Dear Harold

NMAC logoJune 8, 2021

Mr. Harold Phillips
The White House
Washington, DC  20500

Dear Harold,

Congratulations on your well-deserved selection as the next Director of the White House Office of National AIDS Policy. Please thank the President and Dr. Rice for including community in this important decision. You have NMAC’s support, and we look forward to working with the administration to end the HIV epidemic.

Your life is about to change. As a Black Gay Man leading our nation’s efforts to end the HIV epidemic, you stand on the shoulders of Reggie Williams, Calu Lester, Alvin Ailey, Tim Offutt, Craig Harris, Max Robinson, Ron Simmons, Willli Smith, Sylvester, and many other Black Gay heroes we lost to HIV. While most people know you from your work at HRSA-HAB, I get to brag that you got your start at NMAC.

With your new appointment, community needs you to deliver. There are too many people living with HIV who have fallen out of care. There are too many people who need PrEP, but we can’t seem to reach them. While the solution to ending the HIV epidemic might be biomedical, it is not simple. That’s the problem with the previous administration’s strategy. They believed you just needed to make medications available. The reality is so much more complex and nuanced.

COVID has pressed pause on everyone’s work but, as America reopens, it’s time to get back to planning to end HIV. While we appreciate the President’s commitment for more HIV funds, we also need to make sure the funding goes to where it is most needed. I believe the Biden-Harris administration is looking for ways to bring racial equity to government. HIV sits at the intersection of that search. What does it mean to bring racial equity to our fight to end the HIV epidemic in America? How will HHS, HUD, CDC, HRSA, SAMHSA, CMS, NIH, OAR, NIAID, and other federal agencies be required to carry out this White House mandate?

With your new appointment, community needs you to fight. While we are very happy that you got this job, it only works if you fight for us. As a member of the White House’s Domestic Policy Council, we need you to bring the fight to end HIV to them. Too many people think the epidemic is over. Your voice represents more than you, it is the voice of the multitude of communities fighting HIV.

It is time to reconstitute the President’s Advisory Council on HIV/AIDS (PACHA), and it needs to be real. Your office needs the support of a Council that embraces the White House’s commitment to racial equity across government, a Council that understands it’s here to support you and the President to end the HIV epidemic.

The HIV community is extremely diverse and you can’t please everyone. There will be times when community may disagree with the administration. Please do not take critiques personally. As your job is to stand-up for the President, our job is to stand for community. I believe there will be lots of agreement, as the White House has shown their commitment to healing America.

As you prioritize tasks, we look forward to the Biden-Harris plan to end the HIV epidemic. There is no need for a completely new process; however, the previous plan did not directly address race and its impact on ending the epidemic. As I know you understand, addressing the racial divide in HIV is core to ending the epidemic. For too long we’ve danced around race and racism and focused on things like the social determinates of health. The color of your skin should never be a factor in your health outcomes, yet for too many diseases this is true. HIV can be the example for how to use race to address too many health disparities in America.

As you know, the population of people living with HIV is aging. While this is wonderful, it was not something fully anticipated when the original Ryan White program was envisioned. Now we need to make sure the HIV service mix includes specialty care like gerontology. While PLWH are living longer, they also face multiple challenges from aging and HIV. The Biden-Harris administration needs to create and implement a comprehensive “standard of HIV care” for this growing community.

The White House needs to tell the Centers for Disease Control and Prevention (CDC) to stop classifying people with transgender experience with gay men in their HIV epidemiology profiles. Justice for the transgender community starts by having CDC understand the difference between gender identity vs. sexual orientation. Too many administrations have promised to make this change, yet nothing ever happens. Ideally, we hope Assistant Secretary for Health Dr. Rachael Levine leads this charge.

The Biden-Harris plan should take a systemic approach to ending infectious diseases in America. It’s not enough to focus on HIV. Now is the time to also address Sexually Transmitted Diseases (STDs) and Hepatitis. You can end three more epidemics that have challenged America for too long. Our solutions should focus on the whole community and not any one disease. As COVID has shown us, there is a great need for comprehensive health infrastructures in too many communities in America. The plan to end HIV should serve as the foundation for bringing healthcare to communities that are too often overlooked. As we used the HIV vaccine infrastructure to test the efficacy of COVID vaccines, now we can use the HIV prevention and care infrastructure to bring long term health to communities in need.

Harold, I am so proud of what you accomplished. Now is the time to take those years of experience working at NMAC and HRSA-HAB to build the plan that you know is needed to end the epidemics. NMAC stands in solidarity with you and the administration. We will see you at the Opening Plenary for the 2021 United States Conference on HIV/AIDS, so please bring your boss.

Yours in the struggle,

Paul Kawata
Paul Kawata's Signature




40 Years of HIV

Thousands of people march past the White House during a candlelight vigil in support of funding for AIDS/HIV research Washington, DC, May, 1993.

This week there will be lots of stories about the 40th Anniversary of the first reported cases of a disease that would later be known as AIDS. Back then, this milestone was unthinkable. All we wanted to do was get through the next week without someone dying. To mark this important anniversary, NMAC invited four longtime activists to talk about the impact that report had on their lives. Over the month of June, we will release those conversations in our social media and via our weekly newsletters.

While people aren’t dying from HIV in the same numbers and new cases have dropped by 9% from 2015 to 2019, there are still widespread disparities. African Americans are eight times more likely to get HIV when compared to White America. Latinx are four times more likely. NMAC is still fighting for all the communities hardest hit by HIV. We are still committed to addressing the racial disparities that has plagued HIV for too long. Does the Harvard Law Review hold the key for including race as a component of HIV funding? A May 31st article in the New York Times noted:

“The Harvard Law Review, for instance, selects 30 of its 48 editors based on some combination of a writing competition and grades. Another 18 editors, a statement on its website says, are “selected through a holistic but anonymous review” that may consider “racial or ethnic identity, disability status, gender identity, sexual orientation, and socioeconomic status.”

The question of whether this diversity produces a better result was answered by a study that looked at 13,000 research articles. It found the “median citations of the Harvard Law Review increased by 23% in the five years after the adoption of diversity programs.” According to the authors of the study, this is statistically significant.

Can the same rules be applied to federal HIV funds? While most of the awards are given out on a competitive basis, there is a certain number of awards that are holistically and anonymously reviewed that may consider racial or ethnic identity, disability status, gender identity, sexual orientation, or socioeconomic status.

There is a racial reckoning coming to America after the death of George Floyd and protests from Black Lives Matter. Critical race theory is at the center of the culture wars and neither side will give up without a fight. The fight for racial justice is a fight for the soul of America. Who do we want to be as a country?

I believe the Biden-Harris administration is looking for strategies to fight racism by prioritizing racial equity across government programs. They understand there is a problem, but like most of us get lost trying to figure out solutions. Taken as a whole, the problem is overwhelming. How do you end racism in America? And it doesn’t stop at racism. Justice for people of color can lead to equity for the transgender community, women’s community, and LGBTQ community. That is why the Harvard Law Review is such an interesting example.

It’s hard to believe that the world has now been living with HIV for four decades. Time has moved much too quickly, and I am now an old man. I just want to live long enough to be here for the end of HIV and to see America on the right side of the fight for  justice and equity.

Yours in the struggle,
Paul Kawata

Paul Kawata

I Made A Mistake

I made a mistake in last week’s piece on the Minority AIDS Initiative (MAI). I believe good leadership is owning your mistakes and working to fix it. As you probably know, I am not an epidemiologist. However, NMAC will always follow the data and the science and the data I shared last week did not capture the impact that MAI has by race/ethnicity. Here is the corrected data that I received:

These data (from two CDC reports: Estimated HIV Incidence and Prevalence in the United States) show the disparity between African Americans and Latinx persons compared to White persons. While there is a slight decrease for African Americans and a slight increase among Latinx persons, the trend is essentially flat between 2010 and 2018.

Thank you to Eve Mokotoff, the Director of HIV Counts, for correcting the record.

There were also concerns about the amount of credit I took for NMAC’s role in the development of the MAI. To be clear and fair there were many leaders and organizations involved in the creation of the MAI. While NMAC played an important role, we were not the only ones. I did not mean to dishonor any person or institution.

I’ve been in Washington fighting HIV since the Reagan administration. I’ve made a lot of mistakes and will probably make more. Fighting HIV is a high wire act that is not for the faint of heart. Leaders who worry about making mistakes usually don’t take any risks. For NMAC, it’s not the mistake but the way it gets cleaned up or covered-up.

NMAC is focused on the Minority AIDS Initiative because we believe the Biden—Harris administration is committed to doing something important on race. After Black Lives Matter, there is a racial reckoning coming to America. It is not enough to point out racism. We are at a moment when the White House and Health and Human Services are looking for solutions. But we can only win by telling the truth and cleaning up mistakes

Yours in the struggle,
Paul KawataPaul Kawata

Standing Up Against Anti-Asian Racism

Too often, Asian Americans are incorrectly labeled as the “model minority.” The label minimizes our pain and the challenges we face living in America. Some of us could assimilate, but too many continue to live in poverty, especially people with limited English-speaking skills.

The rise in violence and discrimination against Asians was just another example of the world going crazy. How much more stress, recriminations, and loss can America endure? We are all living on the edge waiting for the next shoe to drop. Would Asians fight back? Would our friends stand with us? Would the President stand in solidarity or blame us for the virus? Please watch this video of an older non-English speaking Chinese American who fought back.

TW: Violence, and Anti-Asian Hate Crime

Don’t mess with “Grandma.” Under similar circumstances, I’m not sure I would have her courage. I definitely understood her pain. It is the pain that too many Asians and too many people of color carry. “Why do people hate us just because of the color of our skin, our accent, or where we were born?” These are not things I can or want to change, but they make so many people angry and define how many Asians show up in the world.

I am the executive director of the National Minority AIDS Council, yet I am still asked to get people’s drinks or hang their coats. Part of why I dress so outrageously is so guests understand that I am not the help. Even at the United States Conference on HIV/AIDS, I’m still asked to get coffee for a table during plenary sessions. It’s taken a long time for me to learn to speak back and now you can’t stop me. Too many Asians cannot speak up. My parents were interred for nothing more than being Japanese. They taught their children the hard lessons they learned from that experience. Keep your head down, try to blend-in, and never speak up.

That’s why I am so inspired by the Asians who are fighting back and the people who are standing in solidarity. People of all races, genders, gender identifies, sexual orientations are standing with the Asian community like never before. Thank you to everyone who posts on Facebook, makes a donation to an Asian nonprofit, attends a vigil, or just talks with their friends. You know your real friends when the s*** the fan (that is so Japanese).

This experience taught me that leadership matters. The President matters. The Vice President matters. I am so proud of the Asian American elected officials who are speaking out. For too many this is their first time on the national stage. Watching the tears of Representative Grace Meng (D-NY) as she called out a member of Congress for hijacking the hearing was an incredible moment. Her words were both heartbreaking and empowering. Her courage to stand up to power and take back the hearing reminded me of warriors like Maxine Waters and Nancy Pelosi.

This is the legacy of racism that is breaking the fabric of our society. How many people have todie? Unfortunately, the answer continues to be that our lives don’t matter. Calling out anti-Asian violence is interconnected to NMAC’s fight to lead with race to end HIV. None of us can do it alone and we’ve got to figure out how to work together. Divisions are killing us and our communities.

Yours in the struggle,
Paul Kawata

Paul Kawata

Leadership Matters

I’m getting my COVID vaccine today. Words cannot adequately express my gratitude. The vaccine means I get to live. I get to survive another pandemic. I sobbed when I got the news. However, I am also painfully aware of my first world privilege. As the HIV movement did after the International AIDS Conference in Durban, South Africa, we must now stand in global solidarity for Covid vaccines for the world. NMAC is truly thankful to Congress and the President for the $3.5 Billion for the Global Fund and $250 million for PEPFAR that was part of the American Rescue Plan Act. As we tested the COVID vaccine using the HIV vaccine infrastructure, we will now use the international HIV infrastructure to address COVID worldwide.

Leadership Matters. As we are seeing first hand, leadership matters when working to end a worldwide pandemic, leadership and money. The same is true for ending HIV. Are you the leader our movement needs to end the HIV epidemic? Ending HIV requires tens of thousands of leaders. However, they may look very  different. The HIV community is not exempt from the hopes/tensions the country feels about race and Black Lives Matter. It’s the struggle for the soul and future of America. COVID showed the need for better, different, expanded healthcare infrastructures. Not just health services, but as HIV taught us, much-needed wrap around services like housing, mental health and food security. Our movement needs to build and support agencies that not only end HIV, but also address the multitude of challenges facing our community. COVID shined a spotlight on the lack of healthcare for too many. Agencies need to expand their mix of services to address multiple needs in our diverse communities.

Communities have diverse needs. They can’t and won’t go to multiple agencies for different services. After COVID, community expects to get services virtually, yet the digital divide is real. Getting an appointment for a vaccine depends on access to technology, yet too many in our communities do not have this access or speak English as a second language. Consumers want agencies that provide a multitude of services, in multiple languages. Organizations must be prepared for change. Some of us are dinosaurs and don’t want to adapt, but we won’t have a choice. The world is changing and there is a right and wrong side in history. To be clear, I’m not saying all older executive directors need to resign, but they do need to look at the role they are playing in fighting or maintaining systems that oppress too many. I believe COVID has changed more than where we work, it has changed what we value and who we want to be. Like so many, I made a pact with God that if I survived COVID, I would be a better person. I would fight harder for my community and not be afraid to ask for grace.

COVID also highlighted our differences. Some people always wore a mask, others usually, and too many never wore a mask. Sound familiar? Substitute condoms for masks and it’s the identical question. We’ve learned how hard it is to get everyone to wear masks and condoms. Yet we can’t give up on either. Until everyone gets the vaccine, we need them.

Thank you, Mr. President for your words about the potential for a more normal 4th of July, for letting me dream. After my vaccine, I look forward to watching the fireworks on the national mall. We still do not fully understand the changes that are about to happen in our world. It seems impossible to go back to the way things were before COVID. How life will change depends on our ability to absorb and integrate the lessons of COVID, the lessons of Black Lives Matter, and the lessons of losing everything. COVID exposed the inequities in the world and hopefully we can no longer look away. As we have seen, access to healthcare is not a luxury, it is a core value for all Americans. Now we understand the need to improve the healthcare infrastructure for all communities. Like the world used the infrastructure for HIV vaccines and the Global Fund, maybe it’s time to use the domestic HIV service infrastructure to buildout our COVID services. Healthcare by itself is not the solution. Domestic HIV services documented the critical importance of wrap around services like housing, mental health and food security. How do we take the lessons learned from HIV and use it as the foundation to build the healthcare infrastructure needed in America after COVID?

Yours in the struggle,
Paul Kawata

Paul Kawata






Being a Black Gay Man

Jezreal Rodriguez Anderson
Program Coordinator

Anthony J AndersonI am tasked with writing an article about Gay Black men, one of the hardest things I must do to date. If I were asked a year ago, it would be the easiest thing in the world, back when my life revolved around being what I deemed a “Black Gay Man.” However, as of recently, I am at a loss for words when it comes to this idea of Black gay men. As much as I crave the community of other Black gay men, I also fear it. I fear that the relationships I build will hurt me and I fear that the life I always thought I wanted was something that did more damage than good.  

As funny as it sounds, when I got to college, I thought I was an anomaly. I thought as a Black Gay man I was the conundrum that people only heard about in myths. Up until this point, there were no Black Gay men in my life to befriend and as someone who went to a 100% African American school, I never found another man I could find solace in over my sexuality. TV shows like “Queer as Folk,” a program I snuck to watch, did not have Black gay characters and Davey Wavey, the white gay YouTube star I looked up to, did not discuss race, so going to college I was the only Black Gay man in the world and, oh, how that task. 

That all changed when I took a break from my white institution and engulfed myself into the world of the District of Columbia. During my break from school, I built strong relationships with some Black Gay men who became my idols. It was the first time I saw Black men who were fully comfortable in their own sexuality and I wanted it. It was not long after that I realized that the same people I looked up to were also the people who would let me down. 

As humans, we build ourselves based on the relationships we make. In 2021, being gay and being socially expressive is something that is still new in our world. We are in an era where we are still learning what it means to be Gay and what it means to be in a healthy relationship and, sometimes, we fall short of that. We as youth look up to individuals who are still looking for their own identity. The truth of the matter is, we go from being “straight men” to fucking them and there are issues that come with that.  

Even though I have spent four years being in the Black community, I can tell you I still say have no idea what it means to be a Black gay man. For me, sometimes it is putting away my sexuality for the greater good of the community or being so gay that other Black people do not even acknowledge it. For some, it is doing lines of coke in the bathroom with their good friend and for others it is praising God during Sunday worship. None of these experiences are right and none of these experiences are wrong but they are the reality. As Black gay men, we are not a monolith, we are individuals; that is the most important part of this story. 

A lot of Black gay men, including myself, will conform to what society deems a Black gay man is and then spend a lifetime trying to find our own selves. We look for the leaders in our community only to find they still cannot lead themselves. We look for intimacy through sex instead of just learning the importance of being in each other’s presence. It is time for us to find our own idea of what makes us Black and gay. 

Sometimes I say too much and sometimes I do not say enough for fear of judgment. Some days I crave the relationship of other Black Gay men and sometimes I crave the intimacy I never gave myself. This chapter of my life being a Black Gay man means being my own self and having a keen sense of that. If we want to stop HIV, we need to first stop denying ourselves from healing first. Many of us are battling mental health issues, substance abuse, sex addiction, financial instability, and many other demons that are very valid and real. I can say, in the past five years, as strong as my relationship has been with other Black men, I can count on one hand the times someone asked me, “when was the last time you took your meds,” but I can tell you the last time someone asked me for a line of coke, or even the last text received about a “wild” sex party (that I might have gone to). I do not fault any of these individuals because this is their narrative and story. However, right now as a black community, we need to assess what are healthy habits and what are vices we are using to cope with deep hurt.  

When you are searching for love, as all people do, sometimes we are willing to jeopardize our whole self to make that a reality. We will jeopardize our morals, our ideals, and, most importantly, ourselves for fear of being weak or alone. I know that is what I did until I realized that nobody could make me whole but myself. I found that all the unhealthy habits that were just for fun prior to COVID-19 became the same vices that I did alone when nobody was looking. I realized that all the love I thought I needed from others was not the love I give myself. To be honest, in 2021, we are not focused on how to stop HIV; we are focused on how to stop doing our vices before they kill us. If we do not forgive ourselves and understand that we are worth living for, then we will never see the importance of making sure we manage our HIV and take our PrEP. As Black gay men, no narrative is the same and to be empowered is to realize that, as an individual, you find it important to live a motivated life.  

In all, the Black Gay community has so much beauty and many niches that have and continue to shape society. I am really blown away by the Black gay leaders in the community who take noes and turn them into yeses. Even through our hurt and ostracization, we get up each day and try to survive in the best way, in a world that wants us dead. When I first started this journey as a Black Gay Man, I thought I was the only anomaly, but I come to realize every person in my Black Gay community is too. We are all hurt and we have all hurt other, yet we still love and forgive. We ignore our own hurt to let others shine and that’s the beauty of it. In every mess you can always find beauty, and I am just as messy as the rest and it’s what make all of us so great. During this Black History Month let’s work on holistic healing. Let’s work on facing our fears head on and to become the person we are meant to be. Let’s work on realizing as a Black Gay Man you hold the power to move mountains and shape history. That is what I want to see this Black History Month: healing and self-love!  

Are We Ready?

Lauren MillerLauren Miller
Health Equity Program Coordinator

Are we ready to lose the chains of white supremacy that have bound Black folks and prevented us from reaching our greatest potential?

Are we ready to topple, desecrate, and destroy every idol, statue, and name inscribed that caused harm to black folks?

Are we ready remove to white supremacists from their seats of power; unapologetically?

Are we ready to restore the black communities left behind and destroyed by the crack epidemic?

Are we ready to close the jails and privately owned prisons that have capitalized off of black bodies?

Are we ready to right the wrongs caused by the medical community that have led to mistrust?

Are we ready to provide reparations to the ALL the descendants of enslaved Africans?

I am ready. I believe America is ready. And if you ain’t ready, I hope you get there soon or you will find yourself on the wrong side of history.

“We have nothing to lose but our chains”

For 400 plus years in America white supremacy has reigned and kept us all behind. WE all saw what happened at the Capitol. And the world saw it too, live and in color.

The revolution will not be televised……
but the insurrection of disgruntled hateful white supremacist will be

White Supremacy could no longer be hidden, burned, discarded, lynched, and erased from history.

It is now. It is us.

But we are not the same.

Our ancestors have taught us so well.

Marsha, Martin, Malcolm (thank you for your radicalism, your beauty, your sacrifice).

It is their voices that guide us as we fight to liberate every black body, and we don’t intend to leave nobody behind.

Mumia, Matulu, Janine (thank you for your radicalism, your beauty, your sacrifice)

My Journey with PrEP

Terrell ParkerTerrell Parker
Associate Program Manager

A few days ago, I started primary care with a new doctor. I recently relocated back to Indianapolis now that my job is virtual. When my doctor walked into the room, she asked me about the blood pressure medication I take, and then she asked…… “so I see you want to be prescribed PrEP, tell me about that?”

Me: “Well, I’m gay. I have receptive anal sex, and I sometimes don’t use condoms. This puts me at high risk for HIV, so I take PrEP.”

Doctor: “Okay, great.” (trying to mask her shock and surprise).

Me: “Have you ever prescribed PrEP?”

Doctor: “No, this is my first time.”

Me: “Well, you want to do an HIV test on me, full STI screening, check my kidneys, and…”

Doctor: Laughs.. “Thanks, but I asked a colleague and he walked me through the process already…”

Me: “Great, if other people in your practice need some education, I can refer you to a PrEP providers training program.”

The rest of the conversation went pretty well. I walked out of the doctor’s office with an order for PrEP called into the pharmacy less than a mile from my home. A few years ago, this was not my reality. As I drove home, I couldn’t help but reflect on how far I’ve come. I couldn’t help but recall the days before I had quality health insurance, before I had a car to easily make it to appointments, and before I had the education to advocate for myself.

My journey towards PrEP has been long. I first learned about PrEP attending an HIV prevention conference in 2014. Five years later, I finally began PrEP in November of 2019. Before coming to NMAC, I was a young professional just starting in the HIV workforce. Like many beginning professionals, I worked for a low salary and no health insurance benefits.

After learning about PrEP, I made it my mission to increase awareness in my local community.
I began educating anyone who would listen. I held community talks, focus groups, launched a PrEP campaign, and helped develop internal processes/external partnerships to increase PrEP referrals and navigation for young, Black gay/bisexual men and transgender women.

Even as I worked to increase PrEP access in my community, I faced the reality that PrEP was not accessible to me. No health insurance meant no PrEP. I knew, however, when I did have access to insurance, I was going to start PrEP—period. I just needed to hold on to my negative HIV status long enough to get a prescription.

PreP gives us the power to transform our narratives and rewrite history as Black gay men. Many of us have heard the CDC projection, “½ of Black gay, bisexual men will contract HIV within their lifetime” if current trends in HIV acquisition continue. PrEP is a powerful tool we MUST use to change this trajectory. We will only change this, however, if everyone who wants PrEP has the access, resources, and support to sustain PrEP uptake.

PrEP has been revolutionary for me. I think back to 2011, being madly in love with someone, and having that person tell me they could no longer be with me because they feared transmitting HIV to me. Fast forward 10 years, and I have proudly and openly dated people living with HIV with no fear of HIV transmission. PrEP gives us the power to take control and finally enjoy a health sex life free of fear and shame. I have never enjoyed sex and intimacy as much as I have since starting PrEP.

In honor of Black HIV Awareness Day, we must ensure everyone can be a part of the revolution. My experience today is still not the experience of most Black gay men I talk to who want to access PrEP like my friend, who told me this weekend his primary care doctor first refused to prescribe him PrEP and later tried to dissuade him due to him not “being a good fit” for PrEP. Thankfully, he did not listen. He persisted and now has an appointment to being PrEP this week.

We must ensure everyone has access to adequate health insurance and informed care providers.

Putting PLWH First in Line for COVID Vaccine

The COVID vaccine roll-out is another gift from the Trump administration. They punted to states to implement vaccine roll-outs not understanding or caring that states were already overwhelmed managing COVID testing, healthcare, and deaths. NMAC is particularly concerned about access to the vaccine for people living with HIV. We have already heard reports of PLWH who were turned away from getting the vaccine because they were immune compromised, stories of PLWH who were told that taking antiviral meds was contraindicated for the COVID vaccine. Like so many in this country, people don’t know whom to trust.

Talking with a federal colleague, I was told that “people with HIV should be in the 1c vaccine category, if not 1a or 1b for another reason.” Unfortunately, the state by state roll out currently underway has resulted in different policies and timelines. As a result, NMAC made an appeal to the CDC asking them for clarification. Our movement needs to push to ensure PLWH are classified as 1a so they can have immediate access to the vaccine. This is particularly important because PLWH are aging and too many suffer from age advancement due to meds. There are also too many PLWH who are still immune compromised and need to move to the front of the line.

The Need for National Leadership

For the next two years, local health departments will continue to be overwhelmed by COVID and their roles in managing this disease. As we have seen, you can’t just leave it to states. Ending COVID or ending HIV takes national leadership. The federal government can’t just tell states it’s their responsibility to figure out how to get the vaccine into arms or to put together a plan to end the HIV epidemic in their region. Both movements are crying out for national leaders who tell the truth and who will stand with community on the frontlines of both epidemics.

COVID has shown us what happens when you don’t have the national leadership needed to guide the country through a terrible moment in history. Why should HIV be any different? There are too many people who are afraid to get the COVID vaccine. There are too many people who don’t trust PrEP. Our goal has to be about more than getting drugs into people. It’s also about understanding the systemic barriers that keep people from living their best life. As we have learned from Ready Set PrEP, just because the drug is free does not mean people will take it. While cost is always a factor, there are many other variables that must also be addressed. Ending the COVID or HIV epidemics is not only about meds. Until we understand and address the complex human challenges of race, sexual orientation, gender and gender identity, we will fail in our efforts to get herd immunity for COVID or the numbers needed for U=U and people on PrEP to end HIV.

It breaks my heart to think of the people I lost to HIV in 1994-96. The time right before protease inhibitors and combination therapy was the stuff of night terrors. Now that we have a COVID vaccine, we just need to hold on until it is our turn. Unfortunately, that may be months for most of us. I’m fighting to find the courage to stay alive. I need you to fight with me.

Yours in the struggle,

Paul Kawata

A Change is Gonna Come

A President’s Inauguration is usually a joyous moment of celebration, at least for the winning party. Because of COVID, unemployment, and the raid on Congress, there is little happiness or the mood to celebrate. I just want this inauguration to be over as quickly and safely as possible. There is lots of work to be accomplished.

The Biden’s administration number one priority has to be COVID and getting control of the pandemic while rapidly getting out the vaccine. If we’ve learned anything from this experience, we learned that we weren’t ready and too many people died because of it. The Centers for Disease Control and Prevention (CDC) has a long way to go to repair its relationships, both internally and externally. I asked the Biden transition team focused on the CDC to make sure the new director, Dr. Rochelle Walensky, addresses the toxic culture of racist aggressions outlined in a July 2020 New York Times article. NMAC supports their request that the director declare “racism a public health challenge.” Not only will that go a long way to heal internal issues, but it will also put the CDC in alignment with the Biden administration.

President Biden says racial justice will be a priority for his administration and NMAC says prove it by ending the HIV epidemic. How will this White House priority transform HIV services to align with this presidential priority? What is HHS, CDC, HRSA, HUD, SAMHSA, NIH, et al., doing to meet these new administration’s values? NMAC challenges all federal agencies to show how their HIV funding is addressing the President’s call for racial justice.

NMAC applauds President Biden’s nomination of Dr. Rachel Levine to his Assistant Secretary of Health. She will be the first out transgender federal official to be confirmed by the Senate. Federal offices with significant HIV funding should follow his lead by hiring people living with HIV, people of color, LGBTQ, and especially people of trans experience as federal employees. If Black Trans Lives Matter, then there should be Black Trans people in leadership positions at HHS, CDC, HRSA, HUD, SAMHSA, NIH et al. NMAC is concerned that too many federal offices with significant HIV funding have too few staff from the communities hardest hit by HIV. How can you build programs that reach community when community isn’t on your team? One of the unfortunate lessons from COVID, like HIV, is that, while the viruses don’t discriminate, the lack of healthcare and prevention infrastructure can kill you.

COVID has shown us that we must call out these inequities. We cannot stay silent and expect things to change. Because the Democrats control the White House and Congress, we have an opportunity to make real change. However, it’s only a two-year window. With Speaker Pelosi’s 2022 retirement, I worry for our future. We will never have another Speaker who will be as friendly to the HIV community as she was. Our community owes her a great debt of gratitude.

Yours in the struggle,

Paul Kawata