1. Status Neutral: The New Normal for HIV

2. Exploring biomedical interventions including PrEP, PEP, and TasP, and how they reduce stigma
I. Participants will gain a deeper understanding of biomedical interventions
II. Participants will gain proficiency in language that reduces stigma
III. Participants will gain proficiency in understanding the data regarding biomedical interventions and the story the data tells

3. What does Status Neutral mean?
Treatment as Prevention and Prevention as Treatment
Status Neutral Care Environment
Stigma and Disclosure
Improved Adherence and Self-Efficacy

7. Portion of Patients in Care with Suppressed Viral Load Using HIV Status Neutral Prevention and Treatment Cycle
Source: HIV Care Continuum Dashboard 2015, NYC Public Health

8. Undetectable = Untransmittable
PARTNER Study – AIDS 2016
1166 heterosexual and gay sero-divergent couples, not using condoms
Zero transmissions from over 58,000 times that couples had sex without condoms
The only instances of transmission were linked to sexual activity outside the couple
When a person living with HIV has an undetectable viral load, the risk of passing on the virus to another person is ZERO
Source: Rodger AJ et al for the PARTNER study group. Sexual activity without condoms and risk of HIV transmission in serodifferent couples when the HIV-positive partner is using suppressive antiretroviral therapy. JAMA, 2016;316(2):1-11. DOI: /jama (12 July 2016). Full free access.

13. Lets speak truth to power!...what do you think?
The effect of Status Neutral care on:
Stigma
Adherence to treatment
Disclosure to partners
Self-Efficacy
Quality of care

14. Language that Reduces Stigma
Person first language
Correct usage of gender pronouns, names, and terminology for body parts
Thoughtful sexual health dialogue
Avoid non-essential questions that could be potentially triggering
Avoid using labels for people

15. Language that Reduces Stigma

16. Gender Care at Kind Clinic
Gatekeepers vs. Informed Consent: Who Decides When a Trans Person Can Medically Transition?
“Informed consent is a medical provider laying out your risks and benefits, and the most current information they have about those risks and benefits, and giving you the choice about what to do with your own body. For me this is a basic human right, a matter of bodily autonomy,”
Marti Abernathey, Trans Activist.

17. The Benefit of a Sexual Health Dialogue vs Risk Assessment
Words matter:
The Benefit of a Sexual Health Dialogue vs Risk Assessment
Source: Safer Sex for Trans Bodies
Whitman-Walker Health and Human Rights Campaign Foundation

18. Integrated Clinical Care Model
Engaging a patient into clinical care by first meeting their primary needs, and then addressing other needs such as sexual health and wellness.
The Kind Clinic engages trans patients into care by first meeting their needs for hormone therapy. Then, they are also offered services for:
PrEP and PEP
STI testing and treatment
General wellness exams
Access to free counseling, case management, and assistance with name/gender marker change

19. Transgender Wellness Program Collaborative

20. Informed Consent for TGNC
Source: TGNC Card, a collaboration between Fenway Health Institute and the Trans Masculine Sexual Health Collaborative

21. 1400+ Unique Patients Kind Clinic Successes 91% identify as LGBTQ+
70 Transgender/Gender Non-Binary
37% identify as Hispanic/Latino
35% are Uninsured
45% make less than $45k
94% identify as Male
31 Average Age
1400+
Unique Patients

22. Potential Barriers to Status Neutral Care
Can you think of any drawbacks to this model of care?
Can you think of any potential challenges in incorporating Status Neutral care?
What are some ways we can address those barriers?

23. Wrap-Up Questions
How do you feel about Status Neutral care and the U=U campaign?
How can you incorporate a Status Neutral care environment with your clients?
Potential wokshop opportunity

24. Thank you. Joe McAdams joe@texashealthaction
Thank you! Joe McAdams Sarah Palmer, MPH