World Aids Day

World AIDS Quilt

Nearly 30 years into the AIDS health crisis new infections are on the upswing yet again, with the Carolinas seeing high numbers of people living with HIV.

With World AIDS Day rapidly approaching on December 1, Out in Asheville has decided to focus on some of the facilities where HIV treatment is available and the circumstances under which they provide care. In an email sent to approximately 20 clinics, care centers, and other facilities; seven questions were presented to the staff in order to get a better sense of the climate and situation concerning HIV awareness, progress in treatment, and other issues pertaining to the disease.

Responses included here will be from the following individuals: Mike Baker of the Triad Health Project, Jacquelyn Clymore of the Alliance of AIDS Services-Carolina, and Michael Harney of the Western North Carolina AIDS Project (WNCAP).  In order to more easily compare and contrast the various responses received they will be presented side-by-side in sections titled by the question to which the facility spokesperson is responding.

Compared to other area of the country, how is the rate of HIV infection changing. Compared to your own area, is the current rate of infection higher now than it has been in the past?

Mike Baker of the Triad Health Project sent this reply: “By the end of 2007, well over 1 million people in the United States alone have been infected with HIV.  The annual rate of new infections in the U.S. is now well over 54,000. Marked increases are occurring in the South disproportionately from the rest of the county, a direct result of pockets of poverty that prevent access to quality health care, prevention information, social stigma that may prevent some individuals from seeking their HIV status for fear of repercussion from family/friends/church, and the ‘Down Low’ cultural phenomenon that has some African American males in heterosexual relationships engaging in sexual activity with other men, yet do not consider themselves ‘gay.’

“Nearly half of all new HIV infections in the U.S. are presently occurring in young people under 25.  In fact, a recently released report from the U.S Centers for Disease Control and Prevention paints a startling pattern of how HIV is affecting more and more young gay men. This data covering 33 states found that the number of young Men Who Partner with Men (MSM) under the age of 25 being newly diagnosed with HIV has been rising 12% annually since 2001 – an increase about 10 times higher than in the gay male community overall, where the number of new infections has been increasing about 1.5% during that same time frame. In contrast, the rate of new HIV infections among heterosexuals has shown declines over that period. Some experts are questioning whether a ‘second wave’ HIV/AIDS epidemic is now underway in the U.S. gay male population.

“From July, 2004 to June, 2008, Triad Health Project has collaborated with the Guilford County Department of Public Health to coordinate weekly free, confidential HIV testing.  Of 1,969 total individuals tested during that 4-year timeframe, 33 individuals received HIV-positive test results, with 29 of those individuals self-identifying as men who partner with men (MSM).”

Jacquelyn Clymore of Alliance of AIDS Services-Carolina told Out in Asheville in conversation that “Infections in the South are definitely increasing. In North Carolina there are about 2,000 new cases each year, with fully one third of these diagnoses being full-blown AIDS, not merely HIV infection. People simply do not know that they have sero-converted, and so they never receive treatment or infection management. It takes 7-10 years on average for HIV to become AIDS, but lack of medication and good health care can shorten this considerably. Drug use and other factors can also accelerate HIV symptoms. HIV is a significant and increasing problem in our region.”

Michael Harney of WNCAP had this to offer: “The North Carolina HIV/STD Quarterly Surveillance Report has data about HIV/AIDS, Chlamydia, Gonorrhea, and Syphilis.  The end-of-year report is the best look at the numbers, and 2007 is the last complete report available.  It is my understanding that the state is working on its reporting system, so we have not had quarterly reports during 2008.  There were 1,943 new HIV case reports in North Carolina during 2007.  The number of new HIV case reports per county is available in this report. Buncombe County appears to have had a jump in new HIV cases reported, but it is my opinion that there is something not completely correct in that number compared to the several years prior to 2007.  Recently, we have had numerous people living with HIV/AIDS move to this region from other states where they were first reported HIV+, so they are not ‘new’ cases reportable in North Carolina, though they affect the need for services and funding.  Somewhere between moving here, and getting services here the number of ‘new’ cases gets mixed up.  I am hoping that the 2007 report of 50 new cases will be clarified when the 2008 end-of-year report comes out.  In general, we have had a low, but consistent number of new HIV case reports in this region of the state (Western NC).”  

Where do you receive your funding, and is that source of money under duress?

Baker replied, “Unrestricted funds are most valuable to our vital administrative functions (special events and individual contributions).  This type of income covers the operating expenses that more targeted or ‘restricted’ funding streams do not, such as corporate/foundation/United Way grants. Additionally, it allows the agency to develop in ways not specifically funded by government grants and contracts that provide public money, yet continue to remain flat or decrease each year. Overall, funding has remained steady, but not increasing as incrementally as we'd like, most assuredly a result of how our supporters are feeling the pinch in their pockets books at the present time. 

“To ensure the continuity of Triad Health Project’s (THP) comprehensive mission well into the future of the HIV/AIDS epidemic in Guilford County, THP strives to capitalize on and maintain a diversified funding base through the pursuit of traditional funding sources, such as advocating locally and regionally for increased government investment in HIV/AIDS related services, foundation/corporation grants, agency sponsored special events, and a large-scale donor direct-appeal campaign.”

Clymore said the approach at Alliance of AIDS Services-Carolina is similar: “Out funding stream is diverse. We receive private gifts. We have a funding foundation. But all of our sources of income are under duress. The shaky economy places it under severe duress, actually. State and Federal funds like the Ryan White Moderation Act is not under threat by being refunded, but deficits may cause Congress to delay reauthorizing or reapproving the fund. Our advocates spend a lot of time in D.C., because the government needs to redirect more money to the South. The funds are used to pay salaries, emergency rent, medications, ADAP for people without Medicare/Medicaid, and emergency health and dental procedures. Our fundraisers and grants will be threatened by the economy, and by the simple fact that many people mistakenly think AIDS is over.”

Harney offered, “WNC AIDS Project provides case management services, prevention education programs, and volunteer opportunities. Therefore WNCAP receives federal, state, and local funding.  WNCAP also depends on privately funded grants, and donations from major events such as the Raise Your Hand auction, and Dining Out For Life. Throughout the year other events and donations provide a boost to those funding sources allowing the agency to provide extra financial assistance to the clients (320+ clients yearly), and to purchase prevention education supplies, and to provide activities such as the WNCAP picnic and holiday party.  It is always necessary to seek alternative funding sources, but through advocacy at the federal and state levels several funding streams do remain available, even if they haven't increased much in the past decade.” 

Over time, would you say that the strategies implemented to prevent/lower infection have been effective or not? Why do you think so?

Baker said, “The agency is proud of the fact that among the most populous counties in North Carolina, Guilford has consistently displayed one of the lowest rates in new HIV reports since 2003, according to the NC HIV/STD Surveillance Report (while continuing to rise, rates of new HIV infections in Guilford County are not rising faster than those North Carolina counties of comparable size and populous).”

Clymore replied that, “Trying to measure a negative is always problematic. Methods for prevention have probably kept some people from getting infected, but behavior change is difficult. We try to focus on harm reduction, but cultural and religious factors get in the way. Many don’t believe they are at risk. Others, despite knowing they are, still don’t modify their behavior. We’ll be looking at new strategies for a long time. Not all plans fit all people, and so prevention can’t be treated like a cookie cutter. We need more variety to address the full spectrum of everyone at risk.”

Harney wrote that, “Over time many basic prevention strategies such as comprehensive sex-education, condom distribution, and harm reduction programs (which include needle exchange) have not been fully implemented.  Only an estimated four percent of the $23.3 billion dollars the U.S. federal government will spend this year on HIV/AIDS will go to prevention.  Fifty percent will go to treatment and care for people living with HIV/AIDS. There is other research about ways to prevent or lower new infections, such as male circumcision, pre- or post-exposure prophylaxis, microbicides, and vaccines (which to date have been less successful in preventing or lowering new infections than the basics, which were proven effective in the early years of the epidemic).  In this region we can at least boast that we distributed over 140,000 condoms last year, and that there is a needle exchange program serving the region, plus many opportunities for prevention education forums, and a supportive community in general. Not all regions in the state, or even in the South, have this much support.”

What progress have you noted, whether it be directly measurable or not?

In his prepared response, Baker told Out In Asheville that, “During the 2007-2008 fiscal year, THP welcomed 340 individuals at its weekly HIV/STD testing clinic, a testament not only to the need for such a program, but also the level of ease it can be accessed. Triad Health Project works diligently in an effort to help our community-at-large combat HIV, and ultimately reduce the number of individuals in Guilford County who become infected.  Varied prevention and community outreach strategies will help individuals make better decisions about protecting their health and reduce or eliminate their risks of HIV infection.  Triad Health Project is successful each time an individual learns new information and, as a result, modifies his/her behavior in a way that reduces risk of infection.”

Along a similar vein, Clymore said that, “Where we progress most directly is in working directly with individuals who are then able to report specific maintained behavior changes. On a harm reduction model we find that individuals don’t respond effectively to a one-hour prevention program aimed at a generic audience. Smaller settings over a period of time with personal interactions show us the best results.”

Harney explained that, “Progress may be difficult to measure.  There is always a new opportunity to educate someone about HIV/AIDS, and Hepatitis - a major issue beginning to be addressed in North Carolina.  Obviously progress in treatment and care has developed over the last decade or more and people are now living much longer with HIV/AIDS than they did overall during the earlier part of the epidemic.  Stigma and discrimination still exist, but not as they did over the years.  The effort to empower people living with HIV/AIDS is a work in progress; and prevention education must continue to be available for each new generation of sexually active teens and young adults.  Human rights for men who have sex with men, transgender members of our community, public sex workers, and drug users are lacking – and any woman can tell you that there is a huge need for human rights and equality for all women.  These are all things to be noted.”

What continuing or new challenges are you noting in your efforts?

 “Locally,” said Baker,  “even though the so-called ‘face of AIDS’ has changed in recent years disproportionately to African American, the number of new HIV infections among the young, gay male population also keeps growing, outpacing all other forms of transmission.  This trend is a ‘call to arms’ for THP, a mandate for the agency to continue its mission in the tradition of its 14 LGBT founders who incorporated the agency 22 years ago.

“While lack of adequate monies for HIV care and prevention education is always a concern, what is more so is the political climate that currently censors many gay-focused outreach programs (or more specifically, anything that is not ‘abstinence-based’).  Triad Health Project would like to enjoy an environment where it is safe to provide comprehensive, science-based, HIV prevention, education, and outreach without potentially coming under fire by a local and regional conservative culture.”

Clymore said that prevention is specifically blocked by ignorance and apathy. “There is a whole body of young people who don’t know a world without AIDS, so the ring of urgency is diminished. They need to be alarmed. You people in specific are at risk, because they’re not paying attention.

“Another problem is that a large number of Latino and African immigrants in the area do not speak English, and in North Carolina we have a diverse population. Our message isn’t even reaching a large number of people.

“Finally, in North Carolina there is still the ‘gay disease’ because of the religious culture here. AIDS is seen as a morality issue, rather than as a disease. It is seen as a punishment instead of a public health crisis.”

“Challenges are part of this work,” said Harney.  “Finding ways to reach the entire community is always a challenge.  How is everyone reached?  Can everyone ever be reached?  Whose face should represent a particular community or its needs?  What resources must be acquired to meet those needs?  How does one add a new task to an overloaded job description?  What is the best way to remain focused, energized, and able without getting burned-out?  How can an agency adapt to the needs of clients, and the changing client base over the years?  All of these things can be considered when looking at challenges.  Many agencies in the social services field probably face these challenges, among others.”

Do you collaborate with other organizations? Which ones, and in what way? Does pooling resources tend to equate with a synergistic outcome?

Mike Baker replied by saying, “Triad Health Project maintains a highly visible presence in our community in an ongoing effort to educate the population about how to best avoid HIV infection and other sexually transmitted diseases.  We collaborate with the Guilford County Health Department to offer confidential testing free-of-charge on a regular basis at the agency’s two office locations, and health educators also participate in outreach testing at colleges, health fairs, and nightclubs frequently throughout the year, placing particular emphasis on venues for high-risk groups such as Men Who Partner with Men (self-identified as gay or bisexual, regardless of race/ethnicity).”

Focusing her answer more on other HIV-specific agencies, Clymore noted “Wake and Durham County Health Departments, all local clinics, private clinics, non-profits, Duke University, UNC, half of the 84 United Way agencies, other case management agencies that deal with immigrants in their native languages, and any other non-profit or government agency that deals with mental health, drug and substance abuse, and HIV care. Each agency is made more effective in carrying out its mission by way of these collaborations, which is to lower the infection rate in general and to reduce personal risk specifically.”

Harney echoed these positive opinions by saying, “Collaboration is key to a successful agency and its service outcomes.  WNCAP collaborates with partners far and wide.  The United Way is a major partner with us, but in almost every grant we seek, no matter from where, collaboration with other agencies is suggested and encouraged.  Case managers must be creative in finding resources for clients related to housing, transportation, food, and no telling how many other personalized needs.  Knowing who in the community may provide what is needed adds to the collaborative effort among agencies. 

“In prevention terms, many local businesses, including the bars, collaborate on events and outreach activities providing the venues for the work being done.  The various media resources collaborate when news must be reported, and advertisement space is needed.  ‘All hands on deck’ keeps the community above water and makes sailing smoother.”

If you could offer people in general one piece of advice about lowering their risk of infection, what would it be?

Baker replied that, “We have a sizable client base that, unfortunately, has had to come to us as not only an HIV service provider, but also a conduit for dealing with the emotional impact an HIV diagnosis has, especially for those clients who become infected by someone they either assumed was negative because they were allegedly in a ‘committed’ relationship, or did not indicate their status before engaging in sexual activity. Never assume the status of anyone you choose to partner with sexually, because ultimately, it is your responsibility to protect yourself by practicing safer sex behavior. And, while THP does advocate refraining from substance abuse, if you engage in IV drug use, confront your addiction and seek treatment, meanwhile making sure the paraphernalia you use is always sterilized prior to use.”

Clymore, speaking with a firm and urgent tone said simply, “Use. Condoms. Every. Time. No one is immune. You don’t know what your partner was doing 10 minutes ago. A vaccine is not on the horizon. Prevention is still key. Trust and communication are critical. Get tested regularly – at least once a year at a minimum.”

“Want to lower the risk of infection?” Harney asked rhetorically. “Beyond the usual messages about using a condom every time you have sex, being faithful to your partner, and never sharing needles, at least once a month visit a favorite HIV/AIDS related website or resource and keep this issue at the forefront of thought. Say HIV and AIDS, and talk about it with your family and friends. Suggested sites to visit: www.cdc.gov; www.AIDS.gov; www.hivandhepatitis.com; www.wncap.org.”