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Stigma & HIV in Rural Iowa

April 29, 2019 | By NAP, News

Written by Ashlee Folsom, Prevention & Outreach Specialist for Southwest Iowa

In April 2018, I started a project funded by the Iowa Department of Public Health, to increase HIV testing in rural Southwest Iowa.  Since the project began, I have had a lot of success building relationships with community service providers and clients, providing HIV testing, and connecting clients to needed services.  However, I have also encountered an important roadblock: stigma. 

I have taken time to build relationships to overcome stigma.  When I started the project, I reached out through existing agency partners to connect with community service providers in Southwest Iowa.  Although many providers were excited about the project and saw the need their clients had for HIV testing and other related services, several community service providers commented that they did not provide HIV testing or other related services to their clients, due to a lack of HIV in the area.  I have worked to overcome this stigma among community service providers in several ways.  First, I have relied heavily on the IDPH Rural Outreach Liaisons.  The information they share with medical and other community service providers has been wonderful to dispel myths about HIV in rural Iowa.  Next, I have been so grateful for print and media information from IDPH, on current Iowa HIV statistics.  Furthermore, I have continued to build relationships by attending community collaboration meetings and networking in person with community service providers.  Building trust among community service providers is a key step to the success of my project. 

Retrieved from iowadot.gov
Ashlee serves 16 counties in Southwest Iowa, including Pottawattamie County (Council Bluffs).

As I have continued my project and worked directly with clients, I have also heard many myths that are contributing to stigma.  Many clients have said they feel that HIV doesn’t happen in their town, that they would definitely know if they had a HIV due to symptoms, that they can tell by looking at a person if the person has HIV, that they definitely don’t have HIV because they are in a long term relationship, or that they have been tested for all HIV due to having blood drawn at some point.  To overcome this stigma, I have found it best to provide HIV 101 education to groups of clients, right before offering testing.  I am able to build rapport and dispel myths, so that clients feel comfortable, and see the importance of HIV testing.  Providing education first, and testing after is also a key step to the success of my project.  I also find that encouraging clients to test by offering other services, such as Hepatitis testing, or conducting testing at an agency where other services are happening at the same time (vaccinations, a free health clinic, or health fair) works great.  Clients are more likely to get tested for HIV if they can also receive these other services.  Furthermore, I find that offering a prize for testing gives clients an “excuse” if they really want to get tested — but they can tell their friends they just want the free T-shirt.     

In conclusion, I have had to work to overcome stigma related to HIV in rural Iowa.  The steps I have used to overcome stigma have helped the success of my program.  Most importantly, connecting with community service providers, providing education to clients, and offering HIV testing along with other services has helped me overcome stigma and increase HIV testing in rural Southwest Iowa. 

Ashlee enjoys metal music and spending time with her two dogs Maverick & Harper.
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Knowledge is Power – HIV & Pregnancy

March 7, 2019 | By Brent Koster, News

March 10th is National Women and Girls HIV/AIDS Awareness Day #NWGHAAD

This year, we’re taking a moment to consider HIV and pregnancy and that knowledge is power.

During my first pregnancy, in my first OB appointment, I received STD testing. I assumed this meant all STDs, including HIV. However, I learn this wasn’t the case until years later, when I began working at NAP. Nebraska was one of the few opt- in states, meaning that I would have to have ask specifically for an HIV test during my pregnancy, in order to get tested. That blew my mind. I realized I could have unknowingly passed on HIV to my son. And it made me wonder perhaps how many other expecting mothers didn’t realize they were at risk of not knowing their status? My doctor’s office never asked me if I wanted an HIV test. I went my whole pregnancy without knowing my HIV status, and the more I thought about it, that also meant I went my whole sexually active life without knowing my HIV status, because I had never specifically asked for an HIV test.

According to the Centers for Disease Control and Prevention, what does HIV and pregnancy look like today?

  • Approximately 8,500 women living with HIV give birth annually (based on an estimate from 2006, the most recent available).
  • Between 1994 and 2010, an estimated 21,956 cases of perinatally acquired HIV infections were prevented.
  • In 2016, 99 children under the age of 13 received a diagnosis of perinatally acquired HIV.


Rate of Perinatally Acquired HIV Infections by Year of Birth and Mother’s Race/Ethnicity
2010-2014

CDC, 2019

In February 2018, the Nebraska legislature passed LB 285, a bill that changed Nebraska from an opt- in state to an opt-out, meaning expecting moms have to ask not to take the test. It is now considered part of routine testing for pregnant women.

I’m now in my second pregnancy and my first OB appointment featured a consent form for an HIV test. It has made me think about the benefits of expanding the Nebraska law to include all health care patients. According to CDC recommendations, “HIV testing and opt-out HIV screening be a part of routine clinical care in all health-care settings while also preserving the patient’s option to decline HIV testing and ensuring a provider-patient relationship conducive to optimal clinical and preventive care”. Some people are worried about the ethical implications of being required to take an HIV test. But the point is you don’t have to. You can say no because you are given the choice, rather than never knowing there was a choice to begin with.

What it comes down to is that knowledge is power. Knowing your status is power.

Hayley is a soon-to-be mother of two and works at Nebraska AIDS Project in Omaha.
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Advocacy: National & Local Pathways

February 6, 2019 | By NAP, News,Spotlight

As part of his State of the Union address Tuesday night, President Trump announced a ten-year plan to end HIV as an epidemic in the United States by 2030.

We agree with the President that now is the time to take intentional steps towards ending HIV transmission through tools such as: U=U, PrEP, and rapid treatment for people diagnosed with HIV. However this administration has targeted communities in ways that worsen the U.S. epidemic, including cuts to the Affordable Care Act, budget cuts in HIV research, and attacking the human rights and safety of transgender people.

Ending the HIV Epidemic: A Plan for America

The four key strategies outlined by Ending the HIV Epidemic: A Plan for America, Diagnose, Treat, Protect, and Respond reflect how far science has advanced in preventing new HIV infections. We are committed to monitor this plan and push for inclusivity in ending the epidemic.

In Nebraska, we have several current legislative opportunities to advance overall health and wellbeing for our community. While these initiatives do not address HIV directly, these important bills provide protections to the LGBTQ communities, which are disproportionately affected by the HIV epidemic.


Warner Chamber at the Nebraska Unicameral
Photo: Nebraska Unicameral Information Office

LB 167 & LB 168 – Conversion therapy

  • Ban advertising and profiting of conversion therapy statewide
    • Conversion therapy means practices or treatments that seek to change an individual’s sexual orientation or gender identity, including efforts to change behaviors or gender expression or to eliminate or reduce sexual or romantic attractions or feelings toward individuals of the same gender.
    • This does not including counseling that provides acceptance, support, and understanding of an individual
  • Classify placing a minor in conversion therapy as child abuse

LB 627 – Prohibit Employment Discrimination

  • Gender identity and expression and sexual orientation will be protected classes, prohibiting employment discrimination

Nebraska AIDS Project is submitting letters in support of both of these legislative bills.

Both of these bills are scheduled for hearings on Thursday, February 7th at 1:30 pm with the Judiciary committee.
We urge you to contact your senator and testify in support of these bills.

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Executive Director chats on KIOS

November 12, 2018 | By NAP, Events,News

Executive Director, Brent Koster chatted with Mike Hogan on “Live & Local” this morning to talk about the important work Nebraska AIDS Project does, and the event of the year, Night of a Thousand Stars!

This year’s event is held on Saturday, November 17th, with the theme Hooray for Hollywood. The evening will be filled with cocktails, hors d’oeuvres, silent auction, and raising money for Nebraska AIDS Project.

Listen to the interview here on KIOS, 91.5’s website.

Every year Nebraska AIDS Project recognizes a community member who has gone above and beyond to advocate and education about HIV and AIDS in our community.

The 2018 Shining Star Recipient, Erin Share Fulton has been making a difference in the Omaha community by volunteering as a Certified Testing Counselor with NAP since 2014. Erin believes that by sharing her story, she will be get others #ThinkingTalkingTesting.

Read more about Erin, on the blog here.

To join Honorary Chairs, Rick Clark & Tommy Wolf at the event on Saturday, November 17th, purchase tickets here.  General admission tickets are available until November 17th at noon. Tickets can be purchased at the door.

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Night of a Thousand Stars 2018 – Shining Star Recipient

October 11, 2018 | By NAP, News

Nebraska AIDS Project is pleased to announce our 2018 Shining Star Recipient, Erin Shafer Fulton.

Every year, Nebraska AIDS Project recognizes a community member who has gone above and beyond to advocate and educate about HIV and AIDS in our community. This year’s Shining Star Award winner is Erin Shafer Fulton. It has been an honor and privilege to know and work with Erin. Her work advocating for HIV testing and prevention has made a huge difference for the Omaha community and, especially, the work in HIV and AIDS.
Nebraska AIDS Project was founded in a time of great uncertainty – at a time when the President refused to even utter the word “AIDS”. No one knew how things would play out, but courageous people knew that, in the face of impossible odds, they had to do something. It’s because of those people that we have places like NAP today. They made what seemed impossible possible.

Erin Shafer Fulton is a passionate person working fiercely to stop the stigma of HIV and AIDS. She is married to her husband Troy of 9 years. Erin is a mother and bonus mom to 4 children, Ashley (17), Charlotte (8), Michael (16) and Kaylee (21). Erin is celebrating living with HIV for 25 years. She believes that adherence to her antiretroviral medication, healthy lifestyle and her positive outlook contribute to her success. Erin graduated from Bellevue West High School after she was diagnosed in 1994. She attended Cape Cod Community College and Metropolitan Community College. Erin has worked as a Financial Advisor since 2007. Erin decided to make a difference in the Omaha community by volunteering as a Certified Testing Counselor at NAP in 2014. Recently, Erin competed as Mrs. Douglas County for Mrs. Nebraska and won the Mrs. Congeniality Award and The Patty Steele Lifetime Achievement Award. Erin believes that by sharing her story she will get others #ThinkingTalkingTesting.

We congratulate Erin in all of her hard work to help end HIV/AIDS and we look forward to formally recognizing her efforts at Night of A Thousand Stars – Hooray for Hollywood on November 17, 2018.  Purchase tickets here.

Volunteers are still needed for Night of A Thousand Stars. We are looking for volunteers for set-up, tear-down, and during the event. And, all volunteers will receive 1 General Admission Ticket to the event! To volunteer, please fill out the Volunteer Registration Form.
If you have any questions about volunteering, please contact Mitch at 402-552-9260 x 116.

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