The social drivers of HIV: In conversation with Charles Stephens Part 3

Original content from our Mapping Pathways blog team

"I'd like to see us...reflecting on our successes. It has been proven that testing someone for HIV and, if positive, linking them to services and care as soon as possible has very positive health outcomes."

In the final part of this three-part series, Charles Stephens of AIDS United, a Mapping Pathways partner organisation, speaks about the successes in the HIV prevention landscape and some of the challenges faced by people in rural areas. Read part one here and part two here.

MP: What are the things being done well in the HIV prevention landscape?

CS: Models like the Mapping Pathways project excite me. The process of collecting data from a variety of different experts and stakeholders on the field and using that data to make a strong case is an excellent model. Other interesting models are AVAC’s HIV prevention research advocacy working group, which I’m a part of, and the community education and research advocacy work of the Black AIDS Institute. Most importantly, stakeholders and leaders within communities are trained and supported to go back to their communities with new biomedical HIV prevention information to disseminate it within their communities.

One of the things I’d like to see more of is reflecting on our successes and planning how to build on the victories we’ve seen over the last few years. It has been proven that testing someone for HIV and, if positive, linking them to services and care as soon as possible has very positive health outcomes. Also from the community perspective we have achieved certain successes like reducing stigma, mobilising communities and providing support networks and services. I’m extremely interested in finding out how we can build on these successes.

MP: What are some of the challenges individuals and communities face in rural areas?

CS: Capacity is one of the main challenges in rural areas. I find that the doctors on the ground are often very knowledgeable, passionate and committed, but the problem that is there just aren’t enough doctors and medical resources. 

Transportation is another huge barrier in rural areas. People have a hard time getting to their doctors, as the transportation infrastructure isn’t always in place. Some people have to travel three or four hours to get to their physicians.

Addressing these barriers has been a challenge, but there have been some innovations like telemedicine, where doctors can remotely provide medical information and check in with their clients from a different location.

MP:  Are there any trial results that came out recently that you have followed closely? Are there any upcoming trials you are interested in?

CS: The HPTN 061 study, which looked at 1553 black, American MSM, shared initial results at AIDS 2012 that reinforced what a lot of us had been seeing on the field. One of the most startling projections of the study was that unless improvements are seen, more than half of all young black gay men who are gay or bisexual will be infected by HIV within the next decade.

Other upcoming trials I will be following with interest are the HPTN 073 study which looks at ways to optimise PrEP adherence in black MSM and the HPTN 069 study, also called NEXT PrEP, which seeks to assess the efficacy of four ARV drug regimens used as PrEP to prevent transmission of HIV in a population of at-risk MSM.

[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position. Please look for us on Facebook here www.facebook.com/MappingPathways and you can follow us on Twitter @mappingpathways as well.]

The social drivers of HIV: In conversation with Charles Stephens Part 2

Original content from our Mapping Pathways blog team

"HIV has never been just a question of behavior. It forces us to look at science in a critical way and examine behavioral and social factors." 

In the second of this three-part series, Charles Stephens of AIDS United, a Mapping Pathways partner organisation, speaks about the social drivers of HIV and its impact on vulnerable communities. Click here for part one.

MP: According to the Centers for Disease Control and Prevention (CDC) figures, men who have sex with men (MSM) accounted for 61% of all new HIV infections in the U.S. 2009. There was also a 48% increase in HIV incidence figures among young black gay men (aged 13-29). Why has the HIV epidemic seemed to have disproportionately affected this demographic?

CS: I think there are a number of researchers right now investigating that question. I feel we are still at the stage of trying to figure out what questions we should be asking. For example, a number of researchers have done work that suggests that black gay men don’t necessarily engage in any higher sexual risks or drug-taking risks than white gay men. However, there is a higher incidence of HIV among black gay men – so why is that?

One argument is that there is a higher prevalence of HIV within existing black, gay male sexual networks, which leads to higher incidence numbers. There is also some thought about ways that poverty, stigma and other social factors can play a role in driving the HIV epidemic among black gay men.

HIV has never been just a question of behavior. It forces us to look at science in a critical way and examine behavioral and social factors. One of most exciting conversations I’ve witnessed in the research and advocacy realm is ‘What are the social drivers of HIV and how do those social drivers disproportionately impact some communities over others?’

I think researchers should be looking at lot of areas. But more importantly, considering the impact of HIV among young black gay men in particular, I think its important that researchers, policymakers and community members all come together in grappling with this really severe epidemic.

MP: Can you elaborate on some of the social drivers you talked about?

CS: Some of the questions we have to ask are: What is the role of housing or joblessness? What are the roles of social class, stigma and homophobia? These questions force us to think about HIV in a very intersectional way. By intersectional, I mean the challenge and issue of HIV is also connected to these other larger social issues.

An intersectional approach forces us not to operate in silos. It forces us to be very innovative in how we think about grappling with HIV. It’s impossible to think about HIV without some analyses of social issues because very often those social issues reinforce the impact of HIV, particularly in vulnerable communities.

Ultimately, it is important to look at communities that are most vulnerable. But what we seem to find is that communities vulnerable to HIV are also vulnerable to a number of other social issues, which means that we have to think very critically about the role that these other social drivers of HIV play – particularly in the lives of young black gay men.

MP: What are some of these challenges and issues that young black gay men seem to face in particular? What makes them so vulnerable?

CS: I think that, again, is a research question. There needs to be a research agenda around young black gay men, particularly in the context of HIV, that asks those very questions. Some of the questions to be asked are: How do we understand the vulnerability of this population? What are some of the forces that contribute to this vulnerability?

The research agenda should bring together researchers from multiple disciplines and approaches. This research agenda requires diverse methodologies, skillsets and worldviews. In effect, this would not just be a research agenda but a research and advocacy agenda, with the research helping drive the advocacy.

Current vulnerabilities include, but are not limited to, joblessness, poverty and stigma. We talk about stigma, in particular, as a barrier to someone accessing prevention or care services. Someone might be unwilling to get an HIV test because they don’t want to be seen going to an AIDS service organisation because of the stigma associated with HIV. Someone diagnosed with HIV might not tell people and thus fail to build a support system around them.

Lack of healthcare access is another vulnerability in this population. Communities that are marginalised because of race, class or gender sometimes don’t have access to the best healthcare resources, which contributes to negative health outcomes.

A number of steps have been taken to make HIV testing as accessible as possible. There are efforts to bring HIV testing to communities and one sees HIV testing events at community centers and mobile testing.

Stay tuned to the blog as we bring you part three of our conversation with Charles, where he speaks about some of the challenges faced by people living with HIV in rural areas and shares his thoughts on the good work being done in the HIV prevention landscape. 

[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position. Please look for us on Facebook here www.facebook.com/MappingPathways and you can follow us on Twitter @mappingpathways as well.]