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DC Community Coalition c/o Health HIV 2000 S S treet NW Washington, DC 20009 www.dccaids2012.

org Octobober 12, 2011

DC Community Coalition for AIDS 2012 Policy Platform for the District of Columbia Preamble The District of Columbia (DC), the seat of the nations capital, bears the unfortunate distinction of having the highest HIV prevalence in the United States. The Districts HIV epidemic is defined by many stark disparities defined by race and ethnicity, gender, sexual orientation and gender identity, place of residence and socioeconomic status. The Districts HIV epidemic has devastated the city for the past 30 years. Compounding this problem, DC residents also endure some of the nations worst health outcomes which can be attributed to poverty, limited access to care and other social determinants of health. Residents of every Ward of the city are affected by HIV. The persistence of HIV/AIDS related stigma; federal policies which limit Districts ability to spend its own money to employ effective evidence-based public health interventions; and failed local governmental and political leadership have allowed the District to lose significant ground in fighting this disease. The confluence of these factors is largely responsible for the dire situation we now face. However, we are now at a pivotal moment in the course of this epidemic, in which a bold political will, greater coordination from community partners, and meaningful participation and leadership from people living with HIV can be harnessed to turn the tide and ultimately end the HIV & AIDS epidemic in the District of Columbia. Who We Are The DC Community Coalition (DCC) for AIDS 2012 is a broad cross-section of people living with and affected by HIV and AIDS throughout the Washington DC Metropolitan Area, working together to serve as the Local Outreach Partner for the XIX International AIDS Conference (AIDS 2012) to be held in Washington, DC, July 22-27, 2012. . The DCC sees AIDS 2012 as an opportunity for increased accountability by all DC Metropolitan Area leaders toward reducing HIV infection rates and providing comprehensive programs for those infected, affected, and at risk of by HIV.

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Our diversity as a community in Washington, DC is our strength. DCC members are all active in identifying and implementing solutions to reduce HIV infection, promote education and awareness on HIV, push for stronger leadership and accountability mechanisms in DC, and enhance HIV testing, treatment, care and support services. We represent families, youth, children, and adults of all races and ethnicities from across all Wards of DC. Among us are: heterosexual, homosexual, transgendered and bisexual persons; people who inject drugs, sex workers, faith leaders, parents, children, students, educators, and health care and social service providers. We recognize some of our community members are more affected by HIV than others, and because of this we are united in our approach and see common themes emerge across communities that we want our elected and appointed officials to address in partnership with us. Through a series of town hall meetings, engagement events and online surveys held in 2011, the DCC has developed this policy platform demanding greater leadership, accountability, management and coordination for HIV prevention, care and treatment in Washington DC. This platform outlines priority actions adopted through consensus by those most affected and engaged in turning the tide of Washington, D.C.s HIV epidemic. Some of us are affiliated with HIV-related organizations, most of us are residents of Washington DC living with or affected by HIV, and all of us see a need for fundamental changes in the process, governance and attention to HIV prevention, care and treatment in the nations capitol, our home. Purpose The aim of this document is to provide the government on all levels including Mayor Vince Grays newly formed HIV/AIDS Commission and the Districts HIV/AIDS community consisting of patients, healthcare providers and prevention organizations a discrete list of policy and programmatic recommendations to gain real ground in the local fight against HIV/AIDS in the months prior to and the years following the 2012 International AIDS Conference. Additionally, as international focus is turned to DC during the summer of 2012, this document will serve as declaration to the global HIV/AIDS community of the most pressing challenges DC faces as we enter the fourth decade of this epidemic. As such, we seek to inspire the international community and model what novel strategies have worked or failed in the effort to accelerate progress on the prevention, treatment, care, and cure of HIV/AIDS. Ultimately, the recommendations presented in this document offer an opportunity for the Gray Administration, the Council of the District of Columbia, and our citys unique relationship with the Federal Government to address our concerns through action. It is our hope that the current administration will strongly consider the following recommendations, borne
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out of a collaborative effort that represents the collective voice of the DC community and not just the limited perspectives of a select few. In approaching our demands for ACTION, we affirm the recommendation made in the 2011 Appleseed Report that the Mayor engage the entire city in the fight against HIV1. Challenges and Key Obstacles We acknowledge that much has been done to address HIV/AIDS in the District by civil society, people living with HIV, government, and other stake holders, but there is still much to be done. Key obstacles to curbing the HIV epidemic in Washington DC are leadership, governance, coordination, communication, education, poverty, and legal status. Generalized epidemic. In 2010, 3.2 percent of District residents were HIV positive2. Compounding the problem, approximately 40 percent of District residents who are HIV positive do not know their HIV status; indicating that 6 percent may be a more accurate estimate of the citys actual HIV prevalence. The District far exceeds the threshold of 1 percent HIV prevalence, which defines a generalized and severe epidemic according to UNAIDS and the World Health Organization3. As a result, all local residents are considered at risk. Stigma. Pervasive stigma continues to marginalize certain populations both inside and out of the physicians office. As a result, many DC residents who do not fall into traditional risk groups continue to present to the emergency room with late-stage HIV disease, children are born to HIV positive mothers who are unaware of their status; and stigma around the disease prevails. Criminalization and Discrimination. Criminalization of people who use drugs in Washington, D.C. compounds the problem of HIV stigma and discrimination, and hinders those who are criminalized from accessing harm reduction kits and health and social services.4 District residents are hurt by discriminatory and stigmatizing practices that exist despite anti-discrimination laws. Government and agency employees are in need of sensitivity training to combat discrimination against transgendered persons, youth, foreign-born nationals, and all populations seeking HIV-related services and assistance. Drug overdose. Drug overdose is a significant cause of mortality among people living with HIV; District residents are at greater risk of
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DC Community Coalition for AIDS 2012 Policy Platform

overdose than the national average. In 2009, there were 50 percent more deaths from overdose in DC than from traffic accidents and an average of two District residents die every week from an overdose. Evidence-based interventions and policies reduce overdose fatalities among high risk groups including people who inject drugs and live with HIV and are needed as part of a comprehensive HIV/AIDS prevention strategy in DC. Women and girls. Women and girls in the District need and deserve better leadership and programming to eliminate domestic violence, to ensure safe access to HIV and reproductive health services, and other social supports. DC Statehood. In the District, progress has also been hindered by the citys inability to make its own decisions on how to spend its money to advance the public health of its citizens, and local community efforts to use evidence-based initiatives have been repeatedly undermined by the ideological whims of the US Congress. Service provider coordination. HIV outreach and service organizations in the District vie for limited resources and funding, pitting communities against each other, as opposed to following a more cooperative strategy, in which progress is continually evaluated, monitored and driven by where the epidemiological evidence indicates there is greatest need and opportunity for inroads into the local fight against HIV. Community engagement. People living with HIV/AIDS, at risk of infection, and those working on the front lines of the epidemic who are experts in HIV treatment and prevention, are not meaningfully engaged in the Districts oversight and advisory committees or visible in agency staffing. Citywide HIV/AIDS Strategy. Poorly integrated programming of social and health services, including HIV prevention care and treatment, is a major barrier to better health outcomes in the District. Current federal HIV grant strategies for the Metropolitan DC areas treatment, care and prevention services are incongruent and not linked geographically nor programmatically.

Demands of the DC Community Coalition The DC Community Coalition for AIDS 2012 members are convinced that, from a human rights perspective, there is a need for concrete actions to reform public health HIV leadership, foster private sector partnerships,
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expand outreach to faith leaders, consistent engagement of education systems, research and scientific communities, as well as ramping up the commitment of those in politics and public policy management: 1. Governance and Leadership Building on the current Mayors One City approach, the Gray Administration must enforce a transparent accounting of all funding from all sources provided to the Government of the District of Columbia to address HIV prevention, care and treatment.

ACTION 1.1: The Mayor must ensure that the appropriate Mayoral
appointees and agency heads compile and document all HIV-specific and HIV-related financial and other resources allocated to Washington, D.C., and present them to community stakeholders in a fully transparent and understandable format by December 31, 2011. Goals set by the current Mayoral Commission should go beyond health service delivery provision models toward multi-sectorial coordination and high profile leadership and governance strategies specific to HIV

ACTION 1.2: The Mayors administration must develop a strategy to


reduce social, institutional, gender and cultural-based HIV-related stigma across the communities and Wards of DC and the Council of the District of Columbia must identify funding for this strategy it by June of 2012. The Districts committees and commissions, such as the Mayoral Commission on HIV and AIDS, must act in synergy with the myriad of other planning bodies devoted to HIV prevention care and treatment in Washington DC and work with people living with HIV. Planning bodies such as the Ryan White Planning Council and the HIV Prevention Community Planning Group do not work collaboratively. Funding source requirements determine prevention and care program activities rather than comprehensive assessment of need across diverse funding streams. In the case of housing services for people living with HIV, there is no housing planning body. Therefore there is no plan to end the housing waiting list.

ACTION 1.3: The Mayor, working through the Deputy Mayor for Health
and Human Services, must shift the planning paradigm to develop a comprehensive plan modeled after the National HIV/AIDS Strategy to end the epidemic in DC based on community need and comprehensive planning rather than funding source by June 2012.

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ACTION 1.4: The Mayor, working through the Deputy Mayor for
Health and Human Services, must ensure that all required federally required HIV/AIDS needs assessments, gaps analyses and other planning products are completed by the June 2012.

ACTION 1.5: The Mayor must direct the City Administrator to


implement collaborative planning for HIV/AIDS prevention, care, housing and all other services required by people living with HIV by June 2012.

ACTION 1.6: The Mayor must establish a District housing planning


committee to ensure appropriation and allocation of housing transparent, strategic and used to support those most in need. The DC Council must adopt policies that end the marginalization and blanket criminalization of District residents who engage in sex work and people who use drugs, and establish public health and legal protections for individuals who seek addiction treatment services.

ACTION 1.7:

The DC Council must stop the use of harm reduction and public health supplies such as condoms and clean syringes, as evidence in criminal prosecution. The DC Council must ensure through its legislative powers that evidencebased interventions and policies to reduce overdose fatalities among high risk groups including people who inject drugs and live with HIV including access to harm reduction kits that help to mitigate the spread of HIV.

ACTION 1.8:

The DC Council must request an analysis of and routinely monitor the gaps in syringe exchange programs in the District and fund full coverage of our neighborhoods. Congress must stop using the District of Columbia as a political football. By over ruling decisions made by our elected officials and local government, Congress undermines our efforts to appropriately address HIV/AIDS with evidence based interventions.

ACTION 1.9:

The District must lead mobilization efforts toward DC Statehood and demand the United States Congress remove any prohibitions in funding syringe exchange programs from DC appropriations bills. In collaboration with community and public health leaders, people living with HIV and their allies including representatives from each of the youth, gay, women, drug user, transgender and all identity groups, political leadership
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across the metropolitan DC region, including the Mayor of the District of Columbia, the US Delegate to the US Congress, Governor of Maryland, Governor of Virginia, Mayor of Baltimore, and other leaders should hold a summit on HIV before July 2012 with HIV communication, prevention, care and treatment strategies as a key area of focus. The output of this gathering should be a detailed timeline with actions that will be reported to the attendees of AIDS 2012.

ACTION 1.10:

The Mayor should plan and hold this regional HIV policy and planning meeting in Spring 2012. Lesbian, gay, bisexual and transgender (LGBT) young adults who reported high levels of LGBT school victimization during adolescence are nearly 4 times more likely to report risk for HIV infection, compared with peers who reported low levels of school victimization5. DC needs legislation to address the link between discrimination at school and increased risk for HIV infection. The Bullying Prevention and Intervention Act introduced in the 112th Congress can serve as a model for local legislation.

ACTION 1.11: The Council of the District of Columbia should enact


legislation to engage education officials in anti-bullying efforts. A bill should engage education officials, and include: a reporting system to track incidents of bullying and harassment; create an implementation task force of community advocates and officials from affected city agencies; establish a broadened definition of bullying and harassment to include a full list of protected groups and characteristics as reflected by the DC Human Rights Act; protections for individuals who associate with members of protected groups; and enforcement provisions. 2. Education and Research DC Government must take steps to increase District residents understanding and awareness of HIV, its impact across communities and populations, with the goal of heightening reducing HIV/AIDS related stigma. The Mayors office should partner with DCCC and other community leaders to develop communications on HIV in the District leading up to and during AIDS 2012.

ACTION 2.1:

ACTION 2.2:

Continue developing HIV prevention and awareness materials and programs targeting Seniors 50+. In conjunction with the DC Office on Aging, continue developing a social marketing and awareness program seniors. There should be no sexually active population in DC unaware they are at risk for HIV.

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DC Government must educate the community to understand the role that HIV and HIV-related research plays in combatting the epidemic and the importance of participation in clinical trials and other research programs.

ACTION 2.3:

The Mayor should call for an inclusive, transparent, Washington, DC-specific HIV-related research agenda in collaboration with community groups, planning bodies, care and treatment providers, and social services agencies. DC Government must advocate for HIV research within the District that best addresses the needs of DC infected and affected communities. Such research must include the study of social determinants that influence HIV risks (e.g., poverty, homelessness, homophobia, sexual ecology, etc.).

ACTION 2.4:

DC-FAR research agenda should be developed in collaboration with community priorities. A key priority is examining sexual ecology and why black gay men in the District have greater prevalence despite reporting less risky behavior. DC Government public health agencies must request, and when invited accept, membership on Community Advisory Boards that support US federally funded HIV research taking place in the District, and make these research protocols publicly available.

ACTION 2.5:

DC Government should publicly support the Toward the Cure approach for the discovery of a cure for HIV by the year 2020. Comprehensive sexuality education (including HIV prevention and treatment information) curriculum should be implemented and evaluated annually across the District of Columbia education system, and also in vocational education setting, prisons, post-incarceration services and non-school based youth care.

ACTION 2.6:

The Mayor and the Council of the District of Columbia must request regular reports that monitor the implementation and impact of comprehensive sex and sexuality education programs in Washington D.C. This should include information on sexual diversity including sensitivity and understanding of transgender and intersex persons in our city. 3. Optimization of Comprehensive High Impact Prevention Programs and Quality Care and Treatment Services

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In collaboration with community leaders, develop and disseminate state-ofthe-art comprehensive HIV prevention strategies for the District of Columbia that incorporate prevention treatment, testing and linkages to other social and mental health services.

ACTION 3.1:

The Mayor should develop a Strategy for eliminating the Districts housing waiting list for persons living with HIV and AIDS. The current strategy to address housing needs and HIV in the District responds to funding source requirements and not a transparent comprehensive strategy that articulates housing as a key component to an effective HIV response. Attention should be paid to the need for increased multi-unit housing for women and children.

ACTION 3.2:

The Mayor should adopt consensus-driven postincarceration HIV prevention, care and treatment support services.

ACTION 3.3:

The Mayor should expand HIV treatment literacy campaigns in the District aimed at the general population that clearly explain and promote HIV treatment options

ACTION 3.4:

The Director of the Department of Health should develop strategies that promote HIV services as integral components of comprehensive health care including the strengthening of linkages and ensuing services between sexual and reproductive health and HIV services, strengthened linkages and ensuing services between Domestic Violence and HIV Services, and support mechanisms for transportation to HIV prevention, care and support services.

ACTION 3.5:

The Deputy Mayor for Health and Human Services working through the Director of the Department of Health and the Department of Mental Health should develop and implement strategies to integrate mental health and substance abuse services with HIV care and prevention services and take steps to foster collaboration between APRA, HAHSTA and DMH. 4. District-wide Leadership and Accountability In preparation for AIDS 2012, the Mayor should lead District policy-makers, in collaboration with the private sector, faith communities, health care providers, civic and cultural institutions, educational and higher learning institutions and all sectors of community representatives should engage together in the preparation of city action plans for AIDS 2012. These action plans should take advantage of the opportunity of AIDS 2012 in July 2012, but should aim to sustain efforts long into the future.

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ACTION 4.1: The Government of the District of Columbia should,


before July 2012, develop a user-friendly printed and online resource directory of available HIV and HIV-related services in Washington, D.C. and provide grants to key constituent groups to adapt the resource guide for youth, substance users, gay men of color, transgendered persons, women, homeless persons and other hard hit populations. Implementation of comprehensive HIV workplace education and awareness programming into all departments and relevant public institutions of the District Government would promote awareness of HIV prevention programs and enhance treatment literacy throughout the District Government.

ACTION 4.2: The Mayor should require all District-funded agencies to


report back to the Mayors Host Committee for AIDS 2012 on steps each agency will take to heighten awareness about HIV and to support the goals of AIDS 2012.

ACTION 4.3: The Government of the District of Columbia should


contract with CBOs to conduct training and campaigns on HIV for all District of Colombia employees and contractors including information on anti-discrimination laws for people living with and affected by HIV. Public-private partnerships can urge and incentivize business leaders in the District of Columbia to develop working collaborations with community HIV service providers. Such collaborations can focus on resource development, public education, and outreach and stigma reduction. The Government of the District of Columbia and the DC Chamber of Commerce can form the basis of a viable partnership.

ACTION 4.4: The Mayors Office should work with the DC Chamber of
Commerce to convene a partnership development forum between business leaders and HIV prevention, care, and treatment providers in the District. District residents make significant HIV prevention, care, and treatment and advocacy contributions on a daily basis. Their leadership is worthy of public recognition and support through awards, scholarships and internships.

ACTION 4.5: The Mayor and the Council of the District of Columbia
should establish an award committee inclusive of corporate and foundation partners and set a timeline for making leadership awards to District residents instrumental to HIV/AIDS field. Awards may coincide with nationally recognized HIV/AIDS awareness days. The first honorees should be named in conjunction with District focused activities during AIDS 2012.
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DC Councilmembers should encourage awareness of and honor families living with and affected by HIV and AIDS in their neighborhoods.

ACTION 4.6: Each Ward in the District should hold a Candlelight


Memorial for families who have been living with or affected by HIV on Sunday May, 18 2012, the commemoration of the International AIDS Candlelight Memorial. Each councilmember in collaboration with community organizations, faith leaders and families should organize a commemoration.

ACTION 4.7: Each Ward should use its Constituency Fund to provide
five scholarships from each Ward for residents to participate in and report back on learning from AIDS 2012. The DC Community Coalition for AIDS 2012 Policy Platform for the District of Columbia marks the first time in the history of the HIV epidemic that diverse community stakeholders have come together to formulate comprehensive visionary policy recommendations for addressing the Districts epidemic. The Mayor HIV/AIDS Commission is a promising catalyst for change. The DCC is willing to work in partnership with the Gray Administration and the Council of the District of Columbia to end the epidemic in the city. We will be watching and hold government, community and private sector accountable. Achieving our shared goal will take renewed political will. It will take commitment on the part of government and civil society. It will force challenging dialogues and hard choices. We know that DC can make things happen and that DC is ready for the challenge.

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DC Appleseed Center, HIV in the Nation's Capital - Sixth Report Card. 2011: Washington, DC. District of Columbia Department of Health, DC 2010 HIV/AIDS, Hepatitis, STD, and TB Epidemiology Annual report Update. HIV/AIDS, Hepatitis, Syphilis, and TB Administration. 2011: Washington, D.C. 3 UNAIDS and World Health Organization, Estimating National Adult Prevalence of HIV-! In generalized epidemics, 2009. 4 Soyka, M., et al., The World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Biological Treatment of Substance Use and Related Disorders. Part 2: Opioid dependence. World J Biol Psychiatry. 12(3): p. 160-87. 5 Russell, S.T., et al Lesbian, Gay, Bisexual, and Transgender Adolescent School Victimization: Implications for Young Adult health and Adjustment, J Sch health. 81(5): p 223-230.

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