Integration of Care Committee Meeting February 17th, 2021

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INTEGRATION OF CARE COMMITTEE

Danielle Beiling & Donald Powell, IOC Co-Chairs

Wednesday, February 17th, 2020, 10a-12p

Zoom Meeting

https://vimeo.com/514016889

Video of the meeting https://vimeo.com/514016889

MINUTES

Attendance: Danielle Beiling (co-chair), Donald Powell (co-chair) Janet Goldberg, Leo Ruiz, John Schoepp, Deborah Greene, Bill Gross, Mitchell Caponi, Stephanie Serafino, Paul Carr, Ronnie Fortunato, Billy Fields, Brenda Starks-Ross, Greg Bruckno, Michael Ealy, Dorothy Farley, Matthew Lesieur, Rose Chestnut, Annette Roque-Lewis, Randall Bruce, Micheal Ealy, Charmaine Graham,

Staff/PHS: Jose Colon Berdecia, David Klotz, Guadalupe Dominguez Plummer, Graham Harriman (Governmental Chair), Bettina Carroll, Kimbirly Mack, Ashley Azor, Cristina Rodriguez-Hart, Bettina Carrol, Rachel Crowley, Claire Simon,

Agenda Item #1: Welcome/Introductions/Moment of Silence/Review of Minutes

Conducted. Moment of silence led by Billy Fields. Minutes were accepted.

Agenda Item #2: Public Comment

Bill Gross invited us to SAGE’s showing of Tongues Untied in honor of Black History Month.

Agenda Item #3: Anti-Racism, Anti-Blackness and HIV Services with Tracie Gardner

Gender Affirmation & Intersectionality with Octavia Lewis

Tracie Gardner works with the Legal Center on issues of decarceration, racism and health equity. HIV highlights how the system is broken and inequitable. Racism and health systems, and silo-ing of substance use and mental health are pervasive to the country.

Criminalization of substance use and mental health has fed the cycle of incarceration. Community health & correctional health are inextricably linked. There is a refusal to acknowledge that criminal justice policies impact community health. Need to be grounded in history. Starting in slavery and reviewing all the laws over history to continue the oppression of Black people. Cannot think there are quick fixes because these issues are endemic and historically rooted.

Billions of dollars over decades and centuries directed to criminal justice over public health. Thinking about the fundamental divestment and destruction of Black bodies – the weakening of Black bodies and continued lack of access to interventions. Can’t get housing unless HIV+

Incarceration as a national drug policy – important to think about other agendas, such as Rockefeller drug laws and the disparities in prison sentences. When the mainstream is impacted – changes occur, including approach – crime or health issue.

Lack of preventative care – Medicare for all is overdue. Can’t close Rikers if it is a community health care center – which is it. 

The impact of COVID should not have been a surprise in NYC when you look at the maps of poverty, prison incarceration and HIV.

Harm reduction – recognition that the vilification of drug use is not useful. The churn of jail and prisons are destabilizing to communities. Fullilove discusses the community as a cell – and the need to ensure that health promoting systems are in the cell/community. Stigma is a form of oppression – thinking about Black harm reduction – reducing the harm imposed on Black people. 

Still struggling with how people have sex, use drugs, etc.

Octavia Lewis is a trans activist, scholar and mother.

Do definitions change? Why hasn’t there be more change?

It takes a long time to make change. 

The symbolism of progress has changed over time – understanding and impact of oppression has expanded.

Are not talking about the hunger and need that are happening in the communities we serve.

Think we have come a long way bc you can now take one pill a day – but if you’re not stable, mentally, or not housed- how helpful is a one pill a day regimen.

Not thinking about what it takes for people to make it into an appointment to access services.

We continue to treat people as if they have silo-ed systems in one body. Not holistic. HIV is a singular health issue that is so stigmatized we created a entire set of systems to protect people. But HIV has become medicalized – and the question is, can HIV practice help change the inequities around health systems.

You shouldn’t be able to access funds unless you can prove you can impact lives. Why is PrEP uptake so low among Black and brown people and women?

We should be putting ourselves out of this business instead of hinging investment on the existence of sickness.

Why don’t you get PrEP? Need to think about barriers to access present for the most impacted populations.

How committed are we to upholding these oppressive systems that pay us? How can we insert liberation into our work. 

Systems work together to oppress people – challenge of accessing housing if you have a record.

Privilege versus earned access. 

Only include people who can articulate themselves. Don’t want to sit across from the table from someone who will challenge us to be better. Want to change the system – hire those people.

Need to examine self-degradation among PWH. 

Excited to see health department try to enter community. 

We all bring bias and we need to have honest conversations and dialogue. Important to reckon with the policy decisions being made as these are what perpetuate oppression.

People are seen as a list of symptoms. Their co-morbidities. Housing go to housing program. Mental health go to therapy. Who has time to go to 5 different places – being ill is a job. Must document everything in Ryan White. System of evaluation does not lend itself to seeing clients as people – how do we truly measure if we are making people’s lives better – so we can move closer to treating people as a whole.

What can we do to create a service model that facilitates a better client experience.

This is making me think about vaccine hesitancy – thinking about how Black people have been mistreated and abused by the medical establishment. In the hood, people don’t want to access the vaccine in the hood, because they know what the history is.

This deficit based model makes us forget that we come from strength – that deficit lens must be undone.

Non-profits are about tax incentives/credits for the wealthy. It isn’t about healing. Always a deficit model.

In oppressive systems – we victim blame – so instead of addressing the system, we blame the oppressed. 

How do we take all of this and move forward. What do we measure differently – thinking about gender and getting that to be the standard. We want to see what we have built in HIV in the rest of the world. Now have a huge peer movement – the work peers do goes against the boundary discussions. Peers will talk to people at 10pm – case managers can’t do that. But we may be creating another structure of inequality in the peer model.

People are burnt out – no one checks on the people at the bottom. 

If we start to leverage our privilege and access and say to hell with the system and be committed to serving our most underserved. Every person living with HIV is not meant to be in social services – folks have dreams – this shift is necessary.

As service providers we often take one the role of the oppressor. Invite everyone to read Pedagogy of the Oppressed.

Could do breakout groups to further this discussion.

Agenda Item #3: Public Comment

No public comment.

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