Palladium Senior Monitor and Evaluations Advisor Hanna Tessema reflects on her experience as a speaker at the 2022 U.S. Conference on HIV/AIDS in Puerto Rico.

Just weeks after Hurricane Fiona hit Puerto Rico, 3,000 people convened in the capital of San Juan for the 2022 United States Conference on HIV/AIDS (USCHA). The annual conference, and the largest U.S. based conference on HIV, hasn’t taken place in person since 2019, so this was a true reunion for those of us who have become family working as advocates in HIV/AIDS. The conference organizers worked closely with the local host committee to make the difficult decision to hold the conference in the wake of the hurricane’s devastation in the southwestern part of the island.

Knowing that the meeting participants filling hotels rooms and patronizing businesses at a volume unseen since before COVID-19 would ultimately be a boost to the economy, the Executive Director of National Minority AIDS Council (NMAC) noted that “When the local host committee said to move forward, NMAC knew we had to fight for Puerto Rico like we fight for all the communities highly impacted by HIV.”

Conference sponsors and participants rallied to join the fight, too. My fellow participants and I put together supply bags with necessities for those impacted by the storm at a leadership event sponsored by Gilead, who also committed US$500,000 to HIV service organizations in the South and West. Participant donations totalled US$20,770 to a local organization Coaí, to support people living with HIV impacted by Fiona, and to be matched by NMAC.

A Celebration of Puerto Rican Culture

This conference, organizers thoughtfully put the local community at the center of nearly everything, from each activity, meal, and performance. The intentional acknowledgement of Puerto Rican culture throughout the conference should be a model for convening groups in the future.

Not only was the local host committee consulted for major decisions but also co-created the conference agenda. We honoured Puerto Rican culture and island history through all of the music, storytelling, and performances – complete with features by Puerto Rican performers and recognition of Puerto Ricans in the fight against HIV in the US. Spanish was the primary language of larger plenary sessions, with translation headsets given to non-Spanish speakers – usually we see the other way around at large American conferences.

A Focus on HIV & Aging

An important and new trend was the growing emphasis on HIV, aging, and long-term survivors at this conference. I noted five sessions on aging, a marked improvement from one of the first conferences I attended 15 years ago when very few, if any, spaces were created for discussions on HIV and aging. But attention on this issue is due – over half of the people living with HIV in this US are over the age of 50, and around three-fourths will have aged into this category by 2030. This is thanks to success with antiretroviral therapy, taken as both treatment and prevention, extending lifespans well beyond the early years of the epidemic.

However, more spaces and discussions are needed to unpack the issues that accompany the 50+ age group.

For instance, many older adults living with HIV also live with other illnesses, and just as experienced by the broader aging US population, this warrants expanded training for medical providers, and increased information and support to the folks managing multiple illnesses simultaneously. Along with this comes the complication of inappropriate polypharmacy or taking too many medications that can lead to adverse outcomes. Not only can this be challenging for the folks needing to take many medications daily, but there are real dangers that could come with the lack of communication, coordination, and continuity in care between geriatric care providers and HIV specialists, like taking contraindicated medications.

It can no longer be ignored that the majority of people living with HIV are older, and they should be brought into conversations that support their quality of life. For example, Pre-Exposure Prophylaxis, or PrEP, a preventive medication for HIV, is largely marketed to younger populations at risk. Ageist assumptions that older adults are not as sexually active or at less risk of contracting HIV should be reconsidered. Additionally, older adults living with HIV need social support and outlets for connection, because isolation, loneliness, and depression are common among this age group.

While recognition of aging with HIV is becoming mainstream – I was happy to see continued support through conference scholarships awarded to people over 50 – progress on this path must continue so we can work through these complex challenges that are critical for ending the HIV epidemic.

Highlighting Anti-Racist Approaches to Care

Another noticeable theme in the conference sessions was an intentional focus on anti-racist approaches to health and HIV care. Multiple sessions focused on practical ways to advance health equity and improve clinical care experiences, highlighting a need for inclusive and anti-racist communication, creative and uplifting arts, using dignified, respectful, and appropriate language, and protecting Black women.

Black women commonly experience injustices like not being listened to, believed, or adequately medicated for pain. My presentation focused on advancing health equity through clinical care, delivered to an audience of predominantly Black women. My hope is that these important discussions will be centered in larger spaces, with more mixed crowds in the future, so that we can all work together to advance health and racial equity.

Marching Ahead

It was a joy to reconvene with leaders in HIV/AIDS this month and I was proud to see the conference organizers taking an inclusive approach to convening groups, which should be an example for others in public health working to advance health equity. While there has been more of an emphasis on HIV and Aging and the population of older adults living with HIV grows, it is important that we continue to create spaces for more in-depth discussions on this very important topic.

And as we continue to advance health equity in the U.S., it is critical that we remember there is no health equity without racial equity.

USCHA has allowed for conversations around anti-racist approaches to care to move the needle forward, but my hope for the future is that we see more diversity in racial makeup and in the sectors we represent (e.g., public, private, non-profit, etc.) in the audiences. It is only through multisectoral learning and collaboration that those of us with an interest in advancing health equity can fill gaps with innovative solutions.

Read 'Woman Possibly Cured of HIV: What Does it Mean for New Treatments?' and for more information, contact info@thepalladiumgroup.com.