helps to provide full wrap-around services for those who are living with HIV. I propose that we employ this same strategy as HIV prevention, much earlier. We as a society must ask ourselves: Why do we see higher HIV rates in low-income communities? From that question it can be concluded that poverty is a contributing factor to HIV transmission.
Here's what this would include:
- We must make it a priority to ensure that everyone in our communities has access to a living wage. While you might not think that this impacts HIV rates, studies have shown that children from low-income homes become sexually active earlier than their peers from middle- to high-income homes. Additionally, children from low-income homes grow up or "adultify" faster than their peers.
- We must ensure that all youth in our communities have resources such as technology, including computers and internet access. It is through the ability to explore and learn about the world that youth and young adults are able gain knowledge.
- According to a Brookings Institute report, one strategy for addressing deficits in children and helping them prepare for school would be providing in-home health care. Community health educators would be tasked with visiting low-income families in order to provide real-time health education in the home. This would also be a great opportunity to start educating families about HIV and other health issues such as heroin use.
- "Nothing about us, without us." For example, AIDS service organizations should employ the services of people living with HIV, people of color, trans community members, etc. There is nothing more degrading than not seeing someone who reflects who we are in agencies and their efforts.
- HIV prevention must be tailored to all groups, and it shouldn't be an afterthought to translate it into comprehensible language. Far too many times I have seen prevention campaigns including the voices of minority groups only as an afterthought for the sake of a grant. HIV prevention needs to have consumer involvement from targeted populations in the creation and delivery of the product.
- If we want to reduce HIV in communities with high rates of sex-work, then we must be able to provide alternatives for those who feel that they have no other choice but to use their bodies as a commodity. What are we doing to provide housing and education opportunities for sex workers in order to help them change their situation? For our trans brothers and sisters, this also means providing resources that will assist in their gender transition and safety.
- If we want to end HIV then we must take the time to care for the entire family and the entire community in order to bring about real change. It isn't one person who contracts HIV; the entire family is impacted by an HIV diagnosis.
- Age-appropriate sexual health education must be offered within middle schools and high schools.
- PrEP (pre-exposure prophylaxis) is a great tool for those who have access to it. Each month we are seeing more and more people starting to use it. To date, there have been approximately 48,000 prescriptions written for Truvada in the U.S. There are still, however, gaps in those who are using PrEP, which are being addressed by those who do prevention and community education.
We have been fighting HIV and AIDS for the last thirty-plus years. As with all strategies, we much stop from time to time and take stock of where we are and where we are going. Through it all, we have groups that have seen little to no change in their rates of infection. According to the Centers for Disease Control and Prevention's latest report, diagnoses among Latino and white women have declined steadily over the decade (35% and 30%, respectively). Despite these recent gains, African-American women continue to be disproportionately affected by HIV, accounting for 6 in 10 diagnoses among women in 2014. Latino men and women accounted for nearly a quarter (23%) of all new HIV diagnoses, while representing only 17% of the population.
Improvements in one group can not be viewed as a success when other groups continue to see large numbers of infections. Either we can continue to treat people only when they walk into an HIV clinic or we can explore what we can do years prior. What I propose has the power not only to reduce HIV infection rates, but also to bring about improvements in community health and education initiatives and the general quality of life in our communities.