Important note: Information in this article was accurate in October 2000. The state of the art may have changed since the publication date.The companion piece on San Francisco's recent new infections controversy highlights the lack of prevention services for HIV+ people as a major part of what's wrong with HIV prevention. The San Francisco "11 Point Action Plan" calls for developing and expanding prevention programs for positives as well as reaching more positive folks with appropriate care and support to revitalize prevention and our community's control of its longevity.
This Newsletter has highlighted the struggle to develop and fund a new generation of prevention programs for positives, in Los Angeles and nationally. Being Alive and Women Alive, their current and former staff and board members, and their friends and supporters in the community have spearheaded this effort since the beginning. The LA County Health Department's Office of AIDS Programs and Policy has recently announced the award of contracts to Being Alive, Women Alive and several other community-based organizations who submitted winning competitive applications for the development of several pilot or demonstration projects in positive prevention as part of the national, CDC-funded Prevention for HIV-Infected Persons Project (PHIPP).
All told, the Los Angeles part of PHIPP will command over $3 million a year for the next three years. The contracts are planned to begin as of November 1. It is up to all in the community to make sure these funds are well spent and that the programs are led by HIV+ people! (Can you tell I feel strongly about that?)
Finding and Reaching Unknowing Positives The first goal concerns experiments to discover more effective ways of (voluntarily) finding people who are HIV+ but don't know it yet, so that they can be offered the options of treatment, social services and connection to supportive community organizations. It is imperative that these efforts be, and be perceived as, voluntary, helpful, culturally and individually sensitive, and not necessarily intrusive. On the other hand, they must be effective. We do not need money being sucked up with "same old, same old" counseling and testing and outreach.
The County has awarded contracts in this part of PHIPP to: (1) AIDS Healthcare Foundation (AHF) to provide testing and counseling to current and future partners of HIV+ clients at four of its HIV care clinics, and (2) the Positive Images Counseling and Testing project (a consortium involving the LA Gay and Lesbian Center, Bienestar, Common Ground and Minority AIDS Project) for outreach and on-the-spot HIV/STD testing to high-risk individuals in unconventional venues, including bars, sex clubs, laundromats, bathhouses, cruisy parks and beaches, homeless shelters, food pantries and needle exchange sites. There will be individually tailored and intensive follow-up for those who newly test positive so that they are supported through the process of dealing with the news and linking to care and ongoing support.
The second goal is interventions designed to directly or indirectly support positive people in reducing their risk of infecting others while leading full, healthy and (if desired!) lusty lives. (Okay, so that last adjective reflects a personal opinion! I'm sure it is not put that way in any application or contract.)
Here, the first award is to AIDS Project Los Angeles (APLA) to create a Wellness for Positives Program comprising offering clients prevention case management (PCM) if they wish for intensive counseling and support on issues related to prevention (like disclosure of HIV status to partners, meeting basic living needs, mental health needs, diagnosis and treatment of STDs and accessing and adhering to HIV treatments) or less intensive and less structured support by paraprofessionals known as Prevention Health Advocates.
A major portion of the funds is being committed to the full Positive Images Consortium (led by the Gay and Lesbian Center, and including the Asian/Pacific AIDS Intervention Team, Being Alive Los Angeles, Being Alive Long Beach, Bienestar, Common Ground, Minority AIDS Project, Sunshine Community Counseling Center, Tarzana Treatment Center, and Women Alive). The overall goal of the programs to be mounted variously by each member agency is to provide support mechanisms to HIV+ people in Los Angeles County that help build a culture in which it is the norm for HIV+ people to take responsibility for preventing new HIV infections in sexual and needle sharing partners. Component services will include a toll-free telephone chatline, Internet Web Site, one-on-one counseling, single and multi-session group skills building workshops (on such topics as disclosure of HIV status or how to find and maintain a relationship), large group and socializing events and media or social marketing campaigns. The program will also create a Positive Images Academy, a leadership development program for HIV+ people to increase their self-confidence and to take on roles such as public speakers, mentoring other HIV+ people, and self and community advocacy for the needs of positive folk.
LA Shanti will be funded to create a Clinic-Affiliated HIV Transmission Intervention program (CAHTI). Links will be made with clients of the THE Clinic, AltaMed HIV Services, AHF and Watts Health Foundation to invite them to participate in the Living and Loving Fully with HIV weekend workshops. The 20-hour weekend Living and Loving Fully with HIV workshops will focus on healthy relationships, positive living and protecting others. For those who wish, there will be nine weekly follow-up groups to support participants as they put desired behavior changes in place in their everyday lives. At the end of the weekly workshops, participants will be offered the opportunity for further self-empowerment and leadership skills development by serving as a long-term volunteer at Shanti or at the person's home clinic.
Finally, Tarzana Treatment Center will be funded to provide high-quality prevention services that are relevant to and interwoven with recovery services to its clients who are HIV+.
Note: These thumbnail sketches of the programs are only that. Obviously the plans are much more comprehensive than can be presented in this article. Contact the individual agencies for more specific information. There are also other programs for positive prevention being mounted in the County right now, such as by the City of West Hollywood and UCLA. We will cover these as more information is available.
These projects are all supposed to be demonstration projects, either trying out new ideas or seeing what standard prevention programs apply to HIV+ folks as-is and which ones need changes, and what kinds of changes. Do some projects work in some populations or individuals but not in others? Will HIV+ people come and participate in these programs? Can these projects help rebuild a sense of community and mutual support among HIV+ people or promote such community in new areas of the County and the affected communities? Will a focus on positive prevention inadvertently lead to increased stigma or blame of HIV+ people for the epidemic? How can current controversies be resolved, such as those about the risk of re-infection with a drug-resistant strain, oral sex, whether disclosure is always indicated, or whether or not "barebacking" or unprotected sex is ever safe?
There will be a Community Advisory Board created by the County to help guide, direct and oversee these efforts. It will need strong and independent participation, and not just from the staff and long-term volunteers from each participating community agency. Each agency will also need volunteer involvement to help develop a strong program and avoid pitfalls. Call Office of AIDS Programs and Policy at 213.351.8133 for more information, or call any participating agency and ask for the staff member who will be coordinating its participation in PHIPP.
Personal Stories and Opinions Sometimes Speak Loudest
Finally, the Newsletter needs to hear your stories about building protection and care for partners into your life. What have been some pitfalls and successes? What's hardest and easiest? What makes you angry or satisfied? How do you seek and find intimacy and connection?
We would love to hear your stories, to increase the dialogue and sharing within HIV communities. We'd also like to open a forum for debates and expression of opinions and concerns, controversial or not. If this effort is to help all of us, and if it is to be successful, positive people must lead. To lead, we must first speak and share what's in our minds and lives.
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