Breaking the Invisibility: Our Health, Our Future

National Hispanic/Latinx Health Policy Agenda 2020-2024

Hispanics/Latinx represent the nation’s fastest-growing minority and ethnic population, as well as the fastest-growing aging population in the U.S. Despite the growing population, Hispanics/Latinx are disproportionately affected by health disparities. Hispanics/Latinx experience a lack of access to health services, fueled by high uninsured rates, as well as stigma, structural and social barriers, and lack of income and education, in addition to other risk factors such as racial, cultural, linguistic, and immigration status. These health disparities are often invisible and need to be addressed by sound federal policy and a comprehensive health policy agenda designed for the Hispanic/Latinx population through an inclusive process and participation of Hispanic/Latinx leaders.

Throughout a two-year process, national Hispanic/Latinx steering and planning committees convened work groups charged with communicating their perspectives on national issues, analyzing challenges, and providing recommendations on topics such as prevention, access to health care, stigma, and immigration and migration.

In March of 2020, The Hispanic/Latinx Health Leadership Network, which is a collaborative effort of health community leaders, held a two-day National Hispanic/Latinx Leadership Summit focused on HIV, viral hepatitis, STIs, stigma, and other health disparities impacting Hispanics/Latinx. This was the first ever community driven health policy agenda-setting summit of the National Hispanic/Latinx Health Leadership Network, convening over 150 Hispanic/Latinx serving organizations, public health leaders, elected and appointed officials, researchers, and community members. Summit participants included:

  • Maria Roman, VP, Translatin@ Coalition, Los Angeles, CA
  • Congresswoman Debbie Mucarsel-Powell, U.S. House of Representatives, 26th District
  • Harold J. Phillips, Senior HIV Advisor and Chief Operating Office of Ending the HIV Epidemic: A Plan for America Office of Infectious Disease and HIV/AIDS Policy, U.S. Department of Health and Human Services
  • Dr. Eugene McCray, Director, Division on HIV/AIDS Prevention, (DHAP), Centers for Disease Control
  • Dr. Elena Rios, President, National Hispanic Medical Association
  • Arianna Lint, CEO & Founder, Arianna’s Center/Translatina FL

The summit was a call to action for unity to develop a national health policy agenda and community actions to address the health challenges of Hispanic/Latinx communities. The agenda focused on health policy and encouraged broad community engagement to address national health issues affecting Hispanic/Latinx communities. The process of setting the national health policy agenda and identifying national key issues consisted of providing summit participants the opportunity to take part in roundtable conversations focused on issues impacting Hispanics/Latinx such as HIV, viral hepatitis, substance use, social stigma, and other health disparities. One of the overarching goals is to create visibility during the U.S. Presidential election process and in the nation.

In September of 2020, after approximately 2-years of work from over 200 organizations and about 400 community leaders from throughout the U.S. and Puerto Rico, the National Hispanic/Latinx Health Leadership Network announced the release of the first ever community driven federal health policy agenda titled Breaking the Invisibility: Our Health, Our Future.

Breaking the Invisibility: Our Health, Our Future, outlines federal recommendations focused on eleven national issues impacting Hispanic/Latinx communities:

  1. Prevention
  2. Research and Data
  3. Access to Care
  4. Migration/Immigration
  5. Puerto Rico
  6. Stigma
  7. Substance Use
  8. Mental Health
  9. Plan to End HIV in America by 2030
  10. Challenges in the South of the United States
  11. Leadership

In order to break the invisibility of the health challenges faced by Hispanic/Latinx communities, an action plan must be developed and implemented at the federal level. In addition, the summit leadership encourages the development of local level agendas (state, county, city-level) and action steps that increase awareness, improve access to services, improve equity in resources, and improve the overall health of the Hispanic/Latinx community.

For more information on Breaking the Invisibility: Our Health, Our Future:

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Champion for Change

The month of September 15 to October 15 is National Hispanic Heritage Month in the United States. Organizers chose this time period because it reflects the independence days for many Latin American countries, including Mexico’s famous Grito de Dolores on September 16. First recognized by President Lyndon B. Johnson in 1968 as a week of recognition, President Ronald Reagan expanded it to a month in 1988. People of Hispanic or Latinx heritage represented approximately 38% of Texas’ population in the 2010 census, but that population is “expected to become the largest population group in Texas as soon as 2022.” 

Achieving Together’s Guiding Principles

Despite representing some of the oldest Texas’ residents, the Latinx population in Texas faces many barriers to equity, including access to affordable housing, healthcare, and education. Not only do the guiding principles of the Achieving Together Plan implore us to action in addressing these issues, the plan lays out a guide for addressing many of these barriers in order to successfully end the HIV epidemic in Texas. The plan stipulates that “addressing mental health, substance use disorders, criminal justice, and housing is essential to creating supportive and stable environments in which people can achieve their health and wellness goals.” In addition, the plan recognizes that “Community-guided planning and data that is inclusive of all population groups will support programs and interventions that are culturally appropriate and will help people find the right pathway to meet their health and wellness goals.” Only by recognizing our history and working together to create a shared vision of the future can we successfully end the HIV epidemic in Texas. Join us!

In honor of Hispanic Heritage Month, Texas HIV Syndicate member Elias Diaz, from Eagle Pass, penned the following essay on his reflections as a community organizer and health advocate for his community.

Champion for Change
By Elias Diaz

I’m a mental health care provider, a public health advocate, and a community organizer. Going into politics wasn’t in the plan. Truth be told… I hate politics. I don’t identify as a politician. I’m not sure I ever will. 

Even after a victory, I raise up my head with pride, but can’t help but to feel the effects this battle had on my body. There were a million reasons not to do this, but I’ve never been one to back down from a fight. 

My fight is long and sordid. It’s never been for a political position, but rather to reclaim the power for my people.  It’s tears and it’s bloodshed. It’s swords and it’s stones. It’s conquest and colonization. It’s passion incarnate. 

My fight is like my language. The Nahuatl words hidden in my Spanish. The Spanish clinging to my English sentences. My English decorated with my accent. It’s the sound I’ve given to the little brown boy that lives inside me… the one that learned silence as his primary language in order to survive. It’s the same language that the voiceless child speaks inside the detention centers. It’s the silent song of the early martyrs of the HIV pandemic.

My fight is the unruliness in my hair. It’s rebellion against systems of oppression. The ones that limit opportunities for housing, promote mass incarcerations, and prevent our people from healing. 

My fight is like the pigment in my skin demanding visibility. Visibility for the most marginalized populations. It’s the need of the LGBQ youth to be seen by their families and their communities.  It’s power in presence; a changed gender marker. It’s resilience personified.

My fight is calloused hands and feet. It’s the long journey that my grandparents took to get to this journey. It’s crossing deserts, walking through canyons, and climbing sierras. It’s mental illness and it’s substance abuse. It’s wondering where to go next, wanting to stop, and knowing you have to keep moving. 

My fight is like the strength in my back. The same strength that powers the worker in the fields. It carries the burden of income inequality, lack of access to healthcare, and inequities in education. It is the resilience of the cactus that causes it to thrive in the harshest of environments. 

My fight is the fullness in my lips. They swell and burst with truth. It’s my unapologetic sexuality. It’s the dignity of the sex worker. The vibrant color of the desert flower.  

My fight is like my food. It’s spicy. It’s poignant. It’s full of boldness and flavor. It’s unrepentant. It demands preparation by looking at our past. It fosters collaboration across systems. It promises a seat the table for all. 

My fight is my religion. It is the sacred dance of my ancestors. It is irreverence in the face of fear. My fight is the confession of classism, colorism, and machismo. My fight is resurrection and evolvement time and time again. My fight is building sanctuary across our systems of care. 

My fight is my tradition. It has deep memories of rape and pillage, stolen land, and forced assimilation. It is hope and it is freedom.  

My fight is the greatest of revolutions. It is recognizing and honoring the fight in you. It is empowerment and it is truth. My fight is a battle cry for a heartbroken community. My fight is a call to action to those that have been broken by these systems to rise up and dismantle them. My fight is a charge against our way of doing things. My fight is a plea for you to rise up and be the champion for change that we have continuously prayed for. 

Elias Diaz made history in Eagle Pass after becoming the first openly LGBTQ candidate to get elected to public office in his area. His hard-fought election came after an eight-month long campaign that included a runoff election, postponement of the election due to the COVID-19 pandemic, and multiple personal attacks. Although Eagle Pass is registered as a blue city, the region is home to many residents whom Diaz says identify with “traditional conservative values.”

Diaz has been a longtime champion of marginalized communities. He has overcome a multitude of barriers including economic disadvantage, childhood domestic violence, and sexual abuse, and used his experiences to fight for social justice and equality for others. Diaz put himself through college in LA by starring in adult films. Pictures and videos of his sex work circulated on the internet during his campaign and were used against him in an attempt to demoralize him and question his ability to lead. Diaz remained transparent about his past and used the attacks to connect to inspire voters in his community to rise up against injustice and inequality. In the end, he beat his opponent by 517 votes, according to Eagle Pass Business Journal.

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Immigration & HIV

According to the American Immigration Council, “one in six Texas residents is an immigrant, while another one in six residents is a native-born U.S. citizen with at least one immigrant parent.”

Until 2010, federal immigration law prevented people living with HIV from entering the U.S. However, “effective January 4, 2010, HIV is no longer a bar to entry into the United States for visitation or immigration purposes. This means that HIV status alone cannot be a reason for excluding, removing, or deporting a person from the United States.” 

Barack Obama signs the Ryan White HIV/Aids Treatment Extension Act at the White House, 2009.
Photo courtesy of: Gerald Herbert/AP

How do we support our fellow Texans living with HIV who might also be navigating the often confusing and fear-inducing immigration system?

Let’s first clear up a few acronyms you might have heard or seen.

INS: Immigration and Naturalization Service: formed during the Great Depression and oversaw immigration processes and enforcement until 2003 with the passage of the Homeland Security Act which created the USCIS (see below); no longer exists.

USCIS: United States Citizenship and Immigration Services: agency created in 2003 with the passage of the Homeland Security Act under the Department of Homeland Security; oversees both ICE and CBP (see below).

ICE: Immigration and Customs Enforcement: created in 2003 under the umbrella of USCIS and is tasked with enforcing immigration laws throughout the United States.

CBP: Customs and Border Patrol (aka Border Patrol): created in 2003 under the umbrella of USCIS and is tasked with enforcing immigration laws at and near the U.S. border and is responsible for patrolling the border areas of the United States. You may have had to stop at one of their checkpoints near the border to show proof of citizenship, or have seen their green and white vehicles patrolling near the border.

Achieving Together sat down recently with Stephanie Taylor, JD, an immigration lawyer with Hansen & Taylor, PLLC in Austin, Texas, to help us understand the concept of the “public charge” and how we can best provide HIV services and resources to our immigrant patients and consumers here in Texas. To better understand Public Charge, see the box after the interview.

Current Public Charge Rules and People Living with HIV

While the public charge does not currently affect federal HIV funding, there have been rumors and reports that it could in the future and that the current administration would like to include Ryan White into programs affected by the public charge determination. Can you please inform us where the public charge rules currently stand, what the future of those rules looks like, and how they might affect immigrants relying on federally-funded programs for healthcare, particularly Ryan White and other programs for people living with HIV?

The new 2019 Department of Homeland Security public charge rule was suspended during the declared national emergency related to COVID-19.  However, on August 12, 2020, this suspension was limited to New York, Connecticut and Vermont.  The rule applies everywhere else in the United States.  A timeline of the rule and litigation can be found here: https://www.ilrc.org/public-charge-timeline.

When determining whether or not someone is likely to be a “public charge” the new rule looks at whether the individual receives certain means-tested benefits.  The use of state, local and tribal funded non-cash programs and Ryan White programs (including the AIDS Drug Assistance Program, or ADAP) are not included in the rule and do not count towards someone being determined a public charge. Receiving public benefits does not automatically make an individual a public charge.  Therefore, there is no need to disenroll in services for most people who are subject to the public charge.

The new rule emphasizes consideration of negative factors in a person’s life circumstances when evaluating whether they are likely to become a public charge in the future. The new rule encourages immigration officers to consider age and ability to work, health conditions, income, ability to speak English, and whether or not the person has private health insurance.

Immigration Enforcement and HIV Service Providers

A lot of people working in the HIV field have concerns about Immigration and Customs Enforcement (ICE) showing up at their clinics and/or offices. What should a clinic/non-profit/agency do should ICE show up? What are the rights of staff, and what is the best way to keep their clients safe?

The best thing that individuals and organizations can do to protect themselves against ICE is to be informed of their rights, including the right to remain silent and not identify themselves, and the right to not consent to search. The Immigrant Defense Project has excellent Know-Your-Rights materials and posters in many languages that can be found here: https://www.immigrantdefenseproject.org/ice-home-and-community-arrests/

We recommend that agencies print out these posters in multiple languages and hang them in waiting rooms, and disperse them freely to community members.

The Immigrant Legal Resource Center (ILRC) has an excellent toolkit available online in English and Spanish: https://www.ilrc.org/public-charge

COVID-19 and Immigration

How might COVID-19 affect someone’s immigration status if they are undocumented and show up for healthcare? What are their rights and what ideally should people know ahead of time before presenting at a hospital/clinic if they are worried about their immigration status?

From ILRC: “All noncitizens should get the care they need. USCIS announced that testing, treatment, and preventive care (including a vaccine if one becomes available) for COVID-19 will not be considered in the public charge test. These services will have no negative impact, even if such treatment is provided or paid for by one or more public benefits (e.g., Medicaid). These services also will not impact noncitizens seeking an extension of stay or change of status. (See https://www.uscis.gov/greencard/publiccharge). Additionally, if a person subject to the public charge ground of inadmissibility lives and works in a jurisdiction where disease prevention methods such as social distancing or quarantine are in place, or where the person’s employer, school, or university shuts down operations to prevent the spread of COVID-19, they may submit a statement with their application for adjustment of status to explain how such methods or policies have affected the factors USCIS must consider in a public charge inadmissibility determination.”

Finally, Stephanie states that our LGBTQ noncitizen community members are often the most vulnerable and disenfranchised.  Encouraging them to get screened for immigration relief by a private lawyer or immigration non-profit is important. One of the six focus areas of Achieving Together Texas is to create supportive environments, part of which involves addressing the barriers to HIV prevention, care, and treatment created by the fear of deportation and by the inadequate services offered in immigration detention centers.

We have heard from HIV providers and community members across Texas that fears related to immigration and deportation have affected people accessing HIV prevention and care.  The information in this post provides some guidance to help organizations and individuals navigate through these issues.  What challenges have you experienced as community members and organizations?  Have you developed practices and solutions to continue to support and serve your communities while dealing with challenges related to immigration policies?

Public Charge
 
A question that often comes up when thinking about immigration and HIV services is the concept of the public charge. “Public charge is the language used by the government to describe someone who they think will become dependent on government assistance for their primary source of support to live in the U.S. Immigration officials apply a public charge rule to help decide whether to approve an application for a green card (i.e. legal permanent residence or LPR status) or when deciding who they will allow to enter into the U.S.” According to the United States Citizenship and Immigration Services, in general, public charge is defined as someone who receives one or more public benefits for more than 12 months (total) within a 36-month period. 
In order for someone to be eligible for a visa or lawful permanent residency, they have to show they are “admissible” under US immigration law.  There are lots of different ways someone can be “inadmissible” and therefore ineligible.  For example, if you’ve been convicted of certain crimes, entered the US without lawful status, or have been deported, you would be inadmissible under each of those different sections of the law.  In addition to these examples, someone who “at the time of application for admission…is likely at any time to become a public charge” is “inadmissible.” This is often referred to as the “public charge” ground of inadmissibility.
The grounds of inadmissibility that apply to an individual depend on the type of visa and/or how they are getting their lawful permanent residency.  For example, the public charge rule does not apply to those applying for status based on being a crime victim (U Visa) or a trafficking victim (T Visa).  The public charge rule also does not apply to asylees or refugees.  Additionally, someone who already has their green card generally does not have to worry about the public charge ground of inadmissibility, except in limited circumstances. This law mainly impacts those seeking permanent resident status through family member petitions.
Someone who is undocumented should only worry about the public charge ground of inadmissibility if they have a way to get legal status.  A consultation with an immigration attorney can help you determine whether or not you need to worry about the public charge. 
For example, Natalie entered the United States when she was 4 years old.  When she was 18, she was deported.  She returned to the United States without a visa three years later.  She is now married to a US citizen.  Natalie is HIV positive and wants to apply for free treatment through Travis County.  Natalie is subject to several different grounds of inadmissibility.  The least of her worries in this scenario is the public charge ground. She is probably not eligible for a visa or lawful permanent residence for many different reasons that have nothing to do with public charge. Natalie should talk to an immigration attorney before she makes any decisions that could affect her access to healthcare.
To learn more about the history of the public charge: Read The History Of ‘Public Charge’ Requirements In U.S. Immigration Law

Stephanie Rodriguez Taylor is originally from Brownsville, Texas, and obtained her bachelor’s degree from the University of Texas at Brownsville. After graduating from the University of Texas School of Law, Stephanie received the Julius Glickman Fellowship in Public Interest Law which initially funded her work on criminal-immigration issues at American Gateways (formerly the Political Asylum Project of Austin). She is now in private practice in Austin, Texas at Hansen & Taylor, PLLC, a law firm dedicated to providing immigration legal services for working people and families in Central Texas. The firm operates on a sliding scale to ensure that everyone has access to high-quality legal services, regardless of their income.

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Covering Texans’ Condom Needs: Texas Wears Condoms and The Condom Distribution Network

When used correctly and consistently, condoms are an effective way to prevent the transmission of HIV, as well as other sexually transmitted infections (STIs). The Achieving Together team interviewed two organizations in Texas that distribute free mail order condoms online: Texas Wears Condoms and the Condom Distribution Network. The aim of both programs is to reduce the transmission of HIV and other STIs by making condoms more accessible. By creating access to free condoms available online, Texans are able to obtain condoms regardless of their geographical location. Both programs also work to educate communities and de-stigmatize sexual health.

Texas Wears Condoms

“So far, the program has partnered and collaborated with over 150 community organizations/businesses across the state and distributed 1,913,377 condoms (2019).”

Tell us about Texas Wears Condoms.

This project originally began in 2013 at the University of Texas Health Science Center in San Antonio, now known as UT Health. The grant was originally funded only for services in San Antonio, but in 2017 the program received funds from the Texas Department of State Health Services (TX DSHS) to expand its services to all Texas residents.

What are your goals?

The project has three objectives to meet every year, as set by TX DSHS:

  1. Distribute 2,000,000 condoms
  2. Collaborate with 100 community partners (i.e. retail, civic, faith-based, etc.) to include 50 local (in San Antonio) and 50 statewide.
  3. Have 80 distribution sites including non-conventional businesses, clinics/CBOs/ASOs, and community events. 

Aside from the goals listed above, the purpose of the program is to educate the community and help reduce the spread of HIV and STIs in Texas by expanding free condoms access, improving condom knowledge and destigmatizing condoms/condom use. The program focuses heavily on destigmatizing and normalizing conversations around sex.

What will success look like?

Individuals will have access to sexual health supplies, regardless of their location and income.

Condoms and other sexual health supplies will be destigmatized and not associated with any specific risk behaviors (i.e. you use condoms, so you must sleep around).

We want to serve individuals from every zip code and county in Texas, reduce the numbers of STIs and HIV in Texas, and improve condom variety, brand awareness and delivery time for packages.

We also want to further the conversation about PrEP and PEP.

How does the Achieving Together plan/movement relate to this work?

Several of the guiding principles of the Achieving Together Plan are focus areas of the program: social justice, equity, empowerment, advocacy, and community. The program leverages technology, partnerships and community action to deliver a multi-layered prevention framework to address deficiencies in prevention, care, and treatment. Re-purposing an e-commerce website to provide condoms and sexual health supplies to order and mail directly to consumers has minimized the barriers to access and provided communities with an equitable platform. The program has also empowered individuals living in marginalized, under-served, and geographically isolated areas by making condoms accessible and available with unrestricted access.

What have you learned?

Through client surveys, we have identified barriers to condom use, such as cost, embarrassment, or not knowing what kind to purchase.We’ve also learned that individuals want to learn more about sexual health and how they can protect themselves from STIs/HIV, without the sanctimonious aspect. Individuals want to use safe sex supplies (condoms, lubricants, dental dams), they just don’t always know where to access them, or how to bring up the conversation with their partners.

Social media is a great avenue to connect with your audience and disseminate factual, sex positive information. It can help grow your program’s following organically and with little to no cost.

Finally, we’ve learned that not a lot of people know about PrEP and its benefits.

Condom Distribution Network

“We have decided to focus our efforts in 2020 toward getting younger MSM of color to access our CDNStore this year. This year, our goal is to send at least 65% of our condom orders to 12-35 year-old MSM of color.”

Tell us about the Condom Distribution Network.

The Condom Distribution Network was started in 2014 by AIDS Services of Austin (now Vivent Health) as a way to reach more people through condom distribution. The online store (CDNStore.org) opened around 2016. AIDS Services of Austin (ASA) realized that with so many people of color moving out of central Austin, we needed a way to make it easier for people to get free condoms from ASA without having to come to our locations. We ship free condoms to people in Travis, Williamson, Bastrop, Caldwell, and Hays counties.

We changed our ordering process to make it easier for people to order from us as well as made changes to the way our website looks to give our store a new look. We will be adding videos in both English and Spanish so that people can learn how to put on a condom.

What are your goals?

Our goal is to help more people get access to condoms by removing access as a barrier. We have decided to focus our efforts in 2020 toward getting younger MSM of color to access our CDNStore this year. This year, our goal is to send at least 65% of our condom orders to 12-35 year-old MSM of color.

How does the Achieving Together plan/movement relate to this work?

By normalizing condom use, we believe we can address the stigma around sexual health and testing.

What have you learned?

At ASA, we know that our data can be a great ally to understand what people need. In July, we rolled out our new survey, which captures sexual health information. Within the first month we found that 64% of people who ordered condoms in July had never been tested for syphilis. In response, ASA created a quick one-page infographic with syphilis information, testing recommendations, and locations that were sent out with every condoms order. We were able to see that percentage drop within three months.

ASA has learned that there is still very much a need for condoms in the community and that most people, if given information about this resource, will use it. What we have to do now is make sure this program is getting into the communities that need it and would benefit the most from this program. 

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You’re An Activist, Too!

By Ian Haddock, Houston

Wow! Over a year ago, I had the privilege of submitting a piece to Achieving Together about our project, “Outcry the Docu-Series”. It is now streaming on Amazon’s Prime Video along with the mini-documentary and we are thrilled. Even with all of that, I never expected The Normal Anomaly Initiative to be in the place in which we are today.

It took me a long time to figure out how the work that I was passionate about fit into this work in public health, specifically ending the HIV epidemic. Many of my colleagues were leading the movement as researchers on innovative ways to take PrEP, working for national philanthropic organizations, creating behavioral interventions and working for pharmaceutical companies. I, myself, just wanted to create programming and tell people’s stories. Without any clear plan at the beginning, over the last 5 years, that’s what we’ve done.

Since then, people have begun calling me an activist; I never considered myself an activist. Approximately 8 years ago, I was at the most difficult time of my life following my mother’s passing. I found myself in group counseling for grief followed by seeing a therapist since then. I found that my vulnerability and story was important to create the world that I desired for myself.  Through initiating this healing with myself and following my own path of passion and purpose, I ended up just being a part of a reflection of what healing is in our community. The people who have joined us on this journey have triumphed through their process of healing and now we create programs and curriculum to facilitate other’s journeys for the communities we intersect. It is still a wonder that I am around such visionaries and power.

In August 2019, The Normal Anomaly Initiative was accepted into our first shared learning experience with the Gilead Compass Initiative with a 4-month course in Healing Justice while also being in a cohort for cultivating our organizational infrastructure. This created a space for us to really decide how to not just create projects but pay special attention to what we had to offer to end the HIV epidemic. Since then, we have been taking leadership development training, harm reduction training, enrolled one of our members in Project LEAP, and focused on developing curricula such as cultural humility trainings for faith-based organizations and marketing and branding trainings for emerging Black queer leaders in the South to meet the needs of the communities we are a part of.

Additionally, we have begun to bring some innovative methods that we created based on evidence-based work from advocates across the state. For example, years ago we worked with one of the fearless leaders of Positive Women’s Network, Ms. Venita Ray, on some cultural humility trainings for providers and have now transformed that training into cultural humility trainings for faith-based organizations called “Outcry the Community Project.” We also mixed our healing justice and harm reduction lens and helped to create the Transgender Ally Collective in Houston; this collective is committed to actionable items that will work to protect the lives of transgender people with a current focus on Black transwomen.

With the help of funding sources that are open to our grassroots methods, we are able to make impact that moved from hundreds of thousands of impressions on digital media to hundreds of thousands of in-person impressions in our city over the next few weeks with our billboard in Houston’s 5th Ward.

I love talking about the journey of our grassroots organization, but not just out of pride; it is with the intent to reach each and every community member that desires to do the work to end the HIV epidemic. Many times, we have such a strict focus on those in public health that we miss the people who are doing their part in this work in the community at-large; this work is evident even in the most non-specific spaces. Over the years working in this field, I have found myself working with club owners and promoters and never really understanding the impact that those relationships have on lowering the risk of transmission of HIV; however, these gatekeepers are integral parts of the movement to end the epidemic. For marginalized communities, we have historically had spaces in which we went to escape from the world; for Black people, for instance, it has been the church. For Black queer people, many times, it is the club or a bar. This place of escape translates to one of the places that community shows up both the most vulnerable and the most wholly themselves. For this reason, they are a necessary aspect of outreach, mobilization and community. I also come from a community of sex workers where our conversations helped us figure out how to negotiate sexual encounters even before we knew the proper terminology. Titan Capri, one of the leaders of our programs, teaches people how to talk through their issues through a podcast; additionally, Kimberly Thomas, one of our other leaders, does the work through styling where she builds self-esteem and confidence. Many of our transwomen do the work by simply choosing to step over the threshold of their door every morning into a society that often doesn’t understand their lives and experiences.

From sending people to the Capitol to advocate for better policies to work on OnlyFans advocating sex positivity and accepting responsibility for their own bodies with PrEP, we salute the work that must be done in all spheres to make statements. Long before we had any idea on how to go about erecting a billboard, we were using our small DSLR camera to create impact; we didn’t recognize it then, but we were a part of changing the narrative of what this work looks like. The answer to ending the HIV epidemic will be found at the grassroots level when we recognize that everyone—no matter what they bring to the table—is and can be a part of ending this epidemic; this means you’re an activist, too—even if no one has ever told you and you’ve never worked in public health.

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