Status Neutral: The New Normal for HIV

Exploring biomedical interventions including PrEP, PEP, and TasP, and how they reduce stigma I. Participants will gain a deeper understanding of biomedical interventions II. Participants will gain proficiency in language that reduces stigma III. Participants will gain proficiency in understanding the data regarding biomedical interventions and the story the data tells

What does Status Neutral mean? Treatment as Prevention and Prevention as Treatment Status Neutral Care Environment Stigma and Disclosure Improved Adherence and Self-Efficacy

Portion of Patients in Care with Suppressed Viral Load Using HIV Status Neutral Prevention and Treatment Cycle Source: HIV Care Continuum Dashboard 2015, NYC Public Health https://www1.nyc.gov/site/doh/health/health-topics/care-continuum-dashboard.page

Undetectable = Untransmittable PARTNER Study – AIDS 2016 1166 heterosexual and gay sero-divergent couples, not using condoms Zero transmissions from over 58,000 times that couples had sex without condoms The only instances of transmission were linked to sexual activity outside the couple When a person living with HIV has an undetectable viral load, the risk of passing on the virus to another person is ZERO Source: Rodger AJ et al for the PARTNER study group. Sexual activity without condoms and risk of HIV transmission in serodifferent couples when the HIV-positive partner is using suppressive antiretroviral therapy. JAMA, 2016;316(2):1-11. DOI: 10.1001/jama.2016.5148. (12 July 2016). Full free access. http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.2016.5148

Lets speak truth to power!...what do you think? The effect of Status Neutral care on: Stigma Adherence to treatment Disclosure to partners Self-Efficacy Quality of care

Language that Reduces Stigma Person first language Correct usage of gender pronouns, names, and terminology for body parts Thoughtful sexual health dialogue Avoid non-essential questions that could be potentially triggering Avoid using labels for people

Language that Reduces Stigma

Gender Care at Kind Clinic Gatekeepers vs. Informed Consent: Who Decides When a Trans Person Can Medically Transition? “Informed consent is a medical provider laying out your risks and benefits, and the most current information they have about those risks and benefits, and giving you the choice about what to do with your own body. For me this is a basic human right, a matter of bodily autonomy,” Marti Abernathey, Trans Activist.

The Benefit of a Sexual Health Dialogue vs Risk Assessment Words matter: The Benefit of a Sexual Health Dialogue vs Risk Assessment Source: Safer Sex for Trans Bodies Whitman-Walker Health and Human Rights Campaign Foundation

Integrated Clinical Care Model Engaging a patient into clinical care by first meeting their primary needs, and then addressing other needs such as sexual health and wellness. The Kind Clinic engages trans patients into care by first meeting their needs for hormone therapy. Then, they are also offered services for: PrEP and PEP STI testing and treatment General wellness exams Access to free counseling, case management, and assistance with name/gender marker change

Transgender Wellness Program Collaborative

Informed Consent for TGNC Source: TGNC Card, a collaboration between Fenway Health Institute and the Trans Masculine Sexual Health Collaborative

1400+ Unique Patients Kind Clinic Successes 91% identify as LGBTQ+ 70 Transgender/Gender Non-Binary 37% identify as Hispanic/Latino 35% are Uninsured 45% make less than $45k 94% identify as Male 31 Average Age 1400+ Unique Patients

Potential Barriers to Status Neutral Care Can you think of any drawbacks to this model of care? Can you think of any potential challenges in incorporating Status Neutral care? What are some ways we can address those barriers?

Wrap-Up Questions How do you feel about Status Neutral care and the U=U campaign? How can you incorporate a Status Neutral care environment with your clients? Potential wokshop opportunity

Thank you. Joe McAdams joe@texashealthaction Thank you! Joe McAdams joe@texashealthaction.org Sarah Palmer, MPH sarah@texashealthaction.org