Analysis Sexual Health

The 30 for 30 Campaign: Fighting for Women With HIV and AIDS

Martha Kempner

I talk to C. Virginia Fields the Chairman of the 30 for 30 Campaign, which has brought together numerous national and local advocacy and service delivery organizations to focus on the unique needs of women who are affected by HIV and AIDS, especially black women and transgender women. 

The 30 for 30 Campaign, spearheaded by the National Black Leadership Commission on AIDS (NBLCA), has brought together numerous national and local advocacy and service delivery organizations to focus on the unique needs of women who are affected by HIV and AIDS, especially African-American women and transgender women. Women with HIV enter into care later, are less likely to receive anti-retroviral therapy, have twice as many HIV-related illnesses, and a higher mortality rate than HIV-positive men.  Moreover, women at risk of or living with HIV are more likely to be living in poverty — 64 percent of women in ongoing HIV care have incomes below $10,000 compared to just 41 percent of men. And, while Black and Latina women make up only 12 percent and 14 percent of the female population in this country, they make up 80 percent of those living with HIV and/or AIDS. 

Those involved in the campaign — named to represent the 30 years of the AIDS epidemic and the fact that women make up almost 30 percent of the cases — saw an opportunity to address the needs of women with the introduction of the National HIV/AIDS Strategy (NHAS) which helps focus the government’s response to the epidemic, and the Affordable Care Act, which will shift how health care is provided in this country. I recently talked with C. Virginia Fields, the President/CEO of the NBLAC and the Chairman of the campaign, to discuss the disparities faced by women and the steps we can take to fix them. 

Ms. Fields reminded me that the United States has been requiring any country that received money for HIV/AIDS prevention and care to have a national strategy on AIDS, but that we didn’t have one in place until 2010. She sees the NHAS as a great step forward but feels that there were many missed opportunities to address the specific needs of women. When I asked why she thought this happened, Field’s agreed that HIV is often still thought of as a man’s disease and more specifically a disease for men who have sex with men or those who use drugs. Women, including African-American women, most often contract HIV from heterosexual sex which is less controversial and gets much less attention. Still she suggested an even simpler reason: “Because women’s voices are not at the table when a lot of these decisions are made.”

One of the campaign’s initial goals is to work with the Presidential Advisory Council on AIDS (PACHA) to ensure that the implementation plan for the NHAS includes more specific “provisions, goals, and metrics to measure progress for women living with and affected by HIV.” A good step toward this goal was made just a few weeks ago when PACHA passed a resolution that acknowledges the “devastating and severe impact of HIV on women and their communities.” With the resolution, PACHA calls on Health and Human Services Secretary Kathleen Sebelius to request all relevant federal agencies update the NHAS implementation plan accordingly. In a press release, Fields called the resolution:

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“…a monumental achievement in efforts to assure that the rights and needs of women are being addressed in national policies and decisions affecting women and girls living with and impacted by HIV/AIDS.”

The work of the 30 for 30 Campaign is not done, however, and it is pushing numerous specific ideas on how to address the disparities women face in HIV/AIDS prevention and care, as well as the underlying social drivers that fuel inequalities. The campaign has released three briefing papers that detail these recommendations.

Expand services to address all the needs of women.

Women living with HIV are not only more likely to be living in poverty, they are also more likely to be responsible for taking care of and housing other members of their family, in particular children. More than twice as many HIV-positive women (76 percent) as HIV-positive men (34 percent) are living with and caring for children under 18 and 75 percent of women living with HIV are responsible for housing themselves and their children. These added responsibilities can make it more difficult for women to seek and afford the health care they need. In one study, more than 10 percent of HIV-positive women in treatment reported going without medical care in order to pay for household food and other necessities.     

The 30 for 30 Campaign suggests that a broader set of services is needed in order to help women overcome these barriers.  Women need access to transportation services, stable housing, and food. Food insecurity can be particularly problematic to those on anti-retroviral therapy (ART) because adequate nutrition is required for these medications to be effectively absorbed and can also help reduce side effects. The campaign also suggests a more widespread use of case management services to help women stay in care and adhere to their ART regimens.  In one study, 78 percent of participants with case management services were still using medical care six months after enrollment compared to 48 percent of those without case management. 

Fields explained that a family-centered care approach to both sexual and reproductive health or HIV counseling:

“… would allow for more in-depth discussion that gets in to issues of domestic violence, of other needs—economic status, transportation, food—if they don’t have these things, they’re not going to keep the next appointment.”

Integrate HIV, sexual and reproductive health, and intimate partner violence services.  
Fields described the care women now receive as being “siloed” so that HIV prevention, treatment, and care is separate from sexual and reproductive health care which is separate from services to prevent and treat intimate partner violence. The campaign suggests that this split:

“…forfeits opportunities to engage women in HIV testing, improve their prevention behaviors, and assure the access to care and information needed by HIV-positive women.” 

In 2010, for example, nearly five million women accessed federally-funded family planning services but fewer than two in 10 of them were tested for HIV during their visit. Similarly, fewer than 10 percent of HIV providers screen for intimate partner violence even though such violence is thought to account for at least 12 percent of HIV/AIDS infection among women in romantic relationships. 

The campaign envisions integrated HIV, STI, and violence services. Under such a system voluntary HIV counseling and testing would routinely be offered in family planning and sexual health care clinics; HIV/AIDS services providers would refer all patients to STI screenings as well as other family planning and reproductive health care services (or better yet be able to offer such services themselves); and screening for intimate partner violence would be provided in all settings that provide HIV and/or sexual and reproductive health services. 

When I asked Fields why she thought these clearly related services were so isolated she pointed to funding as a baseline issue: 

“I think the way the funding has been allocated speaks to the problem. Funding sexual and reproductive health clinics separate from HIV is a problem.  If the funding incorporates the two, it creates a level of integration of services that is needed.” 

Fields also acknowledged the role of discomfort and stigma around HIV:

“Centers that typically don’t do HIV testing, treatment, have been reluctant to engage around integration of some of these services.”

Her organization has started some training programs to help those that do sexual and reproductive health care become more comfortable with HIV care.  Fields argues that:

“Dealing with the whole person, gives us the chance to adapt [our services] to that person.” 

Focus on Women-Controlled Prevention Methods

The first line of defense against the sexually transmitted spread of HIV is the male condom but obviously its use depends on a willing partner and many women, especially those who are experiencing intimate partner violence, are not in a position to negotiate condom use with a male partner. The 30 for 30 Campaign suggests that providers of male condoms be trained to provide the female condom in order to help overcome the negative perceptions of this prevention method.  That said, the female condom does not solve the larger problem as it is not a method that can be concealed from an unwilling partner. The campaign recommends an investment in treatment as prevention options, pre-exposure prophylaxis, and microbicides. 

Produce Better Data and Research on Women

In order to better address the needs of women, public health professionals and medical providers need a deep understanding of the existing gaps in services and how they impact women. The campaign points there is a great deal that we don’t know because of the data collected and the way it has been analyzed. For example, we don’t yet know:

“the gender break-out among people living with HIV whose viral load is currently undetectable, or the number of women on ADAP waiting lists, or what percentage of condoms purchased by state health departments are female condoms.  Worse, transgender women are often completely missed and not accurately counted in HIV surveillance data due to provider discomfort.” 

The campaign suggests that all data must be disaggregated by sex and gender.

I ended the conversation with Ms. Fields by asking about the social drivers highlighted by the campaign.  The underlying poverty and the disparities that go with it are not only at the root of the HIV/AIDS epidemic but the overall STI epidemic as well as teen pregnancy and births in this country and so many other public health crises. I asked her how we even begin to deal with such an systemic problem. Like many people, Fields believes that the NHAS is a good start because it recognizes all of these factors and accepts that HIV does not stand alone. She believes that it has begun to address HIV/AIDS issues in a new way but that the next step is to ensure that all federal funding and agencies are working together from the Centers for Disease Control and Prevention to the Department of Housing and Urban Development to the Department to Education — which is often left out of the equation. 

Moreover, she said that we have to stop the worrisome trend of sliding back into a medical model of prevention that handles one “at-risk” population (like men who have sex with men) at a time instead of looking at communities:  “One thing that needs to happen in the Black community, for example, is that we need focused efforts almost like a laser beam until we can see a turn around.  We know, based on data and zip codes, where the problems are and we need to focus on them until there is acknowledgement that they are all at risk.”

(Note: All of the data comes from the 30 for 30 Campaign Briefing papers. At this point only one of the briefing papers is available online but check the NBLCA website as they should be up soon.)

News Health Systems

The Crackdown on L.A.’s Fake Clinics Is Working

Nicole Knight

"Why did we take those steps? Because every day is a day where some number of women could potentially be misinformed about [their] reproductive options," Feuer said. "And therefore every day is a day that a woman's health could be jeopardized."

Three Los Angeles area fake clinics, which were warned last month they were breaking a new state reproductive transparency law, are now in compliance, the city attorney announced Thursday.

Los Angeles City Attorney Mike Feuer said in a press briefing that two of the fake clinics, also known as crisis pregnancy centers, began complying with the law after his office issued notices of violation last month. But it wasn’t until this week, when Feuer’s office threatened court action against the third facility, that it agreed to display the reproductive health information that the law requires.

“Why did we take those steps? Because every day is a day where some number of women could potentially be misinformed about [their] reproductive options,” Feuer said. “And therefore every day is a day that a woman’s health could be jeopardized.”

The facilities, two unlicensed and one licensed fake clinic, are Harbor Pregnancy Help CenterLos Angeles Pregnancy Services, and Pregnancy Counseling Center.

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Feuer said the lawsuit could have carried fines of up to $2,500 each day the facility continued to break the law.

The Reproductive Freedom, Accountability, Comprehensive Care, and Transparency (FACT) Act requires the state’s licensed pregnancy-related centers to display a brief statement with a number to call for access to free and low-cost birth control and abortion care. Unlicensed centers must disclose that they are not medical facilities.

Feuer’s office in May launched a campaign to crack down on violators of the law. His action marked a sharp contrast to some jurisdictions, which are reportedly taking a wait-and-see approach as fake clinics’ challenges to the law wind through the courts.

Federal and state courts have denied requests to temporarily block the law, although appeals are pending before the U.S. Court of Appeals for the Ninth Circuit.

Some 25 fake clinics operate in Los Angeles County, according to a representative of NARAL Pro-Choice California, though firm numbers are hard to come by. Feuer initially issued notices to six Los Angeles area fake clinics in May. Following an investigation, his office warned three clinics last month that they’re breaking the law.

Those three clinics are now complying, Feuer told reporters Thursday. Feuer said his office is still determining whether another fake clinic, Avenues Pregnancy Clinic, is complying with the law.

Fake clinic owners and staffers have slammed the FACT Act, saying they’d rather shut down than refer clients to services they find “morally and ethically objectionable.”

“If you’re a pro-life organization, you’re offering free healthcare to women so the women have a choice other than abortion,” said Matt Bowman, senior counsel with Alliance Defending Freedom, which represents several Los Angeles fake clinics fighting the law in court.

Asked why the clinics have agreed to comply, Bowman reiterated an earlier statement, saying the FACT Act violates his clients’ free speech rights. Forcing faith-based clinics to “communicate messages or promote ideas they disagree with, especially on life-and-death issues like abortion,” violates their “core beliefs,” Bowman said.

Reports of deceit by 91 percent of fake clinics surveyed by NARAL Pro-Choice California helped spur the passage of the FACT Act last October. Until recently, Googling “abortion clinic” might turn up results for a fake clinic that discourages abortion care.

“Put yourself in the position of a young woman who is going to one of these centers … and she comes into this center and she is less than fully informed … of what her choices are,” Feuer said Thursday. “In that state of mind, is she going to make the kind of choice that you’d want your loved one to make?

Rewire last month visited Lost Angeles area fake clinics that are abiding by the FACT Act. Claris Health in West Los Angeles includes the reproductive notice with patient intake forms, while Open Arms Pregnancy Center in the San Fernando Valley has posted the notice in the waiting room.

“To us, it’s a non-issue,” Debi Harvey, the center’s executive director, told Rewire. “We don’t provide abortion, we’re an abortion-alternative organization, we’re very clear on that. But we educate on all options.”

Culture & Conversation Family

‘Abortion and Parenting Needs Can Coexist’: A Q&A With Parker Dockray

Carole Joffe

"Why should someone have to go to one place for abortion care or funding, and to another place—one that is often anti-abortion—to get diapers and parenting resources? Why can’t they find that support all in one place?"

In May 2015, the longstanding and well-regarded pregnancy support talkline Backline launched a new venture. The Oakland-based organization opened All-Options Pregnancy Resource Center, a Bloomington, Indiana, drop-in center that offers adoption information, abortion referrals, and parenting support. Its mission: to break down silos and show that it is possible to support all options and all families under one roof—even in red-state Indiana, where Republican vice presidential candidate Gov. Mike Pence signed one of the country’s most restrictive anti-abortion laws.

To be sure, All-Options is hardly the first organization to point out the overlap between women terminating pregnancies and those continuing them. For years, the reproductive justice movement has insisted that the defense of abortion must be linked to a larger human rights framework that assures that all women have the right to have children and supportive conditions in which to parent them. More than 20 years ago, Rachel Atkins, then the director of the Vermont Women’s Center, famously described for a New York Times reporter the women in the center’s waiting room: “The country really suffers from thinking that there are two different kinds of women—women who have abortions and women who have babies. They’re the same women at different times.”

While this concept of linking the needs of all pregnant women—not just those seeking an abortion—is not new, there are actually remarkably few agencies that have put this insight into practice. So, more than a year after All-Options’ opening, Rewire checked in with Backline Executive Director Parker Dockray about the All-Options philosophy, the center’s local impact, and what others might consider if they are interested in creating similar programs.

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Rewire: What led you and Shelly Dodson (All-Options’ on-site director and an Indiana native) to create this organization?

PD: In both politics and practice, abortion is so often isolated and separated from other reproductive experiences. It’s incredibly hard to find organizations that provide parenting or pregnancy loss support, for example, and are also comfortable and competent in supporting people around abortion.

On the flip side, many abortion or family planning organizations don’t provide much support for women who want to continue a pregnancy or parents who are struggling to make ends meet. And yet we know that 60 percent of women having an abortion already have at least one child; in our daily lives, these issues are fundamentally connected. So why should someone have to go to one place for abortion care or funding, and to another place—one that is often anti-abortion—to get diapers and parenting resources? Why can’t they find that support all in one place? That’s what All-Options is about.

We see the All-Options model as a game-changer not only for clients, but also for volunteers and community supporters. All-Options allows us to transcend the stale pro-choice/pro-life debate and invites people to be curious and compassionate about how abortion and parenting needs can coexist .… Our hope is that All-Options can be a catalyst for reproductive justice and help to build a movement that truly supports people in all their options and experiences.

Rewire: What has been the experience of your first year of operations?

PD: We’ve been blown away with the response from clients, volunteers, donors, and partner organizations …. In the past year, we’ve seen close to 600 people for 2,400 total visits. Most people initially come to All-Options—and keep coming back—for diapers and other parenting support. But we’ve also provided hundreds of free pregnancy tests, thousands of condoms, and more than $20,000 in abortion funding.

Our Hoosier Abortion Fund is the only community-based, statewide fund in Indiana and the first to join the National Network of Abortion Funds. So far, we’ve been able to support 60 people in accessing abortion care in Indiana or neighboring states by contributing to their medical care or transportation expenses.

Rewire: Explain some more about the centrality of diaper giveaways in your program.

PD: Diaper need is one of the most prevalent yet invisible forms of poverty. Even though we knew that in theory, seeing so many families who are struggling to provide adequate diapers for their children has been heartbreaking. Many people are surprised to learn that federal programs like [the Special Supplemental Nutrition Program for Women, Infants, and Children or WIC] and food stamps can’t be used to pay for diapers. And most places that distribute diapers, including crisis pregnancy centers (CPCs), only give out five to ten diapers per week.

All-Options follows the recommendation of the National Diaper Bank Network in giving families a full pack of diapers each week. We’ve given out more than 4,000 packs (150,000 diapers) this year—and we still have 80 families on our waiting list! Trying to address this overwhelming need in a sustainable way is one of our biggest challenges.

Rewire: What kind of reception has All-Options had in the community? Have there been negative encounters with anti-choice groups?

PD: Diapers and abortion funding are the two pillars of our work. But diapers have been a critical entry point for us. We’ve gotten support and donations from local restaurants, elected officials, and sororities at Indiana University. We’ve been covered in the local press. Even the local CPC refers people to us for diapers! So it’s been an important way to build trust and visibility in the community because we are meeting a concrete need for local families.

While All-Options hasn’t necessarily become allies with places that are actively anti-abortion, we do get lots of referrals from places I might describe as “abortion-agnostic”—food banks, domestic violence agencies, or homeless shelters that do not have a position on abortion per se, but they want their clients to get nonjudgmental support for all their options and needs.

As we gain visibility and expand to new places, we know we may see more opposition. A few of our clients have expressed disapproval about our support of abortion, but more often they are surprised and curious. It’s just so unusual to find a place that offers you free diapers, baby clothes, condoms, and abortion referrals.

Rewire: What advice would you give to others who are interested in opening such an “all-options” venture in a conservative state?

PD: We are in a planning process right now to figure out how to best replicate and expand the centers starting in 2017. We know we want to open another center or two (or three), but a big part of our plan will be providing a toolkit and other resources to help people use the all-options approach.

The best advice we have is to start where you are. Who else is already doing this work locally, and how can you work together? If you are an abortion fund or clinic, how can you also support the parenting needs of the women you serve? Is there a diaper bank in your area that you could refer to or partner with? Could you give out new baby packages for people who are continuing a pregnancy or have a WIC eligibility worker on-site once a month? If you are involved with a childbirth or parenting organization, can you build a relationship with your local abortion fund?

How can you make it known that you are a safe space to discuss all options and experiences? How can you and your organization show up in your community for diaper need and abortion coverage and a living wage?

Help people connect the dots. That’s how we start to change the conversation and create support.

This interview has been edited for length and clarity.

CORRECTION: This article has been updated to clarify the spelling of Shelly Dodson’s name.

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