ASHM Report Back

Clinical posts from members and guests of the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) from various international medical and scientific conferences on HIV, AIDS, viral hepatitis, and sexual health.

Panel Discussion on Stigma, Trauma and Stress: Considerations for HIV Research and Programs

Monday 22nd Feb

Session MD – Panel Discussion on Stigma, Trauma and Stress: Considerations for HIV Research and Programs.

Moderator: Morenike Ukpong-Folayan (Nigeria)

Diversity in panelists: Laurel Sprague, Sethembiso Mthembu and Keith Green.

 

Speaker 1

Laurel Sprague: Limits and Complexity Research on Stigma and HIV. (Milford, PA, USA)

Complex topic for discussion and opening panelist Laurel Sprague opened with Stigma, fear, and anxiety around disease is just as important as the focus on reaching undetectable viral loads.

She continued to highlight that HIV positive people surveyed actually want not disclosing ones HIV status to be decriminalised, and it is the ongoing impact of the possibility for incarceration that is continuing HIV stigma within the US.

Discussion around the Stigma Index Questionnaire within the US and globally. http://www.stigmaindex.org

 

Speaker 2

Sethembiso Mthembu: Women’s Rights and Decision Making in Hormonal Contraception. (Durban, South Africa)

Presented on how there are overriding political issues that continue to impact on the provision of care for women, different contraception is offered in northern regions to southern regions, and based on religion and race.

Increasing awareness into the effects of hormonal contraception – in particular depo provera injection has on vaginal pH levels and thus is actually increasing the risk of HIV transmission for African women, as well as an increased link with higher rates of cervical cancer.

ECHO Study is currently looking at the direct links between administration of hormonal contraception and increased rates of HIV.

http://echo-consortium.com

Current government programs push hormonal contraception onto African women with little education or communication of possible side effects, in HIV positive females, provision of ARVs is withheld until the person can prove they have had their depo provera injection

Ongoing provisions of care complications are highlighted with African women being provided with ‘contraception only’ clinics, which will not and do not address any other complex care needs of women’s health.

We can all argue how effect depo provera is as a form of contraception that is discreet, effective and economically accessible around the world. The point raised by Sethembiso is that we need to consider and understand the impact however such hormonal contraception is being pushed in Africa not as an option but with forced prescription and the impact in relation to HIV risk.

 

Speaker 3

Keith Green: Engaging Young Men of Color in Community HIV Prevention Studies. (Chicago, USA)

Emphasis on multi-disciplinary approach and peer lead and consumer inclusion into study development and implantation.

He notes a major aspect of barriers in engaging youth consumers and participants into new studies and trials is not due to just their own stigma concerns but rather also the fact that youth inherently rebels and does not like to follow set orders or rules, and is just part of their nature as humans.

Keith also highlighted that we should not be so quick at labelling and using terms as MSM to communicate with young people, in todays day and age the better options is to ask the person how they wish the be identified and then use that term.

He has raised some interesting points, but also it does seem that it is increasingly difficult to allow interactions across all politically correct and non judgmental levels without making the research less valid, or repeatable in other settings, if allowing too many broad topics, and individual approaches helps gain numbers of consumers to participate will it then also indirectly make the research less scientifically valid?

The use of facebook and twitter proved valuable to their team in engaging and maintaining participation from youth consumers. The importance of privacy and sensitivity was highlighted but most participants were very happy to communicate via social media rather than phones. In considering the youth of today, mobile numbers change frequently, however very few will ever change their facebook or their email. Putting privacy and internet safety of information aside and assuming all was protected, one would think that this approach could not only benefit in youth interactions but also for all consumer/ client groups that are often lost to follow-up, low retention of care populations and indigenous and/or remote populations within geographically diverse Australia.

Keith repeatedly emphasis the importance of health provision to always remain culturally competent and relevant. This is of course a huge challenge in any community and country around the world especially as technology and communication avenues evolve so rapidly.

 

Open Q&A - Discussion:

The open discussion highlighted some global issues on the topic and some interesting specific examples were given. To summarize the main points of the discussion;

-       HIV prevention and control act implemented in Uganda has actually increased stigma, trauma and stress with the implantation of heavy fines on HIV positive people.

-       Is incarceration as punishment actually discrimination? In South Africa women are targeting for testing drives esp in antenatal screening – however if testing positive are indirectly persecuted, hence promoting fear towards testing.

-       Is the threat of incarceration a why in which governments globally can still impose authority.

-       Fears for women was further highlighted by the following scenario: If a man rapes a women in South Africa he is charged with rape and undergoes mandatory HIV testing, if positive he is then also charged with infecting people. On the flip side, the women raped is also tested, and if she is found to be the source, then she goes from being the rape victim to potentially facing a charge for HIV transmission to the rapist!

-       Do HIV, MSM and Sex worker clinics promote health care and reduce stigma or do they promote isolation and less integration and public understanding by segregation.

-       How can we reduced the distrust between consumer populations and research communities. Is it by educating, training and giving voice in positions to consumer/ peers. Would a society then specifically place aside allocated funding and positions for consumers/ peers to enter the industry and become researchers. In the Australian context how would this be rolled out? Similar to indigenous program models and would this encounter any population bias or speculation, helping reduce stigma or increasing it?

 

Session OS  - Opening Session - Fighting AIDS with Style 

On an additional note the final speaker of the day at the opening session was a special event guest, designer Kenneth Cole, now chairman of amfAR. He has dedicated his social and influential career in the fashion industry since 1985 to helping reduce stigma by being an individual public voice. From his efforts to not live in the dark or silence and instead pushing controversial AIDs and HIV issues into the public light.  https://www.kennethcole.com/lgfg-making-aids-history.html

It is something about the concept of stigma, trauma and stress in relation to HIV in all aspects including research barriers that should be challenged by more people speaking out and making it an acceptable public topic for discussion. When society is forced to fell comfortable about what is actually going on around it and within it, it is then that ignorance and bigotry can be overcome and help reduce stigma and hence promote public health.

Posted by on in Public Health and Prevention
 
At the lunchtime AFAO community hub today, Brett and Phil outlined how 2 Spirits work in culturally appropriate ways with the whole of community. They highlighted how some poorly set up programs may attempt to buy health outcomes, rather than working collaboratively and empowering community to take control of their own health outcomes.
 
Michelle Tobin - Provided background to the Anwernekenhe (National HIV Alliance) Conference which will be held in Alice Springs 12-14 November 2015. Link to the conference website - http://ana.org.au/A6/

 

Tagged in: HIVAIDS2015

This morning I read the headline ‘world leaders pledge to achieve gender equality by 2030’.  This was timely given I had just attended the session entitled ‘Bingo: The use of targets in HIV policy’ chaired by Professor Heather Worth, the day before. This headline reinforced the arguments put forward in the session about use of targets. Can we really achieve gender equality, something that is tied up in complex political systems, social norms and beliefs within the next 15 year? The target filled me with hope and gave me an extra spring in my step as I headed to the conference. But the points made at yesterday’s debate lingered. Are we really able to achieve such aspirational targets such as UNAID’s 90-90-90 target in which 90% of all people living with HIV will know their HIV status, 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy and 90% of all people receiving antiretroviral therapy will have viral suppression within the next 5 years? And if such targets aren’t achievable should we be setting them?

 

The panel put forward differing argument on a debate which essentially focused on aspirational targets vs. more realistic evidence based targets. Professor Charles Gilks spoke about the 3X5 Initiative and said that whilst the target of 3 million people living in low and middle income countries being provided with ART was not achieved by 2005, this aspirational target provided a driving force and focusing of efforts so that it was achieved two years later in 2007.

 

David Fowler, a self-proclaimed cynic when it comes to aspirational targets argued that targets should be evidence based and realistic. Whilst Professor Peter Aggleton put forward the notion that targets have been reduced to ‘sloganeering’. Peter indicated that he wasn’t opposed to aspirational target setting at it ‘motivates our hearts and head’, but also argued that targets need to be realistic, owned by the community and that we also need to look beyond targets and be driven by ‘doing the correct thing’.

 

There were other interesting discussions about how to set targets with Charles arguing they need to be realistic and based on the cost required to achieve them. Midnight Poonkasetwattana proposed that global targets are inappropriate as we need to look at individual community wants and needs rather than producing sweeping global targets.

 

The debate reminded me of another great session by John Kaldor I had attended. John had touched upon what he considered unhelpful dichotomies in disease control such as; technology vs. environment, action vs. evidence, government vs. community driven, medical vs. social and public good vs. human rights. He argued that these things should not be pitched against one another but recognized as both helpful and necessary. I couldn’t help but wonder whether aspirational vs realistic targets should be added to the list and whether it is possible that they could be one and the same thing? What do you think?

 

Tagged in: HIVAIDS2015

Posted by on in Public Health and Prevention

DAY 5 for me as an atendee of both conferences.

Brisbane reminded us that it can rain and rain it has today. 

BE BRAVE BE courageous Was a theme I heard from two very different aspects of the issues up for discussion today.

Presentations discussing how best to harness the power, energy and wisdom of young people towards HIV health promotion engagement, were diverse and interesting. From the voices of young Ugandans, or Australian First Nation youth or same sex attracted young men already somewhat engaged in advocacy the take home messages were; get them interested, ask them what they know now, then ask them to come on board and  lead the way in working out how to engage their peers.But most of all do what they suggest- follow through.

This afternoons BINGO session about Targets for HIV policy once again drew out different opinions on the usefulness and relevance of  targets, one panelsit alluded to the meaning of random numbers anyway.

We heard plausible argument for inspirational targets that can push governing bodies or agencies for visionary levels or can be motivational for aspirations to be more tha "usual practice". Other arguments lauded that aspirational targets miss the current climate of resource limitations and allocation challenges; therefore the setting of targets must be effective. Effectiveness may mean targets based on developed modelling that mobilises resources to areas of most need, regardless of settings. Questions from the floor were thought provoking; what is the alternative? And what about those vulnerable people who do not have a voice to advocate for their issues to be considered.

This is where courage and bravery comes in advocates may need to be the voice of the vulnerable, health professionals may have to be in competition for the same dollars -which disease is more worthy?

Do we teach coleagues , students, managers to take lesons in political health as part of public health advocacy?

 

A great ending to a stimulating day of excellent information.

 

 

Tagged in: HIVAIDS2015

Teddy Cook and Jeremy Wiggins gave a talk on the inclusion of transgender men in the HIV response, which provided much food for thought for healthcare practitioners and a call to action for health policy makers.

The presenters raised concerns that trans men generally report significant HIV risk, yet are overlooked in the HIV response. They highlighted some issues in data collection that may have resulted in trans people not being accurately represented in HIV data.

Particularly, they made the enlightening statement that "Transgender is not a gender identity". Trans men have very different experiences from trans women, and have different health requirements, including different sexual health requirements. 

Also, health data collection does not accurately capture data on transgender people. For example, the Victorian Department of Health HIV notification form gives the gender options of "male", "female" and "transgender". By lumping trans men, trans women and genderqueer people into the same category, health data loses nuances that are important for informing health policy and health promotion.

Also, they highlighted some case studies illustrating how this simplistic gender categorisation has resulted in miscategorisation of trans people in HIV statistics. One case described a non-binary trans masculine person who was assigned female at birth who has sex with men, who was categorised as a heterosexual female on her HIV notification form. Obviously, in order to develop an appropriate public health response to address HIV risk in the transgender community, we need data that accurately reflects what is happening in the trans community.

The presenters suggested the following two-question gender classification in order to overcome some of these issues.

  • Question 1: What is your gender
  • Question 2: What gender were you assigned at birth

On a lighter note, Jeremy pointed out that a recent HIV testing campaign from Victoria did include a trans man. It's a fun campaign, so have a look at the video below:

Twitter response: "Could not authenticate you."