This blog entry varies the course a bit with a short video of a 26-year-old, HIV-positive, homeless man named Walter who lives in Long Beach. Garry Bowie, Chief Executive Officer of Long Beach AIDS Foundation, filmed the poignant video. It’s only an introduction to the full-length version that will be released in June 2011. So, remember to check back. We will follow it up with a frank Question and Answer session with Bowie regarding the current state of HIV awareness and prevention efforts in the US.
Q & A with Garry Bowie, Chief Executive Officer of Long Beach AIDS Foundation
Q: Even though awareness of HIV is more prevalent today in young people 15 to 24, they still account for more than 40% of new infections. From your vantage point, what are the crucial factors behind this increase?
A: Primarily, youth have exuberance. They feel invincible. They feel that harm or death cannot come to them. And they have a lot of energy. Even though they’ve had the HIV message for many years now, when many of them get involved with drugs, primarily meth, they are uninhibited and act in ways that put them at risk with sexual activities. But since they are chasing the high, it isn’t about sex because the pleasure feeling is created by the drug. This also lures them into a false sense that sex is good.
Q: As a homeless man who became HIV positive when he was 22, how does Walter’s story illustrate these challenges in the fight to curb HIV transmission?
A: In order to address the population that’s still affecting the spread of HIV, we have to address the two populations that come in contact with each other: the homeless population and the meth-addicted population. The homeless population is in survival mode: they seek food, clothing, shelter, and oftentimes have substance abuse issues as well. They are struggling to survive day to day. Meth users are chasing the high. The two populations intersect with substance abuse, and oftentimes they engage in risky sexual behaviors. The homeless population don't know their status, don't want to know their status, or don't care to know their status because it won’t get them any additional help. They feel rejected or ignored by the agencies that provide medical services for HIV. This risk group comes in contact with the general population and continues to spread HIV, often with drug use being the gateway.
So, while there is plenty of available funding to deal with substance abuse, there are few if any programs dealing with homelessness and HIV issues. There are homeless programs. There are mental health program for the homeless. Yet there are no programs for the HIV, homeless population.
Q: How did you originally meet Walter and how long have you known him?
A: I met Walter through a substance abuse program when he was 23. He had fallen out of the program several times, but each time he tries to pick up his life and makes incremental improvements, as hard as that is for him. He is now 26. He knows that he looks like he’s in his 40s. Life is getting harder for him at this age, because a homeless life is very dangerous and rough on the body.
Q: In your mind, what factors have contributed to the HIV awareness and prevention community getting “off track”?
A: We forgot the cause. We created personal challenges in fundraising such as walking a walk-a-thon, jogging a jog-a-thon, or cycling in a bike-a-thon, as if we were sharing the pain of those suffering from HIV/AIDS. But this became a challenge to self, and had very little to do with the cause. We need to get back to prevention, which is the most important factor in stemming the tide on HIV. That includes dealing with the homeless, dealing with substance abuse, dealing with ignorance, dealing with cultural issues, dealing with underserved communities – and a host of other lower-priority issues. It also includes continuing education programs, outreach, and providing services to those who are already affected by HIV.
Until we prioritize dealing with these issues, the US will never reach its goal of decreasing new HIV infections by 10 percent by the year 2014. Keep in mind that this is the second time we have set a goal and not been able to meet it, while countries like South Africa have been able to reduce new HIV infections by 25 percent within a three year period. So, when do we get serious about our priorities?
Q: How did the HIV community lose sight of the individual “faces” of HIV, (for example, Walter) which is where the cause began 30 years ago?
A: We lost sight of the faces of HIV as we got away from the message that this can affect anyone and everyone. As a byproduct of our prevention programs, we sometimes focus on specific groups. These groups, although important to address, don’t solve the multifaceted issues that we are faced with. We really have to attack this from all angles at the same time.
Q: As an entirely volunteer-based organization that’s comparatively small, how is the Long Beach AIDS Foundation different from the rest of the HIV community?
A: In our area, we are only one of three volunteer-driven organizations dealing with HIV/AIDS. We don’t receive federal, state, or county funding, and are solely reliant on the contributions from our community. With that comes a greater responsibility to make a measurable impact and achieve greater outcomes. Being smaller and more responsive allows us to address community needs more immediately and make more of an impact. Our ultimate goal is to no longer be needed, while some larger agencies have become huge infrastructures where the constant maintaining of the infrastructure has become their mission. While this may not be politically correct in saying, it is the truth to how we deal with our community issues. We can be huge and popular and not address the needs of the community, or we can be small and agile and serve people.
Q: What impact has “monetizing” the cause (e.g., selling “Red” products like bracelets and tee shirts) had on HIV awareness and prevention?
A: While it has helped to bring hyper focus to the cause in a short period of time, it has also numbed us to “cause marketing.” It was a novel marketing tactic that has an inherently short lifespan. So in the long run, the message gets lost with everyone doing cause marketing for their own causes. The expectation from the public is now to have celebrities involved, products associated with, or some personal benefit for participating in a cause.
Q: What needs to be done to reduce the number of new HIV infections in 15- to 24-year-olds?
A: To reduce new HIV infections, we have to work on self esteem issues. We have to help reduce substance abuse. We have to mentor. We have to create positive youth programs, and we have to expect more from our youth. In addition, we need to prioritize addressing the needs of the community, starting with the most underserved and working up toward the most served. We need to start with the “back end” (the underserved or undesirable populations, like the homeless) instead of starting with the “front end.” In HIV programs, we start with gay people, then target Latinos and Blacks, and then the next largest risk population. In order to be effective, we really need to have a multifaceted approach that reaches everyone at the same time if we are ever going to truly stem the tide of new HIV infections.
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