Ashley Kraybill, MPH
Wisconsin Population Health Service Fellow
Wisconsin Division of Public Health

Madison, WI

Hester Simons, MPH
Wisconsin Population Health Service Fellow
Wisconsin Division of Public Health
Centro Hispano of Dane County 
Madison, WI

 

 On February 7, 2016, we observed the 16th annual National Black HIV/AIDS Awareness Day (NBHAAD), a national initiative aimed at mobilizing communities around HIV testing and treatment in response to the growing HIV and AIDS epidemic in African American communities. Many organizations and people who participated on this day work every day to increase HIV education, testing, community involvement, and treatment among black communities. As Population Health Service Fellows, we have learned about various initiatives around Wisconsin that aim to address these issues.

But, why is this so important?

National Data[1]

·       African Americans are the racial/ethnic group most affected by HIV.

·       The rate of new HIV infection in African Americans is 8 times that of whites based on population size.

·       Gay and bisexual men account for most new infections among African Americans; young gay and bisexual men aged 13 to 24 are the most affected of this group.

Wisconsin Data (2014)[2]

Of the 226 new cases of HIV infection diagnosed in Wisconsin during 2014:	Reflecting national trends, young Black men who have sex with men (MSM) in Wisconsin continue to be the population most affected by HIV in Wisconsin. During 2014:
	Young Black MSM accounted for almost one-quarter (22%) of all new diagnoses in Wisconsin. Diagnoses in young Black MSM more than doubled from 2005 to 2014.

 City of Milwaukee Data (2014)[3]

Milwaukee is disproportionately affected by HIV, as it makes up just 10% of the state’s population yet has 53% of all statewide HIV diagnoses.
2 in 5 Black MSM in Milwaukee are living with HIV
Reflecting national trends, young black MSM in Milwaukee continue to be the population most affected by HIV. One-third of new HIV diagnoses in Milwaukee occurred in Black MSM ages 13-29.

Context 

When considering health outcomes data, especially disparities data, it is important to consider the context in which people live. 

• Wisconsin ranks last in the country in the overall well-being of Black children based on  an index of 12 measures that gauge a child's success from birth to adulthood.[4]
• Milwaukee is the most racially segregated large city in the United States.[5](see map below) 
•  While the infant mortality rate has dropped in Milwaukee in recent years, it remains among the highest of the nation’s big cities.[6]  The infant mortality rate is commonly accepted as a measure of the general health and well-being of a population.[7]     
•  4 in 10 Blacks in Milwaukee live in poverty, compared to 1 in 3 Hispanics and 1 in 7 Whites.[8]  
•  45% of Black adults have completed some college or more education, compared to 29% of Hispanics and 64% of Whites.^[8]  

In a recent article, “5 Reasons Why HIV Disproportionately Affects Black People,” there is an excellent discussion about the social determinants of HIV:

“The question is why? Why do black people carry the burden of this disease, especially when it didn't start out that way? The easy answer would be to say that black people engage in riskier behavior so therefore they are more likely to contract HIV. While personal responsibility is now and always a factor, black populations do not engage in risk behaviors at any higher rates than other races and ethnicities. This gives way to the fact that there are broader concerns that make HIV significantly more difficult to face and overcome in black communities.”[9]

In the face of these challenges, the NBHAAD initiative leverages a national platform to educate, bring awareness, and mobilize the African American community to:

Get Educated about HIV and AIDS;

Get Involved in community prevention efforts;

Get Tested to know their status; and

Get Treated to receive the continuum of care needed to live with HIV/AIDS

So what’s happening in the Fellowship around these issues?

Hester Simons, a second year fellow, is placed with both the Minority Health Program at the Wisconsin Division of Public Health and with Centro Hispano of Dane County. We sat down to discuss her work around HIV/AIDS.

Ashley: What are you doing in the fellowship related to HIV/AIDS?

Hester: Through my placement with the Minority Health Program at the Wisconsin Division of Public Health, I had the opportunity to participate in writing a grant last spring to address the Healthy People 2020 Leading Health Indicator HIV-13: Knowledge of serostatus among HIV-positive persons.[10] This grant is a joint initiative between the Minority Health Program and the AIDS/HIV Program. The overall goal of the grant is to reduce the disparity in AIDS/HIV cases among African American, Hispanic/Latino, and American Indian communities in Milwaukee, Wisconsin by increasing knowledge of serostatus among HIV-positive persons in these communities. Basically, we want to make sure people who have HIV are aware of their infection so they can receive the necessary treatment.

Ashley: How does this grant relate to National Black HIV/AIDS Awareness Day?

Hester: One of the objectives to reach the grant’s goal is to increase the number of people among the target populations (Black, Latino, and Native American) reached through HIV awareness events. This year, the grant will support five HIV awareness days, the first of which was NBHAAD.

Ashley: What did this awareness day look like?

Hester: NBHAAD was celebrated in Milwaukee on February 8^th at Milwaukee Area Technical College (MATC) in the Student Center. The goal was to bring the information and services to people rather than asking them to come to the services. This was a collaborative effort put on by UMOS and several other organizations. It was estimated that more than 1,000 people came to the event and received information. Testing for HIV and sexually transmitted infection (STI) were provided for free and 3,500 condoms were distributed. Almost 50 people were tested for HIV and almost 40 were tested for STIs.  The success of this event was clearly a result of the hard work and thoughtful collaboration of the partners involved.

Ashley: What has your experience been like as a fellow working on this project?

Hester: This project has been a great learning experience! I’ve been given the opportunity and support to take a lead role in the writing of the grant application and its subsequent implementation. It has also given me the opportunity to merge my passions for health equity and HIV. The first six months of the grant have involved a lot of planning and figuring out how we can make the best use of the resources available through this grant. Two important elements that we continue to build into our implementation plans are 1) the need to evaluate our efforts and adjust them accordingly and 2) the need to elicit feedback from the groups we hope to reach with our work and those who are most affected by HIV.

Ashley: Thank you so much for all the work you have done and for telling us about it!

_______________________________________________________________________

Want more information?

Wisconsin Minority Health Program website: https://www.dhs.wisconsin.gov/minority-health/index.htm

NBHAAD web page: http://nationalblackaidsday.org/

Wisconsin AIDS/HIV Program website: https://www.dhs.wisconsin.gov/aids-hiv/data.htm

CDC’s HIV surveillance web page: http://www.cdc.gov/hiv/statistics/index.html

General Information about HIV prevention and care services in WI: https://www.dhs.wisconsin.gov/aids-hiv/index.htm

Blog Post: “Hunted by the State: HIV, Black Folk & How Advocacy Fails Us” http://brownboispeaks.com/2015/12/18/hunted-by-the-state-hiv-black-folk-how-advocacy-fails-us/

Sources

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[1] http://www.cdc.gov/hiv/group/racialethnic/africanamericans/index.html

[2] Wisconsin AIDS/HIV Program (2015). Summary of the Wisconsin HIV/AIDS Surveillance Annual Review: New Diagnoses, Prevalent Cases, and Deaths Reported through December 31, 2014. Retrieved from https://www.dhs.wisconsin.gov/aids-hiv/data.htm

[3] Wisconsin AIDS/HIV Program (2015). Wisconsin HIV/AIDS Surveillance Annual Review 2014 – Addendum: City of Milwaukee. Retrieved from https://www.dhs.wisconsin.gov/aids-hiv/data.htm

[4] Annie E. Casey Foundation, Race for Results, 2014 (using 2010-2013 data).

[5] The Persistence of Segregation in the Metropolis: New Findings from the 2010 Census. JR Logan and BJ Stults, March 24, 2011 (using 2010 census data).

[6] Annie E. Casey Foundation, Kids Count, 2014 (using 2013 infant mortality from CDC).

[7] CDC Infant Mortality fact sheet.

[8] American Community Survey, 2010-2014 Estimates.

[9] http://www.hivequal.org/hiv-equal-online/5-reasons-why-hiv-disproportionately-affects-black-people?slide=1

[10] http://www.healthypeople.gov/2020/topics-objectives/topic/hiv/objectives#4611