|Last week’s Biomedical HIV Prevention Summit saw big numbers. When the final count is done it will be more than 1,400 people. We are particularly grateful to the Houston Host Committee. They made this meeting one for the record books. Here is some of the feedback we received:
The Summit’s Opening Plenary asked the question, “Can we end the HIV epidemic in women without focusing on cis gender black women?” This session was put together by black women who wanted to challenge our movement, researchers, and industry. NMAC’s job is to create a platform for community to speak its truth.
Since the opening was about women, we also wanted to have a memorial moment to remember all the transgender women who were murdered this year. Violence, like HIV, is an epidemic in the transgender community. This session was put together by transgender women who wanted to give names to the souls that were lost and the intersection of HIV, violence, employment, housing, and the healthcare needs of the transgender community.
The Summit is committed to addressing the difficult issues that face our work. NMAC is committed to the authentic voices of community.
NMAC wants to thank all of our sponsors and exhibitors:
We are moving the next Summit to the spring of 2021 because currently it is too close to the United States Conference on AIDS and both meetings had big attendance this year. We need more time between meetings to ensure we are able to produce the best possible trainings. Since USCA is delayed to October of 2020 (end of hurricane season), we felt this would be a good time to push the Biomedical HIV Prevention Summit to the spring of 2021. Look for more information on this in the spring of 2020.
And a reminder: the 2020 USCA will take place October 10-13 at the Puerto Rico Convention Center in San Juan. We have a new domain – usconferenceonaids.org. All 2020 USCA forms will be available when we officially launch the conference website on Feb. 3, 2020. Registration, abstracts, exhibits, hotel, and scholarship information will be posted at that time.
Yours in the struggle,
This World AIDS Day NMAC will Host Two Events
Here is the infamous PrEP ad that was rejected by Instagram. Created by APICHA (Asian Pacific Islander Coalition on HIV/AIDS) Community Health Center. According to Instagram, the ad was rejected on the grounds that APICHA “hadn’t been authorized to run ads about social issues, elections or politics.”
While there was lots of press about why Instagram, a subsidiary of Facebook, would cancel the ads, what got lost in the discussions were the hot Asian guys. For the record, Therese Rodriguez is the leader of APICHA and a long term NMAC board member.
PrEP education campaigns, even ones that are rejected by Instagram, will be key components of our initial efforts to end the epidemic. Jurisdictions will be asked to significantly increase the knowledge and acceptability of PrEP in communities that are hardest hit by HIV, especially communities that have not seen the benefit of the science.
What makes a good campaign?
- Messenger is as important as the message
- Culturally relevant
- Speaks to the values of the recipient
- Sex positive
There are not lots of PrEP campaigns that target Asian and Pacific Islander gay men. As a result, this campaign stands out because the images speak to a very specific community. However, it is not a matter of just substituting the photos. Unfortunately, it is much more complex.
Who Should Local Jurisdictions Target For PrEP Programs?
The federal plan hopes to enroll 900,000 more people on PrEP. Basically, that means everyone it can reach; however, jurisdictions will need to prioritize where to expend resources. Health centers, FQHCs, STD clinics and private doctors should target everyone. STD clinics are particularly important because people who get STDs should prioritized for PrEP education.
Federal funds for PrEP education and outreach needs to reach the communities that are hardest hit by HIV but have not yet received the benefit of PrEP. These communities should be determined by the community viral load for zip codes in the jurisdictions. The zip codes with the highest community viral load need to be triaged and prioritized for PrEP and U=U programs. Science, particularly epidemiology, needs to be the determining factor for what communities are prioritized.
This is where the fight starts…
Can we at least agree that not everyone needs to be equally prioritized to use PrEP? Programs should target people who are sexually active in a “sex positive” manner. Jurisdictions will hopefully prioritize zip codes with the highest community viral load. However, not all the people in that zip code are the same. How should jurisdictions determine who to prioritize? Follow the science and prioritize communities with the highest viral load, particularly those communities that have not seen the benefit of PrEP.
What does this mean in practice? Some PrEP programs need to target everyone who is sexually active or injects drugs. Other programs need to prioritize the communities that are highly impacted by HIV but have not seen the benefits of the science. Metrics for successful PrEP programs must be finalized, particularly programs that can reach thousands, if not tens of thousands of people. The federal plan hopes to get 900,000 more people on PrEP. To reach those numbers, programs will need to expand in ways that are still to be determined. In the past Ryan White programs were able to meet the increased demand by retooling the service delivery model. Can HIV care, treatment and prevention systems retool to accommodate 500,00 more people living with HIV and 900,000 more people on PrEP?
None of this is easy. That is why I was happy looking at hot Asian guys. Thank you APICHA for making me smile. I salute your important work!
Yours in the struggle,
NMAC urgently fights for racial justice and health equity. Health equity means everyone has access to quality healthcare and the medications needed to live long healthy and happy lives. Healthcare is a right and not a privilege. Justice is about prioritizing those communities with the greatest need. The opening plenary for the 2019 Biomedical HIV Prevention Summit will ask the question, “Can We End the HIV Epidemic in Women, Particularly Black Women?” There was some push back to that announcement: “What about Latinas? What about all women? Why only hold out Black Women?” The fact is that Black women account for 60% of all the women living with HIV in the United States. This question highlights the racial justice struggle to end the HIV epidemic. NMAC fights for equal access to HIV services and meds for all women, and we want justice for Black women. The burden of the HIV epidemic on Black women calls out for justice.
NMAC wants everyone to have access to PrEP. When 75% of the people on PrEP are white, it becomes an issue of racial justice. PrEP programs that reach highly-impacted communities of color must come from and be culturally responsive to those communities. Unfortunately, it is not just a matter of switching white faces for people of color. PrEP programs that reach highly-impacted communities of color must come from and be culturally responsive to those communities.
We also need to talk about justice for the transgender community. As long as the CDC continues to classify transgender men and women with gay men, we will never end the HIV epidemic in the transgender community. How can you end what you do not know? If we don’t know the number of transgender men and women living with HIV, how will this initiative know it is successful? NMAC questions the scientific accuracy of CDC’s HIV epidemiological profiles because of this long-held practice. At its core, this is not good public health practice and something that the CDC can and should change.
HIV funding must address equity and justice. NMAC believes that all communities should have the resources needed to end the HIV epidemic; however, as a matter of justice, we believe the resources need to prioritize the communities that are hardest hit by HIV. In the United States, gay men share the largest burden of HIV. As the federal government looks to target resources geographically, HIV prevention and care efforts need to target the communities with the greatest burden of HIV: Black/Latinx/American Indian gay men, Black cisgender heterosexual women, people of transgender experience, and drug users. Funding priorities need to follow the epidemiological profile of that jurisdiction.
This is where the fight starts.
We are all hopeful and thankful for new resources, but will the money get to the organizations that can reach the communities hardest hit by HIV? NMAC hopes the G-57 jurisdictions will put out requests for funding that speaks to community and their strengths. Too often awards are won by organizations who can afford expensive grant writers, but could never reach the most affected subpopulations. NMAC will work with the G-57 to identify best practices that support community responses.
Agencies and health departments that implement new programs should be required to hire people from the communities that effort hopes to reach. If you want to reach the transgender community, then you need to hire transgender people. If you want to reach black women, then you need to hire black women. If you want to reach drug users, then you need to hire people with experience using drugs. If you want to reach people over 50 living with HIV, then you need to hire people over 50 living with HIV.
While this might seem self-evident, you would be surprised how often it does not happen. Now is the time to take a census of who works at the health department, community health center or community-based organization. Does staff reflect, represent, and have senior staff from the communities the work needs to reach? NMAC does not mean to imply that you need to get rid of anyone but, when there are new hires, who gets the job? Now is the time to correct any past challenges and build a work force that can speak the communities this effort needs to reach.
Our work to end the epidemic must be viewed through a racial justice and health equity lens. It is more than retention in care and adherence to meds. It’s retention in care and adherence to meds in the communities that are hardest hit by HIV. NMAC will fight to ensure that all communities have access to the health care and the medications needed to live long healthy and happy lives. We will also fight for justice to make sure that the communities hardest hit by HIV are prioritized. The color of your skin should never be a determining factor for who acqires HIV or any other disease. In the words of the late Congressmen Elijah Cummings, “we are better than this!”
Yours in the struggle,
NMAC Mourns the Loss of Congressman Elijah Cummings
NMAC joins with all Americans who fight for racial and health justice, in mourning the passing of Congressman Elijah Cummings.
“Since 1996, Congressman Cummings not only proudly represented his constituents in Maryland’s 7th Congressional district, he represented all Americans who are marginalized because of their race, sexual orientation, sexual identity, HIV status, and injustices associated with minority health disparities,” said Joe Huang-Racalto, Director of Government Relations and Public Policy for NMAC. “Congressman Cummings was also an unbending voice for civil rights. As Chairman of the Congressional Black Caucus in the 108th Congress, Congressman Cummings helped lead the fight against two federal marriage amendments, which if passed, would have laid the foundation for amending the U.S. Constitution to prohibit same-sex marriages. While we mourn his loss, his legacy of bringing to the forefront and fighting the injustices facing minorities will live on. On behalf of NMAC’s staff, board, and our constituents, we send our deepest thoughts of love and grace to his wife, Maya and their three children.”
Can We End The HIV Epidemic in Women, Particularly Black Women?
For people who have a hard time remembering to take a daily pill, will an injection or implant be a game-changer for them? Understanding implants and “choice” will be a very difficult question for our community. Will they be accepted as an option in impacted communities and will they be accessible if they are acceptable? Can the government force anyone to get implants that protect them against HIV? Since our efforts to end the domestic HIV epidemic requires plans to reach hundreds of thousands of people, do these innovations make our work easier or harder? Without comprehensive HIV treatment education programs, NMAC is concerned that some communities will be left behind as the treatment paradigm is shifting. Plans to end the HIV epidemic must include HIV treatment education for all communities highly impacted by HIV.
2019 Summit Scholarship Recipients
This year the Biomedical HIV Prevention Summit will award 280 scholarships from over 800 applications. NMAC will spend $313,000 on scholarships for the 2019 Summit. The average award is $1,117. Over 200 successful applicants will be receiving an NMAC scholarship for the first time.
Demographics of Scholarship Recipients
Gender/Gender Identity Age Race/Ethnicity HIV Status
|Androgynous||1%||22-24||3%||African American||46%||HIV Negative||44%|
|Female||30%||25-34||47%||American Indian/ Alaska Native||4%||On PrEP||17%|
|Gender Queer||4%||65+||1%||Prefer not
NMAC wants to thank Gilead for their support of the Summit. Additional funding was provided by ViiV, Janssen, Avita, Walgreen’s, Curant Health and InTheMeantime Men. We thank all of our donors; however, it is important to note that they have no input in scholarship decisions or the conference program.
Additional Scholarship From Independent Agencies
100 more scholarships will be given out (25 per agency) by 1) Abounding Prosperity Inc., 2), FLAS Inc. 3), Latinos Salud, and 4). Sister Love. Please contact them directly to get more information about their scholarship process. NMAC thanks them for adding to the scholarship pool. Their process and decision making are independent of NMAC and the Summit.
Scholarship applications were reviewed by members of NMAC’s Constituent Advisory Panels (CAPs) and NMAC staff. One of the major challenges this year was incomplete applications. We encourage everyone to answer each question fully so they can receive the highest possible score. We also have webinars on our website that offer helpful information about the scholarship process. Please know that we value you and your leadership and contributions to our community. Unfortunately, we cannot support all of the requests we receive.
See you in Houston!
Yours in the struggle,
30 Years of Service
Traditionally, the first Monday in October is the day that the US Supreme Court convenes following its summer recess. On Tuesday, Oct 8th the court will hear three cases about whether it is legal to fire someone because of their sexual orientation or gender identity. The court will decide if federal laws that ban discrimination based on sex apply to a person’s sexual orientation or gender identity.
Given the current make-up of the court, the outcome is not certain. If we lose, the decision will codify discrimination into the law and run contrary to the court’s ruling on marriage equality. In 2015, the Court ruled that states cannot deny two people the right to get married based upon their sexual orientation because of the Due Process Clause and the Equal Protection Clause. Same-sex couples, thereby, had the same terms and conditions for marriage as mixed-sex couples. States could not discriminate based on the sex of either marriage applicant. If states can’t discriminate, can employers?
People living with HIV are protected by the Americans with Disabilities Act. This law prohibits discrimination against individuals with disabilities including those living with the virus. That means if you are LGBTQ+ living with HIV, employers cannot discriminate against you for having HIV, but in 25 states they can fire you for being gay, lesbian or bisexual. And in 26 states, you can be fired for being of transgender experience and/or gender non-conforming. Approximately half of Americans reside in a state where you can fired for identifying as LGBTQ+.
The majority of people living with HIV are part of the LGBTQ+ community. Stigma and discrimination are things that they face on a daily basis. Often it is impossible to differentiate where the discrimination started. Were you fired because you are living with HIV or because of your sexual orientation and/or gender identity? Will the Americans with Disabilities Act protect people living with HIV if they are fired because they are LGBTQ+ identified? Is that distinction even possible to make? Can you imagine there is an employer who will protect the straight people living with HIV, but fire the LGBTQ+ person living with the virus?
Why does this matter to our efforts to end the HIV epidemic in America? Over the last 35 years, we’ve seen and documented the impact that stigma has on PLHIV. We’ve learned how stigma impacts access and retention in healthcare and adherence to meds. Whether the stigma comes from living with HIV, race, sex, gender identity or sexual orientation, it is usually impossible to tell. Our efforts to end HIV must address the stigma that the Court may codify into law. If you can be fired for identifying as LGBTQ+, that makes us by law second class citizens who are not worthy of the same rights as our straight counterparts.
The states colored in grey do not prohibit discrimination based on sexual orientation or gender identity in public or private employment. The ones in purple or pink only offer limited protections for public employees.
How many of those states are part of our efforts to end the HIV epidemic?
Here is the map for our efforts to end the HIV epidemic. The dots represent the local jurisdictions and the states in blue represent the states that are part of the effort. Of the seven states that are targeted in the federal effort to end HIV, none of them fully prohibits discrimination based on sexual orientation or gender identity in public and private employment.
Regardless of the state or jurisdiction, most people living with HIV feel that discrimination and stigma are challenges that impact their daily lives. Even if the target jurisdictions has laws that protect them (most of them do), they live in the country where the courts will soon decide if they are second class citizens, not worthy of the same protections. This is important because our solutions must fit within the political realities of where people living with HIV live and why we must fight against laws that discriminate against the communities that are highly impacted by HIV.
This is a terrible injustice and we find ourselves depending on a conservative Supreme Court to protect LGBTQ citizens because the Senate has again failed to act.
I’m hopeful that the Supreme Court recognizes the refusal of the Senate to allow a vote on the Equality Act. Millions of Americans risk getting fired or losing their housing based on who they are and who they love.
On behalf of NMAC’s staff and Board, I strongly urge the Supreme Court to do the right thing – to protect all LGBTQ Americans from employment and housing discrimination. And I call upon Senate Majority Leader McConnell to stop obstructing justice for these Americans – pass the Equality Act.
Yours in the struggle,
This week’s “Ending the Epidemic” is from Ace Robinson, NMAC’s Director of Strategic Partnerships.
More than meds! More than meds!
It is a mantra that our community keeps preaching if we are serious about ending the HIV epidemic. In 2019, we have had medication that can prevent HIV acquisition after someone is exposed in the form of PEP for 14 years. We also have meds to prevent HIV acquisition before someone is exposed in the form of PrEP for the past seven years. We also know that people living with HIV (PLHIV) who have sustained access and use of treatment can live a longer and healthier life. And those people who can maintain sustained access to care and treatment and achieve viral suppression cannot sexually pass the virus onto another person, aka Undetectable equals Untransmittable (U=U) or Treatment as Prevention (TasP).
Compared to 1987, when we opened our doors at NMAC, we have come light years ahead in our journey to End the Epidemic. But one thing that has become more abundantly clear with each passing day is that we will never achieve our common goal to End HIV with just meds. The stark reality is that HIV clinics still have a steady stream of new patients who are either newly diagnosed and have people who have fallen in and out of healthcare.
Why is that? HIV is more than just a virus. It is an opportunistic disease that is firmly rooted in the communities of greatest need. HIV, even more so than before, finds a way to harm the most vulnerable among us. And there are no people more vulnerable in this country than people who are sleeping on American streets. On any given night, over half a million people sleep in shelters are on the streets. And, according to the Office of Housing & Urban Development (HUD), 40% of those people identify as Black/African-American.
The ripple effect of housing insecurity knows no bounds. The HUD program called HOPWA, or Housing Opportunities for People With AIDS, is a lifeline for PLHIV and their families to access housing. And that’s why there is a nationwide call-to-action alert throughout the field of HIV. President Trump’s budget was released for 2020. The budget added nearly $300M in HIV funding for the new Ending the HIV Epidemic (EtHE) initiative announced in February at the State of the Union address. However, that HIV-specific funding increase for EtHE came at the same time as a proposed $63M decrease in HOPWA funding.
The impact on reducing access to HOPWA would be enormous. It would exceed its impact on just PLHIV. Recently Greg Millett, vice president of amfAR, stated, “We know that people living with HIV who are unstably housed are less likely to be virally suppressed. If you are virally suppressed, you are more likely to die from HIV while also making it possible to transmit the virus on to other people. This is why temporary housing subsidies are allowable under Medicaid and the Ryan White Care Act programs. It is an explicit recognition that housing status and health are interconnected.”
And Millett’s assertion is not just supported by PLHIV, their loved ones, and community-based organizations supporting HIV-impacted populations. A few weeks ago at NMAC’s United States Conference on AIDS (USCA), the director of the Centers for Disease Control and Prevention (CDC), Dr. Robert Redfield proclaimed, “I believe it in every bone in my body. Housing is a medical issue…we are never going to get to the end game unless we recognize that housing is a medical issue.”
HOPWA is core to our ability to reduce the numbers of new HIV infections and HIV-related deaths. That fact is clear. HOPWA funding not only should not be decreased. HOPWA funding must be increased. Under no circumstances can we go backwards.
Public health is not rocket science. We must align what we already know is best to achieve our common goal to End HIV in America and beyond. It can and will be done.
I am continually moved by the passion, commitment, and vision of the activists, caregivers, and providers on the frontlines.
This is an epic journey as we fight to end an epidemic that does not yet have a vaccine or cure. Can biomedical HIV prevention take us to the end?
There are people who will try to minimize our contributions because they don’t understand the value and power of community. Their privilege makes them believe they have answers for people that can’t begin to understand.
Here are some of the amazing comments I received on Facebook (I received their permission to reprint):
For leaders who want to extend their education about Biomedical HIV Prevention, we have moved the deadline to apply for scholarships for the 2019 Summit to Friday, September 20th.USCA 2020 will be in San Juan Puerto Rico, Oct. 10-13, 2020. The meeting was pushed to later in the year to avoid the peak of the hurricane season. USCA is going to Puerto Rico to 1) bring much needed economic development to the island after Hurricane Maria, 2) focus on the impact of HIV in the Latinx community, and 3) give attendees the experience of being in a meeting where English is not the only language.I want to extend a final thank you to the NMAC staff, board, and Constituent Advisory Panel members; to members of the DC Host Committee; and to our generous and committed sponsors, including:
Yours in the struggle,