Louisiana has a deep history and unique culture formed over centuries, marked by trauma stemming from causes such as too many devastating hurricanes (including several during the writing of this plan) and systemic racism dating back to our beginnings during the Trans-Atlantic Slave Trade. !at same history has also made Louisiana a beautiful melting pot of Black, French, Spanish, Haitian, African, and Indigenous people that has given rise to Creole and Cajun cultures, including our own languages and cuisine. !at history has also birthed musical genres and styles of dance from Jazz to Bounce and Zydeco, Second Lines and Mardi Gras Krewes, and so much more.

Today, Louisiana is known for many things —its food, music, and football, to name a few. But most of all, it’s the people that make Louisiana so special. It is perhaps because of the unique shared adversity that comes with living in a place like this, namely the frequency of storms and the impacts they have on our homes, health, and livelihoods, that Louisianans are the type of people who will always help a neighbor in need and who are always ready to celebrate life together.

This plan was written with these people —our communities—in mind, and with our history and the unique landscape in which we live guiding our strategy. Louisiana has made some major progress over the past several years when it comes to HIV. Last year, the Office of Public Health announced that the number of people newly diagnosed with HIV in Louisiana had declined over 20% in the past four years from 1,124 new cases in 2016 to 989 in 2018, and 891 in 2019. 2018 was the first year since 2005 that there have been fewer than 1,000 new HIV diagnoses, and the downward trend we saw in 2019 has brought us to the lowest number of new diagnoses since the epidemic began in the 1980s. However, we still have a lot of work to do in order to meet 2030 targets. According to the CDC, Louisiana ranked 4th in the nation for HIV case rates in that same year. Stigma and misinformation still work to slow our progress, as do difficulties in accessing testing and treatment services.

The five-year plan laid out across the following pages reflects the collaboration of so many individuals, community-based organizations, and a variety of stakeholders from around the state. We will take you through our guiding principles, our overarching goals, the process that brought us to this point, and how you can join the movement and Get Loud too. We will then outline our objectives and strategies in five focus areas, highlighting the amazing work and experiences of people living with HIV (PLWH), healthcare workers, and advocates doing the work across Louisiana along the way.

Public health practitioners and community advocates began conversations of taking on an Ending the Epidemic Plan in Louisiana in late 2017. However, when the decision was made to embark on the development of an EtE plan, the Louisiana Department of Health wanted to be intentional about meaningful involvement of the community, particularly PLWH. They began a search for a community-based organization to lead the charge. About one year later, in 2018, they enlisted the help of Women With A Vision, a social justice organization with roots in the early days of the HIV Epidemic and 30 years of history working with communities of color and marginalized populations, to gather community input and ensure a community-driven process.

The process was reinvigorated when 70 providers, community members, advocates, and public health workers from around the state came together again at a statewide meeting in Lafayette in January 2019 to identify barriers, priorities, and solutions for how to improve the lives of those living with, and impacted by, HIV and how to End the HIV Epidemic in Louisiana.

Between March and July 2019, the team traveled across the state holding a series of community conversations, or Front Porch Talks, with 15 groups in six cities, including Baton Rouge, New Orleans, Lafayette, Lake Charles, Monroe, and Shreveport, to gather feedback to inform the statewide EtE plan – and to recruit community members to engage at all levels of the planning process, by joining subcommittees focused on our five priority areas, as well as our coordinating bodies, the Steering Committee and Core Team.

Key themes arising from the Front Porch Talks would form the backbone of our plan and can be seen throughout our plan. Examples include a need for community education around HIV and safer sex practices, improved transportation services, stable housing, more holistic approaches to care, better availability of information on where to access care and other resources such as mental health care and substance use supports. Stories of stigma and discrimination were widespread, including in medical settings, and reinforced our need to focus our sights on stigma reduction before all else.

The team then entered a stage of synthesizing feedback from community meetings and committee meetings to begin drafting the goals, strategies, and activities that would become our Statewide EtE Plan. A second statewide meeting was held in November 2019 to bring participating members back together to spend time developing our objectives in workgroups.

Throughout 2020, subcommittees met to continue drafting strategies and activities for both a detailed work plan and the community plan you are reading today. Working during the COVID-19 Pandemic certainly changed the course of the work in many ways. Our team had intended to revisit the groups we met with during our Front Porch Talks to provide updates, and planned for five in-person town hall meetings around the state to share our work with new stakeholders.

Instead we offered virtual community conversations to debrief around how COVID-19 was impacting our communities and held two virtual town halls and an online public comment period in the Spring of 2020 to share our draft plan with a broader audience and to give community members the opportunity to let us know if we were still on the right track. With positive feedback, we moved forward to refine both our community-facing plan and a detailed work plan that will be used to guide our way as we move into our implementation and monitoring and evaluation phases.

Ending the HIV epidemic in Louisiana is less about ending HIV than it is about addressing the intersections and social determinants of health which drive the epidemic. Today, HIV is a manageable chronic condition and those taking effective treatment live long, healthy lives. Additionally, people living with HIV who have a viral load of 200 or less have no risk of sexually transmitting HIV to a partner.

Working to end the HIV epidemic means working with advocates and communities across Louisiana to address racism, poverty, homophobia, transphobia, sexism, ageism, education reform, policing and criminalization, reproductive justice, immigration reform, HIV criminalization, and so much more. Each of these areas serve as drivers of the epidemic by oppressing communities, entrenching systemic inequities, furthering stigma, and, ultimately, embedding barriers which prevent people from accessing HIV prevention and treatment services.

Addressing each of these drivers of the HIV epidemic will allow for a reduction in the number of new HIV diagnoses by expanding opportunities for all people to access critical prevention, treatment, and social services. We have the tools to end the HIV epidemic and whether HIV advocacy has been your life’s work, or you have never even considered how HIV impacts your community, WE NEED YOU! The time to end the HIV epidemic is now, but we must be intentional about creating mechanisms to coordinate, collaborate, and work across intersectional movements. Our ability to succeed in ending the HIV epidemic is fundamentally linked to the establishment of equity across the various systems and structures that are currently driving the epidemic.

We know that systemic racism has long impacted access to opportunity, financial stability, and quality healthcare. We must address the varied impacts of racism by bringing equity to educational institutions and employment practices both within the field of HIV and beyond. We must demand that our public health leadership, healthcare and service providers work to examine health disparities and overcome biases that negatively impact people of color; and we must hold partners who fail to work toward anti-racism accountable for those failures.

Financial security and stable housing are necessary to provide the security from which a person can take care of their essential needs, including their healthcare. Access to housing and living wages reduce behaviors that put people at risk of acquiring communicable infections, of experiencing violence and poor health outcomes. We believe that housing is prevention, and will stand with those fighting for economic justice and housing the houseless to help our communities achieve that security and wellbeing.

Stigma and discrimination based on gender identity and sexual orientation are still pervasive in our country. In Louisiana, LGBTQ+ persons are still not protected against discrimination under the law. Trans women of color continue to experience disproportionate rates of violence against them, including homicide, compared to other groups2. We must work in tandem with advocates in the LGBTQ+ movements to continue to demand equality and to create trans- and queer-inclusive spaces within the organizations in which we work, the communities in which we live, and the services which we provide.

We understand that power dynamics and gender-based expectations rooted in our patriarchal system still create challenges for women trying to advance in their education and careers, result in their making 81 cents to every man’s dollar3, and leave them more vulnerable to sexual abuse, harassment, and intimate partner violence. Expectations of masculinity also lead to participation in violence, reduced likelihood to utilize mental health services, and higher rates of suicide among men. We will stand with partners and policymakers to create balance, close the gender pay gap, and dismantle toxic masculinity.

We stand with the Reproductive Justice Movement, as ours is inextricably linked. We know that the right to bodily autonomy, to decide when and if to have a family, and the ability to raise your family in a safe environment intersects with all other aspects of our lives. Reproductive Justice is about access to contraception, STI testing and treatment, and comprehensive sex education. It is about the ability to make a living wage, to afford and access childcare and the creation of spaces that support parents and families, and so much more.

The policing of poor people and communities of color has long factored into economic and health disparities. !e criminalization of drug use, sex work, and disproportionate incarceration of and police violence against Black people has devastating, generational impacts on communities. Louisiana has, for many years, held the title for highest rates of incarceration in our country, making this commitment to work with advocates and activists calling to rebuild our justice and policing systems that much more important.

The criminalization of HIV and other health statuses leads to further stigmatization of HIV and is antithetical to both the science of transmission as well as to the promotion of testing or status disclosure. It has detrimental impacts on prevention, health outcomes for people living with HIV, and is weaponized against people living with HIV to deliver harsher sentences for unrelated crimes. We must work in coalition to stop the criminalization of HIV to allow people living with HIV to do so without fear of persecution and as a key step to ending the epidemic.

In addition, we will stand with those fighting for more just immigration reform and education reform that better prepares our youth for the future, those fighting ageism and working for the
security and dignity for our aging population, those continuing the hard-fought battle against ableism, and all those working to gain and preserve human rights in their myriad ways.

With the prevention and treatment options we have today, new HIV diagnoses and HIV-related deaths could both be rare. What continues to propel HIV to epidemic levels is how each of the factors laid out above have worked together to create the inequities inherently responsible for preventing people from accessing critical services. In that vein, we must strive to act together and across movements to end systems of oppression which have resulted in the health inequities and disparities that are so apparent in the HIV landscape.

We know that people living outside of our major cities face unique barriers to accessing care and services, maintaining confidentiality, and dealing with stigma and discrimination. While historically resources have been more limited in our rural communities, one of our goals is to center smaller cities and rural communities in our efforts to End the HIV Epidemic.

We believe that public health funding, resources, policy, and programs should be informed by both the data and the community. We need to improve data sharing and utilization, while maintaining and respecting confidentiality for our clients and residents. We have to measure what we don’t know, monitor our progress, and allocate funding and resources based on need. We must advocate for policies that both allow us to implement solutions that work for the community and allow us to reach our target outcomes.

We know that we have work to do, and we know we can’t do it alone.

HIV has been a part of our lives for over four decades and though we make advances in treatment and prevention methods every day, systemic barriers continue to hold us back in our goals to ensure health and wellness for people living with HIV and to eliminate new transmissions. !e barriers we face can no longer be solved by science alone, or by the small but mighty community of advocates, providers, and public health workers in the HIV sphere, alone. We cannot eliminate poverty, house everyone experiencing homelessness, or rid our service providers of racism, homophobia and transphobia, alone. We cannot educate our entire populace about safer sex and testing, nor erase the stigma ingrained in their minds, alone.

As you can see, many of the strategies we have laid out depend on engaging others and finding allies across different spaces in our communities. We will need to expand our partnerships and work hand-in-hand with policymakers, educators, law enforcement, primary care and mental health providers, housing advocates, disability rights activists, faith leaders, community gatekeepers, and everyone in between.

Society at large still harbors too many harmful beliefs that keep PLWH living in fear and silence. We need those allies who feel safe in doing so, to break that silence and get loud
by starting to talk to their friends and families – about sex, HIV, and STI prevention. Only then can we end the stigma that prevents people from ge”ing tested or seeking treatment, and isolates people from their support systems. Only then can we End the Epidemic. So, as we move forward into implementing our plan, we are going to need you to come along… AND GET LOUD ABOUT IT!