prisons

Alan Perez first said what was to become the theme of Project UNSHACKLE’s first Community Forum in New York.  And it was almost an afterthought.  Alan is the Volunteer Coordinator for Gay Men’s Health Crisis’ Action Center.  On our presenter check-in call, he was explaining what he wanted to cover during his talk at the forum.  Pausing for a moment to find the right words to describe the Action Center’s work, Alan offered, “You know… We’re trying to turn thought into action.”  Those words caught the essence of our work on that call as they framed the efforts at the forum Wednesday, December 10th. 

There’s an often-quoted statistic from the Bureau of Justice that two-thirds of people will be rearrested within three years of their release from prison.

In a packed room on the LGBT Center’s third floor, forum presenters, Alan, Waheedah Shabazz-el, Stacey Thompson, and John Bell painted a vivid picture of what happens to the other one-third.  They all came to their work around HIV and imprisonment through stints in the New York, Philadelphia, and Baltimore jail/prison systems.  And they all have now set their hands to changing the very systems they once found inescapable.  That’s how they have stayed home.  And that’s precisely the message they are trying to pass on to the members of their communities: Reach out.  Get involved.  Turn thought into action.

With the New Year nearly upon us, it’s this message that is guiding me in thinking about Project UNSHACKLE’s work in 2009.   read more »

Blog by Lissa Gundlach, CHAMP Fellow and Student at Union Theological Seminary

As the snow is falling in New York and colleagues are departing for the holidays, I am thinking about Christmas, faith and the beautiful World AIDS Day Celebration at Riverside Church this year.

Over 40 years ago at the Riverside Church in Harlem, Rev. Dr. Martin Luther King delivered his final speech at a meeting of Clergy and Laity Concerned about Vietnam (CLCV), and he opened: "A time comes when silence is betrayal.”

As we know from the ACT UP movement, silence is not only betrayal— it is death.  read more »

At this same historic church on the rainy, chilly eve of World AIDS Day—hundreds of people gathered at the intersection of these two great activist traditions and found a place of refuge in the warmth, hope, and inspiration.  Riverside’s Stop AIDS: Keep the Promise “Lead, Empower, Deliver” event commemorated the 20th anniversary of World AIDS Day and the UNAIDS Joint Programme on HIV/ AIDS.  Local, national, and global leaders addressed the crowd of community members from Harlem and around the world.

Even though we've talked over the last year about the new HIV infections rate (incidence) in 2006, I haven't given any thought to the issue of transmission--how many people actually transmit HIV to an HIV negative person every year? And what does the looking at the rate of transmission over the course of the epdemic tell us about what's working or not working with prevention, testing, treamtment or care efforts?

Well that's why we have smarty pants like David Holtgrave, PhD at the Bloomberg School of Public Health at the John Hopkins University. His study, which JAIDS released online ahead of the publication date, looks precisely at HIV transmission rates over the course of the epidemic. They conclude that the highest rates of transmission occurred in the early years of the epidemic--in the early/mid 80s, and then began to drop off at several different points, particularly from 1985-1986 (31.4-17.4), and 1990-1991 (11.7-6.6). By 2006, the transmission rate declined to 5.0.

In other words, 95% of all people with HIV did not transmit the virus to people who are HIV negative.The study goes on to explain the possible causes for this drop in transmissions:

The general decline in HIV transmission rates over time could be considered a rough measure of prevention success, in that even as prevalence grew over time incidence did not grow proportionately. HIV diagnosis is known to significantly reduce HIV risk behavior, and in the past decade, there has been an increasing emphasis on prevention programs for persons living with HIV that further reduce HIV risk behavior and 2006.

Another interesting thing Holtgrave and co-authors note is that AIDS drugs (anti-retrovirals) didn't have a grand impact on transmission rates, as transmission was declining long before ARVs were on the market. Could it be that marginalised communities with no access to treatment is where those transmission rates did not decrease? Could it be that the prison boom and/or Welfare Reform Act of 1996 (when prison construction peaked and we hit the 2 million prisoner mark for the first time) disrupt or change sexual networks enough to create new HIV transmissions in social networks where they had been stable? Holdgrave doesn't ask these questions, but notes that further research needs to happen to explain why ARVs do not seem to have significantly decreased transmission of HIV. But in a Q & A on Johns Hopkins' website, he addresses the impact of housing stability on HIV risk, and also says what he would do if he was AIDS Czar in the Obama Administration:

I think it is critical to address unmet HIV prevention needs in the U.S. As I testified recently before Congress, my wish for a five-year plan would be for $1.3 billion in prevention funding per year. I might front-load that a bit, so maybe it’s $1.6 billion in the first year, and so on. Over that five-year period, I estimate that as a nation we could reduce transmission by half—but we’d need that substantial investment. And if we really saw a drop in new infections, that higher level of funding might sunset in several years, so we wouldn’t necessarily have to continue to fund it at $1.3 billion per year.

Let's hope we're as lucky to have this come to fruition.

UPDATE: The CDC has published a factsheet and podast on HIV Transmission Rates in the US, based on the release of this data.