World AIDS Day 2020:
Ending the HIV/AIDS Epidemic: Resilience and Impact
• December 2020 •
From Juan Navarro, Executive Director
Los Angeles Centers for Alcohol and Drug Abuse
Ending the HIV/AIDS Epidemic: Resilience and Impact
The first World AIDS Day was observed in December, 1988 – the same year L.A. CADA received our first CDC HIV prevention grant. Our involvement in HIV services has been prompted by the strong correlation between substance use, mental health disorders, and higher risk for HIV. To address this risk, HIV prevention and care has been a vital part of L.A. CADA’s mission to save lives, unite families, and protect the community. Together with so many other agencies in the HIV services field, L.A. CADA has worked on the front lines to reduce HIV infection in vulnerable populations. Our HIV services are led by HIV prevention pioneers Charles McWells and Lawrence Fernandez. Both men have been continuously involved in prevention advocacy since the beginning of the epidemic and were instrumental in development of L.A. CADA HIV prevention services:
Project 90: Serving Black adult MSM (men who have sex with men) in L.A.’s metro area using evidence-based HIV prevention strategies to achieve international UNAIDS goals:
- 90% of all people living with HIV will know their HIV status.
- 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy.
- 90% of all people receiving antiretroviral therapy will have viral suppression.
HISTORIAS Para Jovenes: Working to prevent HIV among Latino youth and young adults. HISTORIAS has adapted the CDC best practice “Community PROMISE” to empower youth through community mobilization, storytelling, and distribution of small-media materials and risk reduction supplies.
HIV Testing, Counseling, Prevention Services: Using evidence-based practices via HIV services storefronts and social/sexual network linkages to identify high-risk adults, encourage HIV testing, and model best practices for HIV prevention using peer mentors.
Velvet Jesus: A gripping, secular theatrical production showcasing the link between substance use, childhood abuse and trauma, and risk for HIV, written and developed by our own Charles McWells.
At the heart of L.A. CADA HIV services is the memory of the millions of people all over the world who have been lost to the HIV epidemic over four decades. And in their memory, we work with other community providers to achieve progress in HIV prevention, resilience, and impact. We know that this can only be accomplished using empirical data to deliver high quality, people-centered HIV prevention and treatment services to those most in need, while tackling stigma and discrimination, and empowering communities at-risk. And L.A. CADA is privileged to be part of this vital work.
See the WAD Timeline
“For most of my life, HIV was the last thing on my mind. I’m shy, but I love to meet new people, have fun, and enjoy life. Drinking and using loosened me up — gave me courage to be who I am. Being transgender is not accepted in my family and neighborhood, so I could never really be myself at home. But when I drank and used, I felt free to express my true self. So, down to Long Beach I went – clubbing, partying, having fun – and being careless. I really don’t know how I didn’t get HIV sooner because I was taking all the risks. I know this sounds weird, but I was actually relieved when I got that positive test. Now people didn’t have to lecture me on getting HIV. I found out I had it in jail. Jail is also where I first thought about getting clean and sober. There were people in the program like me, and they felt happy in recovery. Maybe it would work for me, too. It did – I just got my one year chip. I’ve never been proud of myself before, but today I am – proud of me just as I am.”
SPOTLIGHT – THE EVIDENCE IS IN:
Provider Training in Evidence-Based HIV Prevention
We’ve achieved significant reductions in new HIV infections globally, but incidences remain disproportionately high for persons who use alcohol and/or drugs. Substance users are at heightened risk for HIV infection through sexual contact (unprotected sex, exchange sex, sex while under the influence of drugs/alcohol) and needle-sharing practices. Providers of social and public health services have an opportunity to offer HIV prevention services to individuals at risk, including substance using clients.
Unfortunately, HIV prevention strategies known to reduce HIV infection and transmission have not been offered consistently or systematically. While some agencies offer discrete HIV prevention services, such as testing, the use of one or more such prevention strategies in day-to-day practice has been haphazard and at the provider’s discretion.
In 2020, evidence-based HIV prevention strategies include sexual risk assessments, risk reduction counseling, condom use demonstrations, HIV testing referrals, and the use of PrEP and PEP. Offering multiple strategies or “combined HIV prevention interventions” has been shown to be the most effective way to prevent HIV transmission among individuals at higher risk for infection, including substance users. Recent research shows that, regardless of service setting, providers need to learn the unique needs of HIV prevention and intervention for substance-using clients.