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

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

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

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

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

Hot Asian Guys

Here is the infamous PrEP ad that was rejected by Instagram. Created by APICHA (Asian Pacific Islander Coalition on HIV/AIDS) Community Health Center. According to Instagram, the ad was rejected on the grounds that APICHA “hadn’t been authorized to run ads about social issues, elections or politics.”

While there was lots of press about why Instagram, a subsidiary of Facebook, would cancel the ads, what got lost in the discussions were the hot Asian guys. For the record, Therese Rodriguez is the leader of APICHA and a long term NMAC board member.

PrEP education campaigns, even ones that are rejected by Instagram, will be key components of our initial efforts to end the epidemic. Jurisdictions will be asked to significantly increase the knowledge and acceptability of PrEP in communities that are hardest hit by HIV, especially communities that have not seen the benefit of the science.

What makes a good campaign?

  • Messenger is as important as the message
  • Culturally relevant
  • Speaks to the values of the recipient
  • Nonjudgmental
  • Sex positive

There are not lots of PrEP campaigns that target Asian and Pacific Islander gay men. As a result, this campaign stands out because the images speak to a very specific community. However, it is not a matter of just substituting the photos. Unfortunately, it is much more complex.

Who Should Local Jurisdictions Target For PrEP Programs?
The federal plan hopes to enroll 900,000 more people on PrEP. Basically, that means everyone it can reach; however, jurisdictions will need to prioritize where to expend resources. Health centers, FQHCs, STD clinics and private doctors should target everyone. STD clinics are particularly important because people who get STDs should prioritized for PrEP education.

Federal funds for PrEP education and outreach needs to reach the communities that are hardest hit by HIV but have not yet received the benefit of PrEP. These communities should be determined by the community viral load for zip codes in the jurisdictions. The zip codes with the highest community viral load need to be triaged and prioritized for PrEP and U=U programs. Science, particularly epidemiology, needs to be the determining factor for what communities are prioritized.

This is where the fight starts…

Can we at least agree that not everyone needs to be equally prioritized to use PrEP? Programs should target people who are sexually active in a “sex positive” manner. Jurisdictions will hopefully prioritize zip codes with the highest community viral load. However, not all the people in that zip code are the same. How should jurisdictions determine who to prioritize?  Follow the science and prioritize communities with the highest viral load, particularly those communities that have not seen the benefit of PrEP.

What does this mean in practice? Some PrEP programs need to target everyone who is sexually active or injects drugs. Other programs need to prioritize the communities that are highly impacted by HIV but have not seen the benefits of the science. Metrics for successful PrEP programs must be finalized, particularly programs that can reach thousands, if not tens of thousands of people. The federal plan hopes to get 900,000 more people on PrEP. To reach those numbers, programs will need to expand in ways that are still to be determined. In the past Ryan White programs were able to meet the increased demand by retooling the service delivery model. Can HIV care, treatment and prevention systems retool to accommodate 500,00 more people living with HIV and 900,000 more people on PrEP?

None of this is easy. That is why I was happy looking at hot Asian guys. Thank you APICHA for making me smile. I salute your important work!

Yours in the struggle,

Paul Kawata
30 Years of Service

Paul Kawata

This is Where the Fight Starts

NMAC urgently fights for racial justice and health equity. Health equity means everyone has access to quality healthcare and the medications needed to live long healthy and happy lives. Healthcare is a right and not a privilege. Justice is about prioritizing those communities with the greatest need. The opening plenary for the 2019 Biomedical HIV Prevention Summit will ask the question, “Can We End the HIV Epidemic in Women, Particularly Black Women?” There was some push back to that announcement: “What about Latinas? What about all women? Why only hold out Black Women?” The fact is that Black women account for 60% of all the women living with HIV in the United States. This question highlights the racial justice struggle to end the HIV epidemic. NMAC fights for equal access to HIV services and meds for all women, and we want justice for Black women. The burden of the HIV epidemic on Black women calls out for justice.

NMAC wants everyone to have access to PrEP. When 75% of the people on PrEP are white, it becomes an issue of racial justice. PrEP programs that reach highly-impacted communities of color must come from and be culturally responsive to those communities. Unfortunately, it is not just a matter of switching white faces for people of color. PrEP programs that reach highly-impacted communities of color must come from and be culturally responsive to those communities.

We also need to talk about justice for the transgender community. As long as the CDC continues to classify transgender men and women with gay men, we will never end the HIV epidemic in the transgender community. How can you end what you do not know? If we don’t know the number of transgender men and women living with HIV, how will this initiative know it is successful? NMAC questions the scientific accuracy of CDC’s HIV epidemiological profiles because of this long-held practice. At its core, this is not good public health practice and something that the CDC can and should change.

HIV funding must address equity and justice. NMAC believes that all communities should have the resources needed to end the HIV epidemic; however, as a matter of justice, we believe the resources need to prioritize the communities that are hardest hit by HIV. In the United States, gay men share the largest burden of HIV. As the federal government looks to target resources geographically, HIV prevention and care efforts need to target the communities with the greatest burden of HIV: Black/Latinx/American Indian gay men, Black cisgender heterosexual women, people of transgender experience, and drug users. Funding priorities need to follow the epidemiological profile of that jurisdiction.

This is where the fight starts.

We are all hopeful and thankful for new resources, but will the money get to the organizations that can reach the communities hardest hit by HIV? NMAC hopes the G-57 jurisdictions will put out requests for funding that speaks to community and their strengths. Too often awards are won by organizations who can afford expensive grant writers, but could never reach the most affected subpopulations. NMAC will work with the G-57 to identify best practices that support community responses.

Agencies and health departments that implement new programs should be required to hire people from the communities that effort hopes to reach. If you want to reach the transgender community, then you need to hire transgender people. If you want to reach black women, then you need to hire black women. If you want to reach drug users, then you need to hire people with experience using drugs. If you want to reach people over 50 living with HIV, then you need to hire people over 50 living with HIV.

While this might seem self-evident, you would be surprised how often it does not happen. Now is the time to take a census of who works at the health department, community health center or community-based organization. Does staff reflect, represent, and have senior staff from the communities the work needs to reach? NMAC does not mean to imply that you need to get rid of anyone but, when there are new hires, who gets the job? Now is the time to correct any past challenges and build a work force that can speak the communities this effort needs to reach.

Our work to end the epidemic must be viewed through a racial justice and health equity lens. It is more than retention in care and adherence to meds. It’s retention in care and adherence to meds in the communities that are hardest hit by HIV. NMAC will fight to ensure that all communities have access to the health care and the medications needed to live long healthy and happy lives. We will also fight for justice to make sure that the communities hardest hit by HIV are prioritized. The color of your skin should never be a determining factor for who acqires HIV or any other disease. In the words of the late Congressmen Elijah Cummings, “we are better than this!”

Yours in the struggle,

Paul Kawata
30 Years of Service
Paul Kawata






Where Have All the Funders Gone?

Where Have All the Funders Gone?

Next week (October 28 & 29) donors will come together for Funders Concerned About AIDS AIDS Philanthropy Summit. Here are the 2017 top 20 funders of HIV/AIDS (global and domestic).

Here are the top 10 funders of the US HIV/AIDS epidemic. Eighty percent of the domestic HIV funding comes from the pharmaceutical industry.
Top 10 States Receiving Funds

All of the above data comes from Funders Concerned About AIDS signature report,
Philanthropic Support to Address HIV/AIDS.

Our movement needs a significant influx of private sector funding and leadership if we are to end the HIV epidemic in America. Government support can only do so much and has significant limitations. Private industry, foundations, and donors need to support what the government cannot. This is a once in a generation opportunity to end an epidemic.

Ending the HIV epidemic in America requires culturally-responsive and sustained engagement in health care and adherence to meds for the majority of the 500,000 people living with HIV who have fallen out of care, are unaware of their HIV status, or have not achieved an undetectable viral load. Additionally, the federal plan to end the HIV epidemic in America has set a goal to get around 900,000 more people on PrEP. Does the existing HIV infrastructure have the capacity to serve 1.4 million more people? Is this kind of expansion possible without a significant increase in private sector support?

Where are the business champions? I do not naively believe that we can do it by ourselves. We cannot. Corporations, foundations, and major donors are needed now more than ever. Our movement needs private sector support and leadership. In the past, CEOs like Bob Haas from Levi Strauss would make the case for HIV to his peers. Where are the CEOs working with community to end the epidemic? Other than the pharmaceutical industry, they all seem to be gone. John Dempsey, it’s time to come back to help finish the job.

According to Funders Concerned About AIDS, “For the fourth year in a role, private HIV/AIDS philanthropy to the US has reached a new high, totaling $186 million in 2017, a 7% ($12 million) increase from 2016. This is mostly attributable to a 40% increase in domestic funding from Gilead Sciences.” In the near future, I will discuss the racial justice component to funding, but for now I just wanted to share the numbers.

Yours in the struggle,
Paul Kawata
30 Years of Service

Paul Kawata

Can We End The HIV Epidemic in Women, Particularly Black Women?

NMAC Mourns the Loss of Congressman Elijah Cummings

NMAC joins with all Americans who fight for racial and health justice, in mourning the passing of Congressman Elijah Cummings.

“Since 1996, Congressman Cummings not only proudly represented his constituents in Maryland’s 7th Congressional district, he represented all Americans who are marginalized because of their race, sexual orientation, sexual identity, HIV status, and injustices associated with minority health disparities,” said Joe Huang-Racalto, Director of Government Relations and Public Policy for NMAC.  “Congressman Cummings was also an unbending voice for civil rights.  As Chairman of the Congressional Black Caucus in the 108th Congress, Congressman Cummings helped lead the fight against two federal marriage amendments, which if passed, would have laid the foundation for amending the U.S. Constitution to prohibit same-sex marriages.  While we mourn his loss, his legacy of bringing to the forefront and fighting the injustices facing minorities will live on.   On behalf of NMAC’s staff, board, and our constituents, we send our deepest thoughts of love and grace to his wife, Maya and their three children.”

Can We End The HIV Epidemic in Women, Particularly Black Women?

This is the question for the Opening Plenary of the 2019 Biomedical HIV Prevention Summit.  A recent post on Facebook from Leisha McKinley-Beach with recommendations from the Atlanta Black Women Leaders on PrEP laid the foundation for the Summit’s discussion about the many challenges Black women face to make biomedical HIV prevention work.
I was concerned about singling out Black women, worried that it could further stigmatize them, but in the same Facebook post, someone I admire said that we need to hold up and talk about Black women. I’ve invited Leisha and the Atlanta Black Women Leaders on PrEP to help lead the planning of the Opening Plenary and to write an article for the NMAC newsletter that speaks their truth. We have to tell our “truths” if we are going to end the HIV epidemic in communities shouldering the largest burden of HIV.While I appreciate the above infographic developed by the CDC, there are two big challenges: 1) It states that one in four persons living with HIV is a woman while it should really read that one if four persons living with HIV is a cisgender woman; 2) CDC currently classifies and counts transgender women as men who have sex with men, aka MSM. Also, the CDC classifies Asian, Pacific Islander, American Indian and Alaska Native women as “other”. It is time to stop these out-of-date practices.

During the Opening Plenary, there will be a memorial that remembers the murdered transgender women this year. The American Medical Association says there is an epidemic of violence against trans women, particularly Black and Latina transgender women. Our efforts to end HIV in the transgender community must address the twin epidemics of HIV and violence. The Summit has reached out to Arianna Lint of the TransLatin@Coalition to begin a conversation on how to hold this memorial.
Innovation Plenary/Long-Acting HIV Treatment
Another plenary at the 2019 Biomedical HIV Prevention Summit will look at long-acting HIV prevention and treatment will soon impact how people will take HIV medications, i.e. innovations like injectables and implants of HIV meds. How will they change the nature of our work? Will they work in the communities highly impacted by HIV?

For people who have a hard time remembering to take a daily pill, will an injection or implant be a game-changer for them? Understanding implants and “choice” will be a very difficult question for our community. Will they be accepted as an option in impacted communities and will they be accessible if they are acceptable? Can the government force anyone to get implants that protect them against HIV? Since our efforts to end the domestic HIV epidemic requires plans to reach hundreds of thousands of people, do these innovations make our work easier or harder? Without comprehensive HIV treatment education programs, NMAC is concerned that some communities will be left behind as the treatment paradigm is shifting. Plans to end the HIV epidemic must include HIV treatment education for all communities highly impacted by HIV.

2019 Summit Scholarship Recipients
This year the Biomedical HIV Prevention Summit will award 280 scholarships from over 800 applications. NMAC will spend $313,000 on scholarships for the 2019 Summit. The average award is $1,117. Over 200 successful applicants will be receiving an NMAC scholarship for the first time.

Demographics of Scholarship Recipients
Gender/Gender Identity                           Age                                 Race/Ethnicity                                                       HIV Status

Androgynous 1% 22-24 3% African American 46% HIV Negative 44%
Female 30% 25-34 47% American Indian/ Alaska Native 4% On PrEP 17%
FTM/Transmen 5% 35-44 25% Asian 3% HIV Positive 31%
MTF/Transwomen 17% 45-54 15% Caucasian 20% Undeclared 5%
4% 55-54 9% Latinx 25% Unknown 1%
Gender Queer 4% 65+ 1% Prefer not
to disclose
2% Blank 2%
Male 36%
Prefer not
to disclose

NMAC wants to thank Gilead for their support of the Summit. Additional funding was provided by ViiV, Janssen, Avita, Walgreen’s, Curant Health and InTheMeantime Men. We thank all of our donors; however, it is important to note that they have no input in scholarship decisions or the conference program.

Additional Scholarship From Independent Agencies
100 more scholarships will be given out (25 per agency) by 1) Abounding Prosperity Inc., 2), FLAS Inc. 3), Latinos Salud, and 4). Sister Love. Please contact them directly to get more information about their scholarship process. NMAC thanks them for adding to the scholarship pool. Their process and decision making are independent of NMAC and the Summit.

Scholarship applications were reviewed by members of NMAC’s Constituent Advisory Panels (CAPs) and NMAC staff. One of the major challenges this year was incomplete applications. We encourage everyone to answer each question fully so they can receive the highest possible score. We also have webinars on our website that offer helpful information about the scholarship process. Please know that we value you and your leadership and contributions to our community. Unfortunately, we cannot support all of the requests we receive.

See you in Houston!

Yours in the struggle,

Paul Kawata
30 Years of Service





First Monday in October

Traditionally, the first Monday in October is the day that the US Supreme Court convenes following its summer recess. On Tuesday, Oct 8th the court will hear three cases about whether it is legal to fire someone because of their sexual orientation or gender identity. The court will decide if federal laws that ban discrimination based on sex apply to a person’s sexual orientation or gender identity.

Given the current make-up of the court, the outcome is not certain. If we lose, the decision will codify discrimination into the law and run contrary to the court’s ruling on marriage equality. In 2015, the Court ruled that states cannot deny two people the right to get married based upon their sexual orientation because of the Due Process Clause and the Equal Protection Clause. Same-sex couples, thereby, had the same terms and conditions for marriage as mixed-sex couples. States could not discriminate based on the sex of either marriage applicant. If states can’t discriminate, can employers?

People living with HIV are protected by the Americans with Disabilities Act. This law prohibits discrimination against individuals with disabilities including those living with the virus. That means if you are LGBTQ+ living with HIV, employers cannot discriminate against you for having HIV, but in 25 states they can fire you for being gay, lesbian or bisexual. And in 26 states, you can be fired for being of transgender experience and/or gender non-conforming. Approximately half of Americans reside in a state where you can fired for identifying as LGBTQ+.

The majority of people living with HIV are part of the LGBTQ+ community. Stigma and discrimination are things that they face on a daily basis. Often it is impossible to differentiate where the discrimination started. Were you fired because you are living with HIV or because of your sexual orientation and/or gender identity? Will the Americans with Disabilities Act protect people living with HIV if they are fired because they are LGBTQ+ identified? Is that distinction even possible to make? Can you imagine there is an employer who will protect the straight people living with HIV, but fire the LGBTQ+ person living with the virus?

Why does this matter to our efforts to end the HIV epidemic in America? Over the last 35 years, we’ve seen and documented the impact that stigma has on PLHIV. We’ve learned how stigma impacts access and retention in healthcare and adherence to meds. Whether the stigma comes from living with HIV, race, sex, gender identity or sexual orientation, it is usually impossible to tell. Our efforts to end HIV must address the stigma that the Court may codify into law. If you can be fired for identifying as LGBTQ+, that makes us by law second class citizens who are not worthy of the same rights as our straight counterparts.


The states colored in grey do not prohibit discrimination based on sexual orientation or gender identity in public or private employment. The ones in purple or pink only offer limited protections for public employees.

How many of those states are part of our efforts to end the HIV epidemic?



Here is the map for our efforts to end the HIV epidemic. The dots represent the local jurisdictions and the states in blue represent the states that are part of the effort. Of the seven states that are targeted in the federal effort to end HIV, none of them fully prohibits discrimination based on sexual orientation or gender identity in public and private employment.

Regardless of the state or jurisdiction, most people living with HIV feel that discrimination and stigma are challenges that impact their daily lives. Even if the target jurisdictions has laws that protect them (most of them do), they live in the country where the courts will soon decide if they are second class citizens, not worthy of the same protections. This is important because our solutions must fit within the political realities of where people living with HIV live and why we must fight against laws that discriminate against the communities that are highly impacted by HIV.

For decades, Congress has tried to amend the Civil Rights Act to prohibit discrimination based on sexual orientation, sexual identity, sex-based stereotypes, as well as other life facts.  In fact, on May 17, 2019, the House again passed the act, and again, Majority Leader McConnell is refusing to bring it to the Senate floor for a vote.

This is a terrible injustice and we find ourselves depending on a conservative Supreme Court to protect LGBTQ citizens because the Senate has again failed to act.

I’m hopeful that the Supreme Court recognizes the refusal of the Senate to allow a vote on the Equality Act.  Millions of Americans risk getting fired or losing their housing based on who they are and who they love.

On behalf of NMAC’s staff and Board, I strongly urge the Supreme Court to do the right thing – to protect all LGBTQ Americans from employment and housing discrimination.  And I call upon Senate Majority Leader McConnell to stop obstructing justice for these Americans – pass the Equality Act.

Onward. Together.

Yours in the struggle,

Paul Kawata