Recap & Comment: DC Commission for Women Inaugural Policy Conference

On October 18, 2014 the DC Commission for Women hosted an Inaugural Policy Conference. The Women’s Collective was in attendance, attending the opening and panel sessions, as well as providing free HIV testing at the event. Specifically, we attended the DC Healthy Women panel, which gave an overview of key issues affecting the health of DC women.  Of particular issue to our clients, the panel discussed the effects of HIV in the city, as well as access to reproductive health care.

The DC Health Department spoke about HIV. They gave the sobering reminder that nearly 1 in 5 new cases of HIV in DC occur among African American heterosexual women. However, there is also encouraging news about the HIV epidemic in DC. Overall, the number of new infections in DC is decreasing. Additionally, for those diagnosed with HIV, access to health care is improving. Currently, 86% of people are linked to care within 3 months of an HIV diagnosis, compared to 50% in 2005

However, the panel discussed some actions we can take or continue to support, in order to improve health outcomes and access to care for people living with HIV. These include free access to condoms and clean needles to reduce the risk of HIV transmission; promoting HIV as a routine part of health care, so that all people will know their HIV status; and changing discussions around sex and sexuality, so that they are positive and affirming.

In addition to these actions discussed by the panel, The Women’s Collective is working to support health care access among women living with HIV. Towards this end, we identified access to high quality health care, that is both culturally competent and trauma informed, as one of our policy priorities. Health care access is crucial for women living with HIV, because there are gender-based disparities in HIV outcomes, particularly related to viral load suppression. For instance, a smaller proportion of women in care achieve viral load suppression, when compared to men in care. To address these disparities, and enable women living with HIV to be linked to care, retained in care, and achieve viral load suppression, we believe that support services, such as those provided by The Women’s Collective and made possible through Ryan White funding, can be effective. As such, we believe that in the changing health care landscape, Ryan White funding for support services needs to continue.

Reproductive health care was also discussed at the Healthy DC Women panel. Shockingly, in DC, 70% of pregnancies are unintended. We recognize that this statistic points toward the need for comprehensive sexual education, access to contraception, and access to abortion. However women in DC face particular restrictions: Congress has banned DC from using its own funds to pay for medically necessary abortions for Medicaid recipients. Policies such as this severely restrict a low-income woman’s ability to access reproductive health care, which could have long-lasting effects on her health and ability to meet her basic needs.

While the health forum, in particular, pointed to areas where policy change is very much needed, we want to applaud the focus on women’s issues by the DC government. Recognition of and meaningful discussion about the specific issues women in Washington, DC face is a crucial first step. We hope that this conference and the continued work of the DC Commission for Women can support the creation and enactment of policies to protect the rights and improve the well-being of women in Washington, DC.

It’s National Women’s Health Week!

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This week is National Women’s Health Week (#NWHW) sponsored by the Office on Women’s Health. The goal is to empower women to make their health a priority. National Women’s Health Week also serves as a time to help women understand what it means to be well.

We know that women frequently put their own needs behind those of their families—including the need for comprehensive and quality health care. Moreover, 80% of mothers assume responsibility for their children’s medical visits and are the drivers of their family members and extended family members accessing care. This week, take the time to put your own health care needs first!

Now that the Affordable Care Act has been fully implemented, be sure to take advantage of the myriad of covered services:

–          Routine anemia screenings for pregnant women

–          Breast Cancer Genetic Test Counseling (BRCA) for women at higher risk of breast cancer

–          Mammography screenings for women over 40

–          Blood pressure and cholesterol screenings

–          Breastfeeding support and counseling for pregnant and nursing women

–          Cervical cancer screening

–          Immunizations

–          Contraception

–          Domestic violence screening and counseling

–          Osteoporosis screening

–          HPV DNA testing

–          STI screening and counseling – including chlamydia, gonorrhea, and HIV

If you want to learn more, stop by HealthCare.gov and be sure to check with your insurance carrier to verify your coverage!

Woman-centered Supportive Services are Crucial for Women Living with HIV

The Care Team at The Women’s Collective (TWC) includes four medical case managers (MCM) and two community health workers (CHW) who work together to support our clients so that they consistently stay linked to medical care, treatment, and support services that improve their health outcomes and quality of life. The services we provide are woman-centered and family-focused, which is so necessary in the fight against HIV/ AIDS.  Globally, women make up 54% of people living with HIV. In D.C., women make up 28% of people living with HIV, and Black women represent 92% of women living with HIV. Women of color face challenges that make them more susceptible to HIV and less likely to enter and stay in care, such as gender and racial inequality, discrimination, stigma, poverty, and gender-based violence.  Despite this picture, women are often overlooked or ignored, and are underserved at other agencies.  Our services provide a safe space for women living with HIV, and meet their individual needs as mothers, caregivers, and heads of household.

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Our team provides support well beyond clients’ medical needs, in an effort to address all the issues that might interfere with their ability to enter and stay in care.  The Care Team frequently assists clients with food shortages, housing placement, career planning, emotional support, family services, and substance abuse treatment. Women come to TWC for a hot plate of food for themselves and their families in our Community Kitchen, which has food delivered twice weekly, or shop through clothing donations in our Resource Room. The Care Team provides a Play Room for children while women meet with their MCM. It’s not uncommon to see the Director of Care Programs walking around bouncing a client’s baby, while mom uses the computer in the Resource Room to find employment! In addressing the numerous issues that are specific to women as care-givers, providers, and mothers, we are offering unique services that many women living with HIV/AIDS who reside in D.C. cannot find elsewhere.

The Care Team has historically provided the Coffee House Support Group to clients as a safe space to address issues affecting their daily lives, to share resources, and to develop important social connections that break feelings of isolation. During last month’s Coffee House, harm reduction strategies were introduced to the group as a means to address risk that could compromise women’s health. Medical case managers discussed intimate partner violence (IPV)with women and a range of other topics on different ways women are at increased risk of HIV infection.  Coffee House is also fun!  We recently welcomed a dance instructor to teach some line dances!

The Care Team has also introduced a range of social support groups in response to the varied and nuanced needs of the women we serve. For example, we now have a support group for women who are living with HIV/AIDS who love women.  In April, the Care Team will debut additional support groups that will provide clients with various life skills and emotional support.  Be sure to keep up with our calendar of events to see all of our upcoming groups!

We look forward to using this space to showcase the needs of the women we serve and the myriad ways we meet those needs as women, mothers, and caregivers.

Ryan White Part D Funding: What about Women and Families?

Family 1 SlideOn March 4, 2014 President Obama released his proposed budget for FY 2015. While his budget doesn’t go into effect without congressional approval, and it’s unlikely that congress will approve it without making any changes—the President made an important change in the way HIV related services are funded. The proposed budget condenses Part D of the Ryan White Program (which focuses on providing supportive services and medical services to women and families) into Part C (which provides comprehensive services without a focus on any specific group impacted by HIV/AIDS).

This proposal isn’t itself particularly concerning—Part D funds have always been very competitive and difficult to compete for so the compression of Part D into Part C may open up some new funding opportunities for community-based organizations (CBOs) that had been previously shut out of Part D funding. It also makes sense from the standpoint that there are less children being born with HIV and therefore a reduced need for funding those targeted services.

But we can’t forget about women and families.

The real concern with this proposal is the small part it plays in a larger movement in HIV/AIDS advocacy and funding that increasingly forgets about women and families and their unique needs and barriers. Language matters. Even though there are no funds being diverted out of the Ryan White program, removing “women and families” sends a problematic message about the focus of HIV/AIDS advocacy and services, who is living with HIV, and what their needs are. It lumps everyone living with HIV/AIDS into the same boat when they have distinctly different and complex needs—for women and families, those needs are often ignored.

There’s an argument that women and families served by Part D of the Ryan White program can get those same services through providers that receive Part C funding. That’s technically true. But those providers often don’t have woman-focused or youth-focused services that we know are effective. Women and youth may have a more difficult time articulating their needs and getting those needs met. As a woman-focused CBO, we have a first-hand view of what those needs are. Women aren’t just looking for access to quality health care or treatment. They’re looking for food so they can feed their families; housing so they can provide their families with stability and safety; employment so they can feel empowered to take care of themselves and their families; childcare so they can get to doctor’s appointments and to work; education so they can better themselves and set a good example for their families…

The needs of women go well beyond just taking medicine and adhering to treatment. As we lose focus on women and their needs, we are making it more difficult for them and families to enter and stay in care. The Women’s Collective urges the President and Congress to ensure that in the fight against HIV/AIDS, women are not left behind.

Approaches to Reducing Health Inequities for Women & Girls

The Policy and Advocacy Department at The Women’s Collective is lucky enough to be in the unique position of working to influence public policies from within a direct services organization. Our unique service-informed approach is a result of our work with women and girls living with or affected by HIV/AIDS. Through our efforts to support women to meet a range of self-identified needs, we learn about their struggles and their needs — and their voices drive and define our work. What we find, when working with these amazing women, is that their lives are about so much more than their HIV (as one of the members of our PLUS+ Network says, “I don’t live with my HIV, my HIV lives with me!”).

We’ve been “under construction” lately – spending some time revisiting and revising our policy priorities. In thinking about what’s important to us, as an organization, and to the women we serve, we find that there is an overarching theme to our work—the health disparities, or differences in health outcomes, faced by women, girls, and families.

In the District of Columbia, the life expectancy for African-Americans is 71.6 years, compared to 84.3 for whites. In the U.S., blacks are more likely to have a chronic illness or disability, and those with family incomes below 200% of the poverty level are 26% more likely to suffer from a chronic condition than whites.

HIV infection rate among some heterosexual women in D.C.’s poorest neighborhoods significantly increased from 6.3% to 12.1% from 2008 to 2010 — nearly doubling within two years. This rate is three times higher than their male counterparts at 4.4%.

Moreover, in a 2011 study of people living with HIV in the U.S., women and blacks had poorer health outcomes than other groups.

What we’ve found through our work is that in order to address these disparities, it’s not enough to consider health care access alone. In the 2011 study referenced above, though women and blacks were less likely to start ART, that difference does not fully account for disparate health outcomes.

That’s not to say that health care access isn’t important—it’s crucial that we make sure that all people, particularly women living with HIV/AIDS and women of color, have access to quality health care providers, comprehensive insurance coverage, and appropriate and affordable treatment options. But health care access is just one piece of the puzzle. It doesn’t explain the disparities across race, ethnicity, gender, or socioeconomic status. What does explain those disparities are the social determinants of health – namely, the social conditions in which individuals are born, grow-up, live, learn, work, play, and age – are the most important factors related to one’s health status.

When we look at the issues and barriers that are impacting women we serve and keeping them from getting tested, getting linked to care, staying in care, and achieving viral suppression, they go beyond health care access. And it’s clear to us that, particularly among women of color with low-incomes, we need to address several issues before we can “end AIDS” (or “end” anything, for that matter). Issues that impact women and their ability to access care include: poverty, housing barriers, lower educational attainment, high crime, substance use, mental illness, and gender-based violence. The inequitable distribution of these social conditions across groups contributes to persistent health inequities.More specifically, they pose psychological, emotional, and social barriers to HIV prevention, testing, and care for women and girls affected by HIV/AIDS. Broadening our collective approaches to reducing health inequities by addressing the social and structural conditions needed for good health for all is urgently needed now.

This blog is not just a forum for us to speak about HIV-related policy. It is a forum for us to speak about a multitude of issues affecting women and girls, with emphasis on women and girls of color. We look forward to continuing the discussion, sharing our stories, and highlighting issues that deserve energy and attention to ensure health equity for all.