A few years ago, a colleague asked Aadia Rana, MD, associate professor of medicine and scientist in the Center for AIDS Research at the University of Alabama, Birmingham, what three things would have the biggest effects on ending the HIV epidemic.
She answered that question with another question, and she mentioned just one factor, not three: "How are you going to impact racism?"
At the time, she led Alabama's scientific working group to control the HIV epidemic in that state. She got the reaction she was used to. Her colleague was flummoxed.
"What can we intervene on?" she remembered him asking.
"Anything," she said.
That had been the end of that part of the conversation. But as the United States Conference on HIV/AIDS 2020 (USCHA 2020) kicked off virtually, leaders encouraged clinicians, providers, public health experts, and policymakers to put the fight for Black, Latinx, indigenous, queer, and trans lives at the center of their medical and civic work. At USCHA 2020, Black Lives Matter isn't a topic for debate; it's the premise of every session on HIV treatment, prevention, and policy that will follow.
"Health cannot be achieved until structural racism and injustices are dismantled," Viraj Patel, MD, internal medicine and HIV physician at Montefiore Medical Center and assistant professor of medicine at Albert Einstein School of Medicine, New York City, said as part of the conference's opening plenary session. The powerful opening session included Black trans drag queen Peppermint, a rendition of the U2's "Sunday Bloody Sunday" set to a backdrop of police violence at Black Lives Matter protests, a blessing from an Indigenous elder, and people living with HIV speaking their truth.
"My Life Mattered"
For clinicians, hearing the ways in which other providers have failed their patients can be difficult. But for Esther Ross, MA, BSW, a social worker at the Brody School of Medicine at East Carolina University, Greenville, North Carolina, a prerequisite to truly ending the HIV epidemic is acknowledging the trauma patients experience at the hands of providers who downplay and refuse to treat them.
Ross should know. She said that when she was diagnosed with HIV in 1993, she was told she had a viral load in the millions, a T-cell count of zero, and that the doctor wasn't going to put her on medication.
"I was told that it wasn't worth the doctor's time for him to place me on this expensive treatment that was available to help me, because he felt that I was so insignificant because I was addicted to crack and heroin," said Ross during the plenary. "I went away for a long time."
But eventually a life-threatening accident put her in contact with a social worker who "looked past my circumstances."
"I was able to find my voice," she said. "I was able to stand up and say, 'My life matters and you're not going to treat me any kind of way.' "
From Words to Action
The implication was that Ross's experience wasn't a one-off but part of a larger system of structural racism inside and outside of healthcare, evidenced by the disparities in HIV diagnoses, outcomes including viral suppression, and deaths from COVID-19.
Raniyah Copeland, MPH, president and chief executive officer of the Black AIDS Institute, which built its own Black-centered plan for ending the HIV epidemic, wanted to take the conversation one step deeper in her plenary address.
To the non-Black providers, activists, media people, and healthcare systems, Copeland issued an invitation and a reality check: Don't just be for Black lives; put your bodies and privileges on the line to question the system as it is today, in ways that listen to Black experts, and put Black leaders in the position to influence policies.
"You agree that Black Lives Matter, but when Black people say what we need, non-Black folks, lay in the covert systems of White supremacy that maintain and expand your power," she said. "In our movement, I see well-meaning White people who I know love Black people and believe Black lives matter but don't do the work of questioning why there are so few Black people at tables of power and in positions of power. You don't question why the same big, White-led organizations continue to get exponentially more money than Black-led organizations. You have all the Black Facebook friends, and you use them for your public speaking events and campaigns and as outreach workers."
"Y'all are exhausting," she added.
Moving Forward Together
The session hit home for many attendees, sometimes challenging their role in the plan to end HIV and sometimes affirming their own experiences.
For Zoya Hyatt, an LPN in upstate New York, the focus on Black Lives Matter was welcome, but Copeland's pointed comments about well-meaning White people left her feeling attacked. She said that it is unlikely that she would attend "overtly race-related sessions" at the conference.
"I'm glad they're offered, just not for me," she said.
But for M. K. Carpenter, MPH, MPA, a public health worker in Georgia, it left him feeling ready to move forward together.
"I enjoy the fact that they state [Black Lives Matter] as a fact. There's no controversy surrounding it," he said. "That makes it easier to work with everyone, because they know the importance of caring for the lives of those who are marginalized."
United States Conference on HIV/AIDS (USCHA) 2020: Opening plenary session, presented October 19, 2020.
Heather Boerner is a healthcare and science journalist and author based in Pittsburgh, Pennsylvania.
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Cite this: HIV Discussions Start With Black Lives Matter at US AIDS Meeting - Medscape - Oct 21, 2020.