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Obama’s AIDS Policy

August 7, 2010 1 comment

I may be a bit late to the party here, but I’ve been reading the new National AIDS Policy Strategy and Implementation. Overall I like it, good goals are set and a comprehensive plan is outlined, so hopefully we actually, you know, DO it. It’s a step in the right direction, but it could definitely do better, so I’m going to nitpick the hell out of it.

This report basically ignores two groups that I consider important to any discussion of HIV infection and transmission: trans people and sex workers.

On the first, it’s not that trans people aren’t mentioned in the reports, we actually are: 8 times in the Strategy and 6 in the Implementation. Only two mentions (one each) are independent of a grouping with “LGBT” or “gay and bisexual men and transgender individuals”. It admits that infection among trans people may be as high as 30% (NOT one of the independent mentions, though it does sort of identify trans as a distinct group from “gay and bisexual men”, so let’s call it two-and-a-half), but does not include much in the way of specific protections to help trans people, concentrating its “populations with greatest need” portions on men-who-have-sex-with-men (MSM), black, and latino communities. Looking at the numbers provided, the highest risk groups according to the report are black injected drug users (IDU), 2.7% for black women IDU and 1.8% for black men IDU, and MSM, 1.7% for black MSM, 0.7% for latino MSM, and 0.3% for white MSM. Even if the 30% figure is inflated, it represents a clear outlier. White MSM as the group with the highest NUMBER of infections is a product of sheer mass, and the fact that transpeople didn’t make it to the big graphs in the report is a product of small numbers, but the difference in proportions is shocking.

In terms of the goals of the AIDS policy, goals for transpeople are decidedly lacking. While MSM, black, and latino communities each have a goal of 20% fewer new infections by 2015. The only place where transgendered individuals are mentioned separately in the implementation is to say “By the end of 2011…CDC will expand its work evaluating adaptations of specific interven¬tions for transgender populations and issue a fact sheet recommend¬ing HIV prevention approaches for transgender persons.” Less than 3% population gets a 20% reduction in new infections, but as high as 30% gets a pamphlet? It’s really indicative of how little treatment transpeople have gotten that the government is citing proven prevention methods for other groups in the study, but we still need to do more research on what works for transpeople, and that it’s going to take at least another year to even figure it out.

The policy also fails to address stigma-based infection. While the reports focus some attention on reducing the stigma of being infected with HIV, it does very little with the fact that stigma is often implicated in higher HIV rates and lower survival rates amongst infected individuals. No mention is made of the fact that LGBTQ people that are rejected by their families are at higher risk for HIV infection (Rejecting behaviors in parents and caregivers lead to high rates of depression, substance use, attempted suicide, and high risk for HIV infection). The report does admit that prejudice may be implicated in poorer prognoses for HIV among POC and transpeople, but couples this information with the statement that “Heterosexual providers may not be comfortable asking about sexual history when taking a patient’s history and this may limit appropriate care.” equating harassment, racism, and denial of healthcare to prudish discomfort. And the implementation of the plan makes no suggestions, as far as I saw, for addressing this, the only changes to the behavior of healthcare providers being better coordination of resources. Any comprehensive policy of healthcare should take steps to reduce prejudice people experience from their doctors, so SOMETHING should be included here, at the very least tracking reports of prejudice directed at these programs filed by HIV infected individuals (given that the report already expands regulatory agencies to track effectiveness of programs).

As for treatment of sex workers, there is none. I would love to site numbers that say there should be, but there aren’t any of those either (in the United States…very little information is gathered about workers and their clients. As with Western Europe, many of the HIV cases that do occur amongst sex workers in the U.S. are attributed to injecting drug use rather than sex). In fact, when searching for this, I had to specify “United States” because I kept getting nothing but statistics from Africa and Southeast Asia. We know more about sex workers in Vietnam and Côte d’Ivoire than we do about those in the US. I think this is important, partly because of stereotypes about contracting STD’s (including HIV) from sex workers. It may be that they are not at much elevated risk, as condoms are considered standard fare amongst sex workers (though recent legislation may change that in some places), but surely the report should have contained a request for more information. If we are willing to distribute needles to IDU, than we should be willing to address other illegal activities to reduce HIV infection (other than trying ham-handedly to eradicate them). I don’t even have as much to say here as I did about transpeople, because there’s nothing to quote or pick at at all, just silence.

On a slightly different note: I did find it interesting to see how HIV rates so clearly outlined intersection. Women are slightly more likely than men to be infected, POC more likely than whites, queers more likely than straights, the poor more likely than the middle and upper classes. The only anomaly in this is queer women, which is understandable given the vectors of transmission.

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