“The passion you share for our work can generate a wider circle of change”

Dear Friend of The Women’s Collective,
We have much to be thankful for this holiday season and you are at the top of our list! The financial support you provide makes such a profound difference in our ability to serve women and girls in the Washington DC area.  For over twenty years TWC has provided a wide range of health and social support services, including mental health.
 
Despite changes in the health care landscape and the lack of resources available to community based organizations, TWC continues to make a difference in the lives of women, girls and their families.  Thanks to the incredible efforts of our staff, volunteers and friends like you, we remain committed to our community. 
 
As you celebrate with loved ones this holiday season, will you help us provide for families who are less fortunate? We hope you will consider TWC in your year-end giving during this holiday season. 
 
As you celebrate with loved ones this holiday season, will you help us provide for families who are less fortunate? We hope you will consider TWC in your year-end giving during this holiday season. 
Your donation can provide the following :
$10: Transportation to health and social services appointments.
$30: School supplies and a uniform for a child
$50: An HIV or Hep C test, a hot meal for a family of four
$75: Groceries for one week

$100: Individual and family therapy

You can donate by sending a check directly to The Women’s Collective, via Network for Good, or the Catalogue for Philanthropy. You can also help by inviting your friends and family to support The Women’s Collective.

The passion you share for our work can generate a wider circle of change,

thank you for your kindness and please stay in touch!
Sincerely,
 
Patricia Nalls
Founder/Executive Director 
The Women’s Collective
202-483-7003
“When I was at my lowest point, The Women’s Collective was there to not only lift me up, but to show me that I had a lot to live for.  I’m here today because of TWC!”
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-Dana S (TWC client).

US Women & PrEP: Remember Us?

The New York Times recently ran an article about the use of Pre-Exposure Prophylaxis (PrEP) as the next great sexual revolution – it compared the impact that the pill made for women to the impact that PrEP can make for men who have sex with men (MSM).

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Centers for Disease Control and Prevention. http://www.cdc.gov/hiv/statistics/surveillance/incidence/

We certainly cannot ignore the high rates of new infections among MSM.  According to the Centers for Disease Control and Prevention (CDC), in 2010 63% of new infections are among men who have sex with men. But that statistic, as alarming as it may be, does not mean that we should ignore other vulnerable populations.

On May 14, 2014, the CDC came out with new guidelines for providers on assessing risk and prescribing PrEP. And those guidelines focused on all vulnerable populations – including women.  Though it’s important that we see PrEP for what it is – and the positive outcomes that it will support – as an important step forward in HIV prevention and treatment, that step is not exclusive to men.

Let’s remember that the HIV epidemic is diverse and focus on the ways that our prevention and treatment efforts can reach all vulnerable populations.  We need to decrease stigma associated with PrEP and ensure that providers increase access to PrEP for both men and women.  We need to ensure that there is an effective outreach strategy in place to reach both men and women who are at risk of HIV infection.

TWC calls on public and private entities involved in guideline development and dissemination to work with obstetricians, gynecologists, and thought leaders in women’s health to ensure increasing voluntary and informed discussion of PrEP by providers and use of PrEP by vulnerable populations. We also strongly recommend collaboration between guideline-making bodies and community-based women’s organizations, both within and beyond the HIV arena, the U.S. Women and PrEP Working Group, AVAC, and a diverse group of HIV stakeholders to ensure that guidelines are practical and inclusive of all populations, including women and people of color.

What are your thoughts on PrEP outreach and roll-out? How can we further ensure that women have access to PrEP?

The State of Sex Education in the US: Room for Improvement

In April, the Huffington Post using data from the Guttmacher Institute produced some pretty scary infographics highlighting the state of sex education (or lack thereof) in this country.  While it’s shocking that many states have no sex education requirement, it’s doubly shocking that where sex education is provided, that there are MANY states in which there is no requirement that: 1) HIV information be included or that 2) Information provided be medically accurate.

SexEdMaps1_2Of course, sexuality education courses aren’t the only place that people are getting their information—they’re getting it from movies, television, friends, parents, and, increasingly, people, and youths in particular, are getting their information from the Internet.  The thing about all of those sources, though, is they’re often not medically accurate.  Television and movies rarely show people practicing safe sex—you don’t see a conversation between two people about whether or not they’ve been tested, how recently, if they have a condom—and then you also rarely see consequences from that failure to negotiate safe sex or condom use (unless it contributes to some juicy story line or plot twist).

On the other hand, in a 2009 study, half of the websites that occurred within the top 10-15 hits on Google when someone searched for terms like “birth control,” “morning after pill,” or “sexually transmitted disease” failed to provide accurate or complete information.  Further, an issue brief released by the National Alliance of State and Territorial AIDS Directors (NASTAD) that supported the qualitative data from our previous youth intervention findings showed that the misconceptions held by adults around HIV and sexual health can be passed through generations leading to increased silence around risk and reduced knowledge of the need for prevention services and care.

SexEdMaps4So with all of that misinformation out there, it’s even more imperative to ensure that schools have comprehensive and accurate sex education.  And comprehensive means comprehensive – not just one hour in health class in spring of your Sophomore year. It means starting to provide age-appropriate sexual health information at a young age that enables young people access to medically accurate information rather than misinformation and myths.

And it’s not just about the right to have accurate information—this cloud of misinformation around sexual health has real consequences. In 2010, youth between ages 13 and 24 made up 17% of the population, but made up 26% of new HIV infections. Most importantly, education on sexual health does not lead to an increase in sexual activity. Quality sexual health education often delays sexual activity, increases condom use, and decreases the total number of sexual partners. This data just goes to show that failing to provide sex education, failing to talk about HIV or STIs or contraceptives or condoms, failing to require information to be medically accurate—we’re not stopping young people from being sexually active! They will continue to engage in sexual activity, but the difference is that they won’t be safe or smart about it.

SexEdMaps3

Just as our health care providers have a responsibility to provide accurate information, our schools and our health classes have a responsibility to provide accurate sexual health information. Young people—and people of all ages—have a right to accurate and complete information about their sexual health so they have the tools to make the decisions that are right for them.

Away with AIDS?

Recently, ‘Collectively Speaking’ featured a blog post  from guest blogger Dr. Lisa Fitzpatrick of United Medical Center in Washington, D.C.  The post was originally published on The Huffington Post on February 19, 2013 and, though it’s been over a year since it was first published, her arguments in favor of minimizing the use of the term “AIDS” to decrease stigma are still relevant!

TWC ED & Board ChairIt used to be that an AIDS diagnosis was tantamount to a death sentence.  Once your CD4 cells dropped below 200 or you acquired an opportunistic infection, it would be an overwhelming challenge to regain your health.  In the height of the epidemic, an AIDS diagnosis conjured up images of people with rapidly spreading rashes, who could barely breathe, and who were wasting away into nothingness.

But that’s not true anymore.  More and more people have had their CD4 cell count drop or acquired an opportunistic infection, and then go on to receive safe, effective treatment and return to health.  Despite all the advances in medical care and treatment, we’ve retained the anachronistic idea that once someone is diagnosed with AIDS, they will immediately begin deteriorating until they eventually die…and that’s just no longer the case.

The numbers tell this story clearly.  In 2010, about 487,000 people in the U.S. were living with an AIDS diagnosis. The estimated number of deaths of persons with an AIDS diagnosis, regardless of whether the deaths were due to AIDS or HIV, was 15,529. As a comparison, in 1995, there were over 50,000 deaths of people with an AIDS diagnosis.

Among The Women’s Collective’s small staff alone, several staff members have received an AIDS diagnosis at some point over the course of their lives—all are in treatment and healthy today.  So why should the term, “AIDS,” follow them around?  Especially when it represents the worst of the crisis…a time when people were dying faster than they could be diagnosed.  And, language mattersbecause of the history of the epidemic—AIDS is a loaded term.

There’s a lot behind the language of AIDS—both fear and stigma. Fear can be paralyzing, and stigma is equally problematic.  An AIDS diagnosis doesn’t mean the same thing that it used to—someone who is diagnosed with AIDS isn’t necessarily on the brink of death, and someone who has had an AIDS diagnosis in the past may be incredibly healthy today. It can scare a person living with HIV unnecessarily and it might cause others to treat them differently with no real justification.

There is, of course, is a rational reason to have specific language designate or identify when someone’s condition or health has worsened—we should be able to distinguish between someone who is living healthily with HIV and someone who is not adherent to treatment, has an opportunistic infection, or is in a more critical or serious condition.  However, the time may have come for a new way to identify that someone living with HIV is living with serious medical issues. One option might be to identify different stages of HIV with diagnoses that don’t follow someone over time.  A person’s medical diagnosis would transition between stages depending on their CD4 count, viral load, and whether or not they have an opportunistic infection. Another way might be to rely on those numbers alone. Maybe if we educate the community enough, they will know that having a CD4 count below 200 is serious without us having to designate it with a special term.

A transition away from the discourse of “AIDS” would require a lot of thought, consideration, and effort—and the conversation should include as many participants as possible. However we proceed, we need to remember that language matters and that stigma matters. And it’s worth it for us to consider whether it makes sense to use language from 30 years ago—from the worst of the epidemic—to describe today’s reality for people living with HIV and AIDS.

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.