Transcript NAPWA-With-Dignity-and-Respect-12.16.10

With Dignity and Respect
NAPWA
National Association of People with AIDS
Overview of Presentation
• This segment will primarily focus on:
– the importance of the Denver Principles in
addressing HIV criminalization (start of the call)
– advocacy for alternative programs and services to
replace these laws (Q/A portion of the call or end
of the call)
Presentation Outline
• Brief history about NAPWA
• Importance of the Denver Principles
• Restatement of relevant sections
• Evolution of the Denver Principles into NAPWA’s
Principles for Prevention with Positives
• Restatement of relevant sections
• Why HIV criminalization is a human rights & public
health challenge
• Next steps - advocacy for evidence-based
alternatives to HIV criminalization
NAPWA-US (1983)
• NAPWA is the oldest national AIDS organization
domestically and is the first network of people living
with HIV/AIDS (PLWH/A) in the world.
• NAPWA’s mission statement was revised in 2009 and
now states that:
– NAPWA advocates for the lives and dignity of all people
living with and affected by HIV/AIDS.
• The Denver Principles serve as NAPWA’s foundation.
The Denver Principles (1983)
• The Denver Principles, often been referred to as the
PLWH/A community’s first Bill of Rights and
Responsibilities, contains the following sections
relevant to today’s conversation:
– We recommend that all people:
• Not scapegoat people with AIDS or blame us for the epidemic
– We recommend that people with AIDS:
• Have an ethical responsibility to inform potential sexual partners
of their health status.
– People with AIDS have the right:
• To as full and satisfying sexual and emotional lives as anyone else.
www.napwa.org
Principles of
HIV Prevention with Positives (2005)
• Prevention must be a shared responsibility.
• Effective programs must fully accept the right of
people living with HIV/AIDS to intimacy and sexual
health.
• Stigma, discrimination, shame and fear drive people
underground and make prevention harder for
everyone, especially positive people.
• Coercion/criminalization is not the answer – and
certainly shouldn’t be the first answer.
www.napwa.org
Why HIV Criminalization is a
Human Rights & Public Health Challenge
• People living with HIV/AIDS (PLWH/A) have had to
(and continue to) overcome insurmountable
challenges and hurdles to ensure survivability. With
the advent of life-saving treatments, it appeared that
PLWH/A would have the opportunity to live a
“normal” life. But stigmatization in the form of laws
that criminalize the transmission of HIV have the
potential to dismantle all the efforts the PLWH/A
community has made to ensure that we are treated
with dignity and respect.
International Stigma Conference (2010)
Why HIV Criminalization is a Human
Rights & Public Health Challenge
• The fear and stigma associated with HIV/AIDS led to
the enactment of both civil and criminal statutes that
profoundly violate the rights of PLWH/A and
perpetuate myths about HIV transmission.
Furthermore, HIV criminalization undercuts the most
basic message of HIV prevention and sexual health,
which is that each person must be knowledgeable
about and responsible for his or her own choices.
International Stigma Conference (2010)
Partnering of sound public health and
self-empowerment principles
• NAPWA advocates for a comprehensive continuum
of services to address nondisclosure and
transmission of HIV:
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1. A national awareness campaign to counter stigma
2. Routine voluntary counseling & testing
3. Referral & linkage to care upon diagnosis
4. Access to medications (i.e. reduce viral load)
5. Alternatives to HIV criminalization
Alternatives to HIV Criminalization
Stand Alone or in Combination
It makes no sense to have the justice system continue to treat health
status as a crime. Perhaps we should try to expand funding for evidencebased programs and services that have been proven to be effective.
– Referrals to HIV/AIDS patient education certification
programs
• Community based
• Facility based
– Referrals to substance use treatment programs
– Referrals to mental health services
– Referrals to community mediation programs
Linda Chezem (2010)
Alternatives to HIV Criminalization
Verifiable Patient Education
• Knowledge of HIV status
– Proven reductions in HIV transmission risk behavior
following diagnosis of primary HIV infection.
• “Several studies postulate that annual HIV transmission rates in
the United States are some 3.5 times higher among people with
undiagnosed HIV infection compared to those who are diagnosed,
due to the fact that knowledge of positive HIV serostatus is
associated with substantial decreases in high-risk sexual behaviors
among those so diagnosed.”
» Source: PLoS Med. 2007;4:e200
» Additional Resource: AIDS. 2006;20:1447–1450
» Additional Resource: J Acquir Immune Defic Syndr. 2005;39:446–453
Alternatives to HIV Criminalization
Verifiable Patient Education
• Knowledge of disease could have a doubling effect
with additional benefits:
– An understanding of the disease and of the disease
process.
– An understanding of rights and responsibilities.
– Better coping and decision making skills.
– Better health and an improved understanding of how they
need to live to continue to have good health.
– Improved ability to take control of their lives and live
exactly how they want to live.
– Impact of HIV on the community in which they live.
Alternatives to HIV Criminalization
Verifiable Patient Education
• Drawbacks
– Cultural competency
– Health literacy
– Language barriers
• Possible Solutions
– Peer led sessions in
partnership with a public
health educator
– Evidence based,
community directed and
patient tailored patient
education programs
Alternatives to HIV Criminalization
Access to Substance Use Treatment
• Options such as education, outreach and treatment are more
beneficial to not just the individual but to their families and
society as a whole. In terms of treatment, research indicates
that treatment is more cost effective than incarceration.
• Treatment rather than incarceration would save money by
focusing the underlying causes of habitual use of substances,
rather than institutionalize these individuals.
Alternatives to HIV Criminalization
Access to Substance Use Treatment
• The link between child sexual abuse and risk for HIV infection
has been proposed by several researchers (Caseese, 1993;
Paone, 1993; Rosenfeld, 1993; Zierler, 1991), and recent
research confirms this link.
• Up to 43% of the women enrolled had been sexually abused
as children and 45% had been sexually abused as adults
(Vlahov, 1996, Cook, 1997).
• Childhood sexual abuse was significantly associated with: use
of drugs; exchange of sex for drugs, money or shelter; higher
number of sexual partners; and having had a sexual
relationship with a person at high risk for HIV. Additionally,
childhood sexual abuse was significantly related to adult
domestic violence as well as adult sexual abuse.
Alternatives to HIV Criminalization
Access to Mental Health Services
• Persons infected with HIV/AIDS are at greater risk than noninfected individuals of developing psychopathologies such as
depression. The psychosocial factors of denial, stigma and
social marginalization, lack of support (from family members,
friends, etc.), lack of resources, trauma (current – diagnosis
and/or past – abuse and violence) and mortality often
influence the onset of depression.
• Mental health professionals can help patients harness both
emotional and rational strengths in order to communicate
effectively with healthcare professionals, gather information,
evaluate treatment options, make informed treatment
decisions, and manage their condition.
Alternatives to HIV Criminalization
Access to Mental Health Services
• One study looked at the impact of post traumatic stress
syndrome (PTSD) on patients diagnosed with HIV found that
patients with non HIV-related PTSD reported more PTSD and
depression symptoms and lower levels of medication
adherence. Participants with HIV-related PTSD were more
likely to report reliving the trauma but were more adherent to
HIV medications than participants with non-HIV-related PTSD.
• Results suggest that HIV- and non-HIV-related PTSD have a
similar impact on PLWHA and in both cases impact their
functioning, adherence to medications, and levels of
depression.
» Source: http://www.informaworld.com/smpp/content?file.txt
Alternatives to HIV Criminalization
Access to Community Mediation
• Community Mediation Programs:
– Using a non-adversarial approach, the goal of mediation is
to achieve reconciliation through a process which entails
addressing the parties' interests and needs, and seeking
together a settlement through mutual agreement.
– If fault is found, then the offenders must take meaningful
responsibility for their actions by mediating a restitution
agreement with the victim, to restore the victims' losses, in
whatever ways that may be possible.
– Restitution may be monetary or symbolic; it may consist of
work for the victim, community service or anything else
that creates a sense of justice between the victim and the
offender.
Alternatives to HIV Criminalization
Access to Community Mediation
• Example: Rainbow Mediation
– A Program of the Los Angeles Bar Association’s Dispute
Resolution Services, Rainbow Mediation provides
mediation and facilitation services to the lesbian, gay,
bisexual, and transgender communities of Southern
California. This service provides the opportunity to settle
conflicts outside of court. Typical issues addressed include
HIV/AIDS.
Contact Information
Vanessa Johnson, JD
Executive Vice President
NAPWA
8401 Colesville Road, Suite 505
Silver Spring, MD 20910
240-247-0880 (main-p); 240-247-1016 (direct)
240-247-0574 (f)
[email protected]
www.napwa.org