Rethink Positive: It’s Time to Rethink HIV

By Tarrant County Public Health Disease Surveillance, Outreach and Prevention Division

“Stigma” has become a recent buzzword:

  • TV News anchors are talking about stigma
  • People are posting about stigma on social media
  • People are DMing about it, and it’s even made it to water-cooler chatter

Tarrant County Public Health (TCPH) wants to ensure that ending HIV stigma is more than just a buzz in our community’s ear. We need to keep people healthy by ending the HIV stigma. TCPH has had an individual-level HIV prevention program for years, including HIV testing, PrEP services, and caring for those who are HIV positive. Now we aim to overpower the HIV epidemic at the structural level – wherever people living with HIV encounter the system: in healthcare, education, community organizations, and corrections. 

TCPH created Rethink Positive with a grant funded by the CDC and the State of Texas. We are reaching out to healthcare providers, educators, school nurses, staff of community organizations, and correctional institutions. We don’t need to tell people living with HIV that a stigma exists; we need to change the negativity within the establishment.

We’ve adapted an evidence-based anti-HIV stigma program created by Health Policy Project that has successfully reduced stigma in nine other countries. More information on the Health Policy Project’s efforts can be found on their website. 

We’ve adapted the program to be relevant to our Tarrant County communities and have created interesting, engaging, and practical exercises. Our workshops include the basics on HIV and how it’s transmitted, education on institutionalized racism and its impact on the HIV epidemic, definitions and examples of HIV stigma and discrimination, and optional modules on Universal Precautions and creating a Best Practices Action Plan.

Our customized workshops are appropriate for our participants’ work environment, with examples of recognizing and challenging the stigma that are realistic. The workshops are offered online and in person. Our online workshops are one hour long, while our in-person workshops range from 1½ hours to several days in length.

The workshops started in February of 2021, and we have received valuable feedback that participants are enjoying the material and are learning about HIV stigma, its causes, and how to challenge stigma in their work environments. We’ve created an in-person exercise called a “Stigma Walk,” in which individual experiences of stigma are exemplified in a powerful way. Participants especially like the Stigma Walk exercise. They have indicated that they have learned about the importance of combatting HIV stigma and changing their workplace to be a more welcoming environment.

A program aimed at reducing HIV stigma is successful only if it changes the institutionalized stigma experienced by people living with HIV and those at risk. At present, participants complete HIV- and stigma-knowledge pre-and post-tests to measure the impact of the training. We also plan to have healthcare providers survey their patients on existing stigma in their facility before the workshop and 3- and 6-months post-workshop. We will be using evidence-based stigma-measuring tools that have been revised to specifically measure HIV-related stigma to confirm we are making a real difference in reducing systemic HIV-related stigma.

TCPH is excited to make a difference in our community by combatting institutionalized HIV stigma. We invite everyone to join the effort by instituting changes in their own organization and reaching out to other entities to inform them about the importance of ending the HIV epidemic.

To learn more about our Rethink Positive program or to schedule a workshop for your organization, we invite you to visit our webpage, rethinkpositive.tarrantcounty.com, contact us by via email at PHOutreach@tarrantconty.com or call or text us at 682-216-0657. 

Cultivating a stigma-free climate of appreciation and inclusion is one of the Achieving Together Plan’s focus areas. To learn more about addressing stigma, see the Stigma Resources Page on our website. 

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Guide to Gender Identity Terms

Cultivating a stigma-free climate of appreciation and inclusion is one of the Achieving Together Plan’s focus areas. We recognize that language changes over time and we aspire to create shared language that promotes appreciation and inclusion of all people.

While language and usage may change, what’s important is recognizing and respecting people as individuals. People use a variety of terms to identify themselves, so you should always listen for and respect a person’s self-identified terminology.

NPR recently shared a guide to gender identity terms, with the goal of helping people communicate accurately and respectfully with one another.

“Proper use of gender identity terms, including pronouns, is a crucial way to signal courtesy and acceptance. Alex Schmider, associate director of transgender representation at GLAAD, compares using someone’s correct pronouns to pronouncing their name correctly – ‘a way of respecting them and referring to them in a way that’s consistent and true to who they are.’”

You can find NPR’s guide here. The guide, which was created with help from GLAAD, is not exhaustive and is Western and U.S.-centric.

Remember that we are all learning and evolving and we might make mistakes with regard to someone’s preferred pronouns and gender identity, but if that is the case, simply apologize, move on, and be more cognizant of it in future interactions. We know that creating a life-affirming environment that will promote health and wellness for all people is the only way we can truly create a stigma-free climate of appreciation and inclusion.

Want to further explore ideas of gender identity?

  • Human Rights Campaign also shared a glossary of gender identity terms here.

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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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