An Epidemic of Inequality
HIV-positive youth meet with policy leaders to stare down the crisis in Atlanta
by Larry Buhl
[dropcap]O[/dropcap]n World AIDS Day in December twenty HIV-positive youth advisors met with more than 100 elected officials, community members, clergy and healthcare leaders to introduce their policy agenda for addressing barriers for HIV prevention among Atlanta youth.
It was the culmination of six months of educational sessions. And the work isn’t finished.
The youth advisors are part of the Youth HIV Policy Advisors program, founded by Equality Foundation of Georgia (the education, training and analysis arm of Georgia Equality) to inform legislators and other local policy influencers about the shockingly high HIV transmission rates among Atlanta’s youth, an epidemic within an epidemic that disproportionately affects youth of color.
Operating on a budget of $20,000, the program matches elected officials and clergy with HIV-positive youth advocates who become their personal advisors on the issue.
Emily Brown, field organizer for Georgia Equality and the coordinator of the Youth HIV Policy Advisors Program, said the requirement for participating youth to be HIV positive was to break through the stigma of the virus.
“It’s important to center the voices and experiences of people living with HIV, and people need to see that normal life after a positive diagnosis is possible,” Brown told A&U.
“If we want to talk about modern HIV advocacy we need people living with HIV to speak up and make sure the strategies we employ are authentic and functional for the people most affected.”
One youth advisor, D’Jona King, a twenty-year-old student in Atlanta, said the meeting with lawmakers and community leaders went better than she expected.
“There was no negativity, and all [of the participants] said they wanted to work with us to make our proposals a reality,” King tells A&U.
The twenty youth advisors were assigned legislators and leaders to promote further discussion and action plans. Every agenda item proposed by the youth advisors, from modest to ambitious, will take a lot of heavy lifting and many allies beyond the twenty policy makers matched with advisors.
Atlanta is ranked fifth among U.S. cities when it comes to the rate of new diagnoses of HIV. Even more problematic is this statistic by hivcontinuum.org showing that HIV-positive Atlanta residents wait longer to get tested. There are more than fifty places to be tested in the Atlanta area, but by the time patients go there to be tested, nearly one-third have clinical AIDS among those who test positive.
To be young, positive and black
Simply put, it is hard to be young, gay, and African American anywhere in the U.S. Being all of these in the South carries some extra challenges.
HIV/AIDS is taking a huge toll on young black men who have sex with men (MSM) in metro Georgia, and the South generally, experts say. The reasons are varied, but experts say it’s not because they’re having more sex than others.
“People think of HIV has to do with behavior and that people get it if they have more sex or use IV drugs,” Brown says. “But research is showing that the higher [HIV] rate African Americans is not because they are engaging in more risky behaviors, but rather because of structural factors like homelessness or poverty. It is not because they behaved differently.”
HIV, Brown says, is an epidemic of inequality, and inequality is great in the South.
For two years in a row the Brookings Institute, a Washington, D.C., think tank said Atlanta had the greatest income gap between the rich and the poor among the fifty largest cities in the U.S. Research has also shown homeless people, for a variety of reasons, are at greater risk for HIV.
These grim statistics and their antecedents were the basis for a policy agenda created by youth in the advisors program. In a series of sessions over the summer and fall, Brown and colleagues worked with youth to root out the main risk factors for contracting HIV and roadblocks to having a healthy life with HIV. These include the poverty-based anvils of housing insecurity and food insecurity, plus the lack of LGBTQ-inclusive sex education.
Some Atlanta-specific proposals include:
• Create employment opportunities for groups at risk and living with HIV.
• Increase shelter and emergency capacity for youth living with HIV.
• Implement housing non-discrimination policies and train for LGBT cultural competence.
• Make PrEP free and accessible to teens and young adults.
• Make routine opt-out HIV testing available at pediatric and adolescent healthcare sites.
• Expand young peoples’ access to sexual health services.
• Support scientifically-accurate, age-appropriate HIV and sex education in schools.
At the state level, youth advisors are calling for new standards for sex education, repealing criminal punishments for people with HIV not disclosing their status (which discourages people from getting tested), and an expansion of Medicaid as part of the Affordable Care Act (ACA).
Georgia, like many states with Republican governors and legislatures, opted out of the Medicare expansion provision of the ACA, or Obamacare. Taking those federal dollars would substantially reduce the costs associated with healthcare for the poorest Georgians, and would in theory get more people living with HIV to come out and seek services (and learn of their status) before the virus decimates their bodies.
One of the legislative participants, already an outspoken advocate of HIV prevention, is Georgia state Senator Vincent Fort (D-Atlanta), who told A&U that meetings with youth had opened his eyes to science and medical treatment advances, such as PrEP, as well as the criminalization of HIV.
“I had already committed to introducing a ten-point program on HIV for the Black Caucus, but what I learned from the youth advisors helped me better draft that initiative,” Fort said.
Fort admitted to being surprised by some information presented by the youth, including the effectiveness of pre-exposure prophylaxis (PrEP), and the difficulty in accessing it. He also was disturbed by criminal laws targeting HIV-positive people. Much of what he learned from the youth advisors, he says, will be used in crafting a ten-point program for his caucus to consider—not yet formal legislation, but priorities for reducing HIV among youth in Atlanta.
There is no guarantee that any of the youth advisors’ proposals will make it to law. But even LGBT-friendly legislators admitted to having blinders on about HIV and were shocked at the number of challenges youth of color face. And they see how those challenges increase the risk of contracting HIV and of having worse health outcomes with an HIV diagnosis.
“We know a large chunk of people with HIV in Georgia do not have access to health care and are not virally suppressed,” Brown says. “People not engaged in care are more likely to transmit the virus to others. It’s a numbers game.”
“HIV has no agenda,” Brown adds. “We create the environment for it to survive.”
For more information, log on to www.georgiaequality.org.
Larry Buhl writes the monthly Hep Talk column for A&U.