Ending the stigma
Local healthcare leader shares personal story of combating HIV/AIDS in San Antonio
San Antonio’s week-long expansion of World AIDS Day is both a memorial and a reminder of the impact HIV is still having on people across the globe. It is also a time to remember loved ones who have died due to complications of the HIV/AIDS pandemic, which raged fiercely during the '80s and '90s before viral suppression therapy was ushered into the market.
San Antonio and the HIV/AIDS pandemic
There are an estimated 36.7 million people worldwide who live with the virus and over the past few years there’s been a considerable uptick in new HIV infections in the San Antonio area, according to the Centers for Disease Control and Prevention. The December 1 observance, which was started in 1988 by the ministers of the World Health Organization, has since expanded into a week-long observance called World AIDS Week, and continues to advocate, raise money, increase awareness, fight prejudice, and improve education.
It is also a time to recognize the stigma, isolation, and discrimination that remains a stark reality for people living with HIV. To address this, health organizations have created visibility campaigns beyond the red ribbon, campaigns that they hope will update the masses on discoveries that have helped people living with HIV thrive. An example of this would be the banners that read U=U, which is short for “undetectable means untransmittable.” This means that a person living with HIV who has an undetectable viral load (as a result of taking antiretroviral therapy) cannot transmit the virus to their partners, according to the National Institute of Allergies and Infectious Diseases.
Although we now understand so much more about the condition and have had scientifically sound breakthroughs, San Antonio still averages about 360 new cases of HIV diagnoses per year, according to a 2017 San Antonio Metropolitan Health District report.
While we celebrate World AIDS Week in December, local agencies, including the Alamo Area Resource Center, BEAT AIDS, the San Antonio AIDS Foundation, and other organizations, are working year-round on a grassroots level.
Every day, these organizations are providing support groups, clinics and collectives, HIV testing events, storytelling meetups, performances, lectures, fitness classes, luncheons, and social gatherings to San Antonians in an effort to enhance education and give support to the community.
But the mission to end HIV/AIDS — and the stigma around it — isn’t a sprint, it’s a marathon.
On the front lines
“I think we’re doing better,” says Marissa Espinosa at Alamo Area Resource Center. “But I do way more than that.” She then smiles as she hands me a business card with her official title: community liaison.
Addressing stigma, she explains, is now a priority. In fact, clinics and organizations are strategically compiling guidelines that manage the need to use more inclusive language when talking to patients and clients. “That’s a big deal that we’re doing that.”
“There are a little over 6,000 people who have HIV in the San Antonio area,” she says. AARC serves about 1,600 people living with HIV and in 2019, 17 people were newly diagnosed by the agency. AARC also provides services like housing, case management, psychiatry, and even health insurance programs to help people navigate through the copious amounts of paperwork. Even with private health insurance, premiums can be a financial challenge.
Espinosa explains that some people’s mistrust of institutions in general trickles down to a distrust of the medical care system. This feeling, she believes, isn’t entirely unfounded. “The medical system is not very kind,” Espinosa says. “There’s a lot of barriers within the system. We know them. We’re experts at them. We can help [clients] get in [and] get out. [We] basically hold their hand through that process until they feel comfortable.”
Espinosa began working in this field about 10 years ago, when she answered a Craigslist ad for HIV testers on the city’s West Side. Her job was to educate people who were actively using needles. She was trained to instruct them on how to safely inject and provide tips on how to take care of themselves. “Because you can’t just say, ‘Hey, stop what you’re doing,’” she says. “They’re not gonna stop.” Espinosa was also mindful of this while providing outreach to sex workers. “My job was to provide a safe space for people to come as they are help them reduce risk and get tested on a routine basis,” she says.
“I loved talking about sex and health and helping people who needed [to talk about this] the most,” she says. She was surprised, however, at the lack of education there was on the streets.
When Espinosa started working with AARC, she started doing outreach, which the organization defines as connecting with people who know they have HIV but they’re not in care.
“Sometimes all we had was a name or a phone number. If we were lucky, an address,” she says, adding that the search could, on any given day, lead her to a bar or a flea market. If she was able to find the person she was looking for, she could find out what was keeping that person from coming in for treatment. “[Because] stigma’s real, right? We are addressing that.”
“I outreached a heroin addict for two years before she had her first medical appointment,” Espinosa recalls. “If you’re not ready, that’s okay. But I’m going to keep visiting you.” When she finally came in and began treatment, she says the client soon became “virally suppressed while she was still using, which, to me, is incredible.”
“[San Antonio] is also a population [that] is ill. Because they are not in care, they will [likely] have an AIDS diagnosis,” she says. “Which is scary and even harder to for people to come into care when they’re at that point because of the stigma that’s associated with AIDS.”
The CDC defines an AIDS diagnosis when a patient has a T-cell count below 200 cells.
“We are the only clinic that has an outreach department. I think it’s a great program to have in our city,” she says.
“The message we’re really trying to get out there now is that treatment is prevention,” she says. “The better you take care of yourself, whether you’re positive or negative, that’s prevention. I get tested every three months. I’m aware of my risks. Whether it’s HIV, gonorrhea, chlamydia or whatever. Taking care of yourself is prevention for yourself and for those you love and for the community in general,” she says.
How you can help
Show your solidarity with the millions of people living with HIV by attending one or more of the following events.
World AIDS Day A Walk to Remember — December 4
The World AIDS Committee in collaboration with San Antonio Metro Health will present A Walk to Remember, a World AIDS Day Walk at Woodlawn Lake Park at Pavillon #2. Registration for this free event begins at 6 pm and the 1K illuminated walk will start promptly at 6:30 pm. Each participant will receive a ribbon and a battery-operated candlestick to show their community support. Follow the hashtag #iknowmystatussa and join others in the fight against HIV.
1103 Cincinnati Ave.
Trans Power SA World AIDS Day Mixer — December 5
Trans Power SA and allies invite you to attend World AIDS Day Awareness Mixer at Merkaba, an upscale lounge cozily located beneath Howl at the Moon Bar in downtown San Antonio. Enjoy free appetizers, music, and door prizes while mingling with local trans and community leaders. Everyone is welcome to this free event. Ages 21 and up. Casual, upscale dress is requested. 7-9 pm.
111 W. Crockett St.
World AIDS Day Blowout — December 7
World AIDS Day Dreamweek concludes at St. Phillip’s College with a boisterous party at the Turbon Student Center. This will be a fun-filled day for the whole family. Expect bowling games, ping pong, as well as food trucks and live entertainment featuring Haus of Plastik. Solo theater artist Anna De Luna will also perform excerpts from her highly-acclaimed show, The AIDS Lady. 11 am-3 pm.
1801 Martin Luther King Dr.