Articles, Blog

National Women and Girls HIV/AIDS Awareness Day

August 29, 2019


Chantelle Britton:
Good afternoon, and welcome
to the White House. We’re honored to have
each and every one of you here with us today. We organized today’s event to
coincide with National Women and Girls HIV AIDS Awareness Day,
and we anticipate that this event will engage discussion
among community groups, local health organizations, adolescent
and teenage girls, national organizations and research
experts for a meaningful conversation on HIV and its
impact among women and girls. So just a few
housekeeping notes. The men’s restrooms are straight
out this door, if you go straight down the hallway
past the staircase, the men’s restrooms are on the right. And the women, you have to work
for this one, so the women’s restrooms are straight down this
hallway, so you’re going to leave this room, you’re going to
turn right, you’re going to go all the way down the hallway,
and you’re going to pass a corridor, don’t go straight past
that corridor, you’re going to hook a right around
the corridor and the restrooms will be on the right. So good luck finding those. So today’s meeting is actually
being recorded and live streamed from www.whitehouse.gov/live,
and this recorded meeting will be posted on our website, the
Office of National AIDS Policy website at www.whitehouse.gov/ONAP, O-N-A-P. So now it’s my pleasure to
introduce Jeff Crowley, Director of the Office of
National AIDS Policy. Jeff. (applause] Jeff Crowley:
That’s great. Thank you. Good — hello, everybody. It’s my pleasure to welcome
you to the White House. I also would like to
acknowledge Chantelle Britton, so who you’ve just met. She’s on detail from CMS and she
leads our work on women’s policy issues in our office, but she’s
also — she comes from CMS, the Medicaid office, and so she’s a
health care expert and she leads our health policy work in the
Office of National AIDS Policy, so thanks for all
your good work. We also are very happy to be
joined by one of our biggest champions, and that’s
Congresswoman Donna Christensen, she’ll be speaking to us
momentarily, but, you know, she has a long track record of
working hard on so many issues, but she’s been one of the
strongest advocates for people living with HIV in the Congress,
and so we’re grateful for her work, but also really pleased
she can join us today. I also just want to acknowledge
our partners in pulling together this meeting. So the Office of National AIDS
Policy didn’t do this alone, we’re happy to work with the
White House Council on Women and Girls, and later in this meeting
we’ll be hearing from Tina Tchen who is the chief of staff to
the First Lady, but also the executive director
of the council. And then also we worked very
closely with the HHS Office of Women’s Health, so we’re really
pleased to welcome the director, Frances Ashe-Goins, today
as well as her team. Now, better supporting women
and girls so that fewer of them become infected with HIV, and
so that we better support women living with HIV is really a
critical priority for the nation as well as this administration. Now, this year marks the 6th
annual National Women and Girls HIV AIDS Awareness Day, and
we’re reminded that in the United States, women and girls
account for about a quarter of the HIV epidemic. We’ve lost more than 90,000
women due to AIDS in the United States since
the beginning. Now, thankfully, women and
girls are at lower risk for HIV infection than men, but that
doesn’t mean that we don’t have to take seriously the need to
respond to the epidemic facing women and girls, but also the
unique factors of what are the issues that make them uniquely
vulnerable to HIV and how do we address these issues
in a strategic way. Black women, as you may
know, in particular are disproportionately affected. They’re about 15 times more
likely to become infected with HIV than white women. Latinos about nine
times more likely. HIV infections were the leading
causes of death among black women and Latinos in their
prime of life, ages 25 to 44. Now, these are really
shocking statistics, 15 times, nine times. So part of what I think we need
to do is really come up with strategic responses about how
we’re going to seriously address these very large disparities. Now, today’s meeting was
convened to engage all of us in a meaningful conversation about
HIV/AIDS and its impact on women, young women, girls. The panelists you’ll hear from
will cover a variety of topics, including prevention,
access to care. And we have a panel on the role
of social media in reaching women and girls. Now, as you may know, President
Obama released the national HIV/AIDS strategy for the United
States last July, and really everything that our office does
and we really think as an HIV community everything we do know
really needs to be focused on how do we implement the national
HIV/AIDS strategy, and we hope that today’s conversation will
help us move on that path. Now, I could spend a long time
talking about what’s in the strategy, I’m not going to do
that here, but I’m just going to highlight just a few key
action steps in the strategy. It says we need to intensify
HIV prevention efforts in communities where HIV is
most heavily concentrated. We need to expand targeted
efforts to prevent HIV infection using a combination of effective
evidence-based approaches. We need to establish a seamless
system to immediately link people to continuous and
coordinated quality care when they’re diagnosed with HIV. We need to support people living
with HIV with co-occurring health conditions and those who
have challenges in meeting their basic needs, such as housing. And we need to reduce stigma
discrimination against people living with HIV. Success in doing any
one of these will benefit women and girls. And also there are unique issues
affecting women and girls as we seek to address
all of these areas. As just one example, we’re very
focused on coming up with the best evidence-based approaches
to preventing HIV, and we believe that sort of a challenge
right now is how do we put together various tools, whether
it’s HIV testing, risk reduction education, the
various things we do. Recently biomedical
interventions, you know, oral pills or microbicides, how do
we put all of these together in exciting ways to
really have the best impact on preventing infections. And one of the things that
we anticipate is the best combinations might vary, so what
we would do for young Latino gay men might be very different
than what we would do for older heterosexual black women. So over the next few years,
we’re really trying to say, you know, there’s a lot of activity
at CDC, NIH, HERSA, SAMSA, the federal agencies really
trying to see how can we come up with these best
combinations of prevention. Now, the strategy also
recognizes that many women’s risk for HIV is in many cases
driven by the risk behavior of their male partners, and that
female controlled technologies are important to stem
infections among women. Now, I’m sure all of you or most
of you are very well aware that there’s been a lot of excitement
in the last year about the using anti-retroviral medications,
whether it’s as a microbicide or again as an oral pill, as a
new prevention technology. I believe Dr. Brown is going
to talk a little bit about this in more detail. But I also just wanted you to
know that many people throughout HHS are really thinking
right now how do we take the next steps. You know, these were exciting
findings, but there’s still a lot we need to learn, but how
do we move deliberately and aggressively to use these
exciting findings and put them into action. So in closing, I feel like we
have a lot of momentum within the federal government and
outside to really seize the moment that was created
by the release of the national HIV/AIDS strategy. I feel like we’re doing our part
at the federal level, I think you’ve probably seen more
activity on HIV/AIDS than perhaps ever before. And we’re increasingly looking
to leadership from other stakeholders because,
you know, we have our role, but we can’t do this alone. And so I really hope that
today’s meeting is a forum for sharing a lot of information,
but also a lot of creativity. You know, so it’s not just that
we’re out doing things, but are we doing the most
strategic things possible. And so I’m really looking
forward to this discussion. But again as I said at the very
beginning, we’re very happy to be joined by one of our
strongest champions, so now it’s my pleasure to introduce Donna
Christensen who represents the United States Virgin
Islands in the Congress. (applause) Donna Christensen:
Good afternoon, everyone. Audience:
Good afternoon. Donna Christensen:
And thank you, Jeff,
for your introduction and your — the words that
you shared with us as we began this program. And I want to thank your staff
as well, especially James Albino and Chantelle Britton, and also
to thank Frances Ashe-Goins and her staff at the Office of
Women’s Health, both of you for inviting me to be a part of the
6th Annual National Women and Girls HIV Awareness
Days program. And before I begin, I also want
to thank and applaud Jeff for your leadership at the Office
of National AIDS Policy, your vision and collaboration
that has been nothing short of extraordinary. And I know that while this
epidemic is so complex, I also know that the plan that you and
your team have spearheaded and the coordination that’s ongoing
between the different federal agencies will really play a
pivotal role in this nation’s very significant steps that
we’re going to take forward towards the elimination of HIV
and AIDS, so let’s give Jeff and his team [inaudible]
big round of applause. (applause) Donna Christensen:
And France — where is Frances? There you are. Oh, you’re right in the front. I remember you asking me some
time ago about attending some event, it may have been this
one, so I suspect you, too, have played a role in the
great honor I have of giving today’s keynote. So thank you also for the great
work that the Office of Women’s Health has been doing and what
you’re going to be doing with the expanded role that you’ve
gotten through the Patient Protection and
Affordable Care Act. We’re also fortunate to have a
really great group of panelists, all of — most of whom I’ve
worked with either directly or indirectly over the years, and
an outstanding audience, too. Advocates, providers,
researchers, caregivers and women living with HIV and AIDS,
all of whom are on the front lines every day, and it’s
fantastic to see so many young women in here with
us this afternoon. It’s also significant really
that it is at the White House that this very special,
wonderful and powerful group is coming together to commemorate
National Women and Girls HIV/AIDS Awareness Day. And to join women around our
country and our world to acknowledge the profound impact
that this epidemic is having on women to increase the awareness
of the disease and its risks, as well as the importance of
prevention and the methods of prevention, and to come together
to determine what we can do and how we will take action. Yesterday, as in many other
places, an agency called HOPE, an AIDS not-for-profit in my
district held a rally and health fair to commemorate this day. And most of the individuals that
they’ve been testing lately have been women. The Virgin Islands, along with
Maryland, Connecticut, New Jersey, and Delaware are
among the few jurisdictions where women make up a third
of those who are infected and living with AIDS. It’s not a distinction that
any of us are really proud of. But the rest of the country is
not far behind, and that’s why this day is so important. Women have gone from
representing 8% of AIDS diagnosis in 1985 to
close to 26% in 2009. So ladies, we have our
work cut out for us. And men, we expect
you to be at our side. But we also know that women
everywhere, with or without resources, always
rise to the challenge. And so will we, because
as women, we are mothers, grandmothers, spouses, and
daughters, not only of our biologic mothers, but of our
ideologic mothers, our political mothers, our activist moms. And that list is long. But the women, like Sojourner
Truth, Eleanor Roosevelt, Mary McLeod Bethune, Dr. Dorothy
Height, Wilma Painkiller, Dr. Antonia Novello, Sandra
Day O’Connor, Wangari Maathai, Elizabeth Glaser, Glaser,
Patricia Nells, Jeannie White, and we have with us Hadia
Christina Regan, not to leave out two
of my CBC leaders, Maxine Waters and Barbara Lee. In my time in Congress, it was
the women’s caucus, at least a few years back, that really
practiced bi-partisanship, and we passed legislation together. I’ve seen the Democratic women
of the House lead in times of crisis or fill the void when
there were leadership voids in the Congress. We were extremely proud to
serve under the leadership of a speaker, Nancy Pelosi, who led
one of the most productive congresses in recent years. And Secretary Clinton continues
to make us proud in this administration where several
departments, agencies and offices are headed
by women who lead with distinction and effectiveness. And of course, we have a First
Lady who calls us not only to health and wellness and to
compassion, but also inspires our entire nation to greatness. And every time and every place,
women have stepped forward to lead, some we know well, but
there have been and are now countless others whose
names we will never know. We are in their debt, we stand
on their shoulders, and we are embolden and empowered
by their sisterhood. We won’t let them down, we will
seize the opportunity of the national strategy,
the Affordable Care Act, the 2012 budget, and any
other avenue that we can and we will take action. This administration, as you’ve
heard, has developed a strong national HIV and AIDS strategy. It’s now in the
implementation phase. Despite the recession, the
President in his 2012 budget proposes to increase
discretionary AIDS funding by $382 million, with specific
investments and reordered priorities to maximally
lower the number of new HIV infections, increase access to
care for people living with HIV and AIDS, and to reduce
HIV-related disparities. Although under severe threat
today, that landmark Patient Protection and Affordable Care
Act through its prohibitions on exclusions for preexisting
disease, recisions and lifetime caps, through ending premium and
other discrimination against women, as well as through
the Medicaid expansion, the exchanges, the other consumer
protections, all of them will bolster the ability of women and
anyone who is HIV positive or who has AIDS to access quality
medical care and to access it early, as well as to have
timely prevention services. So now the rest is up
to us, as Jeff said. What can we do to take action? As I’ve already alluded to,
protecting the gains we have made and will make in health
care reform and protecting the President’s budget, increasing
it, of course, if he can, has to be part of the action
that we all have to take. We’re now around 30 years into
this epidemic, women make up a far larger percentage of
persons with HIV and AIDS than at the beginning of it. As Michael Sidibe, the executive
director of UNAIDS said, this epidemic unfortunately
remains an epidemic of women. Worldwide, more than half of the
33.3 million adults living with HIV and AIDS are women. And as we said earlier, women
are around 26% of infections in this country. But especially in
African-Americans and other people of color,
the picture is worse and it has not been improving. The incidence rate among new
infections, as Jeff said, among black women is almost 15 times
that of white women, and for Latinos nine times more. Native American women also have
a higher rate of AIDS diagnoses than our white or Asian
counterparts, with Asians having the lowest. So no matter what advances have
been or how much we now know, still in 2011 we have a
monumental task ahead. And as the administration is
urging us to do, we have to think out of the box. While what we have been doing
has made an impact, we have to admit that and we have to
celebrate it, it hasn’t been enough. So I hope that among our young
people who are with us today, they can infuse not only new
energy, but also point us to some new ways forward. I think the scope of our efforts
need to be broader, especially in addressing this epidemic
that has been with us for far too long. Our vision, and, thus, where we
take action has to encompass the broader aspects and the
underpinnings of our health. We can’t win this battle without
addressing the social and economic determinants of health. The CDC and others have reported
that poverty is the single most important demographic factor
associated with HIV infection prevalence in inner-city
heterosexuals, and that low income areas are where the
generalized HIV epidemics are found in our country. We will not change the course of
HIV and AIDS in this country, particularly in communities of
color where the epicenter is, without addressing poverty
and all that comes from it. I also think we have to change
our approach, and while I don’t really have any great ideas,
they are going to come from all of you about what that approach
ought to be, it’s clear that to change the course of this
disease, we have to go outside of the walls of our offices and
often outside of our own comfort zones, because if you can’t
reach those that we seek to help where they are in their
environments, addressing all of their concerns, of which HIV may
be the least of them, we may not likely reach them at all. And we need to make sure that by
how we structure our services, and how we deliver our
messages, we’re not enabling discrimination or
reinforcing stigma. Most importantly, we need to
acknowledge that the experts in reaching the hard-to-reach are
they themselves, their community leaders and the people who
already have their trust. For the optimal effectiveness,
the programs have to be community designed and driven. An important part of this is
also having providers that come from the community or have the
same background as the community that they’re serving. The rest of us are there to be
consultants, technical experts, and we have to focus, as was the
intention of the minority AIDS initiative, on building capacity
in those communities if the investment that we’re making is
to bear any long-lasting fruit. So I can say without fear of
contradiction that not any one of us in here want
to be here 30 years from now commemorating this day. We don’t want to be
here 20 years from now, not even ten years from now. So I hope that my ramblings
today have reminded us all of the strong legacy that we’ve
inherited from centuries of ordinary women and girls,
because some of those leaders were teenagers. So from women, young and old,
who have done extraordinary things and in doing so
changed or improved the world for all of us. We are their daughters. They knew or came to know their
power, and we must know and use ours. One of their and our strength as
women is our creativity, a word that Jeff used earlier. We can make beautiful
quilts out of rags. My mother used to tell me that
she and her five brothers and sisters had — when they
had nothing else to eat, my grandmother would put together
some soup that was called Loblolly, it was essentially
some kind of an onion soup, but that’s all — if that’s all
they had, that’s what they had for dinner. And I’m sure that every one of
you could give me examples of making something extraordinary
out of something that someone else would be
throwing in the trash. And you could also tell me
of ways that mothers and grandmothers fiercely protected
and defended their families. Another is our inner strength,
our resiliency, our ability when we don’t think we have it in us
to rise to meet any challenge. And we are nothing
if not persistent. Those qualities are what we are
going to bring to our effort to eliminate HIV and AIDS. That virus does not know
who it’s messing with. We’re aware, we’re committed,
we are determined, and we will figure out just what it is that
we have to do and we will do it, we will take action. So thank you for inviting me,
it’s been truly an honor and a pleasure to be a
part of this event. I have a fellow from my office,
Waverly Gordon with me today, and we’re going to stay for
the entire presentation. If you have any questions for
me now, that’s fine, but if you wish, we can wait until the
general question and answer period as well. Okay. We’ll just participate in the
general discussion, because I didn’t — you know, I was just
trying to kind of frame a way to get us all energized
and ready to go. Thank you all. (applause) Chantelle Britton:
Thank you,
Congresswoman Christensen. Let’s give the Congresswoman
another round of applause. (applause) Chantelle Britton:
So we will now have Dr. Gina Brown from NIH give an
epidemiological overview of HIV among women and girls
in the United States. She joined NIH’s office of AIDS
research as a medical officer managing microbicides in women’s
and girls’ research issues. She has worked with the New York
City Department of Health and Mental Hygiene and with
Columbia University. Please join me in
welcoming Dr. Brown. (applause) Dr. Gina Brown:
I am absolutely
honored to be here, and I just thank
you for inviting me. I think it’s a real opportunity
for us to get lots of information from others. I mean, I think you’ll hear from
not just the biological and the epidemiological review that I’m
going to give you, but it will be a real opportunity to see how
this applies to what’s being done on the ground. So my charge today
was to give you a bit of an epidemiologic background. And what I’m actually going to
do is I want to set a context, and I want you to take some of
this information back with you and talk to girls about it, talk
to girls about what HIV is, talk to girls about what the risks
are, what their risks may be, and hope — and it’s hard to do,
especially when I’m saying talk to young girls about this, but
hopefully if we start to educate people and educate our young
women, they’ll have a better sense of their abilities
to protect themselves. Next slide. So what I’m showing you here
first is to just to look at what the impact is of HIV
internationally. Women, as we said earlier, women
make up more than 50 percent of the epidemic, but I want to
bring your eye to two things. One is you’ll see globally where
women are, with sub-Saharan African rates even higher, but
that next line underneath is the Caribbean. And does anybody know
what the air bridge is? The air bridge is this concept
that women and men, people from the Caribbean move quite fluidly
back and forth, particularly along the East Coast, and so
that some of those women that are — that you see on that
listing are also women who may have come in and out of the
United States who may have gotten their HIV in the United
States and gone back to live in the Caribbean, who may have
gotten it in the Caribbean and come into the United States. But we need to understand that
in a fairly short period of time from the epidemic, those rates
rose absolutely rapidly. And we’re talking about also in
a place where you may not get testing done in the same way as
it’s done in New York State, which is where I’ve spent a lot
of my career where all women who come to present for labor and
delivery are offered HIV testing earlier in their pregnancy.
Next slide. In the United States,
you can look at how the epidemic has changed. And if you see the orange line,
and it takes us back to the very early days in the 1980’s when we
first started to recognize HIV in women, women made — if you
look to the right, it gives you the percent of the total,
and on the left it gives you the absolute numbers. Look how very rapidly that rate
has risen and continues to rise. So women started out roughly
being about 8% of the epidemic, by the early to mid ’90s, ’93,
’94, we were offering HIV testing and it was to most women
who were coming in for labor — who were coming in for prenatal
care, women who were coming in for any kind of pregnancy
prevention or reproductive health care were being
offered HIV testing. And so it’s not just about
offering them the testing, we picked up a large number, but
we’re also continuing to see how those rates are
rising over time. And so I think that’s the
take-home message, which is women are one of the fastest
rising rates of HIV infection over the years. Next. If you look at this list, when
we talk about the risk, one the ways to look at the impact
of HIV on a group or on a community is to look
at what’s called case rates. And so you’re looking at the
number of HIV diagnosed cases and you normalize it by looking
at per hundred thousand population of that group. When you break this down,
you can see the black and African-American women have a
case rate that’s much higher than any other group,
with the exception of black and African-American men. So we’re looking at the all
female case rate is 11.5, if you go down the list, you can see
where women lay out, black and African-American women, it’s 56,
meaning for every 100,000 black and African-American women,
there are — who are tested within this 37 states that
reported to CDC in 2008, there were 56 black and
African-American women who were HIV positive. If you go down the list, you can
see how much higher that is than any of the other women’s groups. If you look at all men, black
and African-American men have a much higher rate, but black and
African-American women are right behind them and higher than
any other general male group. So women are a real issue for
HIV disease in this country. If you are looking at the
diagnoses in the U.S. and U.S. dependent areas, that will include Puerto Rico,
the Virgin Islands, Guam, you can see again
how that lays out with black and African-American women having
much, much higher rates. The lowest rates amongst Asian,
people who call themselves multi-racial, with white and
Hispanic being roughly neck in neck. Next. And then if you’re looking at
what the related cause of HIV is or what’s the most likely risk
factor, for women across the three major racial groups that
have the greatest amount of HIV in women, it’s clearly
heterosexual contact. And the other thing you should
understand is, if you list that you’re an intravenous drug user,
that’s going to trump the group that you end up in. So it may have been heterosexual
contact, but if you’re an intravenous drug user, it’s
going — that risk factor is going to be what becomes your
risk factor, whether or not you actually got it that way. So it may — in any case, what
we can look at is you’re still looking at more than
three-quarters of the way in which women get HIV is
through heterosexual contact. So what I want us to understand
when we walk out of here today is how women become infected,
how women can prevent infection, and then how those two things
intersect so we can start to think about some of the programs
and projects that will let us really attack this and prevent
this disease in women in a very organized and sensible way,
because it’s really that intersection, it’s not just the,
you know, how the virus got in, but it’s very much about what
they can do and what women can do to help prevent
it in themselves. So what I’m going to talk to you
about today are just — are the biological — you’re going to
learn a little biology and a little anatomy. Some of you, I know there are
some medical students in here, so you may know that
biology and anatomy. We’re going to talk a bit about
the behavioral socio-cultural, the situational issues, and
understand that all of these things on this list
very much intertwine to increase women’s risk. We’ve talked about race already,
and socioeconomic status in this country is one of the biggest
indicators of HIV risk, meaning being of low
socioeconomic status. So in terms of anatomy, there
are age-related issues. And what we’re seeing for HIV is
a couple of interesting things. Younger women, women of
reproductive age group, and that’s between the ages of 15
and 44, are — make up the bulk. But one of the rapidly growing
groups within women are women over the age of 50. And what we’ve learned over
time, and I think we’re very much at a tipping point on
this, that there seems to be an understanding that there’s a
biology for this, it’s not just sort of by chance or that we’re
starting to diagnose women, but there — what we’ve gotten a
sense of as we learn more and more about women’s risk that
there’s a biology that talks about this. So in pre or periadolescent age
period, so you’re talking about women under the age of 16, 15,
16, there are marked changes that happen in the vagina. Very young women, young girls
have a very smooth vagina, not very pliable, so that when they
have sex, it’s much more likely to tear, whether it’s by force
or whether it’s by consent. And much more likely to get
micro abrasions, so that is something that biologically
can increase their risk. Within adolescence into
adulthood, the vagina is really impacted by hormones at levels
that are starting to rise, they start to menstruate, and the
vagina develops these very nice folds called rugae, and that’s
part of how the vagina expands to let a fetus’ head
out in childbirth. As menopause comes along, as
women become somewhat older, their hormone levels begin to
drop, the vagina again becomes much less pliable, much
smoother, a lot less giving, and so that when they have sex,
they also are at much greater risk of having vaginal either
micro tears or larger tears. And again, it’s a place where
you can look and see what happens with them in terms
of can increase risk. In addition, across these age
ranges, we know there’s some tremendous work
that’s being done that — if you go to the next slide. There’s a wonderful immune
function of the entire female genital tract, and that changes
as women are either younger, middle of sort of reproductive
age group, and as they get older, and all of those may
impact your ability to get HIV infected or your risk. So we know that
the normal vaginal environment is protective. You know, we think it’s actually
somewhat harder to get HIV than we may think, but there’s
something that happens and there’s something
that’s happening that increases a woman’s risk. If she has an infection, either
a sexually transmitted disease or a yeast infection or a
bacterial infection where yeast and bacteria kind of
get out of balance, all of those increase her risk. If there are micro abrasions
from sex or from something like a herpes infection, that
will increase her risk. There’s some tremendous work
that’s being done that’s looking at semen, where semen, where
sperm — the fluid that sperm travels in actually may lower
the immune function of a woman’s vaginal fluid, and the thought
is — I mean, that’s functional. If you want to get pregnant, you
certainly don’t want her to have an immune response to sperm. So it’s functional to do that,
but that’s also a period of time or way in which you can lower
a woman’s immune function. And there may be other immune
parameters that vary over time, and with work done during
pregnancy, an important issue, because one of the higher
risk factors for our current mother-to-child transmission is
if a woman develops HIV during pregnancy, during the course
of pregnancy and has that high viral load, her risk of passing
the virus on to her infant is much higher. The other thing is that when a
woman stands up, which way does her vagina point? I know, I use this word a lot
when I talk about this stuff. And I’m sure it horrifies some
of you, but it’s — okay. The key is it doesn’t point
straight up and down. Can you go to the next slide? The next slide. And so when she’s standing
up, the top of her vagina is actually somewhat
horizontal to the floor. Semen pools in the vagina, and
so two or three days after someone has sex, and I’m doing
a vaginal exam, I can put that fluid on a slide and see sperm. So she has a longer exposure. And I — you know, I’m a
gynecologist, we’ve done that, but she has a longer exposure to
seminal fluid, which is what — where HIV travels, than a man
whose exposure is simply penis in and penis out. The other things, it’s
unprotected sex, not having sex that involves use of
a condom, which is about all we have that’s available. It’s having sex with men who
also have sex with women. And that’s not something that
women often may know, although some do, but it’s question that
needs to be asked, whether or not you get the honest answer,
but it also means being able to protect yourself. It’s anal sex, and I’ll show
you some data on that, because people are starting to ask
that question more and more. And it’s — when we talk about
protection, we often talk about anal sex protection for men, but
you also have to talk about it for women as well. And then vaginal practices,
women from my mom’s generation were instructed to douche, and
then they tried to make their daughters do the same thing. And you can go into CVS or
Rite-Aid or any of these places and find a whole row of many
different kinds of products to put into your vagina to clean
it out because it’s dirty. But in fact, your body cleanses
itself, and all of those things actually can change the PH
balance, can change the normal bacteria that would live in your
body that’s considered to be healthy, and can put you
at greater risk for HIV. And there’s some tremendous
work that’s being done on the different vaginal practices
around the world that can change and increase your risk for HIV. If you’re paying attention to
some of the news and the blogs, there’s some data that’s
being done that’s looking at lubricants, you know, the things
that are — the wonderful TV commercials where people are
just having just wonderful times at 7:30 in the evening
for your children to see. But some of those lubricants
have been shown to be either hyperosmotic as in having too
many kind of salt particles so they take fluid out of the cells
that are in your vagina, or hypo-osmotic, where they don’t
have — they have more fluid than particles, and so they’ll
put water into the cells, and that can be damaging, so that
when you have sex with them, you can actually get some abrasion. And so it’s not great data yet,
but people are starting to look more closely at what impact
these factors can have. And then there’s substance use. There are two ways to look at
it, if you’re intoxicated or your partner is intoxicated,
it’s sure hard to bargain or to negotiate about safer sex. But there’s also been some data
that’s looked at both methadone, looked at heroin and looked at
cocaine and thought that there may be some immune parameter
changes for people who are using those kinds of drugs, and so
there are — they’ve not been able to relate it yet to
actually increase HIV risk, but they are all sort of things
that we need to consider and to think about. When you’re talking about kind
of sex act that people do, there are different risks assigned. So insertive oral, as in penis
going into mouth, that’s considered to be the least risky
for the person with the penis. But if you look at the different
kinds of risks that women may have, receptive oral
has twice the risk. Receptive vaginal,
20 times the risk. And receptive anal sex is
considered to be 100 times the risk of being an
insertive oral partner. So the practices that you have,
the sexual practices can also increase your risk if they’re
done without protection. The National Youth Risk Behavior
survey is a survey of young people that looks at many
different things, up to and including do they wear seat
belts, but they also ask questions about sex. And so this data that was most
recently reported by the Centers for Disease Control looked at
condom use during last sex, and they broke it down by
race and ethnicity. So you look and think, oh, my
goodness, 61% of kids having sex are using condoms. But I urge you to look
at that as 39% aren’t. 68.6% of males, but only 53,
almost 54% of females had condom use at their last
sexual encounter. And I think that’s an important
message to drive home, which is we may be getting better, but
we’re certainly not there yet, and there are a whole lot
of kids who are at risk. And if they didn’t use it at
their last sexual encounter, and they asked that question
specifically because people can’t always remember, you know,
over the last eight months how many times, it’s — you don’t
know how many times — it means that they’re putting themselves
at risk at least some of the time, if not all of the time. The other study that was done
was looking at heterosexual anal intercourse, and it’s something
that people don’t talk about, it’s something they assume that
women are — women won’t do. And they broke it down in terms
of ever having anal intercourse, and you can see it’s as high
as 40-something, 42, 43% in Seattle, to as low as say 31,
32% in St. Louis and New Orleans in that group, and understand
that many people won’t admit that they have it anyway, so
it’s probably higher numbers. And then with their last partner
if they’ve ever had anal sex, and you can see how the numbers
— but I think the thing that was driven home to me is condom
use for anal sex was only 36%. Males used it about
45% and women only 26%. And if you work with teenagers,
I can remember being momentarily horrified talking to a young
woman, 14, 15-year-old girl who talked about that being the
choice, because then you stay a virgin and you save vaginal sex
for either your special partner or for the person you’re
going to marry or the person that you marry. So — and there’s been a lot
more on blogs lately about the risk associated with anal sex,
with people asking the question, isn’t it safer. And that’s really kind of
horrifying, because it’s not that it’s safer,
it’s actually without a condom entirely
more dangerous. And so it’s a message that
needs to get out there. And I think particularly among
young people who may not see it as real sex. So then we need biomedical
prevention, because most HIV is sexually transmitted either
for women or for men. And the current methods that we
have for women in particular are not something that
women can control. So male condoms, clearly you’ve
got to negotiate, you’ve got to get someone to be —
to agree to wear it. A female condom, yes, you can
put it in, but it takes an awful lot of negotiation
to use it properly. And I urge you, if you haven’t
seen one, to go online, Google it and you’ll see what
I’m talking about. It fits in your vagina, lines
the vagina, and there’s a little ring that sits on the outside,
and you’ve got to negotiate to get the person to put the penis
inside the little ring as opposed to alongside. Not an easy thing to do unless
you’re truly committed to this, and not an easy thing
to do if you are fumbling teenager as well. The other thing is current
prevention is contraceptive, and young women and women of
reproductive age have to make the decision of do I trust
enough to have sex without a condom or without protection
so that we can get pregnant. And even in this country, I
think woman’s currency is very much related to her
ability to childbear. And at the moment, we have no
noncondom protection for anal sex, for men or for women. So there have been a number of
studies that have been done, and the most recent is the CAPRISA
study, and it’s been the most successful, and what it did was
look at using Tenofovir, which is an antiretroviral in a gel
form, and women used it within 12 hours before sex and within
12 hours after sex, so they used it twice, it’s before and after
and it’s called the BAT 24 regimen, and no more than
two times in 24 hours. And what they found, you can see
in the lower box is, for women who used the gel compared to
women who used a gel without the Tenofovir in it, there was a 39%
reduction in the HIV incidence in the new infections
in women who were using the Tenofovir gel. If they were absolutely
adherent, they used it correctly, the way they were
supposed to, more than 80% of their sexual encounters,
it was 54 percent. So it actually can
work quite well. And then the sidebar piece of
data from that was it also lowered herpes simplex
virus infection rates 51%. And it’s tremendous, because
herpes can actually be quite related to HIV risk as well. So I mean, that’s a real step
forward in prevention issues for women. Next. Most recently we got some data
on something called the iPrEX study, have you
guys heard of it? It’s iPrEX, it’s looking at
PrEP, which is oral pre-exposure prophylaxis, it’s an oral
prevention, so you take a pill by mouth every day, and when
you have sex, it’s thought that there will be this
antiretroviral in your system, so if the person has HIV, it
will prevent you from taking on the HIV, becoming infected and
then pre-producing the HIV. So it’s a once daily pill. And this study was done with
men who have sex with men and transgender women who
have sex with men. And it was part of a
comprehensive package of HIV services, as was the other
in terms of prevention. There was a 44% reduction
in people who used the oral Tenofovir, plus another drug
called emtricitabine, and it’s together called Truvada, and
if people were more than 90% adherent, there was
a 73% reduction. So we really have moved forward. We have a gel that can
potentially reduce HIV infection rates in women, and we have a
pill that’s been shown to work in men. Next slide. But we still have — we
still have a ways to go. So we have to — there needs
to be some repetition of these studies to show that they
actually work, so that there’s confirmation studies that are
now ongoing for microbicides, and people are starting to
look at other formulations. So now it’s a gel, but we’re
also starting to look, can you make it in a ring form that’s
like the contraceptive ring, something you would put in and
leave in for three months, and then take it out, and it would
work, and for those three months you’d be protected. A lot less fluid, a lot —
for many women, may be easier to use. Vaginal film, if looks like a
two-by-two, like a post-it note, you fold it in half and fold
it in half again, there’s contraceptive film that does
that and the concept is you could probably impregnate that
with a microbicide, put it in, and it would the same way. A lot less messy, easier
to use, a lot less evident. We’re also looking at rectal
safety of the different kinds of microbicides to see if they
are safe to use in the rectum. The current formulation for the
vagina isn’t safe to use, so they’re looking at how can we
formulate this so we can have one product that can
be used in both places. There are also pregnancy
studies, because women who are pregnant may actually be at
greater risk for HIV infection. Women have sex during pregnancy,
and if they get infected during pregnancy, the risk of
mother-to-child transmission is much greater. And then we’re looking at
other special populations in microbicides, and for once,
men are the special population in this group. Adolescents, and then also
looking at the safety and efficacy in menopausal women. The pre-exposure prophylaxis
studies, there are studies that are going on now to confirm it
and to look at how you would implement this in populations,
so giving men the pills to use and seeing what it takes
to get them to do it and how you roll it out. There’s PREP in women
studies that are going on. And then we’re also looking at
currently male circumcision studies prevent HIV heterosexual
transmission in men, but they’re also starting to look at what’s
the impact in women and what’s the impact in MSM. Next. So at NIH, we do this — try to
do this in a very coordinated way, so we pull in the experts,
both community experts and NIH experts to talk about what are
the priorities for research, and that’s how the funding happens. And it’s the annual
trans NIH plan for HIV aids-related research.
Next. Almost done. And we what hope to eventually
end up with is what’s called the toolbox for prevention. Not all of these things
are going to work 100%. You’re going to have
microbicides that work, we’ll hopefully have a vaccine that
works, PrEP, condoms, behavioral modification or behavior change
that will get people to initiate sex at a later age, get people
to have fewer sex partners, but also to use these kinds
of prevention tools. Next. And if you want additional
information, you can go to the OAR website and it can direct
you to the many places you can go to get
additional information. Thank you. (applause) Chantelle Britton:
Thank you, Dr. Brown. There may be time later on to
ask Dr. Brown some additional — some questions if you have them. But we’re going to go ahead and
get on to our panel discussions. So we’ll start with panel one,
and panel one will explore effective strategies for
prevention, and will include insight and perspective on the
facts, risks and real life experiences of those who have
been affected by HIV/AIDS. Our moderator for panel
one is Janet Cleveland. Ms. Cleveland is the deputy
director of prevention programs in the division of HIV/AIDS
prevention at the CDC. She also served in a number of
state and local level public health positions, including AIDS
project director at community action against addiction in
Cleveland, a health educator and disease intervention specialist
with the Ohio State Department of Health, and public health
project manager with the Mississippi Safety Council
in Jackson, Mississippi. So let’s welcome Janet
and panel one members. Thank you. (applause) Janet Cleveland:
Okay. Thank you.
Good afternoon. Audience:
Good afternoon. Janet Cleveland:
It is truly a pleasure
to be here today and an honor, and I want to thank
the organizers for inviting me to moderate this important
discussion this afternoon. We know based on the information
that we’ve already heard that HIV continues to exact a
devastating toll on women and girls in this country and around
the world, and particularly among women of color. So, therefore, prevention is as
essential and crucial as it has ever been in this country as we
talk about moving forward in terms of how to reduce HIV
infections in this country. Today we’re going to hear from a
panel of women leaders who will share with us their thoughts
about HIV prevention and the needs of women and girls and
also strategies for addressing HIV infection in
their communities. We’re going to hear from A. Toni Young who is the Founder
and Executive Director of Community Education Group. A. Toni Young has served
as the Executive Director since the organization’s
inception in 1993. Toni has been committed to HIV
on the local, regional, and national level for more than 20
years, developing solutions to work to ensure community and
government work and partnership to meet the needs of people
living with HIV and AIDS in the United States. Christina Pena is Ambassador
for the Elizabeth Glaser Pediatric AIDS Foundation. Christina has been a Youth
Ambassador for the Elizabeth Glaser Pediatric AIDS Foundation
for over a decade and regularly speaks at universities,
community forums, and fundraising events on a wide
range of topics specific to the disease. Christina — Christina’s area
of focus, excuse me, largely centers on pediatric HIV and
AIDS, transitioning youth, mother to child
HIV-AIDS transmission, education and prevention. And lastly, but certainly not
least, Miss Barbara Joseph, who is the Founder and
Executive Director of Positive Efforts, Inc,
in Houston, Texas. Miss Barbara Joseph is a
heterosexual female who was diagnosed with HIV 27 years
ago from a blood transfusion after major surgery. Having run into many obstacles
trying to receive medication, insurance, and other health
services, frustration led to creative thinking, thus Positive
Efforts, Inc, was born in 1999. Ms. Joseph has been on the
forefront for over two decades educating, testing, providing
services, and comforting those that are infected and/or
affected by the HIV and AIDS virus and speaking out about
the difficulties that face many within our communities. So this is our panel of leaders
for today in terms of our prevention discussion. And I’m going to begin the
conversation by asking these leaders to please tell us some
of your thoughts about HIV prevention for women and girls
today in the United States and what you and your organizations
are doing to make a difference in terms of the epidemic. Barbara Joseph:
They’ll make me do
this first, how about that. One of the things my
organization does in Houston, Texas, is focuses
on my emphasis on women. When I was diagnosed some
27 years ago, there were no services for women. There was no conversation about
certainly a heterosexual woman being infected at all. So with that in mind, I ran
into all kinds of things, and the only people that helped
me in those days was the gay community, the gay white men. They said, this is going
to happen to your community as well. Certainly I didn’t
think that then. I thought I was the only person
in the world that was black and had a disease that I didn’t
know where I got it from. It took six months for them to
figure out that I had got it from the blood transfusion, and
certainly I had signed all the papers, so of course, no, I did
not, was able to sue anyone. But I ran into all their
problems and I’m not sure if we are at a place where I can say
that those problems are not still existing in
our communities. I do a whole lot of women —
a whole lot of education for women, and I continue to hear
the same, some of the same stories that I
heard 20 years ago. So there’s a whole lot that
needs to be done as far as prevention and women
and their concerns. Christina Pena:
So, just to — briefly,
I was born HIV positive, and I’ve transitioned from
pediatrics to adolescence, and now at 26 I’m in my
adulthood, which is wonderful. So much of my experience
stems with the pediatric transitioning youth community. And I really want to address two important points
regarding prevention. One, a component that I feel
is lacking with regards to prevention efforts is
support and services geared towards disclosure. And I don’t want to confuse you. I want to preface it that
I’m not talking about HIV criminalization or prosecution,
but rather services that allow individuals who are HIV
positive, both male and female, whatever age you’re at, where
you need to disclose your status or the concern for being
infected with other STI’s, we need disclosure talking points,
and we need the services to provide that. I do a lot of mentorship for
youth that are transitioning both pediatric and behavioral
youth, and that’s something that comes up time and time again. How do you disclose to your
partner — speak louder, okay. So how — I can
speak a lot louder. How to disclose to your partner. And this is something that
I think is fundamental for prevention efforts. Another quick point that I’d
like to stress is that we have the capabilities to eradicate
pediatric HIV-AIDS. We know we can do it. We can reduce the risk from
mother to child less than 2%. This is huge. Again, when I was born in 1984,
my mom was entirely unaware that she was infected, had no knowing
that she had passed it to me, but the reality that we can end
pediatric HIV and AIDS in this country is paramount. However, still today,
roughly 200 children are born HIV positive. So that’s something in regards
to prevention, we know how to do this for this category of
women, women who are pregnant. So we need to just push
additional efforts to ensure that all pregnant women receive
the accurate information when they’re going through their care
and are offered HIV testing in a holistic way that will entice
them to want to do it and not push it away. Speaker:
Thank you. A. Toni Young:
So what we do at
Community Education Group, number one, we were
originally founded as the National Women
in HIV-AIDS Project. We changed our name in 1996
because, frankly, it was very difficult to raise money for
women and HIV-AIDS issues. Some of you I’ve known
for a very long time and know exactly what I’m talking about. So now we are actually kind of
a hybrid on the local community here in D.C. in Ward 7 and 8. We do approximately
10,000 HIV tests a year. We target high risk
heterosexual African Americans. What we find is a positivity
rate somewhere between 2.8 and 3.1%, but the thing that I’m
probably the proudest of is that we have a 98%
linkage to care rate. And I think that that’s one of
the big things that we have to do is to make sure that we
understand the importance of getting an individual to a
medical home as a part of prevention, whether that’s
prevention for HIV, substance abuse, or finding a primary
medical home for an individual with some other
health disparate. I think one of the important
things that I think where we are — I frequently get very —
my little six year old nephew says “full up”. I get very full up when I think
about where we are with HIV right now. I like to think of it as
almost the perfect storm. Jeff talked about the
National AIDS Strategy. I think that that gives us a
unique opportunity to rethink how we do HIV in the
United States of America. I think that we have an emphasis
on HIV from one of the first times that I can really remember
on a domestic epidemic. I think that we have a unique
opportunity with the ECHPP strategy that’s coming, which
will roll out at some point to be the 12 City Strategy. I think that one of the next
pieces that we have coming to the United States, and I have to
thank the President — you know, he calls me frequently about
this — (laughter) — let’s just say lifting the ban. Because, you know, one person
that’s here that a lot of you may not know is Tiffany Chester. Tiffany, raise your hand. Stand up and raise
your hand, please. I mean, because
this is significant. And if you look at Tiffany, what
you will notice is that she’s not white, gay, man who is
organizing the international AIDS conference for 2012. That’s a big deal. So when we talk about kind of
where we are with understanding and awareness of African
American women, African Americans in the disease
area of HIV, I mean, that’s very, very important. That’s very, very
heavy and weighted. And so I think it’s important to
us as far as prevention is to take action on the local level
with policy, take local action on the service provision, take
local action in government, but I think that we have to take
action in very proactive ways and become effective partners
with our government partners. Janet Cleveland:
Okay, great. Thank you. I was thinking back to
Dr. Brown’s presentation, and she have just so beautifully
laid out for us how important the issue of biology and anatomy
of women’s bodies, how important those things are as we
think about HIV prevention. And so now what I would like to
ask you ladies is, what messages and strategies do you think are
most effective when conveying the importance of prevention to
women that you work with, and I’m also particularly interested
in what messages do you think are effective in terms of
getting women tested for HIV. We’ve had a huge scale up here
in the United States of not only HIV testing but also
helping to ensure that knows women and others
are linked to care. So what are your thoughts
about that particular issue? And why don’t we start with —
we’ll start with Christina this time. Christina Pena:
Great. I’ll speak
up a little louder. Sorry about that. When category of education in
getting these concerns across to our young people, I think we
need to remember sex education right now is outdated
in our school system. We have our students coming
through public and private schools that do not have the
knowledge or the updated information to navigate
through their sex lives. So that’s something that’s
extremely important and crucial. And we know where our students
are, we know where our kids are, so what we need to do, and I
think this is something that would be from the ground level
up, the local communities that focus on the HIV
population needs to partner with the school districts. And this is going to take a lot
of work, and this isn’t going to be overnight, but we do need to
go in there and partner with our immediate local areas and get
into the school districts that serve our students, and
get on there and educate. We can’t rely on the
teachers to do it. Many teachers are uncomfortable. They don’t have a holistic
approach to sex education. So, as community activists and
leaders who are familiar with the disease and familiar with
the threat level, we need to go in there and partner
with our school district. So that’s something
I would really emphasize with prevention efforts. And I really want to stress it
needs to be a holistic approach to sex education. So we need to talk to both our
girls, and our boys, and our coed, and the mix, and all of
it, the whole gamut, about navigating through disclosure
and communication, and when to choose sex, and what to do
with sex, and how to go get healthcare, where the local
clinics are within their area, which ones are youth friendly,
what their hours are. These are things that I think
would be really important to our students, and I know our
students, they’re smarter than they think. Young people are smart. So they’re going to be
hungry for that information. Janet Cleveland:
Great. Toni? A. Toni Young:
I think one of the
first things we do is that we have to teach young women and
girls the idea or the concept of self-compassion, because I think
that they frequently give one another and themselves very
negative message, both about sex, about sexual orientation,
about sexual identity, and I think that’s the first part of
what we have to do is to have them be okay with who they are. I think that’s one of the
greatest challenges that we face as girls and as women. I think the next piece of that
is really to be able to have a conversation about gender
in a context that is very male identified. Whether we like it, agree
with it, HIV is a very male identified health area, and so
how do we begin to talk about gender in a flowing context? But I think as far as HIV
prevention, counseling and testing specifically, I think
that we have to be very committed to go out to the
street where people are and not sit behind our desk and wait for
individuals to come in to get screened for HIV, wait for them
to get screened to be linked to some other sort of preventive
medical care option. We can’t afford to do that
anymore, because what we know is that people are
unlikely to do that. So if we are truly into the area
of prevention, we have to be willing to go get an
individual and guide them to a medical home. Barbara Joseph:
I have to agree with that,
because what I’m finding in my community is
that women want to know what they don’t know. The teachers are coming to us
and saying to us, we can’t teach HIV or anything about
sexually transmitted diseases. The nurses in the schools don’t
have the knowledge that we, some of us that are providers have. We can expand on it much
better than they can. They’re not comfortable with it. The teachers that I know of are
having a hard time trying to explain to these young people
what their risk levels are. Many of them don’t think
they at risk at all. Many of them tell us right
off, they have no fear of HIV. They have more fear of getting
shot by a drive-by, or they have more fear was not being
able to find a job or a roof over their head. So HIV is low on their mind set,
and so what we need to do as women is to focus on what’s
going to make this woman feel better about herself? What’s going to give
her more self worth? Maybe if she felt better about
herself, get the education that she needs, then she
can negotiate condom use and practices. But until we start on the ground
level, everything we are doing on the top level is not
really going to work like we want it to. We have to start where we used
to be in the early days, one or one, meeting people where they
are, catching them by the hand, crying with them if that’s what
it takes in many cases, because that’s what people deal with me. And so if I look at those
things, I think that we need to do as all women is
collaboratively come together and partner and say, enough is
an enough, and we’ve done this long enough one way, let’s try
and do it another way and see if that won’t work. Janet Cleveland:
Yeah, and, you know,
talking about efforts at the local level, you actually
offer a great segue to the next question that I want to ask you. We’ve heard a lot today about
the National HIV and AIDS Strategy, and I know at the
Centers for Disease Control, we have fully taken on the
charge of trying to do things differently and working with our
partners in terms of not only other federal partners and our
sister agencies within the Department of Health and Human
Services, but also partners from a variety of areas in terms of
how are we going to move the needle so that we’re doing a
better job of prevention in this country. Barbara talked about local level
efforts, and I’m wondering, how is the National HIV and AIDS
Strategy specifically impacting your work with the
communities that you serve? How is this work around the
strategy trickling down at this point? Barbara Joseph:
Let me be clear. It hasn’t
trickled down yet. Sorry, Jeff. It hasn’t trickled down yet. Some of the stuff that the HIV
national strategy states is that we need to decrease the
infections, and we’ve been doing that. It’s not nothing new. We’ve been going out there and
hitting the grounds for years and trying to encompass
all of these things. We talk to the store owners
and partner with the community leaders, but a lot of
them are not willing still to talk about HIV. I still have problems in the
community that is all African American targeted area to put a
sign up in a window of a store. They don’t want
to be associated. They’re not ready to discuss it. So, yes, we are so glad to have
the national strategy, but at the same time, there’s got to be
more that we have to do and more partners that’s willing to work
with us to address all of these issues, and they are many. Christina Pena:
So first I do want
to say that having the National HIV-AIDS Strategy, and
this is pulled from the strategy itself, it is a roadmap to move
the nation forward, and at least it gets us talking about this. It’s great that we’re here
today focusing on women’s and girls’ issues. And I think that having the
dialogue and the conversation is what is so important
and imperative to combating this disease. In regards to the strategy, I
know it’s going to take some time to move things into order,
and I’m really excited to see it develop. But something that I really want
to emphasize that was nice, in 2009, December 2009, ONAP held a
youth meeting here at the White House to focus on adolescent
and youth issues, and this was imperative for this particular
population, because it was the first time we were actually,
that I can remember being part of the HIV community,
recognizing adolescent and transitioning youth. And I want to really emphasize
transitioning youth, because from — and that can be from 14
to 29, I believe is the age. 29, it’s getting up there. I thought I transitioned
out a while ago, but. I was kicked out at 21
for my pediatric care. No, but in terms of
transitioning youth, I think it’s really imperative that
ONAP and the White House, that they’re aware that this
population exists, and it’s really important for the HIV
community to also be aware of it, because this is
something that’s new. I’m part of the early generation
who has been fortunate to transition, and this is
something, the issues that we’re experiencing with access to
care, with going out and finding jobs, with going to college,
with managing relationships, with managing long-term
health, again, when you have transitioning youth, sometimes
they’ve been on their medication for years, or you have
individuals who are brand new in the system and have just become
diagnosed, so they have to navigate it. So there’s a lot of complexities
with this population, but I really want to really thank ONAP
for giving some recognition to this age group and having that
included when considering the National HIV-AIDS Strategy
and moving forward. Janet Cleveland:
Okay, Toni. A. Toni Young:
Okay. I completely drank the Kool-Aid. I am all about the National AIDS
Strategy, I am all about ECHPP, I am all about the 12 cities,
and here is how it is on the ground for me. And I can only talk about our
organizational experience and my experience. Is that it has given us, yes,
definitely, a roadmap, but I think organizationally,
it’s given us targets. It’s given us targets
all the way to 2014. It’s actually not just the
National AIDS Strategy, it’s also looking at the Affordable
Care Act and seeing that we have to completely
rethink how we work. We have to rethink
how we work in HIV. We have to rethink kind of
working in my silo and saying, all we do is HIV testing. I mean, we now are having
conversations with Department of Employment Services,
Department of Justice, Department of Labor. Why? Because we have
a jobs program. Why? Because we’re doing bridging to
individuals who primary care that’s not HIV-related. And I think without a doubt, the
National AIDS Strategy gives us that roadmap and should give
each of us that roadmap in our local communities and in
our local organizations. I don’t think it’s the
panacea, but I think that the implementation plans that are up
online now will tell where the federal agencies are going
to go in relation to HIV. I think they’re worth a read. Some of them are kind of dry,
but some of them are kind of good. They kind of tell you what the
goals and objectives of HRSA and CDC and everybody
else are going to be. So they tell me what I need to
do in the next three years. How does it impact me also is
that what I also know is the Kool-Aid that I drank, I’m one
of the few people that drank it. So I have to really kind of
explain to other people what impact this is going to have. How do I, again, engage new
communities in understanding that this piece of policy may
not impact you today, but it will in a year, or in two years,
and you should get on the board now? Janet Cleveland:
Okay, great. Thank you all. Do we have time for
one more question? Okay. We can do a couple of more,
and question and answer. No, okay. So one more. (laughter) We’ve got so much to
learn from you ladies, so thank you for sharing. So I guess what we will end with
then is, you know, your final thoughts in terms of this,
and we’ll have time for Q&A. But what is the best advice do
you think that you could provide the people that are sitting in
this audience today about HIV prevention for women
and girls specific? What would you want to leave
this audience with in terms of your messages? And let’s see, Barbara,
should we start with you? Barbara Joseph:
I think that one of
the messages I’d like to see us leave with is being open,
open communication, being able to discuss this in dialogue
forms, if necessary, or one-on-one, or whatever, but
get people, get women and young girls to test early and
find out their status. Teach them how to negotiate with
their partners and to use the protections of the barriers
that we have out there. Don’t be afraid. I want our women to start
teaching our young women earlier and not waiting until they get
into trouble before we say anything to them. Many mothers are not willing to
talk to their daughters, their young ladies, because they’re
just not comfortable with it. So I think that one of the
things that I would like to see is that all of us get involved
and all of us start at a very early age to putting this
in their heads, and maybe, maybe we will win this one. I think we can. Christina Pena:
Yeah, very similar,
what I’d like to leave the audience with is also, you
know, to women and girls, and this is something that we
can do all in this room. We just need to provide our
women in our lives, and the girls in our lives, and the
teenagers, with the confidence to navigate their sex
experience, the communication skills, the education and,
again, more importantly, that confidence. That’s something
that we see lacking. I know Dr. Brown had mentioned
that when she was up. We really need to give our young
women and children the skills to help define and,
more importantly, guide their own
sexual experiences. And then we need to have those
conversations as mothers, as grandparents, as daughters, as
teachers, as community leaders, as the strong women that we are
in this room today, we need to go and move the next generation
and the generation that we’re a part of to support
this kind of dialogue. A. Toni Young:
I mean, I think Barbara and
Christina really laid it out, and you’ve laid it out, Gina has
laid it out, Jeff has laid it out, Representative
Christensen has laid it out. We need to take action. I think it’s time for us to
really re-up and recommit to kind of fighting this
epidemic right here at home. This is not just about it being
an international epidemic. We have challenges here that are
built in some systemic issues, race, class,
poverty, and gender. That means that we have to do
double duty on the level of work we have to do, but it
doesn’t mean don’t do it. It means that it’s really an
important time and, I believe, a critical time in us taking
action to get people where we want them to be, particularly
given where we’re going to be in 2014. HIV will no longer be in the
silo that it’s been in, and so we have to figure out ways
that we’re going to impart new prevention and health
messages to communities that need them the most. Janet Cleveland:
Well, thank you to
all of you for not only your thoughts that you’ve shared
with us today, but for your collective leadership in
terms of HIV prevention. As we clearly heard, the time is
now, the time to take action is now, and you are certainly
demonstrating that by your leadership and in terms of your
actions, in terms of trying to make a difference,
in terms of women’s health and HIV prevention. I also want to pay special
acknowledgment and said a special thank you to the women
who are living with this disease, not only on this panel,
but for women in this room who may be living with the disease. Even in 2011, it is not an easy
thing to be able to get up and disclose one’s status and to
tell a personal story about living with HIV disease in
this country, because it still continues to be
a huge challenge. So I thank you not only for your
commitment, but I thank you for your courage, and I thank you
for what you do everyday. So, let’s give them a hand. (applause) Janet Cleveland:
So now we’ll take a
few minutes for Q&A. If anyone has any — wow, wonderful! Why don’t we start up front, and
we’ll try to get around just as quickly as we can. So the young lady
with the red sweater. Participant:
My name is Amber. I’m a student at
American University. I’m guessing Miss Young or Miss
Joseph would better be able to answer this question. But, have you had any success
with collaborating with the religious communities in the
black communities in prevention and reducing stigma, because
based upon some research I’ve done, this seems to be one of
the biggest barriers and reasons why HIV is more concentrated
in the rural cell? Barbara Joseph:
I’ll attempt to hit it. I was invited to the first
African American conclave that was held in New York,
which was very interesting. All of the top 150 biggest African American
ministers were there. And I was amazed that they knew
as little as they did five years ago about it. Some 15 years ago, when I went
into the first church trying to get the ministers to hear us,
they told us that only those people that deserved it
got it, got this disease. So you know that didn’t
make me feel very well. And my political correctness
went out the door at that time, and I’ve never got politically
correct since then. (laughter) Certainly, the
churches and ministers are trying to work with us a little
bit better than they did in the early days. We have seen some ministers
that’s just — I’m not sure if they’re all coming across the
pulpit with it, but they are allowing us to come in and give
light messages in the churches. No condom — I’m still not being
able to pass out condoms in there, but certainly I tell them
to come to the car and we going to give them to you anyway. (laughter) The young people in
the churches are desperate to get the information. They want to do it. But as long as — I think the
preachers’ wives are the ones that understand better than
the ministers themselves. So that’s my experience. Janet Cleveland:
All right. May we have someone
from the back? Yes? I’m sorry, I was actually
looking at the woman with white scarf on. Participate:
Hi, my name is Lauren. I’m from HHS, Office of HIV AIDS
Policy, and I just wanted to bring up two of our
more elusive targets of low perceived risk and stigma. And, Dr. Brown, I think you
actually brought this up in your presentation when some of the
risk behaviors that we talk about, folks just
don’t identify with. If they think that they’re not
having real sex, then they sort of walk right by our messages. And how do we sort of position
this so that everyone sees that this touches you, as well. And regarding low perceived
risk, for a lot of folks, they’re not engaging in a lot of
things that we’re calling risk behaviors, and looking at some
of those structural factors that create and maintain health
disparities would be great. Thank you. Janet Cleveland:
Okay, do we
have time for more questions? Okay, one more. So, and I saw your hand
go up most immediately. Thank you. Participant:
(inaudible) So,
I had a question for you guys. Hey there, I’m Abby Charles
with The Women’s Collective. We’re based here
in Washington, D.C. And nationally we’ve seen a lot
of, you know, fears of funding cuts for reproductive health
programs, but also with the medicalization of HIV and the
move to what’s testing in a lot of emergency rooms and medical
centers, we’ve seen funding for our prevention program
on the ground cut. So, as the Women’s Organization
in D.C, my question is, how do we expand to get to those people
who are low risk identified and not just the high risk people
who fit into our interventions, such as C or SISTA? How do we get to those low risk
people with messages to get them to test with decreased funding? A. Toni Young:
You know, as I said earlier,
I think it’s about being very strategic. I mean, it’s a strategy. It’s a National AIDS Strategy. And I think it teaches
us to be very strategic. We have the Affordable Care Act
coming, it’s here, but we have most of it being
implemented in 2014. I think that if you look at the
National AIDS Strategy, you look at the Affordable Care Act, you
look at where funding is, both at the federal level, as well as
the local level, particularly here in D.C., I think it tells
us very strategically, we have to think beyond where
we’ve been historically. I think that we can’t look at
individuals as high or low risk. I think that we have to look
at those structural factors. We have to look at race, class,
gender, poverty, and say, what are those people going to need
as a portfolio for prevention? And in order to get them a
portfolio of services for prevention, we may need
to move outside of HIV specific services. We may need to broaden
what it is that we offer. We may need to offer them a
cadre of services, which we’ve not historically done. I mean, we may need to enter
into new agreements and new partnerships that we have not
historically done, both with our local government, with our local
Health Departments, as well as with other providers. We’ve entered into agreements
with organizations and hospitals I never thought would see us as
one of their primary partners, but they now do. And again, that’s because we’ve
all gone one goal in common: How do we deliver effective
prevention and care treatment services in the district? Janet Cleveland:
Great. So I’m sorry,
I’ve been told that we have to stop with the questions and answers, but
I believe that all of the panelists, including myself,
will be here throughout the duration of the program and look
forward to maybe having some conversation at the conclusion. (applause) Janet Cleveland:
Thank you. Speaker:
Thank you. So we want to give our Panel I
a round of applause once again. Thank you guys so much. So Toni made reference to our
Federal Operation Plan Overview Report, and I just want to throw
a plug in that we do actually have the Operational Plan
Overview Reports outside of this room. So if you want to pick up a copy
if you haven’t seen it yet, they’re available outside. So we’re going to move
on to our next panel. Our next panel will explore
the barriers that women, young women, and girls face
in obtaining critical services and supports. The panel is also designed
to address disparities that positive women face,
particularly with respect to health outcomes. The moderator for this
panel is Frances Ashe-Goins. And Frances currently serves as
the Acting Director for HHS’s Office of Women’s Health. In this capacity, she oversees
numerous programs related to women’s health issues, and
throughout her years of service, she has implemented several
innovative programs and national summits to address HIV-AIDS,
violence against women, and the Lupus Educational
Awareness Project. Let’s welcome Frances and
our Panel II participants. (applause) Frances Ashe-Goins:
Thank you. As our panelists come forward,
this session will explore the barriers that women, young
women, and girls face in obtaining critical
services and supports. This panel is also designed to
address the disparities that positive women face,
particularly with respect to health outcomes. I will be asking our panelists
three questions, and we’ll get a response for them. But, first of all, let me
introduce you to our panelists. First we have a long-time
person, one of the very first physicians that I knew working
with positive women, Dr. Mardge Cohen. She is a Professor of
Medicine at Rush University. She graduated from Rush Medical
College in 1976, completed her internal medicine residency and
chief residency at Cook County Hospital, where I knew her from,
and she worked at Cook County for more than 30 years, the
length of the epidemic, and has a long history of care and
advocacy to improve women’s health and reduce
health disparities. Our second panelist
is Heather Hauck. She is the Director of the
Maryland Department of Health and Mental Hygiene,
Infectious Disease and Environmental Health Administration. She served as Chair of the
National Alliance of State and Territorial AIDS Directors and
has membership of national organizations since 2003. She serves on NASTAD’s executive
committee, membership committee, and the NASTAD Global
Program Ethiopia Team. Prior to joining the Maryland
Department of Health and Mental Hygiene, she was an independent
consultant, providing technical assistance to hospitals,
national organizations, state public health agencies on
HIV program development. Our third panelist is
HIDIA Charles. She is a graduate fellow at
Suffolk University Health Wellness Services Office. Though she has an overall
interest in health and wellness, she is especially interested
in sexual and reproductive health and HIV. She has over ten years of
experience working with people infected and
affected by HIV-AIDS. As an advocate and grassroot
activist, she has worked closely and committed personally to
fighting the injustices faced by women across this country,
particularly women living with HIV-AIDS, their families,
and their communities. It is thrilling that I have
these panelists with me in my 40 years as a nurse, and I’m
excited to hear their responses to these very pivotal
questions about healthcare for women with HIV-AIDS. The first question is around
general access to care. What are the main reasons that
prevent HIV positive women from accessing
HIV care? It’s on. Dr. Mardge Cohen:
Thanks a lot, Frances. Well, I think one of the key
issues is systemic issues related to our healthcare system
and that we look forward to changes in the next few years. I must say the sort of
dysfunctional, fragmented care system we have could be
greatly improved with a universal single-payer,
government-sponsored universal access to care, and we’re not
going to get that right away. So, with that in mind, I think
what that would do really is provide an opportunity for
everyone — everyone in, nobody out — to get the care
that women with HIV are desperate to have. Certainly, poor and women of
color who bear the greatest burden of the disease don’t have
that access right now, and that would improve it. But I think there are a lot of
other very specific issues as a provider that I see related to
women’s lack of access to care, and specifically poverty is an
overarching sort of difficulty from transportation, to care, to
being able to provide day care while you have to
go to the doctor, to missing work, et cetera. Domestic violence, a major
issue for women with HIV. Studies that I’ve been involved
in have found that over 60% of women with HIV have a history
of abuse, lifetime history of abuse, and that is very
problematic for continuing access to care related to the
self-efficacy that I think was discussed in the previous panel. Drug use does put people sort of
not interested in sort of doing what’s right in terms of their
healthcare on a daily basis, and of course distrust of our
healthcare system, and providers is a big problem that I
think women with HIV face. Finally, poor support systems
in the community and family sometimes also make
it very difficult. The experience I have with women
with HIV is that depression is a key issue. Again, we found that over 60% of
the women in our studies have clinical symptoms of depression,
and that really prevents them from accessing and understanding
what has to be done to move forward, housing and stability,
and competing issues of survival make it very hard. And finally, I think lack of
disclosure, big, big issue — you brought it up —
continues to be major. And then the only other thing
that I think — you’ve all mentioned all of that before,
but issues of prison also are an access difficulty, either
getting in prison or getting out of prison, both of those places
somehow prevent people from getting good care. Heather Hauck:
Great. Thank you. At the State Health Department
and the local health departments, we spend a lot of
time with our community planning processes and our community
planning groups asking exactly this question: What are
the barriers to access? What are the barriers to
access to prevention services and to care services? The first step always is that in
order for women to access care, they first have to know
that they’re HIV positive. So the first place to start
always is to make sure that women are getting tested. And then, I think, Mardge’s list
of all of those issues ring true from our understanding in
Maryland from talking with consumers about access issues. I would just add two to the
list: Transportation, the literal inability to get there
is another big one always on the list, and then of course
the issue around stigma, as a general issue. I think the other thing that we
are spending a lot of time in Maryland talking about within
the context of healthcare reform is the fact that we don’t
really have a culture of care in our country. We have a culture where we go to
the doctor when we’re sick, but we don’t go for sort of well
baby checkups, and I think we really need to move in the
direction where women and girls are accessing healthcare
proactively rather than waiting for there to be an issue,
especially women who are positive but may not yet feel
sick are certainly busy with all of the other life issues. So getting to the point where
you go for the well baby visits and you go for the proactive
healthcare visits I think would go a long way with changing
the access to care issues. Speaker:
Thank you. Hidia Charles:
I wanted to thank
the Office of National AIDS Policy and the Office on
Women’s Health for inviting me to be on this panel. In thinking about ways to
improve access to care for HIV positive women, I think what
comes to mind for me is the lack of comprehensive services
available in certain facilities. When I worked with positive
women, it was especially hard for me to get them to some of
our programming, because they spent most of their days running
to the doctor here uptown, or going to the GYN
person in Brooklyn. It was not set up in a way where
they could go to one facility and get their dental care, their
GYN care, and then there’s always the issue of child care. And Dr. Cohen mentioned it,
as well, that we have to be cognizant of all the other
issues that are going on in women’s lives, that HIV may
not be a priority at all. They’re thinking
about how they’re going to pay their bills. If and when we do get them into
care, we have to facilitate that process so that they’re able to
see a myriad of doctors so that they can, you know,
keep themselves well. So I think that’s something that
we should definitely look into. Another thing would
be even the attitudes of healthcare providers. Sometimes there’s stigma when
you go to get care, and that can be very detrimental to people,
especially for women who are newly diagnosed. Some women are not comfortable
sharing that information with anyone, and so there’s
no support at all. So once they go into these
healthcare settings, if their attitudes are not of the or the
providers are not such that are welcoming and inviting,
that can also be a barrier to access to care. And so I think those are two
that were not yet mentioned that we also need to be cognizant of. Frances Ashe-Goins:
Thank you. Now, navigating the healthcare
system can be quite difficult. It’s important that we
understand the process of navigating health care, and it
can be overwhelming for someone that’s dealing with such a
highly controversial disease. What have you found to be the
greatest barrier to finding adequate healthcare resources
for women, and then how can we better integrate HIV testing, as
was posed in the last panel, and other preventive interventions
into the clinical setting? Either one of you can start. Hidia Charles:
Navigating the healthcare system can be a monumental task for
anybody, and I think one of the ways that we’ve worked with that
in New York is to implement peer-based programming. And so once people are
diagnosed as positive, there usually is a component
where they’re linked to a peer, educator,
or a case manager of sorts. And when there’s a case manager,
that person can really kind of help to navigate the different
systems, especially in thinking about giving
comprehensive care to people, which for me includes housing. Case managers help
with that, as well. So if there’s an area within the
process of testing, getting your diagnosis if it’s positive,
then linking the women to a peer-based type of support
system, that also helps too. Heather Hauck:
I think as Tony alluded to,
we have a little bit of a perfect storm with some
opportunities that are on the table to increase our capacity
and our ability to better navigate or client’s ability
to better navigate the system. I think we have a lot of
opportunities with health information technology
initiatives that are happening both at the national level
and the at local level. I know many states are
especially Maryland is significantly involved in the
patient centered medical home models opportunities that we
have, and I think you know that is certainly critical when you
are talking about one stop shopping type of models. I think many of us are taking
advantage of the opportunities through health care reform, and
the National Aids Strategy to really look at our State health
improvement plans, and then our local implementations and local
objectives and data that we you know be minding and be
better understanding. I think we are certainly taking
advantage of the opportunities through projects like the Twelve
Cities Project or the Egypt Project to really look at our
joint planning opportunities, to think better about how we are
creating the system in a way that you are better —
client is better able to navigate the system. I think we truly have a lesson
to be learned from the Ryan White Part D networks,
that have been developed. Which are women, infant,
children, and youth. I know in Maryland we have
a very strong network that involves faith
based communities, community based organizations,
university based clinics. So life, health, and
wellness in Baltimore. Sisters together in
reaching in Baltimore. University of Maryland,
and Johns Hopkins. And they really have been coming
together and sit at a table with us on a monthly basis to talk
about that coordinated system of care and how do they work across
prevention and care to make sure that women and girls are being
offered testing, are accessing care, are staying in care, and
then are talking about HIV in their communities. I think we do have some
other opportunities with the Affordable Care Act. And I certainly think that
in terms of how do we better integrate HIV testing and other
prevention initiatives, we do need to look at new and
innovative ways to work in clinical settings, working with
provider offices, especially their business offices
to better understand the issues around reimbursement. I still think there continues
to be a perception, perhaps a reality that reimbursement is
difficult for HIV testing that we need to work on. I think that we need to work
with providers to make sure that they are working
hand in hand with their community based organizations. There is a reality that
their time is limited and so partnering with community based
organizations to deliver those HIV testing and prevention
interventions could be a cost effective and a
resource effective model in clinical settings. Dr. Mardge Cohen:
I kind of think
that it is impossible to navigate the health care
system whether you are an HIV positive woman or not. And you know maybe it is because
I worked in a sort of under resourced public hospital,
but I — it is very hard. I am sure everybody hears
terrible stories of what they have been through themselves. But I do — I do think that
there have been a lot of attempts to deal
with the obstacles. And I was lucky enough to work
and help build a program that did have primary HIV care,
dental services, obstetrics, and gynecare in the same place. Women and children seen
together, psychiatry care, case management, all mental health,
chemical dependency, domestic violence
counseling, pastoral care. And I just want to tell you like
three quick examples of how people still fell
through the cracks. Because there is just so much
— no, it is just an impossible thing that we are actually
asking to accomplish. We can do it. I am a very optimistic person. But I will just tell
you three quick one’s. A 30 year old woman
who came for care. She was admitted to the
hospital with cervical cancer. Late stage
metastatic. With AIDS. She had been — had an
abnormal PAP three years before while she was pregnant. Never dealt with it because
she had a lot else going on. She had only told her mother
that she was HIV positive. She didn’t make it. I mean, this is in
the last four years. It is not just a
very long time ago. A 28 year old who was raped at
15 could never deal with the fact that she was infected. Just could not cope. And, you know, wouldn’t take
medications, had a lot of other issues going on in her life. Multiple admissions for
crytoccal meningitis. Late stage and did not make it. And a 45 year old woman who
was a drug user for 20 years. Came into the ICU, respiratory
failure, TB, multiple other bacterial infections. Somehow made it through every
thing we do to the people in the ICU and she did make it. Stopped using drugs. Still with us. On medications.
On a good regimen. So what I get out of like the
horror of obstacles we put in front of people and people’s
very difficult lives is that there has to be an ambience of
caring that allows people to actually come back to care when
they leave care because that is what people do. That is what women do that I
have taken care of and that I have learned from and with. And men do this too. And it is hard to stay in care
and take medicines ever single day of your life. For your whole life. Especially for young women. My experience in both Chicago
and Rwanda, is that especially young folks have a lot of
trouble thinking of taking medicines for the
rest of their life. So we just have to really allow
there to be opportunities to address those issues. And then I think we’ll
be much better off. But I think the idea of
advocating, having a buddy, peers is an essential aspect. And most importantly, we have to
make sure the voices of women with HIV which is so exciting
that the panel started with that, are there to help us
figure out, the best way to do whatever we have to
do to keep it going. Frances Ashe-Goins:
Thank you. We are really short on time. So I have to go on
the last question. Sorry. The last question is, how can we
reduce stigma and discrimination so more women and girls receive
the best care possible? Now, this can be a
six hour at response. But I would like you to give
me your quickest response. Hadea Charles:
Okay. One of the things that we have
lacked on the most I think is actually the disseminating
information around HIV and care. I don’t know how many of us
outside of this room, know that when a person is on medications,
that they cannot — you know when they have a low viral load,
it is harder for them to pass the virus on. I mean, we are not getting
that information out to other settings. And so I think that information
dissemination is one of the key, key ways for us to
address those issues. And you can go on. Heather Hauck:
So our mantra
in Maryland is talk, test and treat. Because talking about HIV and
all the variety of venues have already been discussed is
really the key to reduce stigma and discrimination. And so, you know, public
education, media campaigns like the Stopping AIDS Is Everyone’s
Business, HIV Stops With Me, We Are Greater Than, I think those
are great comprehensive sexual health education I think has
already been covered and mentioned by the previous panel. Engaging our faith communities
in our work places. And I completely agree with the
couple of statements that have been made, the wisdom of the
community, having HIV positive women leaders speaking out
in various forum I think is critically important
to reducing stigma. I think in terms of testing,
routinely testing, educating the health care work force about
the important of testing and reducing systems barriers as
we have already talked about. And then in terms of treatment,
engaging and staying in treatment is not just about HIV
treatment, it is about substance abuse, it is about domestic
intimate partner violence, mental health, housing related
concerns, sexually transmitted infections, viral hepatitis, and
the whole host of other issues that need to be addressed. And if we are going to
really reduce stigma and discrimination, we need to start
with some of those other issues often with our clients instead
of starting with the HIV. Dr. Mardge Cohen:
I think it is very
difficult to figure it out because it has been so many
years and you know I think we have come a long way. But we sort of haven’t
clinched it yet. In terms of stigma. I think what it comes down to,
as a provider, is taking people very seriously and not thinking
of people as what like they are HIV infected, that people are
whole people, that they come with a lot of other
things besides HIV. Take them extremely seriously
and really be there for people with HIV so that in fact we
figure out great ways to have people have the copying
strategies to deal with the stigma. Of course, on the largest level
if we got rid of gender based violence, if we dealt with
poverty, if we actually felt like we did something about
racism, and incredibly much so sensitize the providers as well
as community leaders, we would be more clearly on the
side of women with HIV. Frances Ashe-Goins:
Thank you. Thank you so much. We have time for two questions. So I saw the lady in
the blue and I saw you. Thank you. Vinetta Charles:
Can it reach? Here. My name is Vinetta Charles, I am
with AIDS United and we do fund raising, funding policy,
and capacity building. We are a national organization
based here in DC. And we actually have a very
large access to care initiative with some of the — with
some of the projects that are specifically focused on women
and they do address many of the issues that you talked about
in terms of having more comprehensive services,
transportation, linking with pure navigators, and we
also have a public private partnership with the
Social Innovation Fund at the White House. But our — our money is limited
and then Ryan White Part D, which Dr. Cohen talked about
which also has psycho social support is often the first
to get cut in the states. So how do we keep sort of the
focus on the need for women in terms of these wrap around
services given sort of the limited resources and that the
psycho social supports that we know are especially important
for women and HIV and access to care on the radar? Easy question. (laughter) Frances Ashe-Goins:
One response. Dr. Mardge Cohen:
You have to be in
the streets I think. I mean there is so much going on
right now in our country that is seems to be related to —
insufficient funding for good programs. I mean, the reason why there is
— there was a part D and there was research because of women
with HIV is because were out there saying, demanding it. And I guess we just
have to do that again. Frances Ashe-Goins:
Thank you. Yes, ma’am, and that
is it. I am sorry. Speaker:
I would stop and
say thank you very much to the panelists and the White House
for organizing this panel. And one of the greatest barriers
to women health is bad politics. You know. It is the elephant in the room
that we never discuss that when we get together. And when it comes to especially
to comprehensive sexual reproductive health for women,
we know that politics is driving that idea in there right now. We know that some of the
resources to actually address the needs of women also — it
is politics that is driving it. So my question to you, the
panelists and the previous panelists, and to Congresswoman
Christensen, how do we as AIDS activists, women’s activists,
how are we going to take on these agenda of bad politics
to really address the needs of women and girls? Thank you. (applause) Frances Ashe-Goins:
Okay. It is your office. Hadea Charles:
I would like to thank you
for that question. I think that you are right,
there is lots of politics involved in it. And I think that my focus in
getting a women’s health degree is to try to bridge the
gap between HIV and sexual reproductive health. See one of the things that we —
that is why I am really happy and excited that Congresswoman
Christensen is in the room, is that we are at a lost for
leaders in places where decisions can be made. And so if we are going to
constantly be on the other end of the spectrum in terms of
advocating and I mean we can’t — we can’t even lobby really. We have to advocate and educate. It puts us at a disadvantage. So I mean I tried to tell people
whenever I come in contact with them, that, you know, there is
an opportunity for you to effect change. And it would just mean simply,
trying to push women like ourselves to run for office. And that way, whenever these
things come up in congress, we have allies. They are there to
push agendas forward. So that would be one of my — my
ways to try to combat the issue. Frances Ashe-Goins:
Thank you very much. On a — yes. Donna. Yes. Congresswoman Christensen:
And thank you for that question. And, you know, it is going
to be more difficult. We — we had a pretty
good shot last congress. So I mean, elections matter. You have got to work for
candidates that you know support your issues and your needs. And, yes, run for office. But it also takes a — I mean a
lot of us are from all over the country. And we all have our own
representatives and we all have our Senates — well,
some people have senators. I don’t have one. But, you know, gather some folks
and go and let them know this is important to you and
that they need your vote. Frances Ashe-Goins:
Thank you. Please give our panelists who
had — we are short on time but excellent on information. Thank you. (applause) Thank you. And we’ll
be around. Chantelle? Chantelle Britton:
Thank you so much
to Francis and panel two. Our next panel and our final
panel will discuss effective strategies such as social
marketing and media that target women, young women and girls
for social marketing campaigns. The moderator for this
panel is Mark Ishaug. Mark recently joined
AIDS United as their new President and CEO last month. He came to AIDS United after
serving 13 years as President and CEO of AIDS — of the
AIDS foundation of Chicago. Under his leadership there,
Mark developed an innovative initiatives to promote awareness
of and raise funds for HIV AIDS. Let’s welcome Mark
and panel three. (applause). Mark Ishaug:
This is not me. You can have you. Thank you. Perfect. All right. Good afternoon, everyone. It is such an honor
to be here with all these powerful women and men. I am very honored to be here. I have only been on this job
as she said about six weeks. So I am feeling very green,
even though I have been around for a long, long time. I have to divert for a second. Of our very limited 30 minutes,
just to say I have been doing this work for 25 years and
Mardge Cohen who was just up here is one of my inspirations. I met her on the first
day of the job I think. And she really has inspired
me for the whole time. She is a doctor,
so she has annoyed me a lot of the time too. As doctors do in their very
powerful way to get the services that they need
for their clients. I just got to say in all of my
work, Chicago is a different place because of Dr. Cohen. Rwanda is a different place
because of Dr. Cohen. And we are eliminating perinatal
transmission in this country because of Dr. Cohen and a
whole bunch of other people. So thank you for inspiring me. (applause) So I have the job today of just
standing up here and moderating this very distinguished
and brilliant panel. And I am joined today right
here on my left by my very dear friend and other hero, Regan
Hoffman, the editor and chief of Poz Magazine and the editorial
director of Smart And Strong. This is the multi-media health
information company that has a whole bunch of
brands under it’s name. Focused on health and wellness. Regan is an award
winning journalist. An author, woman living with HIV
and one of the fiercest and most articulate advocates in
the fight against AIDS. How I moderate her
today, I have to no idea. To next, I am going to go right
down to the end and then come back to Susan. Is Dr. Cheryl Smith on the end. And the founder of the Mount
Morris Medical Center, a primary care practice in Harlem. She is the lead clinician with
the Brownsville Multi Service Family Health
Center in Brooklyn. She is all over the place. She is Associate Medical
Director of Clinical Services at New York State Department Of
Health’s AIDS Institute where she directs clinical education
initiatives and shares the social media work group. I do not know how you get
through the day and I stopped her biography very quickly. And last but not least,
our middle guest here, is Susannah Fox,
the Associate Director of the Pew Research Center, Internet
and American Life Project. Susannah is an anthropologist
and journalist by training, but she describes herself as
an Internet geologist. I just love that idea. So she researches
and studies rocks, she said, but she doesn’t judge them. She leaves the judging to us. So she has also researched the
social — how do I say it? Social life of health
information as well as the role the Internet plays
among the people living with chronic diseases. So that is why when
I last with Susannah. I would like you to start by
talking about your experience, your research in fact on the
Internet and especially how girls and women both utilize
the information, utilize the Internet, and how they are
effected by that Internet. Susannah Fox:
Thank you so much. So how many people here
know exactly where their cell phone is now? This is the reality
of the information landscape at this point. What we find is that nine out
of ten teenagers are on line. If we are just looking at 14 to
17 year olds, eight in ten, if they are on line, use
social networking sites. Eight in ten have a cell phone. The numbers continue to be high
among women, adult women and really only start to
drop down around age 65. This has really changed
the information landscape. What we find in our research
is that information has gone mobile. It has gone social. And we have heard a lot today
about the powerful women who can teach all of us. And what we have seen in the
research is that the Internet, has changed from being an
information vending machine to being a two way
communications device. And mobile social tools are
allowing people to be peer educators within their
own Facebook groups. They are able to be peer
educators using text messaging and so the most powerful message
I have for you is that you can’t control the conversation. We all know that. But you can contribute to it. Thank you. Mark Ishaug:
Thank you. So Cheryl why don’t
you follow-up on that. Given that you work in the
public sector which must make the challenges of marketing and
social marketing challenging. As well as a community based
health center with very limited resources. Dr. Cheryl Smith:
Right. I think what I will do is
actually talk about one of the other sectors that I live in,
that will inform both my public health portion and
my clinical practice. And it is a real tangible
example, of how we — we can do this. One is I am a parent. Right. I am a parent. I am a very, very
active family member. So I am almost a mother
to my niece, my nieces. And one of the things that we
found is the fact that one of my niece, and also my niece
that is 20, 19 about to be 20, couldn’t find her. Oftentimes her mother
is frustrated with her as you all know. She is an older teenager,
young woman at this point. And she just was not listening
to what we had to say as it relates to prevention messages
which is what we do in public health. Right? We try to protect the public,
especially in terms of health care. Well, one of the things she is
an avid social media person. I mean, she knows everything
known to mankind, what is coming, what is going. So she is on four squares,
she is on Twitter, she is on Facebook all at the same time. And what we decided to do as
a family was to track her. And, literally, so we — I can
tell you where she is at every like 15 to half an hour
increments literally. So I can say well, she is in
Soho right now, and she is the mayor of this particular spot. At that particular time. And then I could look on her
Facebook page at exactly what she is doing. So one of the things that we did
— I mean, first of all, you have to do this in a non
judgmental manner as her mother — her mother couldn’t
do it properly, because she was judgmental. And once we figure out a
strategy for how to handle this situation, in terms of maybe
having high risk behaviors, then what we did was we tracked her. We decided we would
track and then subtly provide prevention messages. Right, subtly. But as a parent, it is very
hard to do the subtle part. So what we did was we tracked
her where her locations, we looked at the Facebook and
Twitter messages for what it is she was engaged in. One particular, I won’t go
in to anything because then she will kill me. But one particular one, she
wanted to get a tattoo, right? Fine. Not a problem.
We tracked that. She is telling her friends where
she is going to get it done. What she is going to do. So for me as a health care
person, I am concerned about where is she going
to get it done. Right? So what I did was I am tracking
where she is saying she is going to get it done and what we did
was we subtly around sent her via other people on her Facebook
and her Twitter pages to — to the appropriate places
that where she could do it safely. Right? And she actually went there. She didn’t necessarily know
that I was the one that did it. Because then if I sent her,
she wouldn’t have gone. She really wouldn’t have. So one of the things that I find
that is probably and the public health sector is missing this,
is we do not engage in active social listening on all of our
— all of our social media or new technology tools. And I think that is the next
phase of where we have to go in order for us to be
truly effective. Because if we engage in social
listening to what is going on, then we can potentially
develop strategies that are very effective. We can look at — we can trend
behaviors as they are going on. It takes much shorter time
periods for us to be able to do that. So that is one of the things
that I think that we — that is one of the most I think, one of
the things that we will have to do in order to be
much more effective. Mark Ishaug:
Well, Regan,
I think this is a perfect follow-up. I love Poz Magazine. I am on it all the time. (applause) I think you get four
million insane hits a month or something or page views I
think is the proper word. So a lot of people are going to
Poz and my belief is that you are listening and people
at Poz are listening. Can you tell me a little bit
about what you are hearing from women and girls? I think they are talking not
directly to you and they are talking through and to Poz and
how you are talking to them and how you use Poz and other
websites and other forms of media and social media
to listen and to hear these women and girls? Regan Hoffman:
Okay. Well, it is on. Great. Thank you so much. I want to thank the White House
for having me here today and also to say how inspired I am by
all of the women in this room. It is truly a remarkable day. Awareness days come and go and
all of us to go this is like a shot in the ARM, this
is like 20 B12 shots. Also thanks. We do, we have hundreds of
thousands of users on line every month at Poz.com. And the five years since
I have come to the magazine, I have watched it. It is like a coral wreath that
lives and breathe and moves underneath our noses. I contracted HIV in
1996 when I had stopped hearing the messages. In the 80’s I was paranoid,
I was dragging people to get HIV tests. I was dragging my virgin
friends to get HIV tests. I had no idea. You know, I was so paranoid but
when the messaging stopped, so did my vigilance. And that is exactly when the
virus entered my life in 1996. I was on birth control, I was
aware, I was careful, but HIV wasn’t on my radar. As you have heard through all of
the presentations today and as we all know, the message
is not getting out there. And that is born
out by the data. But luckily, we do have this new
media, to communicate through. And, you know, we have talked
about changing for example, the sex education
program in schools. That is going to take a long
time and that is going to be difficult. We don’t have to wait. With social media, what Cheryl
just said is dead on the money. Parents can watch where
their children are. Know that your Facebook page
for your child is probably one of seven. You know that they know
you are watching them. And so embedding messaging and
sharing information with people who will then embed it in their
communities and will be leaders to take it in. I live in suburban New Jersey. And so I have a lot of young
women who are trying to get their sex education through
me, because they won’t get it through school and they won’t
get it from their parents. So I have, you know, embedded
messages or asked them to go places and get the information. There is no question that
we have created this viral community and it is weird word
obviously for HIV, but it is safer for people. There is still because of the
stigma so much inability for people to come forward and we
have an opportunity to both listen and to communicate. And just quickly, I think the
messaging that is out there for women, we have touched on it
in a lot of different ways. The core is really self
empowerment and self esteem. And that is where it starts. And whether you are talking to
an 11 year old child, and by the way I am the first one to not
want to talk about sex to an 11 year old. But if my 11 year old was
getting into a car, I wouldn’t want them to just drive
the car without advice. So whether we like it or
not, they are doing it. And we need to teach
them how to do it safely. And we have seen when we educate
people are more likely to, A, do it better, and B, do it later. So there is no
question about that. The empowering messages
and the connections. I mean, women are — we are such
an incredible force when we connect to one another and give
each other the support that we can’t find out in
the society at large. I have seen women go from
death’s door to entering the forums on Poz.com or being
connected to a community and they are rural and they
are isolated and they are disenfranchised, you are right,
HIV is not the first thing on their minds. But when they get together and
other women give them license to correct their health,
they will do it. Give them encouragement. Mark Ishaug:
Susannah, I think a
lot of public funders and private funders don’t want
to pay for social marketing. They say sort of what is it? Does it work? You know, is it effective? What is your response to
all of those questions? Susannah Fox:
What we see is
that the conversations that are happening are
happening in private. And the peer education, that is
happening, is — is happening not necessarily on Facebook. What you want to do is free the
information that you have, so that other people can share it. And what we find is that if you
make something easy to share, the really important information
that you as an individual hold or your organization holds, make
it as easy to share as possible. Make it so that somebody can
e-mail it privately, because we have found that when there is
something sensitive, people want to keep it private. And not necessarily
posted on Facebook. But make it easy for people to
share and they often will share it. And what we find, is that people
living with chronic disease or who have gone through a
significant health change in the past year, are more likely than
other people to look on line for someone like them. People are still going to health
professionals with their major health questions. But the advice you get from
someone just ahead of you on the path is actually going to be
even more powerful than anything you might get from
an institution. Dr. Cheryl Smith:
Yes, I just wanted
to follow that up with part of my responsibilities
as well as actually providing clinical education. And what we find in
New York State guidelines, we prepare guidelines. One of the things that we find
that continues to be a very, very high utilization
is our guidelines on syphilis and hepatitis. So that continues to be
a real driver for us. We find that people are looking
for that information on line. And just to piggyback on the
prior questions specifically around how health centers and
actually clinical institutions can potentially use new media. One of the things that we are
finding is that actually using text messaging specifically
amongst young women in general is extremely helpful as it
relates to getting them to their appointments. So it is extremely, extremely
helpful as it relates — reminding people about their
appointments, and engaging them in care so that way they
can stay — remain in care. So that has been very helpful. Mark Ishaug:
Regan. Regan Hoffman:
Yeah, I just
want to piggyback on what Susannah’s point. Our information is shared
on 300 social sites. I don’t even know
what half of them are. It depends on what age you are. Whether you are on
tumbled or stumbled upon. Or all of those other sites. There is a baby Facebook I
haven’t even figured out yet. And they change all the time. But to your point when the
information is passed along not by Poz or taken by Poz where it
is accurate hopefully and then passed along by a peer that is
where it really gets taken in. And also I think the
other way is to listen in. Because you have of such an
ability to do research and obviously it is not as clinical
or structured as we would like. We hear so much first at Poz
because we are listening to the street. We are listening
to the rumbling. We are hearing that it is day
care, that women aren’t putting their own selves first. It is not HIV. That is not their main problem. So listening to your audience an
feeding that back and that is what we try to do, figure out
those solutions for those primary concerns for people. But I think that knowing also
the fear of privacy increases as you get older. I think for older women and we
have a real range of ages here. But you go from people in
their tweens and teens sharing everything and too much to
people in their 40’s and 50’s being afraid to
being on Facebook. So we have to adjust
you know for that. I am trying to get
my mom on Facebook. But I sort of don’t
want her on there. Mark Ishaug:
So I have been told
we have to move on. But before we do that
for the ten minute Q&A. If you were able to convince NBC
or ABC or some network or non network to run one series of
PSAs to use millions of dollars of their money for a social
marketing campaign, what would you do? Regan Hoffman:
I would show women and
people living with HIV engaged with other people and
debunk those basic myths. 30 years in, yes, you can swim
in a pool with me, yes, you can hug me. Yes, you can drink
out of my soda can. We still have to go
back to the basics. I think people living with HIV
are the answer and I think we have to make the environment
safe for them to come forward and we have to show there are
literally millions out there and they are normal. Mark Ishaug:
Susannah. Susannah Fox:
I will
give my time to Cheryl. Dr. Cheryl Smith:
Well, sure. I actually think that the
actually putting time into routine testing. I really believe that looking at
just providing health care in general, and getting women into
care, to — phrase that I love is self compassion. That phrase I love to teach
women to really look at themselves and to really
care about themselves first. And to really get
themselves looked at and to love themselves. That would be the PSA. Because I really think the issue
is not — it is not just HIV. It is all of these other things. It is class, it is race, it is
poverty, and I think those — that is a pretty
important message. Mark Ishaug:
Perfect. Awesome. Can you please give a warm
welcome and thank you. So we have about ten minutes for
questions and answers and I will start right there in the back. Do you need a mic? Speaker:
My name is — [Inaudible]
One of the things that AIDS has taught us I think indisputably,
is that stigma is cultivated not only by what is said, by
also by what is not said. And I have to say while we are
talking about communications, it is notable to me that
we haven’t talked at all today about sexual workers. Population primarily with very
high HIV and that sexual worker is not mentioned once in the
National HIV — [inaudible] I wonder if you could comment on
what this omission means and what it reflects in terms of
— [inaudible] Mark Ishaug:
Well, I also have to say for
this last ten minutes of Q&A before we move on, that anyone,
not putting any pressure on the panelists here. Any one. Jeff can answer,
Chantil can answer. Oh, Jeff. Any panelist that spoke before
can answer or really anyone that wants to talk can talk. I love Anna Forbes too. I am so glad she is here. Who is going to
answer that question? Jeff, I would love you
to answer that question. (laughter) Jeff Crowley:
Well, the issue
of sex workers, you know, it wasn’t mentioned. I would say a couple of things. One of our challenges in the
strategy wasn’t to identify every group that is high risk. It is really talk about where we
are focusing our attention and it wasn’t to omit that. But a lot of the work on the sex
work, epidemiology, is — looks very differently in this country
and they are much smaller population in the United
States than in other places. It doesn’t mean they
are not important. Hopefully, the issues we talk
about in the strategy about targeting it in the same way
that we address transgender. Transgender populations
contribute very few infections compared to the overall
pool nationally. But they are at very high risk
and we called them out and I think you can make similar
observations about sex workers. So I think in specific
communities we need to think about how we focus on that. And as we really talk about
driving our resources, targeting to the local epidemics, I think
this could come to play more prominently in some local areas
than in other places as well. Mark Ishaug:
Thanks, Jeff. And before we take the next
question, do you want to respond to that as well too? Speaker:
I think it is
important to think about the kinds of transactions women
may have for survival. Within that is sex work but also
within that is women who may not be able to or may be — I can’t
say willing but are unable to really negotiate safer sex
because that can mean the difference between food on your
table, your children getting to school, a roof over your head,
and if you want — for some women it may be an organized
sort of an approach to survival what you may call sex work, but
for many women it is just an organized approach toward their
daily lives where they may not view themselves as sex workers. I am not sure that necessarily
singling out one group versus another will help as much
as being able to have the discussions with both men and
women about how people need to protect themselves and protect
themselves against HIV. But also putting forth all
the energy, time, money, and research that is necessary to
look at developing ways that women can protect themselves. Mark Ishaug:
Thank you, Gina. In the back. Yes. Speaker:
Good afternoon. My name is — [Inaudible] Mark Ishaug:
Folks come to the mic. They are recording this. So they want to make
sure we hear everything. Victoria Kirby:
All right. Good afternoon, my
name is Victoria Kirby. I am a second year graduate
student at Howard university here in Washington, D.C. and I
have a question, in reference to social media piece. So many messages on the Internet
in particularly in the social media platforms, advertisements,
other organizations that are also vying for people’s
time and attention. How have you been able to
distinguish your message on the social media platforms,
particularly to our young women who may be more interested in
what Justin Bieber has to say then what we are
saying about health. And so I just want to know what
you guys have done in your experience to really distinguish
your messages to get it out there? Regan Hoffman:
We do two things. We look at real time
responses to what works. Masturbation as a head
line works very well. Anything with sex. Literally, we have — we look at
what people are responding to. And we put messages there. We also use people who are
getting a lot of attention. When Lady Gaga tweets about
safe sex, it is very helpful. You know, — you have to use the
people that are already getting the attention. I think those are two, listen to
your audience and use what is already working. Mark Ishaug:
Great. Thank you. We’ll have time for one more
question after this question. So you are next. Speaker:
Hi. My name is — [inaudible] I
am from Outer Kids For Youth. My question is, related to sort
of intersectionality in social media and who has access? Especially when you are talking
about communities that we want to be targeting our low income
of color, and so how are you sort of able to branch out and
reach those communities when there are access barriers? And how do you sort of build
cross messaging to make sure you are reaching the forums because
of the — [Inaudible] — in social media? Also by the way, I have been
live tweeting the whole time. So — Mark Ishaug:
Thank you so much.
And Susannah and Cheryl are both going to respond. Susannah Fox:
Thank you so much. And I will look at
your tweets later. What we find is that mobile is
really changing the Internet access equation when people have
smart phones, it — they are now using the Internet
in a different way. And access is going into new
communities, communities that are still off line include
recent immigrants, people age 65 and older, really 70 and older. And people with lower
levels of education. And I could go on. You can imagine what all the
populations are who are off line, which is why mobile is
a really important marker for people to keep your eye on
in terms of what access is. And one note about that is that
we have found that people are starting to look for
health information using their cell phones. And according to the yahoo’s
data, actually three out of five of the top health search terms
using their mobile platform are sex related. And so what we see is that the
mobile Internet is pretty much the ultimate just
in time wherever you are information resource. Dr. Cheryl Smith:
Just in terms of commenting,
I know there was a question earlier about how do
you reach that faith based community because
you could not distribute or distribute information that you
wanted, in the church itself? I think social media new
technology’s mobile especially enables you to reach that faith
based community, because if you are in that particular
community, you can give them where you are on line. That is what I found in some of
the churches in New York, that is what they are doing. So we may not be able to go in
and say penis or use terms that they may initially approve of,
but what we do is reach out to them and say come
to us for this. And people have reached
out in that manner. So I think that is — I think
that is one way that the church faith based communities walls
will be significantly expanded by new media. Athena Moore:
Hi. Thank you for taking the time to give me an opportunity to present a question. My name is Athena Moore, and I
am the Director of Public Policy For The National Black
Leadership Commission on AIDS, and I also handle the National
Black Women’s Conversation Initiative through
our organization. I am excited to hear this
conversation because we just launched a new campaign 30
years strong and it is a social marketing campaign. And it tries to take advantage
of many of the recommendations that I have made. What we find is that when you
are dealing with faith based communities which is part of
our audience as well as with a volunteer base, a strong
volunteer base, that it is very difficult to you know access
the resources as needed. So I am under scoring just the
critical of that importance of that on going. But also that asking all of
you, what success have you had. We talked about funding only
briefly and really establishing those sort of collaborative
relationships to put those proposals out there that get
social marketing and messaging opportunities funded. We have recruited
pharmaceuticals to get involved with us, and we are continuing
to try to engage others. But I know that the challenge
of resources is always just ever present. Dr. Cheryl Smith:
Well, New York —
New York State Department Of Health recently
held a social media conference where we dealt with some
of the issues of funding. Clearly social media or new
technologies are fairly it seems inexpensive, but it does
take funding to do this. A lot of it is human resource
funding Twitter, Facebook, all of these things are
free to get engaged in. But one of the most important
things that I think is, one, having a strategic plan and
integrating that strategic communications plan with your
overall organizational plan and getting the right personnel and
the right skills in order to do it. I think that it is a
conversation that I think at the federal and state level that we
really need to have in terms of how it is that we fund
these technologies. And part of — I think part of
the maybe one of the limitations for that is that we are still so
early on as it relates to the evaluation of the impact and
outcomes of the technologies. I mean, we can give you
anecdotal stories, but when we are looking at overall
organizations, what is the ultimate impact on — on clients
behavior or — let’s talk about adherence to medications because
that is another way we can — we have used the technology in
order to get people to be much more adherent or appointments,
so I think we are fairly early on. But I think that is — it is a
great question and we have the right people in the room to
ask some of the questions. As it relates to funding,
funding initiatives around new technologies. But I think that needs to happen
next because it is really I think part of the new frontier
in terms of listening first and then developing strategic
actions for what happens after the listening process. Mark Ishaug:
And I am going to let
Regan have the last word on this. Regan Hoffman:
It is a huge
opportunity that we have to catch up with quickly. When — you know when I started
in magazines, it was magazines then to websites. We went to basically
putting the content on line. Now we are a daily
newspapers, that is 24/7. So we have so many more
needs and the hunger for the information and the
responsiveness of the community. I can communicate in real time
to hundreds of thousands of people if I don’t sleep and
none of my staff sleeps. We have the ability to do it. We need the resources and it
would be terrific if we worked as a group to convince people
of the validity of this. It’s measurable and
it works immediately. And again we employ the whole
world with us when we do — when we do social networking. So we get the world
to help us out. Mark Ishaug:
Thank you. So big round of applause for the
panelists and for all of you. (applause) Dr. Cheryl Smith:
Mark,can I say one
quick thing? I am sorry. I will be one quick second. Only because I have — I will
neglect my international AIDS society responsibilities,
we did talk about 2012. Women’s health is extremely,
extremely important. Tiffany is here. So please if you have questions,
you want to participate, you have ideas in how to deal with
women and girls specifically at the conference and how it is
that we can push the agenda as it relates to that,
see myself or Tiffany. We are more than happy to get
your ideas, your concepts, and the like. So thank you. Mark Ishaug:
Thank you. (applause) Thank you so much. Okay. And we are very, very lucky
today to have closing remarks by Tina TChen, the Chief Of Staff,
to First Lady Michelle Obama. It’s such an honor for me as
a Chicagoan to be able to welcome her to this podium. I feel like I have known
her forever as well. Powerhouse lawyer, an amazing
community organizer, a great and beyond great philanthropist. And according to our friend,
Janet Schakowsky, Congresswoman Janet Schakowsky, Tina sleeps
four hours a day and always smiles and laughs as
she just did for us. We are so fortunate to have with
us today, a great leader, a great woman and a
great chief of staff. Tina Tchen. Welcome. (applause) Tina Tchen:
We haven’t seen each other
since I came to DC, this is great. Well thank you. Thank you Mark and thank
you all for being here. I know you have been here
for several hours already. And for that one, let me start
by acknowledging and thanking you all to take the
time to be here. And to address this
important issue. I am here to both convey in my
capacity as Chief Of Staff for the First Lady, her regards
but also in my capacity, I have two hats. Nobody does one thing
in this White House. Everybody does multiple things. I am also the Executive Director
Of The White House Council On Women And Girls. And in that capacity, I want to
convey the President’s greetings and thanks to you all of you
for the work you are doing. The Council For The Women And
Girls for those of you who aren’t familiar with it, was
actually — you are actually here now I realize it on
the two year anniversary. Two year anniversary was
yesterday for Council On Women And Girls. So you know this was created. We were created. We were created as in the first
year of the administration to really be how we here push
for women and girls policy. And we do it throughout
the agencies. It is a council that is made up
of all the federal agencies and all the major white house
offices, so that really everybody gets the message from
the President that every part of the Federal Government has
responsibility to pay attention to and work on the needs
of women and girls. And on especially on this issue. I am so pleased that you are
here today to call attention to and especially with a theme
of a day of taking action for women and girls. And you have had some great
leadership here today. I want to thank the congress
woman for being here and for her many years of
leadership in this area. For Francis, the HHS office of
women’s health is important partner with the council. Has been since our beginning
and your leadership on this. And I have to acknowledge
Mardge, Mardge and I have known each other for years and years. In the trenches.
All the way back. To the beginning and so it is
really great to see you here. I am so delighted you are here. And of course Jeff Crowley. Jeff has really you know what he
has been able to do on AIDS on HIV policy and really being the
spirit and the force behind the national strategy, I mean,
really always taking care to make sure we address the needs
of vulnerable populations. We have done several — when we
start the beginning work on the national strategy and as we have
continued that work since it was issued last year, to really
focus you know on minority populations, on women, and
today’s session on women and girl is really representative of
his leadership and his work and I am really grateful Jeff
to everything you do. I am really here to convey that,
to convey our thanks to you as an administration. You know, one of the things as
you all know from the President, he realizes that as an old
community organizer himself that it is in communities that you
know, that solutions really take hold, that where problems really
get solved and where you really understand because you are
working with the people who are in need everyday. And so while I am really pleased
we are able to have this session today to give you a chance to
communicate with each other, to communicate with us, to convey
the information and that experience and that knowledge
that you have to challenge us which I am sure I heard
you just did right now. And I am sure it has
been happening all day. But that is what we need. And challenge not just us, but
the rest of the policy makers here in Washington to keep an
eye on this issue and to keep moving forward. The national strategy
was just to start. But an important framework to
underscore the commitment that the President has and really the
entire administration has to addressing HIV and AIDS. And especially again as I said
under scoring the needs of women and girls is so important. So thank you very much. And I know it is end
of a very long day. Thank you for all of the work
that you have done, the work that you will do, and we will
look forward to doing that in partnership with all of you. So thank you and let me turn the
podium back over to the Jeff. (applause) Jeff Crowley:
Well, my job is
just to say thank you very much. Have a good weekend. We are glad you came. This was actually a really rich
discussion and hopefully it will continue. If you have other ideas or
thoughts, share them with us. But, you know, I always
sort of reinforce to people, not all roads lead to us. Hopefully, we are a catalyst of
a lot of creative thinking and hopefully you will meet a lot
of people here and keep talking amongst yourselves
and sharing ideas. I do think we have a lot of
momentum with our strategy and where we are trying
to go as a nation. And we look forward to
continuing to try to work with you as we seize the moment
and do great things. Thank you. (applause)

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