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>>OKAY, WE’RE READY TO RECONVENE THE MEETING,
AND NOW WE’RE GOING TO, IN THE TRADITION OF OUR PREVIOUS PACHA MEETINGS, WE’VE REALLY
AS WE’VE TRAVELED TO JACKSON, MISSISSIPPI, MIAMI, FLORIDA, WE’VE REALLY TAKEN THE TIME
TO HEAR FROM THE LOCAL COMMUNITY TO INFORM THE PROGRAM, SO NOW SINCE WE ARE IN WASHINGTON,
D.C., WE’RE GOING TO FOCUS ON WASHINGTON, D.C. AND THE EPIDEMIC HERE.
AND FIRST I’LL TURN IT OVER TO JOHN SAPERO WHO IS GOING TO RUN THE FIRST SESSION.
>>THANK YOU. SO IN THE SPIRIT OF REACHING OUT TO THE COMMUNITY,
WE’VE ASKED OUR COMMUNITY TO SHARE SOME OF THE LOCAL COMMUNITY TO SHARE SOME PEOPLE FROM
THE COMMUNITY TO TALK TO US ABOUT LOCAL EXPERIENCE AND THEIR THOUGHTS AROUND ENDING THE HIV EPIDEMIC
HERE IN THE WASHINGTON, D.C. AREA. WE’VE GOT THREE WONDERFUL PEOPLE TO SPEAK
WITH YOU TODAY, COLLEEN, CORRIE AND RONALD WHO I HAVE THE OPPORTUNITY ON MEET ON A PHONE
CALL LAST WEEK, AND I FOUND QUITE ENGAGING AND I’M REALLY EXCITED THAT WE GET TO SHARE
THEM WITH OUR COMMUNITY AND WITH OUR NATION TODAY.
FIRST IF I COULD HAVE EACH OF YOU TO KIND OF INTRODUCE YOURSELF AND SHARE A LITTLE BIT
ABOUT YOURSELF. WHY DON’T WE START RONALD, WE’LL GO WITH YOU.
AND YOU’LL NEED TO PUSH THE BUTTON AND HAVE THE MIC FAIRLY CLOSE TO YOU.
>>GOOD AFTERNOON, EVERYBODY, MY NAME IS RONALD SHANNON, I’M ORIGINALLY FROM RICHMOND, VA
VARKS I AM CURRENTLY WORKING AS A NONMEDICAL CASE MANAGER AT US HELPING US, I STARTED MY
CAREER IN PUBLIC HEALTH, I HAVE TO GIVE A SHOUT OUT TO THE DC DEPARTMENT OF HEALTH,
HEALTH IMPACT SPECIALIST PROGRAM WHERE I STARTED OUT AS ASSIGNED TO THE URBAN COALITION FOR
HIV/AIDS PREVENTION SERVICES WHERE I WORKED AS A PROGRAM ASSISTANT, LIKE I SAID CURRENTLY
NOW NONMEDICAL CASE MANAGER AS US HELPING US, I WAS DIAGNOSED, I AM A PERSON LIVING
WITH HIV, I WAS DIAGNOSED IN 2008 IN RICHMOND, VIRGINIA, SO I HAVE RECEIVED SERVICES ACROSS
RICHMOND, VIRGINIA, BALTIMORE, MARYLAND AND NOW CURRENTLY WASHINGTON, D.C.
>>HI, MY NAME IS CORRIE FRANKS. I AM CURRENTLY WORKING AT FAMILY AND MEDICAL
COUNSELING. I’VE BEEN LIVING WITH HIV NOW FOR 32 YEARS.
I AM A PREVENTION EDUCATOR AND ALSO AN ADDICTIONS COUNSELOR.
AND IT WAS THROUGH OUTREACH THAT I WAS ABLE TO BECOME ALSO A RECOVERING ADDICT.
>>HI, I’M COLLEEN EDWARDS. I’M CURRENTLY A CLIENT OF FAMILY AND MEDICAL
COUNSELING SERVICE. I’VE BEEN POSITIVE SINCE JULY 2, 2004.
I DID HAVE THE OPPORTUNITY IN THE PAST TO WORK WITH THE AGENCY AS WELL AS VOLUNTEER
WITH DIFFERENT AGENCIES. CURRENTLY RIGHT NOW I’M NOT EMPLOYED, BUT
KIND OF JUST FIGURING SOME THINGS OUT. THAT’S IT.
>>THANK YOU SO MUCH. SO WE HAVE FOUR QUESTIONS TODAY THAT WE’LL
ASK EACH OF YOU TO ANSWER, AND WE’LL JUMBLE IT UP A LITTLE BIT SO YOU’RE NOT THE FIRST
PERSON ANSWERING FIRST EVERY TIME. SO I’LL START OUT, RONALD, WHAT DO YOU THINK
IS NEEDED TO REDUCE THE IMPACT OF HIV IN YOUR COMMUNITY, AND YOUR COMMUNITY HOWEVER YOU
WOULD LIKE TO DEFINE IT.>>THANK YOU.
AND I KNOW WE’VE HEARD THIS A LOT, AND I’M JUST GOING TO CONTINUE TO ECHO IT AND SAY
IT AGAIN, STIGMA AND WHEN I SAY STIGMA, WE NEED TO START TO, I FEEL, TO NORMALIZE THE
CONVERSATION OF HIV, JUST LIKE WE WOULD NORMALIZE THE CONVERSATION OF DIABETES, JUST LIKE ALL
OF THE OTHER HEALTH DISPARITIES THAT AFFECT AFRICAN AMERICANS, WE NEED TO ESPECIALLY CONTINUE
TO BE STIG — TO DESTIGMATIZE IT AND NORMALIZE IT INTO THE CONVERSATION, THAT WAY WHEN YOU
BRING THIS UP IN THE ROOM FULL OF PEOPLE WHO ARE NOT AFFECTED BY IT, THEY WON’T FREEZE
AND YOU THEY WON’T HAVE THAT DEER IN THE HEADLIGHTS LOOK THAT IT TRNZ TO IMPACT THE STIG — CONTINUES
TO IMPACT THE STIGMA AND THE SERVICES THAT WE PROVIDE EVEN JUST HOW THE COMMUNITY SEES
HIV-POSITIVE PERSONS AS A WHOLE.>>CORRIE?
ED.>>YES, I THINK ONE OF THE THINGS WE NEED
TO DO IS WORK ON OUR COMMUNICATIONS TO THE COMMUNITY.
WE HAVE KIND OF SENSED — WE HAVE KIND OF SENT SOME MIXED MESSAGES TO THE COMMUNITY
IN TERMS OF PREVENTION, AND WE’VE DONE A LOT OF GOOD THINGS, AND I REMEMBER THE DAYS WHEN
I STARTED OUT IN 1998 WHERE CONDOMS OF THE PRE– WHERE CONDOMS WAS THE PREVENTION, AND
NOW WE HAVE PREP, BUT WE NEED TO TAKE A LOOK AT, YOU KNOW, WHAT’S COMMON SENSE TO US IS
NOT COMMON SENSE TO CERTAIN COMMUNITIES. SO THE WAY WE COMMUNICATE THINGS IS VERY IMPORTANT.
WHAT I’M GOING TO SAY IS WE DELIVERED A MESSAGE OF THE EFFECTIVENESS OF COME COMES, AND NOW
IN OUR COMMUNITY WHEN YOUR PRIMARY FEAR IS CONTRACTING HIV AND THEN YOU COME UP WITH
PREP AND THINGS CHANGE H YOU KNOW, PREP COMES WITH THE CONVERSATION OF STILL CONTINUING
TO USE CONDOMS, BUT THE PROBLEM IS IF MY PRIMARY FEAR IS HIV AND THAT WILL PREVENT ME FROM
GETTING HIV, THEN WHY DO I NEED TO USE THE CONDOM, YOU KNOW?
AND HOW WE PRESENT THAT TO COMMUNITIES AND HAVE THAT CONVERSATION BECAUSE JUST SAYING
PREP IS JUST GOING TO DO THIS, THEN WE HAVE AN ISSUE ON THE OTHER SIDE OF — THAT COME
INTO PLAY. SO, YOU KNOW, AND I’LL SAY JUST THIS LAST
LITTLE PIECE, WE ALSO CAME OUT AND WE TALKED ABOUT, WE HIT THE COMMUNITY WITH PEOPLE LIVING
WITH HIV WHO TAKE THEIR MEDICINE ARE NONINFECTIOUS. WELL, REMEMBER THAT THOSE PEOPLE THAT WE GOT
TO USE CONDOMS AT FIRST NOW HAVE A DIFFERENT OUTLOOK OF NOW I’M NOT INFECTIOUS SO I DON’T
HAVE TO WEAR CONDOMS ANYMORE. WE’RE SENDING SOME MIXED MESSAGES THAT HAVE
CAUSED SOME ISSUES IN THE COMMUNITY THAT’S KIND OF CONFUSING IN A WAY, IF YOU UNDERSTAND
WHAT I’M SAYING.>>JUST AS A REALLY GOOD FOLLOW-UP, WHAT’S
THE PERCEPTION OF PREP AMONG THE FOLKS THAT YOU WORK WITH?
>>IT’S — WE STILL HAVE SOME ISSUES FROM SPEAKING, THAT, YOU KNOW, THAT I CAN’T TRUST
THAT, AND THEN YOU HAVE, AGAIN, PEOPLE NOT GETTING THE FULL INFORMATION.
AND I’LL USE THIS AS AN EXAMPLE. WHEN WE STARTED PUTTING COMMERCIALS ON TV
ABOUT PREP, IT WAS A GOOD THING, HERE IS PREP. BUT ON THE FIRST INITIAL GO ROUND, WE DIDN’T
TALK ABOUT THE SIDE EFFECTS OF PREP. NOW THE NEW COMMERCIALS HAVE THE SIDE EFFECTS
OF PREP. SO JUST LIKE WE HAVE DIDN’T TELL YOU ABOUT
PREP, YOU NEED TO SAY THE WHOLE THING. IT’S A GOOD THING TO SAY YOU HAVE A DRUG TO
PREVENT SOMETHING, BUT GIVE ME THE WHOLE PICTURE, GIVE ME THE SIDE EFFECTS TOO, GIVE ME ALL
THAT AT THE SAME TIME. DON’T JUST TELL ME, OKAY, GET THIS AND THEN
LATER ON DOWN THE LINE, YOU KNOW, GIVE ME THAT INFORMATION.
>>CAN I JUST ADD REALLY QUICKLY, THE NUMBER ONE QUESTION I GET FROM ESPECIALLY BLACK FEMALES
IS HOW IS THIS GOING TO HURLT ME GETTING PREGNANT OR HOW — WHAT ARE MY CHANCES, HOW IS THIS
GOING TO AFFECT MY PREGNANCY IF I DECIDE TO GET PREGNANT, DECIDE TO HAVE CHILDREN.
ON THE MSM SIDE, BLACK MEN WHO HAVE SEX WITH MEN, THE MOST FREQUENT QUESTION I GET IS,
WELL, WE WERE TOLD YEARS AGO THAT ART’S WERE HARMFUL, SO HOW IS THIS GOING TO HARM US EVEN
IF I’M A HIV NEGATIVE BLACK MAN AND I’M TAKING THIS JUST LIKE YOU SAID, STILL THERE’S A LOT
OF MEDICAL MISTRUST WITHIN THE AFRICAN AMERICAN COMMUNITY WHEN IT COMES AROUND TO YOU GUYS
PUSHING A PILL TO US TO TAKE EVERY DAY.>>WHAT DO YOU THINK IS NEEDED FREERCHT HIV
IN YOUR COMMUNITY, COLLEEN?>>I BELIEVE BEING A WOMAN WHO IS POSITIVE,
ENCOURAGING PEOPLE THAT ARE TO DISCLOSE THEIR SEX, THAT’S A HARD PILL TO SWALLOW, BECAUSE
YOU HAVE TO GO TO YOUR FAMILY AND FRIENDS AND TELL THEM SOMETHING, AND THEY SAY IT WITH
A STIGMA, THEY THINK YOU KNOW WE CAN’T TOUCH YOU OR WE CAN’T BE AROUND YOU OR THEY’RE TREATING
YOU IN A CERTAIN WAY, SO WITH THE ADVANCES IN MEDICATION LIKE WE DO HAVE PREP, I DIDN’T
HEAR ANYBODY, ANYBODY TALK ABOUT POST-EXPOSURE PROPHYLAXIS.
SO IF YOU DO HAVE AN INCIDENT, YOU CAN TAKE YOUR PARTNER IN TO GET HELP.
SOME PEOPLE DON’T KNOW ABOUT THAT WHO ARE POSITIVE AND IF THEY DO KNOW ABOUT IT, THEY’RE
STILL SCARED TO SAY SOMETHING BECAUSE THEY DON’T KNOW HOW THAT PERSON IS GOING TO REACT.
SO JUST GETTING PEOPLE, GETTING HELP WITH PEOPLE WHO ARE POSITIVE TO EDUCATE THEMSELVES
AND BE COMFORTABLE DISCLOSING THEIR STATUS WITH THEIR PARTNERS, IS KEY, EVEN IF SOMEONE
IS USING SUBSTANCES, THEY USE NEEDLES, LIKE TRYING TO, I GUESS, WHAT DO I WANT TO SAY,
MAYBE TRYING TO GET HELP WITH, YOU KNOW, NOT SHARING AND GET EDUCATED WITH THAT AS WELL.
SORRY, I’M A LITTLE NERVOUS.>>YOU’RE ALOWRED TO BE NERVOUS — YOU’RE
ALLOWED TO BE NERVOUS TOO. IT’S OKAY.
THANK YOU.>>OUR NEXT QUESTION, CORRIE, I’LL START WITH
YOU ON THIS ONE, HOW DO YOU THINK THE EPIDEMIC HAS COMAINGD IT YOUR COMMUNITY — CHANGED
IN YOUR COMMUNITY OVER TIME?>>I KNOW IT’S CHANGED BASE BASED — BASE
MED ON THE FACT THAT WE HAVE MEDICATIONS. THE BEHAVIOR, NOT SO MUCH.
AND JUST LIKE I SAID, YOU KNOW, WHEN WE USE THAT TERM UNDETECTABLE, IT CHANGED THE BEHAVIOR
OF LIKE I SAID A LOT OF PEOPLE WHO HAD GOT TO THE POINT WHERE USING CONDOMS WAS WHAT
YOU WERE SUPPOSED TO DO, AND WHEN WE PUT THAT WORD UNDETECTABLE AND NOT TRANSMITTIBLE OUT,
WE TOOK THE CONDOM OFF, AND WHEN WE’RE TALKING ABOUT PEOPLE WHO ENGAGE IN USING DRUGS, THAT
THEY RELAPSE, THEY STOP TAKING THEIR MED CAKES, AND THEN WE’RE — STOP TAKING THEIR MEDICATION,
AND THEN WE’RE BACK AT TRANSMISSION AGAIN. AND THAT’S, YOU KNOW, A BIG ISSUE NOW.
WE HAVEN’T TALKED A LOT ABOUT PEOPLE WHO ARE ALREADY POSITIVE VERSUS TRYING TO KEEP PEOPLE
FROM BEING POSITIVE, BUT THERE’S STILL A LOT OF PEOPLE WHO ARE HIV POSITIVE WHO HAVE ISSUES
WHEN IT COMES TO UNPROTECTED SEX, WHETHER VIRALLY SUPPRESSED OR NOT.
>>COLLEEN, HOW DO YOU THINK — VIEWS HAVE CHANGED WITH THE COMMUNITY SINCE YOU LEARNED
YOU WERE HIV?>>WELL, MY PERSONAL EXPERIENCE, WHEN I FIRST
FOUND OUT I WAS ABOUT 20 YEARS OLD AND FOUR MONTHS PREGNANT, AND I WENT INTO A DOCTOR’S
OFFICE FOR A ROUTINE APPOINTMENT FOR THE FIRST VISIT AND I GOT A PHONE CALL ABOUT A WEEK
OR SO LATER TELLING ME TO COME IN, AND I’M LIKE OH, GOD, NO, I’M LIKE CHLAMYDIA OR GONORRHEA,
THAT’S WHAT WAS ON MY MIND. NEVER ONCE DID I THINK I WAS GOING TO GET
THAT DIAGNOSIS. SO WHEN I CAME IN AND SHE TOLD ME, AND I GUESS
SHE WAS TRYING TO FIND A WAY PROBABLY NOT TO HAVE ANY EMOTIONS AND THEN ALL SHE TOLD
ME WAS TO GET BLOODWORK DONE. I WASN’T GIVEN A INDICATION MANAGER — I WASN’T
GIVEN A CASE MANAGER, I WASN’T TOLD WHERE TO GO TO GET MAYBE SOME SUPPORT, THERAPY,
MENTAL HEALTH, ANYTHING. SO I WAS JUST KIND OF LEFT TO MY OWN DEVICES
AT 20 YEARS OLD WITH A BABY ON THE WAY. I KIND OF STAYED THAT WAY FOR A FEW YEARS
SNL I RAN — UNTIL I RAN INTO SOMEBODY THAT LED ME TO AN AGENCY THAT COOL GIVE ME THOSE
SUPPORTS. BUT I’VE SEEN AGENCIES OVER THE YEARS THAT
DO GO OUT IN THE COMMUNITY, THAT DO EDUCATE THE COMMUNITY, AND I GUESS HELP THOSE THAT
DO GET A NEW DIAGNOSIS TO TAKE THEM DIRECTLY INTO TREATMENT, VERSUS LEAVING THEM OUT THERE
FOR FIVE, SIX OR SEVEN YEARS WHY WITH NO HOPE AND THINKING I’M GOING ON DIE IN LIKE THREE
YEARS. SO THAT IS A POSITIVE OVER THE YEARS, THE
CHANGE THAT I’VE SEEN IN THE COMMUNITY.>>THANK YOU.
RONALD?>>SO JUST OUTSIDE OF I’M GOING TO ECHO, WHEN
I WAS DIAGNOSED IN 2008, I DIDN’T GET WHAT I CALLED THE FLUFF.
RECENTLY I WAS JUST IN A TRAINING WITH DOH ON TESTING IN NONCLINICAL SPACES AND IT WAS
VERY STRIG TRIGGERING FOR ME WHEN IT CAME DOWN TO DOOPGHT ROLE PLAYS BECAUSE IN THE
ROLE PLAITZ WE HAD TO ROLE PLAY ON GIVING A POSITIVE AND A NEGATIVE RESULT TO A CLIENT
AND IT WAS EXTREMELY TRIGGERING BECAUSE AS I WATCH THE VIDEO THROUGH THE TRAINING MATERIALS,
MY DOCTOR DIDN’T GO THROUGH THIS TRAINING, I DIDN’T GET THAT, JUST LIKE YOU SAID, I DIDN’T
GET CONNECTED TO CARE, THE ONLY WAY I GOT CONNECTED TO CARE WAS BECAUSE I HAD A FRIEND
WHO WAS DIAGNOSED IN ELEVEN WITH HIV AND HE AND I HAD A REALLY GOOD RELATIONSHIP AND THAT’S
HOW I WAS ABLE TO CONNECT MYSELF TO CARE AND TO MENTAL HEALTH AND I DID ALL OF THE RESEARCH
THAT I NEEDED TO DO FOR MYSELF, AND BEING THE NONMEDICAL CASE MANAGER IN THE INDUSTRY
S ONLY MALE, WHICH IS APE GREAT THING, WE ARE TRAINING PEOPLE ON HOW TO TALK TO AND
HOW TO GIVE THESE RESULTS AND HOW TO ENGAGE AND COUNSEL AND GET PEOPLE CONNECTED TO CARE,
HOWEVER, LIKE I SAID, IN 2008 MY DOCTOR DIDN’T GO THROUGH THAT TRAINING, AND THAT IS SOMETHING
THAT I HAVE SEEN THAT HAS CHANGED FOR THE GOOD, FOR THE BETTER, AND I THINK IT’S SOMETHING
THAT WE NEED TO TON DIVE DEEPER IN IN GETTING INTO THOSE NUANCES OF THE CARE SIDE OF HIV.
OUTSIDE OF THAT, ALSO ONE OF THE THINGS THAT I’VE NOTICED IS THE DEMOGRAPHIC OF NUF CASES
THAT ARE — NEW CASES THAT ARE COMING IN, AND I SAY THAT BECAUSE ME I’M FAIRLY NEW TO
PUBLIC HEALTH, BUT THE NUMBER OF YOUNGER BLACK MEN AND WOMEN WHO ARE CONTRACTING HIV VIRUS
AND WOMEN, BLACK WOMEN WHO ARE PRETTY MUCH AT THE FOREFRONT OF CONTRACTING THE NEW CASES
IS SOMETHING THAT I’VE SEEN CHANGE, SO COMMUNICATION IS JUST SOMETHING THAT I FEEL LIKE IT MAY
BE MISSING BETWEEN GETTING THE MESSAGE OUT TO THOSE COMMUNITIES, AND IN 2008, I’M A PREACHER’S
KID, I WAS IN THE NOTION OF THIS CAN’T HAPPEN TO AMERICAS I DON’T FIT THE DEMOGRAPHIC, I
DON’T FIT THE MOLD FOR THIS. THERE’S STILL A LOT OF PEOPLE THAT ARE OUT
HERE TODAY WHO FEEL LIKE I CAN’T BE TOUCHED BY THIS, I DON’T FIT THIS DEMOGRAPHIC, I DON’T
FIT THAT MOLD, AND THAT’S SOMETHING THAT WE DEFINITELY NEED TO CHANGE BECAUSE THEY’RE
FITTING THE MOLD.>>CORRIE?
>>YEAH I’M GOING TO AGREE WITH RON IN THAT FITTING WITH THE MOLD AND BEING THAT HETEROSEXUAL
AFRICAN AMERICAN MAN, YOU KNOW, I WAS AN INJECTION DRUG USER, AND SO I’VE ALWAYS BEEN IN THE
DEMOGRAPHICS OF BEING AN INJECTION DRUG USER, BUT I HADN’T INJECTED DRUGS IN 25 YEARS, SO
NOW I’M A HETEROSEXUAL AFRICAN AMERICAN MALE WHO IS HIV POSITIVE, RIGHT?
AND THAT POPULATION HAS BEEN UNDERSERVED FROM THE BEGINNING IN THIS EPIDEMIC.
SO, YOU KNOW, WE’RE TALKING ABOUT AFRICAN AMERICAN WOMEN GETTING INFECTED.
WHO ARE THEY GETTING INFECTED BY? AFRICAN AMERICAN HETEROSEXUAL MEN WHO SINCE
THIS EPIDEMIC HAS STARTED HAVE NOT HAD ANY INTERVENTIONS, YOU HAVE INTERVENTION FOR MSM,
TRANSGENDER, WOMEN, AND WE STILL ARE NOT ON THE MAP FOR BEING, YOU KNOW, TARGETED FOR
INTERVENTION. AND IF WE’RE ABOUT SOLVING AND ENDING THE
EPIDEMIC, WE’RE GOING TO HAVE TO FIGURE OUT A WAY TO TAKE THE STIGMA OFF BECAUSE A LOT
OF HETEROSEXUAL MEN STILL DON’T GO TO CLINICS, WE STILL DON’T GO TO PLACES BECAUSE THE STIGMA
IS EITHER YOU’RE AN INJECTION DRUG USER OR YOU’RE AN MSM.
SO IF I DON’T SEE MY, I’M NOT COMING. AND IF YOU DON’T BRING IT TO ME TO LET ME
KNOW THAT HEY, AND IT’S UNFORTUNATE THAT TODAY WE NEED TO PUT HETEROSEXUAL ON THE PAPER SO
THAT I KNOW THAT’S ME. AND SO WE HAVE THAT ISSUE A LOT.
I KNOW A LOT OF HETEROSEXUAL MEN WHO DIDN’T SHOOT, WHO DIDN’T — DIDN’T SHOOT DOPE, WHO
DIDN’T SLEEP WITH MEN, AND THEY GOT PROBLEMS, WHERE DO I FIT, WHERE DO I GO, BECAUSE AFRICAN
AMERICAN MEN HAVE ALWAYS BEEN IDENTIFIED AS IDU’S, NOT SEPARATELY, YOU KNOW, NOT IN THEIR
OWN CATEGORY. SO WE HAVE TO DO BETTER WITH THAT IF WE’RE
ABOUT ENDING THE EPIDEMIC.>>COLLEEN, I’LL START THE NEXT QUESTION WITH
YOU. WHAT DO YOU THINK ARE BARRIERS TO CARE, TO
ACCESSING CARE, STAYING IN CARE?>>THERE ARE A LOT OF BARRIERS THAT I SEE,
AND I COULD RELATE TO SOME OF THEM AND I HAVE SEEN FRIENDS GO THROUGH IT.
MENTAL HEALTH IS A MAJOR BURDEN. IF YOU’RE NOT MENTALLY DOING WELL, YOU MIGHT
THINK BACK INTO EITHER USING DRUGS OR NOT GOING TO CARE OR THE DEPRESSION AND DIFFERENT
THINGS, I’VE NOTICED WITH THE MENTAL HEALTH, LIKE A LOT OF PEOPLE STRUGGLE WITH, YOU KNOW,
WHERE THEY’RE GOING TO STAY. THEY’RE STAYING HERE, THEY’RE STAYING THERE,
THEY’LL WANT TO GO — THEY DON’T WANT TO GO A SHELTER BECAUSE THE SHERTLE AREN’T CLEAN,
SO THEY’LL STAY WITH FRIENDS ASK THEY’RE GOING THROUGH THAT, THEY MIGHT STAY WITH SOMEBODY
WHO IS USING, THEY MIGHT, WELL, OKAY, I’M GOING TO GO BACK TO DOING WHAT I WAS DOING.
SO WITH THE MENTAL HEALTH A LOT OF THINGS COME WITH THAT.
AND GETTING PEOPLE BACK INTO CARE IS EXTREMELY DIFFICULT.
I HAD DEALT WITH GETTING BACK INTO CARE FOR A WHILE, AND IT WAS NOT REALLY — AT ONE POINT
I WAS GONE FOR A LITTLE WHILE AND I CAME BACK, AND IT WAS LIKE WHERE YOU BEEN?
AND I WAS LIKE I AIN’T BEEN GONE THAT LONG, BUT I DIDN’T REALIZE HOW LONG I WAS OUT OF
CARE. SOME PEOPLE KNOW THEY’RE OUT OF CARE, THEY’LL
GET SOME OF THE SERVICES THEY WANT FOR THE TIME BEING BUT THEY WON’T GET THE WRAP-AROUND
SERVICES, THEY WON’T GO TO THE DOCTOR OR THEY WON’T GO SEE A MENTAL HEALTH PROVIDER BECAUSE
THEY’RE OKAY, MOG IS WRONG WITH THEM, WHEN EVERYBODY ON THE OUTSIDE LOOK NG CAN SEE SOMETHING
SERIOUSLY WRONG. SO HOW CAN YOU DO INTERVENTION WITH SOMEONE
THAT DOESN’T WANT THE HELP? IT’S EXTREMELY DIFFICULT TO HELP SOMEONE THAT
DOESN’T WANT TO BE HELPED. KEEP TRYING.
I’M NOT SURE HOW YOU CAN PROBABLY GET SOMEONE BACK INTO CARE THAT DOESN’T WANT IT, OTHER
THAN, YOU KNOW, I GUESS JUST STILL BEING POSITIVE AND KNOWING THEY’RE WANTING LOVE.
>>THANK YOU. RONALD, HOW ABOUT YOU NEXT, SAME QUESTION,
WHAT DO YOU THINK ARE BARRIERS TO CARE AND REMAINING IN CARE?
>>I’M GOING ON ECHO COL EXPLEEN SAY AS WELL, MENTAL HEALTH, HOURSING AND TRANSPORTATION.
MENTAL HEALTH, HOURSING AND TRANSPORTATION — HOUSING AND TRANSPORTATION.
WHEN I SAY TRANSPORTATION, I’M THINKING OF BEYOND UBER CARS, BEYOND METRO CARKSZ I’M
TALKING ABOUT ACCESS. THERE ARE PLAIPSZ IN THE CITY THAT YOU CAN’T
EVEN CATCH THE BUS OR GET THE BUS TO GET TO WHERE YOU NEED TO GET TO OR IT’S TOO EXPENSIVE
TO GET ON THE SUBWAY BECAUSE OF XYZ PURPOSES. WHEN I SAY TRRNTION I MEAN ACCESS TO TRANSPORTATION,
NOT JUST GIVING US UBER OR METRO CARDS TO GIVE TO THE CLIENTS, SO WE CAN HAVE THESE,
AND EVEN HAVING CLINICS IN PLACES IN THOSE AREAS.
HOUSING, AGAIN, AS A NONMEDICAL CASE MANAGER THAT IS THE NUMBER ONE THING THAT COMES THROUGH
THE DOOR IS HOUSING, HOUSING, HOUSING, HOUSING, AND I’VE BEEN TOLD THAT, YOU KNOW, DC HAS
A LOT OF RESOURCES, BUT THE WALLS YOU HAVE TO KNOCK GOWN TO ACCESS SOME OF THESE THINGS
FOR YOUR — KNOCK DOWN TO ACCESS SOME OF THESE THINGS FOR YOUR CLIENTS IS EXTREMELY RIDICULOUS,
THAT’S A BARRIER FOR ME, I’M NOT GOING TO TAKE MY MEDICINE IF I DON’T KNOW WHERE I’M
SLEEPING TONIGHT, I’M NOT GOING TO GO TO THE DOCTOR IF I DON’T KNOW WHERE I’M SLEEPING
TONIGHT, AND MENTAL HEALTH IS ANOTHER BARRIER, AND WE’RE SPEAKING ABOUT PEOPLE WHO HAVE GENERATIONAL
TRAUMA AND WHO YOU’RE ASKING THEM TO MENTALLY MAKE DECISIONS FOR THEMSELVES AND RIGHT MIND
AND THEY HAVEN’T DEALT WITH STUFF THAT THEY’VE BEEN GOING THROUGH AS CHILDREN AND THAT MENTAL
ACCESSING MENTAL HEALTH AND HAVING — BEING AFFIRMED IS ANOTHER THING.
IT’S A DIFFERENCE, I’VE HAD THERAPISTS, AND THIS IS NO OFFENSE TO ANYONE, I’VE HAD NONCOLOR
OF PEOPLE THERAPIST AND IS I’VE HAD PEOPLE OF COLOR THERAPISTS AND THERE’S A BIG DIFFERENCE,
AND THEY’RE GETTING CONNECTED WITH SOMEONE THAT AFFIRMS ME VISUALLY AS WELL AS KNOWS
WHAT THEY’RE TALKING ABOUT PSYCHOLOGICALLY, IT MAKES A BIG DIFFERENCE.
>>CORRIE?>>YEAH, I’LL GO ON THE SUBSTANCE ABUSE PART,
AND I’M GLAD THAT SAMHSA IS IN THE HOUSE. YOU KNOW, I HAD THE ADVANTAGE OF 25 YEARS
AGO GOING THROUGH A PROGRAM THAT MANY — THAT HAD A COMBINATION OF SUBSTANCE ABUSE AND HIV,
AND I WILL TELL YOU THAT IT WORKED. WE DON’T HAVE THAT ANYMORE.
A PERSON LIVING WITH HIV AND SUBSTANCE ABUSE, WHICH YOU DEAL WITH BOTH SWAITIONDZ AT THE
SAME TIME. MOST PEOPLE WHO ARE HIV POSITIVE WHO GO TO
TREATMENT CENTERS GO BACK OUT THE DOOR WITH THE SAME PARTNER THAT THEY CAME IN THERE WITH
HIV. SO WE HAVE TO START HAVING IMPLEMENTING THINGS
INSIDE THE PROGRAM SPECIFICALLY FOR PEOPLE LIVING WITH HIV.
THAT HAPPENED FOR ME, AND AGAIN IT WORKED. MOST, YOU KNOW, IF WE’RE GOING ON STOP THE
EPIDEMIC, IT’S JUST LIKE A PERSON WHO IS HIV POSITIVE GOES INTO A TREATMENT CENTER AND
THEY DON’T GET TO TALK ABOUT HIV BECAUSE OF THE STIGMA.
SO WHEN THEY LEAVE AND GO HOME AND ALL OF A SUDDEN THEY SEE A BUMP, HERE IT COMES AND
THEY’RE USING AGAIN, BECAUSE THE HIV WAS NOT ADDRESSED, AND ANYBODY WHO TESTS POSITIVE
FOR HIV HAS A MENTAL HEALTH ISSUE AUTOMATICALLY. SO WHEN THAT DIAGNOSIS COMES, MENTAL HEALTH
SHOULD BE ONE OF THE FIRST REFERRALS THAT JUST HAPPENS ONCE THAT DIAGNOSIS HAPPENS.
>>THANK YOU. WE’LL START WITH YOU ON THIS, RONALD, WHAT
ARE YOUR THOUGHTS ABOUT THE ACTUAL ON THE GROUND IMPACT OF ENDING THE EPIC — THE EPIDEMIC
PLAN ASK OUR NATIONAL EFFORTS TO GO THROUGH?>>TO BE HONESTLY, I DON’T SEE IT.
I DON’T SEE IT. IT WAS NICE WHEN WE GOT THE ANNOUNCEMENT AND
WE GOT THIS REALLY LONG, YOU KNOW, HUGE DOCUMENT TO READ AND IT HAD ALL THESE DELIVERABLES
AND ALL THIS FLUFF IN IT, BUT ON THE GROUND, IF I WERE NOT IN THE INDUSTRY, I WOULD HAVE
NEVER KNOWN WHAT ENDING THE EPIDEMIC IS, I WOULDN’T HAVE KNOWN THAT IT EVEN EXISTS.
IS IT REALLY HAPPENING, ARE WE GOING TO DO IT, WHAT DOES IT MEAN?
I MEAN, THERE’S HARDLY BEEN ANY TYPE OF ADVERTISEMENT, THERE’S NO VISIBILITY IN IT, THERE IS NO — IT’S
JUST OKAY, HERE, THIS IS WHAT WE’RE GOING TO DO AND THAT’S WHAT WE’RE GOING TO DO.
THERE HAS NOT BEEN ANY CONTINUOUS EFFORT TO SAY LIKE TO EVEN MY PARENTS, MY FATHER AND
MY MOTHER I HAD THEM CALL ME AND ASK ME, WHAT IS XYZ, WHAT IS ENDING THE EPIDEMIC, WHAT
DOES THIS MEAN, HOW COME WE ONLY HEARD ONE THING ABOUT IT ONE TIME?
AND WHAT ELSE, IS THIS PLAN ACTUALLY REALISTIC, LIKE IS IT SOMETHING THAT WE CAN ACTUALLY
POSSIBLY DO? THERE ARE JUST SO MANY QUESTIONS AROUND IT
THAT HONESTLY OUTSIDE OF PUBLIC HEALTH AND WORKING IN IT, YOU DON’T SEE IT, IT’S NOT
SOMETHING THAT IS TANGIBLE OR SOMETHING THAT WE SEE ON THE GROUND THAT’S BEING THROWN IN
OUR FACE AND HOW DOES THE PUBLIC KNOW WHERE THEY FIT IN IN ENDING THE EPIDEMIC IF WE’RE
NOT GIVING OUT THIS INFORMATION AND WHAT WE’RE SUPPOSED TO BE DOING, LIKE, YOU KNOW, THAT
COULD HELP END THE STIGMA. YOU’RE TRYING TO END THE EPIDEMIC BUT WE’RE
NOT TALKING ABOUT IT AT ALL ENOUGH FOR ME.>>THANK YOU.
CORRIE?>>YEAH, I’M KIND OF WITH RON IN THAT, YOU
KNOW, BEING HERE TODAY IS OKAY, BUT WHAT HAPPENS AFTER THIS?
YOU KNOW, HOW DO WE KNOW WHEN THAT MONEY TRICKLES DOWN TO WHEREVER IT GOES?
DOES IT GET TO THE RIGHT PEOPLE? YOU KNOW, IT’S JUST HARD TO SAY HOW WELL THINGS
ARE DOING WHEN YOU DON’T GET TO KNOW WHAT THE OUTCOMES HAVE COME BEHIND IT, YOU KNOW,
WHAT ACTUALLY HAPPENED AFTER THIS GO-AROUND AND DOES THE COMMUNITY GET THAT INFORMATION
TO SAY, WELL, WE’RE DOING A LITTLE BETTER HERE.
IN MOST OF OUR COMMUNITIES IN THE AFRICAN AMERICAN COMMUNITIES, YOU COULD SAY UP TO
THIS POINT NOTHING HAS CHANGED. SO, YOU KNOW, THERE NEEDS TO BE A LOT MORE
TRANSPARENCY, THERE’S A LOT OF THINGS ANEED TO COME DOWN THE PEOPLE WHO ARE ON THE GROUND
TO REALLY KNOW WHAT’S GOING ON, YOU KNOW, HOW WELL WE’RE DOING.
YOU KNOW, YOU TALK ABOUT DATA AND THINGS LIKE THAT SOMETIMES, AND I’VE ALWAYS BEEN, BECAUSE
I’VE HAD STIGMA ABOUT THE COLLECTION OF DATA ABOUT AFRICAN AMERICAN HETEROSEXUAL MEN WHO
ARE HIV POSITIVE, AND IF YOU GO LOOK FOR THAT DATA, IT’S GOING TO BE KIND OF HARD TO FIND
BECAUSE FOR A LONG TIME THEY DIDN’T EVEN COLLECT THAT DATA.
SO, YOU KNOW, IT’S HARD TO TELL EXACTLY HOW WELL — YOU ALL ARE DOING, YOU KNOW, YOU SEND
THE MONEY, BUT ON THE GROUND, WE JUST HAVE TO DO WHAT WE DO BECAUSE THIS IS WHAT WE LOVE
TO DO, AND A LOT OF TIMES IT AIN’T EVEN ABOUT MONEY, IT’S JUST LET US DO WHAT WE NEED TO
DO. BUT SOMETIMES YOU CAN’T DO WHAT YOU NEED TO
DO BECAUSE THERE’S PROTOCOL AND POLICY AND THINGS LIKE THAT.
SO WE’LL SEE.>>COLLEEN, WHAT DO YOU THINK IS IMPACTING
THE LOCAL COMMUNITY?>>I’M NOT SURE I KNOW, WITH MY PEERS MANY
PEOPLE WHO ARE POSITIVE, WELL, A COUPLE OF MONTHS AGO WE HAD A GROUP, AND THE GROUP USED
TO COME BETWEEN TEN AND TWENTY PEOPLE, IT WAS ABOUT THREE OR FOUR OF US THERE, I THINK
IT WAS FOUR THIS PARTICULAR DAY, AND WE WERE ASKED AFTER THE GROUP, YOU KNOW, CLOSE TO
THE END, WE WANT YOU TO WRITE DOWN NAMES OF PEOPLE THAT’S NOT HERE, WHETHER THEY’VE MOVED
ON, THEY JUST DON’T COME OR THEY’VE DECEASED. WE HAD ABOUT 15 SHARES — WE HAD ABOUT 50
CHAIRPZ IN THE GRUM AND WE ADDED ALL 50 CHAIRS AND WE’RE ADDING ONE EACH TIME TWO AT A TIEVMENT
OVER THE LAST COUPLE YEARS, THAT’S A LOT OF PEOPLE THAT ARE NOT COMING BACK FOR WHATEVER
REASON OR DECEASED AND THAT’S A MAJOR PROBLEM, SO HOW ARE YOU GOING TO END AN EPIDEMIC WHEN
PEOPLE ARE DYING AND ARE NOT COMING BACK?>>WE HAVE JUST A COUPLE MINUTES.
TALKING AGAIN, WE HAVEN’T TOLD YOU WHAT WE MIGHT ASK IN ADVANCE, IF THAT’S OKAY, BECAUSE
I THINK COLLEEN, YOU ALLUDED TO DISCLOSURE AND OVERCOMING STIGMA, AND I THINK FOR PEOPLE
LIVING WITH HIV WHO ARE RIGHT NOW SCARED TO DISCLOSE, SCARED TO GET IN CARE, SCARED FOR
PAY VARIETY OF REASONS — SCARED FOR A VARIETY OF REASONS, AND I WONDER IF YOU COULD SHARE
HOW YOU OVERCAME THAT SCARY MOMENT OR THAT MINDSET OR WHAT HAVE YOU TO REALLY — IS THERE
ANYTHING THAT YOU WOULD SHARE WITH ANYBODY LIVING WITH HIV RIGHT NOW WHO FEELS STIGMATIZED
OR CHALLENGED ABOUT HOW TO OVERCOME THAT AND MOVE FORWARD IN A POSITIVE WAY?
>>IT TOOK A LONG TIME. I HAD TO DEAL WITH A LOT OF MENTAL HEALTH,
AND IT WAS MENTAL HEALTH BEFORE I WAS DIAGNOSED. YOU KNOW, I HAD APRIL LOT OF SELF-ESTEEM ISSUES.
SO IT’S A LITTLE DIFFICULT WITH YOU TELLING SOMEBODY THAT AND YOU ALREADY HAVE SELF-ESTEEM
ISSUES. SO IT TOOK ME A WHILE AND I GUESS A LOT OF
ENCOURAGEMENT FROM PEOPLE WHO CARED FOR ME TO START GOING ON THERAPY.
THERAPY HELPED AND I STILL DO IT BECAUSE THERE’S A LOT OF THINGS I STILL HAVE TO WORK ON.
BUT IF YOUR SELF-ESTEEM ALREADY ISN’T THERE AND YOU’RE NOT BUILDING ON T YOU’RE NOT GOING
TO FEEL COMFORTABLE WITH HAVING SOMEONE LOOK AT YOU LIKE OH, DON’T TOUCH HER OR OH DON’T
BE AROUND HER OR WHISPERING BEHIND YOUR BACK. I’M NOT GOING ON SAY NOW TODAY IT STILL DON’T
HURT WHEN PEOPLE TREAT YOU SOME KIND OF WAY, BUT PEOPLE ARE GOING TO BE PEOPLE REGARDLESS,
AND I JUST HAVE TO TELL MYSELF THAT’S THEIR IGNORANT, BUT EVERYBODY ISN’T THERE.
SO WHEN I DO HAVE A FRIEND, PEOPLE TALK ABOUT THEM, I TRY TO TAKE THAT FOR THEM, YOU KNOW,
WHY ARE YOU WORRIED ABOUT IT? SHE’S FINE, THAT’S MY FRIEND, YOU KNOW, TRY
TO STEP IN WHEN THEY DON’T WANT TO STEP IN FOR THEMSELVES.
SO I MEAN, IT’S A LITTLE DIFFICULT TO ENCOURAGE SOMEONE TO COME OUT, BUT THAT KIND OF KEEPS
PEOPLE STUCK IN WHATEVER SITUATION THEY MAY BE WITHHOLDING THAT IN BECAUSE THAT KIND OF
STILL LEAVES YOU WITH A DO NO HARMFUL THING, SO THAT COULD HARM YOURSELF AS WELL AS THE
COMMUNITY.>>THANK YOU.
CORRIE?>>FOR ME, THE FIRST TIME THAT I WAS ABLE
TO STAND IN A ROOM AND TELL A BUNCH OF STRANGERS THAT I WAS AN HIV POSITIVE BLACK MAN WAS ABOUT
A YEAR AGO, AND WHAT’S THE HELP OF — AND WITH THE HELP OF ME GOING THROUGH THE DC DEPARTMENT
OF HEALTH HEALTH IMPACT SPECIALIST PROGRAM AND ME BEING AFFIRMED BY THE OTHER YOUNG BLACK
MEN IN THERE WHO WERE ABLE TO STAND AND YOU SHARE THEIR STORIES AND EVER SINCE THEN I’VE
PROBABLY TOLD MY STORY SEVERAL TIMES, IT EMPOWERS ME EVERY TIME THAT I TELL MY STORY.
SO FOR ME, I KNEW THAT THERE WAS A PURPOSE WITHIN MY PAIN, THAT I WAS GOING THROUGH,
AND I KNEW THAT I HAD A DUTY BECAUSE I HAD A DUTY TO SAVE THE NEXT YOUNG BLACK MAN FROM
CATCHING HIV OR FROM GOING THROUGH WHAT I WENT THROUGH MENTALLY WHEN I FOUND OUT THAT
I HAD HIV. AND SO THAT’S WHY I’M ABLE TO TELL MY STORY
AND THAT’S WHY I TELL MY STORY. TO SOMEONE WHO IS STILL MENTALLY IN THAT SPACE
THAT, YOU KNOW, IS AFRAID TO TELL OUT, I WOULD JUST SAY THAT, YOU KNOW, TAKE YOUR TIME.
IT’S SOMETHING THAT NO ONE CAN FORCE YOU TO DO, TWO, YOU HAVE TO COME THROUGH YOUR OWN,
YOU HAVE TO WORK THROUGH YOUR OWN MENTAL PROCESS WITH BEING COMFORTABLE AND BEING ABLE TO AFFIRM
AND STAND IN YOUR TRUTH AND SAY THIS IS WHO I AM.
YOU EQUAL AS YOU ALSO HELPED ME RELEASE SOME OF THAT STIGMA BECAUSE I HAVE FAMILY MEMBERS
WHO WON’T LET ME USE CERTAIN CUPS IN THEIR HOUSE TO THIS DAY.
IT’S 2020. AND THEY’LL HAND ME A APPROXIMATE RED CUP
INSTEAD OF HANDING ME A GLASS CUP IN THEIR HOUSE.
THERE’S STILL A LOT OF WORK IS THAT NEEDS TO BE DONE AND THERE’S STILL TIMES I TELL
MY STORY AND CERTAIN PEOPLE FLINCH OR BUT LIKE I SAID, THERE WAS AND THERE IS A PURPOSE
IN MY PAIN ASK I HAVE TO DO THAT AND I DO THIS FOR THAT PURPOSE.
>>AND THEN FOR ME, I HAD TO LEARN HOW TO DISCLOSE MY STATUS, YOU KNOW, FOR ME TO STAY
CLEAN, IN ORDER FOR ME TO STAY DRUG-FREE, I HAD TO BE ALL RIGHT WITH ME.
SO WHAT I STARTED DOING WAS WHEN I WOULD BE AT MEETING, I WOULD ANNOUNCE THE FACT THAT
MY NAME IS CORRIE AND I’M AN ADDICT AND I’M AN HIV SURVIVOR, I NEEDED TO DO THAT TO LEVEL
THE PLAYING FIELD IN THE ROOM. I’M ALL RIGHT WITH ME.
WHETHER YOU’RE ALL RIGHT WITH THAT, IT DOESN’T MATTER TO ME.
AND WHAT THAT DID WAS FREED UP THE ROOM FOR EVERYBODY ELSE WHO WAS POSITIVE IN THAT ROOM
THAT THEY COULD SEE IT, YOU KNOW, WAS THE THING THAT GOD TOLD ME TO SAY CORRIE, DON’T
WAIT FOR NOBODY ELSE TO SAY IT, YOU SAY IT. SO PEOPLE COULD SEE THAT YOU COULD STOP USING
DRUGS AND STILL BE POSITIVE AND I’VE BEEN ALL OVER THE DISTRICT AND IT DOESN’T MATTER
TO ME, LIKE I SAID, I NEED TO DO ACCEPT THAT FACT ABOUT ME.
IT WAS OKAY, I DID THAT, I REMEMBER LOOKING INSIDE THAT SYRINGE, SEEING THAT BLOOD AND
PUTTING THAT NEEDLE IN MY ARM BECAUSE I NEED TO DO GET HIGH, SO I COULDN’T BLAME IT ON
GOD AND NOBODY ELSE, CORRIE, YOU DID THAT, SO IT WAS VERY EASY FOR ME TO GO AROUND GETTING
HEALTHY, GOING IN AND OUT OF PLACES AND LET PEOPLE KNOW WHO I AM.
AND IT’S OKAY TODAY, BUT LIKE I SAID, IT’S A PROCESS, YOU HAVE TO GET THERE.
I DON’T WORRY ABOUT WHAT PEOPLE THINK OF ME ANYMORE, BECAUSE WHEN I WAS USING DRUGS, DIDN’T
WORRY ABOUT WHAT THEY THOUGHT ABOUT ME THEN. SO THAT’S KIND OF WHERE I’M AT.
>>COLLEEN, CORRIE, RONALD, THANK YOU SO MUCH FOR SHARING GREAT INFORMATION WITH US, WE
REALLY APPRECIATE YOUR TIME AND YOUR ENERGY. THANK YOU SO MUCH.
>>THANK YOU FOR HAVING US. [APPLAUSE]
>>WE HAVE A QUESTION. MIKE.
>>BEFORE YOU GO, FIRST OF ALL, THANK YOU VERY MUCH.
YOUR INSIGHTS ARE FABULOUS. WHILE YOU’RE HERE ACCIDENT I WOULD LIKE TO
USE YOU GUYS AS CONSULTANTS — WHILE YOU’RE HERE, I WOULD LIKE TO USE YOU GUYS AS CONSULTANTS.
HERE IS THE QUESTION, HOW DO WE ENGAGE THE YOUNG PEOPLE, ADOLESCENTS AT RISK RIGHT NOW,
IF YOU TO DESIGN A PROGRAM FROM SCRATCH IN YOUR LOCAL AREA, KNOWING EVERYTHING YOU KNOW,
WHAT YOU WENT THROUGH AND IN THE CASE OF IF THEY’RE USING, THE YOUNG PEOPLE USING, IN
CASE THEY’RE EXPOSED SEXUALLY, HETEROSEXUAL, OTHERWISE, GIVE YOU — GIVE US YOUR BEST SHOT
AT THE PROGRAM YOU THINK WOULD WORK AND HOW, JUST QUICKLY, HOW YOU THINK IT WOULD BE MANAGED.
THAT’S REALLY WHAT’S DESPERATELY NEEDED RIGHT NOW.
>>I THINK ONE OF THE THINGS THAT I’VE LEARNED ABOUT DOING PREVENTION EDUCATION WITH YOUNG
PEOPLE IS THAT YOU’VE KIND OF GOT TO SCARE THEM AND YOU’VE GOT TO GIVE THEM THE DATA
THAT APPLIES TO THEM. MOST OF THE YOUNG PEOPLE THINK THAT’S FOR
PEOPLE IN 30S, 40S. WHEN YOU GIVE THEM DATA THAT SAYS THIS IS
HOW MANY 18-YEAR-OLDS ARE HIV POSITIVE AND, YOU KNOW, THINGS LIKE THAT, IT CHANGED IT
CHANGES AND GIVE THEM SOMETHING TO THINK ABOUT, THAT THAT’S NOT EVERYBODY ELSE, THAT’S YOU,
THAT’S YOUR POPULATION, AND LET THEM KNOW THAT YOU CARE ABOUT THEM.
YOU KNOW, THAT’S ONE OF THE KEY THINGS THAT I KNOW THAT WORKS IS WHEN YOU PRESENT SOMETHING
TO THE YOUNG PEOPLE, YOU NEED TO MAKE THEM FEEL LIKE YOU CARE ABOUT THEMES — ABOUT THEM.
>>JUST OFF THE TOP OF MY HEAD, TO BE HONEST WITH YOU, I’VE BEEN TRAINED TO THINK OF SOLUTIONS,
AND THE FIRST THING I CAN THINK OF, ESPECIALLY WHEN TALKING ABOUT THE YOUNG DEMOGRAPHIC IS
AN APP, IS TECHNOLOGY, THAT’S WHAT GETS THEM THERE, WHETHER THAT TECHNOLOGY APP LOOKS LIKE
AN APP THAT’S ON MY PHONE THAT I CAN SCHEDULE AN APPOINTMENT BECAUSE I THINK I’VE BEEN EXPOSED
OR WHETHER THAT’S AN APP THAT I CAN GET CONNECTED TO SOMEONE WHO HAS BEEN EXPOSED, BECAUSE I
JUST GOT — I FOUND OUT I’M HIV POSITIVE AND I DON’T NECESSARILY WANT TO WALK INTO A CLINIC,
WHETHER THAT LOOKS LIKE — I DON’T KNOW EXACTLY WHAT THAT LOOKS LIKE, BUT IT’S TECHNOLOGICALLY
BASED. I AGREE WITH WHAT CORRIE SAID AS THEY NEED
TO CLUR THE DATA — CLURP THE DATA, THEY NEED TO SEE DATA THAT INCLUDES THEM AND SEES THEM
AND, YOU KNOW, I GREW UP ON THE SCARE TACTIC, YOU KNOW, I GREW UP, HEY, THIS IS WHAT’S GOING
TO HAPPEN, I’M A PK, SO IF YOU PASSIVELY GIVE YOUNG PEOPLE INFORMATION, THEY’RE GOING TO
PASSIVELY, IT’S GOING TO GO RIGHT OUT THEIR BRAIN AND THEY’RE NOT GOING TO RELATE TO IT
IF IT DOESN’T HIT THEM WHERE IT IS. SO OUTSIDE OF BEING AN APP OR SOME KIND OF
TECHNOLOGY-BASED PROGRAMMING THAT CAN BE EXCLUSIVE TO THEM AND THEY CAN JUST DO WHAT THEY HAVE
TO DO TO GET CONNECTED TO WHERE THEY HAVE TO GET TO, WE’VE GOT TO GIVE THEM THE DATA
AND MAKE SURE THAT THEY UNDERSTAND THAT THEY TOO FIT THE MOLD.
>>I’M KIND OF NOT SURE. I REMEMBER BEING ABOUT 18 OR 19 AND OUR PROGRAM
HAD SOMEONE COME IN, AND THE ONLY THING I REMEMBER HER TALKING ABOUT WAS WHEN SHE FIRST
CAME IN, SHE SAID HER SPIEL AND THEN SHE SAID SHE WAS POSITIVE AND WE WERE SO SHOCKED BECAUSE
SHE DID NOT LOOK STHAIK WE DIDN’T EVEN FOCUS ON HER — SHE DID NOT LOOK SICK, SO WE DIDN’T
EVEN FOCUS ON HER PRESENTATION. SO I GUESS HAVE SOMEBODY THAT THEY CAN CONNECT
WITH, THAT THEY CAN ABSORB THE INFORMATION FROM, BECAUSE I DON’T EVEN REMEMBER HER PRESENTATION,
BUT I REMEMBER THE VOICE AND OH SHE LOOKS GOOD, BUT WE WERE SO FOCUSED ON HER LOOKS,
WE WEREN’T FOCUSED ON THE INFORMATION WE WERE SUPPOSED TO GET.
HAD I BEEN FOCUSING ON THAT, MAYBE THINGS — YOU KNOW, THE INFORMATION WASN’T CONTAINED.
>>WE’LL TAKE OUR FINAL QUESTION. DID YOU HAVE A QUESTION?
>>YES.>>OKAY.
>>SO MY QUESTION IS AROUND THE DATA AND THE PROGRAM, BECAUSE SOMETIMES WHEN WE TALK ABOUT
THE DATA PARTICULARLY IN CERTAIN POPULATIONS LIKE MSM, THERE’S THIS FEAR THAT THE NUMBERS
ARE SO SHOCKING, YOU CAN TALK ABOUT THE LIFETIME INCIDENCE PROBABILITY OF ACQUIRING HIV THAT
IT MIGHT JUST SHUT PEOPLE DOWN. I KNOW BOTH OF YOU SAID DATA AND I JUST WANT
TO CHECK, IS THAT THE SORT OF DATA YOU’RE REFERENCING IN TERMS OF SOME OF THOSE EPI,
IN TERMS OF SOME OF THOSE STATISTICS OF ONE OUT OF TWO AND ONE OUT OF THREE?
OR IS IT DIRECT DATA?>>WELL, I THINK JUST WHEN YOU HAVE TO SAY
THAT 18 TO 21 OR, YOU KNOW, THAT SPECIFIC KIND OF AGE RANGE DATA, YOU KNOW, THAT LAST
YEAR 10 PERCENT OF THE POPULATION THAT GOT INFECTED WAS BETWEEN THE AGES OF 15 AND 19,
THAT KIND OF THING.>>YEAH.
WHEN I SAY DATA, THAT DATA CAN REFLECT THAT, BUT THAT COULD ALSO GO OVER THEIR HEADS.
I’M THINKING OF GIVING THEM THE — I MEAN, YOU CAN SAY ONE IN TWO AND ONE IN, YOU KNOW,
XY AND Z, BUT IF YOU’RE NOT SHOWING ME, IF I DON’T CONNECT WITH IT OR IF I DON’T PHYSICALLY
SEE IT IN FRONT OF MY FACE, LIKE YOUR EXAMPLE OF HAVING SOMEONE COME OUT AND SPEAK, IF I
DON’T MAKE THAT CONNECTION, HEY, THIS IS A BLACK MAN IN FRONT OF ME WHO DIDN’T THINK
HE WAS IN THE DEMOGRAPHIC, LIKE THAT’S THE DATA THAT THEY NEED TO SEE, THAT THERE ARE
BLACK MEN THAT LOOK LIKE YOU, THERE ARE BLACK WOMEN THAT LOOK LIKE YOU THAT ARE IN THIS,
AND I DON’T KNOW IF THAT NECESSARILY MEANS A NUMBER OR IF THAT MEANS A PERSON PHYSICALLY
IN THE ROOM THAT’S GOING ON SAY, HEY, THIS IS — I’M ONE IN THREE, I’M ONE OF THOSE IN
X, Y AND Z.>>NOW AGAIN, THANK YOU VERY MUCH FOR SHARING
YOUR STORIES, SHARING YOUR COURAGE, YOUR SINCERITY, YOUR HONESTY, SO THANK YOU VERY MUCH.
WE APPRECIATE THAT. [APPLAUSE]
NOW I’M GOING TO TURN OVER TO MARC MEACHEM WHO I HAVE TO FIRST SAY DEVOTED A LOT OF TIME
AND EFFORT INTO PLANNING AND FOCUSING ON THE DC AREA, SO THANK YOU, MARC, AND THE FLOOR
IS YOURS.>>WE ARE GOING TO ASK OUR GOVERNMENT PANELISTS
TO COME UP TO THE FRONT.>>(AWAY FROM MICROPHONE).
>>WE REALLY WANTED TO TAKE A 360-DEGREE VIEW OF HIV IN THE DMV AND WE THOUGHT IT ENTIRELY
APPROPRIATE FOR PEOPLE LIVING WITH HIV AND HEAR THEIR VOICES, WE’RE DELIGHTED TO HAVE
GOVERNMENT OFFICIAL TION WORKING WITH HIV ACROSS THE REGION.
I WANTED TO ASK IF EVERYBODY COULD GIVE THEIR NAME, AFFILIATION AND INSTITUTION AND DIVE
INTEUFER THE QUESTIONS. MICHAEL, WHY DON’T WE START WITH YOU.
>>WELL, GOOD AFTERNOON, MY NAME IS MICHAEL KHARFEN.
I AM THE SENIOR DEPUTY DIRECTOR FOR THE HIV/AIDS HEPATITIS STD, THE WHOLE PORTFOLIO ADMINISTRATION
IN THE DC DEPARTMENT OF HEALTH, HOME OF THE WORLD SERIES CHAMPION WASHINGTON NATIONALS,
AND WNBA CHAMPIONISTICS.>>I’M DIANA JORDAN WITH VIRGINIA DEPARTMENT
OF HEALTH AND I OVERSEE HIV AND STD PROGRAMS FOR THE STATE OF VIRGINIA.
>>HI, MY NAME IS RAVINIA HAYES-COZIER, DEPUTY DIRECTOR OF HIV/AIDS, ONE OF THE PROGRAMS
IN THIS PROCESS.>>GOOD AFTERNOON, I’M TRAVIS G GAYLES, HEALTH
OFFICER AND CHIEF OF PUBLIC HEALTH SERVICES FOR MONTGOMERY COUNTY, MARYLAND.
>>I’M PETER DEMARTINO, CHIEF AT THE MARYLAND DEPARTMENT OF HEALTH FOR HIV PREVENTION AND
HEALTH SERVICES.>>FIR FIRST QUESTION I WANT TO ASK, WHAT
HAS WORKED IN COOPERATION BETWEEN JURISDICTIONS IN DMV TO INCREASE ACCESS AND ATTENTION TO
CARE? PETER, WHY DON’T WE START WITH YOU AND GO
BACK.>>SURE.
SO I THINK WE’RE SOMEWHAT UNIQUE IN THE NATION AND NOT ONLY IS OUR POPULATION MORE RURAL,
BUT SO IS OUR DATA AND OUR PROGRAM PLANNING AND OUR PROGRAM EVALUATION AND THE WORK THAT
WE DO. I THINK THE THREE LARGER JURISDICTIONAL BODIES
WORK VERY CLOSELY TOGETHER, AND ONE OF THE GREAT THINGS ABOUT ENDING THE EPIDEMIC OPPORTUNITY
HAS REALLY BEEN ELEVATING OUR LOCAL HEALTH DEPARTMENTS AND OUR JURISDICTIONAL PARTNERS
IN SUBURBAN MARYLAND AND ALSO BALTIMORE CITY TO THE TABLE, BECAUSE I KNOW WE TALK ABOUT
THE DMV AS BEING NORTHERN VIRGINIA, THE DISTRICT AND SUBURBAN MARYLAND.
THERE’S A LOT OF FOLKS COMMUTEING FROM — RIDE AND 8 BUCKS AND THERE’S A LOT OF WORKING AND
LIVING AND PLAYING HAPPENING UP AND DOWN THAT WHOLE CORRIDOR FOR MARYLAND.
>>I WOULD ADD COMING FROM A GOVERNMENT COUNTY THAT IT’S HISTORICALLY NOT BEEN A LOT OF THE
CONVERSATIONS AROUND HIV PREVENTION IS THAT THE REGIONAL APPROACH HAS HELPED BOLSTER OUR
PARTICIPATION IN THOSE CONVERSATIONS AND HAS HELPED ENCOURAGE THE FORMATION OF A DATA DRIVEN
INFRASTRUCTURE WITHIN OUR JURISDICTION THAT NOT ONLY LOOKS AT THE LARGE SCALE DATA FROM
THE STATEMENT AND NATIONAL LEVEL BUT ALSO ALLOWS US THE OPPORTUNITY TO ASK VERY SPECIFIC
DATA DRIVEN QUESTIONS THAT GET TO THE HEART OF WHAT’S DRIVING THE EPIDEMIC, SO WHEN WE
TALK ABOUT SOCIAL DETERMINANTS OF HEALTH, WE’RE NOT JUST ASKING HOW MANY NEW CASES DO
WE HAVE IN OUR JURISDICTION, BUT WE’RE ABLE TO LEVERAGE THOSE PARTNERSHIPS TO ASK, WELL,
OF THOSE CASES, HOW MANY OF THOSE ARE TIED TO HOUSING INSECURITY, ACCESS TO TRANSPORTATION,
ACCESS TO A PRIMARY CARE PROVIDER, AND IT’S BEEN A GODSEND TO US BECAUSE IT’S HELPED US
SHIFT THE CONVERSATION IN THE COUNTY TO BE ABLE TO PARTICIPATE WITH THE OTHER JURISDICTIONS
AND ALSO LEVERAGE OUR COUNCILMEMBERS AND POLICYMAKERS WHO HAVE HISTORICALLY NOT HAD HIV ON THEIR
RADAR.>>SO FOR US I THINK IT’S EXPAND OUR PORTFOLIO.
I THINK WE’VE ROIMENTZED FOR YEARS — RECOGNIZED FOR YEARS THAT WE HAVE INVISIBLE BORDERS,
SO THEREFORE, THERE’S BORDERLINE THAT SAYS HERE IS D-C HERE IS VIRGINIA AND HERE IS ANY
OF THE OTHER JURISDICTIONS THAT WE WORK WITH. BY DOING THAT I THINK WE’VE HAD AN OPPORTUNITY
TO HAVE DISCUSSIONS ABOUT WHAT DO WE THINK OUR STANDARDS OF CARE STHUD LOOK LIKE.
BECAUSE THERE ARE NO BORDERS, OUR CLIENTS GO FROM ONE PLACE TO THE NEXT.
SO IT’S IMPORTANT FOR US IN OUR DIALOGUE TO TALK ABOUT DEVELOPING STANDARDS OF CARE THAT
WILL ALLOW WHERE THE CLIENT GOES — NO MATTER WHERE THE CLIENT GOES, THEY SHOULD EXPECT
THE SAME KIND OF CARE FROM EVERYBODY. THE SECOND THING I WOULD SAY IS DATA THAT
WE GET FROM THE STATE HAS REALLY HELPED US TO SHAPE WHAT WE ARE DOING AND WHAT WE PLAN
TO DO. IT’S NOT JUST ENOUGH TO LOOK AT — THE COUNTY
IS VERY DIFFERENT. WE’RE A LITTLE BIT OF COUNTRY AND A LITTLE
BIT OF ROCK & ROLL. [LAUGHTER]
AND PROBABLY A LITTLE R & B TOO. BUT I THINK WHAT THAT HAS ALLOWED US TO DO
IS TO LOOK WITHIN THE REAL COMMONALITY WITHIN THE ZIP CODES OR THE DIFFERENCE IN THOSE ZIP
CODES AND THE DATA HAS HELPED US TO NOT ONLY LOOK AT HIV/AIDS BUT WHERE THEY ARE FOOD DEZ
ERTSZ, WHERE — DESERTS, WHERE THERE IS OTHER KINDS OF SOCIAL DETERMINANTS THAT WE OVERLAY
WE HAVE TO ADDRESS BEFORE WE EVEN GEF GET ON HIV/AIDS SO SHARING HAS BEEN EXTREMELY
— DATA SHARING HAS BEEN EXTREMELY HELPFUL TO US.
>>ON THE DATA SIDE I THINK I WOULD ADD IN THAT THE TYPICAL JURISDICTIONAL BASED APPROACH
IS TOTALLY INADEQUATE, TO JUST BE PERFECTLY BLUNT.
IT’S LARGELY MANUAL AND TO TRY TO DUPLICATE ACROSS STATES IS NOT WORKING.
IF YOU WANT AN ACCURATE CARE CONTINUUM. I WOULD SAY THAT PART OF OUR COLLABORATION
REALLY CAME OUT OF THE CARE CONTINUUM TO REALIZE WE WERE ONLY SEEING LIKE A COUPLE WITH MISSING
PIECES BECAUSE LITERALLY MYSELF I’VE LIVED IN PG AND MONTGOMERY COUNTY, I LIVE IN VIRGINIA
NOW, I’VE WORKED IN ALL THREE JURISDICTIONS, THAT IS TYPICAL HERE.
SO IF YOU WORK ONE PLACE, LIVE ONE PLACE, GET YOUR CARE SOMEWHERE ELSE, YOUR CARE CONTINUUM
IS WRONG. SO I THINK PART OF OUR COLLABORATION REALLY
STARTED OUT OF WANTING TO HAVE AN ACCURATE PICTURE OF THE HEALTH OF PEOPLE IN OUR REGION
AND THAT WAS GREAT TO FIND THAT COMMON GROUND AND TO FIND A REALLY HELPFUL ACADEMIC PARTNER
WHO WAS ABLE TO CONVENE US AND HELP US SET UP A NOVEL PROCESS FOR WHAT WE WANTED TO DO
TO HAVE ACCURATE DATA.>>SO TO BUILD ON THAT, IN THE LOGISTICS OF
THAT, WE ESTABLISHED DATA SHARING AGREEMENTS ALONG THE JURISDICTIONS SO WE ARE ROUTINELY
MATCHING DATA OF OUR SURVEILLANCE DATA, AS WELL AS WORKING ACROSS OUR PROGRAMS LIKE RYAN
WHITE, FOR INSTANCE WE ENTERED INTO A SORT OF REGIONAL COLLABORATION AROUND RYAN WHITE
PART A AND PART B SO THAT WE’RE DECIDING, LOOKING AT OUR ALLOCATIONS OF RESOURCES ACROSS
THE ENTIRE REGION AND COORDINATING AMONG THE THREE DIFFERENT PROGRAMS.
WE GOT A CDC DEMONSTRATION PROJECT, 15709 AND WE INTENTIONALLY AIMED THAT AS A REGIONAL
PROJECT AND WE WORKED WITH MARYLAND AND VIRGINIA AND THE COUNTIES TO SET UP A PROGRAM THAT
COVERED THE ENTIRE METROPOLITAN AREA. SO THAT NOVEL TECHNOLOGY THAT DIANA WAS MENTIONING,
THE BLACK BOX STARTED WITH DC, MARYLAND AND VIRGINIA AND NOW CDC HAS SMARTLY EXPANDED
THAT AMONG MANY OTHER JURISDICTIONS, SO THAT OUR AIM IS TO TRY TO GET THAT REALTIME, AS
CLOSE TO REALTIME UNDERSTANDING AS TO HOW PEOPLE ARE WITHIN THE CARE CONTINUUM AND WILL
WE’VE ALL FOUND — AND WE’VE ALL FOUND LITERALLY THOUSANDS OF PEOPLE THROUGH THIS MATCH WHO
WERE INVISIBLE TO US OR SEEMED TO HAVE DISAPPEARED AND WERE ACTUAL UNTIL CARE IN ONE OF THE OTHER
TWO JURISDICTIONS. SO IF YOU’RE GOING TO END THE EPIDEMIC, WHICH
WE ARE ALL OPTIMISTIC WE CAN DO, BUT WE HAVE TO DO THAT REGIONALLY, WE CAN’T DO THAT JUST
WITHIN OUR SINGLE JURISDICTIONS.>>I HAVE A FOLLOW-UP QUESTION ON THE DATA
ISSUE. WHERE WOULD YOU PUT THAT ON 0 OR 100 WHERE
YOU WOULD LIKE TO BE WITH DATA INTEGRATION OR WHAT NUMBER WOULD YOU PICK?
>>I’M GOING TO JUMP IN THERE BECAUSE I THINK THERE’S VERY SPECIFIC DATA WE’RE TALKING ABOUT
HERE, WHICH IS SURVEILLANCE. WE ARE STILL VERY SEGREGATED ACROSS PROGRAMS
WITH DATA, AND SO WHEN YOU SAY WHERE I WOULD LIKE TO BE, I WOULD LOVE TO BE LOOKING AT
THE IMPACT OF OUR HIV RESPONSES REGARDLESS OF WHO PAYS FOR IT.
AND REPORT IT GO AS ONE NUMBER. THIS IS WHAT WE DID.
AS OPPOSED TO DEVELOPING PROGRAMS THAT ARE OUTCOME SPECIFIC.
SO — A PROGRAM TO HOUSING, MENTAL HEALTH, SUBSTANCE ABUSE, AND THEN THEY COME BACK TO
ME AND SAY YOU KNOW WHAT, I’M GOOD ON THE PREP, I’M GOING TO SKIP WITH CONDOMS AND OCCASIONAL
M-PEP THAT’S NOT A POSITIVE OUTCOME FOR A PREP PROGRAM, SO THAT’S I THINK WHERE I WOULD
START AS TO WHERE WE ARE WITH DATA IS WE’RE MATCHING OUR SURVEILLANCE DATA, WE’RE NOT
DOING AS WELL WITH OUR PROGRAM DATA.>>I WOULD ADD THAT I THINK THERE’S MULTIPLE
LAYERS, I THINK THERE’S THE SURVEILLANCE LARGER SCALE DATA BUT I THINK THE THING AIS MISSING
AND I WOULD SAY IS PROBABLY A TWO OR THREE OUT OF TEN IS HOW WE’RE OPERATIONALIZING THE
DATA AND ASKING THOSE DEEPER QUESTIONS TO SEE HOW PARTICULARLY NOT TO HOOPER A POINT
BUT LOOK AT HOW SOCIAL DETERMINANTS OF HEALTH ARE DRIVING PREVENTION OUTCOMES AND MEASURES,
AND SO AS OPPOSED TO LEADING SOLE WELL HERE IS A CONDOM OR HERE IS PREP, HOW DO WE LOOK
AT DATA THAT SHOWS HOW THOSE OTHER FACTORS FLUPS SOMEONE’S RISK PROFILE.
AGAIN HAD OUR COUNTY WHAT’S RESONATED MOST WITH POLICYMAKERS IS HOW WE START, AS RAVINIA
WAS POICT — POINTING OUT WHEN WE START LOOKING AT DATA ON A ZIP CODE LEVEL SO SAY HERE IS
MY HIGHEST INCIDENCE, IN ADDITION HERE ARE WHAT THE CHARACTERISTICS.
NEIGHBORHOOD LOOK LIKE, HERE ARE THE NEEDS OF WHAT THAT LOOKS LIKE SO TO GET SOME CON
— GIVE SOME CONTEXT THE HEALTH DEPARTMENTS IN MARYLAND HAVE ALSO BEEN TASKED WITH ENDING
THE TYPE 2 DIABETES EPIDEMIC AND ALL OF THE SAME THINGS WE’RE LOOKING AT TO PREVENT TYPE
2 DIABETES ARE THE SAME THINGS WE’RE LOOKING AT IN THIS PHASE SO I WOULD SAY WE HAVE TO
DO A BETTER JOB OF OPERATIONALIZING THE DATA TO BE ABLE TO REMOVE THOSE BARRIERS THAT ARE
NOT JUST FOR HIV PREVENTION AND TREATMENT BUT ALSO ARE CONSISTENT WITH OTHER ILLNESSES
AS WELL.>>AND I WOULD PIGGYBACK THEN, I THINK OUR
DATA HAS BEGAN TO TELL A STORY NOT JUST A NUMBER, AND HAS TO TILS A STORY ABOUT WHAT
WAS SUCCESSFUL AND WHAT DIDN’T WORK AND WHY DIDN’T IT WORK AND WHO DIDN’T IT WORK FOR.
OUR DATA DOESN’T DO THAT NOW BECAUSE YOU’RE RIGHT, WE’RE DEALING WITH SEVERAL OTHER ELEMENTS
THAT DEAL WITH THE IMPACTED OF SOMEONE GETTING CARE, WHETHER IT’S FOR DIABETES OR HIV.
CHANCES ARE THAT PERSON IS GOING TO GO TO THE SAME PLACE, AND SO HOW DO THEY MAKE THAT
STORY GO BEYOND JUST INDIVIDUAL — MAKING A REAL STORY ABOUT THAT INDIVIDUAL OR THE
CIRCUMSTANCES OF THAT INDIVIDUAL.>>EVEN WITHIN CLOSELY RELATED FOLLOWING RIGHT
ALONG WITH WHAT YOU SAID, WITH CLOSELY RELATED CONDITIONS LIKE HIV AND STD’S, WE’VE MADE
A LOT OF HEAD WADE ON OUR HIV SURVEILLANCE DATA, IT’S BEEN A HUGE LIFT, WE’RE NOW JUST
STARTING TO GET OUR STD DATA WHICH IS CLOSELY RELATED AND OFTEN THE SAME PEOPLE INTO THE
AUTOMATED HIGH EFFICIENCY BLACK BOX MATCHING PROCESS SO OUR TEAMS ARE WORKING GREAT TOGETHER
BUT IF YOU’RE LOOKING AT HIV AND NOT LOOKING AT SYPHILIS YOU’RE STILL JUST SEEING ONE PART
OF THE PICTURE AND THAT’S NOT EVEN TALKING ABOUT CONDITIONS THAT ARE AFFECTING THE SAME
POPULATION.>>JUST ONE QUICK ADD TO THAT IS WE’VE BEEN
PILOTING WORKING AGAIN ACROSS THE REGION WITH OUR EIS FUNDS OF A REGIONAL EARLY INTERVENTION
SERVICES STRATEGY THAT IS A STATUS NEUTRAL. SO WE’RE UPPING THIS KIND OF SILOING EFFECT
TO SAY, OKAY, WE’RE ONLY GOING TO RECORD ONE PIECE OF DATA HERE, ONE PIECE OF DATA THERE
AND NONE OF IT WILL EVER MATCH, SO WE’RE EMPLOYING TO — SO WE’RE GOING TO LOOK AT PILOTING TO
SAY WELL, SOMEBODY COMES IN, WE’RE GOING TO COLLECT THAT DATA AROUND PEOPLE WHO ARE HIV
POSITIVE AND PEOPLE WHO ARE HIV NEGATIVE AND THAT THE PERSON IN FRONT OF YOU IS NOT GOING
TO HAVE TO SAY I CAN’T TALK TO YOU ANYMORE BECAUSE OF THIS PART OF YOUR STATUS, SO TO
TRY TO MAKE THIS A MUCH MORE INTEGRATED APPROACH.>>WE ASKED OUR LAST PANEL ABOUT HOW THEY
SEE THE IMPACT OR HEAR ABOUT WHAT THEY KNOW ABOUT ENDING THE EPIDEMIC.
CAN YOU TALK ABOUT HOW ENDING THE EPIDEMIC HAS AFFECTED YOUR WORK?
MICHAEL?>>WELL, OKAY.
IT’S BEEN GREAT. SO —
PRINCE GEORGE COUNTY OR MONTGOMERY COUNTY, IN THE APPLICATION IN WAYS WE HAD NOT TRULY
DONE BEFORE, WE HAD ALREADY INTEGRATED OUR PLANNING COMMISSION, SO OUR RYAN WHITE PLANNING
COUNCIL AND OUR HIV PREVENTION PLANNINGGROUP WE MERGED TOGETHER INTO ONE REGIONAL
PREVENTION AND CARE PLANNING BODY, SO THAT’S ALSO GIVEN US AN OPPORTUNITY TO LEVERAGE THIS
PLATFORM FOR AROUND ENDING THE EPIDEMIC. SO WE’VE ALREADY STARTED HAVING CONVERSATIONS,
WE MET ACTUALLY JUST LAST WEEK, ONE OF THOSE THINGS IS WE MEET FACE TO FACE, OUR AIM IS
TO DO IT QUARTERLY, AND WE BRING OUR TEAMS TOGETHER AND IT’S A WAY TO BRAINSTORM IDEAS
AND WE STARTED OFF OUR LAST MEETING TALKING ABOUT ENDING THE EPIDEMIC AND ALL OF THE CONVERSATION
TOPICS THAT WE DID THAT DAY FROM EVERYTHING FROM DATA TO PROGRAMMING, PREVENTION AND CARE,
LINKAGE TO CARE, GETTING PEOPLE, SUSTAIN PEOPLE, HARM REDUCTION, EVEN HEPATITIS AND STD’S HAS
BEEN, WAS ABOUT IN THE FRAMEWORK OF ENDING THE EPIDEMIC.
SO IT CERTAINLY HAS LIFTED UP SOME OF THE CONVERSATIONS THAT WE’VE HAD, AND WE’VE BEEN
DOING AS A 1906 GRANTEE, WE’VE BEEN DOING A BUNCH OF COMMUNITY ENGAGEMENT, AND THAT’S
ALSO HELPED FACILITATE A NEW WAY OF CONVERSATIONS IN OUR COMMUNITIES THAT I THINK HAS BEEN VERY
INSIGHTFUL.>>SO AS A JURISDICTION THAT DIDN’T GET ENDING
THE EPIDEMIC MONEY, I THINK ONE OF THE IDEAS I REALLY WANTED TO SHARE TODAY IS YOU’RE NOT
GOING ON END THIS EPIDEMIC ONE JURISDICTION AT A TIME.
YOU’RE JUST NOT GOING ON, SO NATURALLY WHEREVER LEADERSHIP CAN REINFORCE EVEN IF WE DON’T
GET THE MONEY THAT IT IS COLLABORATION THAT’S GOING ON HELP, VERY, VERY HELPFUL.
WE ARE IN AN EXCELLENT SPOT COLLABORATIONWISE NOW, I’VE BEEN DOING THIS LONG ENOUGH TO SAY
THAT HASN’T ALWAYS BEEN THE CASE AND THAT WHEN THE FEDERAL BARRIER TO COLLABORATING
IS LOWER, IT HELPS US, YOU KNOW, SO SOMETIMES WE GET A LOT OF QUESTIONS ABOUT WHAT WE’RE
DOING AND WHETHER WE’RE FOLLOWING ALL THE JURISDICTIONAL RULES, AND I WOULD SAY FLEXIBILITY
IS REALLY HELPFUL IN ENDING THE EPIDEMIC.>>I WOULD SAY THAT THE FUNDING ACTUALLY HAS
GIVEN US A VOICE. I FEEL LIKE IN THE COUNTY OUR VOICES HAVEN’T
ALWAYS BEEN HEARD BEFORE THIS. IT GIVES US AN OPPORTUNITY TO USE THE PHRASE
FOREST BIASED, THAT WE CAN LOOK AT PRINCE GEORGE COUNTY NOW AND WE CAN LOOK AT WHAT
WE DO, HOW WE DO IT AND WHAT OUR ISSUES ARE AND GAPS ARE AND THEN BE ABLE TO SHARE THAT
WITH THE REST OF THE FOLKS. I THINK IN THE PAST THAT’S BEEN HARD FOR US
TO DO. RIGHT NOW I THINK WE’RE IN A GOOD SITUATION
WHERE WE’RE BEING INVITED TO MEETINGS THAT WE DIDN’T EVEN KNOW WERE THERE OR GOING TO
BE HELD THERE, SO THE SECRET IS AT. AND SO IT HAS MADE US AN ENTITY, I THINK A
REAL ENTITY OF ACKNOWLEDGING THAT THIS DISEASE IS BEYOND A STATE OR THE DISTRICT OR EVEN
VIRGINIA LEVEL, BUT IT’S REALLY AT THE JURISDICTIONAL LEVEL, SO HAVING THOSE CONVERSATIONS I THINK
HAS BROUGHT TO THE TABLE A BROADER DISCUSSION ABOUT WHAT THE EPIDEMIC REALLY LOOKS LIKE
IN THE TRISTATE AREA. SO TO THAT EXTENT, IT’S BEEN VERY HELPFUL.
>>FOR US IN MONTGOMERY COUNTY, IT’S BEEN GREAT BECAUSE IT’S FORCED A CRGS THAT HADN’T
— CONVERSATION THAT HADN’T BEEN PREVIOUSLY ONGOING.
IN LARGE PART WE TAKE OWNERSHIP OF THE FACT WHEN I SAY WE HAVEN’T PARTICIPATED IN DISCUSSIONS,
A LARGE OF THAT IS DRIVEN BY THE FACT THAT MANY FOLKS IN THE JURISDICTION DON’T UNDERSTAND
OR DIDN’T COMPREHEND THAT HIV WAS AN ISSUE OR IS AN ISSUE THAT IMPACTS OUR COMMUNITY.
TO BE VERY FRANK, WHEN WE FOUND OUT WE WERE ONE OF THE ENDING THE EPIDEMIC JURISDICTIONS,
I HAD SOME CONVERSATIONS WITH SOME OF THE POLICYMAKERS IN THE COUNTY AND OTHER STAKEHOLDERS
AND SOMEONE ASKED ME, THEY SAID ARE YOU SURE THIS INCIDENCE IS RIGHT, IS THIS REALLY, IS
THIS COUNTING PEOPLE FROM OTHER JURS JURISDICTIONS FOR COMING HERE AND TESTING POSITIVE AND THEN
GOING BACK TO THEIR OTHER PLACES? AND I’M LIKE NO, THESE ARE PEOPLE WHO LIVE
WITHIN OUR JURISDICTION. SO IT’S FORCED US TO ENGAGE IN A CONVERSATION
IN A MEANINGFUL WAY, IT HAS BEEN CONSISTENT WITH OUR EFFORTS AGAIN TO IMPORT DATA AND
USE THAT STRATEGIC TOLL DRIVE OUR PUBLIC HEALTH INTERVENTIONS, AND IT’S ALSO ALLOWED US THE
OPPORTUNITY TO PARTNER IN MORE DEPTH WITH THE ACADEMIC PARTNERS WITH OUR PEER JURISDICTIONS,
AND AGAIN GOING BACK TO THINKING ABOUT HIV THE SAME WAY WE THINK ABOUT OTHER ILLNESSES
AND PUBLIC HEALTH CONDITIONS FROM THE LENS AND PERSPECTIVE OF SOCIAL DETERMINANTS OF
HEALTH. IT HAS BEEN GREAT TO BE ABLE TO HAVE A TANGIBLE
EXAMPLE WHEN TALKING ABOUT WE UTILIZE A HEALTH IN ALL POLICIES APPROACH TO ALL OF THE PUBLIC
HEALTH ISSUES THAT WE LOOK AT, AND IT’S BEEN GREAT TO BE ABLE TO — NOT GREAT, BUT IT’S
A GOOD EXAMPLE TO BE ABLE TO SHOW STAKEHOLDERS HERE IS AN EXAMPLE OF HOW A CONDITION IS INFLUENCED
BY HOUSING, TRANSPORTATION, ACCESS TO CARE AND WHY IT’S IMPORTANT TO HAVE THOSE FOLKS
AT THE TABLE WHEN TALKING ABOUT DESIGNING AND IMPLEMENTING INTERVENTIONS.
>>SO I THINK FOR THE MARYLAND DEPARTMENT OF HEALTH THERE’S REALLY TWO THINGS.
SOMEONE WE TRY TO TALK ABOUT ENDING THIS ENDEMIC AS MUCH AS POSSIBLE, REALLY TALKING ABOUT
ALL OF WHAT MY COLLEAGUES HAVE BEEN MENTIONING, YOU KNOW, THE MEETING WE HAD LAST WEEK WE
BOOK ENDED ENDING THE EPIDEMIC AT THE TOP AND THE BOTTOM, BUT A LOT OF THE TOPICS IN
BETWEEN WERE NOT HIV. SO WE TALKED ABOUT HOW DOES HEPATITIS FIT
IN, HOW DO STI’S FACILITY IN, HOW DOES OUR LINKAGE TO CARE MODEL ENGAGEMENT FIT IN, HOW
DOES OUR DATA SHARING FIT IN, SO THAT WAS REALLY IMPORTANT.
AND THEN THE OTHER THING FOWRMS AT MDH IS WE’RE REALLY EMBRACING THE WE’RE NOT A DANGEROUS
JURISDICTION AS A STATE, THIS IS A LOCAL ISSUE. GIVE OUR LOCAL JURISDICTIONS EVERYTHING THEY
NEED AND ASK FOR AND THEN GET OUT OF THEIR WAY.
IT HAS TO BE DONE AT THE LOCAL LEVEL. SO I THINK THAT’S BEEN REALLY POWERFUL FOR
US.>>THE NEXT QUESTION IS ARE THERE OTHER THINGS
THAT CAN BE DONE TO ACCELERATE THE RESPONSE INTERVENE, A COMMENT BEEN MADE ABOUT THE STANDARD
OF CARE, BECAUSE THERE’S SOMETHING THAT HAPPENED LAST YEAR AND I CAN’T REALLY GET IT OUT OF
MY MIND WITHOUT TELLING THIS STORY, BUT I HAPPENED TO BE TALKING TO A PROVIDER IN THE
DC AREA AND THERE WERE TWO PROVIDERS, WHICH ONE — RECENTLY A NEW STATION, AND IN BOTH
CASES THOSE PEOPLE — [MIC MUFFLED] IN MARYLAND OR VIRGINIA AND THEY WEREN’T TREATED
FOR ANYTHING — [MICROPHONE DISTORTION]
SO IN TERMS OF THE STANDARD OF CARE, THOUGH, COULD YOU TALK ABOUT HOW THAT STANDARD OF
CARE IS BEING EN FORMED OR EN — ENFORCED OR ENCOURAGED ACROSS THE HEALTHCARE SYSTEM
INCLUDING ER’S AND ANY OTHER THOUGHTS YOU HAVE ON OTHER BARRIERS?
>>– TO WANT START FIRST?>>NOT REALLY.
[LAUGHTER]>>THAT’S A TOUGH ONE.
SO I ALWAYS ADD D SECTION DRUGS. SO THERE’S AIRPLANE LOT THAT YOU JUST ASKED
ME TO UNPACK IN THAT. YOU KNOW, WE’RE TALKING ABOUT WHY AREN’T WE
DOING REGULAR SCREENING IN ER’S, WHY AREN’T WE DOING BETTER OUTTREECH OUR PROVIDERS AND
WHY AREN’T WE TRAINING ALL OF OUR HEALTH PROFESSIONALS TO BE ABLE TO RESPOND?
SO I’M GOING TO LOOK TO MY COLLEAGUES TO WEIGH IN ON THAT.
>>WELL, I’M HAPPY TO WEIGH IN. SO WE ARE LOOKING AT WAYS TO MAKE NEW STANDARDS
OF CARE AND PART OF OUR LEARNING COLLABORATIVE, AND I REALLY DO THINK THAT THAT’S PART OF
THE WAY THE APPROACH WE HAVE IS IT IS A LEARNING COLLABORATIVE, SO FOR INSTANCE, IN DC WE’VE
BEEN PILOTING RAPID ART AT TWO OF OUR LOCATIONS, ONE OF THEM BEING THE HEALTH DEPARTMENT, WE’VE
SHARED THE PROTOCOL WITH VIRGINIA SO WE’RE LOOKING AT HOW WE CAN CREATE THAT AS — ESTABLISH
THAT AS A STANDARD OF CARE. THE DC CFAR, OF WHICH THE HEALTH DEPARTMENT
IS A MEMBER, HAS GOT THREE OF THE SUPPLEMENTS FOR THE DC AREA AND ONE OF THOSE WAS ON RAPID
ART, ANOTHER WAS ON PREP SCALEUP AND THE THIRD WAS A BETTER UNDERSTANDING OF THE TYPE OF
RESPONSE, THE CLUSTER PIECE AROUND THE INTERSECTION OF SURVEILLANCE AND COMMUNITY.
BUT THE RAPID ART WE HAVE A GROUP OF PROVIDERS FOR THE METROPOLITAN AREA AND WE’RE LOOKING
TO HAVE OUR COMMISSION SORT OF ESTABLISH THAT AND THEY PUT IT IN THE REGIONAL ARS PROGRAM
DEFINITION, SO THESE ARE WAYS THAT WE’RE TRYING TO AFFIRM ACROSS THE METROPOLITAN AREAS.
YOU GAVE AN EXAMPLE OF TOO MANY CAME TO OUR HEALTH AND WELLNESS CENTER, FORMERLY NAMED
THE STD CLINIC, AND THEY PRESENTED WITH AN STD, THEY HAVE BEEN TO A PROGRAM IN MARYLAND
AND THEY HAD SYMPTOMS, SO THE MARYLAND PROGRAM SAID, WELL, GO TO DC TO GET TREATED.
WE GAVE THEM AN HIV TEST, BOTH WERE HIV POSITIVE AND WERE UNAWARE OF THEIR STATUS, WE STARTED
THEM ON ART THAT DAY, IT TURNS OUT THEY LIVE IN VIRGINIA.
SO THEY HAD GONE ACROSS THE METROPOLITAN AREA AND ENDED UP IN THREE DIFFERENT SPOTS, SINCE
WITHIN THREE WEEKS BOTH OF THE — BOTH WERE LATINO AS WELL, BOTH WERE VIRALLY SUPPRESSED,
UNDETECTABLE. AND ONE OF THE INDIVIDUALS WE RECONNECTED
TO ONE OF THE NORTHERN VIRGINIA HEALTHCARE PROVIDERS AND THEY’RE BOTH DOING — ONE MOVED
OUT OF THE REGION, BUT THEY’RE BOTH DOING WELL, THEY’RE BOTH ENGAGED IN CARE.
SO I THINK THESE KINDS OF PERCEPTIONS OF THESE BOUNDARIES, THAT IS ONE OF THESE OBSTACLES
THAT WE HAVE IS THAT IF I’M NOT FAMILIAR WITH A PROVIDER OR AN AFIN AFFINITY WITH A PROVIDER,
HOW TO BREAK DOWN SOME OF THOSE BOUNDARIES, AND THIS WAS AN EXAMPLE OF ONE WHERE IT WORKED
AND OTHERS, THERE’S OTHER EXAMPLES OF IT WORKING AS WELL.
BUT YOUR EXAMPLE WAS A TOUGH ONE, AND THERE’S STILL AN ARC THAT WE HAVE TO GET TO PROVIDERS,
I THINK IN SOME CASES PARTICULARLY THOSE WHO ARE NOT UP TO DATE WITH WHAT HIV IS TODAY
IS ONE OF THOSE CHALLENGES.>>SO I THINK ALSO THAT WHERE WE DO WELL IS
A LOT DIFFERENT BECAUSE WE TALKED TO — WHERE WE DON’T DO WELL IS WITH THE PROVIDERS.
WE HAVE OVER 90 PERCENT VIRAL SUPPRESSION RATE.
WHEN WE LOOK AT THE COUNTY, IT’S ABOUT 58 PERCENT.
SO THE WORK THAT WE HAVE TO DO IS TO MAKE SURE THAT THE QUALITY OF CARE AND THE COMPREHENSIVENESS
OF CARE MATCHES WHAT WE SEE IN RYAN WHITE AND THAT REALLY IS WHAT WE HAVE TO DO BECAUSE
THAT’S NOT WHAT WE’RE SEEING OUT IN THE COMMUNITY, SO THAT’S THE WORK THAT WE HAVE TO DO.
>>I WANT TO ADD THAT I THINK THAT THE RYAN WHITE SPRAM A REALLY HELPFUL STRUCTURE BECAUSE
IT TAKES INTO ACCOUNT A METROPOLITAN AREA. WE STRUGGLE MUCH MORE FOR OUR STD PROGRAM
FUNDING AND FROM THE ASPECT OF HIV SURVEILLANCE BECAUSE IT IS STATE BASED AND IT’S NOT A ROBUST
FUNDING SOURCE, SO OUR LOCAL STD CLINICS ARE NOT FUNDED BY ANY FEDERAL FUNDING STREAM,
WE HAVE TO FIGURE OUT HOW TO FUND THOSE FROM OTHER SOURCES, SO I THINK AT THE FEDERAL LEVEL
THINKING ABOUT WHERE CAN FUNDING BE FLEXIBLE ENOUGH TO SERVE ACROSS JURISDICTIONS REALLY
HELPS US, OTHERWISE WE’RE JUST FIGURING OUT, WHICH WE’RE TRYING TO DO, BUT I DO THINK SOME
OF THAT BOUNDARY, THE BORDERS WOULD BE REALLY HELPFUL FOR SOME OF THE OTHER PUBLIC HEALTH
FUNDING STREAMS.>>I WILL ADD AND I WILL PREFACE THIS BY SAYING
MY BIAS IS, I MEAN, I’M AN ADOLESCENT MEDICINE DOC BY TRAINING SO WHEN SOMEONE ASKED THE
QUESTION IN THE PREVIOUS PANEL HOW DO WE TALK TO ADOLESCENTS, I THINK IT’S A GOOD EXAMPLE
OF ONE OTHER COMPONENT OF THIS IS PATIENT EMPOWERMENT AND MAKING SURE THAT THE MODELS
WE HAVE IN PLACE EMPOWER PATIENTS TO UNDERSTAND WHAT RESOURCES THAT ARE AT THEIR DISPOSAL
AND TO EMPOWER THEM TO BE ABLE TO ASK THE QUESTIONS AND NOT JUST RELY ON THE PROVIDERS
TO LEAD THAT CONVERSATION BECAUSE AGAIN I THINK WHEN WE LOOK AT EMPOWERMENT MODELS,
WE KNOW IT HELPS AFFIRM PATIENTS, CLIENTS TO BE ABLE TO MAKE AFFIRMING DECISIONS FOR
THEMSELVES AND HAVE A BETTER UNDERSTANDING OF HOW TO NAVIGATE THE RESOURCES, AND AS IT
PARTICULARLY RELATES TO ADD LESS ENTS, I THINK THAT AND THIS MAY NOT BE POPULAR ACCIDENT
BUT I THINK THAT COMING FROM PRACTICE IS BEING ABLE TO TALK ABOUT SEX IN A HEALTHIER MANNER
AND NOT TALK ABOUT SEX SOLELY, MICHAEL REFERENCE END THE STD CLINIC, WE RENAME THE BUILDING
BECAUSE STD INFERRED SOME TYPE OF STIGMA ASSOCIATED WITH SEXUAL HEALTH.
SO I THINK IF WE HAD MODELS THAT TALK ABOUT SEX IN A HEALTHIER MANNER, THAT, AGAIN, EMPOWER
YOUNG PEOPLE TO UNDERSTAND THEIR RISK PROFILE WHEN THEY ENGAGE IN DIFFERENT ACTIVITIES,
THAT WILL LIKELY LEAD TO BETTER OUTCOMES AND ALTHOUGH A — AND ARE AT A MINIMUM ELM POWSH
THEM TO UNDERSTAND WHAT THE RISKS ARE AND WHAT RESOURCES ARE AVAILABLE FOR THEM TO TAKE
ADVANTAGE OF.>>WE HAVE ABOUT 14 MINUTES LEFT AND OUR FEDERAL
PARTNERS, DO THEY HAVE ANY QUESTIONS FOR THE PANEL, SO QUESTIONS FROM OUR FEDERAL PARTNERS
OR PACHA.>>(AWAY FROM MICROPHONE).
>>IN KEEPING WITH MY SHY PERSONALITY, I’LL GO FIRST.
>>THANK YOU VERY MUCH. ASSUMING YOU GET TO DATA COLLECTION 303 WHERE
YOU’RE LET’S SAY SEVEN OR EIGHT ON THE SCALE OF TEN HAPPY WITH THE DATA, I WOULD ASSUME
THAT YOU WOULD START SEEING HOT SPOTS POP UP, AND MY IMAGE OF THIS OUTWARDLY IS THAT
YOU CAN TARGET CERTAIN AREAS TO INTENSIVELY INCREASE ADVERTISING OR DO MORE OUTREACH,
BUT AS I THINK ABOUT THAT IN THE CONTEXT OF EVERYTHING YOU JUST SAID ABOUT THE CORRIDOR,
YOU MIGHT SEE A HOTSPOT HERE, BUT THE PEOPLE IN THE HOTSPOT MAYBE HAVE HAD EXPOSURE ANYWHERE
RANGING FROM RICHMOND, VIRGINIA, TO NORTH OF BALTIMORE.
SO HOW DO YOU MANAGE THIS OR DO YOU JUST IGNORE THAT FOR A MOMENT AND SAY THIS IS A HOTSPOT,
WE’RE GOING TO GO HERE AND AT LEAST TARGET IN SOME KIND OF WAY?
>>I THINK YOU DO BOTH BECAUSE WE WANT TO LOOK AT OUR CLUSTERS AND WE WANT TO IMMEDIATELY
RESPOND IT THE CLUSTERS AND WE ALSO WANT TO TARGET THE COMMUNITY TO INFORM THEIR COMMUNITY.
I THINK ONE OF THE THINGS WE WERE TALKING ABOUT AT THE LAST MEETING WAS DOING A SOCIAL
MEDIA CAMPAIGN OR DOING SOCIAL NETWORKING WITH ONE ANOTHER SO THAT AGAIN THOSE BORDERS
THAT DON’T EXIST, EVERYBODY WOULD KNOW. BUT IMMEDIATE HE WILL THE RESPONSES WOULD
BE TO THAT CLUSTER OF FOLKS THAT WAS IDENTIFIED AND IN THE COMMUNITY AND THOSE COMMUNITIES
AROUND.>>I WOULD ADD ONTO THAT, I WOULD SAY WHAT
YOU’RE TALKING ABOUT IS PART OF THE CHALLENGE WITH THE WAY THE DATA WORKS, YOU TALK ABOUT
A POWERFUL TOOL LIKE HIV CLUSTER DETECTION AND IF YOU DO IT WITH A NATIONAL IT’S WAY
TOO SLOW, YOU’RE TELLING ME WHAT HAPPENED A YEAR OR YEAR AND A HALF AGO SO I THINK APARTMENT
OF IT IS THE CONVERSATION TO SAY HOW CAN WE DO IT AT THE JURISDICTIONAL LEVEL CLOSER TO
REALTIME BECAUSE THE TYPICAL WAY IS JUST TOO SLOW TO HELP YOU KNOW WHAT’S HAPPENING RIGHT
NOW.>>IS IT MICHAEL OR KOSHER OR WHATEVER WORD
YOU WANT TO USE TO DO SOME DEGREE OF CONTACT TRACING IF YOU GET A NEW CASE OR CAN YOU GO
THROUGH THAT PERSON’S CLINIC AND BEGIN TO EXPLORE JUST LIKE WE DO WITH SYPHILIS TESTING?
>>YES, AND IN FACT, WE’RE DOING SOME OF THAT NOW.
OUR TEAMS TALK ON A REGULAR BASIS. FOR INSTANCE, ALSO MAISH MAYOR — ALSO MARYLAND
AND DC BALLS THIS IS A LOT OF CROSSOVER AROUND SYPHILIS IN PARTICULAR AND CHLAMYDIA AND GONORRHEA,
MARYLAND HAS NOW EMBEDDED THE INVESTIGATOR IN THE DC HEALTH DEPARTMENT, SO WE’RE TRYING
TO AGAIN REMOVE THOSE, SEALING OFF OF THAT KIND OF ACCESS OF THINGS.
TO YOUR POINT, AND AGAIN AS DIANA ALSO SAID, THE WAY OUR SYSTEMS WORK ARE ALSO MAYBE NOT
— THE SURVEILLANCE DATA WE GET BY RESIDENT SAYS THAT MAY NOT NECESSARILY BE WHERE PEOPLE
ARE ACTUALLY SOCIALIZING AND WHERE THAT EFFORT MIGHT BE BETTER ADDRESSED.
AND SO I THINK PART OF WHAT WE’RE LEARNING THROUGH THIS PROCESS IS TO AND CERTAINLY FROM
THE KIND OF COMMUNITY ENGAGEMENT AND INPUT WE’RE GETTING IS WHERE AND HOW TO MAKE THIS
AS LOW BARRIER ACCESS AS POSSIBLE ACROSS THE REGION.
WE TALKED ABOUT DOING A REGION — WE’RE GOING TO WORK ON A REGIONAL SORT OF HOME STD TESTING,
SO WE ALL HAVE DIFFERENT JURISDICTIONAL PROCUREMENT AND THOSE KINDS OF ISSUES, BUT WE’RE GOING
TO PROBLEM SOLVE IT TOGETHER AND FIGURE OUT, OKAY, HERE IS ANOTHER ACCESS ISSUE, WHICH
IS FOR PEOPLE TO GET WHEREVER THEY LIVE IN THE AREA TO GET THAT OPPORTUNITY, GET THAT
TESTING RESOURCE.>>WE’VE HONED THAT A LITTLE BIT WITH VIRGINIA
AND MARYLAND FOR HIV TESTING, AND I’M ALWAYS SURPRISED TO SEE THAT 40 PERCENT OF THOSE
TESTS ARE COMING FROM THE BALTIMORE REGION, WHICH SPEAKS TO THAT FLUIDITY.
WHERE I’M AT JUST AROUND CLUSTER INVESTIGATION IS WE HAVEN’T QUITE MADE THE NEXT STEP, WHICH
IS HOW DO WE IMPACT THE SYSTEMS THAT WE AREN’T PAYING FOR?
AND I THINK THAT’S A BIG ISSUE IS WORKING WITH PROVIDERS WHO MIGHT BE IDENTIFYING NEW
POSITIVES, WHO MIGHT BE TREATING PEOPLE WHO ARE FLOWING IN AND OUT OF CARE, WHO AREN’T
ACHIEVING THE BEST OUTCOMES AND HOW DO WE WORK WITH THOSE SYSTEMS, AND I THINK THAT’S
THE NEXT STEP FOR US IS REALLY TRYING TO FIGURE OUT WHAT IS THIS CLUSTER TELLING US ABOUT
THE SYSTEM OF CARE OUTSIDE OF RYAN WHITE SAMHSA CDC HUD, HHS.
>>AND ACTUALLY PART OF — WE’RE STILL AWAIFTING NEWS FROM HRSA, BUT PART OF OUR — WHICH WAS
GREAT ABOUT THE HRSA NO FO WAS TO SAY THE ONLY QUALIFICATION IS YOU’VE GOT HIV.
SO TO THINK BEYOND THE PROGRAM BOUNDARIES THAT WE’VE BEEN LIVING UNDER IN SOME CASES
AND ALL THREE OF US WHEN WE THOUGHT ABOUT PRINCE GEORGE AND MONTGOMERY AND DC, WE’RE
THINKING WE NEED TO ENGAGE A SYSTEM OF CARE THAT WE DON’T HAVE A LOT OF CONTACT WITH.
WE NEED TO TALK TO PRIVATE PROVIDERS, WE NEED TO BUILD MORE CAPACITY IN SOME OF THOSE PRIVATE
PROVIDERS TO ADDRESS THE ISSUES BECAUSE THE DATA SHOWS PERSONS WHO ARE BEING SEEN BY PRIVATE
PROVIDERS HAVE LOWER RATES OF VIRAL SUPPRESSION. I MEAN, WE KNOW THAT BECAUSE WE KNOW WHO THE
PROVIDERS ARE. SO THAT WAY — AND A LOT OF THOSE PROVIDERS
TELL US, WELL, I DON’T HAVE THE CAPACITY TO GO OUT AND TALK TO THAT PERSON.
THEY COME INTO MY OFFICE, I TELL THEM YOU SHOULD BE TABLE YOUR MEDICATION.
— TAKING YOUR MEDICATION. AND THE PERSON IS LIKE YEAH, AND THEN THEY
WALK OUT. BUT IF THERE WAS A WAY, WHICH IS WHAT WE’VE
ALL PROCEED POSTED ACTUALLY, TO BE ABLE TO HAVE, WELL, HELLO, HERE IS BILL, JOHN, MARY
TO TALK WITH YOU, WE COULD SORT OF CLOSE SOME OF THAT GAP OF PEOPLE WHO AREN’T ACCESSING
THOSE OTHER TYPES OF SERVICES.>>IT WOULD ALSO ALLOW US TO OUTPOST PEOPLE
OUT INTO THE COMMUNITY AND INTO THOSE PROVIDERS, WHICH WOULD ALSO HELP TO BALANCE THE WORKFORCE,
CREATING PURE RELATIONSHIPS AND SUPPORT RELATIONSHIPS — PEER RELATIONSHIPS AND SUPPORT RELATIONSHIPS
OUT IN THE COMMUNITY THAT WOULD GIVE SUPPORT TO INDIVIDUALS WHO NEED TO COME BACK INTO
CARE, WHO LOTION THE CARE — LOST THE CARE, SO A LOT OF DIFFERENT WAYS OF LOOKING AT HOW
THEY CAN INCLUDE THE COMMUNITY AND AT THE SAME TIME WORKFORCE IN THE COMMUNITY AS WELL.
>>A LITTLE BIT OF A — WE HAVE BOB, JUSTIN — (AWAY FROM MICROPHONE).
>>OKAY. WE APPRECIATE LEARNING ABOUT THE COLLABORATION
BETWEEN MULTIPLE CITY, COWRN TI, STATE, FEDERAL GOVERNMENT, INCLUDING VETERANS ADMINISTRATION
WHICH IS A SEPARATE ENTITY AND AN IMPORTANT ONE, I SUSPECT.
WHAT YOU PERCEIVE ARPTZ THE DATA COLLECTION BARRIERS, CAN YOU EXCHANGE RECORDS, CAN A
PRIVATE PHYSICIAN SEND YOU BE THE RECORDS? CAN YOU DO CONTACT TRACING AS YOU RECALLED
FOR SYPHILIS BETWEEN STATES, COWN TIPS AND THE FEDS?
AND FOR MARRIAGE LICENSE FOR EXAMPLE, DO YOU DO A TEST AS YOU WOULD FOR SYPHILIS?
MULTIPLE QUESTIONS.>>I’M JUST GOING TO ASK THAT WE HAVE JUST
ONE PERSON FROM THE PANEL ANSWER QUESTIONS SO WE CAN HAVE MORE QUESTIONS LINED UP.
SO I’LL LET YOU ALL DECIDE WHO IS MOST PASSIONATE.>>JUST A QUICK TRY, I THINK.
SO A LOT OF WHAT WE’VE HAD TO WORK OUT IS THE LEGALITY OF HOW YOU DO THIS, SO AS FAR
AS DISEASE INVESTIGATION WE FOLLOW, AS I SAID, WE’RE A HYBRID SYSTEM, WE FOLLOW THE STANDARD
PROCESS OF EXCHANGING INFORMATION AT THE STATE LEVEL AND THEN ISSUING THE INVESTIGATION FROM
THE STATE LEVEL EXCEPT FOR THE NEW EMBEDDED MODEL.
TESTING VARIES BY JURISDICTION BECAUSE IT’S GOVERNED BY STATE LAW, MARRIAGE TESTING IS
COVERED BY JURISDICTION, STATE LAWS, AND I WOULD SAY THAT A LOT OF THE WORK WE’VE DONE
IS HOW DO YOU SET UP A DATA SHARING AGREEMENT THAT YOU CAN GET THREE JURISDICTIONS, THAT’S
BEEN A HUGE AMOUNT OF THE WORK HERE, I THINK WHEN WE’VE COME UP WITH SOMETHING THAT WORKS
WE LOVE TO SHARE IT, SO THE OTHER STATES CAN START FROM WHERE QUESTION ENDED — FROM WHERE
WE ENDED RATHER THAN FROM THE BEGINNING AGAIN.>>I WOULD LIKE TO JUMP IN AND SAY — (AWAY
FROM MICROPHONE).>>WE ACTUALLY WORK VERY WELL WITH OUR VA
MEDICAL CENTER. SO WE DO GET THEIR DATA.
>>I SEE.>>THANK YOU FOR THAT WONDERFUL CONVERSATION.
SO THIS IS JUST A POINT IN THE CONVERSATION, I WOULD LOVE TO SEE ANY LANGUAGE THAT YOU
HAVE THAT SOPT OF SUPPORTS THE COLLABORATION AS I’M THINKING ABOUT AS WE COULD DO IN GEORGIA,
SO I MIGHT PICK YOUR BRAIN LATER, BUT THAT’S NOT MY QUESTION.
MY QUESTION IS JUST AROUND, SO MUCH OF THIS PROCESS IS DRIVEN THROUGH OR SHOULD BE DRIVEN
THROUGH COMMUNITY ENGAGEMENT, AND I WANTED TO KNOW IF YOU COULD LOOK UP ANY SUCCESSES
OR BEST PRACTICES AROUND HOW YOU CARRIED OUT YOUR ISSUES RELATED TO ENGAGEMENT PROCESS,
SPECIFICALLY WHAT WE’RE HEARING A LOT OF IT IS THAT A LOT OF THESE CONVERSATIONS ARE HAPPENING,
IT DOES END UP BEING A LOT OF US THAT WORK IN THE FIELD, AND I’M REALLY CURIOUS TO HEAR
ABOUT HOW FOLKS ARE THINKING ABOUT GETTING TO THAT NEXT LEVEL OF ACTUALLY ENGAGING THE
FOLKS THAT WE ARE HERE TO SERVE, RIGHT? SO CAN YOU LIFT UP ANY EXAMPLES OF HOW FAR
THAT’S WORKED OR HOW YOU’RE THINKING ABOUT DOING THAT MOVING FORWARD?
>>FOR PRINCE GEORGE’S COUNTY WHAT WE DID IS WE DON’T BELIEVE THAT THE HEALTH DEPARTMENT
CAN TALK TO EVERYBODY, SO WHAT WE DID IS WE AS THE RYAN WHITE ORGANIZATION TO WORK WITH
SPECIFIC POPULATIONS AND ZIP CODES THAT WE WANTED THEM TO TARGET AND TALK DIRECTLY TO
THOSE COMMUNITIES. SO WE HAD SPHOAKS WHO TALKED TO — WE HAD
FOLKS WHO TALKED TO YOUNG BLARKS WOMEN — BLACK, WOMEN TRANSGENDER PEOPLE, THERE WAS AN EXAMPLE
GIVEN WHERE PEOPLE GO OUT ON THE STREET AND TALK TO HOMELESS PEOPLE, WE DID THAT.
SO WE HAD AN ARRAY OF INDIVIDUALS WHO SPOKE TO THE FOLKS, INITIALLY CAME UP WITH QUESTIONS
WE WANTED ANSWERED, HOW MANY UTILIZE THE SERVICES, WE CAME WUP A LOT OF DIFFERENT THINGS, AND
WE ASKED THEM TO GO INTO THE COMMUNITIES AND THE 15 HIGHEST RATES OF INTRAVENOUS INFECTION,
AND WE ASKED THEM TO COME BACK WITH 50 PEOPLE IN EACH OF THEM.
THAT’S HOW WE GATHERED OUR DATA. SO I THINK OUR SECOND PIECE TO THAT IS TO
GO BACK AND THEN ASK THE QUESTIONS THAT WE DIDN’T ASK AND CONTINUE THAT PROCESS.
AND FROM THAT ALSO ORGANIZE AND JURISDICTIONALLY DEVISE A COMMITTEE ON HOW WE COULD TWEAK OUR
DRAFT PLAN TO A FINAL PLAN THAT WOULD INCORPORATE ALL OF THAT INFORMATION.
>>ONLY ONE PERSON IS SUPPOSED TO ANSWER, I KNOW, AND THAT WAS A GREAT ANSWER.
WE TOOK A DIFFERENT APPROACH TO THIS, WHICH WAS NOT TO WORK WITH OUR PROVIDER ORGANIZATIONS.
NOT THAT WE DON’T LOVE OUR PROVIDER COMMUNITIES, BUT IT TENDS TO BE THE SAME PEOPLE IN THE
ROOM. SO WE THOUGHT, WELL, LET’S TAP INTO SOCIAL
NETWORKS THAT ARE DIFFERENT THAN THAT AND ALSO DO THAT WITHOUT REGARD TO STATUS.
SO WHAT WE DID IS PARTLY WE STARTED WITH THE PEOPLE IN OUR OWN OFFICE WHO ARE ALSO ALONG
VERY DIFFERENT SOCIAL NETWORKS. YOU WANTED TO TALK TO AFRICAN AMERICAN WOMEN,
GO TALK TO AFER — HAVE AFRICAN AMERICAN WOMEN INVITE THEIR FRIENDS AND PEOPLE THAT THEY
KNOW, BRING SOMEBODY THAT THEY KNOW TO THE ROOM AND THEN CHECK TITLES AND EVERYTHING
AT THE DOOR. ALSO NOT TO DO IT AT ANY COMMUNITY BASED ORGANIZATION,
TO DO IT AT A NEUTRAL SPACE BECAUSE PEOPLE MAY FEEL HESITANT TO TALK ABOUT THE SERVICES
THEY GET AND THE PLACE WHERE THEY GET THAT SERVICE.
SO SO FAR, WE’VE BEEN VERY SUCCESSFUL WITH THIS APPROACH, WE’VE ALSO ADDED REFRESHMENTS,
KEEPER STRATEGY. BUT NO OTHER INCENTIVE THAN THAT.
BUT BASICALLY A SAFE PLACE FOR PEOPLE TO TALK AND AS WELL AS FINDING WHAT’S THE RIGHT TIME.
WE HAD A GROUP OF TRANSGENDER WOMEN, WE THOUGHT, WELL, LUNCH IS A GOOD TIME, ACTUALLY NO THAT’S
NOT A GOOD TIME. SO WE HAD FIVE PEOPLE THAT SHOWED UP.
THEN WE DID AN EVENING PROGRAM AND EVENING ACTIVITY, 20 PEOPLE SHOWED UP.
SO IT’S ALSO FINDING OUT WHERE THE COMMUNITY IS IN TERMS OF WHAT IS THAT — IS GOING TO
BE MOST EFFECTIVE IN HAVING THEM PARTICIPATE.>>(AWAY FROM MICROPHONE)
>>(AWAY FROM MICROPHONE).>>[DISTORTED MICROPHONE]
ON A DAILY BASIS. AROUND JURISDICTIONS.
AND SAN FRANCISCO OAKLAND IS AN EXAMPLE. TO START IDENTIFYING THE REGIONS THAT WE NEED
TO BE FOCUSED ON. SO CONGRATULATIONS.
IT’S REALLY REFRESHING TO ME.>>I HAVE A QUESTION, TONAL GOES TO ONE OF
YOU. WE’VE TALKED A LOT ABOUT STIGMA, WE’VE TALKED
APRIL LOT ABOUT AWARENESS, LIKE PREP OR U EQUALS YOU.
I HAVE A QUESTION, I’VE ACTUALLY TRIED THIS MYSELF, BUT DO ANY OF YOU HAVE A POSITIVE
EXPERIENCE WORKING IN SCHOOLS TO PROVIDE AWARENESS EDUCATION IN ISSUES AROUND STIGMA THAT YOU
COULD SHARE? I THINK THAT WOULD BE INTERESTING.
IS THIS SOMETHING YOU WOULD RECOMMEND WE PURSUE IN TERMS ENDING THE EPIDEMIC?
>>I WOULD START WITH COLLEGES AND UNIVERSITIES AND YOU MAY TALK MORE ABOUT SCHOOLS, BUT SUCCESS
IN URBAN –>>(AWAY FROM MICROPHONE).
>>OKAY. SO WE HAVE A LOT OF SUCCESS I THINK IN OUR
COMMUNITY COLLEGES, WE ALSO HAVE HISTORICAL BLACK COLLEGES, AND I THINK THE WAY IT WORKS
BEST IS YOU WORK WITH THEM TO INSTITUTIONALIZE THE SERVICE.
SO FOR EXAMPLE, THERE’S A PART ON YOU PROGRAM WHERE THEY ACTUALLY FOR THE FINAL PROGRAM,
FINAL TEST, THEY HAD TO CREATE A THEATER PIECE AROUND HIV/AIDS.
SO THE STUDENTS GOT ACTIVELY INVOLVED AS WELL AS SHOWING THE CAMPUS.
THE MORE I THINK WE LOOK AT PROGRAMS AND WE CAN ACTIVELY INVOLVE THE STUDENTS, WHETHER
IT’S ON A CAMPUS OR SOMEPLACE ELSE, IN A HIGH SCHOOL, THERE’S NO POINT IN COMING IN AND
GIVING THEM LECTURES AND TALKING ABOUT HOW YOU GET IT AND HOW YOU DON’T AND THOSE KINDS
OF THINGS — THERE’S A POINT, BUT THE MORE EXPERIENTIAL, THE BETTER OUTCOMES.
>>I’LL JUST ADD, I’LL USE DC AS AN EXAMPLE BECAUSE I USED TO WORK IN THE DC DEPARTMENT
OF HEALTH IS THE DC SCHOOL BASED SEXUAL HEALTH PROGRAM I THINK IS A PHENOMENAL EXAMPLE THAT
HAS ACCOMPLISHED WHAT YOU’RE TALKING ABOUT AROUND STI’S IN GENERAL BUT ALSO CRERSING
AWARENESS AROUND HIV RISK AND — CRERSING AWARENESS AROUND HIV RISK AND ACCESS TO PREP,
SO SHOUT OUT TO DC DEPARTMENT OF HEALTH, I THINK THAT WOULD BE A GOOD EXAMPLE TO LOOK
AT.>>I WANT TO THANK OUR PANELISTS, CELEBRATE
COLLABORATION THEY’VE DEMONSTRATED HERE. THANK YOU SO MUCH FOR JOINING US.
[APPLAUSE]

James Carver

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