A Call to Action
Houston is hosting a nationwide HIV leadership summit in March-isn't it time we started showing some leadership?
by Dena Gray

The time to address HIV is now. In Houston, we are not doing this. We HIV advocates throw down the glove and challenge the city and the health department to start truly working to stop HIV from spreading-and the deadline is four months away.

The eyes of the HIV-prevention and -care community will be in Houston on March 2001, as our city hosts the Annual Community Planning Leadership Summit. Sponsored by the National Minority AIDS Council, the conference focuses on how we can work within our communities to stop the spread of HIV infection.

This is our chance to either show that we are serious about addressing this epidemic...or that we are going to continue to ignore it. Which one will it be? Only the city council, Mayor Lee P. Brown, and Dr. Mary des Vignes-Kendricks, director of Health and Human Services, can address that.

Yes, a state of emergency was declared by the mayor, but where are we one year later? Community leaders have asked the question time and again, that in a "state" such as we are in, where are we? Yes, we have encouraged more churches to get involved in this war. But have we put out the money to give their congregations somewhere to go? No. Yes, we have broadcast PSAs on HIV and ways to stop transmission-but how often has our city council and mayor addressed this issue publicly to show their support not only for the cause but for the people? Never. Have we looked at ways of increasing our HIV/AIDS service organizations' resources so that they can do more than provide "adequate" prevention methods? No. A Call to Action was published after the mayor's declaration-where are we on those objectives to date? I believe it is time for the mayor, city council, and the director of Health and Human Services to give the community an update on our accomplishments as well as shortcomings. What better time than during the 2001 summit?

If the mayor and city council are pleased with the actions that they have taken to date to address the severe need for increased HIV-prevention resources-and by that I mean dollars-then everyone should know about it. If we have met our Call to Action goals and have made a significant impact on HIV infection in the city, we should be talking about it. But we are not. So that begs the question, Why not?

The Community Planning Leadership Planning Summit provides Houston with the opportunity to prove its dedication on the war on HIV/AIDS. It gives the chance to encourage continued collaboration with community-based organizations and allows for a more aggressive and action-oriented approach as we enter this second year of "emergency." Let us treat it like an emergency. What will our response be?

Dena Gray is the director of volunteer services at Bering-Omega. Dena-along with Kevin Ballew, Harry Livesay, Theresa Southall, and Michael Peranteau-have put together an installation called State of Emergency at Project Row Houses in the Third Ward, 2501 Holman. As part of the project, they will be issuing a call to prominent African-American leaders to get tested for HIV on Nov. 12, including Mayor Lee Brown, U.S. Congresswoman Sheila Jackson Lee, United Way executive director Jackie Martin, NAACP executive director Yolanda Norman-Smith, state Reps. Rodney Ellis and Garnet Coleman, and director of Health Department Dr. Mary des Vignes-Kendricks.

What's Wrong With the "State of Emergency"?
An insider talks about who took action-and who didn't-to address the current crisis
by Steven L. Walker

For nearly a year now, Houston's African-American community has been under a State of Emergency, as declared by Mayor Lee Brown and County Judge Eckels last December. The declaration was made as current HIV-infection data indicated that nearly 61percent of the newly reported HIV infections were among African-Americans. Also released with the declaration was a State of Emergency Plan that outlined the epidemic and offered some immediate HIV-prevention strategies, including community mobilization, public information, and one-on-one education to raise levels of awareness to the disease.

At the time the declaration was made, I was manager of the city's HIV Prevention Program. Almost immediately after the mayor completed his address, I began answering the question, "Where's the state of emergency?" as many community members, HIV service organizations, and others expected more. Many persons seemed to expect a greater intensity, notwithstanding the increased radio, television, and billboard advertising and community awareness meetings that began in the months following the declaration. I said then and still say today that addressing HIV/AIDS involves a complex and comprehensive approach; Houston's HIV epidemic is entering its 20th year, and it's unrealistic to expect that substantial decreases in the infection rate will occur after just a few short months.

So what's wrong with the State of Emergency? In my opinion there are three critical issues. First, the lack of resources dedicated to HIV prevention. It's unfortunate that as the Declaration and State of Emergency Plan were being developed, the city was soon to announce a financial crisis and subsequent spending reduction across several city departments. This meant, in short, that we saw no increased allocation of funds specifically for HIV-prevention efforts. Aside from new grants received, the city's allocation to HIV prevention has remained relatively flat for nearly 10 years. This year, in fact, the city will spend more non-grant funds on office supplies than it will HIV-prevention efforts. At this critical juncture in the health of Houston, we have council members who still don't get it, and would risk further reduction in public health programs by proposing and approving a tax rollback at a time when the city can least afford it. Money is not the cure to HIV, but it can help spread the message via the media, and allow more organizations and individuals to provide the greatly needed services.

Second, there remains a void in leadership in the area of public health. In my view, the mayor, as he has done on other issues, deferred to the responsible city department for leadership-in this case, the Department of Health and Human Services. This is as it should be. By all accounts, our public health department should play a leading role in this struggle, as it is responsible for properly managing the community-planning process and disbursing millions of dollars in grant funds for HIV prevention. It is the duty of the public health department to set the standard, influence public policy, and unify providers.

In this regard, however, the public health department has fallen short of my expectations, and those of many in the community. I wish I could say that during my tenure at Health and Human Services, every decision made was done with the public's best interest and health in mind. Whether it is staffing plans, setting performance standards for all providers, or developing messages for the community, the proverbial too-many-cooks-in-the-kitchen readily applies. This would not be a problem if all the cooks agreed on the meal being prepared; it's disastrous, however, if one person, who with a lack of program knowledge and experience, declares herself the head chef and changes the menu, without consultation or advisement of the others. If I was not already bald, the amount of time I spent dealing with personalities and egos within the department would have truly caused me to pull out any remaining follicles.

Third, in my opinion, also unrealistic is the expectation that the mayor alone bear the burden of addressing HIV/AIDS. As I mentioned earlier, the Health and Human Services Department is responsible for maintaining the health of Houston. Yes, the mayor indicated in his State of Emergency address that he would attempt to incorporate HIV/AIDS-awareness messages in all major speeches. I have witnessed the mayor doing this at several key gatherings of African-Americans. He has also spoken rather clearly about the HIV/AIDS problem on several African-American radio programs. I have been equally impressed with HIV-prevention lectures delivered by Councilmember Jew Don Boney; at a concert in May, he delivered one of the best synopses of the problem and strategies of prevention (including condom use and early HIV testing) that I have ever heard from a non-health official.

This is where I personally drew the line. Neither the mayor nor any member of City Council are public health or medical professionals. I prefer that people specifically trained in this regard conduct HIV testing, education, counseling, and support groups. On several occasions, I challenged myself and staff to really understand our roles in addressing the epidemic. If the HIV infection rate continued to increase, we had to think seriously about restructuring our approach. The same is true of any community-based organizations that conduct HIV/AIDS programs.

If Houston is to be successful in eradicating HIV/AIDS from the landscape, it will be necessary to continue progress on a common goal: survival of the community. This requires collaborations and cooperation at a new level. Involvement of citizens in prevention-planning processes and engagement of people responsible for placing a true budget priority for HIV-prevention efforts, including council members, public health officials, and community representatives alike.

The former administration manager for the HIV Prevention Program of the Department of Health, Steve Walker is now executive director of the Donald R. Watkins Memorial Foundation. His opinions and views do not necessarily reflect those of the foundation.