Changing the Conversation

World AIDS Day--recognized every year on December 1 since 1988--is an occasion to reflect on the global impact of HIV and AIDS and health care inequities across world populations. On this day, HIV/AIDS organizations around the world affirm their commitment to eliminate stigma and expand testing and treatment to people living where rates of HIV and AIDS remain high.

The U.S. Global AIDS Coordinator--Ambassador Deborah Birx, M.D.--asserts, “We will only end the AIDS epidemic by 2030 if no one is left behind. It is unacceptable that key populations still face stigma, discrimination, and violence, which impede their ability to access quality HIV services.”

This year, the U.S. is working to control an epidemic in Scott County, Indiana that has a higher incidence of HIV than any country in sub-Saharan Africa. Austin--the county seat with a population of 4,200--has more cases of HIV than all of New York City. In this small, rural county, the forces of poverty, addiction, and politics drove an injection drug problem to cause the first-known HIV outbreak related to the current opioid crisis in America.

“You’re going to need to do some homework,” she said.

It was my first week of working at Youth on Fire (YOF), a drop in center and HIV prevention program for 14-24 year olds experiencing homelessness and housing instability.

“Okay,” I replied, expecting to be given some books or articles to read.

“I want you to go home, stand in front of a mirror, and say the words ‘blow job’ and ‘anal sex’ thirty times per day for the next week.”

This is a poem I come back to over and over again. I found it years ago, and every time I look at it, it seems to resonate in new ways.

After some days of supporting clients, it’s the “immense responsibility and very little authority” that catches me. After other days, it’s about “resounding triumphs and devastating failures.” And still other days, it’s about “always be[ing] frustrated.”

My frustration is sometimes directed at the systems. Why are they so complicated? Why do they set people up to fail? Why don’t they support people the way they should?

Sometimes, quite honestly, my frustration is directed at the people with whom I am working. Why did she go back to her abusive partner? Why did he spend his $10,000 settlement in a month? Why did he pay his phone bill, but not his rent? Why did she use again?

I have been an HIV Prevention provider for over 25 years. I consider myself a Harm Reduction Provider/Harm Reductionist—a title I am very proud to claim—though it wasn’t always this way. I first heard about Harm Reduction in the mid-1990s through a program doing needle exchange in the low-income, community of color where I worked and lived. As I saw White men coming into a Black neighborhood handing out needles, I had many concerns. I thought their message was: “Go ahead, destroy your lives and your community, just don’t get the rest of us infected!” I also couldn’t understand why our cries for more treatment were being met with more needles. Since then, I have learned just how wrong I was about the intentions of needle exchange programs and the underlying philosophy of Harm Reduction.