Ryan White Part D Stands in the FY 2015 Spending Plan

In a previous Policy Brief, published in the spring of 2014, The Women’s Collective commented on the President’s proposal to condense Ryan White Part D funding into Part C in the budget for the 2015 fiscal year. Ryan White Part D provides medical care and support services to women, infants, children and youth, while Part C provides comprehensive primary health care to people living with HIV/AIDS, without a focus on a specific group. We argued that there is some merit to this proposal, as Part D funding has been especially competitive and the number of children being born with HIV is declining. However, we also voiced serious concern about this proposal, as it is signifies the underrepresentation of women and families effected by HIV. Women and families effected by HIV should not be forgotten in HIV services, funding, and advocacy—they have unique needs that go beyond quality health care and treatment.

With these concerns in mind, we are pleased that the spending plan released by Congress on December 9, 2014 did not enact the President’s proposal, that would have eliminated Ryan White Part D. While Ryan White Part D will not be collapsed into Part C for the 2015 fiscal year,  we must continue to work to ensure that HIV’s effect on women and families is recognized and addressed.

Break The Silence

By Mary Bowman

On October 29th at 10:23am, I had an epiphany. Six days before the epiphany my office, The Women’s Collective, was saturated in purple for ‘Purple Thursday’ in recognition of Domestic Violence (DV) awareness month. It was amazing to watch women going back and forth sporting everything from purple clothing to matching purple jewelry. I even adorned a mad hatter styled purple hat. We took lots of pictures and posted all over social media in an effort to bring awareness to something that one in every four woman will experience in her lifetime, DV.  That plagued my mind for days. One in EVERY four women will experience DV in their lifetime.

On the morning of October 29th I was reminded, with flashbacks of my father’s fists to my face, my mother’s eyes watching helplessly, and screaming in the middle of the street for help, that I was that one in every four woman. I had experienced DV and didn’t even think to call it what it was. I wasn’t the child that was physically abused by her parents throughout her childhood and I never had an intimate partner DV situation. My father only physically attacked me once so; I assumed I was exempt from the title of DV survivor. I thought, wow, how many other women walk around with these stories in the attics of their minds? How many other women or even men don’t realize that they are a survivor of DV.

Thankfully there are women in the community who are not only survivors of DV but advocates of DV Awareness by sharing their own personal stories. On October 30th I accepted an invitation to an event called ‘Break The Silence’. I went representing my organization but I ended up standing in solidarity with fellow survivors and pouring libations for those who we have lost to DV. The event was held at a community center in the Benning Park area of South East, DC. Guests, both women and men, arrived on time with their families and friends eager to find solace, support, and information about DV. There were two main speakers one of which was Ms. Queen Afi, a compassionate, no nonsense, straight forward and candid mental health professional who experienced firsthand the unspoken dichotomy of DV. She was not only a survivor of DV but through the toils of life’s experiences, became an abuser as well.

After the speakers finished the guest enjoyed catered food, raffle getaways and even belly dancing to help change the mood after the exchange of DV stories. I connected with Queen Afi and have plans to work with her as we here at The Women’s Collective seek to bring awareness not only to DV but also gender based violence using the trauma informed care approach. Attending the event settled by emotions that followed my unexpected epiphany. It allowed me to see that DV comes in different shapes and sizes and with my new outlook on DV I am better equipped to help bring awareness and support to others who are survivors just as I am.

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.

Recognizing the Connection between HIV and Domestic Violence

October marks Domestic Violence Awareness Month. Over the course of the month, events occur in communities around the country, to bring to light both the pervasiveness and effects of domestic violence. TWC will be participating in awareness raising events in the coming weeks, such as Purple Thursday, where members of our office will wear purple to show support for survivors of domestic violence.

We believe we have an important role in supporting and advocating for survivors of domestic violence, because of the intersection between HIV and domestic violence. In fact, we identify gender based violence as one of our five policy priorities, which guide our policy and advocacy work. Gender based violence is identified as one of our policy priorities, as it effects the health of women living with or at risk for HIV.

For example, women living with HIV in the United States experience intimate partner violence at a rate that is double that experienced by all women in the United States. This violence leads to HIV infection, and vice versa.  Women who are abused by their partner fear condom negotiation and report more unprotected sex, a risk factor for HIV. Additionally, women who are HIV positive have experienced violence when disclosing their HIV status to their partner. Further, violence has been linked to a greater chance of antiretroviral therapy failure among women living with HIV.

With this research in mind, it is clear that domestic violence can have a substantial effect on the health and well-being of women living with and at risk for HIV infection. To best address this link, we recommend that a focus be placed on trauma informed care, so that HIV care providers can best recognize and support HIV positive patients who are survivors of violence. Additionally, we recommend resources to promote healthy relationships, beginning with educating youth on healthy relationships and providing resources to support violence free relationships throughout life. During all months of the year, but especially during Domestic Violence Awareness Month, we call on policy makers and advocates to continue to push for resources that support violence-free relationships for all.

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).

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?

Employment Training: Lifting DC Women Out of Poverty

As The Women’s Collective’s care program targeting women living with HIV grows so does the number of women participating and the wide range of services that are required to meet their need.

Again and again we hear women identify job readiness programs that would provide education and employment support as a priority.  So many women come through our doors and express frustration around the fact that they have difficulty getting experience, finding available jobs, filling out job applications, creating an attractive resumes, and drafting an effective and compelling cover letter.

Center for American Progress. The Straight Facts on Women in Poverty. October, 2008.

They are desperately seeking a way out of poverty for themselves and their families—a poverty that is incredibly pervasive among women and African-Americans in D.C.  In all racial and ethnic groups, women are poorer than menBlack and Latina women are twice as likely as white women to be living in poverty. In fact poverty is the single most important factor  in whether inner-city heterosexuals are infected with the AIDS virus according to the Centers for Disease Control and Prevention (CDC).

Our medical case managers take a number of steps when a woman comes in looking for a job or for help with a job application.  Often, staff members (whether it’s the medical case manager, community health worker, or even a youth team member) take the time to help clients edit their resumes, craft their cover letters, and fill out and submit their applications.  However, staff have full case loads, and are not always able to carve an hour or two out of their already packed day to work on an application or a cover letter with a client.

In addition, we make a wide range of referrals to job readiness centers throughout Washington, D.C. that provide job skills, resume assistance, mock interviews (including both the interview and “dress for success”), computer skills, on-site counseling. One relationship we have begun to forge is with Byte Back that seeks to improve economic opportunity for individuals. Their goal is to provide high quality computer courses to unemployed and underemployed residents and support them in obtaining employment that pays a “living wage.”  They also provide job readiness assistance such as mock job interviews, resume writing skills, and assistance with job searches.

Mom & Daughter 1These services are critical for the support and opportunities they provide to women but they’re not enough—services need to be more accessible as many women face barriers in accessing them. For example, women often do not have the extra funds to get to sites around the city as the costs for public transportation continues to increase. Women often do not have child care for the time that they need to attend a class or meet with a counselor. Another significant barrier is access to professional clothing for job interviews. To address this we created an onsite “clothing closet” so that our clients can find attire to wear for an interview. (Donations are always accepted for gently used clothing and shoes so stop on by with a bag or two!)

If community-based organizations (CBOs) that are already providing myriad support services for women had additional funding to hire staff, they could either free up time for their current staff to work one-on-one with women who are seeking employment search support or they could hire employment counselors and computer training specialists that would provide services on-site.  This could work in two ways: women who are in need of employment support services might be more encouraged to see their medical case managers, and check in about their care, because they’re already on-site and, likewise, women who are already on-site for any of the other services offered by a CBO would be able to take advantage of the employment support services without the added burden of additional transportation or child care.  We will be seeking ways to build this type of funding and more synergy with CBOs throughout D.C. and across a range of services.

Each service and referral that The Women’s Collective provides is important to the women we serve.   The Women’s Collective provides a combination of services for women to overcome barriers that keep them homeless and/or destitute and that prevent them from accessing care and taking control of their health.  We can only do so much—we need additional unrestricted funding and strong partnerships with CBOs so that we can continue to keep women moving forward on a path out of poverty.

The Women’s Collective will continue to foster, nurture and provide encouragement to turn a life around.

Outreach in DC: Meeting Community Needs and Testing for HIV

The Women’s Collective offers free HIV-antibody counseling and testing at our office, at partner agency sites, and at locations throughout Washington, D.C. through our mobile testing unit. By taking our testing service “on the road,” we are literally able to meet women and their partners where they are—in their neighborhoods and as they access services from other D.C. organizations. In order to determine where we’ll be offering testing throughout the city, we gather information from “gate keepers” (respected leaders in the community), ward mapping, epidemiological data, and staff to identify areas in which D.C. residents are at highest risk. Then we take our testing on the road.

mobile_van_testing_1024x683Our work with the community doesn’t stop with an HIV test—we strive to meet other needs by providing referrals, as well as various incentives. Incentives both encourage individuals to get tested and help them meet individual needs—we vary our incentives depending on the needs we’re seeing out in the community. For example, we offer gift cards to local businesses, including Subway, Murrays, Giant, Dollar Tree, and McDonald’s. We also offer hygiene bags, which include toothpaste, toothbrushes, underwear, body wash, body lotions, and seasonal clothing items, and grocery bags of boxed and canned foods. In warmer weather, we offer TWC-branded clothing as an incentive such as a tank top and tights or a dress for getting tested. Anyone who refers a friend for testing receives a pair of flip-flops.

In reviewing client files as part of our quality assurance (QA) process, a pattern emerged that many individuals who received HIV testing frequently asked for referrals to a food bank. Our team met to discuss this trend and developed an incentive in response. We purchased bulk canned and boxed groceries (including pasta, mac and cheese, ramen noodles, mashed potatoes, sloppy Joe, chili, Vienna sausage, apple sauce, vanilla pudding, beef ravioli, and other nonperishable products) from a grocery store, which were divided up and placed in bags. We placed a bright fluorescent poster aboard our unit that reads, “Get a Bag of Groceries + a Free HIV Test.” This incentive directly meets need in the community we serve, especially among women who have children and limited household budgets.

Incentives are an integral recruitment strategy for HIV testing. Incentives have helped us to reach our monthly testing numbers and have surpassed our program testing objectives annually. They also provide us with an opportunity to address a widespread need in the D.C. community that directly ties into the crippling poverty that exists in some neighborhoods—primarily the neighborhoods that we serve. The Centers for Disease Control and Prevention (CDC) has identified poverty as the single most important factor in whether inner-city heterosexuals are infected with the AIDS virus. Strikingly, according to the D.C. Fiscal Policy Institute, 1 in 5 D.C. residents lived below poverty in 2012; 26% of Black residents lived in poverty compared with 7% of White residents. Among female-headed households, the poverty rate is a staggering 32%.

These statistics most certainly contribute to the high rate of HIV in D.C. as the lack of economic and educational resources and opportunities impacts the health and well-being of communities. HIV testing can be the gateway to other services and support that can contribute to ensuring individuals take control of their health and improve their quality of life. At The Women’s Collective we believe that we all can and must do more to support those in D.C. who need the most as resources continue to become scarce.

(Note: We will be conducting outreach in honor of National HIV Testing Day on Friday, June 27 with collaborative partners United Planning Organization and Physicians Rx Pharmacy in DC! Get the details here and join us!)