Why We Need to Go Beyond One-Size-Fits-All Strategies to Prevent HIV
MICHAEL CHANCLEY, Jr., MSW | HIV Testing & Prevention Senior Coordinator
As a young person, I often volunteered to do HIV prevention outreach and the messaging was pretty simple and consistent - if you don’t want to get HIV, use a condom every time you have sex. Of course, HIV prevention was more nuanced than that, but that was the message that I received and the message that I gave to the public. I never had to think about the people I passed out condoms to as complex individuals with their own logic, reasoning, and barriers in addressing their own risky behaviors. Even when these barriers were expressed, I often talked instead of listening, and parroted the same one-size-fits-all prevention messages that I learned through trainings and interventions. It wasn’t until I got into the field of HIV prevention professionally four years ago that I began to have in depth conversations with people about their own risks during one-on-one HIV counseling and testing sessions.
Currently, the Gulf South holds the biggest burden of the HIV epidemic in the U.S. The work of our HIV Testing and Prevention Program at the Institute of Women and Ethnic Studies (IWES) focuses on African-American and Latino heterosexual people in the Greater New Orleans area who may be disproportionately impacted by factors increasing their risk of transmitting HIV. Some of the circumstances I’ve seen are unstable housing, incarceration (of self or partners who were previously incarcerated), engagement in sex work, mental health and healthcare access, and intimate partner violence, to name a few.
During an HIV counseling and testing session, I often engage people in risk reduction conversations that not only encourage condom usage, but also address other factors that can impact their risk of transmitting HIV. I get very shocked reactions from people when I respond by validating their feelings or concerns about consistent condom usage, instead of responding with shame or judgment. I’ve even had many people say they feel more comfortable opening up about their risk behaviors, and are more willing to ask sexual health questions that they were a little too embarrassed to ask before. I strive to make people feel at ease because discussing sex and risk behaviors with a stranger isn’t always easy.
When talking to people who have issues with consistent condom usage, getting tested regularly with their sexual partners, or accessing sterile syringes, I make referrals to resources that can address their needs. These resources include social service programs, healthcare and mental healthcare services, partner testing, syringe access programs, or other services to address barriers. For many people, addressing these barriers can have a positive impact on reducing their risks, but for some people, even addressing these barriers may not immediately translate into consistent condom use, getting tested with partners, or reducing their number of partners. For these clients, we also discuss other risk reduction methods such as pre-exposure prophylaxis (PrEP) or treatment as prevention (TasP).
PrEP is a risk reduction strategy which includes taking the same antiretroviral medications used for the treatment of HIV, along with regular HIV and STI screenings, and other risk reduction methods, to reduce the risk of getting the virus by people who are HIV-negative. As of now, the FDA has approved the drug Truvada for the use of PrEP. It can be prescribed by any healthcare provider and there are a variety of resources that can make PrEP low-to-no cost for higher risk people.*
As a part of IWES’ work to reduce HIV transmission, for those who are living with HIV, we refer clients to our ARTAS Program, which links people who are out of care into treatment services. We do this because people who are consistently in treatment can suppress their HIV viral load. This is extremely important because, in September of 2017, the Centers for Disease Control and Prevention stated that people with a suppressed viral load effectively pose no risk of transmitting HIV to their HIV-negative partners.**
Since condoms are still very effective at preventing the transmission of HIV and other STIs, as well as preventing unintended pregnancy, at IWES I continue to distribute condoms during outreach, and I educate people about how to properly use condoms. These sessions are also another good time to hear the barriers people have to risk reduction, and then we can also discuss ways they can reduce their risk.
If you take anything away from this piece it’s this:
Prevention doesn’t look the same for each person, and in order to address the disparities in HIV, we must provide prevention tools that effectively fit the needs of all.
*For more information about accessing PrEP in Louisiana, visit https://www.louisianahealthhub.org/prep-overview.
**For more information about treatment as prevention, visit https://www.cdc.gov/hiv/risk/art/index.html