A Brief Reflection on the Intersections between Race, HIV, Sexual Orientation, and Gender Identity

As a Black and gay male, I understand the urgency of addressing the HIV epidemic that affects me and others within our community. National Black HIV/AIDS Awareness Day, February 7, is a time set aside for us within the Black community to increase HIV education, testing, community involvement, and treatment in an effort to end the HIV epidemic. It is also important to take time to acknowledge distinct barriers to prevention and care that impede efforts ending the HIV epidemic. One such barrier is the unique experience of LGBTQ people in regard to the intersection of HIV/AIDS and domestic abuse.

Power and control wheel

“LGBTQ Relationship Violence” From the National Domestic Violence Hotline

In his article, Just*in Time: HIV & LGBTQ Domestic Violence, Justin B. Terry-Smith voices the struggles of the intersection of HIV/AIDS and domestic abuse. He details a few tactics of abusers: using HIV guilt as a weapon, taking away or controlling access to HIV medication – this control over medication can be for PrEP, nPEP[1], or antiretroviral HIV medications – controlling access to money and other resources, using social media to manipulate and threaten, and creating or magnifying stress and trauma. All of these tactics can make a person’s HIV diagnosis more dangerous for their health. An abuser’s ability to victim-blame, isolate and control by using social media, and regulating HIV medication is amplified for LGBTQ Blacks and African Americans, who at the same time are experiencing racial disparities within the healthcare and domestic violence services systems. Additionally, resources for LGBTQ people are already limited, and an abuser isolating an LGBTQ partner can be especially detrimental for health outcomes.

According to the United States Census Bureau, we lack equity in economics, insurance coverage, and health.

  • Economics: In 2017, the Census Bureau reported the average Black median household income to be $40,165 in comparison to $65,845 for white households. Also in 2017, the Census Bureau reported that 22.9 percent of Blacks in comparison to 9.6 percent of whites were living at the poverty level. Further, in 2017, the unemployment rate for Blacks was found to be twice that of non-Hispanic whites, 9.5 percent and 4.2 percent, respectively.
  • Insurance Coverage: In 2017, the Census Bureau reported 55.5 percent of Blacks in comparison to 75.4 percent of whites used private health insurance. Also in 2017, 43.9 percent of Blacks in comparison to 33.7 percent of whites relied on Medicaid or public health insurance. Lastly, 9.9 percent of Blacks in comparison to 5.9 percent of whites were uninsured.
  • Health: According to Census Bureau projections, the 2015 life expectancies at birth for Blacks is 76.1 years, with 78.9 years for women, and 72.9 years for men. For whites the projected life expectancies is 79.8 years, with 82.0 years for women, and 77.5 years for men. The death rate for African Americans is generally higher than whites for the following: heart diseases, stroke, cancer, asthma, influenza and pneumonia, diabetes, HIV/AIDS, and homicide.

“never reported, contracted HIV.” — Gay male, 29, Charlottesville*

The National Domestic Violence Hotline goes even further into the unique mental and physical tactics LGBTQ abusers use to gain power and control, detailing that LGBTQ tactics to gain control are all rooted in homophobia, biphobia, heterosexism, and transphobia. Threatening to “out” a survivor’s sexual orientation or gender identity, denying the survivor’s sexual orientation or gender identity, suggesting the abuse is “deserved” because of the survivor’s sexual orientation or gender identity, and explaining away abuse by upholding the abuse as masculine or some other desirable trait. These mental tactics all serve to isolate the survivor from the LGBTQ community. This is especially damaging for LGBTQ people since there are fewer specific resources for LGBTQ people. Similarly, these tactics can be combined with racism to compound the isolation and damage experienced by the person being abused.

It was a friend. The first gay person I ever knew. I really was reaching out for the first time trying to find a mentor. He was older and I wanted to learn what it was like to be gay in my rural community … but then this [violence] happened.” — Gay queer male, 23, Richmond*

As Black and African American LGBTQ people, we are tasked with managing our health, regardless of HIV status, finding ways to navigate institutions that were not designed with us in mind, stigma that is associated with HIV/AIDS and domestic abuse, and various other societal pressures without much structural or institutional support.

“I didn’t think it was a big deal; it felt normal or not what I thought “domestic violence” was;” –Bisexual female, 20, Richmond*

It is also important to acknowledge and understand the power we have as individuals and as a community to combat stigma accompanying HIV/AIDS and domestic abuse and bring change to existing institutions. Reducing stigma by acknowledging anyone – regardless of gender – can be in an abusive relationship, and that domestic abuse is more than physical abuse; domestic abuse can also be mental abuse and emotional abuse. Stigma reduction also helps in disregarding victim-blaming narratives linked with HIV/AIDS and domestic abuse, respectively. Educating ourselves to understand the circumstances that would lead to a HIV diagnosis or to someone being with an abuser, likewise, helps reduce victim-blaming. For example, understanding that prevention measures such as nPEP and PrEP may not be available due to lack of accessible healthcare options, or unable to access because a person’s abuser is controlling their lives, are two examples of how reducing stigma also reduces victim-blaming.

I believe we as a nation will reach equity in regard to race, gender identity and expression, and sexuality. True equity would mean no one would be able to determine a person’s health outcomes based on their race, gender identity and expression, and/or sexuality. We can and do have the power to combat HIV/AIDS and domestic abuse in all of our communities, across race, LGBTQ identities, and other dimensions.

“I really believe that LGBTQ hate crimes, domestic violence, discrimination and bias are still quite a problem in our time. Since I was involved in a support group for LGBTQ folks (Dignity/Integrity Richmond, now defunct, from the mid-1980s to the mid-1990s) I became aware of these issues, particularly LGBTQ domestic violence. All of these issues were occurring then and I am quite sure they continue to occur today. For the most part I think LGBTQ folks are aware of these issues but for the most part I think LGBTQ folks, for whatever their reasons, don’t report them or try to deal with them on their own. This is the reason, I think for surveys like this one and I think it’s a good thing.” — Gay male, 51, Henrico*

You can reach the Virginia Disease Prevention Hotline (Monday-Friday, 8am-5pm) at 1-800-533-4148, where counselors answer questions and provide crisis intervention, referrals, and written educational materials regarding Sexually Transmitted Diseases (STDs), HIV/AIDS, and Viral Hepatitis. 

If you or someone you know needs help or resources, contact the LGBTQ partner abuse and sexual assault helpline 24 hours a day, 7 days a week, at 1-866-356-6998. Or, text 804-793-9999 or chat: www.vadata.org/chat

*The quotes in this post come from the Virginia Anti-Violence Project 2008 Survey.

Sources:

The State of Violence in Lesbian, Gay, Bisexual, Transgender, and Queer Communities of Virginia: A Report of the Equality Virginia Education Fund Anti-Violence Project

National Black HIV/AIDS Awareness Day

Just*in Time: HIV & LGBTQ Domestic Violence

Income and Poverty in the United States: 2017

The Black Population: 2010

Health Insurance Coverage in the United States: 2017

Census Bureau, 2018. 2017 American Community Survey 1-Year Estimates

The National Domestic Violence Hotline page on LGBT abuse

[1] Pre-exposure prophylaxis (PrEP) and non-occupational post-exposure prophylaxis (nPEP) are HIV prevention strategies.  They are medical interventions and public health approaches used to prevent infection. (Learn more about PrEP and nPEP.)


Christian Carr is a Ryland Roane Fellow for the Virginia Department of Health and is currently working alongside Minority Health Consortium to help empower the Richmond, Virginia community.

Happy 20th Birthday, VAdata!

More than twenty years ago, America Online dominated the World Wide Web, floppy disks were disappearing, and music fans were avoiding the high cost of CDs by downloading music from Napster. When VAdata was first envisioned in 1996, domestic or sexual violence agencies did not use the internet as a primary resource or use email as a routine method of communication, but a group of dedicated sexual and domestic violence advocates saw opportunities for these technological advances to improve their work. They wanted to develop a way to collect information on the experiences of survivors of sexual and domestic violence and describe the services provided to them by agencies around the Commonwealth.

Happy 20th birthday, VAdata! This month 20 years ago, VAdata was born! Hear, Hear to 20+ more years!Without considering that the idea to create a database that “lived” online was groundbreaking, these advocates set out to create a data collection system that was responsive to users as well as responsible to survivors. From the beginning, statewide data collection prioritized the confidentiality and privacy of survivor data. This meant that Virginia was ahead of the curve when the federal Violence Against Women Act (VAWA) prohibited the collection of identifying data in electronic systems in 2006. VAdata was the first electronic data collection system in the nation to collect information about sexual and domestic violence, and to this day, remains the only electronic data collection system that is managed by an advocacy agency. VAdata’s management by an advocacy agency allows its focus to remain survivor-centered, trauma-informed, and safety based as it has always been.

As VAdata comes of age, here are some reflections of its journey from a few of its creators. Happy Birthday, VAdata!


“What makes me most proud to have been involved in VAdata project is that survivors and interest of survivors was always front and center of our work. Yes, we were developing a data collection system to meet a variety of needs, including those of funders and policy makers. However, the project’s leadership understood that those data elements are personal information about survivors and their families and thus were committed to evaluating the impact of collecting and reporting ANY data element, no matter how small, on the survivors–in the short term and longer term; on an individual level and in the aggregate.”

–Kristine Hall, currently at the University of Virginia Medical Center and former Policy Director for the Action Alliance.

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“VAdata turns 20! When I started in this field back in the day, collecting information for grants was VERY different. We had ‘contact sheets’ that we filled out to document the services we were providing. I used pen and paper ‘tic’ marks to count the services that were being provided. My next endeavor was to use Xcel. So I created a looooong spread sheet. Because VAdata still didn’t collect everything I needed, I learned how to use Access to build our own data base.  Teaching Access to other staff was cumbersome. This helped but Access was still was not user friendly.

Then the most wonderful thing happened. VAdata was born! A lot of time and energy went into creating something that local programs could use safely and securely. The Action Alliance drew off a great deal of wisdom from other’s in the research and data community to make VAdata happen.

When I first began using VAdata, I still had to have a separate data base because it did not collect all the information I needed for each of our grants and work plans. However, over the years VAdata has matured and gotten better with age! I still use spread sheets as a check to VAdata, but I currently use VAdata exclusively for reports and work plans. In addition to using it for reports, I use VAdata to identify trends in services. I can pull data to help gather local data or data elements that are specific to something we are tying to define.

VAdata has made my data needs so much easier and much more advanced. So happy birthday VAdata and thanks for giving so much to local programs! YOU ROCK!”

-Robin Stevens, Services Coordinator at CHOICES, the Council on Domestic Violence of Page County.

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“In the mid 1990’s Madonna and Whitney Houston rocked the radio, Bill Clinton was President and there was a terrorist bombing in Oklahoma City. I was the Director of Empowerhouse (then RCDV) at that time. I remember working with the husband of one of the staff to develop our first data collection system, using dBASE. It was a life saver. We had previously been using multi-colored codes on the bottom corner of every client form, service document and hotline call sheet to tally our statistics for our VDSS grant reporting. The process of compiling the report took a good day. This was barely steps away from punch cards, but I digress and date myself.  Our fancy dBASE program reduced our grant reporting time by hours, but it was very far from perfect.

Y2K. For those of us who are old enough, the year 1999 may bring back waves of fear on what would happen come January 1, 2000. Would electric grid work? Would water flow? But more importantly, would our donated Compaq 286sx computers work? How would our statistics calculate properly? Birth dates were reflected in the computer by the last 2 digits of one’s birth year and circling back to 00 would muck with the calculations.

Thankfully, folks at the Action Alliance (then VADV) were forward thinkers. When new opportunities became available before Y2K, they geared up to develop a new data collection system for all domestic violence programs to use. The Action Alliance staff was a fraction of the size it is now and I’m sure that the small amount of grant funding they received to develop VAdata didn’t come close to covering the time that they invested. This was a big deal and every agency across the state had its own ideas of what this should look like. I joined one of the committees, because I, too, had ideas. We had an instant thirst for data and wanted to collect everything. One of our challenges was to differentiate the information we wanted to know from the information we needed to know. We sorted through all the potential data fields and landed with a minimized plan. 

While the Action Alliance staff worked with programmers, codes, technical issues and countless other problems, local DV agencies dealt with their own new problems. They were all going to need computers, but not all were there yet. Some had computers, but no access to the internet. They had to get additional phone lines or risk being bumped offline by an incoming call (dial up modems were our only choice!) The lucky few with computers and internet often had only one centrally located computer shared by all staff.

Technology might not have been part of our grassroots beginnings. And looking back you might not think that the first version on VAdata was cutting edge. But that’s where you might be wrong. VAdata was the first web-based statewide domestic violence data collection system. Virginia had the capacity to run reports for a single agency or for the whole state with just a few clicks while other states were still hand compiling their data. 

When VAdata was in the planning stages, there was so much excitement. Ideas being tossed out there on how it would look, act, the information we could gather to better help victims, survivors, caring friends, judicial system, professionals, etc. As it became a reality the excitement never left me, the Hotline Form that was created and in the beginning it turned out to be quite a few pages long, there were so many things we wanted to gather information on. Needless to say, there was quite a bit of tweaking done to bring it to a manageable size of questions that wouldn’t overwhelm the Advocate or Caller.

Our work today isn’t the same as it was Y2K. Thankfully we are adaptable to the changing needs of our communities and of families experiencing violence. VAdata doesn’t look the same today as it did then, either. She’s grown and adapted and has met just about challenge that’s come her way. Congratulations on your 20th Birthday VAdata, and thanks for keeping track of all the services we’ve provided!”

–Nancy Fowler, Program Manager for the Office of Family Violence at the Virginia Department of Social Services.

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“I was lucky to be part the VADV staff that traveled around the state to train all of the DV and SA programs in VA. Not only was VAdata new to us but the Internet and computers were very new to some of the programs. Some folks that came to the trainings had never had the opportunity to have worked with a computer. So not only were we training on VAdata we were also doing a quick 101 on Using Computers and getting on the internet. I remember one training where after we had gotten everyone on the mock VAdata internet, we were explaining how to tic off the check boxes on a form. We had told the audience to take their mouse and put it on the little square and click on it. We had one person say her mouse wasn’t working, when I got back to her she was holding the mouse against the screen covering the box and a lot more of the form and clicking away, as hard as I tried a little snicker still emerged from me. Happy Birthday VAdata, I still get excited with the information you’re able to give us!!!”

–Debbie Haynes, Coalition Operations Manager at the Action Alliance.

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“Where were you in the fall of 1999? I was traversing the Commonwealth with coworkers, introducing sexual and domestic violence agencies to VAdata, their new data collection system. Three years earlier, state funding agencies expressed a need for a Y2K-compliant database to collect, at minimum, federally required data from funded sexual and domestic violence agencies. The Action Alliance (then known as VADV) applied for and received funding from VAWA the first year those funds reached Virginia. For 3 years, a dedicated and creative committee met to design the country’s first internet-based data system, collecting data from survivors of both sexual and domestic violence. The committee included state coalitions, state funders, advocates and directors from SDVAs, university researchers, and database/internet experts.

Our relationship with technology was VERY different in 1999. Most SDVAs had no more than one computer, dial-up connections, and limited email experience. Most of us did not have cell phones, nor did we see a need for them. In the nonprofit world, the concept of an internet-accessed database was novel and ahead of its time. A few staff in SDVAs were excited, but most were apprehensive about giving up their paper and pencils for keyboards and monitors. Twenty years later, we know that while the learning curve was steep in 1999, we made the right leap into the future.

Like all technology, VAdata has done nothing but evolve and grow in 20 years. The VAdata programmers/system managers at Advanced Data Tools Corp. have assured that VAdata is supported by current and robust applications. The VAdata Advisory Committee has assured that the system is responsive to new data needs from funders, SDVAs, and policy makers. And they have done so while being consistently mindful of confidentiality and an absolute commitment to only collect data that will serve to improve quality of life for survivors and their children. Information from VAdata has been used to enhance intervention services, advance prevention efforts, increase funding, and inform policy. VAdata has been referenced in the VA General Assembly and even in the U.S. Congress.

I was the first VAdata coordinator and continued in that role for 20 years until my retirement in 2016. In writing this blog, I was asked to consider VAdata’s future. This request caused me to reflect on my personal growth as a result of my work with VAdata. I am by nature a “finisher,” and working on this project taught me A LOT about the value of thoughtful processing. My hope for VAdata is that it will continue to be a thoughtful process, one that embraces advancing technology while also being mindful of making the system work well for all of its cohorts and maintaining its core commitment to survivors as a tool that protects privacy and dignity while providing information to improve conditions for survivors and enhance prevention for everyone.”

–Sherrie Goggans, nurturer of VAdata from the late 1990s until her retirement from the Action Alliance in 2016.

 

Supporting Survivors – A Hotline Responder Blog

It is July 1st, 2016 on a humid summer morning in Richmond, Virginia. Staff and hotline workers are gearing up for a special day at the Virginia Sexual and Domestic Violence Action Alliance. Today, for the first time in over 30 years, the 24/7 Virginia Family Violence and Sexual Assault Hotline is being answered solely here in Richmond, Virginia at the Action Alliance. Prior to this date The Action Alliance shared responsibility of answering the hotline with Project Horizon in Lexington, Virginia.

The day starts quiet as my coworker and I arrive at 7:45 to start our day. I call Project Horizon staff one last time to check for messages from the overnight shift. The overnight hotline staff worker expresses to me how busy of a night it was and wished the Action Alliance all the best with the hotline. I expressed my gratitude towards her and for the entire staff at Project Horizon for answering the hotline and supporting us.

My coworker and I unforward the lines and log into ICAROL, the system that allows us now to chat and text with survivors 24/7.  I made a cup of coffee, took a deep breath, and prepared for the busy day.

 

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The day starts off with a few calls here and there from domestic violence/ sexual assault programs across the state taking their lines back and checking for messages. I hear my coworker take a call from a survivor checking in for shelter in the Chesapeake region. She talks to her, gets her information, and calls the on call for the program in that area to relay the information that this survivor is in need of shelter.

Outside of the hotline room I hear the commotion of my colleagues getting ready to present a webinar to the new and existing programs that wish to utilize our hotline services. Currently the Statewide hotline answers for over 20 programs, which will increase with the signing on new programs starting July 1st.

The afternoon quickly approaches and I receive a call from a survivor of intimate partner violence who had questions about how to get a protective order. I listen to her story, provide emotional support, answer her questions and explain the process of obtaining a protective order, and safety plan with her. I also provide her with the number to her local domestic violence program and let her know what services they could provide to her to offer her additional support and encourage her to reach out to an advocate if she feels comfortable.

As our conversation begins to wrap up I hear my coworker answer the PREA line. PREA stands for Prison Rape Elimination Act and allows us to speak to incarcerated individuals who are experiencing sexual harassment or sexual assault. My coworker listens to his story, informs the caller what the PREA line does, collects his information about the harassment he is experiencing from a correctional officer, gets his consent to make a PREA report.

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My coworker and I document our calls in our call sheet and VADATA and starting chatting about what we are going to eat for lunch. Our conversation quickly becomes interrupted by a call coming in from the LGBTQ line.  In addition to the PREA and statewide hotline, we operate a 24/7 hotline for LGBTQ survivors of intimate partner violence and sexual assault.

While I am on the phone, my colleague receives another call from a survivor from the Fairfax area who was recently sexually assaulted by her boyfriend.  When I hang up from the LGBTQ line I almost immediately get a call from someone in the Virginia Beach area looking for shelter. However, this time it was single female looking for shelter due to homelessness. My tummy growled as I connected her to local homeless services and shelters in her area. While we are a hotline for survivors of violence we get many calls that are not related to violence and still are a resource for those folks.

We quickly eat our lunches at our desk, talk about our pets, and discuss who is working the late night and overnight shifts for our first official weekend that is 24/7. We talk about our plans for the 4th of July Holiday. I let my coworker know that I am working July 4th among many of my other colleagues as well.  Working on a 24/7 hotline for survivors requires willingness of staff to work holidays and weekends that are often spent with families and friends.

The day continues in this fashion for the 8 hours that I am scheduled to work. My coworker and I receive calls, chats, and texts from survivors from survivors, family, friends, and professionals from all over the state seeking support for the violence they or someone they know have experienced.

Our work on the hotline is not always straightforward or easy, it is full of complexities. We hear about pain, anger, trauma, and sadness on a daily basis but our role is critical. We offer compassionate and trauma informed services and crisis intervention to callers around the clock and I am honored and privileged to work with survivors and the incredible the hotline team at the Action Alliance.

 

To reach the hotline call: 1.800.838.8238

To text us text: 1.804.793.9999

To chat: http://www.vadata.org/chat/

To call the LGBTQ hotline call: 1.866.356.6998  (Please note that you can also reach the LGBTQ line through our chat and text feature as well).

Jennifer Gallienne is a Senior Hotline Crisis Specialist and Outreach Specialist here at the Virginia Sexual and Domestic Violence Action Alliance. She has worked at the Action Alliance for 3 years and supports anti-violence work through other community organizations as well. 

 

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Joining the Action Alliance adds your voice to making change in Virginia. Start your membership today or call 804.377.0335. 

To inquire about submissions for blog, please check the submissions page for requirements or email colson@vsdvalliance.org

 

Crisis Hotline Response: The Intersection of DV and Suicide

“How do you prepare yourself for a job like that?”

When you are introducing yourself to a new person, it is not long before you are asked “Where do you work?” When I tell them I work as a hotline crisis services specialist, the next question is invariably, “How do you prepare yourself for a job like that?”  The answer is training and very specific training.

As a hotline crisis services specialist at the Action Alliance we provide a 24-hour toll-free system of crisis intervention, support, information and referrals for the entire Commonwealth of Virginia via phone (1.800.838.8238 (v/tty), chat  or text (804-793-9999). We provide a wide variety of information as well as emotional support and need to be prepared for almost any question.

A lot of training happens before anyone takes a call solo. While development is an ongoing process, in addition to sexual assault and domestic violence, we cover broad topics like anti-racism, homelessness, human trafficking; and underserved populations, such as folks who are LGBTQ+ identified or folk who are incarcerated.

Suicide  is one of the many important issues we respond to on the hotline, and today I want to talk more about that issue. The National Alliance on Mental Illness (NAMI) reports that “suicide is the 10th leading cause of death in the U.S., the 3rd leading cause of death for people aged 10–24, and the 2nd leading cause of death for people aged 15–24.” When dealing with the trauma of intimate partner violence or sexual assault, a person’s mental health is impacted and a survivor may contemplate suicide. The ABA Commission on Domestic & Sexual Violence cites research saying twenty-nine percent of all women who attempt suicide survived physical assault by their partners. In their white paper, The Psychological Consequences of Sexual Trauma; Yuan, Koss and Stone find that “childhood sexual abuse was associated with an increased risk of a serious suicide even after accounting for the effects of previous psychological problems and a twin’s history of suicidal behaviors (Stratham et al., 1998).” What do these statistics mean for hotlines? It means we get callers who survived violence and are now suffering from suicidal thoughts. It means hotline crisis services responders need to be trained in more than advocacy; we need to be trained in suicide first aid practices.

Several of our hotline staff and an Action Alliance intern had the opportunity to attend Living Works Applied Suicide Intervention Skills Training (ASIST) hosted by Richmond Behavior Health Authority.

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Steve Alexander and Kristen Vamenta in ASIST training.

Living Works encompases the core belief that suicide is an issue for the entire community and that as a universal human problem, suicide should not be the domain of any one discipline or viewpoint. Living Works holds the belief that everyone, working together, can help to prevent suicide in the community.

ASIST is for everyone 16 or older—regardless of prior experience—who wants to be able to provide suicide first aid. By the end of the training, we were better able to understand the ways attitudes affect views on suicide interventions and provide individualized guidance and suicide first-aid to a person at risk. These skills translate beyond the workplace, beyond the hotline and into our everyday lives.

As we go about our work with survivors and in our personal lives as community members, I keep coming back to an often shared quote attributed to multiple sources such as Plato, Philo of Alexandria, Ian MacLaren, John Watson:

“Be kind, for everyone you meet is fighting a hard battle.”

The Hotline Crisis Services Team is comprised of an awesome team of trained staff who work 24/7. The hotline staff is:

Reed Bohn, Erin Cave, Charmaine Francois, Jennifer Gallienne, Mishawn Glover, Jennifer Harrison, Shirnell Lewis, Emily Robinson, Kristin Vamenta, and Carmen Williams

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Joining the Action Alliance adds your voice to making change in Virginia. Start your membership today or call804.377.0335.

To inquire about submissions for blog, please check the submissions page for requirements or email colson@vsdvalliance.org