Chapters Transcript Video The Impact of Stigma and Bias on HIV Care The Impact of Stigma and Bias on HIV Care Tuesday, April 6 12:30 PM - 2:30 PM EDT Yeah. Hello and welcome. I am Christopher Chance Watson, associate director of HIV Marketing at Gilead Sciences and on behalf of our employees worldwide, we would like to welcome you to our second blueprints for success Training Institute for 2021. Today's program will look at the importance of addressing stigma and implicit bias within the HIV care setting. And we will also offer ways to counteract them within our health care environment as well as beyond brief agenda for today's program is that we will have to 20 minute presentations and 1 45 minute workshop led by our amazing community liaison. Our first presentation will be given by the Doctor Michele and drastic and is entitled the impact of implicit bias and stigma on HIV care. Our second presentation will be given by none other than the reverend dr, Tommy Watkins Jr and it's entitled tackling stigma within our community. Each presentation will have some polling questions. So we're looking forward to your participation in this as well. Our two presentations will be followed by workshop on best practices as well as strategies that you can take home to address and mitigate implicit bias as well as stigma. After that workshop, you'll join our expert panelists along with our moderator to have a Q and a session. Well, you have a chance to ask your questions on today's content from the program. Please double click below to ask any questions and submit your questions throughout the program. At the end of the program, you will receive a toolkit that is designed to be a resource for you to go back to your agencies to continue this important work. As a reminder. This is the Second Institute in a four part series. We will hope that you have joined us for some of the previous training institutes and look forward to you joining us for additional institutes that are upcoming. Now, without further ado, I'm excited to introduce our moderator for today. Dr David Malebranche, who's an internal medicine position and HIV specialist in Atlanta Georgia. He has specific training and expertise not only in men's health and correctional health, but also student health, racial inequities within medicine and LGBT Health as well as both prevention and treatment of HIV and sexually transmitted infections. As you can tell, Dr Michelle branch is not only dynamic, but he's passionate about our community engagement and outreach efforts and appears on a number of video series, including Hashtag Ask the HIV dot, which promotes education and empowerment on HIV prevention as well as treatment and revolutionary health, a weekly Youtube Live Health web series that is a part of the counter narrative project, which is an advocacy organization for black same gender loving mitt. Without further ado, the dynamic Dr David Male branch, Hey, thank you chauncey. Um and I want to welcome everybody back to the second edition of the Training Institute. It's it's good to have everybody back with us. I'll just move forward quickly so we can kind of get through this in a timely fashion. Our first presentation today will be given by dr Michelle and drastic and dr Andras sick is the director of social and behavioral sciences and community engagement in the HIV vaccine trials network and Covid 19 prevention Network. She is also senior staff. Senior staff scientists say that 12 times fast in the vaccine and infectious disease division at Fred Hutchinson. And in addition she's a clinical associate professor in the Department of Global Health at the University of Washington in Seattle. So I'd like to turn it over to doctor and drastic for a presentation the impact of implicit bias and stigma on HIV care. Take it away. Thank you so much. Doctor Mall Branch. I want to thank the organizers further efforts in developing this critical institute and for including me in this incredible work. I look forward to engaging with all the participants later in the program. Just to provide a brief overview during the presentation, I plan to examine the many levels at which stigma and implicit bias exist in both health care and the broader society. We will explore the multiple ways in which stigma and bias create barriers in our efforts to end the HIV epidemic and look at how we need to effectively address bias and stigma if we are ever going to make a dent and the existing racial ethnic, socio economic and other inequalities that are pervasive and persistent in our society. So before we get started, I think it's important to understand that many factors that are associated with stigma, implicit bias is one of the many cognitive processes that facilitate bias. We are immersed in cultures that provide ongoing and consistent depictions of devalued persons in stereotyped in negative ways. And even though we may work to actively reject these negative ideas and images about devalued identities, um, you know, we hold these attitudes and stereotypes unconsciously and they affect our understanding our actions and our decisions. So it's really important to note that these implicit biases do not require our attention for expression. There automatically triggered explicit bias. Um, are the biases of the attitudes stereotypes of groups that we're consciously aware of and that we actively endorse microaggressions are the chronic and commonplace, daily verbal, behavioral or environmental indignities and injustices that can be intentional or unintentional, and it doesn't matter if they're intentional or not. The data show that they have the same impact. They communicate hostile, derogatory, demeaning, invalidating or negative slights and insults toward people with devalued identities, stereotypes are sort of the oversimplification of the stories that we are inundated with based on these health widely held beliefs and they're really what we tell ourselves about groups of individuals. Uh, and then prejudice is the outward expression of these attitudes. You know, whether it's our behaviors or our emotions towards different individuals. So I'd like to go to our first poll question, to what extent have you observed some of these things stigma bias prejudice in your organization? You can take some time to complete that pole and we can move to the next slide. So much of what we know about implicit biases, based in research done on racial bias. Our biases developed early in life from repeated, reinforced social stereotypes, and what we know to be true is that implicit pro white bias can be seen in Children as young as three years old throughout the world, implicit bias occurs again without our conscious awareness and as often in conflict particularly for individuals who see themselves as liberal and progressive with our personal beliefs. And what we found is that as people age, what a person explicitly believes about race. So there are conscious awareness of race becomes more egalitarian, but implicit bias remains and is enduring and often unchanged without action. And so we really need to take action to address our implicit biases. So let's go to our poll results. Do we have those yet? Okay, all right. So next slide please. So it's really important that we understand that human beings are biased, it doesn't make us bad people, it makes us human. We grow up in an incredibly racialised heteronormative and gender binary society and we receive constant messages about what is good and right and acceptable, as well as what is bad and wrong and unacceptable. We find ourselves in situations and circumstances where these messages may be automatically triggered and influence our behavior without our awareness and our privilege. That is our societal, economic and political benefits often result in experiences of fewer barriers and access to greater resources. And this privilege can result in blind spots where we don't recognize the vulnerabilities of other. This is particularly true if our lived experience is largely from a socially dominant and privileged space. So these blind spots are often exacerbated by negative messages we have received about certain identities and we store them unconsciously. And again, this results in implicit bias and research has shown that approximately 70% of americans exhibit a pro white anti black bias, resulting in pervasive inequities in health care, housing, education, criminal justice and other systems. And if we go to the next slide, what we know to be true, is there a strong evidence indicating that health care professionals, physicians, nurses, all exhibit the same level of implicit bias as the wider society? And research suggests that implicit bias contributes to health care disparities by shaping physician behavior, producing differential medical treatment based on characteristics like race, ethnicity, gender identity and sexual orientation. It's critical that we note that implicit biases in health care most often negatively impact patients who are already vulnerable. So those individuals who are marginalized as a result of their devalued identities, you can see several examples of the data we have on the issues here on this slide. I think it's important to note that there have been three systematic reviews of the literature on implicit racial bias among health care providers, One in 2013, 1 in 2015 and one in 2017. And all of these studies looked at patient adherence, patient provider communication, physiological and mental health outcomes and provide a decision making. And each one of these reviews consistently found that implicit racial and ethnic bias among providers is um not only present, but it is significantly associated with health outcomes. And I think it's important to note that again, much of the literature faces on focuses on racial bias. I'm sure if these same systematic reviews were done on gender and sexual minority individuals, we'd find the same thing. So let's go to our next polling question. Did we ever get the results back from that first polling question? Oh, they are in the chat. Okay. Uh, so from that first polling question that we did, uh, it looks like 38 said that um they had witnessed stigma prejudice and bias to a large extent, 34 to a little extent and 15 neutral. So that is about 70 of individuals, which is in line with much of the data that we have seen with regard to the presence of um stigma bias and prejudice. So let's go to the next polling question. So which implicit bias? Have you observed most in health care settings? Gender identity bias, racial ethnicity bias, sexual orientation. Or have you observed them all equally? And we'll look at the polling results after the next slide. So if we can go to the next slide, so this five shows that there are two pathways that implicit bias uh takes to negatively impact health outcomes for people living with HIV and I think what is important is that regardless of the path, these implicit biases take the path where provider bias impacts judgments and decisions about patient care, or the path where provider bias impacts the patient provider relationship and communication eroding trust and increasing engagement. The result is the same continued and persistent health inequities in our systems. So if we go to the next side, we can see that the impact of bias in HIV has resulted in disproportionate rates of HIV diagnoses and disproportionate rates of people living with HIV in african, american communities, Latinas, communities, transgender communities and um same gender loving men communities as well as heterosexual cis gender, women of color, all groups with devalued identities. Many of those groups, as you can see, have intersecting devalued identities, which makes the impact even greater. If we move to the next slide, we can see that in HIV prevention and treatment, we often reference what you see here this HIV status neutral care continuum. This continuum provides um what many consider a comprehensive view of people living with HIV as well as those who experience circumstances and contexts that place them at greater risk. And what we know to be true is that trauma violence stigma, victimization, racism, transphobia and marginalization as well as the myriad other social and structural factors that individuals with valued identities face in their day to day lives create barriers at every step along this continuum. And before we move to the next slide, I just want to take a look at the poll results. Um 15% of you said that you have witnessed um gender identity bias, 32% said racial and ethnic identity bias, and 42% said that they have observed them all equally And that 42 is representative of what we know to be true, is that many of these stigmas are experienced equally in different settings. And so again, individuals who have multiple devalued identities are receiving these um messages, these behaviors in uh you know multiple situations and across multiple circumstances. So if we go to slide 11, I also I think it's really important to note that there are certain identities that are more devalued than others and as a result, experience more negative biases and stigma. These include women, people with fewer resources, racial and ethnic minorities and sexual and gender minorities as we you know discussed and I'm sure all of you are aware of. And the next slide shows that among individuals who experience greater stigma, we know its impact is great on one's ability to reduce their risk, disclose HIV status and attend HIV care visits. So greater experience of stigma can increase things like emergency room visits, decrease your ability to take your medications regularly, decrease your ability to discuss your HIV status or your HIV risk with others, which are critical in terms of ensuring um safe uh practices and ensuring good health outcomes. So the next slide please. So what we know to be true is that longstanding biases, biases in the US have resulted for many communities in the reality of legacies of violence, abuse, victimization and trauma. And this is particularly true for racial, sexual and gender minorities. When HIV was first identified in the early 80s, these already existing biases laid the foundation for HIV Stigma. HIV stigma is rooted in the fears and myths that arose early in the epidemic and continue to persist today. Not only was HIV inextricably linked to devalued identities, it was associated with behaviors that have been judged as unacceptable and this was exacerbated by the fear of death and its associations with sex and as such. What we have seen is a continued discourse wherein HIV was not situated as an infectious disease but a sign of moral failing and weakness, most often for individuals again who already had devalued identities. And if we look at the next slide, this slide notes that there are several levels where stigma exists, I think it's really critical to note that many individuals internalize the negative messages and views of themselves and this results in self stigma or internalized stigma. This can impact testing, status, disclosure, motivation to seek medical care and a myriad of other health outcomes. Other levels of stigma include community and family stigma. Healthcare stigma, which we have discussed already at length, can also include employment travel, legal government to sigma really can impact individuals in every context across their day to day life. And then the next slide we see that there are ways in which stigma can devalue and traumatize people living with HIV, you know, discrimination of um overt discrimination uh you know, so you know actions and attitudes that um you know are obvious um can impact a person with HIV and that's often labeled as enacted stigma. So this is actually, you know, the stigma being played out in behavior and attitudes, et cetera. And then there's also anticipated stigma which is equally impactful on an individual. And this is where a person with HIV uh fears prejudice or discrimination because of their status and expects to be treated badly most likely because they've seen it happen before. So they are anticipating that stigma will happen. And again that is just as powerful in terms of how it impacts a person's behavior as as um enacted stigma. And the normative stigma is where stigma is seen as normal and acceptable so often when stigma is enacted, uh people don't even recognize it because it has become so normalized in our speech in our behaviors and the way we view things. And then I talked about internalized stigma in the previous slide and this is incredibly powerful especially in terms of someone's self esteem and there's um self concept. Um if we go to the next um poll question, I think it's time for our next poll question. How frequently have your clients shared experiencing any kind of stigma due to their HIV status? So let's take a closer look on the next slide. And I think it's important to note that there is a cyclical relationship between stigma and HIV. So marginalized people experience more stigma and discrimination which increases their vulnerability and places them in situations and circumstances that expose them to HIV. And then because an H. I. V. Zero status is a devalued identity. People living with HIV are by default more vulnerable to stigma and discrimination. And again this reality. The cyclical relationship places individuals in day to day situations and circumstances that result in lower A. R. T. Adherence, denial of health services, loss of income along with a myriad of other social and economic and health inequities that impact them uh throughout their life. And if we go to slide seven, I just want to you know, note hopefully it's clear and I know that this is a very quick presentation but hopefully it's clear that individuals with devalued identities experienced stigma which further marginalizes them. And then for HIV individuals it's really important to note that this could result an emotional and mental health challenges like lower self esteem, internalized racism, homophobia, transphobia and um reliance on ineffective coping strategies such as substance use, sexual sensation seeking other risk behaviors which place individuals at higher risk of HIV. And then for people living with HIV experiences of poverty, compromise, social and emotional well being limited access to quality health services, harassment, violence, discrimination and abuse can compromise uptake in maintenance of care, treatment, adherence resulting in illness and early death. So, let's take a look before we go to our next slide at the polling results. Uh, 47 of you stated that your clients have shared experiencing stigma due to their HIV status. So, almost half of you say that this happens frequently. And then another Quarter of U 22 say very frequently and then 23 say occasionally. So obviously, you know, here we are, many decades after HIV um first entered into our consciousness and we are now in a in a reality where HIV is a chronic disease and people living with HIV still continue to experience high levels of stigma and stigmatizing behaviors. So if we go to the next slide, you know, hopefully this is really underscored for you that all members of your organization and institution must be engaged in addressing stigma from the front desk, the volunteers, medical providers and any other personnel, health care providers and other service providers. We really need to explore our biases, how these biases might impact our beliefs as well as how they impact patient provider relationships. You know, interventions often use um imagery as well as online resource materials that you can find. And again, this is really an introduction. The you know, the first step uh and for some of you may be several steps along the way to uh to make sure that we are doing what we can to effectively address our biases because they are there and we need to be not only be aware of them, but identify strategies to help them prevent um negative impacts for our patients and for our um for anyone that we provide services to. And finally, I'll end with this next slide, which is a summary of what we've just discussed again. I think it's important to underscore that we must all do the work to effectively eradicate structural racism and other ISMs and phobias. We have to address our own biases through self reflection. And this process is not like you're gonna get it and you're like, okay, check the box, I'm done. It's an ongoing and iterative process. It's also important to ensure that we are creating safe and welcoming spaces and working to debunk the myth of devalued identities by celebrating minority identities, investing in communities and ensuring that our actions are building capacity and not one of the myriad behaviors that have effectively blocked growth. So seeking seeking equity requires that we all address social inequities and work to dismantle systems that sustain these current health inequities. So thank you all. I know this was very brief overview. Uh, thank you again for inviting me. Thanks doctor and drastic. Um, I think it's really interesting when you talk about the pathways, there are several other pathways that we see as well with regards to this bias. And then also on top of that, when patients don't engage in care, the bias rears its head again when we actually how we interpret someone not engaging in care. So I think it's important for people to acknowledge their bias upfront to how that affects their direct patient care, but then also how we interpret patients may not be engaged in care, and instead of looking at ourselves, we tend to blame the victims in this situation so well done. And I look forward to the conversation that we're all going to have in a little while. So our next presentation is going to be given by the reverend, Dr Tommy Watkins, Jr who is the adjunct professor at the University of Alabama, Birmingham School of Social Work, and he's also director at the ST Andrew's Episcopal Episcopal Church in Birmingham. And Dr Watkins is going to be talking about tackling stigma in the community, which is a nice transition over what doctor and drastic has just been speaking about. So, dr Watkins take it away now, can you hear me? Thank you, Good afternoon. Um I appreciate thank you uh for Gilead for the invitation and um Dr Michelle for your wonderful presentation and for the great introduction. Um Dr David. Um It's a uh this presentation will focus on then tackling uh stigma in the community. And as dr Michelle laid out the myriad of ways internalized self stigma, the communal aspects. What could reducing then the impact of stigma? Mean for our community, we believe this presentation will look at how it could achieve greater willingness to be tested, more disclosure, more inclined uh individuals to be tested and treated and remain in care, removing the stigma and bias and of their own self worthiness for treatment, motivation to start antiretroviral, antiretroviral therapy and then Mosul more social support from the individual community and also social and faith based organizations which improve the quality of life. Um What then are next slide shows that there's many impacts that stigma may have on people living with HIV uh that internalized anticipated stigma. Many individuals have a negative outlook and expectations of how communities will react and interact with them because of the multi layers based their race, gender, ethnicity, sexuality and how those labels then um intersect and devalue and in many times devoid an individual of uh care and their worthiness of theirselves to enter care. So people live with HIV uh anticipate greater stigma and they're more likely to engage in the negative strategies. And we see that in kind of the maybe drug use and uh other addictions, gambling, sex, uh online social support, negative social support. And then uh the less likelihood of disclosing their HIV status when we look there next at the how stigma may impact the people. We see that community stigma, There's also health provided stigma. Dr Michelle talked about that, which goes into self esteem, are negative family interactions are unworthiness or the bias that somehow the victim blaming. Dr David mentioned. It's our fault that we're living or have the identities. People might say we choose uh to disclose. So we deserve what happens to us. We choose to disclose our sexual orientation and that can generate degenerative of internalized homophobia. And that then a few negative impacts is a sexual sensation seeking and then the negative sexual behavior increased, uh, maybe sex partners, uh, not using protection, etcetera, or using, um, or having sex when uh, inebriated or inhibited. So we moved to our next slide to look at than the impact of HIV stigma on the family. Uh, then this is our first then um, polling question uh, this the quote says that my family were embarrassed and didn't want to talk to me. My mother essentially said, good luck you're on your own. And we see an increased rising homelessness of HIV positive using young adults of color especially, and how that impacts of the negative impact of stigma. Some people see faith based organizations as their uh, family. And so stigma impacts the family, family's identity. I don't want people to know you should keep your business out of the street, um, and be silent about it. And so, uh, to what extent then our first polling question, To what extent have you observed stigma, bias and prejudice? Uh, then in your own organization. And as we move to the next slide will give you a chance to uh, answer that we know that people reducing stigma and HIV means addressing those myriad of layers. Um, and I think also it is important to note, stigma often involves shame and they kind of live together. I would say they're married if you will. And that stigma and shame against racial and ethnic minorities or because of my sexual orientation, um maybe my trans identity, we see a lot more uh in the media and things about that uh uh of addressing that with people and then stigma against women, people with low income and people against sex workers. We also see stigma against people who use drugs or maybe addicted and then if we move to our next slide. Uh, so HIV stigma also exists within the L G B T Q positive communities. Uh, these beliefs can be increasing the risk of transmission and also that HIV negative men, people who may we use that term sero discordant. Maybe I date someone who is not the same HIV status as I have. And so there tends to be this internalized clients is and then maybe I'm better than someone who's HIV positive and negative, even though the risk behaviors may be the same. So we have this negative attitude or stigmatizing within the LGBTQ plus community and that invokes the violence, ageism, social exclusion, maybe even rejection discrimination based on health status. And then we see a lot with body image issues the way that I look hitting the gym are trying to fix myself up so that I can overcome that stigma and shame within the community. So if we look at our next slide to see how do then we reduce that stigma to improve the disparities in HIV care. We know that stigma is linked to the sub optimal treatment adherence and miss healthcare visits. I'm not worthy of care. Sometimes I see hospitals and taking medication and sick care versus wellness. Um, we tend to have a healthcare system that doesn't really talk about health and we look uh some people to some people, it talks more about me being sick so I can skip an appointment or I may not go because I'm looking at disclosure and how that impacts of my um health care or HIV status and also my health care. So if we go to the next slide to look at um the need, then this is the first polling question um, uh, mistakenly spoke earlier. But the need for the multi pronged approach to reduce HIV stigma when we look at engaging the community uh, in which of the following approaches to stigma. Is your organization the strongest? Is it engaged in the community helping individuals uh institution recognized the stigma expanding and retroviral therapy, addressing social stigma and the environment responding to the needs then of stigma stigmatized populations use a media uh, that shows HIV has a human face or your organization the strongest and involving people living with HIV in it. So we'll move to the next slide and then look at the results. We see that community wide interventions are shown to be more effective. You gotta, if you're going to impact and address a problem, you've got to look at it on those multi different layers. So do we um, we think challenging negative messaging, seeing positive relationships, uh, to rebuke and rebuffed the idea of loneliness and isolation or that if I'm the only one living this way, I'm the only one thinking this way. Uh, so we provide opportunities in a community wide therapy and counseling, support groups, Um, and then looking at increasing assets to accurate information. We know that sometimes, um, the negative uh, information or inaccurate information about how even in 2021, how uh, taking medication, how engaging with other people living with the virus can impact us. And so people end up with negative information or inaccurate information and we pass it on through maybe Tiktok or are mixed message media. So we have to use then um mixed message uh and methods with media, you know, facebook and tick tock and all of that to look at then how do we put a accurate view and look on uh people living with HIV and also their gender identity, racial and ethnic identities? Uh and they expose people to different messages that are anti uh stigma and anti shame that looks at the individual is holistic and as a individual and a human individual, not just an object or that person, you know, living with HIV rather than an HIV positive or the stigmatization of, I'm just this thing and so offering other information on HIV stigma is biased. So if we move to the next slide, um forming alliances then to combat stigma, when we look to um public health departments, community based organizations, private companies looking at uh engaging them in community wide events as well, and it can empower them, people and groups most affected to disclose your HIV effect uh status to get treatment and care for it and make efforts to normalize uh living with HIV as uh and debunk and d myth against those myths of the common perceptions of people living with HIV that. Um And you know, I still talk to people who think that you can look at someone that shows that they're HIV positive or look at someone and still see their if they're gay or straight or their sexual orientation. And so I think um the stigma then will emphasize anti stigma campaigns, will emphasize that people living with HIV are in all parts of the community and in all aspects. And so, um As we move to the next slide, the results of that poll shows that 38 of you responded that your organization is stronger than engaging in the community and 20 of you buy one in five said expanding antiretroviral therapy access and use is your strongest organizations strongest point. And another 20 said yours as organizations responding to the needs of stigmatized populations. So then if we look and then the many components of community and identity, we see it more as a flower that can be open and you look at than the idea of uh it reminds me of uh of living, you know, kind of an egg. You know if an egg is uh rebuked of the stigma on the outside can crush the egg and it gives death. But if the egg is opened up from the inside it means life and nurturing. And I think the flower represents that same idea and open flower then can be the community uh and aspects of different family in school and you know often we see faith based organizations as something negative and it can be then um something very positive and something that we live with and and turn that around. So we look at in our next slide uh families can help to come back to stigma and and and right here when I say, it doesn't always mean our biological families. There's often individuals that we adopt or we adopted by brothers from another mother or our sisters that come and take care of us or have mentored us. Uh and so family members blood and not blood can show strong resilience and strength and give its members strength and it helps a lot with identity and uh the myth and uh the stigmatizing shame. And we looked in at our next slide to show then how the other component um examples of community interventions, these are often um supported by then the government or health departments. One example is project change, which challenge HIV stigma to gain empowerment. This was done in new york, but it was looking at a quote here says by Nico that everyone to hear my story so they can better understand how harmful these moments of discrimination can be to those living with daily with HIV. Um And I think the the the point in the quote is that the misconceptions, you know this idea that um I don't know anybody living with HIV, I don't know anybody who has experienced discrimination, this is wrong. And if I knew about it I would tackle it. And we find that cut the stigma shows by the like a C institute and lambda legal to that. We often do know people living with HIV. We just don't know that we know. And so cut the stigma looked at uh it was a campaign to show people living with HIV um and how that impacts that individual putting a face to it. So we look at then our next slide to show how community level stigma reduction strategies for youth uh youth and their young adults are people who act like youth or young adults. And we partner with youth based communities uh to link youth to testing and other services. We know that identities are people that are tested and treated early on and achieve uh using antiretroviral antiretroviral therapy then can achieve a healthy and holistic life. And so if we look at the next line community level reduction schools and business, uh engage in detention facilities so that they're not punitive, but they also show and can help with testing strategies. And when individuals leave the detention centers, they are linked back into communities with schools and business and other community organizations. It is important and to incorporate all the training and cultural competency that those specific entities, uh, the Black Church or Hispanic Community Center or the Women's Center can work together. Then a multilayered approach to reduce that stigma uh people especially for youth and young adults. So we look at our next slide, um fostering contact and the inclusion of people living with HIV. And if we look next at how then involving youth and all the stages of HIV. Uh you know, sometimes we just want to do support groups and peer groups and then utilizing the digital media that we talked about in social marketing campaigns, where you've kind of resigned now and their life or online rather a lot of times rather than physical. Um so then we look at our next polling question as we move to the next slide, um how much do you agree with this following statement that my organization has addressed stigma for youth living with HIV, for example, through their families, through their community levels and social media. How much do you agree with the following statement that your organization has addressed stigma for youth living with HIV? And I think you did a question now. You just take a moment to write that down and then uh I mean select the option. So if we look um then uh we'll have the results in a moment. If we look at how showing the face of people living with HIV act against AIDS Leadership Initiative founded by the C. D. C. And then the Kaiser family, we know that de stigmatizing and uh eradicating shame has been shown that give voice these programs give voice to individuals living with HIV and encouraged communities to fight against the disease. So if we move to the next one faith based organizations, um as you can see being a minister, that uh many faith based organizations have been very instrumental early on the Black Church Week of Prayer for the healing of HIV and AIDS. Many faith based organizations, not just christians have looked out and are doing uh interventions at the family level. Council shows counseling social support, um shaping public opinion by showing up leadership and also human rights approaches being involved in the uh Blm movements or other movements that the stigmatize individuals and women and also ethnic minorities. So if we looked in at our next slide to look at uh some people use the biblical rationale as looking out for the marginalized and stigmatized. And there's an idea that creates tour uh it looks at creation and reaches out for those that are most vulnerable. And faith based organizations have begun to adopt that same model where it's non judgment but love that you can't love and judge people at the same time. So faith based organizations have played a key role in expanding those treatments programs and thus reducing stigma and showing people that they are loved and supported. And they also, many faith based organizations are looking at tackling um sexual violence, physical violence stigma, um and developing HIV prevention strategies that are culturally competent, culturally sensitive and really address than the needs of a of the individual communities that they serve. Um and so you all said in your poll, how much do you agree with the following statement that 33 of you disagree that your organization has addressed stigma? 29 of you agree, and 28 of you are neutral. So as we moved into the next slot, um, looking at our face face, uh this is one I talked about the Black Church and HIV AIDS um when it comes to churches, they uh the hispanic community, uh many faith based organizations that are looking at women and the role of women in religious and faith based organizations and Liberation Theology has been one of the main tenants uh for sermons and homilies and programs and outreach that really look at the most vulnerable and marginalized and stigmatized specifically around homelessness and looking at the intersection of addiction, homelessness, HIV status, race, poverty. That dr uh Michele talked about as well. So as we move forward and on the next slide to look at faith based organizations are really supported or they're really the ones that are ready to help address the root cause of HIV vulnerability, that they can be the uh epicenter if you will for uh HIV as a social justice issue that HIV uh impacts an individual marginalising and stigmatising and so it can be uh a reason to do that. So, if we are last polling question as we move forward, what then if you agree? Um to what extent has your organization partnered with Faith based organizations to help you address health inequalities and reduce stigma? I think you can see that question now. To what extent has your organization partnered with Faith based organizations to help address health inequities and reduce stigma? Your choices are there? And while I do the summary, we'll wait for the pole. But as we talked about stigma uh impacts negatively in many ways on people living with HIV, as we talked about, we talked about stigma being lamed with shame or married with shame and remember shame and stigma uh kind of evoke this idea of the definition I like to use is the intensely painful feeling. Burn. A brown talked about this, that an individual is unworthy of love and belonging. And so uh stigma then uh anti stigma campaign can then um help through the community based level faith based organization. Uh look at stigma and shame, how stigma is a complex phenomenon that requires a multilevel approach and look and not forget that people with HIV have that internalized oppression or is um against themselves. And so health organizations, the private sector of the businesses can all impact and work together to positively address stigma and eradicated in in our communities and lastly, but our families, uh biological or not, can play a critical role in helping uh combat stigma in that way. So, I think our chat uh let me see if the poll maybe up um our last fall. Mhm. Mhm. Mhm, mm hmm. So as we end, it says that 26 of you said very little extent, 44 of you said little extent 17 said the largest sent for your uh faith based organization. So we welcome your questions and I look forward to dialoguing with you and in a few and I will turn it back over to Dr David, Thank you Dr Watkins, um for that excellent presentation. I'm looking forward to getting to the discussion. Um I want to remind everyone just like dr Watkins said, please submit your questions for the Q And a session which is going to come after the breakouts. But even if you want to put your questions in now, while they're on your mind, after these two excellent presentations, that would be helpful and we'll tackle them and answer as many questions as we can in the Q and a session a little bit later. Now we're gonna move into the workshops so please click on the button on the lower part of your screen to join the workshop presentations. All right everybody, I hope everyone enjoyed the breakout sessions and had some stimulating discussion. Um We are now going to start our panel discussion uh this afternoon. I want to remind everyone we have about a half hour for the panel discussion. So we're bringing back both doctors and drastic as well as Dr Watkins um to have this discussion with us. And I just want to remind all of you, please submit some questions. Um we're gonna be answering these questions. I'm obviously going to start off with a question first of all and I think I'll pose it to both of our panelists separately and I want to start off with you doctor and drastic. I think when we listen to some of the stats that you gave and I believe one of those surveys talked about 70 of people can harbor some kind of implicit bias that is you know, more centered towards whiteness and and demonstrates anti black attitudes. And I think when when I first heard that statistic, I felt completely overwhelmed because it's almost like if you have 70% of the population that's harboring this bias, it almost seems like an insurmountable mountain that we're facing when it comes to health care as well as HIV and I think what was great about both your presentations is that you kind of contextualized the definitions. What's happening, gave us a lot of the statistics and the science that back up that this is a reality that, you know, causes problems with health outcomes and with health inequality. And then Dr Watkins talked a little bit about uh, stigmatized communities and what's happening in communities and what we can do about that. I think for anyone who's out there in the medical professional in general communities, it may seem overwhelming and people may be thinking, well, what can I do? Where do I start? I'm working in the Health care center, I'm working at a community based organization or in my communities. What do I have to do or how can I start? I can't just start a program up. I don't know how to get funding these things. What are some steps or some things you would recommend to our listeners out there who may be feeling a little bit overwhelmed or kind of like well I want to do the work, but where do I start? Um and so I throw that to you doctor and drastic first and then we'll go to Dr Watkins. Yeah, but I think a really good tool and it it truly is a tool to increase your awareness would be uh you know, to take an implicit associations test. You can take them for free there on the Harvard website, um you know, implicit bias, go on the Harvard website, search for that and I can also provide a link to everyone, but that will just give you an idea of sort of where you are with your bias. Again, it's really about increasing awareness of your own bias and how and and being uh you know, cognizant of how that may manifest in yourself and how that may um you know, show up in your behavior, your attitude, your worldview and that's just you know, if you feel like you can do nothing else, you can make changes in yourself. And I think another important thing is just you know, being aware of how historically rooted all of this is I mean one of the reasons why we have uh these persistent biases is because for for a long time we haven't really brought our attention to them. I mean we in this society have 100 or more years of race based science not based in any data. Um that has really permeated the way we talk, the way we view things. I mean one of the things that you were saying before, dr mall branch was how we tend to blame the victim that's rooted in our race based science that is sort of permeated into other devalued identities. So really understanding where these things come from, I think is really critical to ensuring that they're not perpetuated again in in the future. And there are many resources I can share those as well to again increase your awareness of your own bias and sort of the foundation of some of the um messages that we get with regard to devalued identities. Yeah, that's it's a great thought to have. And I think starting with that implicit bias test and starting with yourself is kind of a good place because I think people think that they have to have these solutions that are, you know, either community level or globally. And the truth is it really has to start with you and then it can kind of fold out Um so, dr Watkins also to you, you know, what do you think? Someone who's thinking about these things and wants to start doing some work? What can they do in the communities, and also in, you know, faith based organization and our faith communities? I think what your presentation showed me, at least I hope showed our audience is that, you know, the typical stigma that we always tend to attach to black churches and black church communities, that it's always bad, there's always homophobic rhetoric being spouted, um that tends to be a one sided uh media representation. And you were showing a lot of the positivity that's coming out of faith based organizations, faith based um practices. So, if someone is in a church or in the community and wondering where they can start, what advice would you give them? Mhm. I think initially, to show our uh like dr uh Michelle was saying to really look at um the individual and his relationship to the community. I think many people say, well, I'm not racist or homophobic or sexist, but systems are, you know, the entity is the institution is and I think individuals forget we abide and live through institutions. So a tool is to look at many of the assessments that are out there like a race uh assessment where you go through your actual organization, you look at how many individuals of color, how many gender, you know, different gender, sexual orientation. And just look at why there is inherent bias. And um I think the other problem is that we tend to dichotomies black, white, gay, straight, uh and don't look at the multi layered and tiered identities in within an organization. And so I think education is the key. Um you know, I think one of the one of the uh interesting things is that many faith based organizations don't think they're racist or biased. And yet on Sundays, we all attend many organizations. That's the most biased time the week is that we go to our homogeneous uh institutions and and feel comfortable and not really realized we live in a heterogeneous society and what that heterogeneity look looks like. And and I think also becoming cognizant of the social constructs that create the bias and stigma. So race is not real. You know, we we invented it. You know, what's white, What's black, what's gender, what's masculine, whats feminine? We made that up, rise the boys wrong. Blue girls wrong, you know pink? Where do we get that from? And I think so. I think the main a way is to look at your relationship to yourself and in the organization and actually do an audit, racial audit, gender audit and make a systemic change. Uh, you know that way? Alright, and dr um Watkins, I'll stick with you. We just got a question from the audience. What tools would you suggest to engage community, especially faith based organizations in efforts to ending the HIV epidemic? So I think one of the low hanging fruit is to get individuals involved and um the current uh health or gonna health, uh what am I trying to say? The health testing um and HIV prevention programs that are already undergoing so february black church or black HIV AIDS awareness days, uh in March and april Black Church Week of Prayer, uh june HIV testing day december 1st World AIDS Day. So start with a prayer for the healing of HIV. Um I mean, so and and you might not get anywhere initially with theological discussions and debates. Uh, and I always encourage people if you're gonna go to theological theological differences to be, you know, number one comfortable with having differences, it's fine and dialogue Dia, but two log talk, you know, conversation, not debate, I'm right and you're wrong and help faith leaders understand your experience. So, hey, this is my experience. I'm not saying what's right or wrong, this is my experience. No one can argue with your own direct experience. So, sharing your experience with faith based communities and leaders, um, and getting involved with the testing days, I think are also uh important uh to increase health awareness. And and and I really think in inviting community into systemic change. And I'm gonna say real quick, like, I don't see HIV testing, um uh prevention, uh, you know, things in the media now or or the stamp that used to be there. I mean there's kind of this loss of you know, community engagement in some levels to this. So. Yeah. And I think um there's another, you know, another aspect to that and someone just asked about this and I was gonna mention as far as resources where you can find out these these days during the year where we we honor, it's whether it's space based specifically on HIV. I think the C. D. C. Would be a good resource. We're getting some information if you want to know where to start, if you want to get grants, things like that. Are there any other websites that either of you would recommend that people could go to for some resources about how to start those conversations or to look at those lists of dates so they can start actually honoring and having prayer and other events on those days. Look sorry I was talking and I was muted. Sorry. I think you know it it really depends also on um the community, you know, their specific resources. I think that are really invaluable for different communities like the indian health services and the tribal health research offices out of NIH for american indian Alaska native and Hawaiian native brothers and sisters. Uh you know, there are several community groups and organizations for asian and pacific islander individuals. And I think it's just really critical to you know, reach out and look at the groups that are and the leadership within those groups to find out what the pressing issues are, what the appropriate and respectful language is and how you might be an ally um in the work for those specific communities. That's a great point. I also forgot to mention that you can check with your local department of health, your county or state Department of Health and ask for other resources. There are lot of departments of health that I know that are just waiting for organizations to contact them so they can help out with testing initiatives, educational initiatives, conversations, meetings, those kind of things. So those are always resources. Another audience question. I'm going to direct you to let me just real quick uh, to that point, a lot of you mentioned funding and I think sometimes the ideas I need money to do something. There's a lot of financial resource in the community that I think like you said that it cannot be under scored enough that uh, they're waiting on churches and faith based organizations to really reach out and say, hey, I need a speaker speakers bureaus. There are people that needs space to do the testing. Often the buildings that empty several days a week and it can be innovative thinking and community partnership, do a clinic and involved HIV testing. So the other thing I want to distress is looking at partnerships where churches don't try to go it along, but join with an organization that's already doing like medical care and looking at health screenings, including HIV and the church do that where it's not, maybe not just HIV focused, but looking at holistically that individual, including mental health. Oh yeah, that's probably what's important. Also think just people investigating in their own congregations and faith based communities to say, well, who among us, our mental health professionals, who are nurses, doctors, physician assistants, nurse practitioners, other holistic practitioners and bring everybody on board and utilizing the community resources that we have is extremely important. You know, just follow up on that because I think, you know, we've seen that happen a lot in covid like here in Washington. Uh, many of our black churches and other community groups have taken on vaccination of our communities and that is how we are getting at equity. So they're utilizing the church space. The clergymen are clergy, men and women are sitting in the observation rooms talking to people about vaccines and talking about the importance of community health. And I am inundated with emails from people saying, you know, my grandmother got vaccinated because she, the church was doing it. You know, or my auntie got vaccinated because the community center was doing it and she let me drive her there. So I think, you know, I just want to underscore that, that we have resources in our community and often they are underutilized. And it's, I think it's really critical to to be aware of that. And just, I know we don't appoint just one more quick thing. There's a number of individuals retiring and they're retired health professionals, nurses, doctors who are sitting idle waiting to be utilized and faith based organizations, I mean, you get a bunch of retired nurses to do health screenings and testing. So, um, uh, I think that number will increase and so faith based organizations are poised to do that. Ready to do that engage those individuals or retirement contract folks. Yeah. And I think the take home point that both of you are getting at is a lot of it starts in communities. And if we're seeing all this justifiable distrust in our communities against medical um institutions because of a lot of their bias that our people are experiencing as they go into these clinics, into these hospitals and into these spaces. The answers when they come from the medical and public health communities, of course people may distrust them, but if they come within the communities, our communities organically, um then it may be better received, which is a is a good point to take home. So, um doctor and drastic this question I'm going to pose to you. How would you comment on the relationship between addressing stigma and burnout among people in the HIV field? Mm Well, I think, you know, self care is really critical. Many of us who are in HIV also have devalued identities and so taking care of ourselves and making sure that you're doing what you need to address your own mental health and physical health is really critical. You know, it's like being on a plane, you want to put your mask on before you help the people around you. And I think that that is really, really critical. So whatever you need for your own self care, uh and self care can take many different um uh you know, can look very different for you uh you know, when compared to me, so whatever you need for your own self care, I think is really critical and finding the resources to do that. And I think also social support is really vital for um many of us who do this work, you know, and social support is not only the emotional support that we often think about when we think of social support, but also just having someone to talk to and to invent. Um you know, or someone who, you know, you can rely on when things get tough for whatever you need, you know, making sure that you build up that social support around you I think is really critical and that will make you more effective in working with your own experiences of stigma as well as the experiences of the stigma for the people that you offer services to. That's what ken's any comment on that. Yeah, I think, you know the idea of, of a fountain or a uh, you know that it feels first and then gives its water away and I think too many times uh individuals in the field, we enter the field because of an injustice or what we've experienced and often broken and uh dehydrated ourselves. We try to do this work. And so I think uh it's a reframing and re centering of an individual to think of themselves as that fountain. Hey, I got to be full first and give the overflow. So think of their jobs they're giving of other people their overflow and when they are depleted to step back and get full. And I think often the spiritual aspect of that individual because there's an idea that all of us have that center, spiritual center or core, whatever nourishes that for you. Um, I don't think we focus enough on that. The human, uh, the person that's working in this field is the instrument. The other stuff are tools, but the individual is the instrument. So we need them sharpened. And if they get dull, it's time to go back and be re sharpened and, and to take that time, I think that too many of us are exhausted retire. We beat down and parade and we're making ends meet. We all, you know, and it nothing changes. If nothing changes. And so the individual has to step back and say, Hey, this is my overflow. You're not gonna take on the water. Yeah. And I think those are all great idea. And I love the analogies between, you know, the airplane and when the oxygen drops down, the fountain being full of the tools being sharpened. Those are all great analogies. And I think one of the things that people don't realize when you work in the field and the HIV field can be a very draining field to work in as a clinician, as a social worker, mental health researcher where a teacher, educator, wherever it may be, you can experience a lot of burnout. And one of the things that I always stress the people is to make sure, you know, because they're always organizations will do this kind of self care stuff or they'll say, oh, we have this wellness program. But yet they don't change the system that's causing the burnout that necessitates the wellness program. And so you know, no, your agency for those of you listening out there that are in organizations, communities, clinics, medical spaces where you have, you know, issues that are going on with people burning you out. Our systems burning you out and realize that you have the power to kind of bring up some change. And so the systems are immutable where you know, an individual can't have an influence. You never know if you speak up, everyone may have been afraid to speak up before and say, hey, you know, there's a problem here. Um, but there's something that you can actually do about that uh, in those cases. Um, I want to shift gears right quick because they ask a couple questions about this and I think doctor and drastic you mentioned this before, but someone asked, is there a psychological or clinical tests that can measure bias? And then someone also asked, are there screening tools to test bias? I don't know whether they heard you initially. When you mention the implicit bias test. Um do you want to repeat, you know, kind of what you said about those psychological clinical tests that can do that and maybe where they can find them. Or if there's some other tests as well that they can utilize. Sure. Yeah. So the implicit associations tests the I-80. It can be found on the hard heard website. There's an implicit if you search for implicit bias in any of the search engines, you will find it implicit associations test. It's free and you can take it for race, gender, sexual orientation. There's even one that you know shows your bias in who you think the president should be and what the president should look like. It's uh, you know, you could spend uh days I think taking those tests and I think it's really critical to note that those tests are really just to raise your awareness. It's a tool to give you some insight into your own biases. It. You know, they it's not something that you should be like a ha you know, this is the end all tell all, but really just another tool and it is again the most widely used tool. It's not perfect, but it is considered the gold standard in terms of measuring bias. Uh There are other tools that you can use. You know, there are many other psychological um you know frameworks that really look at bias. Uh and I can provide, you know some resources for those implicit bias is just one thing that impacts our the way we see the world. Uh There are certainly other um cognitive processes that impact our world view as well. That's great information. Um someone asked will the slides be available? Uh and the answer is the slides will not be made available, but everyone will receive a tool kit that contains much of the information presented and discussed today. So we have two minutes left with the question answer. And since I don't see any more questions, what I'm gonna do is throw it to Dr Watkins first and then to you doctor and drastic. But we'll start with Dr Watkins. You know, people who are leaving here, I like to, you know, we talk about the problems a lot and the issues that are going on with implicit bias and some of these other biases. What are your take home message or what's your take home word? We'll give you a spoken word here on Tuesday Dr Watkins if you want to if you want to drop a good word, the good reverend doctor um, that people can leave home with, uh, that they can go back to their agencies, their communities, their workspaces and, and feel, you know, agency to tackle this bias. What would you tell them that to practice love? So I know that sounds cliche but to remember that biased stigma and shame, all the generative of fear and fear and love came about the same space and our job is to transmute that stigma and that shame that people are coming to us with this gun, conscionable and uh, desperate feeling that they're unworthy, the painful, intensely painful feeling that they are unworthy of love and belonging and were asked to help them and to work with them. And I think if you assume given in our social constructs that we live in, uh, that people are biased, we are racist, we are sexist. And so the job is to look at that not as something bad that needs to become good, but something that's unhealthy that we need to be healthy. And I think talk more about health and wellness and not sickness and lastly to remember holistically, so remember your spiritual, emotional, mental, physical and sexual health. We often talk about HIV but never talk about how to be healthy sexually, that sex is a gift, it is not taboo. We shouldn't shame all of us got here because of sex, somebody did it. So it can't be all that bad. So I think our thing today is to look at the positive aspects of being a holistic human and helping people live and not just survived in love after a drastic final word. Yeah, I would say you know that it's only recently that I feel that we've honestly given um bias and stigma any real attention and these things have been sewn into the fabric of our society for, you know, over a century. And I think it's really critical to think about you know, ourselves as pieces of that thread that's sewn in, you know, and if you pull out one little piece of thread, you can make a big difference in how things stay together or how things change. So often, I feel like we get really overwhelmed, like what can I do? What is my piece of it? And I think all of us are critical ingredients to the larger recipe and so we can do our part. We can, you know, increase our awareness, uh you know, learn some skills and tools to ensure that the way we show up in the world is with a lens of social justice and a lens toward equity. And I think that that will make a huge difference To never forget that you are an important piece of thread in the larger fabric and what you do makes a huge difference. Excellent work. Thank you for that. I want to remind everybody that the Gilead Training Institute, this is actually a series and we're going to have two more events that are going to be coming up in our third training institute. Mark your calendars will be on Tuesday May 11th and will explore the potential of telehealth uh, and helping to address barriers on HIV care. And then our final training institute will be on Tuesday june 8th and will focus on sustaining the urgency in ending the HIV epidemic. And remember again, Tuesday May 11th and Tuesday june 8th will be our final events in the series. I want to remind everyone who's participated today that you will receive a short follow up survey. Please complete the survey because your feedback will help us improve the blueprints for success Virtual training institutes moving forward and in addition you're going to receive a certificate of attendance as well as a tool kit that includes key takeaways from the program and where to look for additional information. If you complete all four programs, you will receive a certificate of completion for attending the blueprints for success Virtual Training Institute series. Again, I want to thank doctors and drastic and DR Watkins for coming and dropping some knowledge and some good science and a good word on us this afternoon. Thank everyone for coming today and participating in our programme. Thanks to Gilead for sponsoring this event and we hope to see you at future upcoming training institutes. Everyone be good for yourselves and others and we will see you in a month. Created by
