In early 2008, the Philadelphia Department of Health released HIV and AIDS in Philadelphia, a report that sounded an alarm for health care activists and community members. The statistics revealed that Philadelphia’s HIV/AIDS incidence rate was the highest in the city’s history.
To make matters worse, infection patterns seemed to follow the path of other disparities that were already challenging Philadelphia’s population. African Americans accounted for two out of every three cases of HIV/AIDS at a time when the group was already struggling with a poverty rate of 31 percent.
Determined to make a difference in a community in crisis, Zupenda Davis, DrPH, MPH, MCHES, a training specialist for the Pennsylvania/MidAtlantic AIDS Education and Training Center at the Health Federation of Philadelphia at the time, decided to also put her skills to work for a local initiative sponsored by the Black AIDS Institute.
"I became an advocate to increase awareness about various social factors—poverty, racism, incarceration, etc.—that increase people of color’s risk for HIV/AIDS. I took on a leadership role at the organization’s Black Treatment Advocates Network to help get out the prevention message," says Davis, a graduate of the Robert Wood Johnson Foundation (RWJF) Project L/EARN program (1994).
"We brought people together for educational sessions about prevention, treatment, related health risks, and helpful resources. In 2011, I even had the privilege of traveling to the XIX International AIDS Conference and bringing the latest prevention and treatment information back to Philadelphia."
In a December 2, 2013, ceremony commemorating World AIDS Day, Davis received a Red Ribbon Community Leader Award from the Community Advisory Board of the University of Pennsylvania’s Penn Center for AIDS Research. Before a standing-room only audience of her peers at Philadelphia’s City Hall, she was honored for her outstanding leadership in HIV/AIDS education and advocacy.
A Lifelong Commitment to Tackling Disparities
Davis says she started investigating the AIDS epidemic as a student. “I began to see the impact that HIV/AIDS was having on Black women and Black heterosexual men, and decided to study the situation for my dissertation.”
But she credits Project L/EARN, in part, with her pursuit of an advanced degree in public health. Project L/EARN is an intensive, 10-week summer internship for undergraduate college students who are from socioeconomic, ethnic, and cultural groups that have been traditionally underrepresented in graduate education. Over the past 23 years, 190 students have participated in the program and 150 of them have gone on to graduate school.
"I may not have gotten my MPH without the program because it taught me the skills needed to conduct research." Davis says. "It also made it possible for me to have Kaplan training for the graduate record exam. I would not have been able to afford it on my own."
Ongoing Need for Outreach
Davis was excited about receiving recognition for her efforts, but she remains deeply concerned about the work that still needs to be done. "HIV/AIDS is off the radar for many people. There’s a sense that we have solved the problem, perhaps because of the new, highly- effective treatments. But there’s also a sort of AIDS fatigue—people say, ‘Are we still talking about this?’"
New antiretroviral therapies have turned HIV/AIDS into a chronic disease for many, but there are also people who cannot tolerate the new regimens. And while advocates such as Davis have certainly made a difference, Philadelphia’s HIV/AIDS crisis is far from over. The city’s Department of Health reports that as of 2013, 800 to 900 new HIV infections are reported each year.
Davis hopes that the lessons and legacy she has left behind (in October she became the director of the Bachelor of Science in Public Health Program at the La Salle School of Nursing and Health Sciences) will help to turn the tide. She shares her advice for others who will take on the work.
- Involve the community. "It is absolutely critical to talk to community members and let them tell you what kind of information they need to understand the epidemic. Let them be a part of your training and education team," Davis advises.
- Policy must address financial barriers. "One of the most powerful prevention tools we now have is Pre-exposure Prophylaxis–[PrEP] or Post-exposure Prophylaxis–[PEP] [treating people with the drug Truvada or a combination of HIV medications to prevent new infections]. Yet one of the most pressing issues for providers is where will the money come from when you want to prescribe PrEP or PEP? Existing medication coverage is for people who have already tested positive for HIV," explains Davis, who spearheaded a workgroup that attempted to design a PEP protocol for Philadelphia. "Some clinics create a relationship with a pharmaceutical company to get the drugs, but that’s not comprehensive. A protocol adopted as a standard of care, increased awareness, access to PEP, and financial resources to cover uninsured candidates are needed."
- Draw on grassroots resources. "When it comes to HIV/AIDS education at the community level, the presenters should be from the community. We worked with consumers, advocates, local HIV care, treatment and prevention providers who really knew how to communicate with people. People trust them and are more willing to ask them questions," Davis says.
She also expresses optimism about the ongoing HIV/AIDS epidemic in Philadelphia. "There seems to be an increase in testing and a much bigger push to get newly diagnosed people into treatment and other services. I can also see an increasing awareness of the impact of AIDS among providers and community members."