I've been pretty busy lately, attending seminar after seminar, presentation after presentation....mostly motivated by my drive to get as many CEU's as I need to maintain my professional clinical license to continue practicing counseling. Yesterday's presentation ("Clinical Issues Affecting Women with HIV/AIDS") though has to be (by far) the best, most relevant and informative one I have attended thus far. I went in with an open mind and walked out the door with even more questions and frustrations than I did going in. It's not enough to know the current trends of what's been going on with populations most affected by this tragic pandemic. Sadly, as the woman articulated quite clearly yesterday, the data of copious research collected and analyzed does not tell us the WHY the outcomes have not gotten better. Counter-intuitively, research actually shows that even when women are provided with optimal medical care and adhere to strict medical regimens (having to take HIV/AIDS medication 95% of the time for it to be effective!).....the disparities between illness and wellness have grown worse, not better. This invited an interesting debate for dialogue between the speaker (Catherine Christeller, Executive Director of Chicago Women's AIDS Project) and the constituents (in this case, all of us clinical therapists, psychologists, and case managers).
Is it shame and the stigma of telling other people that you are living with AIDS, thus it goes untreated and leaves a woman with inadequate support on top of it all?
Is there inadequate funding? What about misleading/misdirected preventative methods and harms reductions solutions?
Is there a disproportionate focus on a particular aspect to the detriment of other relevant aspects?
Is there a lack of balance in treating the problem holistically and systemically instead of blaming one particular factor?
Answer to all of the above: Y E S.
Thank you Mr. President, once again for contributing to keep things shitty AND leading us down an even shittier path of problems. Let's start with the funding issue.
Our wonderfully intelligent current President came up with the idea of PEPFAR (President's Emergency Plan for AIDS Relief), his own personal global funding/"prevention" that requires 1/3 of the money be spent on abstinence-until-marriage programs. What is the problem with this, you ask? Such programs do not address REALITY.
According to the Center for Health and Gender Equity's April 2007 stats and information, "In 2006, there were 4.3 million new HIV infections. 80% of HIV infections among women worldwide result from SEX WITH THEIR HUSBANDS (my emphasis is in caps!) or their primary partners. 50% of all new HIV infections worldwide are among youth aged 15-24, a clear indication that young people are already sexually active. Prevention programs need to be comprehensive for individuals. Segregating "abstain" or "be faithful" messages from messages about condoms and negotiating safer sex leaves people vulnerable. Violence against women and girls must be addressed as part of a comprehensive prevention intervention." Are we going to make AIDS all about politics too?!
Conversely and perhaps more appropriate, enacting the "PATHWAY Act" could:
***Remove the requirement of PEPFAR.
***Require the President to develop a comprehensive and integrated HIV prevention strategy to address the vulnerabilities of women and girls.
***Increases access to male and female condoms.
***Integrates HIV prevention with reproductive health and other basic health care services.
(Email or call your representative and ask him/her to co-sponsor the PATHWAY Act.)
Cutting federal and state funding for health care and social services is adding fuel to the fire as well. Medical services aren't enough, considering the typical profile stats of those women served by community based services with Chicago Women's AIDS Project in 2006:
***88% are at or below poverty level.
***44% have dependent children
***38% have been incarcerated in the past
***45% have been physically abused and 40% sexually abused as a child
***62% have been abused by an adult partner
***71% have been on HIV meds for 6 or more years
***94% report other health problems besides HIV, with 57% reporting 2 or more chronic health problems besides HIV
***58% were diagnosed with depression, but only 46% were seeing a therapist
***62% have a history of drug or alcohol treatment
***41% report not using condoms wtih current partner and 46% have had unprotected sex since being diagnosed
Why am I reporting stats for women in Chicago? After all, it's JUST Chicago, right? Wrong. CWAP's Catherine Christeller reports that this is a systemic problem. She passed out handouts on national averages as well. Alarmingly, she adds that Chicago trends tend to closely parallel those of national trends, putting those populations at greatest risk in any community across the country...particularly African American women AND men.
We cannot scapegoat a particular population as the culprit (such as the controversial "on the down low" phenomenon), however, as this is a community level problem. We need funding and emphasis on prevention AND a harms reduction approach.Thus, sex education and risk prevention in schools and other sectors of the community are an absolute necessity. While society may wish to deny or condemn homosexual activity in the criminal justice systems, it IS going on folks. Crossing our fingers and hoping for the best is not going to prevent or cure the HIV/AIDS crisis. Jails and prisons are undermining proper care. It would behoove prison systems to provide condoms to its inmates. For more on that specific topic, here's an interesting article I came across: http://abcnews.go.com/Health/AIDS/Story?id=2724605&page=1
Racism, poverty, unequal access to treatment (ie, lack of health insurance/coverage, referrals and/or access to a variety of social support services), and the prevalance of comorbid conditions (existing conditions that may or may not accelerate the deterioration of the individual living with HIV/AIDS: diabetes, liver disease, Hepatitis C, lung disease,etc) add to the complexity of HIV/AIDS as a systemic issue. Being labeled an individual with 'mental illness' also tends to be associated its own specific stigma; many don't feel comfortable being identified as having mental problems. In turn, they may be too embarrassed or ashamed to seek treatment for their mental health.
Don't lose hope though! While having a dialogue regarding medication and overall treatment, I asked the speaker how long an individual could live, given an optimal treatment plan regimen. "Indefinitely." Of course, it depends on the individual's overall health, lifestyle factors, etc. But still....indefinitely?! Isn't that hopeful enough to put forth all our community efforts in a more holistic and systemic way to treat and prevent this tragic disease? I don't know about you, but I think it's worth the time, funding and energy.
It's called saving lives.
2 comments:
The bottom line is - why do people contract HIV/AIDs? Mostly it is having unprotected sex. Yes, I think distributing condoms and educating people is important, but let's face it: you don't need to know anything about AIDs to know that you will basically die young/early. Yet people have the "it won't happen to me" approach and continue to have unprotected sex. Maybe you're catching me in off mood, but the bottom line is that people make bad choices because everybody wants to live in the moment and acheive instant gratification and because sex feels better without a condom. I don't know if educating people would change this.
Why do people get ANY disease? Eh, never mind. We could go back and forth about that for days!
I agree with you to an extent, as far as the instant gratification mentality part you mentioned...which is why it's all the MORE important to enforce harm reduction and treatment. We know people are not likely to change their values overnight....but we CAN educate them on their options, should they choose to engage in such behaviors and/or high risk situations. THAT is the bottom line. :)
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