How to address the Hispanic-Macho population who refuse to wear condoms? How do we get rid of condom stigma?
Negotiating protected sex with a male-controlled method has been one of the most difficult challenges during the HIV epidemic for all women. There has been no magic solution in the four decades of HIV; however, evidence-based interventions have been developed that have demonstrated significant results for women across a number of ethnic communities. In the United States, these include SiSTA for African American women, an adaptation of it for Latina women called AMIGAS. There has also been Salud, Educación, Prevención, y Autocuidado or SEPA, and Video Opportunities for Innovative Condom Education and Safer Sex or VOICES/VOCES. These and others are included in the CDC Compendium of Evidence-Based Interventions and Best Practices for HIV Prevention. What they typically have in common is an emphasis on self-efficacy and negotiating condom use with partners, including under challenging conditions. Role-playing, skills-training and often social support are involved. Many of these interventions have had video components that are no longer available on the CDC website. Videos developed by other organizations can be found on YouTube; however, they are not necessarily a product of scientific evaluation. In the near future, we will identify open access resources and post links to them on our website.
The reality is providers only have a few minutes to really address concerns. For example, my agency allots 15 minutes per patient to the providers. How do we maximize time with doctors when we have both health concerns and sex questions?
This is a valid concern that arose several times during the Summit. Preparation for the medical visit can partially help mitigate this problem. One participant during the Summit suggested patients have a provider checklist or questionnaire developed before a medical visit to ensure that all questions are answered in the brief encounter time. By using this approach, the patient can have their immediate concerns addressed, and it may also help to change the provider’s attitude about the patient and motivate the provider to work together with the patient. Competing pressures often make it difficult for individuals to make such lists themselves. Our project will be developing aids to assist women in facilitating such conversations with their doctors, and versions for providers could also be distributed in the community.
Women of color and Latinas think that because they are in a monogamous relationship and having sex with their main partner, they don’t need to use HIV prevention strategies. What kinds of work are we implementing in this community to address this issue?
We agree this is a serious underlying problem that may be contributing to increasing HIV rates among minority women in South Florida and in other communities across the United States. Florida’s SOS (Sistas Organizing to Survive) is a stellar example of local efforts, which can provide a model for community engagement and mobilization. It was also discussed at length during the African American break-out session, which was led by Evelyn Ullah. Local chapters are being reinvigorated to continue the work by community leaders such as Kalenthia Nunnally, who was also a speaker at the Summit. Community ambassadors will be trained to help promote the importance of testing, prevention strategies such as PrEP, and treatment. Leisha McKinley-Beach, who was a member of the Summit Planning Committee and also spoke and moderated, recently posted a video about SOS to YouTube: https://youtu.be/KUnLa_jn2hI.
How can we talk about sex if our doctors have trouble?
One of our primary objectives is to assist women so that they become confident to advocate for their sexual health despite a provider’s attitude. If women are knowledgeable and proactive, it will help women obtain the care they need, even if providers are uncomfortable with this topic. If a provider continues to be resistant, it should not deter women from doing everything she can to ensure she receives the necessary information and treatment she is seeking. However, back-ups are needed for the individual woman going to the doctor. One of the aims of this project is to develop these back-ups to facilitate provider-patient collaboration and aid in communication.
I went to California (Los Angeles) and they educated me on the HIV testing bus. Why isn’t it happening here?
Mobile testing units are also available in South Florida. Some examples are through our partners at Borinquen Medical Centers (305-576-6611) and Care Resource (careresource.org/testing-hours-locations/; 305-576-1234). Additional HIV resources for our area and nationwide can also be accessed through the applications HIV.gov and AIDSVu. The Florida Department of Health is also a good local resource that can be accessed at www.floridahealth.gov/diseases-and-conditions/aids/. However, part of this project is to develop an intervention strategy that is responsive to the needs of minority women in their communities and to enlist the collaboration of stakeholders in empowering women to spread the word.
When I speak to a provider friend of mine about PrEP, he said: “PrEP will give them the green light to get Hep B, syphilis, gonorrhea and chlamydia.” Please comment.
One critique of PrEP since its implementation has been that it can lead to increased risk of sexually transmitted infections (STIs) and unwanted pregnancies. For this reason, when relevant, PrEP is promoted along with condom use since PrEP cannot protect against any of these STIs or prevent unplanned pregnancies. To avoid a negative secondary outcome of acquiring an STI, this is an important point that must be emphasized and reinforced by providers themselves. Nonetheless, an important message that emerged during this Summit is that PrEP is the first practical female-controlled method of HIV prevention and should be seen as a window of opportunity that has never existed previously for engaging women to become proactive in their sexual health. When seen in this way, PrEP is not merely an end in itself but also a vehicle for taking the first steps to achieving equal sexual health.
Can a regular primary care physician, not from an HIV clinic, provide or prescribe PrEP?
Some medical specialties that are not related to sexual and reproductive health may prevent the prescription of PrEP. However, most healthcare providers should have the knowledge and ability to prescribe PrEP. The applications preplocator.org or www.greaterthan.org/get-prep can be used to find PrEP providers throughout the United States. We learned during the Summit that CVS may be establishing programs in Florida through their Minute Clinics to dispense PEP and PrEP, utilizing a model established in New York City. Utilization of mobile vans for dispensing PrEP is also under discussion in S. Florida.
What should women do when trying to educate their kids about sex? I think this is lacking in our society.
Adolescent reproductive health is key to a positive trajectory of reproductive and sexual health in adulthood. While this is not one of our direct goals, by educating women who may also be mothers, we hope that we are empowering them to have honest and accurate discussions with their children, and that we will ultimately contribute to a cultural shift among future generations who will be more knowledgeable and empowered when it comes to making decisions about their sexual lives. Broward has one of the most comprehensive sex education programs in the nation, which Miami-Dade also wants to develop. At the summit, there was some discussion about mobilizing PTAs and educating parenting groups on how to have sex education discussions with their children. Miami’s Getting to Zero effort has also included discussion of how to facilitate education of children.
At what stage should gender affirmative care happen?
Gender affirmative care should be taught to individuals when the topics of client interaction, rapport, and care are taught.
Why is it that 51% of transgender individuals did not receive treatment after being diagnosed as HIV positive?
There are many factors involved in lack of HIV care after diagnosis for transgender individuals. Many live in areas lacking transgender-competent medical providers. Some find out they are positive through incarceration and may find no access to necessary medications. There are also those who face stigma and further discrimination by publicly entering a HIV-related facility.
Are interventions designed for MSM [Men who have sex with men] or women effective for transwomen?
There is a clear difference between sexual orientation (who you are attracted to) and gender identity (who you are internally). Interventions designed on the basis of sexual orientation are ineffective for the transgender community, which is comprised of many differing orientations. Women of cisgender experience and women of trans experience have more in common, and yet also have different behaviors that vary with different levels of injustice that are encountered.
How will new policies on abstinence preferred sex education be implemented?
The mobilization to end the HIV epidemic and achieve equal sexual health in our minority communities has always been an imperative transcending and motivating local, state, and federal governmental initiatives and extending beyond any current or past administration of all U.S. jurisdictions. As Christopher Bates emphasized in his call to action, we all must be engaged to end the epidemic. Our next steps will be focused on how to sustain this engagement.
Why is it that 51% of transgender [individuals] did not receive treatment after being diagnose[d] as HIV positive?
There are many factors involved in lack of HIV care after diagnosis for transgender individuals. Many live in areas lacking transgender-competent medical providers. Some find out they are positive through incarceration and may find no access to necessary medications. There are also those who face stigma and further discrimination by publicly entering a HIV-related facility.
Does [sic] interventions designed for MSM [Men who have sex with men] or women effective for transwomen?
There is a clear difference between sexual orientation (who you are attracted to) than gender identity (who you are internally). Interventions designed on the basis of sexual orientation are ineffective for the transgender community, which is comprised of many differing orientations. Women of cis experience and women of trans experience have more in common, and yet also have different behaviors with different levels of injustice.
How will new Trump policies on abstinence preferred sex education be implemented?
The fight for health: in women’s rights, transgender rights, LGBT rights, immigrant rights, and minority rights extend beyond any current or past administration. We as soldiers must use what tools available to increase and uplift the health of our communities in whatever way we can in order to succeed.