No F@gs Allowed!

By the end of June, the Supreme Court will hand down decisions on two cases that could have profound impacts on our world. Happy Pride! After overturning Roe, we should not be surprised. While the cases are not HIV specific, these decisions could hurt communities highly impacted by HIV. The two cases include:

  • 303 Creative LLC vs. Elenis
  • Affirmative Action

303 Creative LLC vs. Elenis is about freedom of speech and public accommodation. Does the owner of 303 Creative LLC have the right to publish the following on her websites, “I will not be able to create websites for same-sex marriages or any other marriage that is not between one man and one woman. Doing that would compromise my Christian witness and tell a story about marriage that contradicts God’s true story of marriage.”

Since we already lost the case of the Christian baker who did not want to make wedding cakes for a same-sex couples, there is precedence to discriminate. What makes this different is her desire to put this statement on her corporate webpage. Does her right to free speech supersede local ordinances against discrimination in public accommodation?
Make no mistake, the wording is different, but the sentiment is the same. People of color have a long history fighting these actions, and they seldom end well. If she is allowed to post this statement, does that open the door for other businesses to follow? Does it stop with same sex marriages? What about others who compromise her Christian witness, for example, Muslims or atheists? While I am not concerned about a single website developer, I am very concerned that this seems to be part of a larger concerted effort to weaponize my community. When SCOTUS flipped, it seemed like an inflection point to ramp-up their campaign of hate. This year there are multiple court cases, hundreds of pieces of legislation, and too many elected officials leaning into the culture wars. It can’t be a coincidence. As they rewrite the role of the courts in our democracy, it becomes a pathway for the minority to control and “bring America back.”

You may not remember, but there was a time when funeral homes regularly refused to cremate people who died from AIDS. Hospitals turned away or made people living with HIV so uncomfortable as to make them leave. Laws to stop discrimination in public accommodations were written for a reason. If she wins, then we, the LGBTQ community, will in fact be second class citizens. People and corporations will not only legally be allowed to discriminate against us, but they can also explicitly note that in their communications. Most large corporations will continue to support the LGBTQ community; however, this decision further divides our country and stokes the flames of discrimination and hate. It also could set the precedent that hate speech overrides local or state laws protecting access to public accommodations.

Affirmative Action is also under review by this court. While most of the press is focused on higher education, it is important to understand the implications this decision could have on efforts to end the HIV epidemic in America. The Minority AIDS Initiative was created in the late ’90s to build organizations and infrastructure in communities of color to address the epidemic. At that time, people of color were disproportionately impacted by HIV.

The Bush Administration used a previous Supreme Court ruling on Affirmative Action to gut the MAI. Funding priorities went from minority led nonprofits to minority serving nonprofits. That simple change decimated many of the minority led HIV organizations. To this day it is still being used as the reason change is impossible. An unintended consequence is that 10 years after the MAI was gutted, people of color became the majority of new cases and the majority of people living with HIV.

Black Lives Matter moved the dialogue about race in America. It was a reckoning that both opened important discussions and scared others to “take back America.” NMAC, along with the Latino Commission on AIDS, SF Community Health Center, and Southern AIDS Coalition are working with Congresswoman Maxine Waters and Congresswoman Barbara Lee to bring a portion of the MAI back to its original congressional intent. This year we got so close, and all of us remain committed to this effort. We will continue to work with the Congressional Black, Hispanic, Asian, LGBTQ+ Equality and HIV caucuses.

The HIV movement knows race matters. You see it in our programs, services, and staff. In many ways we are the model for diversity. So why does our work fail to reach so many in need? What are the systemic changes needed to bend the curve of new HIV infections. Recently CDC data showed a significant decrease in the cases of HIV, unfortunately those decreases were not across the board.

HIV sits at the intersection of so many critical and divisive challenges in America. Community based nonprofits and health departments are to be applauded for their ability to hire people with lived experience. This means many of your employees come from the communities hardest hit by HIV. They/we expect you to stand up and fight for community and to fight for our shared values and humanity, especially as we are weaponized for political gain. The pain is not just out there, it is also in our house. America feels like it is overrun with homophobia, racism, sexism, and transphobia. Not only are the consumers we need to reach in trauma, but our staffs are in trauma. I am in trauma.

Allowing her to write on our webpage, “I will not be able to create websites for same-sex marriages or any other marriage that is not between one man and one woman. Doing that would compromise my Christian witness and tell a story about marriage that contradicts God’s true story of marriage.” is the equivalent of No F@gs Allowed. Not only does it legalize trauma and discrimination, but it also supersedes any state or city public accommodation laws.




Yours in the Struggle,

Paul Kawata

Paul Kawata

My Coming Out Story

At 16 I realized feelings for my best friend were about to become a problem. I’m sharing my coming out story because there are too many working to define this pivotal moment in my life as shameful and wrong. They are using my community and my life for their political gain by telling lies about what it means to be LGBTQ.

After decades of HIV prevention work, our movement knows to prioritize people with lived experience and not folks who have no understanding, but lots of judgements. My story is about a kid who didn’t want to be gay because good Japanese boys were supposed to fit the mold of the model quiet American. I spent the rest of high school failing to suppress my sexual feelings and looking for a way get “fixed.” Back then nobody talked about being gay. We wrongly thought it was something shameful. I hid and suffered until I needed therapy. In truth, I hoped counseling would cure me. When people say being gay is a choice, they have no idea of the harm they are causing for kids who are confused and scared by feelings they don’t understand and can’t control.

I was that little boy who could not hide his gayness. My mouth opens, and a purse falls out. I was born this way. From an early age, I loved Barbra Streisand, the Supremes, and musicals much to the bafflement of my parents. You could say it was in my DNA. That’s why I know being gay is not a choice. Who would choose a life fill with stigma, discrimination, and threats of violence? At the same time, you can’t taste freedom and not want to be free. As Americans, we innately understand this proposition. Being gay is who I was meant to be and praying to God would not change that reality.

In college I could live a lie and be miserable or open my heart to love. We were both pledging the same fraternity. It was the kind of love that is only for the young. Full of drama, testosterone, and keeping our love a secret. The closet is an awful place to live. While I wanted to tell the world, the culture was not ready. So, I began my lifelong journey to reconcile my desire for men with the good Japanese boy narrative. If I was going to be homosexual, I wanted to be a great homosexual. It was the late ’70s at the height of the EST movement, and I turned to Gay EST, the Advocate Experience to be part of the vanguard who believed we could change the world by coming out to friends and family. The act of speaking our truth held immense power. I still believe in coming out. Sharing my story is how I heal my life.

This photo was taken at the 1979 San Francisco Pride Celebration. I’m marching with my new family from the Advocate Experience behind a banner that would bring me great pride in my old age. This photo marks the exact moment I came out to family and friends because it was on the cover of the San Francisco Chronicle. Surprise! I was blessed to find my new family. They helped me understand and believe I was OK. Their values formed the foundation for my activism, I am Gay and I Love You. Three years later, an unknown virus would again change the course of my life. I never strived to run a national organization. Back then no one wanted these jobs. It was considered career suicide. Like so many, I had no choice because people I loved were getting sick and dying. I could not live with myself if I did nothing. Like many, I jumped blindly to fight an epidemic that was scary and completely unknown. It was not without a cost. I still work to manage the trauma from the early days of the epidemic. I would be lying if I didn’t acknowledge the sadness and grief that sits in my soul. For me, it’s the combination of growing up Gay in America with the trauma of fighting the HIV epidemic in the early days that defines my life and the lives of so many who came of age at that time.

Margaret Heckler, President Reagan’s Secretary of Health, and Human Services said we would have a vaccine in four years. I told my family in Seattle that I would be gone four or at most five years. Little did I know. Little did we all know. The story of fighting HIV is that of bravery and courage in the face of great adversity. I will not allow others to control our narrative. We are not groomers or pedophiles. The implication is offensive and wrong. We are heroes who changed the world and saved our people. HIV is no longer a death sentence. We built a healthcare infrastructure from nothing. Working in Washington, our community created and maintains multiple federal budget lines that annually provide billions in support. Activism not only changed the FDA drug approval process, but it also gave meaning to our lives. We even got money from the Trump administration to end the HIV epidemic in America. Don’t tell me we can’t achieve the impossible.

There is a whole generation coming of age in the 2023 era of trauma and vilification of the LGBTQ community. It is real shit right now and will only get worse with the Presidential election next year. I worry for the future. Then I remember that we stand on the shoulders of heroes. To the 16-year-old boy, I say look at me now. This picture was taken when I was a marshal at DC Pride. Our history documents our strength. Overcoming adversity is in our DNA. It took a long time and many tears for that scared boy to become this outrageous Queen. While I am still a work in progress, coming out and speaking my truth changed the trajectory of my life. Happy Pride everyone!


Yours in the Struggle,

Paul Kawata

Paul Kawata


Happy Pride! Pride Celebrations across the country are facing real challenges concerning the safety and health of attendees. Not only are we concerned about HIV and a resurgence of MPox, but the threats of violence are real. If our work was not difficult enough, now it must be implemented in an environment that is hostile to the communities we need to reach.

NMAC holds lots of regional meetings and recently we’ve noticed a shift in the treatment of our guests. There is a significant increase in the level of disrespect and dour behavior in some regions of the country, particularly staff working in deep red states. As a result, NMAC is rethinking where and how to hold meetings. Safety for attendees was always considered when making site selections, now it is a priority.
While it’s disheartening to acknowledge the existence of violence against the communities hardest hit by HIV, here are some initial strategies that were crafted by ChatGPT for this e-newsletter:

  1. Develop a comprehensive code of conduct: Clearly outline expected behavior and explicitly state that discrimination, harassment, or violence based on HIV status, race, gender, sexual orientation, or gender identity will not be tolerated. The code of conduct will be prominently displayed and communicated to all participants and hotel staff before and during the conference.
  2. Provide staff training and education: NMAC will offer workplace support on inclusion, allyship, and understanding diverse gender identities and sexual orientations. Educating hotel staff about the issues faced by our communities can help foster empathy and respect.
  3. Implement a reporting system: Create a confidential and easily accessible reporting mechanism for incidents of harassment, discrimination, or violence. Encourage participants to report any incidents promptly and ensure that appropriate actions are taken in response.
  4. Engage security personnel: For our larger meetings, NMAC will have visible security personnel present at the conference venue to deter potential acts of violence or harassment. Make sure security staff are trained in LGBTQ sensitivity and are aware of the specific safety concerns faced by the community.
  5. Foster an inclusive culture: Emphasize the importance of inclusivity and respect through keynote speeches, panel discussions, and presentations. Encourage speakers and presenters to use inclusive language and promote diverse perspectives throughout the conference.
  6. Promote networking and support: Facilitate opportunities for participants to connect and support each other. Host networking events, discussion groups, or mentorship programs specifically designed for individuals attending the conference.
  7. Conduct risk assessments: Prior to the conference, conduct a thorough risk assessment to identify potential safety concerns and address them proactively. This can include reviewing the venue’s security measures, considering emergency protocols, and ensuring the accessibility of facilities for all attendees.
  8. Regularly evaluate and improve: Gather feedback from participants after the conference to evaluate the effectiveness of safety measures and identify areas for improvement. Incorporate suggestions and lessons learned into future conferences to continually enhance participant safety.

In addition to your physical safety, our movement needs to stay diligent about HIV and a resurgence of MPox. Here are some general guidelines to help mitigate the risk of transmission:

  1. Promote vaccinations: Encourage participants to be up to date with their vaccinations, including routine immunizations and any specific vaccines recommended for the region or specific risks associated with the conference location. Encourage attendees to consult their healthcare providers for guidance on appropriate vaccinations.
  2. Communicate health guidelines: Provide clear and accessible information to all participants about preventive measures, such as hand hygiene, respiratory etiquette (covering coughs and sneezes), and proper disposal of tissues. Display posters or signs promoting these practices throughout the conference venue.
  3. Ensure proper hygiene facilities: Make sure the conference venue has easily accessible handwashing stations equipped with soap, water, and hand sanitizers. Regularly restock these facilities to maintain hygiene standards.
  4. Encourage safe practices: Remind attendees to practice safe behaviors, such as using condoms, U=U, PrEP, or PEP. Provide free condoms.
  5. Implement infection control measures: Work closely with the hotel staff to ensure proper cleaning and disinfection protocols are in place, particularly for high-touch surfaces such as doorknobs, handrails, and restrooms. Provide ample waste bins for proper disposal of tissues and other waste.
  6. Facilitate testing and counseling services: Collaborate with local healthcare providers or organizations to offer voluntary testing and counseling services for HIV or other relevant diseases. Provide information on testing locations and encourage participants to take advantage of these services.
  7. Maintain a healthy environment: Ensure the conference venue has adequate ventilation to improve air circulation and reduce the risk of airborne transmission. Consider organizing sessions in open-air spaces whenever possible.
  8. Stay informed and follow local health guidelines: Monitor updates from local health authorities and follow their recommendations and guidelines regarding disease prevention and control measures. Stay informed about any specific risks or outbreaks in the area where the conference is being held.

This e-newsletter was created with the support of ChatGPT. Artificial Intelligence (AI) is changing the way we work. Remember, creating a safe environment requires ongoing commitment and vigilance. By implementing these measures and promoting a culture of respect and inclusion, everyone can contribute to making meetings safer for all participants.

Yours in the Struggle,

Paul Kawata

Paul Kawata

Dear Tennessee

N.M.A.C. leads with race
Dear Tennessee Colleagues,

Friday is our last call. At the beginning of the year, none of us knew we were about to become best friends. While NMAC had concerns about Texas, Tennessee was not on our map. Your governor brought us together in what might be called a shot gun marriage. This was an important test for our movement. Could local, national, and federal agencies work together to figure out real solutions? This was the first time a state had turned back their core prevention funds, so there was no precedent. However, there was lots of fear. Would other states follow Tennessee? Given the numbers, NMAC was particularly concerned about Florida and Texas. And we still are concerned.It started with an email from Wayne Smith:

“Hello Paul. This is Wayne Smith from Knoxville, Tennessee and Samaritan Ministry reaching out about some issues with HIV prevention in Tennessee. I don’t know if you have heard, but our governor is pulling all CDC funding for prevention from our state. I think he is attempting to replace CDC funding with state funding so that he can control who gets prevention messaging and care. This looks to me like it is an effort to politicize HIV prevention and exclude people that he doesn’t think deserve this kind of service, especially the LGBTQ community. I wonder if this would be something that might be an agenda for other red states that want to control to whom services are provided. If you would like to discuss this with me to see how NMAC might be involved, please call.”

I’ve known Wayne for years; he is part of Samaritan Ministry. His email promoted a phone call where together we decided to hold a zoom with community-based organizations in Tennessee. He invited local colleagues, and I invited the Partnership to End the Epidemics (AIDS United, NASTAD, NCSD, NMAC, and the AIDS Institute) as well as Lambda, Funders Concerned About AIDS, and the Southern AIDS Coalition. For the next four  months we would meet on a weekly zoom to share information, concerns, and support.

On top of the loss of federal HIV prevention funds, there was also a 340B impact that was not as obvious. HIV PrEP uses FDA approved medications. Community organizations depend on 340B revenue to run their agencies. Given the state’s rejection of core HIV funds, would CBOs also lose their 340B funding? There are more 340B dollars then core federal HIV prevention support in Tennessee. Solutions needed to also address this important source of revenue.

The first calls were about setting ground rules and building trust. The Tennessee community needed the nationals to understand that what worked in deep red states is different and we needed to follow their lead. Like we’ve learned over the years with HIV prevention, there is not a one size fits all solution. The Tennessee strategy had to work in an environment where the state legislature had a super majority of Republicans who were also going after the transgender community, drag queens, and other legislators. HIV was just another in a long list of ways to remake their state. Tennessee became a flash point for the culture wars in America.

Building trust was difficult, especially when leaders don’t get along. The divisions were particularly challenging between local jurisdictions. Unfortunately, Tennessee like so many other states, created an environment of mistrust due to the competition for money and resources. This happens all too often, especially when there is not regular communication and partnership building between agencies. NMAC hopes this was not a one-off experience. Please consider a statewide coalition that can increase trust and support through regular communications.

Folks quickly realized there would not be a state legislative solution, so the group turned to the White House and the Centers for Disease Control and Prevention. This is where the nationals played a key role. It’s taken decades for our movement to build relationships with key federal agencies and every four years this could change. Back in the Reagan administration, much of our support came from closeted officials who were always looking over their shoulders. Now we get invited to the White House without having to hide. For Tennessee, the White House stayed out of the discussions because they understood the President could be a lightning rod. Our coalition worked primarily with the CDC while keeping the White House informed.

The biggest challenge in working with the CDC was the lack of time. I got Wayne’s email on January 192023, and the state was turning back funding as of May 31, 2023. Moving government bureaucracies takes time, especially one as large as the CDC. Could we get them to move in a timely fashion and what was the direction they needed to move?

None of this would have happened without CDC’s cooperation and leadership. The nationals became that annoying pest that kept bugging them into action. It started with having the CDC join our weekly calls to hear directly from community about the impact of the governor’s decision. You were able to paint a picture that only people working on the frontlines can share. CDC saw you as the heroes.

I don’t know what happened internally at CDC, but they were able to move in a timely fashion and follow our recommendation to fund the United Way as a neutral third party. While it may have seemed effortless from the outside, I know this was not as easy lift. As I was told, there was lots of support to do the right thing, but there were systems and approvals that need to be followed. Nimble is not a word that is usually associated with a government bureaucracy. What makes CDC’s solution so important is that it built the playbook for what to do if other states take similar actions.

Friday is our last call and I want to say “thank you.” You are heroes in the fight to end the HIV epidemic in America. It’s been my honor to work and get to know you. Together we showed our movement that local, national, and federal leaders can not only work together, but also accomplish the impossible. I hope not to see you again, especially for the joyous celebration when we end the epidemics.

Yours in the Struggle,

Paul Kawata

Paul Kawata

What the Early Days Taught Me

What are the lessons to be shared about the early days of the epidemic? By my 28th birthday, I attended and/or planned the funerals of so many friends that I lost count. The trauma is real. Over the last decade, I’ve continued to lose friends to suicide, drug addiction, and murder. Trauma from the early days never seems to go away. It impacts how I see the world and my self-worth. It comes from lots of deaths, and too much prejudice and discrimination. In my small circle of friends, more than half are dead. Like so many who came of age at the start of the epidemic, we suffered the unspeakable that continues to this day. To all of you who have found peace, please share. It has eluded this old Queen. I think it’s why I stay. I’m waiting for the end.

Right now, too many fools get platforms to speak vile untruths about the communities highly impacted by HIV, especially the transgender community. How do we live in a world where politicians, church leaders, and “concerned citizens” are calling us groomers and pedophiles? They are storming school board meetings to get books banned, passing legislation to stop healthcare for our community, and letting us know that we are not welcome in their America. It isn’t just the transgender community watching and worrying about these actions. Important players are calling out strategies that lean into the culture wars because they understand the cost of civil wars. Part of our job is to connect the dots so that multiple communities understand that we are all in this together.

In the middle of this insanity, how do we work to end the HIV epidemic in America? Especially in this deeply divided country?  Our work cannot be divorced from whom we serve. We need to prioritize HIV testing, PrEP, and PEP. Long acting injectables are a game changer, but I worry about the uptake in communities of color. HIV cannot continue to work in a silo. We must look for systemic solutions. That starts with other sexually transmitted viruses.

We cannot allow their hatred to slow our progress. If that happens, then they win. While most of the news looks bleak, we recently had a win in Tennessee, but we don’t want to draw attention to it. When the governor turned back core HIV support, our movement got tangled in the culture wars. NMAC worked with national, community, and federal partners to create a work around that is trying to fly under the radar. What makes this solution so important is that it sets a precedent should other states consider similar actions. It took lots of coordination and leadership to make this happen. Hopefully it documents the value of national partners and the need to work across sectors.

The ‘80s are my reference point for how bad things can get. While life is currently awful, we have survived worse. Recently I learned the Transgender Law Center (TLW) has a $13 million annual budget. That reality brought much joy and pride. TLW was inconceivable back in the ‘80s and now they have an annual budget that is bigger than NMAC’s. I celebrate them and all the communities working to end the HIV epidemic. We are stronger than we understand.

Yours in the Struggle,

Paul Kawata

Paul Kawata

Health Equity

I wish I could say I had the foresight to hire Toni Newman because I understood how the right would weaponize the transgender community. Unfortunately, I am not that smart. It was the constant punching down that clarified NMAC’s responsibility. Toni is the Director of NMAC’s newest program, Coalition for Justice and Equality Across Movements. After the court case in Texas and the governor’s decision in Tennessee, NMAC understood the need to build a bigger tent by working in coalition with other movements who are also under attack.

Given the onslaught of hate against her community, I’ve asked Toni to step into the spotlight, and she needs your support, especially as the world propagates lies, misinformation, and violence against her people. As a transgender Black woman, her voice and those of her peers are central in the larger culture wars. The transgender community shoulders the burden of over 450 anti-LGBTQ pieces of legislation. Please read Toni’s Op-Ed that was published in The Hill.

Key Message: Health Equity
A key message for why other movements want to work in coalition with NMAC… HEALTH EQUITY. Across movements, leaders shared how they could get behind a coalition that prioritizes this critical issue.  As we know, communities of color, the LGBTQ+ community, and many economically-disadvantaged groups don’t have access to the health care they need. It’s an issue that impacts tens of millions of Americans, and leaders across movements shared their interest to build a coalition that prioritizes tangible ways of advancing health equity.

The transgender community is taking it on the chin. Our movement needs to elevate their voices and be an ally in the fight. With all the hate from the right, the stories of transgender heroes need to be told in their beauty, complexity, and challenges. It is not easy to be transgender in America. I’m sharing this information to be transparent as NMAC works to give Toni a bigger platform. During this difficult political moment, we will lead with Toni in our outreach to media and work across movements.

The way America treats the transgender community becomes a mirror for our country’s support of people who are different. To everyone’s frustration, they are trying to fit square pegs into round holes. This struggle will define our nation for generations. To humanize the people that they vilify, NMAC enlisted The Raben Group for support with communications. During this difficult political moment, we need professional help, especially working the corridors of power in DC. This firm is part of a larger strategy to get NMAC and our movement ready for the culture wars. I’m concerned this will be a war like we’ve never seen. It’s already started with the multiple pieces of legislation, the banning of books, and the erasure of the right to an abortion.

The HIV movement must stand in coalition with other movements to support the multiple communities under attack. This includes abortion, equality, gun control, adoption, affirmative action, immigration, and the myriad of issues disproportionately impacting our families. We are stronger with others and it’s time to build bridges across movements.

As we’ve always said, the messenger is as important as the message. Putting Toni in this role is how we live our values, but it won’t work without your support. It’s about fighting for all the communities highly impacted by HIV and holding-up the voices of the oppressed.

Yours in the Struggle,

Paul Kawata

Paul Kawata

Reflections on the 2023 Biomedical HIV Prevention Summit

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

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

Paul Kawata

Bragging About NMAC

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)

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).

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.

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

Paul Kawata

Braidwood vs Becerra

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 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 ( 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

Paul Kawata