AIDS DIVA Film Screening Report

The “AIDS DIVA: The Legend of Connie Norman” film screening and advocacy panel was held on Thursday, June 30, 2022 at the UCLA Fowler Museum from 6 to 8pm.  The community event was planned and organized by the UCLA CHIPTS Community Advisory Board in partnership with UCLA Family AIDS Network, REACH LA, and Northeast Valley Health Corporation. The film was selected because it gave a historical overview of AIDS Advocacy in Los Angeles County through the life story of Connie Norman, a leader of ACT-UP.   The film aimed to motivate and encourage those in attendance to be ready to speak up about issues that improve prevention and treatment of HIV/AIDS as well as LGBTQ rights.

The hosts were thrilled to host 60 attendees – community members, students, and representatives from AIDS service organizations such as the Black AIDS Institute, JWCH Institute, Bienestar, Watts Health Corporation and more, to be inspired by a powerful documentary that brought LGBT rights and HIV Advocacy to the forefront.

The event was moderated by James Aboagye and Eddie Sanders, CAB Co-chairs of the CHIPTS CAB, a  group of community leaders and advocates, who advise CHIPTS scientists on research, dissemination of results and other activities that are relevant to the lives of diverse communities impacted by HIV/AIDS.

The event concluded with a reflective discussion session led by the film’s advocacy panel consisting of Dante Alencastre, award-winning documentary filmmaker and LGBT community activist, Rabbi Robyn Podolsky, Los Angeles Program Manager for At The Well organization, and Tony Newman, Interim Chief Executive Officer and President for the Black AIDS Institute. See panel members’ biographies below.

To learn more about the film, AIDS Diva, visit the website: https://www.aidsdivaconnie.com/

Panelists Biographies

The advocacy panel consisted of Dante Alencastre, Film Maker, Rabbi Robin Podoloky, and Toni Newman, Executive Director and Advocate.

  • Dante Alencastre is an award-winning documentary filmmaker and LGBT community activist based in West Hollywood.  His filmmaking and work on the boards of Los Angeles LGBT arts organizations, and political and community groups is focused particularly on the overlapping Latinx Transgender and Gender non-conforming sub-tribes within the community. He is currently director of the California LGBT Arts Alliance. Dante found his personal calling documenting the lives of LGBT individuals and communities during a trip to his native Peru, resulting in the 2007 award-winning filmEn El Fuego (In the Fire ) (2007) (LA Outfest Audience Award), and later, El Fuego Dentro (The Fire Inside) ( 2012), documenting the lives and struggles of a group of trans activists in Lima.  Dante’s film,Transvisible: Bamby Salcedo’s Story ( 2013), documented the powerful Trans Latina activist embarking on her community-based work. Raising Zoey (2016 ) follows the story of  a 13-year-old Latina trans girl and her highly supportive mother, through discrimination towards advocacy. Both premiered at Outfest and toured widely. This film, AIDS DIVA: The Legend of Connie Norman (2021) revives a remarkable figure in AIDS activism and early trans advocacy and her continuing influence on her surviving activist colleagues today.
  • Rabbi Robyn Podolsky is the Los Angeles Program Manager for At The Well, a Jewish women’s wellness organization. She was interviewed in the film as a former ACT-UP LA member and someone who had worked alongside Connie. Robin serves on the Board of Governors for the Sandra Caplan Community Bet Din, writes at TribeHerald and jewishjournal.com, and serves as writing facilitator and dramaturg for Queerwise, a spoken word and writing group. Her most recent academic article, “Sumud Freedom Camp: Levinas’ Face-to-Face in Praxis” was published in Religions, Vol.10, No. 4. She conducts workshops, rituals and study sessions, for Jewish holidays and other occasions, that combine modalities: text study, personal work and small group sharing, writing (except on Shabbat and Yom Tov), prayer and meditation.
  • Tony Newman is the Interim Chief Executive Officer and President for the Black AIDS Institute Black AIDS Institute (BAI). She was the Interim President for LYRIC, and a faculty member at the Transgender Strategy Center and Chair of the Board of Directors for TransCanWork. Toni is a graduate of Wake Forest University and current candidate for her Juris of Doctorate (JD). Toni was the Interim Director of Employment Services at the SF LGBT Center, Executive Director for St. James Infirmary and the Director of Development for Maitri Compassionate Care, and previously served as the Interim Director of Development & Communications at To Help Everyone Health and Wellness Centers and as a Strategic Fundraiser, Volunteer Recruiter, and Legislative Aide for Equality California. Additionally, Toni is a best selling author, noted for her memoir I Rise -The Transformation of Toni Newman released in 2011. Her memoir was based on the poem I Rise by Wake Forest University Reynolds Professor, Dr. Maya Angelou, who Toni interviewed with in 2012. She and her partner are currently working on a feature film, Heart of a Woman, based on her memoir I Rise.

 

 

 

 

HIV Risk Reduction & Earned Income Tax Credit

The California HIV/AIDS Policy Research Center (CHPRC) in collaboration with the Center for HIV Identification, Prevention and Treatment Services (CHIPTS) shared some newly published findings that are both exciting and impactful to efforts of ending the HIV epidemic and beyond. This published paper and accompanying infographic, is the first to examine the relationship between a state Earned Income Tax Credit (EITC) and HIV risk behaviors among single mothers in the United States.

The Journal of AIDS & Behavior published a paper authored by Drs. Kimberly Narain, MD, PhD and Nina Harawa, PhD, MPH, entitled “Evidence for the Role of State-Level Economic Policy in HIV Risk Reduction: State Earned Income Tax Credit Generosity and HIV Risk Behavior Among Single Mothers.” The paper looks at the generosity of the state Earned Income Tax Credit in the United States and HIV risks behavior among single mothers.

In the United States, the generosity of each state’s EITC differs from each other, with many states lacking an EITC. In states with more generous EITCs, the study found, HIV risk behaviors decreased significantly  in single mothers compared with single mothers in other states with less generous EITCs. The effect of a refundable state EITC on HIV risk behavior was what we would expect for two or more hours of intensive HIV risk-reduction counseling, an intervention few low-income single mothers can readily access.

These findings demonstrate the impact of anti-poverty policy interventions: the straightforward act of distributing cash aid to those in need. These policies became more common during the pandemic, but have expired in many cases. For example, the monthly Child Tax Credit which lifted millions of children from poverty (source). Additionally, a reduction in HIV risk behaviors lowers the risk for other ailments such as pelvic inflammatory disease, cervical cancer, and liver cancer.

The published paper may be accessed by following this link. Additionally, CHIPTS has created an accompanying infographic, in collaboration with the California HIV/AIDS Policy Research Center (CHPRC). The infographic entitled “HIV Risk Reduction & Earned Income Tax Credit, ” provides insight on the following:

  • What is an EITC, and which states provide it?
  • What is the difference between refundable and non-refundable EITC, and why is this important?
  • How generous does a state EITC have to be to reduce HIV risk behaviors?
  • What other risk behaviors are reduced by cash assistance programs like EITC?

Note: The finding of a negative association between state Earned Income Tax Credit generosity and a composite measure of HIV risk behavior is particularly important given that the population observed in this study is at high risk for contracting HIV.

Please find a copy of the infographic and additional resources, available for download below:

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We hope that you can review the infographic and publication and share the important findings with your networks. Help us circulate this important work to your networks! Share on social media below:

Share on Twitter & Facebook (Retweet), Create your own social media posts using the suggested language below:

Twitter:

NEW Infographic from @CHIPTS and @ca_hiv_policyrc: Single mothers in U.S. states with more a generous Earned Income Tax Credit (EITC) engaged in significantly less #HIV risk behaviors compared to those in states with less generous (or nonexistent) EITCs, demonstrating the benefits of #antipoverty policy.

Facebook:

NEW Infographic from @CHIPTS and @ca_hiv_policyrc: Single mothers in U.S. states with more generous Earned Income Tax Credits (EITC) engaged in significantly less #HIV risk behaviors compared to those in states with less generous (or nonexistent) EITCs. The effect of a refundable state EITC on HIV risk behavior was what we would expect for two or more hours of intensive HIV risk-reduction counseling, an intervention few low-income single mothers can readily access. This finding demonstrates the impact of #antipoverty policy.

Equity and Access: A Roadmap to Improving Vaccination Equity in South Los Angeles

July 8th, 2022 – Our partners at UCLA Center for Behavioral and Addiction Medicine (CBAM) and Charles R. Drew University of Medicine and Science (CDU) in collaboration with the California Community Foundation (CCF) are excited to share a newly published report entitled, “Equity and Access: A Roadmap to Improving Vaccination Equity in South Los Angeles,” that advises and provides insights on how to reach communities of color and those hardly reached to educate, build trust, and disseminate vaccines in South Los Angeles given historical experiences with medical mistrust.

This community-based study identified inequities and how these inequities interfere with access to COVID-19 vaccines for Black and Latina/o/x communities in South Los Angeles. The project focused on three goals, which are to:

  • Facilitate community, public, private, and governmental partnerships to reduce COVID-19 vaccine inequity.
  • Educate communities of color in South LA about the COVID-19 vaccines through virtual town halls.
  • Navigate communities of color in South LA on how to access available COVID-19 vaccines.

The study systematically gathered perspectives and experiences around COVID-19 vaccination access and equity from three key groups in South Los Angeles: community members (i.e., essential workers), community leaders (i.e., clergy, faith-based leaders, and leaders of community-based organizations), and community providers (i.e., clinicians and clinical providers) for our focus groups and community education summits.

The findings in this report are intended to guide efforts to enhance engagement with key stakeholders, and to help build capacity of community and public agencies to be better positioned to provide a timely response to future public health emergencies.

Views, opinions, and comments expressed by the participants are those of the particular individual speaking and do not necessarily represent the views and opinions of other participants, the research team, or the funder.

Please find a copy of the report and additional resources, available for download below:.

 

 

HIV Testing Dropped Sharply Among Key Groups During First Year of COVID-19 Pandemic

June 27, 2022 – Today, CHIPTS honors National HIV Testing Day, a day dedicated to encouraging people to get tested for HIV, know their status, and get linked to care and treatment. This year’s theme for #HIVTestingDay is “HIV Testing is Self-Care.” Knowing your HIV status is a key step to enabling you – regardless of status, to live a long, happy, and healthy life. Learn more below from CDC.gov

Resolve and commitment to end the HIV epidemic remains strong, despite setbacks in testing and prevention during the onset of the COVID-19 pandemic.

New CDC data published ahead of National HIV Testing Day (Monday, June 27) show a sharp decrease in the number of CDC-funded HIV tests administered in health care and non-health-care settings (43% and 50%, respectively) from 2019 to 2020, the first year of the COVID-19 pandemic. These concerning drops were seen among groups disproportionately affected by HIV, highlighting the urgent need to scale up testing and reduce disparities among the people who could most benefit from HIV prevention and care.

In non-health-care settings—where people who get tested for HIV provide information about race/ethnicity and transmission—reported HIV testing declined:

  • 49% among gay and bisexual men
  • 47% among transgender people
  • 46% among Hispanic and Latino people
  • 44% among Black people

To compensate for HIV testing and diagnoses missed during the COVID-19 pandemic, CDC encourages partnerships between state and local health departments, community-based organizations, and health care systems to increase access to HIV testing services, including strategies such as self-testing and routine opt-out screening in health care settings.

HIV testing is the bridge to highly effective treatment and prevention. Delayed diagnoses can lead to negative health consequences and increased HIV transmission. CDC recommends that everyone between the ages of 13 and 64 get tested for HIV at least once and that some people get tested at least annually.

While the full impact of COVID-19 on HIV is not yet known, these concerning findings add to recent CDC data that showed a steep reduction in HIV diagnoses and slowing pre-exposure prophylaxis prescriptions from 2019 to 2020.

To meet rapidly approaching national goals to end the HIV epidemic, the nation must accelerate efforts to protect health and expand access to proven HIV prevention tools nationwide, including focused, innovative local efforts through the federal Ending the HIV Epidemic in the U.S. initiative (EHE). The EHE initiative, which includes an emphasis on the role of routine testing, is intended to decrease disparities among populations most affected by HIV.

To help communities move forward with EHE, the President has requested $850 million in FY 2023. These resources are critical. Efforts must be escalated urgently to equip communities with the resources they need to get back on track and meet national goals.

Please attribute the following quote to Jonathan Mermin, MD, MPH,
Director of CDC’s National Center for HIV, Viral Hepatitis, STD, and TB Prevention

“We welcomed 2020 with optimism. New HIV infections were declining, and attention to HIV was increasing. But just as COVID-19 disrupted our lives, it changed the course of HIV prevention. Now we are at a crossroads. Will we accept the massive reductions in HIV testing, or will we bounce back stronger?”

Please attribute the following quote to Demetre Daskalakis, MD, MPH,
Director of CDC’s Division of HIV Prevention

“Everyone should enjoy good health—and getting an HIV test is part of a successful plan to do so. Some people may not get tested for many reasons, such as concerns about HIV stigma, homophobia, transphobia, and a host of other -isms and phobias. Or they may not know that an HIV test could benefit them. We must continue working together to overcome these and other factors that stand in the way of equitable HIV prevention and care.” 

Find an HIV Test
National HIV Testing Day is observed each year on June 27 to encourage people to get tested for HIV, know their status, and get linked to care and treatment. Find fast, free, and confidential HIV testing at CDC’s Get Tested or by calling 1-800-CDC-INFO (232-4636). HIV self-tests may be purchased at a pharmacy or online or check to see if the local health department or another organization is providing a rapid self-test for a reduced cost or for free.

Additional Resources

CDC Media Fact Sheet: The State of the HIV Epidemic in the U.S.

CDC’s Role in the Federal “Ending the HIV Epidemic in the U.S.” initiative

CDC Media Fact Sheet: HIV and Black/African American People in the U.S.

CDC Media Fact Sheet: HIV and Hispanic and Latino People in the U.S.

CDC National HIV Testing Day Resource Library

New Campaign Seeks to Improve Health of People with HIV and Prevent New Transmissions

This content originally appeared on HHS.gov. View the full article here.

NEW CAMPAIGN SEEKS TO IMPROVE HEALTH OF PEOPLE WITH HIV AND PREVENT NEW TRANSMISSIONS

Community members share how HIV medication helps them achieve and maintain viral suppression

The U.S. Department of Health and Human Services has launched a national campaign called “I am a Work of ART,” to encourage people with HIV who are not in care to seek and stay in care and achieve viral suppression.

“Everyone with HIV can stay healthy and achieve their potential through HIV medicine called antiretroviral therapy (ART). When taken as prescribed, ART allows people with HIV to protect their health as well as the health of others,” said ADM Rachel L. Levine, MD, Assistant Secretary for Health. “‘I am a Work of ART’ focuses on the positive benefits of being virally suppressed.”

People with HIV who take ART as prescribed to achieve and remain virally suppressed can live long, healthy lives and will not transmit HIV to their HIV-negative partners through sex.

The campaign features individuals with HIV from different backgrounds—cisgender, transgender, Black, Latino, American Indian, younger, and older—who share their stories about living and thriving as a “Work of ART.”

“By engaging the community, including those with lived experience, local leadership, and providers in strategic locations across the country, we collectively release ‘I am a Work of ART’ to help the people who need it most,” said Kaye Hayes, MPA, Deputy Assistant Secretary for Infectious Disease and Director of the Office of Infectious Disease and HIV/AIDS Policy.

A full summer of campaign activities is planned, including a June 18 roundtable discussion among the campaign’s creative partners, facilitated by Harold Phillips, Director of the White House Office of National AIDS Policy.

Viral suppression is a key strategy of OIDP and the entire federal government under the National HIV/AIDS Strategy (2022-2025) (NHAS) and the Ending the HIV Epidemic in the U.S. (EHE) initiative. Both the NHAS and EHE initiatives aim to reduce new HIV infections in the United States by 90% by 2030.

For more information about the ‘I am a Work of ART’ campaign, visit HIV.gov/ART.

Special Issue of JAIDS Highlights HIV Implementation Research in the EHE Initiative

In July 2022, the Journal of Acquired Immune Deficiency Syndromes (JAIDS) released a special issue focused on implementation research to end the HIV epidemic. Our CHIPTS research team led by scientists Ronald Brooks, PhD, and Dilara Uskup, PhD, PhD, published an article in this issue that explores the use of digital PrEP interventions to improve PrEP care continuum outcomes among Black and Latina cisgender women in Los Angeles County. Access their article here: https://journals.lww.com/jaids/Fulltext/2022/06001/Acceptability_and_Appropriateness_of_Digital_PrEP.17.aspx

This content originally appeared on HIV.gov. View the full article here.

The Ending the HIV Epidemic in the U.S. (EHE) initiative set a goal to virtually eliminate new HIV infections in the U.S. by 2030. This ambitious and unprecedented goal was predicated on decades of scientific discovery delivering the necessary tools: highly sensitive tests to diagnose HIV infection, effective interventions to prevent and treat infection, and cutting-edge technologies to identify outbreaks. Implementation research to end the HIV epidemic is the focus of a July 2022 special issue of the Journal of Acquired Immune Deficiency Syndromes (JAIDS) . Access to the supplement is open and has been organized by the Implementation Science Coordination Initiative (ISCI) , housed at the Third Coast Center for AIDS Research spanning Northwestern University, University of Chicago, and numerous public health and community partners in Chicago.

This special issue reports findings from 2019-2022 Center for AIDS Research (CFAR) and AIDS Research Center (ARC) EHE supplement projects, as well as other larger domestic HIV implementation research studies funded by the National Institutes of Health. The articles included in the issue cover all geographic regions of the United States, including urban as well as rural locations. Equally important is the fact that the studies focus on priority populations, including sexual minority men, Black and Latina cisgender women, and transgender people. Readers will find articles in this issue address all four pillars of the U.S. Department of Health and Human Services’ EHE initiative: prevent, treat, diagnose, and respond.

One article, led by NIH Office of AIDS Research Senior Science Advisor Dr. Mary Glenshaw, provides an overview of the NIH’s role in EHE. Another led by officials from CDC, HRSA, and NIH describes the inter-agency collaborations that enabled EHE’s signature science partnerships. The JAIDS issue also includes papers reporting results of implementation trials, such as the paper by Dr. Sylvie Naar of the Florida State University College of Medicine’s Department of Behavioral Sciences and Social Medicine and colleagues that tested a set of implementation strategies designed to improve Motivational Interviewing competence in youth HIV services providers.

Implementation science is a relatively new field that is seeing rapid adoption among HIV researchers who want to work with communities on strategies for effective implementation of these lifesaving innovations. The articles in this special issue showcase a range of implementation science approaches and can serve as examples to researchers and practitioners who want to join this initiative and develop their knowledge on applying implementation practices to their own research and communities.

Of the 27 articles in this special issue, 17 showcase findings from the one-year FY2019 CFAR/ARC EHE supplement projects supported by ISCI activities, while the additional 10 articles describe other domestic HIV implementation research studies. For example, readers interested in the state of the science on barriers and facilitators of PrEP can read a systematic review paper on the delivery and use of PrEP by Dr. Dennis Li and colleagues who used an implementation science lens to measure determinants.

In addition, those interested can also access the innovative online ISCI HIV Implementation Literature Review Dashboard  to search for the latest findings by key populations served, geographic region, and other important contextual factors. The dashboard is an interactive data tool comprised of hundreds of US studies that identify multilevel determinants of HIV implementation and is available for use now. It will be updated later with literature on determinants and strategies for PrEP, testing and HIV care.

To highlight the contents of the JAIDS supplement, ISCI will be hosting a satellite symposium at the 2022 International AIDS Conference  in Montreal titled, “Leveraging Implementation Science to End the HIV Epidemic in the United States: Highlighted Findings from a JAIDS Special Issue.” Following opening remarks from Dr. Maureen Goodenow, Director of the NIH Office of AIDS Research, authors of select studies in the special issue will present their findings. Other scholars will review the challenges, evidence gaps, and future directions in the field of implementation research.

About ISCI

ISCI provides high-quality technical assistance for EHE-funded implementation research teams and creates opportunities to share generalizable knowledge to help end the HIV epidemic in the US. ISCI provides interactive tools, decision support for researchers, curriculum for practitioners, HIV implementation science resources, and much more. All tools are publicly available at HIVimpsci.northwestern.edu .

The authors are co-directors of the Implementation Science Coordination Initiative.

National Asian & Pacific Islander HIV/AIDS Awareness Day 2022

May 19, 2022 – Today, CHIPTS honors National Asian & Pacific Islander HIV/AIDS Awareness Day  (#APIMay19), a day dedicated to raising awareness about the impact of HIV and exploring strategies to combat HIV in Asian & Pacific Islander communities. This year, CHIPTS Combination Prevention Core Scientist Dr. Wei-Ti Chen shares a reflection highlighting challenges faced by many Asian Americans and Pacific Americans living with HIV, and interventions to help address these challenges. 

May is Asian American and Pacific Islander (AAPI) Heritage Month and today, May 19th, is National AAPI HIV/AIDS Awareness Day. During this time, we would like to highlight the impact that HIV has on the experiences of AAPI in the United States. Asians and Pacific Islanders are a rapidly growing minority group in the United States whose growth has been followed by an increase in HIV incidence. From 2015 to 2019, percentages of persons living with diagnosed HIV infection increased among Asian, Hispanic/Latino, and Black/African American groups but remained stable among the other federally recognized racial/ethnic groups (Estimated HIV incidence and prevalence in the United States, 2015–2019 (cdc.gov)).

According to the CDC, many of the HIV-related statistics are missing for AAPIs, which include HIV risk behavior, pre-exposure prophylaxis (PrEP) coverage, HIV incidence, HIV diagnoses, knowledge of status, and viral suppression. Existing data estimate only 74%-76% of AAPI with HIV received some HIV care, 53%-59% of them were retained in care, and only 60%-65% were virally suppressed. Unfortunately, estimates also demonstrate significant numbers of AAPAWH develop AIDS before even becoming aware they are HIV positive. Taken together, this paints a picture of a vulnerable population who is likely to see continued increases in HIV incidence in the future. Asian Americans and Pacific Americans living with HIV (AAPAWH) may be reached through culturally-sensitive interventions to promote HIV awareness, testing, and prevention (e.g., PrEP) that serve to enhance linkage to care and care engagement – with these essential steps, we can achieve both better quality of life and improvement in health outcomes for AAPAWH.

From our previous studies, there are many issues that influence care engagement in the AAPAWH community.  Many AAPIs are immigrants to the United States. One report estimated that one in seven Asian American immigrants were undocumented with some arriving via migrant smuggling. The top three countries where undocumented AAPI originated from are India, China and the Philippines. In our paper that focused on experiences of the AAPAWH during their immigrant process, more than half of those surveyed came to America via migrant smuggling.  The motivation for them to leave their home countries was due to their “American dreams”, prospects of financial rewards, success stories from hometown pioneers, and sexual orientation and amnesty history.  Potential HIV infection routes in our sample were found to be rooted in risky behaviors associated with the migration process such as unprotected sex and substance use.  As the smuggling process is usually arranged by snakeheads (Chinese gangs that smuggle people), dangerous routes with long detours are often taken by migrants. Mentally, they worry about their uncertain futures and after arriving in the U.S., they often need to work long hours to pay back their snakeheads. The immigration experience impacts not only their physical and psychological status but also their healthcare access and health engagement. Many face issues related to lack of insurance, HIV-related stigma, mental stress, financial hardship, low health literacy and lack of health care access.  For AAPAWH who travel under migrant smugglers, the long, dangerous and unsanitary smuggling routes and risky behaviors of smuggled migrants are associated with negative health outcomes including risk for HIV transmission and other potential traumas.  For healthcare providers who work with the AAPAWH population, disease prevention and health promotion strategies should include treatment and screening for infectious and chronic diseases during every care encounter.

Family support can improve health engagement with HIV care and enhance patient–provider relationships. Our dyad analysis explored the AAPAWH experiences and their need for family support. After disclosing their serostatus to family member, AAPAWH found support from family caregivers in terms of their physical, psychological, spiritual, informational, social and practical supportive care.  For the most part, family support is perceived to be positive however there are cases of dissimilar perceptions between family caregivers and AAPAWH. Many of the AAPAWH were hesitant to disclose their HIV status until it was no longer possible to hide, e.g., accidental exposure or hospitalization. Those AAPAWH that rely on children to provide care and translation are especially emotionally overwrought. AAPAWH felt embarrassed as they might need to disclose how they became infected with HIV and at the same time, children felt awkward to be caught between their parents’ personal life and the healthcare facility serving their parents. In addition, psychological support itself can be stressful. Caregiver burdens and depression were high in this study and many of them sought religion and spirituality for peace of mind. This study also points out that intimate partner violence before and after HIV diagnosis are concerns in the AAPAWH population, especially in discordant couples. To respond to the health needs of AAPAWH in a culturally-sensitive way, intervention designs can focus on language barriers, caregiver burdens as well as intimate partner violence in AAPAWH populations.

Sleep disturbances are common complaints among people living with HIV (PLWH), which includes difficulty falling asleep and achieving deep sleep, awakening early or awakening unrefreshed. As we know, sleep disturbances, physical symptoms and psychological status interact with each other; thus, depression, anxiety and psychical symptoms (e.g., pain, fatigue) can be worse in PLWH. A recent study focusing on how coping strategies impact physical symptoms and sleep disturbances suggests implementing effective strategies to improve sleep disturbances and decrease physical symptoms can improve effective adaptive coping and reduce maladaptive coping among AAPAWH. This study showed AAPAWH with severe sleep disturbances suffered from greater physical symptoms intensity and vice versa.  Moreover, sleep disturbances may indirectly trigger adaptive coping strategies through the mediation of physical symptoms.  Especially in AAPAWH with sleep disturbances, maladaptive coping strategies (e.g., venting negative emotions, coping through alcohol and/or substance use, and disengagement or denial of their illness) are triggered more than the adaptive coping strategies.  Also, HIV-related physical symptoms (fatigue, shortness of breath, weakness, rash, tingling of arms) in AAPAWH can prompt adaptive coping strategies like seeking healthcare and social support. At the same time, physical symptoms can also trigger the maladaptive coping strategies such as escape or ignoring the physical discomforts by diverting attention or even through denial of potential supports. Healthcare providers should assess sleep quality and physical symptoms when dealing with AAPAWH to understand potential coping strategies to employ during their HIV management. Future research into culturally relevant, integrated intervention programs for AAPAWH can enhance sleep quality and decrease physical symptoms, and lead to more adaptive coping and less maladaptive coping among AAPAWH.

AAPAWH are a vulnerable group with significant issues that impact their healthcare and access via a myriad of causes including physical, psychological, spiritual, informational, social, and practical reasons. Culturally-sensitive interventions to promote HIV awareness, testing, and prevention among AAPIs also need to address HIV care engagement in order to promote equity in health access and shrink the gap of HIV disparities seen in this population.

Hepatitis and HIV Care

This content originally appeared on TargetHIV. View the full article here.

Note: May’s observance of Hepatitis Awareness Month is an opportunity to highlight approaches to addressing the syndemic of HIV and viral hepatitis, approaches called for in both the National HIV/AIDS Strategy and the Viral Hepatitis National Strategic Plan.

A, B, and C. These are the three most common hepatitis viruses. The first two are preventable by vaccines. The third is curable.

These facts come from the latest Viral Hepatitis National Strategic Plan for the United States: A Roadmap to Elimination 2021-2025 (January 2021), which states in its Executive Summary: “the nation faces unprecedented hepatitis A outbreaks, progress on preventing hepatitis B has stalled, and hepatitis C rates nearly tripled from 2011 to 2018.”

May is Hepatitis Awareness Month and May 19 is Hepatitis Testing Day.

Hepatitis C co-infection among persons with HIV is of particular concern as the disease progresses more rapidly and is more prevalent. From 15 to 30% of people with HIV are also infected with Hepatitis C, as cited in the Hepatitis C Coinfection chapter  of the National HIV Curriculum. Coinfection rates are much higher among injection drug users who have HIV, according to CDC.

Fortunately, effective treatments for hepatitis C are available.

Hepatitis C Treatment

Hepatitis C treatments called Direct-Acting Antivirals  (DAAs) became available in recent years They are more effective than earlier interferon-based regimens. For the first time, persons infected with hepatitis C can be cured, with all-oral, once-daily treatment regimens that last 8-24 weeks. Efficacy rates for these medications are high (above 90%) for both hepatitis C monoinfected and HIV/hepatitis C coinfected people. Side effects or contraindications of these medications are minimal.

Moreover, studies have shown that hepatitis C treatment is effective for individuals with substance abuse disorders. See the AETC on Myths about Treating Substance Users with Hepatitis C Virus .

Current All-Oral Therapies
HCV Co-infection: An AETC National Curriculum » Section 4: HCV Treatment Fundam… 

HHS guidelines recommend that all people with HIV be tested for HCV, with those testing positive be considered for HCV treatment. CDC Recommendations for Hepatitis C Screening Among Adults — United States, 2020 recommend expanded screening for all individuals over 18 years of age and testing for various groups, including people with HIV.

Clinician Resources

HRSA’s HIV/AIDS Bureau has developed provider resources on hepatitis screening and treatment for use by Ryan White HIV/AIDS Program (RWHAP) agencies. These and other tools are summarized on the AETC National Coordinating Resource Center’s (NCRC) viral hepatitis confection topic page . Highlights include the HIV/HCV Coinfection: An AETC National Curriculum  and the National HIV Curriculum’s Hepatitis C Coinfection  section.

The HIV/HCV Coinfection: An AETC National Curriculum includes HIV/HCV Co-infection Resources  for providers as well as patients and patient educators, like tools to engage patients in HCV care.

Hepatitis C and Planning –  Incorporating Hepatitis C in Integrated HIV Prevention and Care Planning  is a webinar review of how select RWHAP jurisdictions are integrating hepatitis C services within their HIV care and prevention plans.

HCV/HIV Care Delivery

In addition to the AETC clinic-focused curricula and patient tools, HRSA’s work on HCV/HIV coinfection care also includes identification of innovative interventions. RWHAP agencies are also using HRSA performance and data monitoring guidance to measure efforts and efficacy in providing care to HIV/HCV co-infected individuals. These initiatives, and resulting technical assistance tools, can be found in our Hepatitis topic page . Highlights include:

  • Hepatit is C Prescriber Toolkit , a directory of state-specific resources (prescribing restrictions, ADAP coverage, Medicare coverage) and contact information for all state programs.
  • Curing Hepatitis C among People of Color Living with HIV . This SPNS initiative (2017-2020) focused on expanding a full array of services for HCV/HIV coinfected individuals, in collaboration with SAMHSA-funded substance abuse agencies. Among the products developed by the Curing Hepatitis C project were mobile apps for use by patients and staff (clinical and non-clinical) to educate clients and improve the patient/provider experience. See ConnQuer HepC and TACKLE Program  and download their apps.
  • Jurisdictional Approach to Curing Hepatitis C among HIV/HCV Coinfected People of Color . This HRSA HCV SPNS initiative (2016-2019) focused on improving HCV services among HIV/HCV-coinfected people of color.
  • Performance Measurement. The HRSA HIV/AIDS Bureau has a framework of resources to support RWHAP programs in monitoring the delivery of HIV care, inclusive of hepatitis. HAB’s Performance Measures are comprised of multiple sets, with an adolescent/adult set of measures that includes specific measures addressing hepatitis B screening and vaccination and hepatitis C screening.
  • Data Monitoring . HRSA’s Ryan White Services Report, the RSR client-level data system , is used by RWHAP recipients and subrecipients to collect performance measure data on hepatitis B screening and vaccination as well as hepatitis C screening.

Listen to insights on hepatitis care from HRSA and front-line RWHAP agencies in a range of workshops  convened at the 2020 Ryan White Conference on HIV Care and Treatment.

Indian Health Service Announces Five Million Dollars in Funding for Ending the HIV Epidemic in the U.S.

This content originally appeared on HIV.gov. View the full article here.

The Indian Health Service is announcing five million dollars in funding for “Ending the HIV Epidemic in the U.S. ” to support work toward the elimination of HIV and hepatitis C in Indian Country.

“At HHS, we continue to confront the HIV epidemic head-on by ensuring resources are focused on the communities and people who most need them,” said HHS Secretary Xavier Becerra. “This funding will help us reach people in Indian Country and engage people who are disproportionately impacted by HIV.”

“We are excited about this new funding opportunity for Indian Country to address diagnosis, treatment and prevention activities that are aimed at eliminating disparities and reducing HIV’s impact,” said Acting Director Elizabeth Fowler. “We are committed to providing American Indians and Alaska Natives who are at risk, or are living with HIV, with the culturally-appropriate support and services they need.”

The funds include $2.48 million for three-year cooperative agreements for tribes, tribal organizations, and urban Indian organizations to support activities that address HIV/HCV and sexually-transmitted infections. The deadline for tribes, tribal organizations, and urban Indian organizations to apply for the funding is June 17, 2022.

Since the late 1980s, enormous progress has been made in the fight against HIV, but there is still work to be done. National interventions have reduced the number of new HIV infections, but not everyone is benefiting equally from these advances. New diagnoses are highly concentrated among men having sex with men; minorities, including American Indians and Alaska Natives; and those who live in the southern United States. Among people living with HIV, American Indians and Alaska Natives have the largest percentage of persons with undiagnosed HIV infection.

Stigma in Native communities can also be a debilitating barrier preventing someone living with HIV or at risk for HIV from receiving the health care services they need and deserve. IHS continues to address barriers for people living on Indian reservations and in other rural communities that limit opportunities for education and HIV testing.

In addition to the cooperative agreements, approximately $1.5 million will support clinical training, including funding for ongoing case-based training and technical assistance. Approximately $620,000 will support national infrastructure, and approximately $400,000 will support a national media campaign.

This funding comes in addition to the several Indian Health Service activities that are also supported by the Minority HIV/AIDS Fund, which has provided national-level programs like web-based youth education and prevention services, clinical training for HIV care, expansion of pre-exposure prophylaxis for HIV prevention, case management support for people living with HIV, support of National Native HIV/AIDS Awareness Day, and indigenizing the National HIV/AIDS Strategy. In June 2021, the IHS distributed close to $10.5 million through this competitive funding opportunity.

The Biden Administration is also continuing its support of the Ending the HIV Epidemic initiative within Indian Country. The president’s budget requests $52 Million in FY 2023 for IHS to treat or reduce the transmission of HIV and Hepatitis C.

The IHS, an agency in the U.S. Department of Health and Human Services, provides a comprehensive health service delivery system for approximately 2.7 million American Indians and Alaska Natives who belong to 574 federally-recognized tribes in 37 states.

New National Drug Control Strategy Release: HIV-related Impact

This content originally appeared on HIV.gov. View the full article here.

The 2022 National Drug Control Strategy was released on April 21, 2022. Over the course of a year, it was developed through requests for written consultations from more than 2,000 external stakeholders, including the entirety of the U.S. Congress; all 50 Governors; and hundreds of advocates representing law enforcement, public health, and Tribal communities.

This new Strategy is the first ever to emphasize working directly with people who use drugs to prevent overdose and infectious disease transmissions, improve their physical, mental, and social wellbeing, and offer flexible options for accessing medical care and substance use treatment. This evidence-based approach builds trust and engagement with people at risk for an overdose and is known as harm reduction.

The Strategy breaks ground and proposes bold, targeted, and consequential actions to bend the curve on overdose deaths in the immediate term and reduce drug use and its consequences in the long term. These actions are grouped around eight thematic areas. Two of these action areas are highlighted below and are relevant to those working on HIV-related issues:

  • Helping people who use drugs access the services they need to stay alive long enough to enter treatment, the Biden-Harris Administration will focus on three priority harm reduction interventions:
  • Expanding access to the overdose reversal medication naloxone, which is a cost-effective tool that has the most potential to save lives today.
  • Ensuring people who use drugs can access drug testing strips so they can detect the presence of fentanyl and other dangerous substances in their supply.
  • Supporting syringe services programs that facilitate linkages to substance use treatment and prevent the spread of infectious diseases like HIV/AIDS and hepatitis.
  • Supporting people with undiagnosed or untreated substance use disorders who too often end up interacting with the justice system, creating severe consequences for individuals, their families and communities and society. Furthermore, arrest and incarceration for crimes related to substance use and possession disproportionately affect Black, Indigenous, and People of Color (BIPOC) communities.

The National Drug Control Strategy aligns with the Administration’s emphasis on equity and breaks new ground by including a criminal justice chapter that directs agencies to ensure that non-violent offenders in incarcerated settings, as well as those who re-enter society do not overdose and instead have access to the continuum of services and support, thereby removing unnecessary barriers to treatment.

This Strategy also aligns with the National HIV/AIDS Strategy. For people experiencing substance use disorder and those at risk for and with HIV, these strategies call for effective programs, policies, and services to improve public health and end both the opioid and HIV epidemics.

For more information on the new National Drug Control Strategy, click here.