The AETC Program is Transforming HIV Care

One of Achieving Together’s Focus Areas is to Collaborate, Cooperate, and Coordinate across Systems. This involves creating systems and processes to share data and resources and to build collaborative partnerships. AIDS Education and Training Centers (AETCs) play an important role in building partnerships and increasing the capacity of HIV providers.

AIDS Education and Training Centers are a national network of leading HIV experts who provide locally-based, tailored education, clinical consultation and technical assistance to healthcare professionals and healthcare organizations to integrate state-of-the-science comprehensive care for those living with or affected by HIV. The AETC Program transforms HIV care by building the capacity to provide accessible, high-quality treatment and services throughout the United States and its territories. 

Texas is part of the South Central AETC (SCAETC) region, with a regional central office at the University of New Mexico (UNM) at Project ECHO. SCAETC has six regional partner sites in Texas who support the SCAETC mission to increase the number of healthcare providers who are effectively educated and motivated to counsel, diagnose, treat, and medically manage people living with HIV, and to help prevent HIV transmission. The program serves all healthcare team members (from those new to the field to experts), health profession students and faculty, and other multidisciplinary care team members.

Highlighted trainings from our Texas partners for 2022 include:

  • VAC Project ECHO: Linkage to Care and Case Management virtual sessions are held biweekly on Thursdays. These ECHO sessions unite a multidisciplinary team of experts providing care to HIV positive persons in rural, under served, and key population areas.
  • VAC Rural HIV ECHO sessions are offered on a Bi-monthly basis on 1st Friday of the month. These sessions primarily focus on rural HIV care services providers and how they have acclimated to the pandemic to continue to serve clients. More information on project ECHO can be found here.
  • The PASO site in Amarillo hosts online training in collaboration with Texas Tech HSC that can be found at: https://healthedu.ttuhsc.edu.
  • Our Houston/BCM partner, in collaboration with partners VAC and UTHSA and TX Dept. of State Health Services, will offer the second Texas Rapid Start Institute in early 2022. The session will be workshop-based to provide health professionals with tools for developing and implementing Rapid Start programs.
  • A comprehensive lunch-hour Ending the HIV Epidemic (EHE) webinar series planned for January 2022 that PHNTX partner is developing. The new series will support management throughout a patient’s life stages and throughout the life cycles from at-risk, to living with HIV, and beyond diagnosis of HIV.
  • The 2022 National Latinx Conference will be held March 24-March 26, 2022, in Albuquerque as a Hybrid event. The Conference on HIV/HCV/Substance Use Disorders (SUD) aims to provide healthcare and social service providers with innovative concepts, best practices, and new information on how to better serve Latinx communities. Workshops will cover a wide range of topics essential to all healthcare providers and practitioners who serve the Latinx Community.
  • The 6th Annual UTMB-SCAETC conference to be held in May (date and time TBD) will be a full-day, high-energy conference to consider how together we can change the face of HIV prevention and care in Texas.
  • The VAC 2022 LGBTQ Health = PRIDE conference will be held in June to provide Healthcare and Social Service Providers with innovative concepts and best practices on how to better serve the LGBTQ+ Latinx communities.
  • The 2022 South Texas Health Equity Conference is planned for September and focuses on all aspects of Health Equity in the South Texas Region.
  • The UTMB site will offer “Countering Stigma and Discrimination in Institutional Culture” and “Engaging Patients in the Texas Department of Criminal Justice Who Can Quickly become Lost in the System” (date and time TBD).

Please visit our registration website here for more information and to participate in upcoming training events. For more information on the SCAETC program in general visit scaetc.org or contact scaetcecho@salud.unm.edu.

Housing is Health: AIDS Services Dallas

AIDS Services of Dallas (ASD) provides housing and support services for low income and homeless individuals and families living with or impacted by HIV. ASD operates four apartment complexes, which are licensed by the Texas Department of State Health Services to serve 225 men, women, and children in 152 bedrooms within 125 privately-configured apartments. Support services include meal and food services, housing-based case management, medical case management, and transportation.

One of Achieving Together’s focus areas is addressing mental health, substance use, housing, and criminal justice. We believe that addressing these needs is essential to creating supportive and stable environments in which people can achieve their health and wellness goals.

Achieving Together sat down with ASD President/CEO Traswell Livingston III to learn more about ASD and the services they provide.

What makes ASD unique?

We’re an exclusive housing provider for individuals that are HIV positive and their families. We use housing as a stabilizer or a health driver for individuals and households. We believe housing is healthcare, so we provide housing first, then we work on an individual basis with care plans and educating them about their HIV. We have an array of services, but the housing part is what makes us unique because we use the housing to start the engagement.

How did you become involved with ASD?

I’ve been in affordable housing since 1998. This has always included LGBT, HIV positive individuals, and those with behavioral health and substance abuse needs. At this point in time our program and our organization focuses on HIV positive individuals.

What are you most proud of?

I’m most proud of the housing we maintain because we don’t develop or maintain what you would think of as affordable housing. The apartments are intentionally designed and operated to look like any private sector housing apartments in the community. Our mantra has always been to be intentional with our design and operations. I’m most proud that we maintain and operate beautiful, quality housing, within an atmosphere that’s beautiful and promotes respect, justice, and mercy. We’ve evolved as HIV has evolved since 1987, but still maintain a residence that people are proud of and have their own independence within. 

How have you adapted in terms of Covid?

Since we work with people with underlying health conditions, education and communication have been an ongoing focus, along with implementation of changes based on local governance. We’ve had to be able to adapt. One of the biggest changes has been the way we serve meals. Serving meals door to door was new for us. We became DoorDash and Uber Eats without the tips. Due to safety concerns in our dining areas, we had to box up the meals and deliver them instead. We became a strong provider of food and nutrition.

In addition, I can’t undersell the education and communication involved. There was so much fear of Covid. Addressing the fear was a stage in itself for our organization. We have people who haven’t traditionally used the health industry as far as navigating healthcare independently. It’s mostly been through medical case management and education through a liaison.

Then we got to the stage of vaccination and faced people’s hesitancy to get vaccinated. That was another phase of education and communication. We had to be examples and model vaccinations. But we’re proud to have a high percentage. Our residents are close to 87% vaccinated. It wasn’t overnight. It took time and modelling and communication.

Are there any myths or misconceptions about the population you serve that you’d like to address?

There are so many misconceptions – including the stigma tied to men who have sex with men, our youth residents and how they identify, and seniors in our program who are 55 and up. Our program includes a wide array of diverse people.

Another misconception is that our residents don’t want to achieve independence. Our residents have overcome adversity, trauma, violence, criminal backgrounds, and rejection in the community. There have been so many barriers, but our residents are resilient. Once given the opportunities, they’ve had so much success – of home ownership, of people getting jobs, of advancing their careers, of helping others and becoming mentors. There’s a perception that it’s a victim population and that’s not true. Someone who is stabilized with affordable housing will want to focus on their health and medications and living safely with HIV, which helps end this epidemic. Our percentages of the 90/90/90 goals are 100/100/97%. We are very, very successful in achieving viral load suppression because people are not living under a bridge or in tents. We serve a low-income population that would be homeless in many cases if this housing wasn’t available to them.

Is there anything else you’d like to tell us?

We’re glad for opportunities like this to spread the word about the services and programs that we do and the model that we have. We want the engagement. We’re proud of our program design. We think it works; we think it’s best practice.  We want to share the design, across the region, across North Texas, across Texas, and nationally. Housing is health. We want people to know that with affordable housing, people can start focusing on other needs that they have as individuals. We invite people to sign up to our newsletter here. We want to yell it from the rooftops – we believe housing is a health indicator and we provide housing intentionally because we want to end this epidemic.

Tarrant County Administrative Agency Actively Involves Community in HIV Work Every Step of the Way

The Achieving Together Texas Plan was developed with six guiding principles to lead the work of ending the HIV epidemic in Texas: social justice, equity, integration, empowerment, advocacy, and community. When addressing empowerment and community, the plan states that we should support shared decision-making between people affected by HIV and providers and across systems. It also acknowledges that lasting change happens at the local level among people who are working together, without a partisan frame, to create a healthy community. Knowing that many ASOs, CBOs, health departments, and other service providers have been operating over the past two years with heroic determination and stamina, under enormous constraints in the midst of the Covid-19 pandemic, we sought to learn more about one administrative agency’s approach to ensuring that community and people living with HIV (PLWH) are included in their planning processes and programming.

Kaitlin Lopez, Grant Coordinator and Quality and AA Planning, with the Tarrant County Administrative Agency recently shared how she and her team actively involve the community and PLWH in their work to help end the HIV epidemic in their community. Tarrant County, home to Fort Worth, Arlington, Grand Prairie, and many other cities, is the third most populous county in Texas after Harris (Houston) and Dallas (Dallas) counties.

Tarrant County Administrative Agency (TC AA), located in Fort Worth, manages all funding for HIV/AIDS care and services in the North Central Texas region. Since 1991, the TC AA has been the only Ryan White recipient in the United States that coordinates all funding parts of the Ryan White Treatment Extension Act (Parts A, B, C, and D) along with Texas State Funds, Housing Opportunities for Persons with AIDS (HOPWA), and Ending the HIV Epidemic (EHE) funds from a single administrative office and with a single planning body. The TC AA presently does not deliver services to clients, but rather utilizes a network model and contracts with subrecipients to provide direct services to eligible individuals.

The TC AA has a number of initiatives currently underway aimed at reducing the impact of HIV in north central Texas including the “CQII Create + Equity Collaborative” which aims to improve viral load suppression and retention in care for: Black women, age 18–39 and Trans women, age 19–39 (CQII stands for “Center for Quality Improvement and Innovation”). Additionally, they provide targeted at-home testing for HIV and run a website and social media campaign tailored to the clients served in this jurisdiction.

You can find the TC AA and learn more about their work on their website: https://beathivtc.org and by following on social media:

One unique and inspiring way they involve the community in this initiative is to ensure that the faces photographed in the campaign are faces of PLWH who live and work in this community.

One standout feature of their work is their Health Improvement Team (HIT) HIV Community Advisory Board (CAB), which has over ten active members who are all living with HIV. This board assists in decision-making and creates initiatives to help improve health outcomes, increase patient satisfaction, and reduce barriers, disparities, and stigma. Additionally, the CAB participates in discussions to change the way services are delivered and how clients are engaged and retained in care. The CAB has developed three work products thus far:

  1. Thriving Guide: A local resource guide with Ryan White, EHE, and Prevention Resources
  2. Diagnosis to First Medical Visit Roadmap: A roadmap that outlines a client’s steps from diagnosis to their first medical appointment.
  3. First Medical Appointment to an Undetectable Status: A roadmap that outlines the steps a client should take to become undetectable.

The above resources are available in Spanish and English in clinics and local points of entry and can also be found online.

Kaitlin says they decided to take this community-centered approach after hosting numerous listening sessions with PLWH. The HIT HIV CAB has provided feedback to the TC AA that has also informed grant activities. PLWH were asking for help crafting initiatives related to stigma reduction, trauma-informed care, care coordination staff that were comfortable talking about sexual health, and resources that were accessible and customized to the community’s needs, in addition to engaging the community in a non-traditional manner. The TC AA hopes that all of these community-focused initiatives will lead to clients living with HIV getting linked to and retained in care, experiencing viral suppression and reaching undetectable status (see U=U), and reduced stigma around HIV within the Tarrant County community.

Kaitlin mentioned that COVID-19 continues to present challenges for outreach and community engagement opportunities. It has impacted the TC AA’s overall ability to create new outreach and community engagement activities. Organizations are prioritizing COVID-19 vaccines and are still focused on organizational recovery. Resources and staff are limited for those who would typically be involved in a partnership with the TC AA to implement new outreach and community engagement activities.

However, despite these challenges Kaitlin and her team offer the following advice to others looking to make an impact on ending HIV in their communities: Talk to your community and actively listen and create actual changes based on feedback from PLWH such as tangible work products and policy and procedural changes. She also underscores the importance of developing a community advisory board that represents your local epidemic and will engage and uplift the voices of PLWH.

We at Achieving Together Texas celebrate the work that the Tarrant County Administrative Agency is doing to end HIV in their community. They are bridging tools, technology, people, and passion while adapting systems and structures to make it easier for all people to access the HIV prevention, care, and treatment they need in order to thrive.

The Tarrant County AA team currently consists of:

Lisa Muttiah, Grants Manager
Renee Thomas, Grants and Data Coordinator
Kaitlin Lopez, Grant Coordinator, Quality and AA Planning
Rebecca Seymore, Financial Analyst
Dulce Lozano, Assistant Financial Analyst
Briana Umana, Office Manager
Damiya Pentecost, EHE Program Manager (not pictured)
Oscar Zuniga, Data Analyst (not pictured)
Brandon Bright, Community Engagement Specialist (Not Pictured)

Alliance of Border Collaboratives: Public Health Leader Helping to Reframe Health Equity in El Paso

Alliance of Border Collaboratives (ABC) in El Paso brings together organizations and individuals to advance the practice of public health and promote social equity, affordable housing, and community development. ABC delivers programs and services in Mexico and the United States, particularly in El Paso.

ABC’s work aligns with Achieving Together’s guiding principles of social justice and equity as well as the focus area of Collaborating, cooperating, and coordinating across systems. We recently interviewed Dr. Susana Villalobos, Interim Executive Director, to learn more about ABC, its mission, and its activities.

How does the Alliance of Border Collaboratives help prevent HIV or support people living with HIV?

The Alliance of Border Collaboratives (ABC) was established as a community based public health non-profit agency in 2009. Since then, ABC’s Executive Board and Staff has worked to ensure that marginalized populations (e.g., homeless, gay and bisexual men, sex workers, transgender people, people with substance use disorders, and others) can exercise their right to receive prevention, intervention, and treatment services for infectious diseases, substance use disorder, and mental health.

Our activities include extensive outreach with our trans community. This includes outreach to highway underpasses, abandoned buildings, and queer bars. Additional prevention activities include passing out condoms, referrals to STI/HIV testing, and encouraging  PrEP.  Grant funding also allows payment of co-pays related to medical consultations for PrEP/PEP as well as transportation to and from appointments for our trans clients.

What would you like people to know or understand about Trans-Fronterizxs?

Trans-Fronterizxs is a peer case management program for transgender individuals in the border region; due to various factors, transgender individuals in our region tend to be isolated from their communities and forced to navigate the world alone, which can lead to lack of knowledge of local resources available. Additionally, some trans folks may not follow-up with appointments due to stigma, fear, and judgment. Ignorance is also a factor that can lead to transgender folks feeling misunderstood and forces them into having to teach service providers in order to receive appropriate care. To this end, peer case management catering to trans individuals, such as Trans-Fronterizxs, can help improve the health outcomes and follow through by providing services in a safe space for transgender folks. Filling out applications, setting up appointments, and navigating the bureaucracy of the local healthcare and social services systems can be daunting for some trans-people (many of whom might not have legal documents that are in agreement with their identity). We assist individuals in these processes and help them navigate the system. For this reason, we believe in meeting the client where they are – whether they are in El Paso or in Juarez – and no matter their current situation. We hope that through our work we can create a tomorrow that is vastly improved from the difficulties and struggles of today.

Our Impact on the Trans Community:

Our trans community has received personalized case management that has helped them enjoy a better quality of life through services such as preparation of name and gender marker applications, referrals, financial assistance for hormone replacement therapy, and transportation through our partnership with Uber health. We’ve carried out this essential work; quarantine or no quarantine. We believe that words fail to capture the relief clients have felt being able to have their identity legally recognized so they can participate in society in a safer way. It opens all kinds of doors to employment and other opportunities; it’s hard to quantify the impact of living your life as a trans woman with documentation that doesn’t match your identity.

For instance, one client had lived more than 20 years openly as a trans-woman and had stopped applying to jobs because of how humiliating it feels to be called by her “dead name.” Trans-Fronterizxs has made an enormous difference; a client reports that, “we’ve changed her life forever.” Other clients have remarked how they were able to do things they never thought they would be able to do, such as getting on hormones and getting their name changed.

What aspect of your work are you most proud of?

Many of our trans clients expressed their frustration on the emphasis of research studies and awareness versus direct client services. As an agency, ABC advocates for direct services funding. Our best efforts focus on a direct response to our community’s needs, and nothing is more important than having people feel comfortable in their own skin, particularly our trans community living on the border.

What keeps you motivated to do this work?

Unfortunately, the trans population often only have each other to rely on. The world is a cruel place when there is fear and misunderstanding. ABC strives to befriend the trans community and advocate for their needs wherever they are needed. We are determined to leave a positive footprint for our trans clients, and make a path to a life well-lived, without fear and judgement.

What does success look like to you?

At the risk of sounding idealistic, I think the ultimate success would be trans organizations becoming obsolete, this would entail having all their needs met. The little victories for the present include improving health outcomes, preventing HIV, funding hormone therapy, clothing and feeding trans people, and helping trans folks update their legal identity documents. Every single trans identified person we help as an agency is a success story.

Are there any myths or misconceptions you would like to address?

Visibility does not equal public support. Often, it results in increased risk for violence. The public support is not there yet. Especially in any place that isn’t a major city.

Another myth that prevails is the notion they were born in the wrong body. Many trans folks have no desire to medically transition. It is society that drives the message that their bodies are incorrect.

Another misconception is that “they” all want “the surgery.” There are several surgeries one might undergo for medical transition. Gender reassignment surgery is increasingly not necessary to update legal identity documents.

Stigma related to sexual promiscuity is another misconception on the trans community. Higher rates of HIV in our community does not equal labeling our trans community for the cause.

Is there anything else you’d like to tell us?

I encourage folks who are interested in being allies to look up local trans folks on their Go Fund Me pages, to contribute directly. For the trans people in your lives, defend them when they are harassed, and stick up for them even when they are not in the room.

Despite the circumstance of the pandemic, our services for our trans community never faltered.  ABC in El Paso, Texas, supports our trans clients with direct financial aid, clothing and legal assistance. Our community agency collaborations help to ease the economic situation our trans people face in their day to day lives.

ABC also integrates evidence-based harm reduction strategies to address the risks associated with syringe sharing and recurrent use of a single syringe, such as HIV, HCV, and soft-tissue infections. ABC provides peer-driven education on HIV, HCV, and soft-tissue infections, in conjunction with access to syringes and injection drug use equipment. 

These initiatives resulted in ABC being recognized by peers as an underground syringe program. It has been challenging to maintain these services, but ABC has strived in the face of adversity continuing to secure and provide both Narcan and sterile syringes (as needed) during the SARS-CoV-2 pandemic implementing protective measures for staff and clients as well as continuing with street outreach throughout the ongoing pandemic.

40 Years of HIV/AIDS and the Gay/Bisexual Community

This year marks 40 years since HIV/AIDS was first reported in the United States. On June 5, 1981, the U.S. Centers for Disease Control (CDC) published an article in its Morbidity and Mortality Weekly Report (MMWR): Pneumocystis Pneumonia—Los Angeles. This article described “cases of a rare lung infection, Pneumocystis carinii pneumonia (PCP), in five young, previously healthy gay men in Los Angeles…This edition of the MMWR marks the first official reporting of what will later become known as the AIDS (Acquired Immunodeficiency Syndrome) epidemic.”

We are all too familiar with what followed. By 1992, the CDC reported that more than 250,000 people had been diagnosed with AIDS, nearly 90% of whom were men, and almost 230,000 had passed away from AIDS. As we honor National Gay Men’s HIV/AIDS Awareness Day #GMHAAD on September 27, we take this time to reflect upon the past 40 years of HIV/AIDS history in the United States and honor those many lives lost and those who fought for access to life-saving treatments and medications, while celebrating the message of U=U and what that means for ending the HIV epidemic. While HIV/AIDS does not only affect gay men, on #GMHAAD, we take this opportunity to honor the struggle and fear that mobilized and traumatized the gay community and their allies in the United States during the past 40 years.

Two documentary films we at Achieving Together find both informative and captivating about the early days of the HIV/AIDS crisis are 5B about the group of nurses and caregivers who opened the first AIDS ward in the world at San Francisco General Hospital and How to Survive a Plague about the activism of ACT UP in the 1980s and 90s.

We give thanks to those brave men and women who cared for AIDS patients over the years and to the activists who put their bodies on the line to fight for better care, treatment, and prevention. Enormous strides in treatments were made over the past 40 years, and we can now celebrate that an HIV diagnosis no longer means a life cut short. Thanks to these life-saving medications, people living with HIV who are on treatment can achieve an “undetectable” status, meaning they can live with the confidence that they cannot sexually transmit HIV to their partners. In other words, undetectable = untransmissible or U=U. You can watch U=U activists share the hope this message brings to people living with HIV, particularly gay men who may have witnessed their friends and loved ones perish from the disease at any point in the previous 40 years on a recent segment from the TODAY show.

You can read more about the U=U movement in our previous post here.

In Texas, almost 60% of people living with HIV are gay/bi-sexual men and they made up almost 2/3 of new diagnoses in 2019. 

One striking thing that we see in the visualization above is disparity that exists between White gay and bisexual men and their Black and Latinx counterparts. We see above that Black and Latinx gay/bi-sexual men represent 40% of people living with HIV in Texas and more than 50% of new diagnoses in 2019. We know that stigma and lack of equal access to prevention and treatment remain significant barriers for Black and Latinx gay/bisexual Texans. Therefore, we’d like to highlight just a few organizations in Texas who are trying to change that narrative and address the gaps that exist in providing HIV treatment and services to LGBTQ communities of color across our state (click on the links to learn more):

·      The Normal Anomaly

·      The Mahogany Project (Houston)

·      The Mahogany Project (Austin)

·      Whatsinthemirror?

·      Embrace

·      Valley AIDS Council

·      Borderland Rainbow Center

·      House of Rebirth

·      Dallas Southern Pride

·      allgo

·      Trans Fronterizxs