A. Identify language for communication: English
B. Identify a spokesperson for group: Madeline Brooks?
C. Begin with one city sharing issues and its ideas for solving it using scale
D. After this perspective, other cities can ask questions to better understand this experience
E. Brainstorm for possible options to help each other move forward
F. Go around table to present best practices
G. Common goals and principles
H. Identify best practices to present during knowledge fair
A. Is being at risk the same as being vulnerable?
B. Vulnerability differs depending on your perspective (e.g., government, community, individual levels)
C. Intention here – dealing with city level; what is the vulnerability for the entire city?
D. Dixon-Diallo – We think of things in terms of risk – who is at greatest/most risk? Should we look at why we are at risk?
• Behavior – not a vulnerability, a choice
• Environment – can increase risk
• Other’s peoples actions – can increase risk
• Behavior and vulnerability
• Concept of vulnerability – risks that people don’t have control over
E. Where’s the line between vulnerability and becoming a victim?
• Issues of stigma
F. How does a health department, municipality, city work to address vulnerability?
• Seattle – they do try to help women (restraining orders), but if women make a choice to stay, how you change things?
- Prevention prioritization – include women and children in prevention, not just focus on MSM
- Get more funding, recognition that women are at risk
• San Francisco – government’s response was initially a medical response (people dying); has now evolved to respond to what the community wants (focus on prevention)
• Quito – Local authority rated as <1; government more focused on poverty; community trying to educate government that addressing HIV is a way to address poverty
G. Needs
• Look at communities within communities (e.g., women and children in African American community)
• Get concrete data on these groups
H. San Francisco example
• Looking at African American community in SE sector
• Issue is that African Americans are less likely to go into treatment before they have full-fledged AIDS
• Less likely to get treatment
• AIDS doesn’t matter as a community issue unless someone is sick (compared to racism, poverty etc.)
• Title I project
• Got epidemiology data
• 1.7 million of Title I reward – develop a center of excellence that will cover range of services
- prevention, treatment, education, counseling
• Had a list of risks/vulnerabilities, had data, suggested that there needed to be a response
- Struggled with issues of racism, heterophobia
• Now getting responses from community to inform services (e.g., involved women, churches involved informally)
• Able to get funding because core data was presented showing what the vulnerable populations were; argued that allocating this money would not destabilize existing system of care
I. Oakland – if you tried to use this in Oakland, the planning council would reject it
• Don’t want to use Ryan White dollars for this
• Planning bodies don’t have an interest in addressing issues affecting Latinos and African Americans (issue of racism)
• Even having data wouldn’t affect this
J. Seattle
• Last year did an assessment on African Americans, Latinos, Foreign-born
• Doing an assessment on the infected/affected, on care providers’ perspectives on what the needs are, why they aren’t getting needs met
• Set priorities on the RFPs when they apply when applying to Title I; be specific
• Need training on preparing grants/proposals – make it easier for these groups to get funds
• A group was started by a few women who began talking about how to address HIV/AIDS in women; eventually evolved into a center to help women and children; have retreats, provide clothing/vouchers, provide a safe haven where they can receive (peer) support
K. Vulnerabilities in two groups
• Persons living with HIV/AIDS
• Persons with negative/unknown status
L. Oakland
• Prevention and care planning councils have merged (previously separate)
• Allows creation of continuum of care:
• Prevention > Care > Prevention for Positives
• “Shotgun wedding” – effort bringing two together was difficult
• Top political person realized that the two needed to be connected
• The larger the city, more difficult to do
M. Quito
• No resources, no information, no good report/data to assess situation (country/city wide), no local planning council
• Have only 1 nation-wide program - $12,000/yr for whole country
• Need to know information/risk groups
• No community-level organizations, no infrastructure
• Seattle – have done community forums; would this work in Ecuador? Cultural/political barriers
• UN trying to develop local programs – HIV/AIDS is one point for development
N. Atlanta
• Set up a council for groups with unmet needs
- Transgender, African Americans (women, youth)
• Create a process within planning councils to specifically address unmet needs
O. Approaching churches
• AIDS ministry
• Go through women in leadership in the church/pastor’s wife – able to influence pastors/general community
• Health committees within churches - make presentations and get them to carry it into the church
• Want pastor to say from the pulpit that the HIV/AIDS is in this church, and that it needs to be addressed with love, compassion and care
• Address stigma
• Have to go incrementally
- First acknowledge that HIV/AIDS is in the community
- Then address the ‘How’
• How to make this issue a high priority that is addressed early on? If no one feels they started early enough, how should it be done?
- Oakland – needs grassroots advocacy, time and political enrollment; need to get community to pressure local government to make it a priority
- Start with issues that are linked to HIV/AIDS
a. E.g., in Quito, child prostitution is a priority; link HIV/AIDS prevention services to this
- San Francisco – who advocates for whom to whom?
- Acknowledgement of needs as a community; identification of resources; connecting intersections of vulnerable groups; doing advocacy on multiple fronts and multiple issues
- Join planning boards, boards of foundations to make sure that underrepresented groups were represented; go to city hall, health departments; get media involved; “Basics” of policy and advocacy
- Look at vulnerable groups within vulnerable groups (e.g., African American MSM)
- Sex education – role of parents, role of schools (including private schools); focus on holistic approach to health and wellness (individual and community level); mandatory sessions for parents
• If we don’t take an active role in our own treatment and prevention messages, it won’t make a difference
- Lack of knowledge about how devastating consequences of HIV/AIDS
• Information/Surveillance
- CDC provides money for reporting/NIH does these study as well (federal/state support)
- Difficulty translating this in developing nations (Ecuador)
• Need to look at effective needle exchange and condom distribution programs (save for Tuesday)
