News

To help individuals using pre-exposure prophylaxis (PrEP) who are also seeking to get or renew coverage in the Insurance Marketplace during the current open enrollment period, NASTAD recently launched PrEPcost.org . The site is an online health plan finder that helps PrEP users or navigators identify and compare access to PrEP in Marketplace coverage options.

PrEP is an HIV prevention method that involves people at very high risk for HIV infection taking medicine daily to lower their chances of getting infected. PrEP can stop HIV from taking hold and spreading throughout your body. It is highly effective for preventing HIV if used as prescribed. Visit HIV.gov to learn more about PrEP.

PrEPcost.org features information on plans available through the 2018 Federally Facilitated Marketplace. Access to PrEP and its cost may be only one of the considerations that someone seeking coverage through the Marketplace may have. It is important to examine costs for all health, prescription, behavioral health and other covered services that are important to the individual. The open enrollment period has begun and ends December 15, 2017.

Use these tools provided by HIV.gov for help completing your application:

• First time using HealthCare.gov? Create an account now.
• Have 2017 Marketplace insurance? Log in now to update your application and compare plans for 2018.
• See answers to your common questions.
• Call the Marketplace Call Center to ask a question, start or finish an application, compare plans, or enroll.
• Search by your city and state or ZIP code to see a list of local people and organizations in your community that can help you.

Read more on BlackAIDS.org

In the heart of the Crow Reservation in southeastern Montana, the 450-person town of Valley of the Chiefs has faced mounting difficulties over the past several decades. In the last two generations, the Crow Nation has lost 80% of its population and 73% of its land. Economic dispossession has rattled Valley of the Chiefs, as members of the community have turned to substance abuse and violence. For youth, who make up around 43% of the population, the town is especially harsh.

Valley of the Chiefs is one of six communities selected this year to participate in Raising Places, a new initiative developed by the Chicago-based design firm Greater Good Studio and funded by the Robert Wood Johnson Foundation to initiate ground-up local projects that will support a healthier environment for children–and by extension, everyone around them. “The research has shown for a long time that where you grow up matters,” says Sara Aye, executive director of the Greater Good Studio. “It matters for your health, it matters for your broader success in life. We can’t create a culture of health in America if we don’t have healthy places for kids to live and grow.”

Raising Places partnered with local groups in each of the communities, which range from a street in Minneapolis to a town in upstate New York, to begin the process of designing and implementing child-centric projects that will bolster overall community health. While a number of projects have originated with children’s health in mind (like the nonprofit KaBOOM!’s initiative to fund innovative play spaces across the U.S.), Raising Places is taking it a step further by actually bringing children and teens into the brainstorming and design processes.

“It was really important to us to develop a diverse and engaged design team in each of the communities,” Aye says. And by “design team,” she adds, she means a cohort of local leaders–artists, organizers, planning department experts, school and youth group administrators, and youth themselves. “They’re not designers, but we’re training them to think as designers,” Aye says. With the help of the Raising Places program staff, these teams will be the ones who will come up with, test, and ultimately carry through the projects.

In Valley of the Chiefs, one of the ideas the team is working with is the concept of a culinary school, Aye says. “In their research, they really saw a focus on food, and the traditions around eating communally and Native food,” she adds. “There’s also a dire need for healthy food and jobs for young people–jobs that can lead to careers.” While the culinary school could act as an avenue to employment, the team is also looking into addressing that need through an idea to build out, from scratch, a real main street in the town, where local entrepreneurs could open businesses to sell goods. The main street, the team imagines, could also be supplemented by an online platform to expand their sales market, and the business owners could act as mentors to the town’s young people, who could also work at the businesses.

Across the country in the Downstreet neighborhood of Hudson, New York, the design team there is focusing on addressing a very different set of concerns. “One of the ideas there is around police and community interaction, particularly how police and youth interact,” Aye says. Hudson is a heavily policed town, and one that’s often plagued by violence; children and young people there, Aye says, often express a sense of trauma around dealing with police. “One of the insights they had is that police are often working to fix symptoms, but they don’t deal with root causes,” Aye says. Out of that observation came an idea for a civilian review board that would include youth, and focus on helping the police force become more self-aware and sensitive to the effect they have on young people.

Read more on FastCompany.com.

“Moving the Race Conversation Forward” is a report by Race Forward: The Center for Racial Justice Innovation that aims to reshape and reform the way people talk about race and racism in the United States.

Part One (pdf) includes:

• Content analysis of mainstream media: Two-thirds of race-focused media coverage fails to consider how systemic racism factors into the story, instead typically focusing upon racial slurs and other types of personal prejudice and individual-level racism.
• Seven harmful racial discourse practices, which reinforce the common misconception that racism is simply a problem of rare, isolated, individual attitudes and actions: Individualizing Racism, Falsely Equating Incomparable Acts, Diverting From Race, Portraying Government as Overreaching, Prioritizing (Policy) Intent over Impact, Condemning Through Coded Language, and Silencing History.

Part Two (pdf) features case studies and profiles of recent interventions and initiatives advanced by the racial justice field to challenge mainstream discussions of race and racism, and the negative policy impacts that dominant frames and narratives have on people of color. They include: Drop the I-Word, Migration is Beautiful, ALEC on the Run, Fruitvale Station, and Ending the Schoolhouse-to-Jailhouse Track.

Watch the accompanying video, produced by Jay Smooth, which breaks down the report in engaging, accessible ways. Smooth is the founder of New York’s longest running hip-hop radio show, WBAI’s Underground Railroad, and Race Forward Video & Multimedia Producer.

Learn more about the report at RaceForward.org.

Mental health problems can make people with diabetes sicker. Countless studies have shown that depression raises the risk of all sorts of bad outcomes in diabetes—from foot numbness to premature death. A new study supported by NIMHD found that stress management classes given by community health workers helped low-income Latino people with diabetes feel better, with fewer symptoms of depression and anxiety. And it wasn’t just their feelings that improved: The approach also helped participants control their blood sugar.

There are two main ways that negative feelings can affect the physical health of people with diabetes. One is physiological: People who are depressed, stressed, or anxious have more stress hormones, which raise blood sugar levels. The other route is through their behavior: Depressed people may not be able to get themselves to exercise, take medication, or monitor their blood sugar levels. Having too much sugar in the blood for too long damages the tiniest blood vessels, leading to complications such as kidney damage and blindness.

But many people with diabetes do not have access to treatment for depression. In an earlier study of low-income Latino people with poorly controlled diabetes, NIMHD grantee and public health nutritionist Rafael Perez-Escamilla, Ph.D., from the Yale School of Public Health, found that more than half had symptoms of depression. In that study, community health workers visited people at home and helped them get their blood sugar under control.

“I wanted to look at what happened if we taught the same population of patients how to manage their stress,” Perez-Escamilla said. So he got in touch with Julie Wagner, Ph.D., a clinical psychologist at UConn Health who studies how psychological and social factors affect the bodies of people who either have or are at risk for developing diabetes.

In partnership with the Hispanic Health Council, the researchers worked with Latino residents of Hartford, Connecticut to design an eight-session, culturally relevant course that taught people how to manage stress. “It’s not just language translation,” Wagner says. “It speaks to the cultural context in which the people are living.”

Because most Latino residents of Hartford have Puerto Rican ancestry, a lot of the analogies used in the curriculum involved weather and fishing—things that are relevant to island life. The pressure cooker, associated with old-fashioned ways of cooking in Puerto Rico, served as a metaphor for personal stress. Stress in the low-income community members’ lives came from factors like not being sure they would be able to afford food or rent so those were the kinds of examples used.

For the study, 107 participants attended a 2.5-hour group session on diabetes education that covered nutrition, medication, exercise, and how to monitor your blood glucose. Then 61 of the participants were randomly assigned to take the stress management course. All sessions were in Spanish and taught by the same community health worker.

Even with transportation provided, participants only attended four or five of the eight stress management sessions, on average. But the response was positive. “Oh my goodness, they loved it,” Wagner says. “We got such good feedback.” Participants were particularly enthusiastic about learning relaxation techniques. And the classes worked. The people who were randomly assigned to take the classes felt healthier, with fewer symptoms of depression and anxiety, than the people who only had the single diabetes education session.

The results also show how valuable community health workers are, Wagner and Perez-Escamilla say. Providing mental healthcare is expensive; the study shows community health workers could improve health by delivering programs like these at a relatively low cost, and in a culturally sensitive way, because the workers come from the community and understand their neighbors’ needs. Community health workers normally provide health information and education and help people navigate the health system, understand medication instructions, find transportation, and a whole range of services that address the social factors that influence health.

Mental health is important to physical health, particularly for the population participating in the classes. Although providing mental healthcare is expensive, Wagner and Perez-Escamilla’s study demonstrates that through programs such as this, community health workers can provide care to people in need at a relatively low cost and in a culturally sensitive way.

Read more on the National Institute on the Minority Health and Health Disparities website.

A group of noted community scholars recently published six principles for collaborating for equity and justice (Wolff et al., 2017). Collectively, these principles argue that coalitions attempting to promote community change for health must embrace strategies with real potential to challenge the status quo and lead to transformative change in power, equity and justice. The principles address social and economic injustice, structural racism, community organizing to facilitate resident power and ownership, structural change, an acknowledgment of complexity, and the need to thoughtfully build on decades of practice and scholarship on collaborating for community change.

Health educators and health promotion specialists have tackled these issue for decades, with an emphasis on coalition-building, community organizing and more recently, policy, systems and environmental (PSE) change. There are a number of promising tools for achieving improved population health, and with strategic focus, reducing health disparities and moving toward health equity. Health Education & Behavior is committed to advancing the evidence-base for scholarship and practical strategies for achieving health equity. The special section on PSE, is a step in that direction.

The current call for papers will highlight recent work on how to work best towards transformative change. The Collaborating for Equity and Justice (CEJ) principles offer ideas for how to move past overly simplistic models, to be more inclusive, and to attempt more transformative changes.

Health Education and Behavior is interested in manuscripts that provide insights into one or more of the CEJ principles. They encourage multi-site or comparative studies of PSE change efforts; empirical studies of coalition efforts aligned with CEJ principles; empirical studies of efforts to achieve collective impact, which can also shed light on the CEJ principles; studies that suggest barriers or shortcomings of the CEJ principles; and other empirically-derived or theoretical insights into CEJ principles.

Abstracts are due December 15, 2017.  Full manuscripts are due July 2, 2018. This theme issue is expected to be published in 2019.

Through its publications, the Society for Public Health Education (SOPHE) explores social and behavioral change as they affect health status and quality of life. Health Education & Behavior also examines the processes of planning, implementing, managing, and assessing health education and social-behavioral interventions. The journal provides empirical research, case studies, program evaluations, literature reviews, and discussions of theories of health behavior and health status, as well as strategies to improve social and behavioral health.

Learn more about this call for abstracts at SOPHE.org.

This is a blog post written by and from the perspective of Roscoe Boyd II, Founding Member of the U=U Steering Committee. 

I have been very public in sharing that I am a person who has lived with HIV for the past 16 years. I am healthy and motivated to make a difference in the lives of people like me, and to help end the stigma that leads to higher transmission rates, particularly in Black communities. It is a very emotional and deeply personal subject matter for me because for much of my life, I have lived in fear of being “discovered” and unconsciously developed a sense of worthlessness and undeserving, largely because of how people shame and judge HIV positive people. 

“People living with HIV who are on treatment and maintain an undetectable viral load cannot pass it on through sex!” The Centers for Disease Control and Prevention has confirmed it, and The Lancet has written about it.

Having a detectable viral load does not mean a person is “dangerous.” But now that my viral load is undetectable, I’m at greater ease knowing that I can’t transmit HIV to my partner. This is empowering for me and for my ability to choose healthy outcomes for my life, especially when I consider my life’s path.

At one time on my journey, I reached a very low point where I was struggling with health—both physical and mental—and trying to find myself, my purpose, and who I wanted to become. As a young black man with huge financial burdens and no job, it was a relief to find much-needed support in community-based organizations that were affirming and “got me”, without judgment. I learned that while many people in the community say they want to help, sometimes that “help” comes with strings attached, or they may not have the competence or ability to be helpful given my particular needs. This time, however, I knew something was different…in a good way.

At age 30, I found myself living in a shelter, working at a local burger joint, not really knowing what to do with my life. I lived with HIV since 2001 and for many years, I felt insecurity, fear, helplessness… like death was near. I was so deep into drugs that they became a “safe place” for me, as I’m sure they do for many who struggle. Never would I have guessed that this gifted kid from Detroit would be in this dark place…but there I was.

Thankfully, there were community members there to help me navigate what I saw as an impossible situation to overcome, and to link me to services that improved my physical and mental health. I learned how to take a more positive approach to living. This collective of community was willing to accept me as I was without judgment, and to help me heal from these health traumas. They became part of my team in progressing and pushing me in meeting my goal of living a healthy, productive, long, and happy life.

Over the last year, I have used my voice to share the good news of the U=U movement (Undetectable = Untransmittable) and garner support of community organizations and local, state, and federal government to recognize this truth. In the struggle, we used factual and verifiable scientific research that people who are living with HIV and maintain an undetectable viral load by taking antiretroviral therapy daily, are not able to pass the virus to others!

This breakthrough U=U science has changed my life. I speak around the country as a health advocate, and help people heal from the psycho-social traumas experienced because of HIV stigma.

However, this information is not being provided to all communities. Everyone needs to know the facts and gatekeepers must, also, be willing to acknowledge the science and help us eliminate the stigma that keeps so many people feeling undeserving of love and their best life. Policymakers must understand that U=U means access to treatment and care which will not only save our lives, but is essential to stopping HIV transmission and to ending the epidemic.

Read more on POZ.com.