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David Phillips

David Phillips

David Phillips is a native of the Washington, DC area and is a subject for studies of HIV long-term non-progressors at the National Institute of Allergy and Infectious Diseases/NIH. After a prolonged seroconversion illness at 17, he chose willful ignorance of his HIV status for almost 20 years due to a difficult prior neurosurgical history. David currently pursues a Master of Public Health majoring in epidemiology at the University of Maryland. His research interests include secular trends in depressive symptoms among people living with HIV and the impact of variations in standards of care on the health of HIVers in resource-poor communities. Follow him at twitter.com/bigolpoofter where he often tweets photos of culinary creations with hashtag #foodporn. 

Photo credit: "Metro Weekly", DC's LGBT nightlife magazine

Aug28

Watch your language

Thursday, 28 August 2014 Written by // David Phillips Categories // International AIDS Conference , Conferences, Health, Sexual Health, International , Opinion Pieces, David Phillips

David Phillips reports from AIDS 2014 on how our community is grappling with calling those groups most at risk for HIV – or should we just be talking about behaviours?

Watch your language

In the days leading up AIDS 2014, several friends and I contemplated what the buzzwords of the conference would be.  Amid the tension between human rights and disease prevention and treatment, it seemed that NGOs and local organizations were warming again to the need to address individuals as individuals with unique needs -- I know, the horror! - -not simply as members of demographic groups with little consideration of the intersection of identities in each living, breathing human. 

The thrill of referring blithely to “MARPs” (most at-risk populations) was finally fading almost three years after UNAIDScautionedagainstit, though seventeen conference abstracts employed the term without redaction or penalty.  Some new term would surely rise in its place amid the plethora of HIV universe buzzwords, though it must reflect a changing paradigm in portraying the needs of individuals living with HIV and those most vulnerable to the disease. 

We decided, this year’s password was “person-centered.”  Person-centered. 

Peter Aggleton’s blistering keynote at the MSM Global Forum pre-conference gave us hope that, although “getting to zero” might be a dream deferred for yet another decade, change may be coming in the ways in which the research, funding, and policy sectors lead others to describe the groups of people of greatest concern for HIV prevention and treatment. As a Gay male Australian academic, Aggleton recounted how Gay and Bisexual men built organizations with their allies and successfully drew attention from all quarters to HIV in the face of heavy losses --”We even created safer sex!” It wasn’t long, though, until an HIV industry, academics, and government bureaucracies created HIV-related agenda that ceased to align with the goals and desires of Gay and Bi men.  Now was the time for Gay and Bi men--and people living with or vulnerable to HIV, by extension - -to re-insert ourselves into the formulation of studies and policies in a meaningful, empowered, and fully participatory manner. 

The opening plenary of AIDS 2014 made clear that, while the “Getting to Zero” charge was being replaced with a more specific “90/90/90” set of goals based on the treatmentcascade, global HIV bureaucracies would perpetrate a new umbrella term as homogenizing as and potentially more sanitizing than MARPs:  Key Affected Populations (KAPs). 

The recoil from many HIVers was immediate; yet, for five days we were bombarded by KAPs, KAPs, KAPs, KAPs.  Apparently, naming sex workers, women, youth, incarcerated persons, persons who inject drugs, trans* persons, and Gay and Bisexual and other men who have sex with men was just too much for UNAIDS and others.  To quote DeNiro, “Mephistopheles is such a mouthful in Manhattan, Johnny!” 

Although UNAIDS had previously cautioned about MARPs and derivative terms, “[they] should be avoided because communities view them as stigmatising. It is more appropriate and precise to describe the behaviour each population is engaged in that places individuals at risk of HIV exposure,” KAPs was meant to be something else. So, let’s see….

Homogenizes the concerns and risk factors prevalent among very different groups?  Check!

Obscures the identities and practices of these groups?  Check!

Stigmatizes those groups, as if none others might be affected by HIV?  Check! 

Thanks for the new catchphrase, UNAIDS, but I’ll keep spelling out the diversity of the challenges we face.

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