December 1, World AIDS Day, will again mark that sad anniversary that, while a time to tout advances such as an entirely new class of HIV/AIDS medications, primarily reminds Washingtonians that HIV/AIDS is the millstone around our collective neck as we drown in an epidemic. Data released by the Mayor Adrian Fenty's Department of Health on Monday, Nov. 26, doesn't offer much succor.
According to the new HIV/AIDS report, HIV-positive children continue to be born in the District -- nearly a tenth of the country's pediatric AIDS cases in 2005 -- while some states have successfully used medication to eradicate mother-to-child transmission. Nearly 40 percent of new HIV infections are transmitted through heterosexual sex, though sex between men still accounts for 27 percent of new infections. Pointedly, black women, who are 58 percent of the District's female population, account for 90 percent of new female HIV infections in D.C. Possibly the most important point -- and the one everyone was likely expecting -- is that the nation's capital leads the country with its rate of AIDS cases: 128.4 per 100,000 people, versus the national average of 14 cases per 100,000 people.
As Mayor Fenty writes in the report's introduction, ''We must take advantage of this information with the sense of urgency that this epidemic deserves.''
Khadijah Tribble is doing her part. Her early activism was as personal as coming out as a lesbian in Tuscaloosa, Ala., and as universal as the National AIDS Quilt.
''It had to be maybe 19 or 20 years ago,'' recalls Tribble. ''I got an opportunity to read names. I had heard about this disease, but it never really hit me. But to be holding pieces of the quilt, to be reading the names, those individuals became very real to me. I viewed this as the issue of my time.''
Roughly two decades after her encounter with the Quilt, Tribble is serving as interim executive director of the local Pediatric AIDS/HIV Care Inc. (PAHC), an organization marking its 20th anniversary in 2007, 20 years of helping D.C. kids from 5 to 18 cope with HIV infection -- either their own, or a loved one's.
Remarkably, it's work that does not leave her feeling depressed, Tribble insists. It could be that she finds comfort in her life with her wife, Robin, and four sons. Or that after the politics of vying to be Fenty's liaison to the GLBT community, hitting the campaign trail for Kweisi Mfume's Senate bid in 2006, or what she saw while helping impoverished/homeless youth at Covenant House Washington, she may see more at PAHC about which she feels hopeful.
''I tell people that 20 years ago the organization was started by a cadre of volunteers providing a safe, nurturing environment to help ease the pain of individuals, babies and parents -- predominantly mothers -- who were dying of HIV-AIDS. We still serve them, but now we serve them in a way that addresses their lives, living with HIV/AIDS as opposed to dying. Folks are living longer and having solid lives living with HIV/AIDS.''
Even with the bad news, Tribble knows the HIV-affected youth of D.C. don't need any gloom from her. So Tribble fights the epidemic her way: for the kids, with a smile.
METRO WEEKLY: What, exactly, does Pediatric AIDS/HIV Care Inc. (PAHC) do?
KHADIJAH TRIBBLE: We provide mental-health therapy in an art-infused, youth-development framework. I'll break that down: We provide mental-health therapy to our young kids.
Obviously, there's trauma associated with being HIV-positive, or having a parent or loved one who has died of HIV/AIDS. Sometimes when a young person is experiencing a terminal illness, it brings about trauma. So we provide therapy. We also use art therapy as a way for young people to express themselves when they can't vocalize or put words around what it is as it relates to their illness.
The third thing is the youth development. We believe that our young people have excellent opportunities and excellent talents and skills and we want to enhance those and bring about opportunities for them to use those skills and make the community a much better place.
MW: This year, PAHC entered its 20th year. How are you marking the anniversary?
TRIBBLE: We kicked it off Oct. 25 with a birthday party. It was our way to kind of signal that we're 20 years, that we're growing up, and that it's time we become more vocal about HIV/AIDS here in the District.
We're going to be doing an event in February in honor of HIV/AIDS awareness in the African-American community. We're also excited about hosting the first-ever HIV/AIDS summit for and by young kids who are HIV-positive. That will be in May or June.
MW: What's the mood like at Pediatric AIDS? How do you keep it upbeat for the kids, while dealing with all the serious issues surrounding HIV/AIDS?
TRIBBLE: I have to be honest with you: There are times when we struggle as an organization with the realities of why these young people are coming to Pediatric Care. But most days, if you stop by and see our office, it's just as chaotic as any youth-development center, because young people come not just for the safe space, but for the camaraderie. It's a family-like environment.
So the mood depends on what's going on. Take this week: There's been a strange kind of mood, one that's been celebratory because we've been around as an organization for 20 years. We're happy to say that because of the interventions and medical advancements, many of our young kids now are not positive, meaning that because of anti-retroviral therapy, parents aren't passing the disease onto their kids as much.
Now many of our kids are affected by HIV/AIDS, meaning they've lost a parent to the disease. So the mood is that 20 years later, we have less and less young people infected with HIV/AIDS, and many of our [HIV-positive] kids who started out with us 15 to 20 years ago are now growing up. They're graduating from high school. We're very excited that with intervention, medicines, our kids are still alive and are doing well and are thriving. On the other hand, we're mourning the loss of parents -- we have anniversaries every month. Kids have the opportunity to express whatever they're feeling around that loss. We do what we can.
MW: You've mentioned that PAHC has struggled at times. Have there been funding or staffing issues?
TRIBBLE: That's such a timely question. We've been around for 20 years and I've felt that folks really don't know who we are. Folks are like, ''Oh, wow, a new organization?'' No, we've been around for 20 years, quietly delivering services to the HIV/AIDS community.
The struggle for the organization has been that what we do isn't necessarily seen in the eyes of folks as HIV/AIDS treatment. We're not advocacy. We're not out pushing, doing media and all that good stuff. We're educating folks about HIV/AIDS and bringing up awareness. A lot of money has been spent in the District of Columbia on those things. They are important.
But what we are mainly is anti-stigma work. We're really about the business of changing the trajectory of the epidemic. Our client base is predominantly African-American. When you look at the numbers of HIV/AIDS infection rates, the African-American woman in particular is greatly affected by that. We believe that can be directly attributed to the silence, stigma and shame that is still associated with HIV/AIDS. It affects one's ability to feel comfortable going to get testing. Once they get tested positive, it affects their ability to get treatment, to stay in treatment.
Our organization exists outside of the ward where many of our clients live, and that's done on purpose. What we've found is that if we provide the services where the bulk of our clients are, they won't come because they're afraid to be associated with an HIV/AIDS organization. They don't want their kids to be ridiculed. They don't want to be isolated from their families.
At the heart of what we're trying to do with our young people is empowering them and creating a safe space and giving them the tools to be more vocal about their status and their family's status in an effort to get at this silence, stigma and shame.
The struggle has been this whole issue about silence, stigma and shame and the need to obviously covet and protect the confidentiality of our clients. At the same time, how do we begin to push the envelope and address these issues of stigma, silence and shame?
MW: We've been fighting HIV/AIDS for more than two decades. Why does any stigma still exist?
TRIBBLE: You know, I wish I had the answer. I honestly don't know. But I know that it's real when I hear stories of a mother telling me that she is positive, one of her kids is positive, and the other siblings don't know. The other family members don't know, but here is a young teen grappling with all those things that adolescents grapple with in a normal day. Then also dealing with the fact that he has an illness but more importantly, he can't share it. He can't talk about the fact that his numbers are good right now. He can't talk about what's wracking his body when he's having a bad day. He has to tell folks that, as his mom puts it, ''He has asthma.'' I don't know why it still exists, but I know that it is alive and well in the communities that we serve.
I'm talking to positive moms or family members who are so afraid of the isolation, so afraid that people are going to treat their kids differently, that they can't openly speak about it. They can't even share their stories. Only they know. That's an incredible burden.
As an out lesbian, every time that I come out to somebody I get to change their idea about what it means to be a lesbian or what it means to be gay. That helps people start thinking differently about whatever the issue is. For us, it's HIV/AIDS. Until we can eliminate the silence, stigma and shame, and empower folks, I don't think we're going to be able to make a dent in [the epidemic]. The thing that changes is when someone shares their story.
One of the things that we're launching this year is called ''Circles of Care.'' We're reaching out to the business community, the religious community, to what we call an affinity group of African-American powerful women. It can't just be our organization actually touting the message. We have to get everyone talking about HIV/AIDS. Everybody says, ''You're crazy about buzz words.'' But we have to start talking about it. That's why I have this [''Got AIDS?''] shirt on. Everywhere we go we have to talk about it. The more we talk about it, you create opportunities for folks to let their guard down, get some information, create the compassion that's necessary. So we're reaching out to these different communities to provide the ''Circles of Care'' and our goal is to give them information to go out and talk to their clients, to their other sister girlfriends when they're having conversations. HIV/AIDS becomes part of the normal conversation and not taboo to talk about it.
Because of the confidentiality of our client base, we are identifying two or three different opportunities. We're going to partner with [Metropolitan Community Church] for an event Nov. 29. We are also going to canvas the area where we're located. Our young people who are ready are going to wear T-shirts similar to mine. Some are going to wear our organization T-shirt, which is a big deal. Seven or eight weeks ago, some of our young people couldn't even say ''HIV/AIDS.'' So to be able to get to the point in a couple of months to wear a T-shirt -- and feel comfortable wearing it -- is testament to the fact that if you do your work it is possible to have some progression.
Van Cleef & Arpels is so graciously agreeing to do a fundraiser that benefits Pediatric Care on Nov. 29 in honor of World AIDS Day. I'll be speaking to a group of folks who are their client base, which is supposedly a very deep-pocket group. I'll have the opportunity to talk to them and share with them where PAHC is and where we're hoping to be and how folks can support us.
MW: What do you think makes the HIV/AIDS rates so high in the District, specifically?
TRIBBLE: My understanding is that the disease has changed as far as who the disease is attacking now in the community. The face of HIV, quite frankly, used to be one of white, gay and male. That has changed significantly to straight African-American women here in the District of Columbia. I think the messages somehow haven't translated to that particular community. The messages that are perhaps used in one venue are not necessarily going to work with this population. When you add on all of the dynamics that are sometimes associated with the disease, how the disease is transmitted, the African-American community isn't necessarily first in line to talk about sexuality issues, not necessarily first in line to talk about drug abuse and use. That compounds the issue in my mind and is why, perhaps, the numbers are so large here in the District.
MW: What do you see that makes you hopeful?
TRIBBLE: I ask myself, ''Why do you keep going back to these organizations where sometimes it's very hard work?''
It's some of the most gratifying work, though. I find my hope in a young person -- and I hope I don't cry -- a young person who literally is positive and has lived with this disease her entire life who said to me two months ago, ''Ms. Khadijah, I don't want to talk about what you talk about. I just don't want to talk about it.''
For that young person to show up at our 20th anniversary celebration and be willing to be associated with PAHC publicly, that's where I find hope. When people begin to share their stories and know that they are not going to be turned away or rejected because they're positive or because their family status is positive, that is where I find hope.
MW: Switching gears completely, let's talk about Mayor Adrian Fenty's LGBT liaison. Your name had been mentioned as a possibility during that search, which eventually led to Christopher Dyer taking the job.
TRIBBLE: As one who threw her hat in the ring to try to field that position, it was tense. To this day, I'm not sure why it was so tense. I do know that there are factions in the LGBT D.C. metro area who believe people should get positions based on X, Y and Z.
I threw my hat in the ring because I could do a good job in that position and that was it. I maintained throughout that the mayor was going to choose someone who best fit his cabinet. If that's me, great; if not, then move on. I don't harbor any ill feelings. The whole idea that it became a race issue, I didn't support. It was about who was going to be the best person to fit into that position based on what was going on in the District.
MW: You seem pleased, optimistic, to be right where you are at PAHC, rather than in the mayor's cabinet.
TRIBBLE: I'm hopeful. I couldn't stay in this work if I didn't think that there was a way to make change.
I told my young people at our anniversary celebration that I'm not going to do all the gloom and doom because that in itself can be depressing, so defeating. The reality is that we have issues, but we also have a huge opportunity to change things. We can take a look at models that have worked in other parts of the world.
I'm really excited about [recently appointed D.C. Department of Health HIV/AIDS Administration senior deputy director] Dr. Shannon Hader because she gets it. My conversation with her was so -- how excited can you be about HIV/AIDS? But it's not so much excited about HIV-AIDS, it's just excited about the opportunity to really make change and make a dent. We can, as a community, dig deep and change the dialogue.
MW: What about the young people to whom you're closest, your four sons? What do they think of the work you do?
TRIBBLE: They think that Ms. KT is going to save the world, because that's how I'm known in the community of young people I work with. I think at times it has been stressful. I can definitely say that during the time I threw my hat in dthe ring for the liaison position, it was a rough time.
One reporter even called our house in Maryland, asking our son questions about where I lived, and the whole issue of whether I was a District resident. It was very tense for them.
Robin and I decided that we were going to be less vocal in the media. We didn't return any phone calls and kind of began to cushion our family. One of my sons had spoken at a number of different events here in D.C. and in Annapolis -- speaking on why his moms should have the right to get married -- and we decided that the family could not do that anymore.
MW: Is there anything you want to talk about that we haven't touched upon?
TRIBBLE: I just want to reiterate that the issue of HIV/AIDS impacts all of us and we can all be a part of making it better. Everyone can do their part in making it better -- just find the opportunity.
We're going to be putting some things up on our Web site about ways individuals can engage with our organization. More importantly, whether you're interested in PAHC, Metro Teen AIDS, the Burgess Clinic at the Children's [National Medical Center], whatever it is, do something. Don't let history go by and you didn't help.
For more information about PAHC, visit the group online at http://www.pediatricaidshivcare.org. The complete 2007 HIV/AIDS epidemiology report for D.C. is available online by following the HIV/AIDS link on the D.C. Department of Health's homepage, http://doh.dc.gov.