2007 PREVENTION JUSTICE MOBILIZATON
ENDORSEMENT STATEMENT
We are united in demanding leadership in the fight against HIV/AIDS and justice in prevention policies.
HIV prevention efforts in the United States have focused on identifying and changing the individual behaviors (unprotected sex, unsafe drug injection, childbirth and nursing) that contribute to the spread of the virus. These efforts include examining “risk factors” (other behaviors or traits that increase the odds of practicing risk behaviors), populations that are most likely to engage in these behaviors and the levels of these behaviors that lead to greater risks for transmissions among individuals.
However, a focus on these efforts alone failed to achieve the CDC’s goal of reducing HIV transmission by half. In fact, in some communities, HIV/AIDS rates may once again be on the rise.
In order to address HIV from a prevention justice standpoint to lower HIV rates, we must examine the community and structural conditions that increase risks for individuals or groups. Social and structural risk factors are sometimes acknowledged in programs, research and policies. But we have little in the way of assessment tools, prevention or intervention strategies that address the structural, social and systemic problems that increase the risks for certain groups of individuals more than others.
For example, unsafe sex between men is a risk-taking behavior. Homophobic environments that demonize any sex between men diminish their options to make healthier choices. We have no way of knowing whether the opportunity to have unsafe sex is a more powerful component of risk than the societal impact of homophobia, or vice versa. Furthermore, the fact that the prevalence of HIV is already so high in some communities (nearly 50% Among African American men who have sex with men (MSM) in seven cities studied by the CDC, for instance), means that the same level of individual risk behavior among such men exposes them to five or even ten times the risk as would the same behavior among other MSM.
Is a resource-poor Black woman with children is more likely to contract HIV because she “chooses” to have intercourse raw, or because she chooses to do so in order to keep the man who pays her bills, feeds her kids and keeps the roof over their head? Which is the greater influence for transmission?
These are just two examples of the scenarios putting indivdual risk alongside systemic vulnerability that play out in the lives of many people every day. A prevention justice approach calls for the evaluation of societal factors as well as the individual behaviors that heighten the risk for HIV transmission or acquisition. And a prevention justice approach incorporates both individual and structural approaches for more effective HIV prevention strategies.
The quest for a “magic bullet,” solution, whether a single behavioral or biomedical intervention, is not likely to end the AIDS crisis. We urgently need theories, assessment tools and hybrid prevention strategies that address risk in the context of vulnerability and that directly address the root causes of vulnerability.
These four key principles that must be reflected in a focused, justice-based HIV prevention strategy that can actually stop HIV/AIDS:
1. WE NEED THE TRUTH AND THE TOOLS: UNIVERSAL ACCESS TO SEXUAL HEALTH EDUCATION, HARM REDUCTION AND HIV PREVENTION
- Prevention justice asserts the fundamental right of all people to expect every effective approach to be employed to prevent HIV transmission. Everyone at risk of transmitting or acquiring HIV must have access to scientifically based, culturally and linguistically-appropriate sexual health, harm reduction and HIV prevention information, materials and tools.
- The federal government bears primary responsibility to fund these efforts at adequate levels (at least $2 billion per year across programs), and must end bans on funding for effective programs such as syringe exchange. The next President of the U.S. should develop a results-oriented AIDS strategy that incorporates prevention justice principles and policies.
- If political and cultural barriers impede such access (such as bans restricting access to sterile needles/syringes, and condoms in prisons and jails; comprehensive, accurate sexual information and skills for school youth or detainees; or the gag rule on naming “harm reduction” in federally-funded research and programs), then funders and providers of prevention services must also provide significant funds or strategies to remove these barriers.
2. IT’S NOT ONLY WHAT YOU DO, IT’S WHO YOU ARE: HIV/AIDS AS PROOF POSITIVE OF INJUSTICE:
- All prevention campaigns and strategies must include explicit goals to lessen and eventually eliminate structural risk factors that lead to community-level or population-level vulnerability, such as homelessness, high rates of incarceration, domestic and other gender-based violence, lack of adequate access to high-quality health care and/or a living wage or income.
- They must include plans to eliminate any significant disparities among populations in HIV prevalence and risk, including those associated with race and ethnicity, immigration status and language, gender and gender identification, sexual orientation, nationality, age and area of residence. The greatest disparities must receive the greatest resources and priority of effort to eliminate.
3. AIDS DOESN’T DISCRIMINATE… BUT SOCIETY DOES: END VULNERABILITY BY AFFIRMING THE DIGNITY AND RIGHTS OF ALL:
- All HIV prevention efforts must include an affirmation of the dignity and rights to equality of every individual (including those living with HIV/AIDS) and must actively confront social, cultural and legal norms that prevent or impede realization of such rights and dignity, such as racism, sexism, and homophobia; HIV and drug-use stigma; or discriminatory legal status.
- Any programs that claim to prevent HIV by attacking the dignity and rights of individuals — such as abstinence-only-until-marriage programs that encourage sexism, homophobia and AIDS stigma — must be defunded and repudiated.
- Since rights are meaningless without the means to realize and use them, all HIV prevention must include or ally with efforts to provide every human with the economic and other material necessities of life, including adequate housing, employment or income, physical and mental care, food and nutrition, and drug treatment – the lack of which have been shown to drive HIV spread.
4. DON’T BLAME US OR SHAME US FOR WHAT YOU DON’T KNOW: RESOURCES, ETHICS, AND COMMUNITY INVOLVEMENT IN CRITICAL RESEARCH AND MONITORIING
- Communities and programs lack the resources and tools to fill the gaps in our knowledge base on HIV prevention. The HIV prevention research endeavor must be funded in sufficient quantity and diversity as to promptly solve critical unanswered questions and provide essential missing tools and technologies. Research must focus on providing tools to assess community vulnerability and structural risk and to guide the design of efficient, comprehensive, multifactorial prevention strategies, as well as investigating new individual behavioral or biomedical interventions.
- Further, government and private entities engaging in research and policies must provide timely, understandable and accurate information on their work and proposals, actively soliciting and integrating diverse community input into resource allocation and policy formulation.
- The basic elements of counting and describing people living with, or risk for HIV infection (surveillance categories and systems, testing, case reporting, partner notification and counseling) must not blindly follow previous, narrow medical public health models, but must reflect the other principles described above. These systems and methods must be designed and implemented with awareness of their direct or indirect impact on individual dignity as well as community health and vulnerability.
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