What Fresh Hell is This?

If there was not enough on our plates, monkeypox has been identified in gay men around the world. What fresh hell is this? Hopefully, this will not become an epidemic like HIV; however, there are reasons to be concerned. HIV service providers, STD clinics, and health departments need to be prepared to pivot as more cases are identified.

How does the HIV community educate about monkeypox and not stigmatize gay men? As we know, HIV is not a gay disease and gay men are the majority of people living with HIV. Our work must thread the needle between the need to educate gay men about monkeypox while not adding to the disease burden of a community traumatized by HIV, STDs, and Hepatitis.

The world has lots of judgements about people who are different. Between monkeypox, “don’t say Gay,” and the anti-transgender bathroom, sports, and school bills, it’s a tough time to be LGBTQ in America. The radical right feels emboldened to lie and label us as groomers in a not too veiled attempt to equate gay men to pedophiles. Have they no shame?

HIVphobia, homophobia, transphobia, racism, sexism, and ageism create the trauma that I believe are major contributors to why 49% of people living with HIV fall out of care and why overall enrollment for PrEP is so low. It’s not enough to offer services, even if they are free. There needs to be active and ongoing outreach to community that provides trauma informed care and prevention services. The CDC has developed six guiding principles to a trauma-informed approach:


The communities we need to reach are the same people who are traumatized because they live in America. COVID, Black Lives Matter, Jan 6, climate change, inflation, immigration, war in Ukraine, fires, baby formula shortages, elementary school shootings, crime, Asian violence, racist mass shootings, abortion, Supreme Court, monkeypox, and the upcoming midterm elections are the trauma impacting our family, clients, staff, donors, and government officials.

We’re trained to wait for the “other shoe to drop.”  Monkeypox is just another on a long list of “what fresh hell is this?” Two years after the initial outbreak of COVID, we are still trying to figure out how to live in a world that has gone upside down. Too many Americans are suffering from some form of trauma, and many do not know how to cope. The trauma is coming from multiple sources/directions and feels never ending.

Not only do we need to support family, clients, staff, donors, and government officials, we also need to take care of ourselves. Do not minimize the stress and trauma of leadership while flying blind. The control queen in me is having a particularly difficult time. I’m learning to lean into the reality that I don’t have the answers. We are making the best decisions we can and there are too many unknowns to be definitive.

After my signature there is a resource list prepared by the White House on monkeypox. Given everything that is happening, it is comforting to know that the President stands with the LGBTQ community. We see it in his words and deeds. By the end of June, the Supreme Court will issue their much-anticipated ruling on abortion. Reproductive health and HIV are connected in our commitment to the sexual health and wellbeing of all Americans. Their fight is our fight.

Yours in the Struggle,

Paul Kawata

Paul Kawata
NMAC

Living My Best Life

The plane broke into spontaneous applause as we safely landed in Puerto Rico. I’d forgotten about this sweet custom and was reminded why I love the islands. Some folks think the applause is a thank you to the gods for arriving safely, others believe it is gratitude for being home with their people. I’m in San Juan to celebrate Pride and hold a board meeting/site visit for the 2022 United States Conference on HIV/AIDS.

Words cannot describe how good it felt to be at Pride in PR. It’s been too long. I missed being with community. I’m too old to walk the entire route, so I want to thank Ariana’s Center for letting me ride on their float. To experience their Trans Pride was a gift. Right now, too many are using the transgender community as a punching bag. It was an honor to ride with them during this difficult moment.

Leadership means showing up for the communities hardest hit by HIV.

Congratulations and thank you to everyone working to hold Pride events in-person. The world is an awful place and it’s easy to be overwhelmed and depressed. Public events are not for everyone. There are real risks for getting COVID or Monkeypox. As we learned from our safer sex days, abstinence from the world is the only sure way to be 100% safe. COVID showed me the challenges of being alone. I need to be in the world, traveling and experiencing life. That’s why I was so grateful for San Juan’s Pride.


This year’s USCHA will be a love letter to Puerto Rico. Life is beautiful and difficult here. The meeting is at their amazing conference center (I took the photo myself) and will lean into the culture by highlighting the organizations and people working to end the epidemic in a country that is also a territory. The Opening Plenary will be in Spanish with simultaneous translation into English. USCHA did this to give attendees the experience that impacts too many non-English speaking clients. You are going to learn about the culture by tasting the food and listening to the music, but the best ambassadors are the people. There is a pride to being Puerto Rican. NMAC is working with an amazing local host committee to give you an authentic experience. USCHA is the first big meeting to happen at the center since COVID. There are many jobs and lots of economic development dependent on us.

The 2022 meeting has the largest pre-registration in history. Two hotels are already sold-out. Only 30% of the exhibit space is still available. People are ready for an in-person meeting. Our COVID protocols are stricter than Chicago. Everyone will be required to have initial vaccines and at least one booster. The meeting will also follow all local ordinances. Masking will be encouraged and celebrated. Rapid tests will be available for free for attendees. However, there are no guarantees. Of the 1,033 attendees at this year’s Biomedical HIV Prevention Summit, four people let us know they got COVID after the meeting. We’ve also had two people test positive at two different regional trainings (one per training). No one was seriously ill or went to the hospital. As a health organization that works with people who are immune compromised, we feel a duty to inform. As a gay man of color living in America, I understand risk. There is no one right answer for everyone. I hope you will join us this year, but completely understand if it is too soon.

The world is crazy and that makes Pride even more important. I reject being labeled a groomer. It’s just the Right’s dog whistle for pedophiles. Make no mistake, they are coming after all of us. I stand with Pride, not only for my own mental health, but also as a “fuck you” to all who would deny my humanity. We are headed for war because nobody wants to go back into the closet. There need to be a NATO pact between the oppressed. When they go after abortion, Black Lives, immigration, Asian Lives, climate change, Trans Lives, limits on guns, and the LGBTQ community, we must stand together in our outrage.

Yours in the Struggle,

Paul Kawata

Paul Kawata
NMAC

Covid Asterisk Year

I’m just going to say it: the world is going to shit. Last week saw another mass shooting at an elementary school and monkeypox. I’m reposting the pictures of the children. I know it hurts to see their bright young faces, but we can never grow complacent about gun violence. Unfortunately, experience says we will. The prior week 10 African Americans were killed in Buffalo in another racist mass shooting. Our failure to protect them is everyone’s responsibility.
Most of the children and adults killed in these massacres were people of color. NMAC is not a gun control nonprofit, but that doesn’t mean we don’t have a responsibility to speak out about the insanity of gun violence in America, particularly gun violence that is the result of racism. Our country is a house divided with little middle ground. The divisions turn mistrust and hate into violence. On one side you have anti-abortion, pro-gun supporters who want to take America back to the days where White cisgender heterosexual men sit at the top of the food chain. On the other side is everyone else. All of us understand it’s a fight for the soul of America. Our country is becoming more diverse but rather than create more seats at the table, some people want to go backwards. The good old days were not necessarily good for everyone.

Black Lives Matter saw hundreds of thousands take to the street to demand justice after too many police shootings of African Americans. We watched on video as George Floyd was killed, yet two years later what really changed? The world has witnessed too many atrocities. We are overwhelmed and numb to violence, death, and suffering. Just when you couldn’t imagine another thing, there is a monkeypox outbreak among gay men. What fresh hell is this? They say it’s not sexually transmitted, but the largest outbreaks happened at a bathhouse in Madrid. Most of the cases are among gay men.

Given the overwhelming sad news of last week, some may have missed the Centers for Disease Control and Prevention announcement that new HIV diagnoses decreased by 17% in 2020 vs. 2019. Normally this would be something to celebrate. The reality as noted in the article was the 2020 data could not account for the COVID impact on HIV services. Good news with a *COVID asterisk. Maybe that’s the best we can expect. Under impossible circumstances with no clear pathways, we did the best that we could. This is not normal. It’s not supposed to be like this.

Yours in the Struggle,

Paul Kawata

Paul Kawata
NMAC

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2022 USCHA Scholarships




Hiring People of Color

Change is hard. It requires great effort and lots of anxiety. Many White-led HIV and LGBTQ agencies recently hired their first person of color to lead the nonprofit. I’m very proud because so many have fought for so long for this representation. At the same time, I worry for our new colleagues’ success. Will these leaders be judged by a different standard? The unfortunate reality is “yes.”

There are no playbooks for how to be the first leader of color of a mostly White agency. I know, because I was the first person of color in too many rooms during the early days of the epidemic. Suki Ports and I would joke that we were a caucus of two at most HIV conferences. Back then, leaders of color started their own agencies because they did not see their reflection in the boards or staffs of AIDS service organizations and/or health departments.

The inequity became a flashpoint. It’s taken decades but change is happening. How should our movement support leaders of color? I talk about race because of its impact on leadership. Our movement needs to fund leadership development for people of color not because it is politically correct, but because it is the right solution. It is not easy to manage white people. I am still amazed at White fragility. Also, too many people of color living with HIV have fallen out of care. Too few people of color benefit from PrEP. I’m not saying throw the baby out with the bath water because there is lots of good. I’m just asking for leadership development to support people of color in key management roles in the organizations working to end the HIV epidemic.

There are so many sad stories of agencies who hired their first leader of color only to have it blow up in everyone’s face. Nobody wins those fights. Agencies need to do internal work before hiring their first executive of color. When you’ve hired one person of color, you’ve hired one person of color. You have not solved racism in the agency, community, or planet. Unreasonable expectations make excitement about new hires go off the rails. While I am grateful to all the health departments and community based organizations who are hiring people of color, please make sure it’s not just entry level positions.

Our community is so quick to judge when someone makes a mistake. As an executive director who has made many mistakes, I appreciate that my board understands the challenges of leading while colored and who understands that people are going to get mad because I lead with race and call out White privilege. It is a very difficult line that leaders of color must walk, particularly when they are new. Many are accused of overusing racism as an excuse but, once again, we all live in different worlds with very different realities. As a person who walks in both, some of you are not as “woke” as you think. It takes work to understand, work that too many are not willing to do.

Thank you to all the agencies committed to diversity, equity, and inclusion. It is an important next step, but there is still more to do. Too often values and systems in the workplace continue while clients and staff change. Too many HIV meetings happen where community is diverse, but government is not. Health departments are not exempt from the need to be diverse. Besides color, that diversity must include gender, gender identity, sexual orientation, and NMAC wants to talk about education.

As a highly educated individual, I think educational requirements for employment are bogus, particularly in the HIV field. Our work requires staff to know communities that you can’t learn about in textbooks. Sometimes lived experience is more important than a BA. It’s time to value community. Another reason I talk about race is that our work is missing too many. Systems led by community need to be supported and valued. Professional standards are not necessarily community standards. Existing systems retain 49% of all people living with HIV in care, but they do not reach everyone needed to end the epidemic. Once again, we need to keep the good and use new funding to figure out ways to reach those who have fallen out or are not reached by existing systems. It is time to expand our business model to include the urban market.

My plea is not only to hire people of color, but to also give them the support and resources needed to succeed. Things you take for granted may not be their reality and vice versa. Too many executives of color have experienced horror stories of donors that are friends to the movement but less than understanding on race or gender identity. Unless you’ve been there, it’s almost impossible to appreciate the trauma these meetings create, having to smile while a person with wealth says, “you’re one of the good people of color.” This really does happen. I have too many stories and too many names of donors who just don’t get it.

It comes down to dignity and respect. It’s what we all want and deserve. In the ideal world everyone would be treated like cisgender White heterosexual men while also keeping their community identity and values. Until that day, it is important to understand that our worlds are not the same. Being a leader of color is hard, especially when people say they don’t see color. There are no roadmaps for how to lead a predominately White agency as an authentic person of color. But understand you will be judged based on values that are not yours and/or you may not even know. Pass these life lessons to the next generation. Hopefully, there will be a time when no one is judged by the color of their skin. A boy can dream! Thank you for the privilege of saying difficult things.

Yours in the Struggle,

Paul Kawata

Paul Kawata
NMAC

Picking Strawberries

I am an old Asian Queen who has spent decades writing about my experiences surviving an epidemic. My musings try to be clever and hopefully funny because the topics are serious and sometimes depressing. Each week I write to thousands about our movement’s work to end the HIV epidemic in America, leaning into the tough issues like racism, homophobia, transphobia, and sexism. Frequently, I talk about my challenges with depression, especially PTSD from surviving the early days. Like too many in our work, I’ve lost more friends than I can remember. I stay in the fight to honor their lives. Regular readers know I don’t care very much about spelling or grammar. Too much attention is paid to the skills and not enough to the essence of what is being said. I always look for the kernel of truth, the writer’s willingness to be vulnerable.

I’m telling stories because May 19th is National Asian and Pacific Islander HIV/AIDS Awareness Day. Sharing my life is how I celebrate my heritage. Like many Japanese Americans who came of age after World War II, my early years were spent fighting racial stereotypes and expectations. Sadly, I still get “ching-chonged.” That’s what I call racist statements made by uneducated people who suffer from the illusion that their America is my America. White privilege is alive and not well in our work.

Not only did I grow up Japanese, I also was a Queen. From a very early age, I was one of those little boys who could not hide the fact that he was gay. It must be genetic because nobody else in my family loved Barbra Streisand. Living in the closet was not an option. Now I am grateful for this blessing, but back then it was difficult. I had no role models for what it meant to be Asian and Gay, so I struggled to figure it out by myself. That lonely little boy is still a driving force in my narrative. As you can probably tell, I’ve spent many years in therapy.

When I turned 12, I was sent to the fields to pick strawberries. We got 25 cents per flat (that was 24 boxes). It was long days and back breaking work, but don’t feel sorry for me. I got to keep the money. Back then it was the Japanese American version of summer camp. No one in my circle of friends could afford to pay to go to camp, but we could all catch the bus together to pick berries. Our mothers would pack our lunch and see us off at the stop. It did not seem unusual because I was with all my friends.

I started going to gay bars when I turned 16. I’m still amazed I wasn’t carded, but I did have a mustache. Back then most gay bars were on back streets, usually via alleys, places that no self-respecting Japanese man-child should go, and I loved it. Going to bars and meeting men felt exotic and grown up. I can still hear the thump thump beat of disco music. Donna Summer (back when we still loved her) wailing “Love To Love You Baby.” Coming to terms with being gay helped me to understand that I did not have to live the life my parents expected. I did not have to be the good Asian boy.

In the hierarchy of desire among gay men, Asian men have our “rice queens,” older White men who are trying to relive their youth during World War II. They desire the Geisha experience and prey mostly upon foreign born Asian men. I’ve disappointed too many rice queens with my big mouth and certainty.

Success in our work depends on our ability to reach communities who live in the margins, in worlds most of us will never understand. I’m telling my story to open a window into the world of an old Asian Queen who is also the executive director of NMAC for over 32 years, to be vulnerable in the world that is not kind to people like me. Fighting HIV stigma is key to the success of our work. Now you are 15 minutes closer to being culturally sensitive. Unfortunately, it takes more than reading my exploits to understand the people we need to reach. Malcolm Galdwell, in his book Outliers, says it takes 10,000 hours to become an expert on a topic. I don’t know if that’s true because I’m still on my journey. I just want to be here for the end the epidemic. Then I get to go home to the rice queens who love me.

Yours in the Struggle,

Paul Kawata

Paul Kawata
NMAC

HIV & Aging at 2022 USCHA

After three years, USCHA returns in person! And what better place to celebrate it than in Puerto Rico, the Island of Enchantment.

Among the many things the conference has to offer, and following NMAC’s work on HIV and aging, USCHA will feature a pathway focused solely on these issues. In addition, 50+ folks will have a lounge just for them. A space where they can go to chill, have fun and decompress as they network with peers. Here are some of the experiences and learnings from the last USCHA from our 50+ members:

Looking ahead to USCHA 2022 in Puerto Rico
By Joey Pons

The opportunity to learn about co-morbidities, mental health issues and well-being of older adults living with HIV was enriching and nourishing for me. To be able to network and share experiences, albeit virtually, was wonderful for all of us living and working with this population. There is no question USCHA is the most comprehensive forum for HIV knowledge in community for all of us people of color living and being affected by HIV. This year, USCHA will be held in-person, and I am very excited it will be in my homeland, Puerto Rico.

 

USCHA 2021: Informativa, útil e inclusiva
Por Silvia Silverio

Aunque virtualmente, durante USCHA pude ver e interactuar con otros líderes comunitarios, entre ellos miembros del programa “50+ VIH Fuerte y Saludable”. El tema más importante para mí fue el taller de “Envejeciendo con VIH” ya que tengo 53 años, de los cuales 35 he vivido con VIH. Aunque luzco joven y saludable creo que es importante aprender de las experiencias de los demás para seguir manteniéndome saludable y evitar enfermedades crónicas y comunes que vienen con la edad.

 

Virtual vs. In-Person Conferences
By Jeffrey Long

My experiences have been awesome with USCA/USCHA, and I’m looking forward to USCHA 2022 and hopefully attending the Biomedical HIV Prevention Summit in Chicago to bring information to clients and future clients on studies being done without Indigenous participation.

Big shout out and a huge Thank you, Sgi, in my native language.

 

 

Looking back at USCHA 2021
by Victoria Graves-Cade

I was extremely moved by Linda Scruggs testimonial from an African American women’s perspective in this HIV journey and how HIV and Advocacy gave her a voice. So often in my HIV journey I felt voiceless because the message and images did not include people who look like me, which fueled my fear. […] This was a powerful and engaging virtual conference and I so look forward to learning more, working harder, and building bridges in person with people who are committed to Ending the HIV Epidemic.

 

‘Co-existing’ with more than just HIV
by Rick Guasco

Treating HIV is about more than just treating the virus. As members of NMAC’s HIV 50+ Strong and Healthy cohort, we are empowered to advocate for a better quality of life for people aging with HIV and to press clinicians and care providers to consider all the conditions that come with living with HIV.

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