World AIDS Day: A Time of Hope & Remembrance

Tyler TerMeer
Executive Director

World AIDS Day is upon us again.  For me, World AIDS Day has always been a time of reflection and remembrance. A time for me to remember those individuals lost along this journey and to reflect on the ways in which HIV has changed the course of my life.

However, this World AIDS Day feels different. This year has felt a bit like we have been under siege.  We have been bombarded with efforts to deprive people of healthcare and attacks on programs that people living with HIV have come to depend. We have felt the tide of racism, xenophobia and misogyny rising. And it’s easy to get overwhelmed by the negativity and fear.

That’s why on this World AIDS Day I am focusing on the ways in which my own life has been enriched. For nearly 14 years I have been living with HIV. As a 34-year-old, gay, HIV positive man of color, I have faced my share of stigma and fear. But I’ve also come to understand the tremendous courage, strength, and compassion that many people have shown in the face of this disease. Personally, becoming positive was a transformation for which I will always be profoundly grateful as it gave me a perspective that was bigger than myself. It catapulted me from a career in the arts to working in HIV policy and activism and it gave me the opportunity to work with and for people most impacted by the epidemic. 

So, this morning, I am thinking of how we can build on our progress and reimagine a new path forward to end the epidemic. We have traveled a long way from the dark beginnings of this disease and have come so far in the fight. The rate of new infections is decreasing and we are diagnosing people earlier. We have a pill, commonly known as PrEP, that when taken consistently can help prevent HIV infection.  Once diagnosed and connected to care, people living with HIV can lead long and vibrant lives. And science now confirms that individuals living with HIV who have an undetectable viral load are no longer able to transmit the virus to others.

In short, there is much to be joyful about even as we grapple with the challenges of our time. As Dr. Maya Angelou famously said “You may encounter many defeats, but you must not be defeated. In fact, it may be necessary to encounter the defeats, so you can know who you are, what you can rise from, how you can still come out of it.”

As we celebrate and remember on this World AIDS Day, we must take her words to heart. We will encounter these challenges, learn how to rise from them, and come out of this stronger together.

Sincerely, Tyler

CAP Reaffirms Commitment To Equity By Creating New Equity Outreach Coordinator Position

CAP is proud to announce that it has created a new position of Equity Outreach Coordinator to address barriers faced by refugees, people of color, people living in rural areas, and others in obtaining the housing resources available for people living with HIV. In addition to direct outreach to high barrier communities, this position will also help inform CAP’s efforts to design programs for improved equity outcomes across the community. The Equity Outreach Coordinator position will report directly to CAP’s Director of Housing & Support Services.

Tyler TerMeer, Executive Director

“This important new position will work to address the very real disparities faced by some of the most vulnerable members of our community,” said Executive Director Tyler TerMeer, “The data we have collect over the past year supports our understanding of the barriers confronting people of color attempting to access housing and other services which often result in longer wait times and lower program participation. There are a lot of factors contributing to this inequity, including higher rates of criminal conviction and eviction history that makes it harder for people in communities of color to access housing. All of which means that CAP needs to work hard to overcome these barriers and achieve parity with white clients.”

“We know that HIV-related stigma is so high in some communities that significant numbers of people who know they are positive are going without treatment and services” said Angie Harbin, CAP’s Director of Housing & Support Services, “We also know that a lot of people, for a variety of reasons, face obstacles to accessing CAP’s services through our existing processes. And, finally, our numbers tell us that we need to be doing more to address the disparities in outcomes among certain groups of people. This position is intended to address these issues.”

The position will be funded with dollars from CAP’s federal Ryan White Housing contract that is anticipated to last a minimum of 5 years.

Download the full press release here: Equity Coordinator Press Release

March 20th Marks National Native HIV/AIDS Awareness Day

March 20th is National Native HIV/AIDS Awareness Day. Unfortunately, new HIV infection rates having been increasing in recent years among American Indians and Alaskan Natives. Yet, rates have been decreasing during this time-period for white communities.  Our Native populations are disproportionately affected by the HIV/AIDS epidemic – a fact that is rarely highlighted even by HIV/AIDS-focused organizations. Part of the problem is the “other” designation on medical and epidemiological intake forms…

“Other” is oft the catchall phrase used to identify American Indians, Alaska Natives, Asians, and Pacific Islanders.  The generic label disassociates the stories, struggles, and resilience of these communities.  Behind the “other” are people, families, and rich culture and traditions.  American Indian and Alaska Native communities deserve the right, just like every other community, to be named.

Today on National Native HIV/AIDS Awareness Day, we urge everyone to remove the “other” label intake forms, reports, and all other means of demographic grouping. Those of Native populations, we welcome your distinct contextualized voice on the effect of HIV/AIDS in your life. To all others, reach out to your Native friends, neighbors, and colleagues with compassion and empathy – or listen to Native HIV stories and PSAs. HIV/AIDS is an enemy all individuals can rally against.

CAP Announces New Mission & Name For LGBTQ+ Health Center

Today, December 1st, marks the 29th anniversary of World AIDS Day – a time for people worldwide to unite in the fight against HIV/AIDS, to show their support for people living with HIV and to remember those who have lost their lives in the epidemic. In commemoration of World AIDS Day, CAP announced that it has adopted a new mission statement to enable the agency to better serve its existing clients and expand services to provide direct medical services to the broader LGBTQ+ community through the creation of a new LGBTQ+ Primary Care Center slated to open in early 2017.

CAP’s new mission:

We support and empower all people with or affected by HIV, reduce stigma, and provide the LGBTQ+ community with compassionate healthcare

“Our new mission statement reflects both our 32-year history of fighting the HIV epidemic as well as our move to providing culturally relevant health care to the broader LGBTQ+ community through our new health center,” said CAP Executive Director Tyler TerMeer. “I am also thrilled to announce the name of the health center: Prism Health. The name is a nod to the rich history of the LGBTQ+ liberation movement and an evocation of the power of science to be used in the service of the community.”prism

“CAP will always be here to work with and support people affected by HIV, but it was also time to look towards the future—which is providing culturally affirming health care to the LGBTQ community,” said CAP Board Chair, Robert Goman. “With a growing LGBTQ population, we need to take action now to ensure that their health needs are met.”

Prism Health, a primary care health center, an integral part of CAP’s expanding mission to serve the broader LGBTQ+ community and will help remove barriers and improve access to health care for all LGBTQ+ individuals. More information can be found at www.cascadeaids.org.

PrEP: A Physician’s Perspective

PrEP: A Physician’s Perspective

By: Matt Pizzuti, Contributor

It could be the most promising—and controversial—HIV prevention tool yet. When used correctly, pre-exposure prophylaxis (PrEP), the daily pill that blocks an HIV infection from taking root in the body, can ensure that HIV-negative people stay that way. Combined with other safer sex strategies such as condom use, PrEP transforms the HIV prevention landscape, but not without a dose of scrutiny as well. What, exactly, is the relationship between PrEP and other risk-reduction strategies like condoms? To understand how a medical doctor thinks about PrEP and discusses it with patients, we spoke to Dr. Christopher Evans, a physician and infectious disease specialist at Oregon Health and Sciences University who works with PrEP patients daily.

 

Matt Pizzuti: Can you tell me a little about what you do and your expertise in PrEP?

Christopher Evans, M.D.: I am an infectious disease trained physician, I trained in New York, and now I work at OHSU doing primary care and also infectious disease consultation. Within the clinic that’s HIV care. I also see patients that are at risk for HIV, partners of HIV-positive patients, etc, as well as the public at large.

 

MP: Who is PrEP recommended for?

CE: PrEP is recommended for anyone who is at risk for HIV; someone who has had possible previous STIs, which may mean you are at higher risk, and high-risk groups, such as someone with an HIV-positive partner, or someone with a partner or number of partners of unknown serostatus (in other words, someone who has sex with people without being able to verify that they are all HIV-negative).

MP: Many of the people currently receiving messages about PrEP are men who have sex with men, and I think it’s sometimes hard for individuals in that category to know whether they, individually, should be considering it. To make this a little simpler, who among at-risk populations would you NOT recommend PrEP for?

CE: First of all PrEP’s not recommended for anyone who’s not going to take it the way it’s prescribed. There also may be people in a long-term monogamous relationship who know the serostatus of their partners and know their partners don’t have HIV. There’s a gray area around monogamous serodiscordant couples (couples with one HIV-positive partner and one HIV-negative partner) when the HIV-positive partner has an undetectable viral load; we know the risk of transmission to the negative partner is low even with unprotected sex. I would add that the CDC still recommends PrEP for serodiscordant couples.In every relationship everyone has to make their own decisions, though. I’m not there to dictate, I’m there to give you the options and talk about your risk.
In more specific cases, PrEP may not be recommended for pregnant women, although we do know that in some cases some women are pregnant when they get HIV. There are some gray zones for people who have chronic hepatitis B because of the risk of a viral flare-up if you discontinue PrEP.

MP: Out in the community there are a lot of strong opinions about PrEP; it’s pretty common to hear people say that PrEP is being used as an “excuse” to have unprotected sex or that it’s leading to riskier behavior.

At the same time, people in public health roles are saying that PrEP is not a substitute for condoms, although it does make sex much safer if you’re not using condoms consistently. In your view, what’s the relationship between PrEP and condoms?

CE: So there are personal comments, and then there’s evidence. Even in big studies, there’s evidence that the incidence of risky behavior decreases in people on PrEP. The big one was iPrEx, a study on gay, bisexual and transgender women who have sex with men, one of the first that looked at using Truvada for PrEP and was used for FDA approval.

Subsequent studies looked at risky behaviors again and found that risky behaviors, over time, went down, in both those on PrEP and those receiving placebo. But both groups also got safe-sex messages while they are coming in, just as in a patient setting, where it’s not like it’s being just given to people without any counseling.

The analogy I use is, if you have a seat belt would you drive faster? Most people would say they would continue to drive the speed limit even with a seatbelt on because it’s the more prudent thing to do.

Regardless, I always talk to my patients about using condoms. Condom use has a lot of different steps, though, and it’s not just putting on the condom; it’s negotiating using the condom, it’s people going out and having a good time (drinking) and still having the wherewithal to use it, and condoms can break—so condoms as a strategy is not 100% effective because people are not 100% consistent. But I think condoms are a cornerstone of public health policy and still important. I’m not ready to throw them out the door and say you have this other option so we don’t need it anymore.

There’s also the issue that having one STD can increase your risk for others; getting syphilis will increase your risk for HIV. So I’ll talk about the way you can get syphilis or chlamydia or gonorrhea, which can be transmitted through oral sex, anal sex, etc, even while you’re on PrEP.

MP: A lot of us, when we go to get tested, have been counseled on the fact that unprotected oral sex is a safer sex option compared to unprotected anal sex, and that’s mainly because of the risk of HIV. Of course there’s still a risk for transmission of other sexually-transmitted infections. So If somebody is on PrEP, is there still a difference between unprotected anal sex and unprotected oral sex or are they about the same level of risk now?

CE: Anal sex is always going to the riskiest sex, especially if you are the receptive partner or the bottom. You could look at the scale of possible risks for HIV and I’d say that oral sex is at the very bottom, but I don’t think any public health official has said there is no risk for HIV from oral sex—it’s just at the very bottom risk.

 

MP: Right, but when it comes to other STIs—syphilis, gonorrhea, chlamydia—is there a difference between unprotected oral sex and unprotected anal sex? Most of the population that PrEP pertains to was already at risk for other STIs because, whether or not it’s ill-advised, very few people use condoms for oral sex.

And here’s why I mention that. One concern I see brought up again and again in the community is this idea that PrEP is driving a spike in sexually-transmitted infections because people are getting on PrEP and no longer using condoms. But one thing I’m not sure about is whether the increase in STIs is in the same population as PrEP users, and if unprotected anal sex would make all that much difference when most were already at risk for those infections through oral sex.
CE:
 I don’t know because there hasn’t been studies done. I don’t think anyone has explained the recent increase in STI rates and I don’t think anyone has linked it to PrEP. That would be a great study to be done, but at this point, nobody knows that to be the case.

 

For more information about PrEP or first steps if you are interested in getting on PrEP, email prep@cascadeaids.org. Find Dr. Christopher Evans’ info at OHSU here.

CAP Honors National Black HIV/AIDS Awareness Day (NBHAAD)

February 27, 2016, Cascade AIDS Project (CAP) is honoring National Black HIV/AIDS Awareness Day (NBHAAD), a community mobilization initiative designed to encourage Blacks in our community to get educated, get tested, get involved, and get treated.

2016 marks the 16th year for National Black HIV/AIDS Awareness Day (NBHAAD), a national HIV testing and treatment community mobilization initiative targeted at Blacks in the United States and the Diaspora.  NBHAAD was founded in 1999 as a national response to the growing HIV and AIDS epidemic in African American communities.

This year’s 1st Annual National Black HIV/AIDS Awareness Day (NBHAAD) celebration will be held at Charles Jordan Community Center located at 9009 N Foss Ave, Portland, OR. Come celebrate with us as we offer fun for the entire family, food (while supplies last), and music. CAP will also offer incentives for those willing to take part in the free rapid HIV testing (with results in 20 minutes).

For more information check out the Facebook event.

CAP Art Auction Returns May 7 with Pop Art Theme

Tickets are now on sale at www.CAPArtAuction.org for Portland’s premier art event benefiting Cascade AIDS Project. This year’s theme is Pop Art, so pick out an outfit that’d make Andy Warhol proud!

CAP’s Annual Art Auction is one of the agency’s major annual fundraisers, raising over $600,000 to support and empower people living with or affected by HIV and to prevent new infections. The After Party ($50/person) includes a salon-style silent auction of over 150 pieces of art along with sweets and savories provided by some of Portland’s best food purveyors. The Patron Dinner ($300/person) includes attendance at the After Party, plus a gourmet meal and a live auction featuring a number of the most outstanding pieces donated by prominent area artists and collectors. 

Cascade AIDS Project Awarded $25,000 From Yahoo!

PORTLAND, OR (November 18, 2015) – For the second year in a row, Cascade AIDS Project (CAP) has been awarded significant support from the Yahoo Employee Foundation. This year’s grant $25,000 supports two important programs, Positive Force Northwest and Camp KC, which aim to help families living with HIV replace isolation with self-efficacy, confidence, and promote wellbeing through community building.

Positive Force Northwest is a quarterly gathering of individuals living with HIV with three areas of focus: community service, advocacy and outreach and educational opportunities. When members of Positive Force gather for community service or to advocate publicly, they wear red tee shirts identifying them as HIV positive. Thus, simply by appearing in public, they encourage other people to see them as normal, valuable, nonthreatening individuals rather than as a disease.

Camp KC gives up to 50 HIV-affected and -infected children from across Oregon the opportunity to enjoy a week camping on the Oregon coast. At Camp KC, children dealing with HIV themselves or in their family can feel “normal” knowing that every other child at camp understands their situation. Camp KC differs from other camps in a few ways. First, the camper-to-staff ratio is about two to one rather than the eight-to-one ratio in an average camp. This ensures that each camper is showered with attention and acceptance. Also, Camp is free for the campers, which is the only way most are able to attend.

“We are extremely gratified that the Yahoo Employee Foundation continues to support CAP in such a significant way” said Tyler TerMeer, CAP’s Executive Director. “Both of the programs work with some of the most vulnerable members of our community and help them achieve empowerment and self-sufficiency through community building.”

About Cascade AIDS Project

Cascade AIDS Project is the oldest and largest AIDS Service Organization in Oregon and Southwest Washington. CAP’s mission is to prevent HIV infections, support and empower people living with or affected by HIV, and eliminate HIV-related stigma and health disparities. www.cascadeaids.org

HIV and the African-American Community by Anthony Rivers, African American Peer Support Specialist

Anthony

If we are going to change the stigma of HIV, we have to stop living it. The African-American community has a history of avoiding or delaying healthcare for various reasons. Some of the concerns go back to the Tuskegee experiments in which hundreds of black men, for 40 years, were intentionally infected with Syphilis to allow the government to study the natural progression of the disease while untreated. Other habits are instilled in black youth inadvertently by our parents who only take us to the doctor in emergency situations. We are conditioned to wait and see due to fears and in many times our socioeconomic status. I fear the same mentality we developed to save us is now killing us.

When dealing with HIV, cancer, and other potentially lethal illnesses, early detection is imperative. Infection rates among the black communities are steadily on the rise because we are becoming infected and infecting others due to our barriers to the health care system. These barriers are part of a stigma in the community that dictates how we obtain health care and what information we share with our health care providers. Our doctors can’t help if we are not forthcoming with our real lives; however, we can’t be forthcoming with our real lives until we have the faith in our doctors that we can speak without judgment and/or shame.

As the greatest affected community, we have the power to begin to eradicate this disease, but it comes at a price. We must be willing to not only engage in preventative health care services but also show our younger generation how to properly access and use medical treatment. We must begin to evolve mentally and understand the dealings of the past are no longer ethically or legally tolerable. We need to educate ourselves on prevention as well as maintenance if we become infected with HIV. By getting tested, using protection, and educating ourselves and our neighbors, we can take a greater responsibility and begin to heal our communities one at a time. We no longer have to die of AIDS when we now have the tools to live productive lives with HIV.