In an article posted on June 10, 2019, I described a public health initiative supported by several major Health agencies here in the U.S. to dramatically reduce the number of new HIV cases. These agencies, like the Health Resources Services Administration (HRSA), the National Institutes of Health (NIH), the Centers for Disease Control and Prevention (CDC), and others have devised a master plan for combatting the HIV epidemic.
It is referred to as the Ending the HIV Epidemic (EHE). They have supported much of the research going on at the grass-roots level that develops practical and sustainable solutions to complex problems related to protecting at-risk communities from HIV and expanding access to critical services for those living with HIV. It is through the intensive collaboration of agencies and programs that we can see changes and transformation.
One such program was recently brought to my attention. The city of Houston is the fourth largest city in the U.S. and one of the most diverse. It is the largest city in the southern region with substantial Latino and African-American populations and as we have seen, the South is the center of a very large HIV epidemic.
The I am life® (IAL) Campaign is an example of a local intervention launched by the Houston Health Department and designed to meet the needs of the most at-risk Houston residents. One of the reasons the epidemic thrives in the South is due to the stigma against HIV and prevalent attitudes against gay men and transgender people. Superimpose onto that the double whammy of racism and how it impacts blacks and Latinos, and you create a climate where many people face regular challenges with employment, housing, and accessing the health system.
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Discrimination based on race, sexual orientation or both is more the rule than the exception and people in low-income communities frequently don’t have the knowledge, skills or financial resources to become more proactive with their health. I am Life® is an affirmative campaign that empowers black and Latino ambassadors to advocate for themselves and recognize their right to respect and longevity.
For the HIV epidemic, IAL drives home the critical elements for successful HIV prevention. First, as I have discussed in many articles, treatment is prevention. A person can only acquire HIV from another person who has HIV and is not suppressed on treatment.
You should well understand from reading my articles that a person who is suppressed on treatment, or who has so little virus in their blood that they are undetectable by the viral load test, cannot transmit HIV to someone else. Undetectable =Untransmittable. But this brings us back to the issue of why people who are prescribed medicine for HIV don’t take it. This is discussed in the recent article on medication adherence.
The IAL campaign developed an approach to get members of these disproportionately affected communities to serve as ambassadors, communicating basic principles of adhering to HIV meds to become and stay undetectable and similarly, to consider PrEP and reinforce adherence for people on PrEP. In this grass-roots approach, interested individuals had to be interviewed and undertake some training to become effective communicators of health information, particularly within networks and venues where the information is most needed.
These ambassadors shared real-life stories that highlighted the challenges of getting into and staying on treatment or getting on PrEP and practical strategies that worked for them. They can provide information and direct individuals in need of assistance to medical care and serve as a peer-support group to maintain people in care. Also, through the IAL campaign, a strategic partnership was developed with the Houston Metropolitan Transit Authority and the local KRIV Fox 26 television station.
Encouraging PSAs and messages are disseminated on local network television stations and cable programming, inside buses and on rail platforms and on social media, digital radio, gay apps, out-of-home (billboards, malls, movie theaters), print and the HoustonIamLife.com website as a regular reminder to live healthier lives. The essence of the campaign for young LGBT persons of color is to reaffirm that “I am here. I exist. I matter.”
The IAL Campaign was just launched in July of this year. Time will tell how influential the campaign will be in reducing new HIV cases in the greater Houston area. However, it is through campaigns and interventions such as these that we will ever see the reductions in new HIV cases that signal to us that the epidemic is on the decline.
Dr. Crawford has over 25 years of experience in the treatment of HIV. While at Howard University School of Medicine, he worked in two HIV-specialty clinics at Howard University Hospital. He then did clinical research as a visiting scientist with the AIDS Clinical Trials Group (ACTG) at Johns Hopkins University School of Medicine. He served as the Assistant Chief of Public Health Research with the Military HIV Research Program where he managed research studies under the President’s Emergency Plan for AID Relief (PEPFAR) in four African countries.
He is currently working in the Division of AIDS in the National Institutes of Health. He has published research in the leading infectious diseases journals and serves on the Editorial Board of the journal AIDS. Any views and perspectives in his articles on blackdoctor.org are not representative of any agency or organization but a reflection of his personal views.
