Community Voices

DC Health HAHSTA Staff

In April 2020, after six months of community engagement with focus populations, the DC Health Ending the Epidemic plan work group engaged 100 staff members from the HIV/AIDS, Hepatitis, STD and TB Administration (HAHSTA) during an online monthly staff meeting. Attendees discussed their thoughts on priority populations and strategies that should be considered to develop the Ending the Epidemic plan and community engagement activities. HAHSTA staff members represent many populations (in terms of education, gender, income, lived experiences, race and ethnicity, and sexual orientation) in the DC region.

Part 1: Interactive Large-Group Session

Facilitators used Kahoot! (an interactive response platform), to question staff members. The following questions, with real-time visual results, were asked:

  • What is a population that you feel needs more focus in future HIV-prevention planning?
  • What is a population that you feel needs more focus in future HIV care and treatment planning? 
  • What do you think HAHSTA does well with preventing HIV?
  • What do you think HAHSTA does well with treating HIV? 
  • What prevention area needs improvement?
  • What care and treatment area needs improvement?
  • How would you describe your role in supporting the prevention of HIV and sexually transmitted diseases? What’s your role in supporting the treatment of STDs, and people living with HIV?

Staff members identified the following four as their top concerns (a combination of priority populations and strategies):

  • Youths
  • Older adults
  • Pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP)
  • Mental health services

Part 2: Breakout Sessions

In May 2020, DC Health staff conducted four virtual breakout sessions, one breakout session for each top concern, with 32 HAHSTA staff members, eight per breakout session. Using the whole-person health framework, facilitators asked HAHSTA staff to identify the concerns, strengths, and solutions of specific populations or strategies.

Youths

Concerns

  • Inability to access safe spaces.
  • Increased worrying about their futures (regarding school, summer jobs, and independence that would have come with leaving for college).
  • Inability to navigate healthcare systems and telehealth (not all youths can safely and privately access telehealth).
  • Experiencing homelessness.
  • Increased feelings of being disconnected and stressed due to the loss of social interactions (such as relationships and friendships).
  • Social justice issues.
  • Increased worrying about the impact that social distancing has on their independence, mental health, relationships with their parents, and substance misuse.

Strengths

  • Resilient and determined
  • Fearless and ready to move forward
  • Creative
  • Adaptable
  • Resourceful and connected

Solutions

What can DC Health do to support youths?

  • Get providers to use technology to reach tech-savvy youths with health and wellness messaging.
  • Develop innovative approaches to programming and make sure health information exists in all spaces (without always having it be the center of the discussion).
  • Develop tools that help youths manage their emotional, mental, and physical health. The COVID-19 pandemic presents such an opportunity.

Older Adults

Concerns

  • Older adult invisibility.
  • Survivor’s guilt for older adults living with HIV and/or have experienced trauma from having friends with HIV who have died.
  • Well-intentioned outsiders trying to bring interventions or technologies to older adults without tailoring them to older adults’ needs.
  • Changes in social supports and outlets as people age.

Strengths

  • Still want to be useful in the community.
  • Have a lot of knowledge to share.
  • Some are great advocates for themselves and others.
  • Are resilient.

Solutions

What can DC Health do to support older adults?

  • Better prepare people for what will happen to their health, both mentally and physically, as they get older and what resources they may need as they age. Show them how and where to access these resources.
  • Know that public health is about keeping an eye on and checking in with patients.

PrEP and PEP

Concerns

  • There is a need for more promotion and education of pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) for heterosexual people.
  • There is a need for more promotion of and education about PEP, not just with consumers but also with community-based organizations and emergency rooms that refer consumers to the DC Health and Wellness Center.
  • Staff would like to be updated on scientific advances and new medications related to PrEP.
  • There is a need for more cross-collaboration among staff members. For example, staff members are not aware of the full scale of PrEP and PEP care services provided by the DC Health and Wellness Center.
  • There is a need to counter negative perceptions about PrEP due to negative advertisements about Truvada for PrEP.
  • Communities that could benefit from PrEP are not accessing it.
  • There is a need for more attention to marketing PrEP and PEP campaigns in communities that need access to PrEP and PEP.

Strengths

  • DC Health has developed a PrEP Drug Assistance Program to assist individuals financially with accessing PrEP.
  • The DC Health and Wellness Center offers PrEP, and individuals can receive navigation and counseling services too.
  • PrEP provides an additional HIV-prevention method for individuals who do not want to use condoms. However, PrEP does not protect a person from other STDs or pregnancy.
  • Medication used for PrEP has been around for a long time, so DC Health has a lot of data on and knowledge about how well the medication performs and its side effects.
  • DC Health provides prevention funding to support PrEP and PEP in the community.

Solutions

What can DC Health do to support PrEP and PEP efforts?

  • Develop more PrEP campaigns that focus on Black heterosexual men.
  • Create brochures, flyers, and social media content promoting PrEP and PEP.

Mental Health Services

Concerns

  • Mental health screening is happening, but there are not enough services. Agencies don’t have enough capacity to meet the needs of the population.
  • There is a lack of cultural awareness and competence among providers.
  • There is fragmentation in the mental health system, which makes it hard to navigate.
  • Stigma still surrounds the use of mental health services. There is a need to normalize mental health services.

Strengths

  • Interns are trained at the DC Health and Wellness Center.
  • DC Health knows that mental health is important.
  • Instead of referring patients to other facilities, the DC Health and Wellness Center offers mental health services.

Solutions

What can DC Health do to support the uptake of mental health services?

  • Provide more funding for mental health services.
  • Find ways to facilitate easier access to mental health services.
  • Build more wraparound services and “one-stop shops” for mental health services.
  • Normalize mental health services in Black and Latino/a/x communities.
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