World AIDS Day—Happy Birthday to me, a proud CBA Provider
I was born on December 1, 1967– the Summer of Love. My mother needed a blood transfusion since there was bleeding when my twin and I were delivered. The blood was contaminated with hepatitis B and she passed away three months later. My father was left to raise six children, all
under the age of six.
At 21, I moved to San Francisco. It was the late 80s, and as a gay man, I became part of a community that was being wiped out. I fell in love with Rod, who would be dead two years later. I started volunteering with the Shanti Project, helping folks die with dignity. They had either been abandoned by their families or lost their social network to AIDS, or both. During that horrible time we would often joke that we were practically middle aged, since so many of us were dying before reaching the age of 40. It all felt out of control, yet somehow in control as these personal and professional experiences were defined by these life event.
It’s funny how growing up in chaos, and being part of a community faced with massive loss and change, made for a solid foundation to do capacity building assistance (CBA) work. Often folks will reach out to us wanting to change the way they “do business”, wanting to grow, wanting to improve the health of their communities. Sometimes our colleagues’ requests involve strategizing how to improve their existing programs, how to introduce new strategies such as PrEP and RAPID, how to update HIV testing training to include PrEP, how to incorporate new testing technology, or how to figure out how to use social media to reach clients, to name just a few of the areas that I’ve had a chance to explore.
Over time, I’ve come to realize that incorporating TA often requires a change process, one that typically follows these steps: 1) Introducing the new ideas 2) Understanding the degree of disruption, 3) Processing the change, 4) then integrating the new practice. In HIV prevention and care, and in healthcare more broadly, you have to stay current, and be able to change, grow and improve. If you don’t, clients suffer because they don’t benefit from the latest science. But change is hard. It comes with uncertainly, chaos, and often a feeling of loss for how things used to be. Much of our CBA work involves us providing that extra support to make the process a bit easier to navigate.
We here in San Francisco are currently going through this change process as we consider new evidence about PrEP on Demand, or what many are calling 2,1,1 (two pills of TDF/FTC before sex, one the day after, and one two days after that). CDC still recommends daily PrEP dosing to prevent HIV, however, I’m amazed how quickly our community is adopting the evidence about 2,1,1. In terms of our collective “stages of change” described above, we currently find ourselves between steps 2 and 3. There is some debate about how the new science about the efficacy and use of on demand PrEP should be considered and messaged. We need time to wrap our heads around how it will impact us. We certainly went through this process when daily PrEP was new.
I’ll turned 50 on December 1st. My childhood and early adulthood in the eye of the storm of the AIDS epidemic both offered life lessons that shape every day for me. It is these lessons that I’m able to apply to my work as a CBA provider. I get such joy drawing from these experiences and my professional work at the health department to support others in introducing changes to their programs that can make a real difference in the health of their communities. Many of us have confronted HIV/AIDS in the 80s and 90s. It’s important that we remember those difficult times, and draw inspiration from all the advances over the past several years to ensure HIV prevention continues to be priority. On World AIDS Day I get to celebrate my birthday. I also acknowledge the progress we’ve made and think about all the work we have yet to do together, to get us to zero.