Diversities, complexities and vulnerabilities
Stemming the long drawn war against HIV/Aids: social diversities and vulnerabilities; introducing the 'tailgate prevention' principle.
The four USA National HIV/Aids primary goals are : to reduce new HIV infections; to improve health outcomes for people living with HIV; to reduce HIV-related health disparities and inequities; and to achieve a more coordinated national response to the epidemic.
I am so excited about the PEPFAR Commitment to eradicate HIV in the world
I am particularly happy with the tone and very apparent commitment in the White House memo: "Shared Responsibility to Strengthen Results for an AIDS-Free Generation.”Since taking office, President Obama and his Administration have taken enormous steps to address the HIV epidemic, both domestically and globally. Indeed I liked this statement most. To me it shows President Obama cares, “We can’t change the past or undo its wrenching pain. But what we can do – and what we have to do – is to chart a different future, guided by our love for those we couldn’t save. That allows us to do everything we can, everything in our power to save those that we can. And that’s my commitment to you as President.”
I am presenting what I term the 'tailgate prevention.' I have borrowed this from the traffic language after watching what transpires day to day on USA roads. Before defining the 'tailgate prevention' principle, as far as HIV/Aids is concerned, one needs to factor in the following six questions: Can we afford to handle HIV/Aids aggressively enough? When we pursue a given strategy how many are we allowing access? How many are we shutting out? What is in place today? What have been the achievements against HIV/Aids? Where do we need to improve? These are questions one needs to have at the back of the mind. This way one will have the readiness to see the complexities, vulnerabilities and influence of diversities in demanding and providing HIV-related services.
Scenario 1: Imagine an organization with a specific mission and objective: to address HIV/Aids needs of young persons as they transition from childhood to adolescence.
The needs could range from: defining who a transitioning adolescent is; understanding bodily growth and development; needs around testing and treatment; health education; prevention prophylactic access; access to regular medication; refills; nutrition; relationships; schooling; access to home/housing; stigma and dignity around living with HIV and transmission. There are many needs that adolescents present. These are mostly around emotional adjustment. Adolescents are readers and consumers of what their peers or media put out. There is need to have platforms that re-assure them when they are bombarded with too much information. Such information may be on work, education, conflict with law, sex and obsession. They need to have mentoring peers who may help them navigate through the information maze.
Scenario 2: Imagine an organization with a specific mission and objective: to address HIV/Aids needs of young black men in USA.
The needs could range from: defining who a black person is not; the needs around normativity; access to interventions in place; access to referral services; access to regular medication; refills; nutrition; relationships and couple counseling; schooling; support associations; sexuality and gender counseling; orientation and identity counseling; same sex roles' counseling; life planning and consequential counseling needs; home/housing; work and employment; conflict with law; stigma and dignity. Young black persons fall in many categories. Some are living with HIV, some not. Many have partners age or cultural related issues. Some have sexuality-genital unresolved issues and some do not. Some are gay and others are not. Black men may have white or Latino or African or Chinese partners. There is need to have all these factors known especially if couple counseling is to be effective. Choices, especially peer pressure related ones such as alcohol and drug use should be anticipated. According to an online paper the Independent “Almost one in five hospital admissions for people in their 40s is related to alcohol and drug abuse, a new report has revealed.” Young black men can be mobilized to take up responsible roles not only as consumers but also contributors in the HIV service assembly-line.
According to the Bill & Melinda Gates Foundation blog the Impatient Optimist, “Worldwide, an estimated 3.6 [3.2–3.9] million people aged 50 years and older are living with HIV. This “aging” of the HIV epidemic is mainly due to three factors: the success of anti-retroviral therapy in prolonging the lives of people living with HIV; decreasing HIV incidence among younger adults shifting the disease burden to older ages; and the often-unmeasured, and thus often overlooked, fact that people aged 50 years and older exhibit many of the risk behaviours also found among younger people. Well. Whether focusing on the unborn babies or the elderly, can the spread of HIV can be brought to a halt? Can we still get to zero?” They raise the issue of diversity across longevity.
Scenario 3: Imagine these as the trending prevention services as far as HIV/Aids is concerned in USA:
National HIV/Aids Strategy;
To reinvigorate leadership and accountability in the domestic response to HIV, in 2010 President Obama released the first comprehensive National HIV/Aids Strategy, which has four primary goals: to reduce new HIV infections; to improve health outcomes for people living with HIV; to reduce HIV-related health disparities and inequities; and to achieve a more coordinated national response to the epidemic.
Ongoing implementation of the Strategy means:
· Focusing on science-driven HIV prevention efforts by supporting and expanding targeted use of evidence-based HIV prevention approaches;
· Making smarter investments by intensifying HIV prevention in the communities where HIV is most heavily concentrated;
· Increasing access to HIV screening and medical care, including through implementation of the Affordable Care Act;
· Supporting a shared response to the domestic epidemic through the support of HIV prevention efforts across all levels of society, including Federal, state, and local governments, centers of learning, faith-based communities, and the private sector.
Children and Young People Matter
The diversities and vulnerabilities
The diversities may be (this is not an exhausted list): race/gender-based; demographic-based; practice-based; knowledge-based; environment-based; somatic-based.
The vulnerabilities may be (this is not an exhaustive list): domestic violence; human to human violence; community driven stigma (school, workplace, religious setting; home/shelter/house access); bio-medical vulnerabilities (mental, physical and health); socio-political vulnerabilities; assimilation needs; skills-set and trainability.
Partnering and Networks are the next line of defense
Organizations tend to narrow down their mandates and put them in boxes. The reason could be because of specificity, an anticipation for smart results or mostly due to budget constraints. The disadvantage with this is that there is risk of missing out on the holistic picture. To address HIV/Aids there is need to look deeper into the issues and how they cascade into the national strategy. These issues feed the fires of vulnerabilities and become the apparent spikes or re-infection drivers as far as HIV/Aids is concerned. By virtue of its quick changing nature, HIV/Aids is sending us a message. Since it is appearing in a coat of many colors, humans should use the 'tailgate prevention' approach too. We need to think deeper and use a potpourri of interventions. There is value for the money invested if this approach is adopted.
Methodology of Tailgate prevention
'Tailgate prevention' is an analysis tool that seeks out diversity-based vulnerabilities. It is when there is a bold move to be mindful of diversities, identify and tag the vulnerabilities as far as HIV/Aids is concerned. Proceed to address them by showing roles of all stakeholders and stop-gaping them. Vulnerabilities follow each other in quick succession and open the way for further infection in case of HIV/Aids. These vulnerabilities frequently raised as far as the fight against HIV is concerned are: unintentional ostracism due to labels; neglect; Intimate partner violence, use of /access to interventions in place against sexually transmitted diseases (STDs), HPV transmission, Hep B transmission, low health seeking practices, lack of cancer examination, low usage of prophylactic prevention tools, Syphilis transmission, gonorrhea transmission, genital warts transmission, lack of testing, lack of treatment and other contexts of vulnerability.
Imagine HPV, gonorrhea or syphilis. These are sexually transmitted diseases. They are also known as gate openers because they lay bear the skin membrane by causing wounds. It is through these wounds that HIV gains entry into the blood stream. In order to manage this, there are layers of interventions that need to be in place. These are: mobilization for testing and treatment; mutual monogamy; immunization; use of protective prevention means in place, involvement in researchand trials with the goal to eradicate HIV. There is need to enroll as many people in investigational immunotherapeutic treatment drives. According to CDC, “Sexually transmitted diseases (STDs) remain a major public health challenge in the United States. CDC estimates that there are approximately 19 million new STD infections each year — almost half of them among young people 15 to 24 years of age. Yet, most infections have no symptoms and often go undiagnosed and untreated, which may lead to severe health consequences, especially for women. The only way to know for sure is to be tested. Talk to a health care provider about which STD tests are right for you.”
The Good Side of Tailgate Prevention
In using the 'tailgate prevention; approach, one makes the mission and objectives of their organization the pinnacle and proceeds to unpack attendant diversities and vulnerabilities (problematizing). This way HIV/Aids will cease to be a moving target.
Tailgate prevention calls for:
-acknowledging existing interventions;
-analyzing different missions and objectives;
-tagging aspects of diversity;
-tagging consequential vulnerabilities;
-making plans to address the vulnerabilities;
-map all stakeholders;
-create partnerships for referral and experience sharing;
-documenting all experiences.