Will Federal HIV Money Reach Communities in Need?

As our nation remembers Dr. Martin Luther King, Jr., NMAC stands in solidarity with him when he said, “Of all the forms in inequality, injustice in healthcare is the most shocking and inhumane.” Our fight to end the HIV epidemic is a fight for justice and equality in healthcare for some of the most marginalized people in America.

Now that we have the 2020 federal appropriation and budget line item to end the HIV epidemic, the real work begins. Figuring out how to bring the promise of biomedical HIV prevention to all the communities that are highly impacted by HIV. There is almost $300 million in new funding to figure out that answer. While it is not enough money, it is definitely a good start.

NMAC is very concerned that the money will not get to the communities in greatest need.

Last week the Centers for Disease Control and Prevention announced that they were looking for a new Director for the Division of HIV/AIDS Prevention, in this announcement the CDC noted that this division has nearly 800 employees. While I’ve not done any analysis of the 800 employees, I am very concerned that on its face that number seems excessive, particularly when there is so much need in the field. This is only one division at CDC. There are staff in other CDC divisions that are also supported by HIV funds. Are we building real solutions or just more federal bureaucracy?

If we did a review of the number of HRSA’s Bureau of HIV/AIDS employees, would we see a similar number? What about HUD’s HOPWA program or SAMHSA? Oversight of federal funds is necessary and essential to monitor the programs and expenses. However, the solution to ending the epidemic happens in community. That is where the work force needs to grow and be developed, not Atlanta.

It’s time for transparency. HHS, how many federal employees are supported by federal HIV funds and what is the plan for the new money to end the epidemic? What percentage of those dollars will go to the field? How many more staff will CDC, HRSA, or SAMHSA hire to monitor the new funding? We will never end the epidemic if the money gets stuck in the bureaucracy.

I have similar concerns about some health departments. How many more health department employees will be hired with the new HIV funds? If we are going to reach 500,000 more people living with HIV and get 900,000 more people on PrEP, then vast majority of the funding needs to support the health infrastructure and services in communities that are hardest hit by HIV.

Dr. Redfield, it’s time to do an internal review of CDC’s use of HIV funds before one is mandated by Congress. How many employees does it take to monitor and evaluate federal funding versus the staff needed in community to end the epidemic? Your commitment to disruptive innovation needs to start in Atlanta. Do you need all these employees, or would our efforts be better served by building the infrastructure in the communities working to get PLWH back into care and sexually active adults onto PrEP?

NMAC wants to work hand in hand with the federal government to end the HIV epidemic and that means making sure the new funding gets to where it is needed. Maybe you do need 800 employees in one division at CDC. I’ve not done a review. From the outside it looks excessive, especially when there is so much need in community. Our fight to end the HIV epidemic is a fight for equality and justice in healthcare.

Yours in the struggle,
Paul Kawata

A New Day at NMAC

NMAC’s ongoing commitment to our constituents requires us to evolve with the challenging atmosphere in Washington.  As we continue to address these challenges, NMAC is incorporating several initiatives and platforms to help us meet those challenges.  I’m happy to share with you this update on the happenings in NMAC’s Government Relations and Public Policy (GRPP) department.  One of those platforms is PoliticoPro.  This tech platform has allowed us to have close to 4000 engagements with Hill staff.  This includes direct emails to Legislative Directors, Chiefs of Staff, and Legislative Assistants.     

We are also developing a longterm strategy plan – to that end, NMAC is pleased to announce fundamental changes to our GRPP department.   

First, NMAC entered into a formal agreement with George Washington University and, as a result, hired two public policy fellows, Linden Yee and Brianna Elghart.  Both Linden and Brianna bring a strong policy background and a driven passion for social justice.  I recognize that in order to drive policy, it will take the efforts of not only talented policy experts; it takes stakeholders who recognize that our cause is worth fighting for.  I’m very pleased to announce that NMAC and Kelley Drye, a powerful D.C. law firm, has entered into a pro-bono contract.  Kelley Drye brings a strong commitment to policies related to minority health, especially in the area of HIV.  As our relationship with Kelley Drye matures, I’m excited to share our goals and successes with each of you. 

Second, On October 17, 2019, our community lost a legend – Congressman Elijah Cummings.  As we continue to mourn his passing, NMAC wants to honor his legacy.  On June 11, NMAC will host its Hill Champions Awards Ceremony.  Since his passing, we worked with his Chief of Staff, Vernon, and his wife, Maya, on dedicating our highest award in his memory.  This year, the Elijah E. Cummings Award for Minority Health Equality will be awarded to Rep. Barbara Lee.  As you know, Congresswoman Lee has been our strongest champion on the Hill.  As Co-Chair of the Congressional Caucus on HIV/AIDS, Congresswoman Lee has a long record of fighting for funding and justice for people living with HIV.  We hope you will be able to join us in June for this well-deserved recognition of Congresswoman Lee.  For more information, please email me at JHuang-Racalto@NMAC.org

Third, NMAC is meeting with the United States Senate Special Committee on Aging to explore ways to address the ongoing crisis of seniors living with HIV.  This population is largely overlooked and continue to face unique health challenges.  I would like community input.  If you have a specific question for committee members, please email me.  As we continue to work with this committee and other members of Congress, I’ll post updates on the latest happenings and how you can help. 

Fourth, NMAC recently welcomed an early champion, Timothy Westmoreland, to discuss the struggles he faced in the ’80s as a senior staff member to former Chairman Henry Waxman.  His compelling story gave us all pause for what it was like in an era when President Reagan repeatedly put up roadblocks on CDC officials, and Congress was deeply, horrifically homophobic.  

Finally, as you can see, NMAC is fine-tuning our policy department.  As we continue to aggressively lobby Congress for increased funding, we remain committed to ensuring policies relating to HIV/STI’s, and minority health disparities, remain on the front burner.     

Joe Huang-Racalto
Director Government Relations | Public Policy
JHuang-Racalto@NMAC.org 

The Heavy Lift

Our movement has a heavy lift for 2020: full funding for the federal effort to end the HIV epidemic in America. The money is essential to support the 57 jurisdictional plans submitted at the end of 2019 (only 53 jurisdictions submitted plans). As NMAC noted earlier, the nearly $300 million in new funding for 2020 was just a down payment.

Do we have the capacity to make this real? If we are serious about ending the domestic epidemic then, beyond the science and reaching communities that were previously missed, it takes money. Without the money, our movement cannot bring to scale the programs needed. Remember we need to reach 500,000 people living with HIV and 900,000 more people who would benefit from PrEP.

Scale will be an important driver of our work. Do the new initiatives reach thousands if not tens of thousands people living with HIV and/or people who could benefit from PrEP? Programs that reach hundreds will not be sufficient. Working off the herd theory of immunity, we need to get large numbers of people living with HIV to undetectable and even larger numbers of people on PrEP.

Where To Start?
From NMAC’s perspective, jurisdictions should follow the data. What does the data say? Not just HIV data. It is important to look at STD and hepatitis data sets. There is an epidemic of STDs. If you overlay states with the highest gonorrhea rates per capita:

and the states with the highest syphilis rates:
and the states with more than half of the people living hepatitis C. Those states include California, Florida, Michigan, New York, North Carolina, Ohio, Pennsylvania, Tennessee, and Texas.

and finally, the states with the highest rates of HIV per capita:

Florida Mississippi, Louisiana, Georgia are in the top 10 for gonorrhea, syphilis, or hep C and HIV. South Carolina, Alabama, and Nevada are in the top 10 for HIV and gonorrhea or syphilis and North Carolina is in the top 10 for gonorrhea, syphilis, and hep C. Jurisdictions in these regions must prioritize STD/HIV/hep C testing sites, health centers, and community organizations that provide tests. Everyone who is tested should also be counseled about U=U and PrEP. Treatment on demand for U=U or PrEP should be available. History has shown that we lose too many people when they have to wait or return to find out results or treatment.

Since the infrastructure is already in place, these services can hit the ground running using existing agencies. There needs to be funding to hire and train staff. While this will work for people willing to access healthcare systems, new structures are needed for those communities that have trust issues. This is where Dr. Redfield’s disruptive innovation will be important.

Need Your Help
It takes money to end the HIV epidemic. It also takes money to support the efforts in Congress for the necessary appropriations. While, historically, our movement has been very effective managing the HIV portfolio on the hill, the need for full federal funding will require unprecedented cooperation and collaboration between the many organizations with a DC presence.

For the last three years in partnership with AIDS United, NASTAD, NCSD, and The AIDS Institute, NMAC has used the services of outside lobbying and communication firms for the partnership’s joint policy efforts. Our collaboration pushed HHS to build the plans and raise the funding to end the epidemic. This year, in addition to existing partnership firms, NMAC will bring on the pro bono services of Kelley Drye. Kelley Drye has more than 125 lawyers, government relations professionals, and economists based in the DC office. NMAC has retained their pro bono services to support our efforts to end the HIV epidemic in America.

AIDS United’s AIDS Watch is coming to DC March 30-31 and is so important this year. At this event, HIV advocates from around the nation join efforts to directly engage our elected officials to bring better services and research to stem the HIV epidemic. And on April 1, NMAC is partnering with health organizations from around the nation to discuss the state of pharmaceutical and other private funding in the HIV field and its explicit or implicit influence on our collective work.

While federal money is critical, that is just the government’s portion. Can the private sector match this amount? There are many efforts that the government cannot cover, including all of the work in Congress. Now is the time for the private sector to step-up. Who will be our champion?

Yours in the struggle,
Paul Kawata

Paul Kawata

Dr. Fauci’s Data from NMAC’s Briefing

Dr. Fauci’s Data from NMAC’s Briefing

In last week’s “Connection,” we told you that Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases/NIH, was the sole presenter at NMAC’s World AIDS Day Congressional Briefing on Thursday, December 5, on Capitol Hill. You can see a video of his slide presentation here. Video of the full briefing […]

Big Numbers for the Biomedical HIV Prevention Summit

Last week’s Biomedical HIV Prevention Summit saw big numbers. When the final count is done it will be more than 1,400 people. We are particularly grateful to the Houston Host Committee. They made this meeting one for the record books. Here is some of the feedback we received:

The Summit’s Opening Plenary asked the question, “Can we end the HIV epidemic in women without focusing on cis gender black women?” This session was put together by black women who wanted to challenge our movement, researchers, and industry. NMAC’s job is to create a platform for community to speak its truth.

Since the opening was about women, we also wanted to have a memorial moment to remember all the transgender women who were murdered this year.  Violence, like HIV, is an epidemic in the transgender community. This session was put together by transgender women who wanted to give names to the souls that were lost and the intersection of HIV, violence, employment, housing, and the healthcare needs of the transgender community.

The Summit is committed to addressing the difficult issues that face our work. NMAC is committed to the authentic voices of community.

 

NMAC wants to thank all of our sponsors and exhibitors:

 

 

 

 

 

 

We are moving the next Summit to the spring of 2021 because currently it is too close to the United States Conference on AIDS and both meetings had big attendance this year. We need more time between meetings to ensure we are able to produce the best possible trainings. Since USCA is delayed to October of 2020 (end of hurricane season), we felt this would be a good time to push the Biomedical HIV Prevention Summit to the spring of 2021. Look for more information on this in the spring of 2020.

And a reminder: the 2020 USCA will take place October 10-13 at the Puerto Rico Convention Center in San Juan.  We have a new domain – usconferenceonaids.org.  All 2020 USCA forms will be available when we officially launch the conference website on Feb. 3, 2020.  Registration, abstracts, exhibits, hotel, and scholarship information will be posted at that time.

Yours in the struggle,
Paul Kawata
30 Years of Service

HIV 50+ Internships and Sponsorships Awarded

Congratulations to this year’s HIV 50+ Internships and Sponsorships Recipients!

HIV 50+ - Strong & HealthyHIV 50+ Advocacy Internship: The Advocates Internship project is a new addition to the HIV 50+ Strong and Healthy Program. This internship is for those scholars looking to engage and participate in a structured effort to advocate on behalf the HIV 50+ population. NMAC awarded 12 internships for advocates to form the steering committee that will conceptualize and spearhead the creation of the National HIV 50+ Advocates Network. Scholars will attend AIDS Watch 2020 in Washington, D.C., a two-day meeting to form the National HIV 50+ Advocates Network and participate in the Federal AIDS Policy Partnership.

Recipients:

  • Cecilia Dennis-Phoenix, AZ
  • Jeffery Edwards-Knight-Charlotte, NC
  • Jeffery Haskins-Philadelphia, PA
  • Kenneth Johnson-Dallas, TX
  • Nadine Ruff-New Haven, CT
  • Nancy Duncan-Valley Stream, NY
  • Patricia Kelly-Orangeburg, SC
  • Porchia Dees-Los Angeles, SC
  • Robert Riester-Denver, CO
  • Stephen Adonna-Orlando, FL
  • Steven Vargas-Houston, TX
  • Thomas Villa-Rockville, MD

HIV 50+ Sponsorship: This year NMAC awarded 21 sponsorships to three selected meetings/conferences on HIV and aging. Sponsorships provide a platform for scholars to advocate, learn and represent the HIV 50+ community

Recipients:

The 10th International Workshop on HIV and Aging-New York, NY

  • William Hall-Seattle, WA
  • Dawn Breedon-Fort Myers, FL
  • Reggie Dunbar II-Atlanta, GA
  • Nancy Duncan-Valley Stream, NY

2019 Biomedical HIV Prevention Summit-Houston, TX

  • Trevor Bradley-Indianapolis, IN
  • Art Jackson-Indianapolis, IN

The International Conference on AIDS 2020

  • Kneeshe Parkinson-Arnold, MO
  • Janice Shirley-Charlotte, NC
  • Michael Smith-Sante Fe, NM
  • Rob Ingwerson- Portland, OR
  • Alan Timothy Lunceford-Stevens-
  • Nicky Calma-San Francisco, CA
  • Jared Hafen- Salt Lake City, UT
  • Porchia Dees- Los Angeles, CA
  • Esther Ross-Greenville, NC
  • Denise Drayton-Brooklyn, NY
  • Carlos Carmona- San Antonio, TX
  • Diana Goodie-Greenville, NC
  • Zeke Garcia- San Antonio, TX
  • Rob Pompa- Allentown, PA
  • Josef Pons-Puerto Rico

HIV 50+ Mini-Grants Awarded

Congratulations to this year’s HIV 50+ Mini-grant Recipients!

HIV 50+ - Strong & HealthyThis year we awarded 11 mini-grants to Scholars to implement programs/projects in their communities related to HIV and aging. These Mini-grants focus on education, advocacy and empowerment among the HIV 50+ population. These Mini-grants will run from December 2019-May 2020. Below are the recipients:

  • Angel Hernandez – Arecibo, Puerto Rico
    Project Title: Celebrating Advocacy for 50+ Moving Forward Together
    Description: This program is targeted to 50+ persons living with HIV and their allies, with a full day framed in a Christmas Celebration in an open space where they will educate on HIV and Aging advocacy awareness beginning with self-advocacy on healthcare, promoting healthy habits with physical activities of aqua aerobics, zumba and goofy games which also promotes good mental health.
  • Art Jackson – Indianapolis, IN
    Project Title: B-FIT
    Description: The objective of the photo and social media campaign will be to highlight 12 members of the 50+ members of the community who have made amazing strides in changing the trajectory of HIV/AIDS in their community by becoming actively engaged in reducing stigma, bias, fear and barriers to care. This unique approach will allow these 12 ambassadors to offer perspectives from a large population whose voices are not shared.
  • Bryan Jones – Cleveland, OH
    Project Title: The Sankofa Initiative…Living Long and Strong with HIV
    Description: This project will develop a short 10-15 minute video that will highlight four people 50 and over living with HIV. Each one will address a specific issue and provide insight into overcoming the issue, including acceptance, stigma, isolation, and disclosure. The creative vehicle used to move the video along will be a phone call between a newly diagnosed person and several long-term survivors.
  • Dawn Breedon – Fort Myers, FL
    Project Title: HIV 50+ Peer to Peer Dine and Learn
    Description: The purpose of these sessions are to educate individuals 50 plus living with HIV about the latest information on U=U, Sexual Health, Living healthy with other illnesses, aging with HIV making money without losing Social Security benefits and socializing within the community.
  • Emilio Aponte-Sierraparetti – Palm Beach, FL
    Project Title: AMIGAS: Empowering Hispanic Women Living with HIV 50+
    Description: AMIGAS was created as a safe space for Hispanic women living with HIV. AMIGAS is a Spanish acronyms where each letter have its own meaning. The meaning of the letter “A” is “Amistad” (Friendship). “M” means “Motivación” (Motivation), “I” means “Integridad” (Integrity), “G” means “Generosidad” (Generosity), “A” means “Amor” (Love), and “S” means “Sabiduría” (wisdom). This group has been a source of support for women who are newly diagnosed with HIV and in shock for the diagnosis or women that have been living with HIV for a while and suffering because the HIV stigma.
  • Esther Ross – Greenville, NC
    Project Title: LAMPS: Leaders Advocating Mentoring Personal Growth and Support
    Description: The LAMPS Project aim is to impact the lives of underrepresented/marginalized People of Color Living with HIV (POCLWH) 50 years and older population. Empowering Women Living with HIV (WLWH) 50 years and older to see themselves as Human beings worthy of dignity, respect and of equal value is an unchallengeable method to reduce internal and external stigma.
  • David “Jax” Kelly – Cathedral City, CA
    Project Title: Striving to Thrive Town Hall
    Description: Striving to Thrive will be a town hall format featuring panels of speakers from the local Ryan White planning board (Riverside County), government agencies (ADAP, HOPWA, etc.), Featured discussion to include planning and implementing a ‘Standards of Care” document for people living with HIV over 50 to be used by planning bodies, clinics and community based organizations. The town hall will be scheduled for late March or Early April 2020.
  • Kneeshe Parkinson – Arnold, MO
    Project Title: Level Up-Women and Men FORUM/Healthy and Strong
    Description: To enhance, educate and empower the lives of those HIV 50+ diagnosed with HIV/AIDS to eradicate STIGMA and improve quality of life with a meaningful impact. In addition the program goals are to increase the knowledge for ally’s from the community and have meaningful involvement to help our fast track city initiatives efforts. FORUM – is a place, meeting or medium where ideas and views on a particular issue can be exchanged.
  • Miguel Delgado-Ramos – Cidra, Puerto Rico
    Project Title: Taking my Life to Another Level”- The “LleVaN”Project
    Description: The purpose of the “Taking my Life to Another Level” Project is to improve quality of life of HIV + persons, mainly HIV 50+ in terms of how to take their life to another level through self-reflection, self-help and self-empowerment by addressing the six dimensions of wellbeing model as proposed by the National Wellness Institute and promoted by SAMHSA.
  • Nancy Shearer – Santa Monica, CA
    Project Title: Intergenerational Buddy Support Program: Celebrating a Lifetime of Resiliency
    Description: The purpose of this project is to develop a program of intergenerational mentorship between older adults living with HIV and younger adults aged living with HIV. The project’s purpose was informed by two overarching goals: (1) to provide an opportunity for social engagement for older adults living with HIV, thus addressing the psychological and physiological threats of loneliness and isolation, and (2) to expose younger HIV-positive individuals to meaningful mentorship, allowing for the destigmitization of HIV as a general concept and discussions centered around resiliency, education, and prevention through safe practices with partners.
  • Robert Cornelius – Chattanooga, TN
    Project Title: Survivors Network
    Description: The goal of this project is to connect individuals who identify as both, aging and have an HIV/AIDS diagnosis, with the education and resources needed to learn valuable life skills. The information will help them continue to grow into the successful survivors that they are! We hope that with this information, it will empower and encourage the population to serve and encourage the younger generation with peer support and history of the virus

This World AIDS Day NMAC will Host Two Events

This World AIDS Day NMAC will Host Two Events
Congressional Briefing
Biomedical HIV Prevention Summit

NMAC will host a Congressional Briefing on the 2019 U.S. Conference on AIDS on December 5 at 11 AM (Eastern). It will be live streamed on Facebook for people who cannot attend (watch future newsletters for more details on where to watch). Dr. Fauci will brief Congress on past achievements and future steps that must be taken, and thanking them for their continued support.

NMAC will also host the fourth annual Biomedical HIV Prevention Summit on December 3-4 in Houston, Texas. Over 1,000 people will join us for this important meeting focused on the developing research, community education, and access to the myriad of biomedical tools to avert HIV infection, i.e., PrEP, PEP, and U=U. We are proud to welcome Houston’s Mayor, Sylvester Turner. The program book is 35 pages. Please visit the Summit website to download.

This year’s Summit will continue to address the tough issues facing our movement. The Opening Plenary asks the question, “Can We End the HIV Epidemic in Women Without Focusing on Black Women?” NMAC fights for health equity for all women. However, we recognize that 60% of all women living with HIV are Black cisgender women who primarily acquire HIV through sexual contact. NMAC firmly stands by our mantra that we must Lead with Race. This health inequity is really an issue of racial injustice that must end.

NMAC is actively partnering with the CDC to ensure that transgender women and non-gender conforming male-bodied persons are not classified with gay men. We cannot accept incomplete  epidemiological data and anecdotal evidence about this impact of HIV on T/GNC persons. Some studies point yield that 50-80% of Black transgender women are living with HIV. One of the highest rates of HIV in America for any subpopulation. The needs of T/GNC people are unique and must be distinguished from MSM.

The plenary will also have a memorial to all the transgender women who were killed this year in America who were primarily Black women. Violence is a growing and uncontrolled epidemic in the transgender community and NMAC believes we can’t end the HIV epidemic until we address the violence against transgender and gender non-conforming individuals.

Other plenary topics include a Federal Update from Harold J. Phillips, Senior HIV Advisor and Chief Operating Officer of Ending the HIV Epidemic: A Plan for America.  Joining Harold are Jhetari Carney, MPH from HRSA; David Purcell, JD, PhD from CDC; and Neeraj Gandotra, MD from SAMHSA.  The closing plenary will look at HIV Criminalization and Biomedical HIV Prevention. It will feature Nikko Briteramos, Kamaria Laffrey and Lambda Legal’s Scott Schoettes.

NMAC is grateful to all of our sponsors of the Summit including Presenting Sponsor Gilead, Benefactors Avita Pharmacy and ViiV Healthcare, Supporters Curant Health and Walgreens, with our Allies In The Meantime Men’s Group and Janssen.

Yours in the struggle,
Paul Kawata
30 Years of Service

Paul Kawata

Remembering Transwomen Lost

This year, 22 transwomen of color have been murdered in the United States. Enough is enough!!! The growing violence against transwomen of color is a serious concern that we must address collectively as a community. We can no longer watch on the sidelines, year after year, as the number of transwomen of color victimized by violence continues to increase.

The Transgender, Gender Non-confirming, and Non-binary (TGNCB) Constituent Advisory Panel in partnership with NMAC and the Trans Latina Coalition will hold a memorial during the Biomedical Prevention HIV Prevention Summit this year in Houston, TX. The memorial will honor and remember the transgender women of color who have been murdered this year as well as our other transgender family members who perished too soon.

If you are attending the Biomedical Summit this year, we invite you to participate in our memorial. As part of honoring those we have lost, we will erect an altar of remembrance that will remain on display throughout the Summit. Altars of remembrance derive from the Mexican tradition known as Day of the Dead, or Dias De Los Muertos, where loved ones remember those they have lost by placing photos, candles, and other items on an altar that reminds them of their loved ones. If you have lost transgender people in your personal life, we invite you to bring item(s) to the Biomedical Summit. We ask that you only bring an item(s) to the altar that you do not wish to keep.

NMAC’s ultimate goal is to erect a standing altar that we can add to annually and possibly take on tour in the future!

We know that an altar will not bring back those we have lost or ease the pain of grief; however, we hope this memorial truly serves as a vehicle to honor and remember our loved ones. We also hope this altar will serve as a visual reminder of the danger trans people face on different fronts, and the work we still need to do to address the challenges that threaten the life expectancy of trans people across the country.

The Transgender Altar of Remembrance will be located in the exhibit hall through the duration of the Summit. For more information, contact us at conferences@nmac.org.

Yours in the Struggle,

The TGNCB Constituent Advisory Panel

What’s Happening in San Francisco?

San Francisco may soon be a “proof of concept city” that biomedical HIV prevention works. In 2018 there were 197 new cases of HIV, down from a high of 2,300 new cases in 1996. The city significantly reduced its community viral load by supporting people living with HIV to become Undetectable and increasing the number of people on PrEP. SF went from 4,400 people on PrEP in 2014 to 16,000-20,000 people in 2018. The large increase in the uptake of PrEP directly aligns with significant annual decreases in new cases.
While San Francisco is moving to become one of the first “proof of concept” cities, it is also worth noting that in 2018 the number of new HIV cases in the Latinx community surpassed San Francisco’s White community for the first time.
While the Latinx community makes up 15% of the total population of SF, they are now the majority of new HIV cases. While this is only one year of data, what are the lessons? Can the shift in demographics for SF’s new HIV cases be attributed to the differences in PrEP uptake? About 18% of the people on PrEP in San Francisco are Latinx versus 16% for Asians, 9% for African Americans, 43% for White, and 19% for other.

Or maybe the surge in Latinx cases has more to do with the economics of the city. San Francisco has the highest density of billionaires of any city in the world. Economics are pushing African Americans and Latinx out. In a city that is set-up for the rich, what happens to poor people, particularly poor people living with HIV? NMAC’s concern is that this economic divide will end the HIV epidemic in rich communities while the poor are left to fend for themselves.

This will be the challenge for ending the HIV epidemic (EHE) plans. While we need to significantly increase the number of people on PrEP in all communities, plans need to target the communities that have eluded previous efforts. With Latinx PLWH making up the majority of new HIV cases in SF, are the majority of HIV services for the newly diagnosed provided by Latinx providers? Are there Latinx leaders in key administration positions in community-based organizations, health centers and the health department? Is San Francisco ready to manage this demographic shift in its HIV epidemic?

All jurisdictions building EHE plans must look at how they are working with and including the Latinx community. Plans are required to have comprehensive community consultations with all the communities highly impacted by HIV. Disruptive innovation asks that we don’t bring the same faces to the table. Our efforts must reach beyond the status quo because we have to enroll communities that have eluded previous efforts.

Reaching the Latinx community means having leaders from the Latinx communities planning and facilitating the meetings that target their community. The same holds true for all community consultations: leaders from the designated community should be in the driver’s seat. This is where the solution gets tough, as certain people and communities must let go of power.

Often I am not the right person to speak up. Understanding your privilege means understanding that you don’t have to speak first. In fact, sometimes you don’t have to speak at all. Just because you can doesn’t mean you should. There are too many in our movement, me included, who think we have the answers. This is why ending the epidemic will be a true test of our leadership. Will men let women speak? Can the cisgender community share leadership with transgender and gender non-conforming individuals? Can African Americans, Latinx, American Indians, Alaska Natives, Asians, and Pacific Islanders work together and not be pitted against each other? And what about White people?

While these issues are so much bigger than HIV, they are central to our EHE plans. Can our movement expand to incorporate gay men of color, Black women, the transgender/gender non-conforming community, and people who use drugs into leadership positions? That’s what it’s going to take to end HIV: sharing power and letting other people lead.

Yours in the struggle,
Paul Kawata
30 Years of Service

Paul Kawata