Posts of: NMAC

This year’s Biomedical HIV Prevention Summit was a risk. I’m sure some thought we were crazy. Honestly, I had concerns, especially in this political environment. Thank you to the over 1,300 attendees. To be clear, there was no federal funding for the meeting. In fact, most feds stayed away. I understand, especially right now. NMAC is very privileged to talk about issues that others can’t, especially people in government. It is also hard for some to fully comprehend the damage caused when every day on the news your people are called sick and demented because of whom they love or how they express their gender. Attendees are requested to submit their final Summit evaluation.

Communities highly impacted by HIV are demonized and weaponized in the courts, state legislatures, governors’ offices, and churches. Their prejudice and misinformation create my communities’ trauma and shame. Folks are making impossible decisions about how to live, especially if they reside in a deep red state. Families with transgender children are literally moving. NMAC celebrates what bigots try to vilify. That’s why the 2023 meeting was so transformative. We do not accept judgements from people who have not walked in our shoes. We are more than enough.

Open discussions at the Summit shined a spotlight on the trauma and shame felt by too many. Even the most evolved of us are suffering. This amazing email helped to crystalize my thinking…

“There was something different about this conference—something magical and for me, transformative.  Even as I sit here writing this message and reminiscing on the last two days, tears are starting to well up in my eyes.  I’ve spent the last several hours trying to figure out why this particular conference evoked such strong emotion from me.  Is it because of the looming legal perils that our communities face?  Is it because of the raw emotion that was felt in the room during the plenaries?  Is it just being so angry and tired of constantly being under attack for being who I am?  The answer to all of these is a resounding ‘yes.’”

HIV is mostly sexually transmitted, yet we’ve minimized discussions about sex because it makes us and our donors, especially government donors, uncomfortable. Politics drive the message and too many HIV prevention efforts have bought into that shame. When the extreme right calls us “groomers” or other ridiculous lies, we validate their stupidity when we stay silent. Sex is something to be celebrated and treasured. I hope the 2023 Summit reminds our movement to never apologize for who we are and whom we love.

Being the oldest Queen in the room, I remember when explicit discussions about sex were essential to HIV prevention. Our movement had to educate gay men about condoms using bananas. It was revolutionary. Over time and thanks to pharmaceuticals, the conversation moved to taking your meds and being adherent. Yet safe sex and not transmitting HIV remains a major motivator for why people go on PrEP or become undetectable.

There is something very liberating about a standing room only space where presenters talked about HIV prevention and sex without shame or judgement.

How does this political environment impact the Biomedical HIV Prevention Summit? We wanted to announce the 2024 meeting in Tennessee but decided against it. Rather than make a political statement, the safety of attendees comes first. Some may think this is unnecessary. Just know LGBTQ organizations are getting Department of Justice briefings about how to manage the safety of events during these divided times, especially with Pride in June. Yes, it is that bad. Look for an announcement later this year.

Thank you to everyone who joined us. You are heroes in the fight for equality and justice in this crazy world. This meeting was made possible thanks to our Presenting Sponsor, Gilead. I look forward to seeing YOU at the 2023 United States Conference on AIDS. The 2023 USCHA is NMAC’s love letter to Black women (cis & trans).

Yours in the Struggle,

Paul Kawata

Leadership is hard, especially during these challenging times. All we want to do is end an epidemic that has confronted our nation and the world for over 40 years. Unfortunately, outside forces can make it even more challenging. NMAC thanks the Centers for Disease Control and Prevention for their leadership, and I want to personally thank Dr. Jonathan H. Mermin, Dr. Robyn Neblett Fanfair, and Dr. Renata Ellington. When the history is written, their names will be included as leaders who stepped up and worked to create real solutions.

There is still much to be accomplished. According to UNAIDS, in 2021, 38.4 million people globally are living with HIV and 40.1 million people have died from AIDS-related illnesses. According to the CDC around 1.2 million Americans are living with HIV. In 2019 there were 34,800 new cases. In 2020, 18,489 Americans who had HIV died. The work is not over, and CDC just took an important step to keep us on track to end HIV by 2030.

Yours in the Struggle,

Paul Kawata

Give me a moment to brag about NMAC’s Center to End the HIV Epidemic in America and the amazing work they are doing to train the field. NMAC believes the messenger is as important as the message. Our staff come from the communities the work needs to reach. Their lived experience transforms HIV trainings into life altering moments. Too often capacity building is led by professionals who have no connection to the reality of what is means to be living with HIV. While these programs transmit information, they do not inspire or build the field. NMAC believes in community, especially in the communities hardest hit by HIV. Our work is grounded in the values and life experiences of the people we need to reach because we are a part of those communities. It’s not about reaching them; it’s about reaching us.

NMAC hired an outside evaluator, TRX Development Solutions, to do a deep review of our HRSA funded trainings. Here is the ESCALATE review: the results exceeded all expectations and documented the difference when the work comes from the communities being targeted. The full 50-page review is available upon request.

ESCALATE Alaska (Native Community)

Background
ESCALATE provides training and capacity building for organizations and programs funded by the Ryan White HIV/AIDS Program (RWHAP) to implement evidence-informed interventions and strategies to reduce HIV- related stigma. ESCALATE provides three tracks of activities for staff and community members associated with RWHAP- funded organizations in Parts A-D, including sub-recipients of Parts A and B grants: (1) training, (2) time-bound, targeted technical assistance, and (3) ESCALATE Learning Collaboratives (LCs). This summary covers the ESCALATE Training Program for Year 2 (2021-2022). https://targethiv.org/escalate

Nine ESCALATE Training Cohorts completed the training during Program Year 2 (9/1/21-8/31/22). Training served a total of 250 participants from 62 RWHAP- funded agencies in 20 states, the District of Columbia, and Puerto Rico.

Results from the second year of training show that the ESCALATE training program is a vibrant, robust, and highly successful project. Notwithstanding some notes on the time and intensity of the curriculum, the facilitators and trainers have created and delivered a curriculum that is widely accepted and appreciated by the participants. The curriculum is challenging and complex, but the results on the pre/post evaluation questions show that most participants have absorbed and gained a better understanding of the concepts involved and feel like they can implement things they learned in the training.

Approach
The ESCALATE evaluation has used the RE-AIM Framework for Implementation Science to assess the extent to which the ESCALATE Training curriculum, or tools and practices introduced in the curriculum, can be placed into practice across RWHAP communities. The framework includes five evaluation elements:

• Reach: By the end of program year two, the training established a wide reach across 22 state and federal jurisdictions and 62 RWHAP-funded agencies in Parts A, B, C, and D of the RWHAP. With 276 participants by the end of year 2, the program is on track for 1,000 or more participants by the end of the project in August 2024.
• Effectiveness: A comprehensive span of retrospective pre/post evaluation questions demonstrates the effectiveness of the training with participants, who consistently report statistically significant, high levels of learning over the course of the training.
• Adoption: Adoption of stigma reduction learning or practices from the training is supported by results on the overall relevance, acceptability, and feasibility of the training, in which over 85% of participants provide positive assessments of the training.
• Implementation: Participants leave the training with a clear set of goals for implementation of stigma reduction practices, as well as the needed supports and understanding of challenges that they may encounter. However, the evaluation to date has been unable to measure implementation challenges to date. Action steps for the next program year will address questions of implementation during 2022-2023.
• Maintenance: The evaluation cannot assess the maintenance of stigma reduction practices at this juncture. In Program Year 3, the evaluation will implement long-term follow-up surveys with ESCALATE participants to determine the extent to which participants were able to implement practices or information from the training in their home SRT agencies.

The Year 2 evaluation also provided strong and encouraging results on the testing of ESCALATE’s adaptation of a cultural humility instrument used in mental health settings. Adaptations to the Ryan White service provision milieu are encouraging. The scale consistently measures perceptions of provider behaviors that can be stigmatizing or judgmental. The scale has returned consistent results before and after the training, and regardless of education or skill level. The scale can be used by both persons living with HIV and service providers to assess cultural humility and shows promise a durable tool that ESCALATE may provide to the RWHAP.

      ESCALATE Miami (English & En Español)        ESCALATE New Orleans

We asked ESCALATE participants: What part or parts of this training helped you the most?

Year 2 Cohort 6 participant response:
The ability to have humility even in a cultural environment that has a different understanding of stigma than a person that is well versed with know how to educate. Learning that stigma not just targeted towards one gender, race, or sexual orientation and knowing that everyone’s impacted by these issues. To be able to change the minds and hearts of those who are open to want to learn the wright way to bring awareness to our city’s state organization so our communities become more open to people in or out of the HIV status and the difference between the two.

Year 2 Cohort 7 participant response:
Understanding bias and how I can identify my personal bias as well as others. The facilitators were very adaptable, and the information shared was thorough. Learning that this knowledge and training is needed everywhere and that we all have this one common goal, and we are not alone in this fight. STIGMA!! Small group activities that were interactive were the most effective parts of this training. The EOSA Discussion Tool helped me to dig deeper and think of ways I can implement new strategies into my daily work. The in-depth information that was presented, a lot was known but it was good to see it in another form as well as the opinions of the other participants.

Year 2 Cohort 8 participant response:
I found the open discussions and free form dialogue within the framework of the daily lessons to be most helpful. Hearing about individual’s real-life experiences intertwined with the relevant subject materiel made everything all the more real and urgent.

Thanks to all the staff who work to end the epidemics. I am honored to stand with such talented and vibrant leaders of color. For more information contact Charles Shazor, the Director of The Center to End the Epidemic.

Yours in the Struggle,

Paul Kawata

In the case of Braidwood vs. Becerra, US District Judge Reed O’Connor dropped another hurdle in the war against HIV prevention. He ruled that the Religious Freedom Act gives businesses the right to deny paying for health coverage for HIV PrEP and STD services targeting gay men. He went further to halt all prevention coverage that was approved by the US Prevention Services Task Force. The next day, the Biden administration filed a notice to appeal at the 5th circuit court. Since this is the same court that was used to overturn Roe v Wade, I worry what this court will say. If history is any indication, HIV PrEP and the US Prevention Services Task Force are on their way to the Supreme Court.

Immediately, I called the White House and the Centers for Disease Control and Prevention (CDC) to discuss next steps. This is a humble brag, but it is important for our movement to know that NMAC and many other DC colleagues have the juice to not only call but also get answers. The day after the ruling, the Partnership to End the Epidemics zoomed with AIDS Czar Harold Phillips and Christen Young, Deputy Director, Domestic Policy Council for Health and Veterans.

Here are top line messages regarding Braidwood:

• This case is yet another attack on the Affordable Care Act – which has been the law of the land for 13 years. As you know, the Supreme Court has upheld the legality of the ACA three times.
• Because of the ACA, 150 million Americans have access to free preventive care like cancer and heart disease screenings. Sixty percent of people use a preventive care service under the ACA every year.
• After the Roe/Dobbs ruling, this is another example of a step backwards – with a right to health care being taken away … this is yet another attack on the ACA from the same judge who declared the whole ACA unconstitutional — and the plaintiffs are represented by the architect of Texas anti-abortion bill.
• The ruling harms the communities most impacted by the nation’s ongoing health disparities and the HIV epidemic – especially Black and Latinx communities that comprised 47% and 24% of new HIV infections in 2020, respectively.
• The implications for these communities’ health and quality of life with decreasing PrEP access means more HIV infections, each of which is associated with $500,000 in lifetime medical costs.
• Preventive care saves lives, saves families money, and protects and improves our health.
• This case gets between patients and their doctors. It’s yet another attack on the ability of Americans to make health care choices free from political interference.
• Efforts to undermine this requirement are wrong and backwards. The Administration will continue to fight to improve health care and make it more affordable for hard-working families, even in the face of attacks from special interests.

The 2023 Biomedical HIV Prevention Summit honors the diversity of the communities highly impacted by HIV. Next week over 1,300 leaders will gather during this politically difficult moment. Governors, state legislatures, and other governing bodies are going after HIV prevention or the communities we need to reach. NMAC works to create a “safe space” that celebrates the people who are weaponized without their consent. Our job is to give traumatized people a place where we see them. The Summit is NMAC’s thank you to the HIV movement for their leadership to end HIV.

This year’s meeting focuses on sex. Since HIV is primarily sexually transmitted, our work needs to reach these/our communities for HIV testing, PrEP, PEP, and/or treatment. Sex continues to be a taboo subject with too many layers of shame. We live in a world where the people who hate us are using LGBTQ sex to scare their base by calling us groomers of children. While we know it’s untrue, we ignore their lies at our peril.

Does the current political environment impact our HIV prevention efforts? While I want to say no, the reality depends on where you live. Right now, HIV prevention cannot ignore these political challenges. The Summit will be NC-17 and children will not be allowed into the space.

Summit Talking Points

• Tennessee. The Tuesday plenary focuses on TN and beyond. It is also an opportunity to introduce Toni Newman in her new role building the Coalition for Justice and Equality Across Movements. Given what is happening in Texas and TN, we need this effort.
• Braidwood. NMAC was very disappointed but not surprised by Judge O’Connor’s opinion. Unfortunately, that pushes the case to the 5th Circuit where we are likely to lose. From there it is on a path to the Supreme Court.
• Attacks on the Transgender Community and Drag Queens. NMAC stands in solidarity with all the communities highly impacted by HIV. The attacks against the transgender community and drag queens are mostly a “look over there” strategy to strike fear in their base. This year’s Summit will have the “look over there” RuPaul’s Drag Race season 7 winner Jaida Essence Hall.

The trauma we feel is real. It’s hard to be transgender or a drag queen in America. It’s hard to be someone living with HIV, a person of color, LGBTQ, a woman, immigrant, non-binary, or undefined. We are all being weaponized against our will. It’s time to have real conversations about the future of HIV prevention, particularly since HIV PrEP is being used to take down the ACA. This is not the first time they’ve come for us. We walk in the footprints of heroes.

Protests
Protests are part of the legacy of the HIV movement. Our meetings are the training ground for future activists and NMAC supports the right to protest. If there are protests, please do not intervene. Call conference staff or go to the conference office. Kindly email me in advance about any protests (pkawata@nmac.org) so we can coordinate disruptions.

Being Safe
HIV taught our movement that safety is relative. COVID is not over. NMAC encourages everyone to wear masks. However, they are optional. Our COVID policy is the same as last year. COVID tests will be available in the conference office. If you feel sick, please quarantine in your hotel room, and call the office for a test. Do not leave your room until you test negative. Conference staff are here to provide support as needed.

You will need to verify your COVID vaccination status to be admitted to the Summit. There will be NO exceptions. You can upload your vaccination card here.

Mobile App
You can now download the 2023 Summit mobile app. It has the full agenda for the Summit along with all the info you need to navigate the conference. Search for “2023 BHPS” in the App Store and the Google Play Store and download to your phone.

Program Book
The Summit Program Book is available for download on the Summit website. There will not be a printed program book but there will be a limited number of printed agendas available at Registration.

I look forward to seeing everyone next week. HIV prevention is caught in the crosshairs of the culture wars in America. We have a huge job to not only work to end the epidemics, but also to be warriors in the fight for our right to exist.

Yours in the Struggle,

Paul Kawata

Yours in the Struggle,

Paul Kawata

I’m not going to lie. The pressure of work, especially what’s happening in Tennessee and Texas, has taken its toll. Communities highly impacted by HIV are weaponized as part of the fight for the soul of America! The extreme right is passing laws, turning back funding, and working the courts to codify religion’s right to discriminate and they’re winning. “It’s against my religion” is now legal justification to bully, discriminate, and deny access to services like HIV PrEP.

During COVID I got addicted to vacation porn, specifically travel to Japan. This month I got to run away to remember who I am and why I still need to fight. In Japan I am tall. In Japan I am butch. You might laugh, but America stigmatizes me as short and effeminate. So many of the communities highly impacted by HIV are minimized because of the color of our skin, gender, gender identity, or sexual orientation. Our lives are under attack. We are being used to scare people to the polls.

Civil rights, voting rights, women’s rights, abortion rights, gun control, same sex weddings – we’ve changed the world and that’s why they’re fearful. This is not the America of their youth. How far are they willing to go to stop change? For me there is no choice. I can’t go back into the closet. I will not go quietly into the night. I will rage against the dying of the light.

America is in for difficult times with lots of trauma. Their “look over there” strategy makes us the totem that gets their base to vote and give money. It is very expensive to run for President and there are some very deep pockets who want to take America back. Their “hit” list includes abortion, affirmative action, critical race theory, immigrants, guns, HIV PrEP, transgender youth, drag queens, and core HIV prevention funds. 2023 is just the opening salvo of message testing for the next presidential election. Imagine how these actions will traumatize clients, co-workers, and friends.

Normally I don’t talk about my breaks, but it felt important to share my process for healing as our movement gets ready for the fight of our lives. After 34 years as the Executive Director of NMAC, I’ve come to understand that HIV is a marathon and not a sprint. Like so many, I prioritize others and wonder why I am exhausted and tired.

This picture was taken in Tokyo at the teamLab*Planets exhibit. It’s a total immersive experience that lets you see the world in new and different ways. Sometimes it’s important to get out of the day-to-day grind and gift your mind and body with rest and the joy of travel.

I look forward to seeing everyone at the 2023 Biomedical HIV Prevention Summit. Approximately 1,300 attendees will come together to discuss the future of HIV prevention in America. Not only will the Summit update the core HIV prevention tools, but it will do a deeper dive into the political realities facing our work. It’s not enough to end the HIV epidemic by 2030. Now we must do it in a world that hates the communities we serve, a world that hates us. Thanks to the NMAC board and staff for allowing me time off. By sharing my trip, hopefully I’m practicing what I preach. Not only do we need to take care of people living with HIV, but we also need to take care of ourselves. Leaders are no good to our movement if we work to the point of exhaustion and burn-out. I return ready for the next fight!

Yours in the Struggle,

Paul Kawata