According to Jim Pickett, director of advocacy for AIDS Foundation of Chicago ( AFC ), "We're in revolutionary, paradigm-shifting times," when it comes to HIV prevention.
But Pickett, speaking as part of the panel titled 35 years on the Frontlines: Local, National and Global HIV/AIDS Prevention on June 6 at AFC headquarters, noted that even with improved prevention technologies and strategies, numerous impediments occur at the service-delivery level.
"Now we have technologies that are super-effective, but we have people who have very fraught relationships with our health care system," he said.
Pickett was joined by Megan McLemore, a senior researcher in Human Rights Watch's Health and Human Rights division, and Erik Glenn, executive director of Chicago Black Gay Men's Caucus, on the panel.
McLemore's recent work has focused on how the dynamics of the criminal justice system perpetuate new HIV infections. She has reported extensively on Louisiana, the state with both the highest incarceration rate as well as the highest rate of HIV infections.
"I want to discuss how going to jail and being arrested are bad for your health generally, and bad if you have HIV," she said.
McLemore presented a video about and discussed Louisiana's needle-exchange system or, more accurately, the lack thereof. In that state, there are so few points of access to clean needles that residents have set up underground needle-exchanges of their own.
"The legal framework makes it very difficult to operate in Louisiana," McLemore said. "The fact that we're still having to fight that fight is very frustrating and very deadly."
Glenn discussed Chicago Gay Black Men's Caucus' goal of getting more Black gay men active in prevention-focused work, adding, "We need to lean into leadership development and create a pipeline and access points for Black men to get into it."
All the panelists recognized the importance of recognizing the vantage points of the communities whom they were serving. McLemore said, for example, that it was often difficult to get sex workers to consider PrEP, since many fear it is a medical intervention being imposed upon them by the government.
"They start with a very adversarial relationship with any sort of state authorities because they are in a criminalized context," she explained. "You do need to look at the structural context of everyone who can benefit from PrEP and what they can do to reduce those barriers."
"They have complex lives and we have to meet them where they're at," Pickett added.
Glenn said that even looking at community-health from a holistic viewpoint can be fraught with problems, since many community members have difficulties conceptualizing their own health priorities, let alone other people's. "When we're talking about 'my health,' that seems like a challenge," he said. "When we're talking about 'someone else's health,' that's another kind of challenge."
