A Love Letter to Black Women

Kim Ferrell is NMAC’s Deputy Director for Operations. She’s been with me and NMAC for over 16 years, longer than any boyfriend. She is the heart and soul of the agency. Kim plans on retiring next year, so to say thank you to her and all the other sheroes, 2023 is NMAC’s love letter to Black women (cis & trans). Like we leaned into Puerto Rico last year, the 2023 United States Conference on HIV/AIDS will celebrate and honor Black women. They are the backbone of NMAC and our work. USCHA is September 6-9 in Washington, DC at the Marriot Marquis. A special Black Women’s Summit will proceed the gathering. The Opening Plenary will tell their stories and celebrate their magic. Their experiences will be highlighted in workshops, institutes, posters, and special events.

NMAC owes so much to so many. We will celebrate Black Women across our movements, from activists to women living with HIV, national advocates, community voices, federal leaders, heath department staff, healthcare workers, and researchers. There are also many important women focused organizations. NMAC will tell multiple stories.

Black women play key roles at NMAC, starting with our founders, Rashida Abdul-Khabeer (formerly Hassen), Sandra McDonald, and Marie St. Cyr to our staff Tara Barnes-Darby (26 years @ NMAC), Alison McKeithen (15 years @ NMAC), Shantá Gray, Diane Ferguson, Asia Moore, Gabriella Spencer, and Lauren Miller to our long-term board members Valerie Rochester, Evelyn Ullah, and Monica Johnson. Black women have been instrumental to NMAC and our movement. Unfortunately, we’ve also lost many warriors like Natalie Cole (NMAC’s first major donor), Linda Jackson (OAR), Pandora Singleton (Project Azuka), Barbara Joseph (NBWHAN), Janet Cleveland (CDC), Dr. Dawn Smith (CDC), Juanita Williams, Dr. Janet Mitchell (Harlem Hospital), and the heart-breaking list goes on. Who are the women you want NMAC to remember, honor, and celebrate?

As part of our commitment, NMAC will also work to support and hire Black women owned small businesses. The agency challenges our sponsors, donors, and government partners to use these businesses and to hire Black women, especially Black transwomen. We must put our money where are principles live. Recently I had the opportunity to visit Queen Victoria Ortega at the Connie Norman Transgender Empowerment Center. They are an incubator for small trans owned businesses. I visited a t-shirt company they are starting. Our movement buys so many t-shirts, so please support the vendors who come from the communities highly impacted by HIV. It’s not always about getting the cheapest t-shirt. You may pay a little more, but you are also building community.

We need to invest in the communities highly impacted by HIV. The world is not fair and, without extra support, our work will miss too many of the folks we need to reach. As we honor Black women, it is also important to acknowledge that HIV PrEP outreach misses too many. We can and must do better if we are to hit the 2025 goals for ending the HIV epidemic by 2030. We can’t end HIV without reaching Black women.

There will be a special scholarship pool for Black women for USCHA and the 2023 Biomedical HIV Prevention Summit in Las Vegas on April 11-12. Our goal is to double the number of scholarships to accommodate all the extra scholarships for Black women. Information about these scholarships will go out in February when the USCHA website goes live. Summit scholarships are open to apply.

Growing Leadership Opportunities for Women (GLOW) @ NMAC
Linda Scruggs started GLOW (Growing Leadership Opportunities for Women) at NMAC. The program is now led by Gabriella Spencer (gspencer@nmac.org) As a young Black cisgender woman, she represents the future. GLOW aims to build robust, sustainable leadership among women of color living with or at risk of HIV. GLOW is grounded in “social entrepreneurship,” where highly innovative individuals and groups are supported to bring their ideas to members of their own community. GLOW is designed for cis and trans women of color.

NMAC aims to recruit 20 women from five different regions. Although the project is designed for women of color generally, in 2023 GLOW will prioritize Black women with Latinx women to be the focus in 2024. Participants can apply for mini-grants ($500) to support local GLOW trainings. Up to 12 GLOW participants will be selected as mini-grant recipients to plan and implement their trainings. GLOW will convene twice annually in wellness summits. These summits will review experiences to implement GLOW mini-grants and build a strong, sustained, national network of women of color for HIV advocacy, leadership development, and social support.

I am grateful to all the Black women mentors who guided and shaped me as a leader. They gave me courage and taught me to never let anyone take my light. To Kim, I will miss you like you don’t know. I’m glad we have a year to celebrate you and other Black women sheroes. As I’ve learned from doing this work, some people are in your life for a moment and others a lifetime. Celebrate and thank them because time passes much too quickly.




Yours in the Struggle,

Paul Kawata w/Kim

Commitment to PrEP

This morning, the US Prevention Task Force for the Affordable Care Act reaffirmed their commitment to HIV PrEP. They looked back over hundreds of studies, particularly new studies for injectables, to again document that HIV PrEP is scientifically safe and effective. While NMAC appreciates this added review, we don’t think it will stop a court case on HIV PrEP that is making its way through the Texas. Using the Religious Freedom Act, some Christians are asserting that they should not have to pay for HIV PrEP because it goes against their religious values. If this sounds familiar, it’s because the same argument is used by some Christian bakers who do not want to make wedding cakes for same sex couples or some Christian website developers who do not want to create websites for same sex couples.

The result of this court case could be legal discrimination that makes LBGTQ Americans second class citizens. The radical right’s strategy is about controlling the courts and using bogus lawsuits to do what can’t be accomplished legislatively. HIV PrEP is just a Trojan Horse. Their goal is to use religion to exempt Christians from providing services to homosexuals and to throw the ACA into chaos.

This afternoon, the President will sign The Respect for Marriage Act. This is an amazing and wonderful outcome, but it won’t stop the extreme right. Unfortunately, there is a robust exemption for religious organizations in the Act. The bill that guarantees our right to marry also codifies their right to discriminate. It remains a question of freedom and democracy for all Americans. This is not a fight that any sane individual wants to have right now in the middle of multiple epidemics, war, recession, race relations, abortion, don’t say Gay, and a world that seems out of control, yet here we are.

Unfortunately, right now, the HIV movement is playing checkers while the extreme right plays 3D chess. We are not ready for the tidal wave that is about to hit us and so many other movements. NMAC’s primary commitment is to the HIV movement; however, we believe the HIV community cannot go at it alone. We are too small and have too few voices. Our movement is dependent on government support to provide HIV research, treatment, housing, care, and prevention services. Losing means the degradation of the HIV infrastructure. Ultimately, they could argue via the courts that some Christians should not have to pay for the care or prevention of HIV because it’s against their religious beliefs. Can Congress or the Administration stop an activist court? What is the HIV movement’s role? What is NMAC’s role?

This is my last musing for 2022. I hope you have a wonderful Christmas and New Year. Thank you for your support. It is not OK that certain communities are using HIV PrEP as a Trojan Horse to blow-up the Affordable Care Act and discriminate against the LGBTQ community. I want you to know that NMAC continues to urgently fight for all the communities highly impacted by HIV. In the ’80s and early ’90s, I witnessed too many friends die before they could become the amazing leaders they were supposed to be. We were robbed, and our community will never know how much it lost. Our fight continues in their memory, to make the losses matter, to make sense of the pain and sorrow, and to use their examples to teach the world.

Yours in the Struggle,

Paul Kawata

Paul Kawata

2022 Wrap Up

2022 was NMAC’s 35th anniversary and another one for the record books. This is my regular yearend wrap-up and request for support. I hope you will consider donating.

No one had MPox or the Supreme Court in their plans at the start of the year. NMAC, like so many, had to pivot to address these new unwanted challenges. The link to NMAC is the agency’s commitment to the communities hardest hit by HIV. Unfortunately, we sit at the intersection of everything the radical right hates. They are using HIV PrEP to throw the Affordable Care Act into chaos. Our work is the target of their bigotry and discrimination. The 5th Circuit is their pathway to SCOTUS and our movement must work with other movements to stop them. The issues are much bigger than HIV; however, the Christian Right choose PrEP as the trojan horse to backdoor the ACA. NMAC is concerned about their challenge to the way the Prevention Task Force members are appointed. We hope there is an administrative fix.

Monkeypox in the US was reported just last May. Like HIV in the early days, it mainly impacted sexually active gay and bisexual men, particularly Black and Latinx gay men. Thankfully there was a vaccine. Using an innovative solution that allowed one dose of vaccine to help up to five people, the number of new cases dropped, particularly for White and Latinx gay men. Unfortunately, that was not the same for Black gay and bisexual men. Like HIV, this is another inequity that must be addressed. I am concerned the White House’s announcement will turn MPox into another unfunded sexually transmitted disease. Health departments, STD, and HIV agencies will argue about responsibility and community will not get the services they desperately need. It’s time for systemic solutions that are based and led by the communities being impacted. NMAC calls on the White House, HHS, and CDC to return a portion of the Minority AIDS Initiative back to its original congressional intent.

This year the radical right played their hand. Justice Thomas clearly laid out his agenda for state attorneys general. Their strategy is much bigger than Roe. They want to reshape America and HIV sits at the intersection of everything they hate. Most of you know me. I’m not crazy, and this email sounds a little insane. I’m our canary in a coal mine that warns the movement about impending challenges. I hope I’m wrong.

With all these new challenges, our efforts to end the HIV epidemic have stalled. The STD numbers are bad. Gay men, people of color, and youth continue to experience higher levels of syphilis and gonorrhea. I’m not saying this to sex shame anyone. In fact, I think we need to put the sex back into our HIV, STD, and Hepatitis prevention programs. Mark your calendars now for the 2023 Biomedical HIV Prevention Summit, April 11-12 in Las Vegas. We can’t let fears about retaliation stop us from doing our jobs and that includes America’s sexual and reproductive health.

Everything is piling on and the world sometimes feels out of control. We did not want it, we do not choose it, but there is a war coming and HIV is in the middle. November gave me a little hope but, with a divided Congress, I worry. We need the FY23 budget passed and signed during this lame duck Congress. That’s why NMAC hosts World AIDS Day events in Congress. Thank you to Joe Huang-Racalto and NMAC staff. The congressional participation was significant, even though it was a business day on the Hill. We are grateful to over 100 members of Federal AIDS Policy Partnership and the Partnership to End the HIV, STD & Hepatitis Epidemics who attended along with 21 hill staff. This is how the work gets done. It is a grind. There are thousands of organizations and movements fighting to get Congress’s attention. The HIV movement is well served by the number, diversity, and experience of the agencies and people working on the Hill. With another new divided Congress in January and the 2024 Election, will anything get done?

Thank you for standing with NMAC and the HIV movement. Please consider a year end gift to our important work. Our work to end the HIV epidemic has taken a turn. HIV PrEP is being used to create chaos for the ACA under the guise of religious freedom. While it seems crazy that we might re-litigate these issues, that’s what the new court means. We are watching their years of planning come to fruition. Anyway… have a great holiday.

Yours in the Struggle,

Paul Kawata

Paul Kawata

Remembering Janet Cleveland

It started with a text from Jono Mermin at the CDC saying Janet Cleveland had passed. I thought it was a mistake, so I did not respond. It still does not feel real. I’ve attended too many memorials or celebrations of life. It never gets any easier and the losses keep piling up.

I imagine Janet had some tough times at the CDC. As a black woman who did not have a medical degree, the CDC in the early days were tragic. Systems were built by white straight male researchers to mostly benefit other white straight male researchers and doctors. At the same time, Janet was the face of CDC to many in the field. She was the first person community called when we had an issue with the HIV bureau. As I would too often say, it’s nothing personal, it’s my job. Poor Janet saw me go off about one thing or another, yet she always smiled and took my calls.

Back in the ’90s, Janet Cleveland, Julie Scofield, Frank Beadle de Paloma, David Holtgrave, and I were the motley crew that worked to put on the Community Planning Leadership Summits (CPLS) that transformed into the HIV Planning Leadership Summits (HPLS). We came together to visibly demonstrate how the CDC can work with health departments and community. Through this process we formed a bond that I miss. Going to Atlanta for Janet’s funeral made me realize how long it’s been since I’ve attended a CDC or NASTAD consultation.

That little dig would usually get me a call from Janet that started, “well Paul, you have to understand…” Image being stuck between me and the CDC. I know it’s not fun and that’s why I respected Janet. At her funeral I learned that she was a good Christian woman, and I will not hold that against her.

This has been a tough year and I have one more in December. I’ve always admired Paul Monette’s ability to find love and joy in the middle of the plague. I was the opposite. The more I lost the more I cut myself off from others. The pain and loss were too much. I needed to protect my heart. My generation was damaged but carried on. We changed the world. The price was heavy, and we continue to pay.

There is a storm on the horizon called the Supreme Court. The 5th circuit is their template for getting cases to SCOTUS and HIV PrEP is in their sights. They are thinking much bigger than HIV PrEP; they want the Affordable Care Act. This case could back door the ACA and throw it into chaos. The impact on the lives of people living with HIV is unimaginable. Are we not ready for this fight?

Janet lived her life with grace and kindness. She was good to our community because she came from our community. Her death is a loss for our movement, and I truly worry for our work to end the HIV epidemic. This Thanksgiving I am thankful for Janet Cleveland and all she did to support community and our work to end the epidemics.


Yours in the Struggle,

Paul Kawata

Paul Kawata

Join Our Capitol Hill Champions Reception for World AIDS Day

America does not feel safe. The radical right has weaponized my existence so there is a bounty on my head, and that of everyone who is different. Club Q was another on a long list of mass shootings. Nothing makes sense and everyone is afraid. The Right hates the Left, the Left hates the Right, and people are being killed. Thursday is World AIDS Day and there are events across the world. I pray for our safety because we cannot hide and must fight. Join us in person or online. RSVP for the briefing and/or the free reception at RSVP@NMAC.org.

Congress of the United States
Washington, D.C. 20515
November 21, 2022

Minority AIDS Initiative Briefing
Thursday, December 1, 2022, 9:30 a.m. – 10:15 a.m.
Followed by a reception, 10:30 a.m. – 11:30 a.m.
2359 Rayburn House Office Building

Dear Colleague:

By now, you should have received an invitation to NMAC’s World AIDS Day briefing on the Minority AIDS Initiative (MAI). The briefing will be held on Thursday, December 1, 2022, from 9:30 a.m. – 10:15 a.m. in 2359 RHOB. Immediately following the briefing, NMAC will host a reception honoring Members of Congress for their contribution towards ending the HIV epidemic. The reception will take place from 10:30 a.m. – 11:30 a.m. in the same room.

Racial and ethnic minorities continue to be severely and disproportionately impacted by HIV/AIDS in the United States. People of color represent the majority of new HIV diagnoses, people living with HIV/AIDS, and deaths among people with HIV/AIDS. African Americans account for 43 percent and Latinos account for 26 percent of new HIV diagnoses. Asian Americans, Native Americans, and persons of multiple races account for an additional 5 percent combined. Tragically, the rate of new diagnoses among African Americans and Latinos is about eight and three times that of whites respectively.

The Minority AIDS Initiative is an indispensable tool in the effort to combat these unacceptable disparities. This critical initiative targets funds for HIV/AIDS prevention, screening, treatment, education, and outreach to minority communities heavily impacted by HIV/AIDS. The funds are intended to provide community-based organizations that serve minority communities with the help they need to develop capacity and deliver culturally and linguistically appropriate care and services. Consequently, the initiative seeks to fill gaps where the needs are the greatest and strengthen efforts to fight the epidemic nationwide.

Presenting at the World AIDS Day briefing will be MAI expert Dr. Maya Rockeymoore Cummings; Harold Phillips, White House Director of the Office of National AIDS Policy; and Joe Huang-Racalto, Director of Public Policy and Strategic Partnerships at NMAC.

We hope you will consider attending NMAC’s World AIDS Day briefing and the reception that follows. To RSVP for the briefing and/or the reception, please email RSVP@NMAC.org.


Maxine Waters                        Barbara Lee
Member of Congress              Member of Congress

This year NMAC honors House Majority Whip James E. Clyburn (SC), the Honorable Sheila Jackson Lee (TX), and the Honorable Jenniffer González Colón (PR). Thank you, Merck, the presenting sponsor for the reception and Kelley Drye for their support. Our movement is dependent on federal funding to care for people living with HIV and to end the epidemics. Our job is to keep HIV, STDs, and Hepatitis on the agenda of Congress and the Administration. On this World AIDS Day, thank you for staying strong during these difficult times.

Yours in the Struggle,

Paul Kawata

Paul Kawata

Remembering Urvashi Vaid

I went to the memorial for Urvashi Vaid. While I did not know her well, I was a fanboy for this powerful out South Asian Lesbian who opened doors. During these difficult times, the service was exactly what was needed. It helps to remember that our work stands on the shoulders of greats. The gathering was so New York and fabulous without trying. Watching Tony Kushner hold back tears as he tried to explain how Urvashi and Kate Clinton gave him a social life to the icon and GOAT Gloria Steinem who connected Urvashi’s work in the larger struggle for justice and equity. It was exactly what she deserved and our movement needed.

I am worried. I don’t know what’s happening to our country. I’m watching in disbelief and sadness. The world does not feel safe for people who are different. We are fighting for our right to exist, to love and be loved. This was not how it should be. Yet here we are, again. The war has started, and we are not ready. Last week the Supreme Court heard arguments to abolish affirmative based on race. Where is the outrage? In Texas there is a case that uses the Religious Freedom Act to allow employers to stop paying for HIV PrEP because it offends their religious beliefs. They are trying to dismantle the entire Affordable Care Act.

Everything seems upside down and backwards. Regardless of how the elections work out, the struggle is not going away. I am not going to stop being Gay because it offends you or your God. My skin is the color of my skin. These are things I would not change even if I could, and I can’t. How do we live in the same country when my very existence is an affront to your God?

It’s time to build institutions and movements that can work across purposes. We need a NATO for social justice. If they go after one of us, we all stand together in solidarity. Supportive donors need to give like never before. The funding needs to be unrestricted and multiyear. Support should prioritize real political power so we can fight back and not be helpless as they decimate our worlds. The radical right has spent the last 50 years working to overturn Roe and reshape America. We must catch up before it is all gone.

This is how I will remember Urvashi. In 1990 she interrupted a speech by then President George H.W. Bush. I was in the room. It was thrilling and scary. Part of an inside/outside strategy about the Ryan White CARE Act.

Like so many in HIV, I’ve attended too many memorials. We are a generation of walking wounded who saw too much and hurt too long. We buried lovers and friends in numbers that are still incomprehensible. I am tired and crushed to see our work going backwards. Make no mistake, this is a fight about our existence on the planet.

Yours in the Struggle,

Paul Kawata

Paul Kawata

Do The Right Thing!


The letter below was sent to HHS Secretary Xavier Becerra from the following members of Congress: Maxine Waters, Bill Pascrell, Jr., Joaquin Castro, Barbara Lee, Raúl M. Grijalva, and Nanette Diaz Barragán. The Black AIDS Institute, Latino Commission on AIDS, NMAC, and the SF Community Health Center are working with key members to bring the Minority AIDS Initiative back to its original intent.

Congress of the United States
Washington, D.C. 20515September 1, 2022

The Honorable Xavier Becerra Secretary of Health and Human Services
Department of Health and Human Services
200 Independence Avenue S.W.
Washington, DC 20201Dear Secretary Becerra:

We write to urge you to return the Minority AIDS Initiative (MAI) to its originally intended purpose of directing strategic HIV resources to minority-led organizations in order to close the racial and ethnic gap in the HIV epidemic. Minority-led organizations have the cultural competence and proximity to the affected communities that make them ideal partners for helping to end the epidemic.

Earlier this year, we requested that the House Appropriations Committee include language in the report to accompany the FY 2023 Labor, Health and Human Services, and Education Appropriations Bill, recommending that the Secretary of Health and Human Services direct MAI resources to minority-led organizations. In response to our request, the Committee included the following language under the subheading, “Minority HIV/AIDS Fund:” “The Committee […] encourages the Secretary to prioritize MHAF grants to HIV-based agencies that are minority led with preference given to organizations led by women, men, and transgender persons who identify as African American/Black, Latino, American Indian/Alaskan Native, Asian American, and/or Native Hawaiian/Pacific Islander.”

It has come to our attention that this language, and its inclusion under the aforementioned subheading, could be interpreted as applying solely to the $60,000,000 that the Committee provided specifically for the Minority HIV/AIDS Fund, which is managed by your office within HHS. We are writing, therefore, to clarify that it is our intent that this language be applied to all MAI funds controlled by all four of the HHS agencies involved in the administration of the MAI. These agencies include the Centers for Disease Control and Prevention (CDC), the Health Resources and Services Administration (HRSA), the Substance Abuse and Mental Health Services Administration (SAMHSA), and the Office of the Secretary.

Of course, we realize that the guidance included in the FY 2023 report will not have standing until Congress has enacted a final Omnibus Appropriations Bill for FY 2023. Nevertheless, we urge you to use your discretion to begin immediately to direct MAI resources to minority-led organizations that have the cultural competence and proximity that enables them to serve minority communities effectively, and to do so across all four of the aforementioned HHS agencies.

We are grateful for your attention to our concerns, and we respectfully request a response from you prior to November 15, 2022. Furthermore, once an Omnibus Appropriations Bill for FY 2023 has been enacted, we would appreciate confirmation from the directors of each of the relevant agencies of their intent to comply with the guidance in the FY 2023 report.


Secretary Becerra and Assistant Secretary Rachel Levine, it’s your move. CDC, HRSA, SAMHSA, and the Secretary’s Office need guidance to quickly address this inequity. As we continue to see with HIV, COVID and now Monkeypox, people of color shoulder a disproportionate burden of disease. When the Congressional Black Caucus works with leaders from the Congressional Hispanic and other Caucuses provide this guidance, it’s time to do the right thing!

Yours in the Struggle,
Paul Kawata
Paul Kawata

Live Monkeypox Town Hall Oct. 10



Monkeypox Town Hall

Monday, October 10, 6:30 PM ET
San Juan, PR
Livestreamed on Facebook

Five of the nation’s leading organizations focused on ending the HIV, STD, and hepatitis epidemics – AIDS United, NASTAD, the National Coalition of STD Directors, NMAC, and The AIDS Institute – will host a Town Hall on Monkeypox at the 2022 United States Conference on HIV/AIDS. This event will be livestreamed on Facebook.

This Town Hall will invite federal, state, and local leaders to come together with USCHA attendees to have an important but difficult conversation on roles and responsibilities with MPV. Unfortunately, this is another virus that disproportionately impacts gay and bisexual men, particularly Black and Latinx gay men.

Vaccinating all sexually active communities that are impacted by MPV will not be easy or cheap. Our agencies are very concerned that HIV or STD funding does not get reprogrammed for MPV. There is also so much misinformation. We are inviting federal leaders to update and clarify what is known and the next steps.

The Town Hall will be facilitated by:

Daniel Driffin
Damián Cabrera

All USCHA attendees and people on Facebook are invited to listen, ask questions, or make statements. Due to time constraints, comments will be limited to three minutes per person. A report will be produced from the proceeds to help inform next steps.

Yours in the Struggle,
Paul Kawata
Paul Kawata

CDC Admits Problems

My world is literally out of focus (cataracts), and I am mad and concerned. If the last two years were not enough, now we must fight Monkeypox (MPV). How much more must we endure? There is too much pain and loss. I am exhausted by the suffering, overwhelmed by the fighting, and worried about SCOTUS. Below is Aug. 18th data from Philadelphia:

Leaders are not supposed to say these things publicly. We are supposed to be the paragon of virtue and hard work. These unrealistic pictures are why so many fail or quit. I’m speaking my truth so you don’t have to feel alone. Life is hard and there is no clear end. The only thing we have is each other.

Centers for Disease Control and PreventionLast week the Centers for Disease Control and Prevention publicly admitted what we all knew: their response to COVID was less than ideal. This announcement was unprecedented and hopeful. They’ve made a commitment to be ready for the next pandemic. I hope they understand that Monkeypox is here. Their ability to stop MPV before it becomes endemic will demonstrate their real-world capacity. I want CDC to succeed but can’t turn a blind eye to the challenges.

This week Daniel Driffin and Damián Cabrera have two meetings with the White House to talk about Monkeypox. Surgery makes it impossible for me to attend. I’ve asked them to do four things:

  • Fight for more vaccine
  • Ensure Vaccine Equity
  • Work to overcome Vaccine Hesitancy
  • Remember SCOTUS

At their meeting with Mr. Fenton and Dr. Daskalakis, they will be joined by people who got Monkeypox. There is too much fear and discrimination. These community leaders will ask the White House to fight the stigma associated with this virus. To understand that it is rooted in homophobia and racism. During these difficult political times it may be used as a weapon to discriminate against the LGBTQI community.

We’ve also invited David Garcia, the executive director of Affirmations in Michigan. Recently, he shared the frustration of getting MPV vaccines to his community. NMAC asked him to share his story. In some regions it is the “Hunger Games” to get shots.

I know the White House and CDC are committed to these values, but can they deliver? As we saw with COVID, CDC’s ability to communicate basic messages often got lost in their efforts to be scientifically accurate. They feel the responsibility to be the CDC, but that happens at the expense of clear messages that community can understand. The world has changed and their position as the ultimate authority is irrelevant in the age of TikTok. The old paradigm of doctors in white coats must give way to the reality that America is diverse and complex. We want to see our faces in the leadership and programs. Communications from old White cisgender men does not cut it in the new world.

To be clear, Dr. Walensky just got to the CDC and these challenges go back decades. COVID showed what the HIV community already knew: our movement needs a CDC who understands how to reach the communities highly impacted by HIV and now Monkeypox and who understands that leadership is collaborative, and their responsibility is to build a bigger table. The days of telling us what or how to do it are over. We wasted too much time on DEBBIs and EBBIs.

If I seem bitter, please know it’s not because of the CDC. My bitterness comes from a world that feels unrelenting and out of control. Just as I was getting ready to exhale, there is another virus that some people will use to make political points. I can feel the judgements oozing from their pores. Gay and bisexual men are getting what we deserve. They see and judge us as scum. With a bible in one hand, they believe we are going to hell. Don’t let your urban bubbles fool you. We are in a fight for the soul of America and we could lose.

Our fight against Monkeypox, like our fight against HIV, must address the racism and homophobia that these viruses engender. Whether we like it or not, these political hot buttons are inextricably intertwined with our efforts to end the HIV epidemic and our work to stop monkeypox from becoming endemic. I worry about the government’s ability to fight what might be inherent in its systems. For too long government systems were built on values that did not reflect community with systems that reward compliance at the cost of innovation. The search for scientifically proven solutions assumes a static community when the opposite is true. COVID/HIV/Monkeypox solutions need flexibility and innovation. That is not usually a strength of government. I wonder if change is even possible.

I know the leaders at CDC are good competent people who want to do the right thing. The challenge is they live and work in a system that was built decades ago by alpha White male doctors who were taught to be gods and not collaborators. To them weakness was a problem and not a virtue. They were going to save us from ourselves rather than take the time to understand and celebrate who we were. Thank you, CDC, for admitting there was a problem. The proof will be in your ability to change. Next up is Monkeypox. Can you put together systems that are more than just getting out vaccines? Monkeypox, like COVID, requires targeted outreach to communities that might not trust the government. As we’ve learned with HIV, it’s not enough to just provide the medication; we must build systems that reach people where they live. Systems that understand and celebrate the communities needed to be reached.

Yours in the Struggle,
Paul Kawata
Paul Kawata

Welcome to Our New MPV Newsletter

This is the first of what will be a weekly NMAC newsletter on the latest developments in the monkeypox (MPV) epidemic. Production of this newsletter is supported by a grant from Gilead Sciences to NMAC to serve as the coordinating center for the policy response to MPV.

These newsletters are intended for service providers, people living with or at risk of MPV, and policymakers at the federal, state and local levels. Each newsletter will provide updates on the latest data pertaining to MPV, especially as it relates to public policy. These newsletters will center the individuals and organizations most heavily affected by MPV, profiling people living with or at risk of MPV as well as the organizations that are contributing to the fight against this national health emergency.

Why NMAC is helping lead the fight against MPV
NMAC leads with race in the effort to end the HIV epidemic in the U.S. This focus demands that NMAC become engaged in the fight against MPV. Gay/bisexual men – the population most heavily affected by HIV – account for at least 94% of people with MPV. People living with HIV make up 41% of people diagnosed with MPV.

As in the case of HIV, the communities of color for which NMAC advocates are disproportionately affected by MPV. Black and Latinx people account for about one-third of the U.S. population but for 54% of people with MPV. In Georgia, Black people account for 33% of the state’s population but for 82% of the state’s confirmed MPV cases.

Just as people of color are markedly less likely than white people to obtain PrEP or to achieve HIV viral suppression, Black and Latinx gay/bisexual men are being left behind in early efforts to roll out MPV vaccines. In the case of MPV, leading with race means immediate action to ensure equitable access to the prevention of MPV, timely treatment of MPV, and MPV vaccination.

MPV: The latest developments
MPV is spreading rapidly

The federal government has been slow to respond

  • There are shortages of every key tool needed to fight MPV (prevention, testing and treatment) – in large measure because of the federal government’s failure to plan and respond aggressively to protect the health of gay/bisexual men. TPOXX, the only drug available for the treatment of MPV, is in short supply, and doctors who have MPV patients must complete a 27-page application and obtain federal approval before they can administer the drug for their patients who are experiencing severe MPV-related pain.
  • The country has an acute shortage of MPV vaccines because the federal government, even though it owned millions of doses of the vaccine, failed to ask the manufacturer to bottle it for distribution. The federal government is now racing to close this gap, but current estimates indicate that the vaccine shortage won’t be resolved before 2023.
  • To make the limited supply of vaccines go as far as possible, the federal government has approved administration of a smaller dose between the layers of the skin rather than a full dose under the skin. CDC also recommends that people exposed to monkeypox receive post-exposure vaccination (ideally within four days of exposure).

The Biden Administration has declared MPV a national emergency

  • The President named Robert Fenton, an emergency response expert, and Dr. Demetre Daskalakis, of the CDC, to lead efforts to coordinate a national MPX response. It is hoped that the emergency declaration will open new funding for the MPX response and light a fire under the federal bureaucracy to overcome its early fumbles.

Building on the leadership of Black and Latinx gay/bisexual men to fight MPV
Given the disproportionate impact of MPV in communities of color, efforts to address this national emergency must elevate the voices of Black and Latinx gay/bisexual men. To help NMAC serve as the coordinating center for the national MPV policy response, Daniel Driffin has agreed to spearhead advocacy with the White House and other arms of the federal government. A Black gay man living with HIV in Atlanta, Daniel co-founded THRIVE Support Services, an innovative community-centered support and service program that aims to promote the health and well-being of Black gay men.

“Regardless of whether it is cancer, HIV, STIs, housing or other social determinants of health, Black gay men are often the last group for whom solutions are provided,” Daniel says. He has seen this with MPV vaccines in his hometown of Atlanta. “Anytime a local health department stands up a vaccine clinic, within minutes all of the available appointments are gone, and the slots aren’t going to the Black and brown men who are most affected.”

Although the challenge of ensuring vaccine equity is considerable, Daniel knows from his own experience that there are solutions to this problem. “COVID-19 has shown that with the right education and the right messengers, Black and brown people have the same uptake of vaccines as other people. Ensuring that Black and brown people are included in the response from the outset – from Day Zero – is critical if we want to ensure equity.”

Yours in the Struggle,

Paul Kawata

Paul Kawata