A Recap of the 2021 Texas Legislative Session and HIV

The regular session of the 87th Texas Legislature began on January 12 and concluded on May 31, 2021. Advocacy is one of the guiding principles of the Achieving Together Plan. Through advocacy, we aim to promote and implement policies that support the work in all areas of the plan. We need supportive policies at the federal, state, local, and organizational levels. Achieving Together sat down with Januari Fox, Director of Policy and Advocacy for Prism Health North Texas, to learn more about the HIV-related items addressed during the session and their potential impact on HIV prevention, treatment, and care in Texas.

What were the main legislative priorities around HIV as this session started?

Going into the session, we had House Bill 369, which would have increased the criminal penalties for aggravated assault by communicable disease, on our radar. This is a typical HIV criminalization bill, even though HIV is not directly named. However, we quickly learned that the budget for the Texas HIV Medication Program was in a critical state. An immediate $52 million in funding was needed to keep the program solvent through August 2021, with an additional $104 million needed for the 2022-23 budget cycle.  The $52 million was found through Coronavirus Relief funds and federal supplemental funding, which was excellent. The work lay with the $36.6 million being requested through an exceptional item in the state budget.

What did you and your fellow advocates do during the session to help push increased funding for the HIV program and how receptive were legislators?

Advocates started visiting with our legislative champions very early on, educating them on the need for the THMP program to remain fully funded. We met with Representatives Toni Rose, Julie Johnson, and Donna Howard, and collected letters of support from Representative Garnet Coleman and Senator Boris Miles. We met with the Speaker of the House’s office, as well as the office of the Governor. Legislative briefs were created and distributed, and we had a great deal of contact with the media, who showed a particular interest in this story. Senator Louis Kolkhorst was one of our strongest champions, rallying for us during the appropriations process.

 What was the outcome and what is your response to the outcome?

I am thrilled to say that the program was awarded $36.6 million in state budget funds through strong community advocacy and watchfulness. However, this is far less than the $104 million needed to keep the program solvent over the next two years. The state HIV/STD department is taking a considerable risk at the expense of people living with HIV. They are counting on federal supplemental funding and Coronavirus Relief funding, which will be determined later. If these funds are not received, by DSHS’s calculations up to 5,800 people living with HIV would be relegated to a waitlist and unable to receive their medications.

 How will the outcome change or not change the work you do?

Our next steps are to ensure the THMP receives the approximately $15 million needed to keep Texans off wait lists in the very near future. This will more than likely happen during one of the upcoming special sessions being called by the Governor. Moving forward, advocates want to focus on the growth of the program, including increasing FPL eligibility, adding more medications to the formulary, and addressing systemic barriers that make it difficult for both people living with HIV and the organizations who serve them to be as effective as possible.

What are ways that others can get involved in the future?

One of the easiest ways for people to get involved and stay up to date is to JOIN the Texas Strike Force. This amazing group of advocates stay on top of all information the community needs to be aware of and organizes accordingly. I also want to encourage people to attend the quarterly Texas HIV Medication Program Advisory Committee meetings. These open meetings are a great way to hear about what is going on at the state level, and attendees are allowed up to three minutes of public comment. DSHS is also making a concerted effort to be more transparent and communicative with stakeholders and have held several town halls and partnership meetings. It is important for us to remain involved and at the table as much as possible.

Januari Fox, Director of Policy and Advocacy for Prism Health North Texas

BQ+ Center for Liberation: Working to forward the mobility of Black, queer persons in Houston

The BQ+ Center for Liberation, a project of The Normal Anomaly in southwest Houston, hosted its grand opening on March 10 of this year. In an OutSmart (an LGBTQ Magazine in Houston) article about the Center, Ian stated that “BQ+ is dedicated to building community resources through programming, events, and collaboration that reduces the incidence and effect of HIV, creating and procuring employment opportunities, housing a community burial fund in partnership with community organizations, building knowledge around policy and advocacy, and providing support groups for issues like intimate-partner violence, racial injustice, and social injustice.”

We sat down with The Normal Anomaly founder and executive director Ian L. Haddock to discuss the history and goals of the center and how they see their work fitting into the current intersecting landscapes of pride and Juneteenth this month.

AT: How did you decide to start the BQ+ Center and how does its work differ from that of The Normal Anomaly?

The Normal Anomaly Initiative, Inc. is the organization and BQ+ is a program in the organization. The Normal Anomaly Initiative, Inc. started as a space to curate stories and tell the narratives of marginalized people, but we have expanded to be more than digital storytelling to working to move the story forward. That is where BQ+ comes in: the BQ+ Center creates a physical space that can deliver resources; space for other smaller community organizations to meet; technology for employment applications; research; and to reach the community where they are. Our work at BQ+ allows for The Normal Anomaly Initiative, Inc.’s work to be more tangible, community-driven and accessible.

AT: What are the goals of the Center?

For us, the primary goal is to see the forward mobility of Black, queer persons. We look at that in a few different ways:

  • Moving people from an anomaly in our programs — which we define as many barriers, minimal resources, etc.–to their new normal-–which we define as lower or lessened barriers and expansive resources.
  • Moving organizations and companies from anomalies –which we define as full of barriers, stigmatizing or unwelcoming programming or services and not accessible to Black, queer persons–to a new normal where Black, queer persons are welcomed, treated with respect and dignity, and are in positions to make decisions.

We do this through four focus areas:

  1. Programming/Advocacy Services
  2. Training/Capacity Building
  3. Preventive Services/Linkage to Resources
  4. Social Connectivity

AT: Who is your target audience? It sounds like y’all were specific in choosing your location and your team. Can we hear more about who your target audience is for the work that the Center is doing? 

We chose to be right in the middle of marginalized communities when we were looking for space for BQ+. Our location at 10039 Bissonnet Street Suite 107, Houston, TX 77036 is right in the center of our target audiences: Black persons of transgender experience, persons living with HIV, gender non-conforming and nonbinary people, sex workers, and young adults just beginning their queer journey. This is a central focus of us meeting our community where they are.

We were even strategic in hiring people from these intersections as our team consists of persons openly living with HIV, former sex workers, persons of transgender experience and those who live in fluid sexualities and genders of queerness. We are for the people, by the people, and with the people.

AT: How do you prioritize your initiatives, work, and goals for the Center?

One of the primary ways we prioritize our initiatives, work, and goals is through our development of our strategic plan and the carryout of the key performance indicators that we accepted with our board, staff, consultants, and community. Our community space is our Community Offering Real Engagement (CORE) Group; this group ensures we are in line with what the community is asking for and creates flexibility in our programming to shift closer to the needs of the communities we serve.

AT: How are you promoting the work of the Center?

We are grateful that, though the center has only been open for three months, we have gotten a lot of media attention both locally and nationally. From hosting the first social media takeover in collaboration with Gilead Compass Initiative on GLAAD’s social media to forthcoming highlights during Pride Month on local television to being in print magazines like Outsmart Magazine, podcast features, and capacity-building work with local universities and Fortune 500 companies, we have been intentional with getting the word out there that we are here for the community and to create space with our work.

Still, we are working on creating some items to be disseminated through social media to speak to the impact we are making on the ground. For instance, 24 people have gone through our employment services program and 33% of those have been connected to sustainable employment thus far. Also, we had a cohort of 10 persons living with HIV that taught empowerment, advocacy, and self-care over an 8-session series. As our programs continue to make impact, it will be important to have platforms to support us in moving the story forward for our community.

AT: What advice would you give to others in other cities in Texas looking to start something similar in their community?

We would offer three things to people who desire to create something like this in their communities:

  1. Understand the root of the problem. For instance, one of our goals is to help end the epidemic of HIV through our Center for Liberation. Many organizations go about that by testing, linkage, and PrEP resources. For us, we had to get to the root of the problem and ask, “What is our community telling us with the disproportionate rates of HIV? What do we truly need to get there?” For us, we found some of those answers to be employment, safety, empowerment and sex positivity programming. Once we understand the root, we can immediately make an impact.
  2. Understanding capacity. These types of programming can’t be a “one-off” of a person’s responsibilities; it must be really focused and, more than likely, at least one person’s full-time job. It is a lot of work to be liberating in this work and requires people who are truly passionate about racial and social justice work.
  3. Provide quality employment. It would be a shame to be doing liberation work and have people working for you for pennies or overworked with a moderate salary. This work is not only time consuming, but it is mentally and emotionally exhausting. Be fair. At our organization, we have a self-care day every single week which reduces our work week to four days/week instead of five. Work hard to find resources to pay folx an equitable wage and do human check-ins several times a week. This work requires every step to be liberating, including the employment of people.

AT:  Finally, since this month celebrates both Pride and Juneteenth, how do you see your work within those intersecting identities and struggles?

The Normal Anomaly Initiative, Inc. is dedicated to the forward mobility of Black, queer persons. In this, we would be remiss in not acknowledging the importance of Juneteenth for the intersections in which we exist. Juneteenth was the beginning of a paramount change for Black people here in Texas; that freedom is a part of the liberation work in which our program and center, the Black, Queer Plus (BQ+): Center for Liberation, is founded on. Still, we must consider the nuances of our identities as we also celebrate Pride during this month. Pride is also an important focus for us as it is one of the months where our queerness is most explored, emphasized and empowered.

We choose not to separate either of these intersections because the Black, queer experience is different in that our queerness is often not accepted by our Black community and anti-Blackness is still pervasive in queer communities. Black, queer reality is that Pride 2020 was the deadliest month of the year for Black transgender women being murdered, the month we spent marching here in Houston for George Floyd with Black Lives Matter, and the first month in history we celebrated LGBT protections in employment as a civil right. This is why each one of our intersections during this month is important to highlight; we have a vast amount of power, resilience and promise, but all our intersections are important because they all require a lot of work to get us closer to liberation.

Long-Term Survivors Awareness Day: 40 year anniversary of HIV

June 5th marked the 40 year anniversary of the first official reporting, in the CDC’s Morbidity and Mortality Weekly Report (MMWR), of cases that would later become known as Acquired Immune Deficiency Syndrome and HIV.  The anniversary is also HIV Long-Term Survivors Awareness Day, honoring those that have lived with HIV for 25 or more years and raising awareness of their needs, issues, and experiences.  It is also an opportunity to reflect on the past 40 years of HIV and the impact it has had on so many communities. 

In Texas, there are 9,580 people who have been living with HIV for 25 or more years.  Last year, Achieving Together was honored to host a webinar featuring a panel of incredible individuals, highlighting the experiences and journeys of long-term survivors from Texas.  We encourage you to revisit the webinar and hear from these wonderful community members as you reflect on this anniversary and honor HIV Long-Term Survivors Awareness Day.

To learn more about the history of HIV check out this short informative video covering the last 40 years.

We also encourage you to visit the National AIDS Memorial to view the virtual AIDS Memorial Quilt and see their 40 Years 40 Stories page where they have begun to share the stories and experiences of people living with HIV.

Resource Spotlight: Center for Innovation and Engagement Website

At Achieving Together, we recognize that increasing medication adherence and retention in care among people living with HIV is a necessary component of ending the HIV epidemic. Here in Texas, 70% of people living with HIV were retained in treatment and care in 2019. Of those retained in care in 2019, 86% achieved viral suppression. Under the Achieving Together Plan, Texas’ goals by 2030 are for 90% of people living with HIV to be retained in care and treatment and for 90% of those retained in care to achieve viral suppression.  Given this is where Texas sits in the HIV epidemic, Achieving Together encourages HIV providers, community organizations and institutions to look for resources which support capacity building activities across the HIV continuum. One such resource is the Center for Innovation and Engagement (CIE).

NASTAD recently launched a new resource to help HIV providers address concerns related to retention in care. The Center for Innovation and Engagement (CIE) website, which is supported by the HRSA HAB Special Projects of National Significance (SPNS) Branch, shares innovative, evidence-informed interventions that support linkage, re-engagement, and retention in care to help end the HIV epidemic. Watch this welcome video to learn more about the project’s goals:

Here’s how NASTAD describes the website:

“CIE serves as a culmination of the collaboration between NASTAD, Northwestern University, Howard Brown Health Center, and Impact Marketing + Communications to identify some of the most effective evidence-based and evidence-informed interventions available and transform them into actionable tools, innovative frameworks, and adaptable resources. Our website showcases a myriad of innovative intervention how-to-guides that are “ready to replicate,” our process for selecting innovative approaches, and much more!

An example intervention that is available now is the Bilingual/Bicultural Care Team intervention. This intervention provides an opportunity to engage and retain Hispanic/Latinx adults with HIV by offering culturally and linguistically appropriate care services, leading to improved retention in HIV care and viral suppression. The intervention was modeled after a program developed by the Truman Medical Center (TMC) in Kansas City, Missouri during the years of 2005-2006. TMC experienced a significant increase in clients scheduling and keeping appointments, from a mean of 2.81 to 5.30 visits per year. The viral suppression rate among clients who met the criteria for ARV therapy increased by 31.5 percent.”

To support the real-world replication of the cataloged interventions, CIE provides steps for implementation and resources such as, but not limited to, replication tips, job aids, a cost calculator, and technical assistance.

Have you explored this website yet? Did it help generate any new ideas? Tell us about it!

ThrHIVing: Strong, Resilient, Black Women Taking Action to End HIV & Mental Health Stigma

May is Mental Health Awareness Month, and to honor it, the Black Women’s Affinity Group, in collaboration with Achieving Together, is hosting a webinar to bust myths and offer support for women living with HIV. This webinar, entitled, “ThrHIVing: Strong, Resilient, Black Women Taking Action to End HIV and Mental Health Stigma” will take place on Monday, May 10th, at 11:00 a.m. Central Time both on Zoom and Facebook Live (through the Achieving Together Texas Facebook page). See the link at the bottom of the blog for registration details.

It is widely known that receiving a diagnosis for any disease can take an emotional toll on a person’s mental health; however, when that disease has stigma associated with it, the risk for mental health complications increases greatly. One study of over 2,800 individuals living with HIV showed that approximately 36% also experienced serious depression and almost 16% experienced increased anxiety.

In the creation of the Achieving Together Plan, community members decided that eliminating stigma by cultivating a stigma-free climate of appreciation and inclusion would be one of the six focus areas needed to have a high impact on the goals of the plan. The Black Women’s Affinity Group is working hard to eliminate the stigma associated with HIV in Texas, particularly among Black women. This group, in collaboration with Achieving Together, is composed of community members working to address disproportionate transmission rates,  health disparities for Black women, and  access to care. The focus of the Black Women’s Affinity Group is to address gaps in connecting with clients, providers, and community through culturally responsive and affirming messaging, provide culturally affirming and empowering self-care, and to ensure Black women are included as decision-makers in regard to prevention and care programming from a planning, financing, and implementation standpoint. 

As part of their work, the affinity group has hosted a series of Did You Know? webinars entitled, “DYK Dialogues.” Their upcoming webinar, facilitated by group member Mattyna L Stephens, features a number of speakers, including:

  • Shadawn McCants, CEO of Know and Live Counseling and Consulting, PLLC, (keynote address) Mental Health Professional and HIV Advocate
  • Sharonda Lynn,Community Advocate and Activist
  • Mia Porter, Community Advocate and Activist
  • Bonnie Samuel, Playwright/Poet

The webinar will address how Black women respond to and thrive with an HIV diagnosis while often confronting the associated fear, shame, and stigma they might experience. The webinar seeks to not only address these concerns, but also offer support and resources for navigating systems of care and accessing culturally-affirming mental health resources.

We asked the keynote speaker, Shadawn McCants, to share her thoughts on a few questions to give a preview of the wisdom she will be sharing on the webinar.

AT: What motivated you to get involved in mental health advocacy?

SM: My motivation was from my own experiences with mental health since childhood. Since the age of remembrance I have always stated I wanted to be a social worker. As I matured, attended college and began working in the arena of mental health it was inevitable that I would become an advocate due to the disparities and lack of access to culturally competent care for marginalized communities and individuals.

AT: What are some of the biggest challenges for Black Women accessing mental health services?

SM: One of the biggest challenges is the belief that Black Women are Super Heroes or invincible therefore they don’t need mental health treatment. Very often the assumption is that Black Women “got it.” The expectation of Black Women is to live up to the cliché Strong Black Woman…well that is a myth! Far too many Black Women have internalized this mantra. It halts their ability to ask for help when needed or results in their symptoms being ignored when brought to the attention of medical/clinical professionals.  Additional barriers include access to culturally competent professionals (i.e., Black therapist) and affordable services.

AT: Why is it important for people to understand the unique intersectionality of stigma, living with HIV, and mental health? How does the unique intersectionality of stigma, living with HIV, and mental health impact Black Women’s health outcomes?

SM: The intersectionality of stigma, living with HIV and mental health is impacted by the sheer fact that a diagnosis of HIV is PTSD! It is traumatic and requires a level of mental and emotional wellness from the moment an individual is given the (HIV) diagnosis. When stigma becomes internalized shame and is untreated, ignored, or violated by the systems that were built to protect them, it results in mistrust, disappointment and at worst a defeated mindset that may impact their desire and drive to get or stay in care.

Want to hear more from Shadawn and the other presenters? Join us and register here today (and make sure to share widely!)