17MayFriends of NAP, The board of directors at the Nebraska AIDS Project has been working diligently to consider the changing landscape of AIDS Service Organizations (ASOs) and the need to ensure that service offerings continue for people living with HIV in the state of Nebraska and beyond for years to come. The past year has been critical in our need to acknowledge that fundraising for HIV as a cause becomes more difficult with each year, and federally funded programs remain stagnantly funded or even reduced over time. I am proud of the leadership that NAP’s staff and board have committed to over the past year, and we are excited about some of the paths we are creating to ensure that HIV continues to be a sustainable focus in Nebraska for the future. As we prepare to execute an ambitious strategic plan over the next 12-18 months, we know that the ultimate success of NAP will depend on the community’s response, and we appreciate the ongoing support from each of you. During this year’s Omaha Gives, we are asking friends to commit to the future with us! Like any strategic plan, ours will be supported by community members who share our vision for sustainable HIV care in Nebraska. We ask that you consider a donation in the amount of $50 (or more) to either Omaha Gives on May 23rd or Give to Lincoln Day on May 31st. Links to schedule your donation for either campaign can be found below. Please also consider challenging a friend, loved one or colleague to match your gift. My thanks for your continued support of the Nebraska AIDS Project. I’m excited to share the details of our future-focused plan with you in the near future. Omaha Gives: https://www.omahagives.org/NebraskaAIDSProject/overview Give to Lincoln: https://www.givetolincoln.com/nonprofits/nebraska-aids-project Donate directly to NAP: https://14770.thankyou4caring.org/sslpage.aspx?pid=298 Warm regards, Jason D. Coleman, Ph.D. Board President, Nebraska AIDS Project 18AprI think back to my younger years and how as a young adult I often felt I could conquer the world. This mindset was never truer than when I became sexually active. I always knew that I was supposed to wear protection or face these horrible consequences that I was often taught in school. However, the messages I received in those years were a very blanketed and vague collection of ideals meant to be used as fear tactics not truly a strong educational reference. It was these tools, or lack thereof, that helped form the mindset of invincibility. I felt I could not relate to what was being presented to me and in my mind so long as I wore protection I was safe. I feel this is ultimately where the disconnection often occurs when communicating messages surrounding sexual health to our young people. There are so many influences that counter the progression in sexual education with false propaganda or fear-based ideology. To name a few, sex is often viewed as a rite of passage into adulthood. Because of the hyped sensation of being sexual active through televised or digital media outlets, or simple peer pressures; these all can hinder any progress achieved in educating our youth. There are other factors that play a vital role in this education that comes from within the family unit. Sex is often not talked about or discussed in the home. Add to that, the impending fears that are used to deter from such conversations within the home either from lack of communication, or even religious stance. It is these same challenges that hinder our work to effectively communicate good, healthy practices, but none the less, it is also opportunity to get in front of the issues. Youth 13-24 make up nearly 22% of new HIV diagnosis. Young adults become sexually active at earlier ages, it is difficult to pinpoint the exact timing that these discussions should take place. But how do we get the word out there? Especially when there are influences that hinder this communication. A possible and effective tool for this demographic is Social Media. There are countless sites in which we can try to reach our youth. Not merely through advertisements, but direct posts of valuable, little “nuggets” of information, that can be referenced. I find that posting lengthy or overly stats driven posts will lose the interest and the information is not effectively communicated. It is important to be brief, impactful, and intentional; remembering to keep the message simple and easy to understand. Although it may be read quickly and then scrolled passed, it may very well implant something in the mind to think about the next time they choose to engage in sexual activity. Furthermore, because many parents utilize these same sites, it may help open the door to effective communication in the home. By educating the parent of the youth, it will give them talking points to help drive these conversations in the home in ways that are not chastising or misunderstood. What do we communicate? Not just stats and numbers, but real facts that communicate that HIV is real and next time it could be you because you are not invincible. Not to communicate fear, but promote making sound and healthy sexual choices. Not endorsing the act of sex, but empowering those if they so choose to engage in sexual activity, to be properly educated and more importantly to create a dialogue in which talk about sex isn’t taboo…but a culture in our living. In a perfect world, it would be nice if we could go into the schools and talk freely about sexual health, and even though some sexual health curriculum has made progress, there is still much room for improvement. By not changing our approach, we are inadvertently reinforcing the message of invincibility in our young people. In the meantime, we have to use the tools most accessible to us and remember to change our approach as the world continues to evolve around us. Tommy Young-Dennis is a Prevention & Outreach Specialist at the Nebraska AIDS Project in Omaha. 16AprI recently attended a meeting in which a number of public health administrators gathered to collaborate on the concept of reducing sexually transmitted infections (STIs) in the state of Nebraska and I was excited and encouraged when introductions around the room begun by saying your name, your job title and employer, and your preferred pronouns. While the concept of stating preferred pronouns during an introduction is nothing new, I’m always very aware of how providers of health care respond to the increasingly popular trend to share their pronouns as casually and frequently as they share other fundamental truths about themselves, such as their name or employer. It always seems there is at least one person in the room who is new to the concept or reluctant to share something they feel is obvious to a room full of strangers or casual acquaintances, further defining the role that privilege plays in how we see ourselves and the world around us. But the truth is that gender identity is rooted in fundamental truth, regardless of whether your personal gender expression is “obvious” to others around you. As an employee in the public health sector, I know that much has been said and done to increase awareness for trans identities during the past 5-10 years. Public representation is vastly important to increasing awareness and individuals such as Laverne Cox and Caitlyn Jenner, while not representing the trans community as a whole, have given the masses a “face” to associate with normalizing what was once considered an identity associated with shame, or at very least, confusion. As I type this piece, Microsoft Word continues to draw a staggered, green line under the word “trans”, once again reinforcing that there are still miles to go in terms of how we talk to and about trans identities. Trans women make up one of the fastest-growing populations of individuals newly diagnosed with HIV each year, steadily increasing since 2009. Living in a world that is still struggling to build acceptance for both transgender identities AND people living with HIV, I wondered about the lives and challenges experienced by someone who is both trans and HIV-positive. We asked someone to help us talk about being trans and HIV-positive. We’ll call her Shevett, a pseudonym she selected to protect her identity. NAP: Briefly describe your experience being diagnosed with HIV for the first time. Was the person caring for you at the time experienced and knowledgeable about HIV? Were there any challenges at that time related to being trans? Shevett: I came out as a transgender woman in 1986. I first learned I was HIV positive in 2012. I was initially distraught and allowed the tears to flow but soon realized this is a part of my life now and I have to cope with it. I immediately thought of my older sister who had also been diagnosed as HIV-positive many years ago. I was fortunate to have a loved one who supported me and knew how to guide me from lived experience. I met my current boyfriend around the same time of being diagnosed. He embraced both my Trans and Positive identities and we have been in a loving relationship for nearly six years. In general, I am a very private person so I’ve chosen to disclose my HIV status only to people that are close to me. NAP: If you are participating in any medical or treatment related to trans care, have you experienced any limitations or side effects in how you positively receive that care on top of HIV care? Shevett: I am not currently engaged in trans-related medical care due to past experience with adverse side effects of hormone therapy. I don’t feel like I’ve experienced any barriers with health providers in relationship to either my trans or HIV-positive status. (note that this may largely be linked to establishing care with providers who are well-informed on trans issues and HIV, this experience may not be the same for everyone) NAP: What would you say the most interesting or difficult social stigma issues have been as it pertains to being trans and HIV+ ? Shevett: I was fortunate to have a network of supportive friends, family, and romantic partners but I acknowledge that not everyone is so lucky. Many people face workplace and housing discrimination for being Trans and/or HIV positive. Due to the lack of awareness in the community, some family members, friends, and sexual partners will not take the news well when they learn that someone they love is Trans and/or HIV positive. The violence against the transgender community creates a constant fear for survival. NAP: Anything else you’d like to share? Shevett: I have a message for young, trans women today who tested positive and that is “keep your head held high and keep on living a fabulous life”. No matter who you are or how you identify, it is not our place to judge someone for who they are or what they have experienced. Lastly, I’d encourage everyone to get tested and protect yourself. Wednesday, April 18th is National Transgender HIV Testing Day. Visit any NAP test site to get tested, scheduling is easy and can be done 24/7 with online access. London Woolman is the Interim Executive Director of the Nebraska AIDS Project. 13Apr
An estimated 1,122,900 adults are living with HIV in the U.S. About 0.35% of the U.S. population. It’s estimated that 15% or 162,500 of those individuals don’t know their status.
Every year the U.S. Department of Housing and Urban Development (HUD) completes a “point-in-time count” to survey people experiencing homelessness. Across the nation, volunteers go out in the evening to survey how many individuals are sleeping on the streets that night. In 2017, 10,171 reported they were living with HIV, and experiencing homelessness that night. And, that’s only those who self-reported their diagnosis.
Depending on who's counting and where, people living with HIV and experiencing homelessness estimate from 8.5% to as high as 19.5% in the United States.
In 2017, 2,501 individuals in one night in Nebraska were experiencing some form of homelessness (on the streets, emergency shelter, etc.).
Additionally, that point-in-time count and HUD do not recognize individuals who are experiencing housing instabilities (couch surfing, near eviction, etc.).
If a person doesn’t know where they going to sleep tonight or if they’ll be safe in the morning, it’s probably difficult to prioritize health.
We can remember Maslow’s Hierarchy of Needs to show that a person’s physiological needs must be met before other needs, such as taking a medication every day.
Amanda, who does street outreach in Omaha for Nebraska AIDS Project reveals more:
"People living with HIV bring a whole new set of challenges to the already difficult time of experiencing a period of homelessness. Think about how you might take a daily medication. Perhaps you have an alarm set to take it at a specific time with a glass of water and maybe a meal. Remembering to take it is wrapped up into your daily routine usually. Now imagine you don’t have that alarm, you don’t have that glass of water easily available, you are not sure when your next meal will be, and you don’t have a clock to tell you what time of day it is. What happens if your medications are stolen and the pharmacy will not refill until 30 days have passed? Can you still take the medication if it has been exposed to extreme cold or extreme heat for long periods of time? How likely are you to take daily medications when you are constantly worried about your survival? What symptoms are you likely to experience if you do not take this medication as directed? These examples are just a few adherence barriers people face when they are HIV positive and also experiencing homelessness. Shelters do the best they can and they provide a needed service but it is wise to acknowledge that shelters are not always a good environment for everyone and shelters are often at capacity or unavailable. We often hear terrible stories of theft, violence, discrimination, sexual assault, communal illnesses, bed bugs, and unwarranted bans that take place within shelters. Some folks would rather brave the harsh weather conditions to live unsheltered instead of giving up a beloved pet, being separated from their partner, and subjected to a vulnerable position. Most people who are experiencing a period of homelessness are not the stereotypical scary criminals and drug addicts. Unless you are Warren Buffett, we are all just a few paychecks away from experiencing homelessness. Maybe you are lucky and have an extensive network of friends and family that would support you, maybe you aren’t so lucky. I simply ask you to please avoid judging those experiencing a period of homelessness. You have no idea what trauma they have lived through and what barriers may be keeping them in this position. Be kind."
Looking at the HIV Care Continuum, we notice that there continue to be gaps in care from the time a person is diagnosed, to achieving viral suppression.
(Graphic from CDC, 2014)
- Housing instability delays HIV diagnosis and leads to increased risks of acquiring HIV.
- HIV medical care and treatment is a lifelong process, housing status is among the strongest predictor of maintain continuous HIV primary care.
- Taking medications may have competing needs, like food, hygiene, and shelter.
- Studies consistently find homelessness and housing instability are directly linked to higher viral loads and failure to achieve or sustain viral suppression, even after controlling other factors known to impact treatment effectiveness such as substance use and mental health needs (Aidala, et at. 2012; Leaver, et al. 2007; Kidder et al. 2007).
Nebraska AIDS Project is lucky to have resources like Housing Opportunities for Persons with HIV and AIDS (HOPWA). This program allows case managers to help clients apply for emergency rental assistance, or a security deposit to get them into safe housing.
Every day, case managers are working to help client avoid homelessness through wrap-around services.
If you are living with HIV and have housing or case management needs, contact us here.
Lacie is the Prevention & Support Services Supervisor for Nebraska AIDS Project in Lincoln.
26MarI was asked to help contribute to this blog entry about “How to Be A Trans Ally”, and I sat down, wrote, rewrote, and really struggled with completing the task. What could I possibly write that hasn’t been written dozens of times before? What’s the shortest, clearest, easiest way to get my point of view across, and what did I want the main message to be? Here’s where I’ve landed - I don’t feel that figuring out how to treat a Transgender person is some big mystery at all. How can you act as a Trans ally? Well, in my opinion, it’s simply this- just treat me, and any other Trans person, and their gender identity just like any other person, or persons on the street. Be cool, be respectful, acknowledge it, and then go about the day. My gender identity is a factor in my life but isn’t the end all be all of who I am nor does it define me as a person any more than a cis gender person’s gender identity defines them. At the risk of basically just saying “Hey guys, just treat me like any average person” because of my gender identity, I’ve come up with a few examples that illustrate my point. Accepting Penny as Penny So, I guess I’ll start with a question- How often in conversations with a cis gender person do questions about that individual’s body, gender identity, pronouns, or any personal information come up? I’d venture a guess and say, not very often. I’d suggest steering away from that type of subject matter with a trans person as well. If you do feel that you’re unclear about which pronouns to use, or how to address someone, the best thing you can do is just ask them. Once you’ve been informed don’t bring it up again, or ask a bunch of questions, that person has just told you how they’d like to be addressed so just follow their lead. It’s only slightly different from having a cis gender friend whose name is Penelope but goes by Penny. Nobody digs at Penny. No further questions are asked. It’s just accepted, it’s just Penny. “What’s Real?” Continuing with this example of your cis gender friend Penny, you know her, you accept her, you address her as she’s asked you to, and you respect her. I’m sure that you wouldn’t ask Penny invasive questions about her body, or appearance? Questions like, if she’s wearing extensions, or if she’s had any alterations to her body. You probably just look at her and say, “Yep, that’s Penny.” I’d suggest using the same approach when it comes to a trans individual. You may feel that some of these questions are harmless, but in my experience when I’ve been questioned about my appearance it feels as though someone is saying to me, “What parts of you are real, and which have you altered to give the appearance of being a woman?” My hair, my eyelashes, and my body do not define or make up my womanhood in any way, and if you were to take those things away I’d still be a woman. It’s all real when it comes to what’s on the interior, and I am a “real” woman – same as cis gender Penny. This Isn’t the Most Interesting Thing About Me Every morning when I wake up, I’m aware of my gender identity. I know that I’m a woman in the same way that good ol’ cis gender Penny wakes up and knows she is a woman. Being trans isn’t something I feel any shame about, but it’s also something I don’t want to have to acknowledge regularly for your benefit. I do not want or need to have daily conversations about it because it’s only one factor of my life. Being trans doesn’t put a limit on what I can and can not do; who I’m able to be; what I am able to do, and it’s not even the most interesting thing about me. At the end of the day, my gender identity is pretty irrelevant. Don’t get me wrong, I’m a woman, and I’m very happy and proud to be one, but being a trans woman shouldn’t raise your barriers, open up any other line of questioning, or result in treatment that you wouldn’t apply to any cis woman. Don’t be Weird, Be Normal Everyone’s got their own sack of rocks. Every day is a little different – somedays you barely notice the weight, and other days the weight is so overwhelming it feels like it’s going to drag you down to depths you don’t want to even think about. My baggage is not the same as yours, but we all have rough days. Approach me the same way you’d want someone to approach, handle, and discuss whichever sack of rocks you happen to be carrying. Everyone is going to have a slightly different take and these suggestions are mine-only. I’m not speaking for any other transgender person…there isn’t one “transgender experience” umbrella that we all fall under, but ultimately I believe the best way to be a trans ally is to treat me/us with the same respect you would any other person. You won’t have to worry about tightrope walking what may or may not be considered offensive. You won’t be reading entries about how to be a trans ally, and maybe we won’t even need to write blogs about what it means to be a “trans ally” because by treating trans folx the same way you would any other cis gender person, you’ll already be one. For More Information Trans Day of Visibility (TDOV) is a day dedicated to celebrating the accomplishments and victories of transgender & gender non-conforming people while raising awareness of the work that is still needed to save trans lives. For more information about TDOV, click here: http://www.transstudent.org/tdov Events happening locally in Omaha: https://www.facebook.com/tdovomaha/ Aubrey Gartner is a Guest Services Receptionist at the Nebraska AIDS Project office in Omaha. 7MarLast spring, we sent our annual campaign letter and reports to you and in the last paragraph it read “with you, we can start to author the last chapter of HIV in our community”. Within the larger community of HIV-focused care, we talk a lot about “getting to zero” as it relates to both new diagnoses and individuals who are HIV+ but not actively in medical care, or “an HIV- and AIDS-free generation”, and yet the number of new diagnoses just in the geographic region that we serve (Nebraska and portions of Iowa and Wyoming) remains steady each year. In order to achieve a future that is free from new diagnoses, we have to become comfortable with talking about our history. A history that, when specific to HIV and AIDS, is often focused and recalled specifically for its trauma. Language is important, and we know that while attempting to author new chapters, we have to acknowledge the use of words like “plague” and “epidemic” and “crisis” that have highlighted the trauma we’ve both experienced and wrote about in our initial chapters. We cannot escape the language or the trauma of our history, but we can actively work toward rewriting our future. We are asking you to join us in re-shaping the future of HIV and AIDS by proudly contributing to a cause that, despite its traumatic past, continues to pursue a hopeful future. With focused investment and action, we can simply do better. Invest in our commitment to:
- Maintain HIV-focused care throughout Nebraska, Iowa, and Wyoming
- Advocate for the interests of persons living with HIV (PLWH)
- Focus on maintenance of stable housing, access to insurance, and viral suppression among PLWH
- Provide targeted outreach, free testing, treatment as prevention, and education to populations at-risk for transmission of HIV