Individuals of transgender experience (ITE) in the United States face an elevated risk of HIV infection. Several conditions have been attributed to the high HIV incidence and prevalence within this group, including experiences of discrimination, unemployment, incarceration, stigma, and elevated rates of sexual risk and substance use.

In response to these needs, the Gay and Lesbian Latino AIDS Education Initiative and Prevention Point Philadelphia, two local community-based organizations in Philadelphia, developed the Transhealth Information Project (TIP). TIP is a peer-led six-session hybrid individual- and group-based intervention emphasizing leadership, social and structural interventions, and HIV risk reduction that incorporates other evidence-based practices for HIV prevention and care. Since 2003, TIP has served over 1,500 ITE and linked them to HIV prevention and care services.

TIP has an established record of reaching ITE and linking them to HIV prevention services and HIV primary care. TIP’s utilization speaks to the need for interventions to respond to the complex, interacting syndemic factors that cumulatively determine HIV vulnerability among ITE.

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The journal Social Work is a benefit of NASW membership. It is available online or, at a member’s request, in print. Children & Schools, Health & Social Work and Social Work Research are available by subscription at a discounted rate for NASW members, either online or in print. You can find out more about the journals and subscriptions at this link.

In elaborating on the theme Ambassador Deborah L. Birx, the U.S. Global AIDS Coordinator and U.S. Special Representative for Global Health Diplomacy at the U.S. Department of State, said, “We now have the unprecedented opportunity to change the course of the pandemic. This brings with it the obligation to ensure that our resources are being used in the most efficient and effective ways and are having the greatest possible impact. Accountability and transparency are essential aspects of this.”

The National Association of Social Workers (NASW) agrees with the sentiments of the World AIDS Day theme. We particularly find the theme’s emphasis on the term partnerships to be appealing and in line with social work values.

Since the beginning of the HIV/AIDS pandemic, NASW has embraced its responsibility of being a partner with governmental and non-governmental organizations in achieving the goal of eradicating HIV/AIDS worldwide.

We give recognition to World AIDS Day-2017 by committing to continue working to prevent new HIV infections by increasing awareness of HIV risks, eliminating racial and socio-economic disparities in risk of and in early detection of HIV infections.

For social workers worldwide, World AIDS Day provides the opportunity to remember that HIV/AIDS continues to be a pandemic that threatens people here in the United States and globally.

Here in the United States, we should be reminded that AIDS-related deaths have significantly decreased since the beginning of the pandemic. Much of the increase in life expectancy for persons living with AIDS can be a attributed to advances in viral suppression medications using Highly Active Antiretroviral Therapy (HAART) treatment protocols.

For example, between 2010 and 2013 the death rate for persons living with AIDS dropped by almost to 30 percent.

However, we must not let our guard down. There are still challenges confronting us. There continues to be a need for HIV prevention, testing, and early treatment intervention that targets racial, ethnic and socio-economic groups that are at high risk for HIV infection.

For example, African Americans and Hispanics/Latinos are disproportionately affected by HIV. Though African Americans represented 12 percent of the population, they account for 45 percent (17,670) of HIV diagnoses, according to the Centers for Disease Control. Similarly, Hispanics/Latinos represent 18 percent of the US population, but accounted for 24 percent (9,290) of HIV diagnoses during that period.

When we look at modes of HIV transmission, gay and bisexual men are most affected by HIV. Again, using 2015 data, gay and bisexual men accounted for 67 percent (26,376) of all HIV diagnoses – and 82 percent of diagnoses among males. Of that number, African American gay and bisexual men had the largest number of HIV diagnoses (10,315) followed by white (7,570) and Hispanic/Latino (7,013) gay and bisexual men.

It is also troubling that there is an emerging threat of increased HIV infections because of the current opioid crisis. According to Politico, “The next HIV epidemic in America is likely brewing in rural areas suffering under the nationwide opioid crisis, with many of the highest risk communities in deep red states that voted for President Donald Trump.”

Public health officials express similar fears that the opioid health emergency could lead to a new HIV crisis. Users of opioids such as heroin sometimes inject the drug and share HIV-infected needles. It was the sharing of needles that led to an unprecedented HIV outbreak in rural Indiana in 2015.

Globally, the social work professional must continue to be outspoken and proactive in working to end the HIV/AIDS pandemic. We must insist on international public health policies that promote worldwide awareness of HIV risks; implements population-specific HIV prevention programs, makes available early medical intervention and immediate access to HIV prophylactics and HAART medication regimes.

Resources:

Looking Ahead to World AIDS Day 2017

Federal Response to HIV

Get Involved on World AIDS Day

Get Tested

Selected NASW Resources:

Social Work Practice: Engaging Individuals, Community, and Systems in Support of of the National HIV/AIDS Strategy

HIV/AIDS information from NASW’s Help Starts Here consumer website

NASW Standards for Social Work Practice in Health Care Settings

Mental health practitioners need specific training in working with HIV-affected populations.  The Substance Abuse and Mental Health Services Administration (SAMHSA) devotes efforts to address the overlap between mental illness and HIV/AIDS through a program designed to educate clinicians in the neuropsychiatric, ethical, adherence, and psychosocial aspects of HIV/AIDS.  The Program, which has been funded under HIV/AIDS Education, furthers the development of a skilled and knowledgeable mental health and behavioral health care workforce.

Since the Program was launched under SAMHSA, more than 130,000 psychiatrists, psychologists, medical students, social workers, and allied behavioral health providers have participated in professional education and training activities.  Additionally, the Program since 2015 has produced more than 50 virtual and in-person trainings forums and has created widely-available evidence-based guidance for mental health professionals.  The Program is essential to increasing the availability of well-trained clinicians, and preparing the next generation of health care professionals to deliver comprehensive and responsive mental health services to the nation’s most vulnerable communities at risk for or heavily burdened by HIV infection.

NASW‘s HIV/AIDS Spectrum Project is a grantee of the SAMHSA program. For more background on this issue, visit The Body Pro article by NASW Spectrum Project Trainer, David Fawcett, PhD, LCSW.

The Senate will be considering whether to provide funding for the SAMHSA HIV/AIDS Education Program for the 2018 fiscal year. In FY2017 the Senate Appropriations Committee committed$771,000 for SAMHSA to administer these education programs. The House Appropriations Committee Report omitted the dedicated funding for this program in FY2018.

Action Requested

Write your Senators today and ask them to maintain funding for the SAMHSA HIV/AIDS Education Program for FY2018.

Panelists share insights to strengthen HIV case management at the 4th Annual Global Social Service Workforce Alliance.

“It’s not going to go away if we act like it’s the health sector’s responsibility or simply a question of ensuring we test and treat everyone,” he said.
“HIV is a disease with its roots in inequality,” Fenn says. To make an AIDS-free generation a reality, efforts must be made to tackle the social and economic factors that fuel and impact the epidemic, he added.
Fenn shared his remarks at the 4th Annual Global Social Service Workforce Alliance Symposium: Case Management and the Social Service Workforce on May 24 in Washington, D.C.
The GSSWA, based in Washington, works toward a world where a well-planned, well-trained and well-supported social service workforce effectively delivers promising practices that improve the lives of vulnerable populations.
Susan Rubin, assistant director of the NASW Foundation, serves on the GSSWA’s Steering Committee. She and other NASW staff attended the symposium.
The meeting, which was streamed live around the world, offered practitioners, government representatives, scholars and other experts an opportunity to examine case management’s role in addressing HIV/AIDS, as well as other causes of vulnerability of issues requiring an integrated approach to social services.
“Case management has truly become the unifying tool in the HIV response, contributing to our efforts to identify, access and prioritize risk and vulnerability; and to our efforts to engage families and communities in the development and monitoring of case plans,” Fenn told attendees.
He added that case management also helps strengthen family capacity and resilience, and supports efforts for children to receive and benefit from comprehensive care.
PEPFAR
Fenn noted the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), is taking on the lion’s share of the global response to treat and prevent the spread of HIV/AIDS.
He said in 2015, five countries provided 80 percent of the world’s multilateral HIV funding and 66 percent of that came from PEPFAR.
Because of PEPFAR’s efforts, 18 million people are now accessing HIV/AIDS treatment, Fenn said. “We’ve seen particular success in tackling new infections among children, as 1.6 million new pediatric infections have been prevented since the year 2000.”
But much work remains ahead, Fenn noted.
He said according to the U.N., the number of HIV infections has not dropped and has stayed at roughly 2.1 million per year. The number of pregnant women with HIV is still at 1.4 million and has been there for six years. In addition, Fenn said adolescent girls are still disproportionately infected with HIV.
In 2015, there were still more than 13 million children who had one or both parents die from AIDS, he said. “The epidemic is still one of the major human rights issues of our time.”
Continued support for social services is necessary to address the social and economic factors that fuel the epidemic, he said. Poverty, food insecurity, drug and alcohol abuse, social marginalization, exclusion, stigma, inequity, gender inequity, violence and sexual exploitation are increasing risk and decreasing resilience.
From the July 2017 NASW News. NASW members may read the full story here.

World AIDS Day is about increasing awareness, fighting stigma and discrimination, improving education, and advocating for access to care, treatment, and support.   For social workers worldwide, World AIDS Day provides the opportunity to remind others that HIV/AIDS remains a global health issue.  Promoting individual human rights challenges the barriers created by stigma and discrimination, and works to ensure the right to access to comprehensive health and behavioral health services.  World AIDS Day provides an opportunity to take action and ensure that human rights are protected for HIV/AIDS prevention, care and treatment.

On November 30, 2016,  the White House Office on National HIV/AIDS Policy (ONAP) released the 2016 Progress Report including an infographic on major milestones between 2010 and 2016. The Strategy’s indicators of progress set targets for 2020, and targets to measure progress annually.   the Report notes that between 2010 and 2013 great strides were made:  new HIV diagnoses decreased by 7 percent; overall, there were increases in knowledge of serostatus, linkage to care, and viral suppression; and the death rate dropped by about 30 percent.  The Report reminds us that challenges continue.  For example: HIV rates have  increased among youth, people who inject drugs, and transgender women; progress in reducing the diagnosis disparity in the Southern United States has stalled; and homelessness among persons with HIV continued to inch upward.

The 2016 Progress Report includes three emerging/critical areas to the targets:  to increase the percentage of transgender women in HIV medical care who are virally suppressed (to 90%); to increase the number of people prescribed Pre-Exposure Prophylaxis (PrEP) by 500%; and to decrease HIV associated stigma among people living with HIV by 25%. You can find the latest findings in the National HIV/AIDS Strategy Indicator Supplement.   President Obama also spoke via webcast about the importance of individual and community engagement in HIV prevention, care, and treatment and thanked those working to end AIDS.

Globally, the social work professional must continue our efforts for inclusion of HIV/AIDS issues into development efforts, emphasizing awareness, prevention, and care and treatment as priority areas to be actively included in organizational systems and policies.

Take Action!  Get tested for HIV; practice harm reduction; seek resources in your community.    Support the National HIV/AIDS Strategy through social work practice at the micro, mezzo, and macro levels of practice.

Stay informed!  Connect with the National HIV/AIDS and Mental Health Training Resource Center

Connect!  Let us know how you and your community recognizes World AIDS Day.

Posted by:  Evelyn P. Tomaszewski, MSW

Douglas Brooks, MSW, LCSW

NASW STATEMENT:

The National Association of Social Workers (NASW) commends social worker Douglas Brooks for his leadership and vision as director of the White House Office on National HIV/AIDS Policy.  Brooks, MSW, LCSW, completed his tenure at the office on March 24.

“Since day one, Douglas has provided outstanding service to the nation,” NASW Chief Executive Officer Angelo McClain, PhD, LICSW said. “Douglas’ clinical experience and macro-level practice perspective ensures that mental health, behavioral health, and structural change will remain critical aspects of our nation’s HIV/AIDS strategy.”

Brooks repeatedly demonstrated a commitment to address HIV/AIDS from a holistic approach.  During his tenure, Brooks stressed the importance of utilizing evidence-based practice and demonstrated a commitment to engaging the community in the development and implementation of policy and practice.

NASW President Darrell Wheeler, PhD, LCSW, ACSW, also voiced his appreciation Mr. Brooks.

“Douglas’ unwavering commitment to social justice, his ability to engage diverse key stakeholders, and his respectful and determined forward movement of the National HIV/AIDS Strategy has created true change for communities and providers across the United States.”

On behalf of its members, the National Association of Social Workers thanks Douglas Brooks.

According to the Centers for Disease Control and Prevention (CDC), of the more than 1.2 million people living with HIV in the  United States, only 87 percent  are aware of their health status.  The impact of lack of awareness and understanding of HIV/AIDS remains a critical concern to social workers and allied providers.

Only four of 10 persons diagnosed with HIV are receiving HIV medical care.  And only 37 percent are receiving HIV medications, a necessary bio-medical  intervention that both helps achieve viral suppression and greatly reduces the chances of transmitting the virus.

Social workers  understand that HIV-related disparities are rooted in range of complex social, economic, environmental, and systemic issues. Thirty years into the HIV pandemic our clients, their families, and entire communities face limited resources and services, varying level of access to care and treatment, and the continued impact of HIV stigma and discrimination.

Evidence has demonstrated that HIV-related health disparities have been linked to the broader social determinants of health, including poverty, unequal access to health care, lack of access to education, as well as the impact of stigma, sexism and racism.

In the United States, there is significantly higher rates of HIV in communities of color overall, particularly African-American women and African-American gay men/MSM.  And for African-Americans diagnosed with HIV, research has shown the person is less likely to be linked to care, retained in care, receive antiretroviral treatment and/or achieve adequate viral suppression.

And, while approximately one in four people living with HIV infection in the United States are women, their health remains at risk.  Of all women living with HIV in 2011, approximately 45 percent were engaged in care, and only 32 percent had achieved viral suppression.

Updated White House National HIV/AIDS Strategy

Earlier this year, the White House issued an updated National 2020 HIV/AIDS Strategy (NHAS). The updated NHAS is a five-year plan that details principles, priorities, and actions to guide and support a national response to the HIV epidemic.

As the largest provider of mental health services in the United States, professional social workers have a key role in supporting the goals of the NHAS:  reduce the number of new infections, increase access the care and treatment, reduce health disparities, and achieve a more coordinated national response to the HIV pandemic.

In support of the NHAS 2020, the National Association of Social Workers released a document outlining the critical role of  professional  social work in meeting the goals of the NHAS 2020, and highlighted  the role of social work practice in facilitating the HIV Care Continuum.

How Social Workers are getting involved

For example, through individual, group, and community engagement, social workers are creating opportunities to talk with clients about HIV prevention, working to improve client’s engagement and access to appropriate health and mental health services, and applying evidence-based practices to help clients identify and build strategies to promote medication adherence.

HIV/AIDS impacts the communities in which social workers live and practice.  As a profession, we are committed to providing culturally competent services that include comprehensive and integrated  mental health and behavioral health services for persons living with and affected by HIV/AIDS. Comprehensive care includes access to mental health and substance use programs that are designed to ensure access to services, supports to remain in care, and culturally relevant tools that promote medication adherence

Globally, the social work profession must continue our efforts for inclusion of HIV/AIDS issues into development efforts, emphasizing awareness, prevention, and care and treatment as priority areas to be actively included in organizational systems and policies.

Everyday — social workers on the front-lines as clinicians, educators, researchers, policy makers, and advocates — are working to create accessible, equitable, and sustainable services for persons living and communities affected by HIV/AIDS.

On World AIDS Day 2015:  Get educated, advocate, and take action.  The Time to Act is Now.

For more information on NASW programs regarding HIV/AIDS contact NASW Senior Policy Associate Evelyn Tomaszewski, MSW, at etomaszewski@naswdc.org 

President Obama noted, “We’ve come a long way in the fight against AIDS and we can’t let up now. For those whose lives are still at risk, and for those who didn’t live to see this moment let’s keep working for an AIDS Free Generation.”

In communities across the nation, social workers are engaged in the practice, policy, and research efforts that support these overarching goals of the NHAS:

1. Reduce new infections.
2. Increase access to care and improve health outcomes for people living with HIV.
3. Reduce HIV-related health disparities and health inequities.
4. Achieve a more coordinated national response to the HIV epidemic.

The White House also announced plans to release a federal action plan to implement the Updated Strategy on December 1^st, World AIDS Day.

To review the strategy and learn more about HIV/AIDS, go to the AIDS.gov website.  And for more information on NASW programs regarding HIV/AIDS contact NASW Senior Policy Associate Evelyn Tomaszewski, MSW, at etomaszewski@naswdc.org.

Since the beginning of the HIV/AIDS pandemic, professional social workers have worked in communities across the United States to identify and respond to the complex psychosocial and environmental issues of persons living with and/or affected by HIV/AIDS.

Social workers are committed to promoting skilled integrated care to address the myriad of complex health, mental health and behavioral health, and socio-economic issues associated with HIV/AIDS. In addition, working within multi-disciplinary settings, social workers are on the front lines of HIV prevention, early intervention, and on-going treatment and care.

NASW supports the profession’s commitment to help end AIDS through addressing HIV/AIDS policy and practice-related issues, and providing workforce development through the federally funded NASW HIV/AIDS Spectrum Project.

NASW has outlined the role of social workers in a document entitled, “Social Work Practice: Engaging Individuals, Community, and Systems in Support of the National HIV/AIDS Strategy.”

Posted by:  Evelyn P. Tomaszewski, MSW

Social workers have a key role in supporting the goals of the NHAS: 1) reduce the number of new infections, 2) increase access the care and treatment, and, 3) reduce health disparities, as well as the broader goal of the NHAS:  using innovation and integration of prevention and care to improve the HIV Care Continuum.

Whether through individual clinical practice or community based agency work, social workers have the opportunity to help clients identify and build strategies to promote mental health and wellness.   We do so by seeking out opportunities to talk with clients and patients about HIV prevention, where to go for HIV testing, and work with clients to build skills so that they can access and engage in health and mental health services.

Educating ourselves is key.  To help reduce the number of new cases of HIV or AIDS, learn about how to incorporate treatment as prevention into your practice.  One example is educating clients about Pre-exposure prophylaxis (PrEP), which is a way for people who do not have HIV but who are at substantial risk of getting HIV to prevent HIV infection by taking a pill every day.    Be a part of the social work response by learning  more about the role of NASW in supporting the National HIV/AIDS Strategy.

To participate in a regional meeting or the on-line public forum schedule for May 2015, go to the Office on National AIDS Policy website. 

Posted by:

Evelyn Tomaszewski, MSW,  Senior Policy Associate – HIV/AIDS, LGBT Issues, and Global Violence Prevention       etomaszewski@naswdc.org