Photo Taken by: NAVESH CHITRAKAR/REUTERS
On December 27 of 2017, members of the President’s Advisory Committee on HIV/AIDS [PACHA] were informed of their dismissal from the committee. News of this immediate shift in national HIV policy took many by surprise (myself included), given the vulnerability of the ACA, and many changes to healthcare policy, the existence of PACHA, was at least a symbolic gesture that the needs of people living with HIV, and those at risk still had some means of influence in the executive branch.
PACHA was founded in 1995, under the Clinton Administration, and has remained a vital asset to the prevention and treatment of HIV. PACHA is made up of our nation’s leading researchers, service providers, advocates, and people living with HIV. Until recently, PACHA and HIV services have benefited from the nonpartisan support of 3 presidential administrations.
According to the council’s March 2017 meeting notes, PACHA’s roster was around 21. However, June of last year, PACHA saw a mass resignation of 6 council members in protest to harmful policy. The PACHA 6 (as they are referred to in the public health community) all claimed that they were not being heard under the Trump administration, although many chose to remain on the council. Some members who chose to remain on the advisory committee were people of color and transgender, representing communities so vulnerable to the virus and in such need of attention that they simply cannot afford to relinquish the representation that they do have.
Quite frankly, the state of HIV and STDs at large is urgent. According to the most recent STD surveillance report from the CDC, the U.S. is experiencing the greatest STD epidemic that we have ever seen, reporting a 4.7% increase in cases of chlamydia, 18.5% increase in gonorrhea, and 17.6% increase in Syphilis. Although HIV rates are much more stable, the CDC also reports a 1 in 2 risks of HIV over the course of a lifetime for black gay men (similar data on transgender communities does not exist, but the risk is likely greater).
HIV risk and survival ultimately comes down to one issue: access to health care. HIV cannot be transmitted by a person who has treated their infection and achieved an undetectable viral load. This means that after about three months of daily treatment for HIV, someone like me, with a known HIV infection, can no longer transmit the virus to another person through any form of contact. I both know my HIV status, and I am receiving regular treatment, but not everyone has the same access to healthcare.
Those who remain at risk are youth, people of color, and transgender people. Any number of factors can disrupt one’s access to health care: immigration status, language proficiency, employment, stable housing, food insecurity, mental health. Realistically any factor that makes it more difficult to priorities, reach, or remember to engage in your own treatment, can become a barrier to healthcare.
There is quite a bit that can be done to address STDs and improve health equity for everyone in our communities, by prioritizing and incorporating a few points into our work and personal lives:
Centering the voices of the impacted: As we engage in any sort of community organizing work, it is essential that we are creating space and positioning impacted people at the forefront, regardless of the specific issue that we organize around. This idea of centering the impacted also includes positioning ourselves to accept leadership from those of marginalized groups. People Living with HIV are often at risk as a result of their needs not being heard or considered in the creation of policy.
Reduce Stigma: one of the single greatest threats to HIV prevention efforts is HIV related Stigma. This is a complicated construct to unpack but includes any negative belief or assumption about HIV and those living with HIV. This includes false beliefs about HIV transmission, laws that would criminalize HIV exposure or other forms of structural violence that would put someone at risk of infection. Disclosing of one’s HIV status is a huge vulnerability for many people, holding the potential for backlash.
Understand Risk: anyone who engages in any form of sexual contact or intravenous drug use with another person is at risk for HIV. With that understood, sex is meant to be enjoyed. It is the responsibility of ever consenting adult to understanding their own individual risk of STD infection, including the factors that are often outside of our control, such as race, gender, and sexual orientation. Understanding our own likes, dislikes, and demographic prevalence helps to better inform our sexual decision-making.