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.]

The social drivers of HIV: In conversation with Charles Stephens

Original content from our Mapping Pathways blog team

"There was a charge at the conference to do more, research more and advocate more because what we are looking at is quite devastating." 

In the first of this three-part series, we speak to Charles Stephens of AIDS United, a Mapping Pathways partner organisation, and get his perspectives on the recently-concluded AIDS 2012 conference in Washington D.C. and the FDA ruling on Truvada for PrEP.

MP: Please tell us a bit about what you do.

CS:  My name is Charles Stephens and I’m the Southern Regional Organiser for AIDS United. In that role, I work with our partners and grantees in the southern region of the U.S. to help build their capacity to engage in and implement advocacy work. I am very passionate about HIV prevention research and my goal is to bridge the gap that sometimes exists between communities and academia, researchers and practitioners.

I provide workshops on advocacy and help to build and sustain coalitions that might develop around an issue or campaign. I also help create tools such as factsheets, which are used by some of our grantees and partners in their advocacy efforts.

My role with AIDS United has given me the opportunity to work with the Mapping Pathways project by helping to disseminate findings and using the project as a community education tool to raise awareness about biomedical HIV prevention in general and ARV-based HIV prevention in particular. Being on the ground with various communities gives me the opportunity to draw upon the perspectives of a wide range of stakeholders to help make the case for the significance and value of ARV-based prevention, which is one of the aims of the Mapping Pathways project.

MP: How did the AIDS 2012 conference go? What were some of the conversations taking place there?

CS: AIDS 2012 was extremely exciting! It was the first time in a long time that a conference was held in the U.S. Several conversations centered on the possibility of ending AIDS as we know it is and we feel this possibility is within our grasp.

There have been a number of scientific breakthroughs, particularly in the context of biomedical HIV prevention, that have given us a lot of hope. TLC+, PrEP and other technologies and strategies were prominently discussed and debated.

There was also a lot of discussion about the catastrophic HIV rates among young black gay men and possible strategies to combat that problem. There was a charge at the conference to do more, research more and advocate more because what we are looking at is quite devastating. There was a contrast, though, between the optimism of envisioning an AIDS-free generation and at the same time looking at the dismal HIV rates among young black gay men. Overall though, I get the sense that many of us left empowered and energised.

MP: What is your opinion on the recent FDA ruling on Truvada for PrEP?

CS: The FDA approval of Truvada for PrEP was another exciting development that lent an air of positivity to the conference. The FDA approval gives us more opportunities to engage in research and demonstration around PrEP and answer key questions.

We have to understand better how PrEP will work in real-world settings. There are a number of questions that a lot of communities and researchers have around PrEP and I think that the FDA approval will allow us to look for the answers to those questions

From an advocacy perspective we are at a unique time. However, we still have to work out accessibility issues and think about how people and communities, particularly vulnerable communities, can afford the drug. Advocates are also having conversations about the Affordable Care Act and other health-care reform.

MP: Is there anything else coming up in the near future that excites you?

CS: I’m looking forward to The National Gay Men’s HIV/AIDS Awareness Day that is coming up on September 27. The U.S. celebrates a number of National HIV/AIDS Awareness days through the year. These provide opportunities to raise awareness and also help de-stigmatise HIV by acknowledging the impact HIV has on certain communities and commemorating unsung heroes in the movement.

The impact of HIV and AIDS on my community motivates me to go out everyday and do all that I can to change the direction things are going in. I’m also thrilled at having the opportunity to work with a number of very talented, skilled and committed individuals. Watching their work inspires me and I think their stories need to be told.

Stay tuned to the blog as we bring you part two and three of our conversation with Charles, where he speaks about some of the social drivers of HIV and the disproportionate impact of HIV on some communities.

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[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.]

From Revolution to Reality: How Will New Science Impact the US National HIV/AIDS Strategy?

via wiredforchange.com

AIDS 2012 Conference Satellite - Free and open to the public

RSVP requested

Sunday, July 22, 2012, 11:15 AM -1:15 PM

Mini Room 4, Walter E. Washington Convention Center, Washington, DC

Hosted by the Coalition for a National HIV/AIDS Strategy

Moderator: Gregorio Millett, Senior Scientist, CDC/HHS Liaison to White House Office of National AIDS Policy DONE

Presenters include (list still in formation):

- Carlos del Rio, MD, Hubert Professor and Chair, Hubert Department of Global Health, Emory University: Treatment Cascade
- Keith R. Green, MSW, Director of Federal Affairs, AIDS Foundation of Chicago: PrEP and the NHAS 
- David R. Holtgrave, PhD, Chair, Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health: Costs, Consequences and Feasibility of Achieving the NHAS Goals
- Molly Morgan Jones, PhD, Senior Analyst, RAND Europe: Mapping Pathways: Exploring strategies in the use of ARV-based prevention

Please register here.

The U.S. National HIV/AIDS Strategy (NHAS) has been in place for two years, and since its release, scientific breakthroughs and new research have transformed our thinking about the US HIV epidemic.  HPTN 052 and successful PrEP and microbicide trials demonstrate that biomedical interventions hold promise that were unthinkable just 2 years ago. 

At the same time, Gardner and his coauthors shine a spotlight on the human factors impacting the epidemic-half of people with HIV are not in medical care, and just 1 in 4 achieves treatment success.  Key researchers, including some who contributed to these breakthrough findings, will weigh in on the implications of new research on the US strategy.

Click here to register.

This session will be immediately followed by the satellite session, "Achieving the Goals of the United States National HIV/AIDS Strategy: Next steps", organized by the U.S. Department of Health and Human Services. 

This symposium is conducted in collaboration with and funded by Bristol-Myers Squibb with no editorial review of content. 


[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.]

Dr. Grant Colfax is Appointed Director of White House Offices of National AIDS Policy Position

via PR Newswire

San Francisco AIDS Foundation applauds President Obama's selection of Dr. Grant Colfax to become director of the White House Office of National AIDS Policy. Dr. Colfax is uniquely suited to continue the momentum established under his predecessor, Mr. Jeffrey Crowley, in advancing the ambitious goals outlined in the president's National HIV/AIDS Strategy and moving us closer to an AIDS-free generation.

"Dr. Colfax has been instrumental in the decline of new HIV infections in San Francisco in recent years," said San Francisco AIDS Foundation CEO Neil Giuliano. "His unique blend of experience serving on the front lines of the epidemic, implementing the national strategy at the local level, working as a direct service provider within the Ryan White CARE system, and conducting cutting-edge research makes him the right person at the right time to lead the Obama administration's efforts to end HIV/AIDS in the United States."

The Office of National AIDS Policy provides essential leadership in addressing the U.S. HIV/AIDS epidemic. As director, Dr. Colfax will be required to take a fresh look at how resources can be targeted to reduce HIV infection rates, increase access to treatment, and decrease HIV-associated health disparities related to sexual orientation, race, gender, and socio-economic status in hard-hit communities across the country. His track record in San Francisco demonstrates he is well suited for this challenge.

"Dr. Colfax will play a critical role over the next several years to ensure the implementation of the Affordable Care Act and HIV service integration to address the health care needs of people living with HIV," said Ernest Hopkins, director of legislative affairs at San Francisco AIDS Foundation. "Having worked closely with him on complex issues and having seen his consensus-building skills among diverse populations, including communities of color, I am confident that the AIDS community will have a strong advocate within the administration. I know Dr. Colfax will work to ensure that the coming changes to our health care system are made thoughtfully, carefully, and with a strong focus on improving the health status of the most vulnerable people."

As director of the HIV Prevention and Research Section at San Francisco Department of Public Health, Dr. Colfax elevated the role of community-based health research in local planning and funding decisions and instituted innovative, evidence-based HIV prevention tools, such as measuring and mapping community viral load and enhancing HIV testing and linkage to care, making San Francisco's HIV prevention planning and service system a model for jurisdictions across the nation. When developing the city's most recent HIV prevention plan with diverse stakeholders, Dr. Colfax was mindful to ensure its consistency with the emerging National HIV/AIDS Strategy. Throughout his career, he has maintained his role as a physician at Ward 86 at San Francisco General Hospital, the nation's first HIV/AIDS-specialized clinic.

San Francisco AIDS Foundation stands ready to work with Dr. Colfax, the White House, and other community partners across the country to reduce new HIV infections, increase access to care for all people living with the disease, and reduce HIV-related health disparities.


[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

Calling all our Indian Readers!

We request all Indian readers to take a few moments and read the facts below:

FACT: HIV prevalence in India is only about 0.3% – however, because of its massive population, India has the world’s third-largest population suffering from HIV/AIDS.

FACT: A fractional increase in prevalence (0.1%) would mean over half a million more people living with HIV.

FACT: While new HIV infections have declined drastically in India over the last 10 years, it’s not time to celebrate quite just yet – about 2.4 million Indians are still living with HIV.

FACT: At present, India spends about 5% of its health budget on HIV/AIDS. The World Bank has stated that India will have to scale up prevention efforts in order to avoid spending more of its health budget in the future.

India stands at a critical juncture in its fight against HIV/AIDS. Policy and funding decisions about treatment and prevention over the next few years could alter the entire course of this epidemic.

The Mapping Pathways project has recently launched on online survey to collect input from individuals in our target countries – one of which is India.

We encourage all Indian citizens who are interested in new ways to prevent transmission of HIV – and want to help shape our project goals and deliverables – to take a few minutes and fill in our survey.

Your efforts will be greatly appreciated!

Take the survey now.


[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

Models: Tools to Improve Decision Making about HIV

Via AIDS.gov, by Ronald Valdiserri, M.D., M.P.H.

For those of us who work in the HIV/AIDS field, the month of July was dominated by exciting HIV prevention news coming out of the International AIDS Society meeting in Rome. Results from the HPTN 052 study showed that early, compared to delayed, antiretroviral treatment resulted in a 96% reduction in HIV transmission to uninfected partners. The TDF2 study conducted by CDC in partnership with the Botswana Ministry of Health, found that a once-daily pill containing two anti-HIV drugs reduced the risk of acquiring HIV infection by about 63% in a study population of healthy, heterosexual men and women. These and other study findings continue to add weight to the notion that HIV treatment is prevention. All of us are encouraged when we think about how these findings could be translated into real world settings in a way that would bring us closer to achieving the goals of the National HIV/AIDS Strategy.

Without minimizing the tremendous enthusiasm that rightly attends the prevention breakthroughs that were presented in Rome, I would like to talk about another scientific discussion that took place in July. As it turns out, this meeting was also held in a world capital, although to a much smaller audience. And while the results of this two-day meeting didn’t garner media attention the same way as the Rome meeting did, the topics under discussion were no less consequential.  In mid-July, I was very fortunate to attend a two-day workshop on “Modeling and Evidence-Based Decision Making” sponsored by amfAR, the Foundation for AIDS Research and cosponsored by the Kaiser Family Foundation, the National Alliance of State and Territorial AIDS Directors, and the Urban Coalition for HIV/AIDS Prevention Services. Meeting participants included colleagues from state and local departments of health, academia, federal government, and professional and community-based organizations.

Colleagues from Los Angeles, San Francisco, Maryland, and New York City shared with us their experiences with using various models to assist in making decisions about “optimizing” HIV prevention investments. Using different approaches, each of these health departments was trying to answer the same question, “What combination of prevention services and activities will result in the greatest reduction of the number of new HIV infections?”

At the onset of the meeting, we were reminded that modeling is used in other areas of health and public policy decision-making, especially when leaders are trying to combine diverse information from a variety of sources in order to make sound decisions at a population level.  However, even the biggest fans of modeling reminded us that a model is not a “crystal ball” nor is it infallible.  Instead, what models do is provide a tool to help us make better decisions about complex realities. Good models should always be clear about the inputs and assumptions that were used to generate the results. And perhaps most importantly, they should be used to guide rather than to conclude any discussions about how best to allocate resources.

Read the rest here.

[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]