End the Epidemics Strategy Meeting Proceedings

November 2, 2022

End the Epidemics (ETE), a statewide coalition that advocates for anti-racist policies and funding opportunities to eliminate health inequities and end the epidemics of HIV, STIs, viral hepatitis, and overdose in California, convened on November 2, 2022. This strategy meeting, with support from the California HIV/AIDS Policy Research Centers and ViiV Healthcare’s Positive Action Community Grant program, helped bring together 80 academic, community, government, and public sector partners to Los Angeles, CA. Proceedings highlight key syndemic priorities for the coming year.

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Authors

Southern California HIV/AIDS Policy Research Center

Background

End the Epidemics (ETE), a statewide coalition that advocates for anti-racist policies and funding priorities to eliminate health inequities and end the epidemics of HIV, sexually transmitted infections (STIs), viral hepatitis, and overdose in California, convened on November 2, 2022. This Strategy Meeting, with support from the California HIV/AIDS Policy Research Centers and ViiV Healthcare’s Positive Action Community Grant Program, helped bring together academic, community, government and public sector partners to Los Angeles, California. Eighty (80) stakeholders from across the state participated in the meeting, bringing forward priorities to address these intersecting epidemics. Meeting participants represented a wide range of stakeholders, including community organizations, advocates, people with lived experience, providers, and public health staff. Participants also included members of the ETE Grassroots Fellowship Program. These Fellows, representing a diverse range of community constituents, receive mentorship and support to develop and execute grassroots advocacy activities and campaigns.

Summary

ETE’s policy priorities center first on the lived experiences of participants and communities they represent. As shared during World AIDS Day 2022, the Community Reflections portion of the convening helped to identify gaps in efforts to address the needs of those most vulnerable and helped facilitate a process to center experiences of marginalization. Participants were asked to consider a syndemic approach, one that not only considers health outcomes associated with multiple disease states but also investigation of the constellation of factors that affect risk, including the social, economic, environmental, temporal, and political contexts.

Policy Context

A summary of the political landscape was shared at the convening. The 2022 midterm election results reinforced California’s image as liberal vanguard. The California legislature is more diverse than it has ever been with roughly 50 seats held by cisgender women in the Assembly and Senate combined. The legislature has arguably achieved proportional representation for LGBTQ+ populations in the state, with 10% of seats being represented by out LGBTQ+ politicians.

Governor Gavin Newsom, who by some accounts appears to be signaling ambitions for the Presidency, won his bid for reelection. State Senator Toni Atkins (San Diego) will continue as Senate President Pro Tempore, continuing as the State’s first out lesbian elected official to hold the office. Assemblymember Anthony Rendon (Los Angeles) will continue as Speaker of the Assembly until Assemblymember Robert Rivas (Salinas) assumes the role on June 30, 2023. The change in leadership will have significant implications for key committee assignments covering health and other key issues. Locally, Karen Bass made history, elected to be the City of Los Angeles’ first Black woman mayor.

Fiscal Forecast

Budget advocacy was facilitated by California’s record budget surplus in 2021-22. Due to noticeably weaker income taxes, on top of inflation, high interest rates, and the threat of recession, the state predicted a $25 billion deficit by the end of 2022 and into 2023-24. It may choose to access emergency reserves or to cut spending in the near future. This likely means public health funding will be harder to secure in the coming year.

Priority Setting

Participants engaged in a process to identify priorities and raised key issues of concern.

Harm Reduction: Harm reduction was a recurring theme at the convening. Participants shared recent experiences with the Orange County Needle Exchange Program closure in 2018 following a lawsuit from the Orange County Board of Supervisors. This closure left thousands of Orange County’s most vulnerable without access to necessary healthcare (McCullen et al 2021). Participants called for continued funding of the California Harm Reduction Initiative (CHRI), a partnership of the California Department of Public Health and the National Harm Reduction Coalition. Formed in 2019 with $15.2 million in funding to strengthen syringe services programs, this was the largest investment in harm reduction in California history. ETE partners proposed the following strategies:

$20 million in funding for innovative demonstration projects around harm reduction
Increased harm reduction funding around linkage to HIV and hepatitis testing and treatment
Identification of statewide hotspots for HIV through a racial and economic justice lens
Inclusion of viral hepatitis services with harm reduction services as affected communities overlap
Expanded mobile services for comprehensive sexual health services and Medication- Assisted Treatment (MAT)

Focus on youth and young adults and exploration of further treatment modalities tailored to the needs of Black, Indigenous and People of Color (BIPOC)

STIs and Sexual Health: Given the state’s current political landscape, some participants said they believed California can pave the way for the rest of the nation by prioritizing STIs and sexual health services. Key recommendations included the following strategies:

- Increased resources for STI prevention and treatment
- Increased funding for pilot programs including reimbursement for providers delivering uncompensated STI prevention and care to communities most vulnerable to STIs
- Increased funding to ensure sex education is comprehensive across the board, with a focus stigma and impacted populations (e.g. LGBTQ+, BIPOC, youth, low income and other affected communities)

Related Concerns: Related concerns included behavioral health services, transgender health and gender-affirming care, and housing. Participants recognized how each of these factors into a syndemic framework:

- Participants noted the pervasive nature of behavioral health challenges and how they intersect with HIV, STIs, viral hepatitis, and substance use
- Gender-affirming care encompasses a range of social, psychological, behavioral, and medical interventions designed to support and affirm an individual’s gender identity when it conflicts with the gender they were assigned at birth. ETE participants expressed interest in continuing to support state efforts to preserve and facilitate delivery of gender-affirming care.
- The Housing First approach is guided by belief that people need basic necessities like food and a place to live before attending to anything less critical, such as getting a job, budgeting properly, or addressing substance use issues. Participants recognized that this work coincides with the CalAIM initiative led by the California Department of Healthcare Services.

Participants stressed the importance of collaboration and supporting existing coalitions and efforts to address these issues, including aligning ETE priorities with administrative priorities (e.g. CalAIM, behavioral health, and housing)

Approach

Ending the HIV, STI, viral hepatitis and overdose epidemics remains a public health priority for all Californians. Participants stressed the need to integrate a social determinants of the health framework and to center racial equity into the ambitious response. In California, the communities bearing the disproportionate burden of these syndemics are Black, Indigenous, and People of Color (BIPOC), as well as sexual and gender minorities who continue to experience identity-based discrimination, racism, homophobia, transphobia, xenophobia, and stigma, making it harder to live, work, and thrive. Participants discussed how promoting the well-being of BIPOC and LGBTQ+ communities requires a robust response reflective of community input. They envision a stigma- free society where individuals living with these conditions feel dignified and empowered to access routine prevention, treatment, and care services which requires reimagining our existing public health approach and improving the circumstances within these environments. Specific approaches discussed by participants included the use of equity building language and actions in bill and budget proposals, ensuring the health of BIPOC Californians is prioritized, advocating for equitable access to state funds for grassroots BIPOC organizations, and facilitating administrative efforts to address funding and programmatic siloes at the state level.

Next Steps

ETE leadership discussed next steps following the convening. Information pulled from the strategy meeting, including recommendations on budget priorities developed by participants, were shared with the ETE Policy & Advocacy Working Group. The Working Group is refining the coalition’s 2023 policy priorities, taking into consideration the upcoming challenging economic environment in California. It will present its recommendations for ETE’s policy priorities in an upcoming ETE coalition call. With coalition feedback, the Working Group aims to finalize and share the 2023 policy priorities and strategy in early 2023.

The ETE Community Engagement Working Group, including ETE Fellows, will design and implement grassroots strategies, providing all coalition members the opportunity and resources to advocate directly with their own elected representatives in support of the policy priorities. These activities will be timed to ensure legislators are hearing from advocates during critical times in the legislative and budget process. Potential grassroots strategies to build community power were presented to meeting participants.

All participants were encouraged to join the membership of ETE and the Working Groups to participate in future discussion. Any questions about the ETE coalition and next steps can be directed to Ryan Clary at ryan@eteca.org.