Chapters Transcript Video The Intersection of HIV, COVID-19, and Racism: WE RISE UP AND MOVE FORWARD The Intersection of HIV, COVID-19, and Racism: WE RISE UP AND MOVE FORWARD Originally Broadcast: Wednesday, May 26 11:00 AM - 12:30 PM ET Yeah. Rise up HIV AIDS Social workers on behalf of the Professional Association of Social Workers and HIV and AIDS and collaborative solutions our staff and our boards. Let me be the first to welcome you to the 33rd national conference on Social Work in HIV and AIDS. My name is Rusty Bennett and I have both the honor and the privilege to serve as the executive director of past WA and the conference chair. Together we rise up to end stigma discrimination, systemic challenges which continue to perpetuate health inequities among people living and affected by HIV and AIDS, especially among persons of color and underserved communities. Today you join hundreds of social workers and allied professionals in the field of HIV and AIDS. For three days of professional development, networking and self care. You join committed professionals across this country who know social work is the end to HIV and AIDS. So welcome to this year's conference. Now, I would like to introduce a longtime friend, an advocate of this conference, reverend doctor Tommy walk ins over the past year, Father Tommy and I have journeyed together. He has a voice for social justice and equity and most importantly a voice for hope in healing. If it wasn't enough, he's also a social worker. Let's join Father Tommy as he leads us in remembering and celebrating all those impacted by HIV and AIDS. Welcome Father Tommy. Thank you. Thank you Rusty. And thanks to all the planners and board members that are here today, The words of Andra Day and I'll rise up, I'll rise like the day and I'll rise up, rise unafraid and I'll do it 1000 times again and I'll rise up high like the waves and I'll rise up in spite of the cake and I'll rise up and do it 1000 times again For you I were you are the souls and the spirits, the pioneers that we see here and those who have died and have gone before to rest to be in peace. Our you are those impacted and still affected and newly infected With a 100% preventable disease. We begin this conference by honoring you those we know by name and those we do not. We honor you with our presence with our future presentations and we honor you in our prayers and in this brief moment of silence I recalled this morning is to continue to rise up to come back the stigma, the bias, the shame, the guilt, remorse, the invisible enemies that continue to keep newly infected individuals in isolation and shame. We rise up to supplant the seminal spiritual and those bio psychosocial eels that impede and arrest positive health outcomes and healing for those we know and love those we serve. We rise up and so I pray that we keep rising together through this conference. Let us be renewed and rejuvenated that our love continues to flow these days. Recommit us to this work to our faith in things seen and unseen. Well what we do is what we love and we do it 1000 times again and again. A man. Thank you. Thank you so much, Father Tommy. I'm always odd by the variety of roles and impact social workers have, Whether one on 1 in a community or in the halls in Washington, D. C. Social workers continue to influence the lives in the communities in which we live today. It is my honor to introduce to you one of our champions, a social worker who has committed her life to address and systemic and social injustice In her position as a congressional representative from California's 9th District. She co founded and co chairs the Congressional Caucus on HIV and AIDS, fighting for resources and policies, which will bring an end to this epidemic. She supports her profession by serving also as chair of the Congressional Social Work Caucus, fighting to elevate our profession. It is my honor to welcome to this year's conference, the honorable congresswoman Barbara Lee. Thank you Doctor Bennett for that very kind introduction and to the Professional Association of Social Workers in HIV and AIDS for your advocacy. Yes, let's rise up and redouble our efforts for an AIDS free generation by 2030 as we continue to face a global pandemic that has strained our public health system and exacerbated public health inequities for communities of color and medically underserved communities. The work of social workers and professionals in the field of HIV and AIDS is more critical than ever. As always, social workers continue to rise up and I am deeply grateful for your always rising to the occasion as a social worker myself. I know firsthand the central role that social workers play in their clients lives, families and communities. I am so proud to serve as chair of the Congressional Social Work Caucus, which has been a strong voice For the more than 650 oh social workers throughout the country. I'm also proud to serve as the co founder and co chair of the bipartisan and bicameral congressional HIV AIDS caucus, which helps lead efforts to advance legislation that addresses the needs of communities impacted by HIV and AIDS, while also educating members of Congress about the virus, its impact and it's affected populations, communities impacted by HIV, especially communities of color, struggled with the stigma, systemic inequality and racism in our public health system. And now they are left to deal with the burden of the coronavirus pandemic. So it is more important than ever that we support social workers in the field of HIV and AIDS. I re introduced my legislation, the Social work Reinvestment Act to re establish a commission that studies the social work profession and promotes recruitment, retention and reinvestment in the field of social work. This is so important. Our moment is now. I'm also working to advance legislation marking social work month and world social work day to celebrate the extraordinary contributions professional social workers make to our communities each and every single day. And finally, my colleagues and I on the congressional HIV AIDS caucus requested president biden to increase funding for domestic HIV and AIDS programs, help our nation advanced racial equity and meet the needs of underserved communities. The dangerous and stigmatizing laws currently in place, undermine public health and can contribute to worsening the HIV epidemic. We must continue our fight to end the stigma and barriers around seeking care for HIV. As social workers in the HIV AIDS field, you play an invaluable role in ensuring quality and accessible care for communities that have been hit hard by this coronavirus pandemic. You know that I will continue the fight to ensure that you have the resources you need to deliver this essential care. Thank you so much again for your commitment and your advocacy. Keep rising up as proud and progressive social workers. Thank you congressman and lee for modelling the power of social work and inspiring us to keep rising up again. I want to welcome you to the 33rd national Conference on Social Work and HIV and AIDS and I'm honored to be here with each and every one of you. Obviously, this conference would not be possible without the commitment of our sponsors or partners and our staff. So let me take a moment to thank them first on behalf of collaborative solutions and the Professional Association of Social Workers and HIV and AIDS. Our staff and boards again, thank you for our partnership and thank you for the work to make this possible. Also to our friends at the Department of Housing and Urban Development, the Office of HIV AIDS Housing, which runs the HOP A program which ensures safe, decent and affordable housing for individuals living and affected by HIV and AIDS. We appreciate the partnership we have shared over these many, many years. You are presenting partner Gilead for their long term partnership with the Professional Association and with this conference it is truly humbling, but also we're honored to work in tandem with you and we thank you for today's plenary session as well for a platinum partner. There are technologies, there are technologies is a new and hopefully a continuing partner with this year's conference and also sponsored and invited us to share during one of their theory Thursdays where board members were able to share our vision for ending HIV and AIDS, also to our bronze level Evita pharmacy and crescent care. Both very long term valuable partners with the conference and support of social workers everywhere. I hope you'll join me in thanking them all for their support of this conference, for the support of the work that you do each and every day and to everyone who works to end HIV and AIDS. I also want to think this year's program committee staff and volunteers through your dedication and time and your passion. You have developed for us, a dynamic in depth learning experience for us all. So I want to thank you so much for all of your hard work and for the work that many of you will continue doing throughout these next three days. So thank you so much. Yes, it is time for us to rise up HIV and a social workers. It's time it's time to transcend. Last year. Last year that was defined by face masks, by fear, by chaos, by public health inequities, social and systemic injustice, oppression and division. It is time to rise up as proud and progressive social workers living our values, values which inspire and ensure that the dignity and self worth of each and every individual is recognized values which recognize the power of each and every relationship, even the relationships with those who challenge us or think differently than we do. A time to rise up to challenge all forms of social injustices, a time to challenge the normalization of division, which promotes a narrative of other instead of all of us. To rise up, not to ignore, rather to value and dignify lives lost due to hate and the failure of our systems yet rise up isn't only about the change we seek in the world, it is also about living the change we seek within ourselves, it's about serving and committing to a profession which seeks to transform the world, even the inner world of our hearts. So today we also rise up to reclaim that change. Knowing it is only possible when we journey in humility and love loving our neighbors as much as ourselves, like the rising sun, which brings new beginnings to each day. We to rise up committed to transform doubt into hope, discouragement into confidence and defeat into victory. To realize this vision, we have created an experience in this year's conference to do two things First to improve practice. This space is a time which I hope you will hold sacred. I hope you'll go into your offices, go into your space, close the door and tell your boss you're offline. This is your time, this is your space and time to grow professionally and personally to advance all forms of social work practice, to end this epidemic, take it all in because you deserve it. Second, it's about creating space to nurture the heart of social work practice connection. Unlike the impersonal trends in virginal conferences, we embrace an environment where interaction in that connection with your colleagues is expected and celebrated. We have created this year, uh, an environment where we invite you to participate in virtual lounges to connect through a variety of groups, infinity groups to further connect with colleagues across this country, um in regions and also in topic areas that may interest many of you. I hope you'll make a take advantage of them that you'll create new relationships with your peers across this country. Use these relationships because they matter, because that's what social work is built upon this conference is for you, enjoy it and remember social work is the end to HIV and AIDS at this time, it is such a privilege and entered to introduce and welcome to you the chair of the Board of Directors of the Professional Association of Social Workers in HIV and AIDS with expertise and experience from a local S 02 running state. HIV AIDS housing programs. Darren Rolls has a deep passion for seeing an end to HIV and AIDS and also a deep passion for this profession. Social work. Darren, thank you and welcome thank you Rusty. Hello everybody. My name as Rusty said, is Darren roles and I'm coming to you from Minneapolis Minnesota. As chair of the Board for the Professional Association of Social Workers in HIV and AIDS, I am so excited to welcome you all to our 33rd annual conference. Botswana has been hard at work over this past year, striving towards our vision to end the HIV and AIDS epidemic by promoting social justice and equity through all forms of social work practice. Since our last conference, I have continued to be amazed at the creativity day after day with my fellow social workers and allied professionals doing HIV work as we adjusted and responded to the COVID-19 pandemic. Thank you all. And as we gathered at our 2020 conference with all the complications from the pandemic, we had no way to know that our world was only going to get more challenging and then George Floyd was murdered by police in Minneapolis. This trauma was the catalyst for waves of uprisings and demands for racial justice that swept across our nation. Ongoing incidents of racialized violence and oppression continues to impact our communities and have sparked a push for racial justice generations in the making through the pandemic, we have once again seen the disparities and impacts of social determinants of health things. We know from our HIV work, things that we see in our HIV work. This was all too familiar with us to us and we know some of the ways to get to the other side. It's time, it's time for us to rise up together. We know that we will not CNN to HIV without addressing racism. We will not CNN to HIV without changing the systems and policies that create and perpetuate injustice and oppression. We must do this work. We can do this work and I am so ready to spend these 33 days with you all as we connect, learn recharge and rise up. Many of you have experienced the energy and impact of this conference before. Thank you for coming back. Many of you are joining us for the first time. Welcome. I hope you enjoy on behalf of the pasta aboard an organization. I think you all for being here have a great conference and with that I will turn it over to Nicole brazelton with collaborative solutions to provide you some technical expertise to navigate our conference. Thank you so much, Daryn. Good morning. Well if you are here watching this presentation, you have successfully navigated your way to the right place. So congratulations! To kick off each day of the conference, we will join each other right here for the morning plenary session, you can always get back to this platform by going directly to the conference website or by going to the app and typing in C. S. I. Events to download our conference app. Once you're in the platform you have the flexibility to make it your own. You may search for sessions by date, title or presenter and even create your own personal list of favorites by selecting the star located near the desire session. There are also links to review speaker bios, download slides, take notes, complete your evaluation or visit our sponsor and exhibitor boosts. Now speaking of evaluations, please remember to complete the evaluation for each conference. Each session I'm sorry on friday you will be reminded to complete the overall conference evaluation which is a requirement of our C. E. Governing body, the Association of Social Work Boards. All evaluations must be submitted no later than june 11th by 11 59 PM. Central time. We will also send out reminders but we want to make sure everyone remembers that particular date, June 11. So mark that on your calendars, Certificates noting approved credits will be provided by July the 15 and step by step instructions for completing both evaluations and downloading the certificates are available on the main website. Under cT guidance, it's also available on the conference app. Feel free to contact me or Valencia Moss through our conference throughout the conference. For anything we can do to help you have a great conference experience at this time. I'll turn it back over to Rusty Bennett. Thank you, Daryn. Thank you Nicole. Um it's always a privilege and honor to work with such a great team and of course this conference would not be possible with a lot of behind the scenes work. It's exciting to be with you and joining you on this beginning day of our conference and look forward to the next three days. Even now, people are still registering to come upon and to be a part of the conference. And so that's very exciting. And I'm glad everybody is joining us Um over these next three days again, I want to say a special thank you, thank you to Gilead for their continued support of this Association of Social Workers of each of you and for this conference and for this gathering and for today's opening plenary session, I'd also just like to say a special thank you to one individual, somebody that is a longtime friend and advocate, a believer in social work practice and the work that we're doing in a champion for this work, chauncey Watson john c This time I'm gonna turn it over to you and say a special thank you to you for all the work that you do in the support that you give us. Good morning everyone. Good afternoon for some of you. And a huge thank you and just welcome to everyone for the social worker conference of 2020. On behalf of Gilead. I am Christopher Chance Watson and I'm associate director for HIV franchise marketing and it's a real delight on behalf of all the employees weren't wanted Gilead that we continue to do the supportive for social workers. Gilead recognizes how important it is to elevate the voices of social workers, particularly in HIV care for the clients that they serve, but also ways that we at Gilead can continue to support them with that We would like to welcome everyone to today's program entitled the intersection of HIV Covid 19 and racism. We rise up and move forward. This plenary presentation will give us an opportunity to elevate awareness about strategies to help address the impacts of racism, health inequities stigma as well as the impact of Covid 19 pandemic on communities most affected by HIV. It will also raise awareness about ways for social workers to support resilience and self care for themselves and their clients at risk for or living with HIV as communities emerged from the pandemic and transition back into the new normal we understand that these skills and tools will allow us to better perform our jobs. Each and every day. Today's program will feature a keynote presentation about the impacts of racism, health inequity stigma as well as the COVID-19 pandemic. The incomparable dr robert. Miller JR will be delivering the keynote presentation and moderating our program for today. Dr Miller is an associate professor and director of the U. S. Africa. Partnerships to build stronger communities at the University of Albany School of Social Welfare in the State University of new york. Doctor Miller is also an inaugural research fellow at the Desmond tutu Center for Spirituality and Society in the University of Western Cape Town in Cape Town, South Africa. After the keynote, doctor Miller will engage in one on one conversation with DR Brenda ingram about the insights and practical ways that can empower social workers to serve within their communities. Dr ingram is a clinical assistant professor of psychiatry and behavioral sciences in the department of psychiatry and the behavioral sciences at the keck School of Medicine in the University of South southern California. She's also the program Director of Relationship and sexual violence prevention and services as well as the associate director of counseling and mental health services at the USC. Student Health in the keck Medicine of USC. This program will conclude with an audience too. And a so please at the bottom, if you have questions throughout the program, don't hesitate texting us or submitting your questions throughout the program at the button below. Without further ado, I would like to welcome dr miller who will now deliver our keynote presentation first of all. Good morning to everyone. Um, Mr Watson. Thank you very much for that lovely introduction. Gillian is fortunate to have you. I first learned chances work when he was at George Washington University in Washington, D. C. It is an honor to be a part of the Professional Association of Social Workers in HIV and AIDS password and their 33rd conference um on social work in HIV. And almost 98% certain that I first learned of your organization this summer before I entered my MSW program at the University of pennsylvania. And um, I actually think I went to the conference in Washington. And so in some ways it feels like a, a full circle moment. And so it is an honor and a privilege to be. Um, with this august invitation, I'm hopeful to share some generative ideas and hopefully inspire some conversation um, among my favorite group of professionals, namely social workers. Um, and as a social worker who teaches at the school of social welfare, um, and a social worker who engages in research in primary and secondary HIV prevention efforts among black transgender women, black gay men at the intersection of spiritual and social work. I deeply admire the profession and his code of ethics, mandating advocacy and social justice priorities with all of our spheres of influence. Um, as a personal note, I, um as a native of Washington, I was first introduced to uh material support for people living with the virus in my home parish of ST Augustine in Washington, D. C, where we provided food assistance with housing and clothing. Um and in some ways that gave me a beginning understanding of what material supports look like and what emotional supports could look like, um and somehow that provide a pathway for me to get social work. And so I'm excited with that. Um This June will be the 40th anniversary of the awareness of HIV and AIDS that published in the new york Times, the mmWr report and Dr Michael get lee. By the time he published that report, there were 250,000 cases of infected people in the United States at that moment. Um In the interview, and this is an interesting point. He suggests that he when he made the report, he didn't, he mentioned five men in a subsequent interview with PBS and Frontline, he offered that it didn't occur to him To mention the race of the five men who were mentioned in the report. And as it turns out, the 6th man was a Haitian man, and the 7th man was an African American. I can't help but wonder if the inclusion of both the Haitian and african american man in that report might have re conceptualized how people began to think about HIV. And so this idea around how social work is able to respect the human decency and human integrity of all, and to engage in social justice and advocacy makes me really proud to think about social work. And it also signals that efficacious and care, intentional care is an act of social justice. It also strives in the service of beginning dismantle white supremacy. And so with that I would like to begin the PowerPoint presentation. Okay, not like great technology. So essential focus of HIV care is testing linkage to care and viral suppression. And so part of that works out is how do you get people to begin testing? Um And then what are the efforts involved in linking them to care? Um Well, as you know, like I know if you feel like you have a trusting relationship with your provider that's going to make them come back to care and further, it's going to help them stay engaged in care. And so part of our work is making sure as we work with our clients to understand and always check in with them, how are their visits going? Um And how what is what is the feeling of engagement with their providers so that they feel like they are part of the treatment team um as they are engaged in care that then there's a conversation around when to start the chemotherapy or the um yeah the therapies and what we need to remember in that is the goal is maintaining viral suppression. The ultimate goal is the adorable viral suppression. Um and from that point we can work with cbc and understand that if you're undetectable then you are untranslatable. If you if the virus is suppressed then you can't transmit the virus. And that's when we talk about prevention as treatment moving forward. Social workers are practitioners and the crucial and implementing the national Strategic Plan for HIV. Um this idea about preventing its and again this notion of how do you start infection And I think as a practical matter we have to think about prevention as both a primary and secondary idea. Primary prevention has to do with if there is no infection present, then making sure there is um no acquisition of the virus. Secondary prevention is once you are achieving viral suppression that then prevents the virus from spreading this notion of improving care and outcomes. Again, people who are undetectable are un transmittable and so that allows for both maintaining a healthy quality of life um and it also has implications for people's mental and emotional health. Um this idea about reducing HIV related disparities and health inequities, quite frankly, we can make an entire conference on this given the reality is that the disparities are structural, they're not always related to individuals, but rather what are the systems in place that helped to maintain differential health outcomes? And then ultimately, how do we combat those in the service of achieving integrated and coordinated efforts in the service of again maintaining durable viral suppression um as well as increasing quality of life for both our partners and our stakeholders moving forward. So this idea about health inequities and structural violence that drive higher rates of HIV. Um so we'll talk about sigma in a moment, but we know what that is. Is that inherent notion of what stain do I have on me that is either emotional, spiritually or psychologically um awful for which we have a difficult time maintaining and coping with moving from preventing HIV. We get to this idea of um silences and what's interesting about this again, in the report that Michael Gottlieb Gottlieb um presented back through in july of um 1981. This notion of what is the import of the silence of who else was impacted by the virus. Because for all of us have been doing this work for any any amount of time, for a good period of time HIV was conceptualized as a gay white male disease. That's what the media presented. And in point of fact, that's how it was conceptualized in communities of color. It's that lack of information, that notion of making or feeling like it wasn't my concern that led to really difficult trajectory and history of the virus. Um and so in thinking about what messaging means, um and also understanding what are the structures that allow for the perpetuation, other physical and psychological harms um that results from this tour information and or how we tend to and as work as we already know this to be true. But I think it's important to remind ourselves that racism is part and parcel of all of this and to the extent that we as practitioners are always conscious of not only dismantling uh white supremacy and combating racism and the various forms of marginalisation and oppression, but we also have to be very mindful about where our blind spots sparks are in this. And to the point if we're not reflective practitioners or if we're not conscious of our work, then potentially or unintentionally were engaging in consequences are behaviors that have unintended consequences. Can we move forward the notion of racial ethnic disparities and HIV disease? Again, it is one might even argue part and parcel of white supremacy um if people don't feel like they are part of the system and feel like they are valued and more importantly, if people feel like they have no real human connection to another, then we get to treat them as the other and then the disengagement or disentanglement, we managed to devalue their humanity and that allows us to engage in behaviors either intentionally or unintentionally. And I think it's those kinds of ideas that drive the racial ethnic disparities in HIV treatment and um and both on the provider side as well as on the client side um this and you would have heard in your own practice, what it means for providers to not are sorry for their for clients not to trust their providers. And sometimes it's not even about the trust is the disengagement in their own treatment process. So for example, if you ask that you prescribed meds, but if they don't understand what the medications are or if they don't understand what the medications are supposed to do or if they don't understand and remember what I'm supposed to take them. That signals to us that there's a disengagement and those are kinds of things that we might want to look for and and ways to decrease the detachment and help increase people's self efficacy in maintaining drug adherence. Um which in part will minimize the disparities in health care and treat moving forward. So there are a number of terms that will be useful in this conversation in the game. I think this is obviously more of a review than it is new information, but it is important to think through issues of implicit bias, um explicit bias. This notion of microaggressions, stereotype and prejudice in thinking about these as you can read the slides yourselves. But one of the things that occurs to me is this idea of for as long as we've been talking about implicit and explicit bias, I do wonder if as social work professionals, we have an obligation to check in with our clients. Are we allowing for implicit bias as an excuse for explicit buyers? Let me be more clear about this. So obviously this idea about implicit bias favoring one group over another, unconsciously contrasted to explicit bias. Were favoring a group consciously or an intentional. I think as providers in 2020, given the state of affairs we have in the United States and from a place of justice and from a place of advocacy, we are well positioned and I think we are well suited to do some interrogation and some assessment. Um, to really question what's explicit versus implicit and to call people to task. I think because our clients, if our clients could do it, they would do. And so in some ways we are position to provide sufficient or lived eagle strength for our clients to engage in that kind of interrogation. Um, and again, stereotypes and prejudice are commonplace ideas. The last thing I'll say about the slide is this notion of microaggression. If we are not careful in our interrogation of both implicit and explicit bias, then I think we leave our clients open to being vulnerable to micro aggressions And you've heard the expression death by 1000 paper cuts, that's a real thing. Um let's move forward this idea of implicit bias and stigma undermining health outcomes for people living with HIV. Um I am reminded of in my doctor program. Um I can remember when I was putting together my proposal. I read a story in the new york times where physicians in the Bronx were having a conversation related to whether or not they were going to prescribe um the highly active antiviral anti viral treatments. And part of the conversation was a doubt related to whether their clients, which were typically people of color and of lower socioeconomic status, whether or not they have sufficient competencies and maintaining adherence. The concern of the provider was that in the absence of a regimented adherence mutations would occur. And there was a possibility of a super virus occurring theoretically. That's an idea. Um But if social work were involved in those levels of conversations, there could be a contrasting conversation or why are we assuming and working from a deficit model versus from a strength space person. Can we have the next slide please? So this idea about the power stigma, One would argue that stigma. Mhm. And you can think about this for yourselves, particularly this idea of being a reflective practitioner if you feel bad or if you think there's something bad about you that just dampens everything. Um There's this notion of internalized and anticipated stigma can worsen mental health outcomes um more likely to engage in negative coping strategies. This third slide is always interesting to me and this, the assertions about disclosure and so while stigma and there's an inverse relationship or the more stigma you have, the less likely you are to disclose. The other thing I just want to highlight on the slide is the counter narrative, namely there may be adaptive reasons why people not, may not feel like they can disclose. And so I think that's just an important point to hold as we move forward on this. Excuse me. Um, yeah, so this idea about the perfect storm, um, the people in 2018 did not see covid coming in the foreseeable future. Um, and I will not get in the political debate. I'll just simply say the following um, the effects on Covid with people living with HIV were devastated. Um, as a slide indicates there are higher odds of viral non suppression in san Francisco despite stable retention and care. And there was a 58% reduction in acute care HIV screen. Um, and you know, as a practical matter, in some ways that makes sense because people were did not understand what they are knuckling at, looking at. Um and this notion of walking to the outdoors without understanding what their risk factors were for Covid, it's an unintended consequence, I get it. Um but as you and I both understand that, that that slide makes sense. Um because in the, in the absence of dependable information, um, people, people sometimes don't always act rationally moving forward. Yeah. Covid and the subsequent substantial psycho, social and structural burdens on people living with HIV. Um I think the shorthand version of this is Covid devastated everything. Um Ron stall and his colleagues at the University of Pittsburgh term or coined the term Sendem IQ health problems. And it's the compilation of existing problems. And instead of having an additive effect, we're looking at a multiplication effect. And so this notion of what do you get when you mix in xenophobia, poverty and social isolation. So and again, as you can see the multiple things on this slide, I think the ultimate point here is in the challenge managing HIV in and of itself. It's one set of burdens and opportunities for growth and development. The overlay of Covid in an unsuspecting way. It as the story goes or the movie and it was the perfect storm. Um it just exacerbated all the problems that we had. And here's the interesting point about this. It also and we'll talk about the moment, but in all of those challenges, it also presented a myriad of opportunities for both clients and workers to engage in both generative conversations and creative opportunities for solutions that were life giving and adaptive. Um so I I teach my students strange perspective, so I have to look at it from a strange place. Um and so while people were engaged in challenges, both from a client perspective, as well as a provide perspective, my sense is that there was some real social work genius have happened as the work went on moving forward, the power of coping. Um this notion of what it meant to impair health related outcomes um Overall, so you hear a 60, um people reported being at covid impacting the lives very much um this idea around the fear of Covid in and of itself and and each of you can tell your own stories about this. Um I can specifically remember and this might be a little off center, but I remember thinking probably in uh March april last year, I understood what this notion of Passover men because Covid passed over my house in some interesting ways and that made me think through what were adaptive behaviors. And while I was in isolation and I was masked up and I was managing these challenges that I did not have real experience for um like our clients, we learn to figure it out. Um and as we were challenged emotionally, um some of us had challenges with the medication adherence. Um, A number of us have challenges financially, um and still others have lifestyle behavior challenges. Um and so one of the things that comes immediately to mind is a number of my students in field talked about what it meant for them to have to manage the increased incidents of spousal and inter partner violence because of the closeness uh, that some people had to imagine and manage. Um so again, there are a lot of challenges that covid brought with us um moving forward just as we would manage this individually from a macro perspective, many employers have challenges with this. Um this notion of our organization being less able to conduct wellness activities. Um people challenges, interesting to think about this challenges in some ways. Make people circle the wagons and make us constrict and constrain our behaviors and there are good reasons to do that. Um but I think the plan of this slide is not only to acknowledge the fact that human behavior is what it is, but more importantly, what is it to understand that there's a micro and meso and a macro impact on what the pandemic did for and to a population. And more importantly, and here's the point as we think about what the challenges were and again micro meso and macro practices. Um these are also the opportunities that interventions and resolutions for post covid activities need to be considered. So as you're thinking about what happens now that we're able to be more free and more mass class in a appropriate way. Um it isn't just about the individual, it isn't just about families and work organizationally what our interventions that are gonna be useful for the restoration of what quote unquote normal cement moving forward. This idea related to a multi pronged approach. Um yeah in some ways where I think as practitioners we understand these things we are agents of our agencies so we're helping our institutions recognize what stigma is as well as how to counter or contesting um expanding the chemotherapy so that to support our clients as they are managing that. Um this idea about addressing social stigma and the environment and that's kind of what our mandates, advocacy for the most marginalized and oppressed population. Um This idea to not only addressing it but listening to the stories of our clients and again you all know this already listening to our clients stories because again they are the expert of the experience number one and more importantly they are also if we listen carefully, they also understand what some of the solutions are to their challenges. And so our work is to co create with them in the reduction uh those of the stigma experienced in our populations. Um again using our own expertise um using social media to help us understand what this means. Um and once again relying on the creative opportunities and the strength of our clients to help gauge and guy the development of reasonable and accessible intervention moving forward. So this notion of where do our clients get support? Um, I think what's most clear is we need to listen to our clients to tell us who their supports are this fact. This idea about family, you know this like I do, but I think it bears repeating, namely family is not biological solely. It is also who are those people that we choose, who have demonstrated their love and care and desire for our best and highest good. Those people get to be conceptualized his family as well. And clearly in this slide however, you conceptualize family. They are able and let's do this way. Instead we can strategize with both the client and their families in the support of the client as they're managing the virus moving forward. So this live I am as a moment of transparency so all of my work is in the at the intersection of spirituality, HIV and um black gay men and transgender women. When I read and being a personal faith quite frankly. Um, I see the slide and the slide does two things for me simultaneously. On the one hand, it certainly is an aspiration. Um, there are faith based organizations that engage in holistic and how do I say this messaging that builds the client up. But I think we would be less than honest if we said that was a one side story. And for those of us who have or may be triggered by faith based organizations, I think we need to give voice to that. I think we need to recognize what the realities are. We need to understand and believe our clients when we hear their stories. And I think we need to rather than to sit in judgment and hold these preconceived notions or here we go, stigmatize faith, faith, faith based organizations, I think being able to hear what the potential is and again, So for me, while there are lots of things we can say about this slide, what I think is most sailing about this slide one, It is aspirational and two it allows us once again to listen to what our clients have to say and to use the language they use in the service of in the service of seeking support and resources from these organizations moving forward. So, um, passion has developed a national social work strategy to end HIV epidemic. One is advancing the professional work of social work in the field. Secondly, it is achieving health equity by recognizing the whole person and the social determinants that promote overall health and well being and expand, expanding the bridge and expanding research that bridges practice and policies that positively impact persons living with HIV and AIDS. Um, I wanna encourage and comment and laud perhaps. What for these three points? Um, this idea of number two, what strikes me about it in addition to achieving health equity and by recognizing the whole person and the social determines that promote overall health and well being. I also think it is useful for both practitioners and clients to feel empowered to identify and call out those structures that seemingly or potentially disempower or otherwise, feel like constraints or obstacles um, to promoting overall health and. Well, I think it's a two pronged approach here. Um, moving forward, this idea about how social workers can take steps to take care of themselves. Um, so there's going to be a conversation with dr ingram about this later. Um, but a couple of things that showed up for me, particularly I was doing my morning walk this morning and and one of them is this idea of self care thomas shown offers a phrase becoming the reflexive practitioner, that notion of self reflection. What is it that we do need to do in order to, what are the questions that we need to engage in to take inventory and to do the assessment around self reflection? Um, so I teach micro and one of the things I teach is you've got to remember your role, your function and your purpose, your role. Who are you in the work, your function? What is the work and your purpose? Why are you doing the work again? Roll function and purpose? Who are you? Why are you doing it? And what are you doing? And as you see clarity in engaging in your role, functioning your purpose? Part of your work is also allowing those answers to be guided by deeper understanding and reflection of how you utilize the Code of ethics. How does that document speak to you? Is and and again you're talking to a micro teacher so expression around that. But I think the longer I do this word, the more grateful I am for the code because it keeps me in check and to the point that helps me understand my role. Um, and then and the larger point is it helps me engage in the questions related. Does the current work still speak to me? I think we've always got to ask that question because in the absence of the question, I think we're not taking care of ourselves number one and I think a lack of self care as you well know, um has implications for clients. Um so then we get over to if and when there are questions of how you use yourself in the service of yourself, you have to figure out what your supports are. So again, who are you, what is the word? Why are you doing the work? Doesn't work. Still called to you? And finally I would say this. So as I'm doing my morning walk, um one of my favorite songwriters is a guy named Donald Lawrence. Donald Lawrence. And he wrote, he wrote this song called 2nd with, and the question is how do you after understanding role function of purpose? How do you understand what your own source of power, your own source of strength? What do you do when you need to soothe yourself? And in so doing um where are the sources for that support? And I would simply say to you that, and, you know, I thought about this and it was just synchronize to the I suspect. But what does it mean to breathe again? And when I'm asking the question for those of us who have life, how do we find our source? How do we utilize that source in the service of being able to breathe again in the service of ourselves as social work practitioners, particularly the specialist social work practitioners who are doing HIV care, and most importantly, how do we breathe life both for ourselves and ultimately in the service of our clients? I think as we think through those questions and engage in both those assessment opportunities, as well as the intervention opportunities, um particularly those deeply resourceful intervention opportunities, I think that we would have gone a far distance and taking care of ourselves um moving forward. And so, um I want to thank you for this opportunity. Um yeah, it's been an honor and a privilege and hopefully we can have some good conversation um in the chat and as we follow, follow forward. Thank you for your time. Dr ingram. Good morning. Good morning, dr miller. How are you? Uh you know, all of it is in your face, my dear. Um so why don't we just get at it? So the first question is why is building strong resilience and self care important for social workers as they serve people living with HIV? Well, as you have talked about, as I've heard so far this morning, it's hard work. Um there are a lot of issues related to doing this work that requires social workers to be at their optimal best. And so promoting resilience is important. Um I also want to sort of even looked at this in a sort of reframe this question in a different kind of away um and and speak about how we work as social workers in terms of building our own resilience and that ultimately the models or frameworks or approaches that we use need to help us to work smarter and not harder. And I think ultimately that approach will help us in terms of our self care, in terms of our resilience. And so how do we understand the work that we're doing as you eloquently spoke about? What is our purpose? Um how do we uh inform ourselves, how do we support ourselves? How do we reflect on network? I think all of those things contribute to um our continued well being. Um I think social workers take on a huge burden both at the micro level as well as the macro level, we work at all levels uh in terms of any sort of social issue or problem that comes around. And so I think all of those things sort of put us at greater risk if you will. And so I tend to come from a perspective of making sure that organizations incorporated trauma informed approach um that not only supports the well being of our consumers or our clients, but supports the well being of our social workers or staff or anyone who is providing those services. And I think that is one approach that builds resiliency um protects the worker, um but also helps us to start to look at the work in a different way. That also helps us to sustain our ability to continue network. So I'm gonna ask a question as a follow up and I realized that the question about to ask could be a four day conference in and of itself. So, as you think about this from a trauma informed perspective, can you give us a couple of symptoms that's related to how you don't engage in vicarious re traumatization? Well, in terms of vicarious traumatization, one of the aspects of again working smarter, not harder is that we view our work through a trauma informed lens. So when we view the work through a trauma informed lens, we uh one of the themes are major uh philosophical values of that work is that we don't re traumatize um and that we don't engage in practices that will create this sort of trauma within the worker. And so again, what do organisations do? Do we provide enough resources for social workers? Do we provide opportunities for them to reflect on their work? How do we use supervision as a regenerative process versus an administrative uh box checking. Um And so again we do talk about clinical supervision, but there is a thing called trauma informed supervision which really helps us to look at the impact of the work on ourselves and how we sustain. I was again uh an organization that we were trauma were from informed. So even part of our um performance evaluation includes a self care plan. And what are we going to do to provide self care for ourselves? And then how does the organization support us in that plan? And it's something that is reviewed on a regular basis and it definitely reviewed in our annual performance. So those sort of strategies really helped too address by carriage traumatization. But I think on top of that it's also about how do we really understand the work that we do? And again, I go back to my little term working smarter, not harder. And I think using a trauma informed approach helps us to do that. So I would encourage the people who are listening to this to think about this question for yourselves, and how do you engage in work and support for yourselves that you're not re traumatizing yourself as you're both engaged in supervision and or having conversations with your colleagues? Um I know time is sure, so I really want to get to this question. Um what are some practical ways for social workers to support sex positive perspectives with their clients at risk for HIV as a means to encourage to HIV test? Well, again, my my frame my my approach is related to again looking at trauma. And one of the things that it's really important for us to understand is the relationship between trauma and HIV uh status. Um there are numerous studies that talk about the role that childhood trauma plays in uh sex positivity uh in terms of communities that are at higher risk for HIV. Um and so I think when we understand that we get to move upstream a little bit more and not just wait until they're adults and say, okay, now I want you to engage in all this healthy sexual behaviors. Um when at that point the ship may have already sailed in some ways. And so I I encouraged us to sort of go upstream if you will and start to work on some of those trauma issues that um set the stage for HIV. Um for example, and looking at HIV with women who are one of the largest um fastest groups. Honey is one of the groups that has the fastest growing numbers, if you will. Again, as you mentioned before, we used to conceptualize HIV from white gay men, but now we need to look at women of color and when are to look at that population and other people of color or other marginalized communities in that regard? We have to address sort of intersectionality that occurs. And so from a trauma perspective, one of the things that I really want people to recognize this intersectional, complex trauma, um, it's it's not a term you've heard a lot. I'm just out there right now to try and get folks to understand this. And it's where we talk about the occurrence of childhood trauma. And again, there's numerous studies that that relate the level of conflicts trauma to the likelihood that someone will contract HIV, that people who have childhood sexual abuse tend not to engage in healthy sexual behaviors. It can engage in high risk sexual behaviors. They didn't have more partners tend not to to engage in using condoms and things of that nature or safe sex practices. And a lot of that has to do with what happened to them, uh Children around sexual abuse. And so when we understand that, then our interventions around uh adherence to medical regimens becomes a lot easier because then we will interact with our folks in a different kind of way. We won't just be okay. You need to do this, uh you need to get tested, you need to understand that for that population that that again, and I'll be at the top of their list. Um, but also they may not have the self confidence. It may not have high self esteem that puts their health at the top of the list of things for them to do. And so then how do we sort of help them to make that shift, helped them to connect their childhood trauma to their current sexual behaviors that put them at risk for HIV. And so those are the sort of things I think, you know, in terms of Boots on the ground approaches, that makes sense and helping us to work smarter uh and engaging, you know, you talked about how do we engage folks? But again, if we're not addressing that, we may be re traumatizing them. If we're not trauma informed can impact the relationship between the service provider and the consumers of those services. And there's tons of studies that talk about how, you know, at this stage, how prominent informed approaches prom informed care makes that relationship better, which leads to more adherence to treatment plans and ultimately results in greater or better outcomes um for patients. So in part, I'm just gonna say so in part, what I'm hearing, what I'm thinking about as I'm listening to you is you got to make sure that in that assessment conversation that you're listening to the stories and that that assessment is just not the check list of Czech bark marks or check boxes. It is Help me understand your life. And how do you use those questions in the service of witness bearing as well as mm truth hold it so that you can hear the truth and you can understand what questions to explore in the service of what revelation you need to know such that you get the interventions that are most consistent with the needed. So this idea of going upstream. I've loved it from the time I've heard it. Um because when I hear it, what I hear is we gotta get assessment right? You got to get the assessment. Um and we have to know what questions to ask in the assessment in the service. Um, go ahead. Anything else about that? I have one more question for you. Oh, go ahead and ask the question back. So how can social workers support and empower other social workers and communities impacted by each other? Mhm. Well, again, I think the connections is paramount and um how we connect, how we support other social workers across the board. I think it happens both in terms of our social connections, but also how do we um educate other social workers? Um You know, there's an assumption that we have social workers all do it the same way and we all know the same things and we're all in the same places uh just because we're social workers, but those of us who have been around a couple of years know that we are a diverse group and not everybody believes the same way. Um I think one thing again, because my uh focus tends to be on trauma is that we really need to integrate more of that in the curricula as we train social workers. Um, it is not consistent across schools, um, even though the uh huh, what is it, the Board of Social work educators talks about the need for all of us to have a firm and extensive knowledge around trauma. We don't do that. And so I think starting at that where we have those sort of key pieces that as part of the curricula, I think is very helpful and then that makes it a little easier for us to come together to have these conversations about how we see the work and how we can support each other to work because again, doing this work, especially when you um I don't know that the vast majority of people you work with have trauma that's hidden trauma, they may not talk about it. Um put you at greater risk for being for developing vicarious traumatization because you're not prepared for it. And so I think that's the social workers need to talk to other social workers, we need to support other social workers and helping them to have this sort of paradigm shift in how we do the work that we do. And I think that's one way that we can support each other and help each other to grow and help us again to work in a way that makes sense. I think the outcomes when we don't see changes in the population, when we don't see that our work is making a difference, um burns us out and and that's what happens with, you know, in this work of social work. So again, the more we are working in a way that we can experience that feedback loop of greater outcomes, more positive issues going on. I think the better we are able to support each other as well as to reduce our own burnout around in the field. So you were quite lovely and not saying what I really thought, I heard you say. And the next point around that is we have to be honest about whether or not the people were seeking support from our competent to provide the support. And I can remember my own practice. My my first gig out of social work school was for a HIV service organization in New York City. This was in 1994. So we were the second wave, this is the same business hospital was still up and we had clients in the hallways. And when we were in supervision, some of the more frustrating conversations would be having to explain what our trouble, what are our challenges with our clients with people who had not done HIV work having to re explain. It is a challenge. And so for me, one of the lessons I took away from that was you need to make sure that the people with whom you're doing supervision and the people with whom you are seeking support, they are knowledgeable in this. And so that all they need is, as my grandmother would say, they got the message. They just have to know the fine print. They have to just hear your particular charity of your detail, not the overarching thing about what this is about. Um And so I think so. But here's the point. I think that requires a bit of honesty and a bit of courage and our own part being able to say whether or not and the gauge in our own assessments related to whether or not we're asking the right people to support us and to provide superficial. Um, and again, I would say the same is true. And we're talking about issues of health disparities um that, you know, what are we doing? Uh it's not enough to show up at work and say, okay, I'm going to take care of everybody, then go home and vote for policies and laws that are oppressive or live in communities that are segregated or engage in activities outside that are not supportive. So, in my opinion, yeah. Take you need to walk the walk, talk, the talk, get it done. So, yeah, I definitely agree. Not everybody can do everything. Um, and so how do we address these issues? I think is paramount. Um, and again, I've talked to social workers who don't get this. Um, don't get it at all. Okay, So I got to know that was okay. Thank you. So now we are transitioning to questions and so I'm going to read them from the chat and um figure out how to get the answer to you. So, um first audience questions, Where was this study done? Um I believe you're asking about the study of 181 social workers around stress and burn it around. COVID, the study was of 181 social workers from around the United States, with 65% of the participants from Missouri Ohio pennsylvania and Virginia. The participants were recruited from online advertisements and of listservs. Yeah. Do you have a professional opinion about the hybrid work from home versus back to full on the ground work in terms of it affecting social workers self care and support? Uh Again, I would say that one of the things that we need to be mindful of is that we are humans first, Social workers maybe second. Uh and so the things of the issues related to the pandemic, I think as you mentioned, impact us as well. And so even though we are all working from home, um it's not easy. I can tell you right now. It's not easy. I work from home part of the time. I work in the office, the other part of the time, we have had to make humongous changes in our workflow. Our understanding of what it means to do wellness texas, you mentioned. Um all of that has shifted. And what has that done to our brains? What has that done to our energy level to make all these shifts and take care of people and not know whether or not folks are doing okay. So I think the pandemic has been a traumatic experience for everyone and for service providers, social workers, et cetera. Maybe even more so because we again have to take care of everyone else on top of taking care of ourselves, our families. Um and so I think all of these issues uh intersect each other and it's gonna be it's gonna be a challenge. So then when we go back to working in the office at a higher level, I'm already getting pushback from my staff about what do you mean? And all of us are vaccinated cause I work in a student health center. And so we have to be vaccinated and so it can't be about that. So what is going on? Another change? Another huge shift in our lifestyle and our way of being that is uh quite honestly exhausting um to now make this new shift. So I think that's something that we need to take into consideration and have some self compassion that if it doesn't come up, we also you know now know of this thing called covid brain where and I don't mean people who have actually contracted covid and the cognitive and the biological cognitive issues related to that. Just the trauma of living in a pandemic where, you know, you're sitting at work and you can't concentrate, you can't focus. You have to read that same page over and over again. Um zoom fatigue. I mean, these things are real and so they have had an impact on our ability to um be resilient. Uh They have taken their toll on all of us and we need to have that compassion for ourselves and not push ourselves in ways that don't make sense. Are organizations need to have that compassion for us and not push us in ways two, Okay. All right, this is over. Go back to work. It's not gonna work that way. And I'm and again, I'm already seeing it in my staff who are like, uh, do I have to come back? Oh, I have this. You know, a lot of things are coming up for them. And again, a lot of that has to do with this, uh, you know, the psychology around change and now I have to change again and so and and not knowing what the future holes, you know, is endemic over. I can't I don't think it is and no one can say for sure that it is. So we're in this thing called an enduring trauma. So all of that being sad. Um, it's it's hard for us to just automatically switch over as if it means nothing to us and we need to think about that. That's right. I think it also gets to the place of what does it mean for us to see how to strategize, to make the work environment palpable and consistent with our new realities. For all the subject you're talking about, right, um how do we as a joint venture, Co create what the new realities are. How do we have the courage and how do we have the honesty um to articulate what our needs are, and have it be a little empirically based, says the researcher here, um, but to be able to really ask for what you need and then strategically co create in ways that are most generative. Um let's hear another question here with the new initiative of creating more community health worker positions within the HIV community. How do you think that will impact the role of social workers? Me or you? I got an answer as you go ahead. Alright, it harkens back, this is not the first time we've asked this question in social work history and in the profession and uh manifestation of social work practice. So go ahead and then I'll outside that. Well, again, I'm I'm in favor of having more people out in the field that are helping. Um, I don't think, and I would not want to see this as a threat to social workers. Um We have so much things on our plates that, however we can bring in other folks to help us again, making sure that everybody is well trained, everybody can do stuff because something, you know, community workers can go places that social workers cannot know. And so I think that for me, it's it's not a threat to their profession. It is an augmentation to the work that we do. It's better. It puts more folks out there doing the work, uh, and what, in creative ways that social workers may not always engaged in or may have our own restrictions that we can't do, you know, sort of this work, but a lot of times having those peer or community workers out there that can do that, um, serve a vital purpose peer support, um, can't say enough about how important that is, how much role modeling that goes on. So, um, I think it's a win. So I'm inclined to agree. And I remember these conversations back when I was in school and in some ways were struck and we have to contest two competing realities. One, we understand that we're well trained, particularly those of a domestic degree, that we, we get that. Um, but as well trained, highly trained, graduate trained professionals, we're not always gonna delegating and in some ways, so we think we have to do everything. Um nurses, I mean, if you you can look at it in a myriad affections. Law has parceled up how to get some of this work done. Nursing is parceled out how to get some of this work done. So you have nurses who are distributing some medications, you have other nurses, um nursing assistants and those kinds of things. So the notion of how do we tear the kind of practice that we're interested in having? And how do we how do we empower people at those various levels, providing the support that they need to go and do the work? Um I think it's a re conceptualization of what the social work practice really looks like and deciding that we don't have to do it. All right. And I think some of the issues around that is in terms of who, who who are the social workers and I know that's a big issue around the profession in terms of what we call ourselves, because everybody who does some sort of social service work says there are social worker and we are really trying to again, professionalized that term so that you need to have a degree in social work. So short of that for me, I think everybody can come to the table. Uh, I want to hear everyone's voice, but I think if we are talking about, you know, the profession of social work, then that needs to be folks who have a degree in social work. So, subsequent to this question is how do we get people to understand that had all interest? Sorry, how do we get people to understand that having good intentions doesn't mean their actions aren't creating negative impacts? Well, good question. I think it's a, it's a huge question with multiple, uh, answers. I think one in terms of just um, how do we hold people accountable? Um, it's going to happen in a more sustainable way through our supervision models. So how do we supervise, how do we hold people accountable? How do we help people to reflect on the work that they're doing? Um, and again, I've worked with, uh, what we used to call foster parents now, resource parents. And I can't tell you how many conversations I've had great intentions, wonderful heart. However, they didn't always get what needed to happen. It was kind of like from their perspective of what made sense. I had. I remember one parent said to me that she always wanted to, she wanted to sit on the bed with her foster Children and read nighttime stories and great, I mean, great intentions. Um, but not thinking about the fact that this is may, uh, you know, your foster child may have been sexually abused when that adults sat on their bed at night. So their experience of what you believe is a fabulous bedtime routine may be terrorizing to them. And so I think you need to have that what you don't see uh, in supervision to sort of deal with those blind spots. That's where the supervisor comes in and does that. But then you need to have a supervisor that can do that too. So that's the other part. So, okay. Um, yeah, I think ultimately, um, we're at this point where we need to close and so I just want again, um, Congratulate the organization on 33 years of this work. Um, it takes heart, it takes intentionality. It takes purpose and it takes something to be see beyond yourself and the service of the other. And so ultimately, and I'm loving every second of it. Um, we are the ones that are helping to build the civil society, right? Because your civil society is as strong as your most vulnerable and most marginalized and vulnerable populations dr ingram. It was not only a joy and a pleasure, it was a teaching moment for which I'll always be grateful. Um thank you. And now that is what time do you get your second cup of coffee at nine wake up on the west Coast? Right. Um so to all of the participants in the conference, many congratulations for seeing this work. Um, thank you very much for all that you do. Um the work is important and mhm. Be courageous, be honest, be intentional. Be strategic and purposeful in your work. Um sure. Be intentional in your work. And again, thank you. It was a joy to be. Thank you very much. Oh mm. Created by
