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PACHA l February 2020 l Day 1, Pt 3: Perspectives from Health Providers

February 21, 2020


>>ALRIGHT THIS FINAL PANEL IS A PROVIDER
PANEL, AND HERE WE WANTED TO LOOK AT SOMETIMES PEOPLE THINK PROVIDER AND THEY THINK JUST
THE MD, THE PERSON WHO IS WRITING A SCRIPT, BUT WE WANTED TO TAKE A MORE REALISTIC LOOK
AT WHO IS PROVIDING CARE, SO WE HAVE A RANGE OF PEOPLE HERE.
SO I WOULD LIKE TO INVITE OUR PANEL TO JUST GIVE A BRIEF INTRODUCTION AND WE’LL DELVE
INTO THE QUESTIONS.>>MY NAME IS MICHAEL SERLIN, I’M A DOCTOR
OF INTERNAL MEDICINE AND INFECTIOUS DISEASES, I’VE BEEN TALKING — I’VE BEEN TAKING CARE
OF HIV PATIENTS SINCE 2003 AND I’M THE MEDICAL DIRECTOR OF FAMILY AND MEDICAL COUNSELING
IN WASHINGTON, D.C.>>GOOD AFTERNOON, MY NAME IS JAMES PERRY,
FAMILY AND MEDICAL COUNSELING CENTERS.>>GOOD AFTERNOON.
MY NAME IS DEMARC HICKSON, I’M THE EXECUTIVE DIRECTOR OF US HELPING US.
>>GOOD AFTERNOON, MY NAME IS TONI YOUNG AND I’M THE EXIFL DIRECTOR OF COMMUNITY HE HAD
— EXECUTIVE DIRECTOR OF COMMUNITY EDUCATION GROUP.
>>FIRST QUESTION, CAN YOU TELL US HOW LONG YOU’VE BEEN WORKING IN THE DMV IN HIV AND
CAN YOU DESCRIBE THE BIGGEST CHANGE YOU’VE SEEN IN THE EPIDEMIC THE PEOPLE YOU’VE SERVED
OVER THE PERIOD?>>CERTAINLY.
I CAME DOWN TO THE DC OR THE DMV IN 2014 SO I’VE BEEN WORKING HERE FOR ABOUT SIX YEARS.
INITIALLY FOR ALMOST THREE YEARS WAS THE MEDICAL DIRECTOR OF THE JUNIOR PROGRAM IN NOVA IN
NORTHERN VIRGINIA WHERE THEY HAD 1500 HIV PATIENTS AND AGAIN ALMOST THREE YEARS AGO
I MOVED OVER TO FAMILY MEDICAL COUNSELING IN DC.
I THINK ONE OF THE INTERESTING DIFFERENCES THAT I SAW IS THAT IN NORTHERN VIRGINIA WE
WERE THE MAIN SITE CERTAINLY AS FAR AS REFERRALS TO GO TO FOR HIV TREATMENT, AND ESSENTIALLY
PATIENTS WHO WERE DIAGNOSED IN THE HOSPITAL, ESSENTIALLY PATIENTS WHO MIGHT HAVE BEEN UNINSURED,
UNDOCUMENTED, SO WE IN NORTHERN VIRGINIA WE HAVE A LARGE POPULATION OF PATIENTS WHO COULD
NOT AFFORD INSURANCE, SO VIRGINIA ADAP COVERED THAT VERY WELL, AND IN TURN, AS FAR AS THE
HRSA FUNDING WE HAD FROM RYAN WHITE AND THINGS LIKE THAT, WE WERE ABLE TO COVER A — RECOVER
A LOT OF — COVER A LOT OF THAT SUPPORT. IN DC, WE DO STILL HAVE A LOT OF SUPPORT FROM
RYAN WHITE FUNDING ASK HRSA AND WE ARE ALSO A FEDERALLY QUALIFIED HEALTH CENTER BUT BECAUSE
WE NEUFD A FEE FOR SERVICE PROGRAM HE IS — MOVED TO A FEE FOR SERVICE PROGRAM HE IS FECIALLY
SPORE — ESPECIALLY FOR RYAN WHITE PART A FUNDING A FEW YEARS AGO FAMILY COUNSELING
IS ABOUT MAYBE 90 PERCENT INSURED AS FAR AS HIV PATIENTS ARE CONCERNED SO A LOT OF SUPPORT
WE WERE ABLE TO PROVIDE TO THEM BEFORE WE SWITCHED TO FEE FOR SERVICE SOME OF THAT WENT
AWAY BECAUSE OF THE DECREASE IN FUNDING FROM THE FEE FOR SERVICE BECAUSE WE HAVE MORE PATIENTS
WHO WERE INSURED THAN NOT.>>I’VE BEEN WORKING THERE FOR ABOUT 15 YEARS,
DC HAS SEEN — GETTING DIAGNOSED.>>SO I’VE BEEN IN DC SINCE JUNE OF 2017.
SO I DON’T HAVE THE ON THE GROUND HISTORICAL PERSPECTIVE OF THE EPIDEMIC IN TERMS OF IT
CHANGING BUT I WILL SAY IN LOOKING AT THE HISTORICAL CHANGE, ESPECIALLY IN THE BLACK
COMMUNITY, THE EPIDEMIC HAS NOT CHANGED. SO IN LOOKING AT THE HIS RIL OF — IN 1985
AND FOCUSED ON YOUNG BLACK MEN WHO ARE BECOMING INFECTED WITH HIV EARLY IN THE EPIDEMIC AND
IT STILL CONTINUES TO THIS DAY. I WOULD SAY THAT WITH A LOT OF THE REDEVELOPMENT,
I THINK THAT’S THE MORE POLITE WAY OF SEEING SAYING T WE’VE SEEN THE EPIDEMIC MIGRATING
INTO SUBURBAN COUNTIES AND INTO MARYLAND SO I WOULD MENTION THAT AND THEN ALSO FROM AN
ORGANIZATIONAL SPHIENTD, I THINK — STANDPOINT, I THINK THE EPIDEMIC HAS CHANGED TO MANY OF
THE COMMUNITY BASED ORGANIZATIONS HAVE HAD TO MOVE FROM A FINGER PRICK ORGANIZATION TO
BEING ABLE TO PROVIDE MORE OF THE WRAP AROUND SERVICES, LIKE WHICH IS HELPING THE EPIDEMIC
AND LOARPG THE NUMBER WE STILL SEE THAT AND THE DEMOGRAPHIC IS STILL THE SAME.
>>SO I’M SAD TO SAY THAT I’VE WORKED IN HIV FOR OVER 30 YEARS.
I GOT MY START ON WHAT WAS WITTMANN WALKER CLINIC’S HOTLINE AT THE TIME, IT WAS THEIR
SUICIDE HOTLINE AND THEIR STD HOTLINE AND I WAS THERE WHEN IT CHANGED INTO US GETTING
PHONE CALLS ABOUT THIS MYSTERY DISEASE, AND THAT BECAME A CONVERSATION ABOUT WHAT THIS
THING WAS, AND THAT WAS BEFORE IT HAD A NAME, BEFORE WE KNEW WHAT IT WAS.
WE WERE SEEING, HEARING ABOUT PEOPLE WHO WERE VERY ILL, VERY SICK AND GETTING SICK VERY
RAPIDLY. SO THAT’S WHERE MY START BEGAN.
MY NEXT BIG THING WAS WORKING ON THE FIRST NATIONAL INDIVIDUAL ON THE MALL, SO THAT’S
HOW LONG AGO IT BEGAN. P COMMUNITY EDUCATION GROUP STARTED DOING
WORK WE STARTED OUT APPEARS THE NATIONAL WOMEN IN HIV PROJECT, WE WORKED WITH THE NATIONAL
OFFICE OF WOMEN’S HEALTH IN DEVELOPING THEIRLESS HIV IN WOMEN AND GIRLS AWARENESS DAY CAMPAIGN
BUT WE’VE ALSO REALLY DONE OUR ON THE GROUNDWORK ORIGINALLY IN SOUTHEAST DC.
I’M HERE TO TALK TO YOU ABOUT WEST VIRGINIA AND I’LL EXPLAIN THE LEAP IN A SECOND, BUT
WE DID A TRAINING PROGRAM WHERE WE TOOK INDIVIDUALS WHO WERE LIVING WITH HIV, EAST OF THE RIVER,
HISTORY OF INCARCERATION, MAY OR MAY NOT HAVE HISTORY OF SUBSTANCE USE DISORDER AND TRAINED
THEM APPROXIMATE A NINETY DAY TRAINING PROGRAM CALLED OUR CHANCE PROGRAM.
THOSE FOLKS ARE NOW EMPLOYED AT US HELPING US, HAVE A COUPLE, ONE AT THE HEALTH DEPARTMENT,
WE HAVE SEVERAL AT WITTMANN WALKER, WE HAVE THEM AT FAMILY MEDICAL, SO THEY ARE NOW EMPLOYED
IN THIS FIELD AND I THINK THAT’S A KEY PIECE OF THIS WORK IS THAT WE HAVE TO FIGURE OUT
HOW TO GET PEOPLE THAIND THAT TRAINED THAT ARE COMMITTED TO ELIMINATING HIV AND ENDING
THIS EPIDEMIC AND ABOUT FOUR YEARS AGO I MADE A TRANSITION TO WEST VIRGINIA.
MOST PEOPLE DON’T KNOW THAT JEFFERSON AND BERKELEY COUNTIES ARE A PART OF THE DC RYAN
WHITE EMA, AND I WAS ACTUALLY THERE NOT THINKING I WAS ACTUALLY GOING TO GET OUT OF HIV, AND
CORRIE THAT DAN FROM HHS — CORINA DAN FROM HHS CALLED ME AND I WAS ON THE PHONE WITH
HER AND SHE SAID, WELL, WHAT ARE YOU DOING, AND I SAID WELL, I THINK I WANT TO DO A BROCHURE
ON HEPATITIS FOR WEST VIRGINIA AND SHE SAID WHAT?
AND SHE SAID HAVE YOU NOT SEEN A PAPER? AND THAT’S WHEN I GOT CDC’S REPORT ON THE
220 MOST VULNERABLE COUNTIES AND LEARNED THAT OF WEST VIRGINIA’S 55 COUNTIES, 28 OF THEM
HAD MADE CDC’S LEST. SO MY WORK WAS — LIST. SO MY WORK WAS GOING
TO BE A LITTLE MORE THAN A BROCHURE. NEXT THING SHE SENT ME WAS AN ARM FROM THE
WALL STREET JOURNAL THAT TALKED ABOUT THE DIRECT CORRELATION BETWEEN SUBSTANCE USE DISORDER
IN WEST VIRGINIA, HEP C AND HIV. MY NEXT CALL WAS TO HENRY MASEUR AT NIH TO
SAY WHAT’S THE PLAN AND HENRY WAS LIKE WHY DON’T YOU COME BACK TO DC WHERE WE REALLY
MIGHT HAVE A SHOT AT ELIMINATION AND I’M LIKE NO NO NO.
SO FOR THE LAST FOUR YEARS I’VE BEEN IN WEST VIRGINIA WORKING WITH THE STATE, WORKING WITH
LOCAL COUNTY OFFICIALS AND AS MANY OF YOU AROUND THIS TABLE KNOW LAST YEAR WE EXPERIENCED
AN OUTBREAK OF MORE THAN 80 CASES IN TWO COUNTIES IN WEST VIRGINIA, I BELIEVE THAT’S THE TIP
OF THE ICEBERG AND THERE IS WORK WE HAVE TO DO IN THE STATE AND THAT WE MUST DO AND I’LL
TALK MORE ABOUT THAT BECAUSE MARC IS LOOKING AT ME NOW.
[LAUGHTER]>>THE NEXT QUESTION, I WANT TO ASK ABOUT
THE NATIONAL EPIDEMIC EFFORT AND WHAT IT’S MEANT TO YOU CONNECT YOU TO THE WORK THAT
YOU’RE DOING.>>AS FAR AS ENDING THE EPIDEMIC IS CONCERNED,
ONE OF THE THINGS WITH HER SEE A LOT OF AT FAMILY MEDICAL AS WELL AS DC IS PREVENTION,
I THINK WE DO A A GOOD JOB OF DOING A LOT OF TESTING OUT IN THE COMMUNITY AND TRYING
TO DO A LOT OF OUTREACH TO BRING THOSE PATIENTS WHO MAY NOT UNDERSTAND THAT THEY’RE HIV POSITIVE
TO DIAGNOSE THEM AND LINK THEM TO CARE, PART OF THAT EFFORT ALSO INCLUDES OBVIOUSLY OPIOID
EPIDEMIC IN DC AS WELL AS A LOT OF OTHER PLACES AND WE HAVE A LOT OF OUTREACH EFFORTS INCLUDING
NEEDLE EXCHANGE PROGRAM WHERE WE GO OUT INTO THE COMMUNITY AND DO TESTING ENLT ON IN ADDITION
TO NEEDLE EXCHANGE BUT ALSO DO TESTING FORS HIV AND HEPATITIS C ON THOSE OUTREACH BANDS,
IN ADDITION TO BRING PATIENTS BACK TO DO BUPRENORPHINE THERAPY AND WE HAVE A LOT OF PATIENTS WHO
HAVE BEEN ABLE TO GET THEIR HIV UNDER CONTROL BECAUSE NOW THEY’RE TAKING BUPRENORPHINE AND
THINGS ARE A LITTLE BIT MORE STABLE FOR THEM BECAUSE THEY’RE NOT TRYING TO SCORE HEROIN
EVERY DAY OR THINGS LIKE THAT SO I THINK A COMBINATION OF ALL THOSE THINGS ARE THINGS
WE DO SEE CERTAINLY AT SMCS TO HELP BRIDGE THAT GAP IN BRINGING THOSE PATIENTS INTO CARE.
>>[MIC DISTORTION] FAMILY MEDICAL KIND OF LIKE IN THE STREET.
THEY CAN BECOME EVICTED AND BECOME HOMELESS, USING DRUGS, SO A LOT OF OUR SERVICES CAN
COMPLEMENT EACH OTHER. THE OTHER THING IS I CAN COME IT THE EXCHANGE,
IF SOMEBODY WANTS TO GO TO DETOX BECAUSE THEY WERE ON DRUGS, GET THEM BACK INTO CARE, SO
IT KIND OF WORKS TOGETHER. FAMILY MEDICAL IS DOING A WONDERFUL JOB.
>>AS FAR AS US HELPING US, IT HAS REVOLUTIONALIZED OUR THOUGHT IN THINKING ABOUT HOW DO WE ACTUALLY
END THE EPIDEMIC AND WHAT DOES THAT INVOLVE, AND ACTUALLY SITTING AND LISTENING TO OUR
CONSTITUENTS AND THE CLIENTS THAT WE SERVE AND ASKING THEM DIRECTLY WHAT ARE THE SERVICES
OR THINGS THAT YOU NEED AND HOW DOES THAT LOOK.
SO FOR EXAMPLE, WE TEST 2,000 PEOPLE THIS A YEAR, MAYBE AROUND 75 TO 100 NEW DIAGNOSES,
WHAT ABOUT THOSE OTHER 1900 THAT RECEIVED HIV NEGATIVE OR NONREACTIVE TEST, WHAT DOES
THEIR RISK LOOK LIKE, WHAT ARE THEIR NEEDS? SO WE KNOW THAT MANY OF THE DETERMINANTS THAT
INDIVIDUALS WHO ARE LIVING WITH HIV FACE, THESE ARE THE SAME DETERMINANTS THAT INDIVIDUALS
WHO ARE NOT LIVING WITH HIV FACE. SO HOW DO WE INTERCEPT THAT CONVERSION.
RIGHT? SO RIGHT BEFORE THE END THE EPIDEMIC PLAN
CAME OUT, WE WERE URGED BY SOME OF OUR COMMUNITY PARTNERS TO BEGIN TO PRESCRIBE PREP, RIGHT?
SO WE HAD, WHICH AS AN ORGANIZATION WHO STARTED TO END THE EPIDEMIC AMONG BLACK GAY MEN, WE
HAD A BLACK HETEROSEXUAL FEMALE WHO IN HER TESTING SESSION SAID OH, WELL, SINCE WE HAVE
PREP, WHERE CAN I GET PREP? AND MY COMMUNITY HEALTH WORKER WENT TO LINK
HER TO ANOTHER PROVIDER, SHE’S LIKE NO, I WANT IT FROM YOU ALL.
AND SO WE’RE LIKE, OH, MY GOODNESS, WHAT DOES THIS MEAN?
SO I HAD TO GO TO MY NURSE PRACTITIONER AND SAY HEY, WHAT DO WE NEED TO BE ABLE TO GET
THIS DONE? AND THAT WAS THE END THE EPIDEMIC PLAN AND
LOOKING AT US AND FORCING US TO THINK ABOUT HOW WE’RE GOING TO LOOK IN THE NEXT FEW YEARS,
SO THINKING ABOUT OUR STRATEGIC PLAN AND REALLY THINKING ABOUT THE THINGS THAT WE’RE GOING
TO DO. SO WHETHER THAT’S, AGAIN, TO PROVIDE WRAP-AROUND
SERVICES, HOW DOES THAT LOOK, ARE WE GOING — HOW OUR COMMUNITY IS GOING BECAUSE OF GENTRIFICATION
IN THE CITY OR DO WE WANT TO REMAIN WHERE WE ARE, AND IF WE TORQUES HOW DOES THAT LOOK?
HOW WE’RE FORTUNATE ENOUGH TO OWN OUR BUILDING, RIGHT, WHICH IS NOT THE CASE FOR MANY ORGANIZATIONS.
SO NOW HOW DOES THAT HELP US UNTIL LEVERAGING WHAT IT IS THAT WE WANT TO DO AS WE MOVE FORWARD?
DO WE WANT TO BE ABLE TO PROVIDE HOUSING? DO WE WANT TO EXPAND AND DO MORE IN OUR CLINICAL
SPACES? SO ONE OF THE OTHER THINGS WE’RE GOING TO
BE LAUNCHING SOON IS A COMPREHENSIVE HEALTH SCREENING, RIGHT?
SO WE’VE BEEN TALKING ABOUT NORMALIZING HIV, REDUCING STIGMA AROUND HIV.
SO GHEN WE LOOK AT THAT — AGAIN WE LOOK AT THAT MODEL AND WE THINK ABOUT ANNUAL EXAMS,
ONE TEST OR SCREENING THAT GENERALLY IS NOT INCLUDED, IT’S MAYBE SOMETHING SEPARATE FROM
INSURANCE, RIGHT? SO WITHIN THIS COMPREHENSIVE SCREENING WOULD
BE SCREENING FOR GLUCOSE AND TRIGLYCERIDES, KIDNEY FUNCTION AND LIVER FUNCTION, SO AGAIN
MANY OF THOSE CHRONIC DHANS THE BLACK COMMUNITIES THINKS OF SO REALLY HAVING THATS AA STANDARD
OF CARE, SO THAT’S HOW WERE THE END THE EPIDEMIC PLAN IS HELPING AWS.
>>SO SO AS MANY OF YOU AROUND THE TABLE KNOW, WEST VIRGINIA WAS LEFT OUT.
FIRST PHASE OF THE ENDING THE EPIDEMIC PLAN. EVERYONE OVER HERE IS LAUGHING BECAUSE I HAVEN’T
SHUT UP ABOUT IT, WHERE IS HAIRMD, I HAVEN’T SHUT UP ABOUT IT WITH HAROLD OR WITH MAUREEN
OR ANYONE THAT WOULD LISTEN TO ME SCREAM BEING ABOUT THIS OVER THE PAST YEAR AND A HALF.
BUT I THINK THAT MORE OF THE LETTER THAT I’VE SENT TO YOU OR GIVEN TO YOU ADDRESSED TO CARL
IS TO ASK YOU TO BRING PACHA TO WEST VIRGINIA, TO HOST ONE OF YOUR REGIONAL MEETINGS IN PREPARATION
FOR PHASE II IN WEST VIRGINIA, TO HEAR FROM THE LOCAL AND COUNTY HEALTH DEPARTMENT.
I THINK THAT OFTEN PEOPLE THINK OF LOCAL AND COUNTY HEALTH DEPARTMENTS AND THEY THINK OF
NEW YORK CITY, WASHINGTON, D.C., BUT WE’RE TALKING ABOUT HEALTH DEPARTMENTS THAT MAY
HAVE FEWER THAN 10 STAFF PEOPLE THAT ARE DOING A JOB TO TRY TO GET THIS EPIDEMIC UNDER CONTROL.
WE ARE NOW IN A SITUATION WHERE WE HAVE 18 IS SITES, 16 OF THEM ARE CO-LOCATED WITHIN
THE HEALTH DMENT AND THEY’RE ACTUALLY UNDER SIEGE, THERE’S A LOCAL BILL, A STATE BILL
INTRODUCED TO CLOSE THEM ALL DOWN SP THAT’S IN THE MIDDLE OF THE PLANNING.
AS WE TRY ON WORK WITH THE STATE IN TRANSPORTATION, I THINK IT WOULD BE A — STATE IN PREPARATION,
I THINK IT WOULD BE A GOOD IDEA FOR US TO START TALKING ABOUT PLANNING FOR THE ENDING
THE EPIDEMIC NOW RATHER THAN WAITING FOR PHASE II TO ROLL OUT AND FOR THE MOST PART WE ARE
A STATE OF PEOPLE WHO REALLY WANT TO RESPOND BUT HAVE BEEN RESPONDING TO AN OPIOID EPIDEMIC
THAT IS UNLIKE ANY OTHER IN THE NATION AND THAT’S ONE OF THE THINGS THAT WE’RE DOING
NOW WITH THE RESOURCES WE WERE TIEBL GET FROM GILEAD IS THAT WE’RE WORKING WITH MAT PROVIDERS,
MANY OF THEM, THAT’S MEDICALLY ASSISTED TREATMENT PROVIDERS IN THE STATE, WHO ARE NOT FUNDED
TO DO HIV WORK. SO THEY SCREEN, THEY MIGHT SCREEN FOR HIV,
BUT THEY’RE REQUIRED TO SCREEN FOR HIV AND THEY’RE REQUIRED TO SCREEN FOR HEP C BUT THEY
DON’T HAVE A LINKAGE TO CARE PLAN, THEY DON’T HAVE A NEXT STEP PLAN, AND DEPENDING ON WHERE
THEY ARE IN THE STATE, THERE MAY NOT BE A PROVIDER FOR HEP C TREATMENT AND THERE MAY
NOT BE A PROVIDER FOR HIV CARE. SO WE HAVE TO FIRST OF ALL GET THOSE MAT PROVIDERS,
WINTER WEATHERIZATION PROGRAMS, THOSE MATERNAL AND CHILD HEALTH FACILITIES ON BOARD TO DO
HIV SCREENING AS A ROUTINE THING AND THAT’S NOT WHERE THEY ARE NOW.
SO INSTEAD OF COMMUNITY EDUCATION GROUP DOING DIRECT SERVICE WORK, WE’RE NOW DOING EDUCATION
WORK, GETTING THEM ON BOARD WORK, DOING COORDINATION WORK.
AND I THINK APPEARS A PART OF THE ENDING THE EPIDEMIC PLAN, EVERYTHING THAT’S IN THAT PLAN,
WEST VIRGINIA WOULD HAVE BENEFITS FITTED FRVMENT PART OF THE REASON I BELIEVE WE WEREN’T INCLUDED,
THE STATE WASN’T INCLUDED IN PHASE 1 IS THAT IT’S A DATA LAG AND WHAT’S LAID OUT IN THE
PLAN SAYS EVERYTHING THAT THE STATE NEEDS. AND WEST VIRGINIA IS A VERY PROUD STATE AND
A VERY PROUD PEOPLE. SO IT’S NOT HAVING THE FEDERAL GOVERNMENT
COME IN TO TELL IT WHAT TO DO, BUT MAYBE TO HELP US UNDERSTAND WHAT RESOURCES ARE GOING
TO BE MADE AVAILABLE UNDER THE ENDING THE EPIDEMIC PLAN AND I THINK THE WEIGHT OF THIS
BODY AND THE WEIGHT OF THIS OFFICE WOULD ACTUALLY BE VERY BENEFICIAL TO THE STATE.
>>I THINK OUR NEXT QUESTION WE WOULD LIKE TO ASK, FIRST I WAS GOING TO ASK, DO PEOPLE
BELIEVE, DO THE PEOPLE YOU SERVE IN TERMS OF PEOPLE LIVING WITH HIV AND PEOPLE OF RISK
BELIEVE THAT WE CAN END THE EPIDEMIC, BUT I THINK I’LL ASK THE QUESTION, WHAT WOULD
IT TAKE TO GET THEM TO BELIEVE THAT THERE’S HOPE AND THAT WE CAN END THE EPIDEMIC?
SO IF YOU COULD COMMENT ON THAT AND THEN ALSO COMMENT ON PERHAPS THE ROLE OF YOUR ORGANIZATION
AND ALSO THE ROLE OF THE NATIONAL RESPONSE.>>YEAH, I MEAN, I THINK OBVIOUSLY IT WILL
TAKE A LARGE EFFORT TO TRY TO END THE EPIDEMIC. HOWEVER, I THINK A MAJOR PART OF IT IS REALLY
TRYING TO ADDRESS THE SOCIAL DETERMINANTS OF HEALTH.
LIKE IN OUR COMMUNITY AND SOUTHEAST DC OBVIOUSLY AS WELL AS A LOT OF OTHER PLACES, NOT ONLY
WITH SUBSTANCE ABUSE AND MENTAL HEALTH, BUT ALSO IN DC THERE’S A BIG HOUSING ISSUE, AND
THAT’S SOMETHING THAT A LOT OF OUR PATIENTS HAVE TO DEAL WITH, THEIR HOUSE SG VERY TRANSITIONAL
SO THEY MIGHT LIVE IN SOUTHEAST DC FOR SOME POINT BUT THEN THEY GET EVICTED AND HAVE TO
MOVE SOMEWHERE ELSE, WHETHER THAT’S OUTSIDE OF THE DC JURISDICTION AND TO ANOTHER PROVIDER
OR THAT COULD BE EVEN WITHIN DC THAT MAKES IT DIFFICULT TO GET TO OUR CLINICS.
SO REALLY TRYING TO ADDRESS THOSE SOCIAL DETERMINANTS OF HEALTH, INCARCERATION, HOMELESSNESS, SUBSTANCE
ABUSE, MENTAL HEALTH AND REALLY TRYING TO GET ALL THAT TOGETHER IS VERY IMPORTANT.
NOW, WE DO OFFER AT FAMILY MEDICAL, WE DO HAVE MENTAL HEALTH AND SUBSTANCE ABUSE THERAPY,
WE HAVE CASE MANAGEMENT AND CARE COORDINATION, WE HAVE A FOOD BANK AND A NUTRITIONIST THAT
COULD HELP SORT OF BRIDGE THAT GAP A BIT, BUT THERE’S STILL A LOT MORE WORK TO BE DONE
TO TRY TO ACHIEVE ALL THOSE GOALS.>>JUST AS A FOLLOW-UP QUESTION IN TERMS OF
A BIOMEDICAL ELEMENT, WHEN YOU THINK OF PARTICULARLY THE POPULATION THAT’S NOT IN CARE OR THAT’S
FALLEN OUT OF CARE, SO 44 PERCENT, DO WHAT WE CALL THE BIOMEDICAL MODEL, DO PEOPLE BELIEVE
IN THAT? I THINK SO.
I THINK THE BIG EFFORT WE REALLY HAVE IS TO TRY TO REACH OUT TO THOSE PATIENTS WHO HAVE
FALLEN OUT OF CARE. I THINK SIMILAR TO THE PREVIOUS DISCUSSION
WITH THE HEADS OF THE HEALTH DEPARTMENTS IS THEY HAVE A LOT OF — THEY HAVE SOME EXCHANGE
OF INFORMATION BETWEEN THE JURISDICTIONS, BUT FOR US ON THE GROUND SEEING THE PATIENTS,
IT’S A LITTLE ABOUT THE MORE DIFFICULT TO HAVE THE EXCHANGE OF INFORMATION BETWEEN VARIOUS
CLINICS. THERE IS SOME INTEROPERABILITY BETWEEN FOR
EXAMPLE THE FAMILY QUALIFIED HEALTH CENTERS AT DC, YOU CAN SEE A LITTLE BIT OF DATA WITHIN
OUR ELECTRONIC MEDICAL RECORD, BUT IF THEY’RE OUTSIDE OF THAT OR SOMEWHERE ELSE THERE’S
OBVIOUSLY A LOT OF PAPERWORK TO GO THROUGH FOR THAT EXCHANGE OF INFORMATION AND SOMETIMES
IT MAKES THINGS A LITTLE MORE DIFFICULT.>>SOCIAL DETERMINANTS, WHAT I’VE SEEN IS
EDUCATION. I THINK EDUCATION IS THE KEY, MORE SPECIFICALLY
AROUND PREP, PEOPLE FALLING THROUGH THE CRACKS, BUT I DO THINK PREP —
I THINK WE NEED MORE COLLABORATION, PEOPLE IN HEALTHCARE.
FOR EXAMPLE A GD PROGRAM, HIGH RISK IN A PROGRAM, SO THAT WOULD BE A GOOD PLAY — GOOD PLACE
TO PRESENT, BUT I HAVE FOUND DIFFICULTY BRIDGING THAT.
BUT ONE OF THE PLACES THAT I WOULD LIKE TO SEE SOME RETURN OF CENSUS, SOMETIME SUBSTANCE
ABUSE, WHETHER IT’S BEING HIV POSITIVE OR HOUSING, BUT I WOULD LIKE TO BE ABLE TO PRESENT,
ESPECIALLY FEMALES, NEW CASES, SO I’M SAYING, OKAY, YOU ARE GOT A NEW FEMALE COMING HOME,
THEY COULD BE INFORMED AND THEY COULD MAKE THE BEST DECISION.
I THINK EDUCATION IS THE KEY.>>YEAH, I THINK I HAVE A TWO-PART QUESTION
OR A RESPONSE. THE EXECUTIVE DIRECTOR STATISTICIAN SIDE OF
ME SAYS YES IN TERMS OF DO WE BELIEVE THAT WE’LL GET TO THE EPIDEMIC BECAUSE IF WE PUT
ALL THESE PARAMETERS IN PLACE, THEN YES, OUR MATHEMATICAL MODEL WILL TELL US THAT YES,
WE CAN END THE EPIDEMIC. THEN STILL FROM BEHIND THE COMPUTER AND ACTUALLY
GO OUT TO THE COMMUNITY OR SPEAK WITH OUR COMMUNITY HEALTH WORKERS AND CHANGES AND IT’S
NO. WE ARE FORTUNATE TO RECEIVE SOME OF THE FUNDING
THAT RAVINIA WAS TALKING ABOUT, SO WE HOLD CHAT, CHIT AND COCKTAILS WITH BLACK AND LATINO
IN PRINCE GEORGE COUNTY AND WHEN WE OPEN UP THE QUESTION TO ASK HAVE THEY HEARD OF THE
EPIDEMIC PLAN, THEY SAY NO. THEN IN CONVERSATIONS ABOUT DO WE BELIEVE
THAT WE WILL GET THERE, AGAIN THEIR RESPONSE IS NO.
AND YET LAYERING ALL OF THOSE ALONG WITH A LOT OF OUR OUTREACH AND WHEN WE’RE TALKING
TO COMMUNITY RESIDENTS, INFORMING THEM OF PREP AND OTHER THINGS AND THEY’LL JUST SAY
OH, THAT’S THE WAY THAT THE GOVERNMENT IS GOING TO KILL US.
SO WE’VE HAD TWO BLACK WOMEN WHO RECENTLY WERE TOLD OF THEIR DIAGNOSIS IN PRINCE GEORGE
COUNTY AND BOTH OF THEM ARE STILL NOT ENGAGED IN CARE BECAUSE THEY DO NOT BELIEVE IN THE
BIOMEDICAL ASPECT OF HIV BECAUSE AGAIN, THEY’RE THINKING IT’S JUST ANOTHER WAY FOR THE GOVERNMENT
TO KILL THEM, SO I THINK IT’S GOING TAKE A LOT IN TERMS OF EDUCATION AND REALLY GETTING
A COMMUNITY THAT HAS BEEN HISTORICALLY MARGINALIZED AND THEN HAVE A LEGACY OF OPPRESSION TO REALLY
THEN BELIEVE, AND THIS IS EVEN COMING FROM INDIVIDUALS THAT LOOK LIKE THEM.
SO I THINK THAT’S A HUGE PIECE THAT WE’RE GOING TO HAVE TO BE ABLE TO ADDRESS, THAT
FROM JUST CONTINUED PRESENCE IN COMMUNITIES, US CONTINUING HAVING CONVERSATIONS ABOUT IT,
BECAUSE AGAIN, WHEN WE TALK ABOUT THE ENDING THE EPIDEMIC, I BELIEVE ONE OF THE QUOTES
FROM ONE OF OUR PARTICIPANTS, WELL WHY NOW DO WE HAVE THE MAIN FOCUS ON ENDING HIV?
SO AGAIN, SO THEN ASKING QUESTIONS IN THESE GROUPS AND WE’RE HAVING TO COME UP WITH THAT
RESPONSE IS AND JUST TAKING THAT OUR THOUGHT AND REALLY THINKING ABOUT HOW DO WE NOW DEVELOP
PROGRAMS OR CONVERSATIONS ABOUT ENDING THE EPIDEMIC.
>>SO I HAVE TO KIND OF ANSWER IT THREE DIFFERENT WAYS.
I KNOW, I’M SORRY, I KNOW, I’VE GOT TO DO EXTRA, RIGHT?
SO ONE WAY IS THE WEST VIRGINIA, THE STATEMENT — THE STATE.
I THINK A LOT OF PEOPLE DON’T KNOW ABOUT THE ENDING THE EPIDEMIC PLAN AND THAT’S LOCAL
GOVERNMENT, INDIVIDUALS, IF I SAID, LOOK, WE NEED TO HAVE A MEETING ABOUT ENDING THE
PLAN, ENDING THE EPIDEMIC PLAN AND START PUTTING TOGETHER COMMUNITY AND HAVE A RESPONSE RG
A LOT OF PEOPLE ARE GOING TO BE WHAT’S THE ENDING THE EPIDEMIC PLAN, IN PART BECAUSE
OF HOW WE’VE BEEN PHASED IN. SO THERE’S THAT.
AND THEN THERE’S THE ACTUAL ENDING OF HIV/AIDS. MOST PEOPLE, AGAIN, DON’T SEE A LEVEL OF RISK
IN THE STATE, EVEN THOUGH THOSE CLUSTERS OCCURRED, SOME BELIEVE THAT THOSE ARE OUTLIERS AND THAT
THERE’S NO OTHER RISK. AGAIN, THEY’RE RESPONDING TO IN HEP C OUTBREAKS,
THEY’RE RESPONDING TO AN OPIOID CRISIS AND THERE’S AN EXHAUSTION WITHIN IT.
BUT WHEN WE LOOK AT IT FROM A PERSPECTIVE OF EITHER AFRICAN AMERICAN COMMUNITIES BUT
ALSO POOR WHITE AND RURAL COMMUNITIES, AIN LOT OF THOSE SOCIAL DETERMINANTS ARE THE SAME,
POOR HOUSING, LACK OF EDUCATIONAL ATTAINMENT, LACK OF ACCESS TO HEALTHCARE.
SO WE HAVE TO PUT AN INFRASTRUCTURE IN PLACE THAT’S NOT THERE, WHICH IS KIND OF LED UPS
TO THE HIV CHALLENGES THAT WE HAVE IN THIS STATE NOW.
SO I THINK KIND OF WHERE I’M GOING TO GO FAR RIGHT HERE IS ON PREP, ONE OF THE THINGS WE
HAVEN’T DONE IN THIS COUNTRY IS MADE A SOUND INVESTMENT IN BLACK WOMEN AROUND HIV IS SO
WE’VE KIND OF PUT THE CART BEFORE THE HORSE WITH THE BIOMEDICAL RESPONSE.
IF WE HAVEN’T ENGAGED AND EDUCATED BLACK WOMEN WHAT PREP IS, WHAT IT’S ABOUT, WHAT THE BIOMEDICAL
SMONS IS AND WHAT IT’S ABOUT, WE CAN’T ASK SOMEBODY TO TAKE SOMETHING WHEN THEY DON’T
EVEN KNOW WHAT IT REALLY IS. MOST WOMEN THAT WE HAVE ENGAGED ON PREP BECAUSE
WE’RE DOING ANOTHER PROJECT ON BLACK WOMEN IN PREP IS THAT THEY’VE REALLY GOTTEN THE
INFORMATION THROUGH THEIR GAY MALE FRIENDS. SO WE HAVE TO BE WILLING TO MAKE AN INVESTMENT
IN WOMEN. WE HAVE TO BE WILLING TO MAKE AN INVESTMENT
IN BLACK WOMEN IF WE ARE GOING TO END THE EPIDEMIC THROUGH PREP OR THROUGH A BIOMEDICAL
RESPONSE, AND UNTIL WE DO THAT, BLACK WOMEN WILL BE LEFT BEHIND AND LEFT OUT OF THE ENDING
OF THIS EPIDEMIC.>>I DO THINK ONE OF THE THINGS WE HAVE TO
DO IS GENERATE HOPE IN THE COMMUNITIES MOST IMPACTED BY THIS, AND I WAS SHOCKED BY THE
LEVEL OF THE IMPACT OF THE DISEASE ON PEOPLE AND KIND.
SOCIAL MEMORY BECAUSE COMMUNITIES — THE MOST EFFECTIVE POPULATIONS OF DIAGNOSIS, SO PEOPLE
REMEMBER THE WORST OF THE EPIDEMIC, BUT I THINK WHAT HAS CHANGED IS THE WAY IT’S COMMUNICATED
AND THOSE TOOLS, WE HAVEN’T FULLY COMMUNICATED THAT THIS IS A NATIONAL EFFORT.
SO THANK YOU FOR THAT. I THINK WITH THAT, I WOULD LIKE TO OPEN IT
UP TO OUR GROUP HERE FOR QUESTIONS. CARL, DO YOU WANT TO GO FIRST?
>>GREAT. THANK YOU.
THANKS AGAIN FOR LETTING US TOUR FAMILY MEDICAL THIS MORNING.
IT WAS REALLY A GREAT OPPORTUNITY FOR ALL OF US.
AND I THINK YOU ADMITTED AGAIN THAT THE PREP UPTAKE IS NOT — AND THIS IS HAPPENING IN
WASHINGTON, D.C. AND OUR GOAL IS TO, YOU KNOW, DO THIS AROUND THE COUNTRY.
AND YOU HAVE A VERY SUCCESSFUL TEAM SERVICE PROGRAM AND THAT WOULD BE AN OPPORTUNITY FOR
PREP AND YOUR FQHC AND YOU ALSO MENTIONED, YOU KNOW, YOU DO A LOT OF HIV TEST, AS WELL
AS YOUR STANCHION USE PROGRAMS, AND PEOPLE COMING FROM THEIR DOCTORS’ VISITS.
SO ARE YOU GOING — YOU KNOW, WHAT ARE YOUR THOUGHTS ABOUT INTEGRATING PREP IN ALL OF
THOSE PROGRAMS, AND ALSO, YOU KNOW, I THINK YOU HIGHLIGHTED THIS MORNING FOCUSING ON AFRICAN
AMERICAN HOMOSEXUAL MEN AND WOMEN, BUT WHAT ABOUT THE BLACK GAY MEN THAT LIVE IN SOUTHEAST?
>>CERTAINLY. AND I THINK VERY DISTINCT ABOUT THIS AS WELL
BUT I JUST THINK ALTHOUGH LEAST IN SOUTHEAST DC COMPARED WITH MY PREVIOUS CASE IN NORTHERN
VIRGINIA, IN NORTHERN VIRGINIA THE PLACE I WORKED AT WAS SORT OF KNOWN AS A PREP CENTER
AND PEOPLE WHO CAME TO US WERE READY ON START PREP SO IT WAS RELATIVELY EASY TO GET THOSE
PATIENTS COMING TO YOU FOR PREP TO START PREP. I THINK CERTAINLY THERE ARE PATIENTS THAT
I SEE THAT ARE NOT HIV POSITIVE THAT WE’LL DO SCREENING OR STD TRAINING OR MIGHT BE IN
RELATIONSHIPS WITH HIV POSITIVE PARTNERS SO THE DISCUSSION ABOUT PREP ALWAYS HAPPENS IN
THOSE SITUATIONS, AND FOR THE MOST PART THE PATIENTS WHO COME TO OUR MEDICAL CLINIC GET,
ESPECIALLY FOR THEIR INITIAL EXAM GET SCREENED FOR HIV AND THERE’S A DISCUSSION AT EVERY
VISIT ABOUT SEXUAL HISTORY AND THINGS LIKE THAT.
I THINK ESPECIALLY FOR HETEROSEXUAL MEN AND WOMEN, I THINK IT’S A LITTLE BIT OF A LARGER
DISCUSSION ABOUT WHETHER OR NOT THEY FEEL THAT THEY ARE AT RISK.
I THINK FOR MEN WHO HAVE SEX WITH OTHER MEN I THINK THE WORD OUT THERE IS FOR THOSE OUT
THERE ALLOWED PREP AND THEY COULD HAVE AN INTERNAL DECISION HE IS SPECIAL WELL THEIR
PROVIDER ABOUT WHETHER OR NOT THEY ARE INTERESTED IN THAT.
I THINK FOR THE PATIENTS WHO ARE SUBSTANCE ABUSERS WHO ARE ACTIVELY USING, I THINK AS
A PROVIDER, TO BE HONEST, MY PRIORITY IS TO TRY TO GET THEM ON BUPRENORPHINE, SO TRYING
TO REDUCE THE RISK OF THEM OD’ING TOMORROW. SO PREP IS NOT PART OF THAT INITIAL DISCUSSION.
TO BE HONEST, I PROBABLY SHOULD INCLUDE THAT A LITTLE BIT MORE AND THAT’S SOMETHING THAT
I THINK WE’LL VIEW CERTAINLY AT FMCS AND MAYBE OTHER PLACES AS WELL, BUT FOR THE HETEROSEXUAL
MEN AND WOMEN, I THINK I DO HAVE PATIENTS WHO ARE MOTIVATED TO START PREP AND THEY’RE
LIKE I DON’T KNOW WHAT MY PARTNER IS DOING, I JUST SUPPORT TO BE FAITHFUL AND OBVIOUSLY
WE PRESCRIBE IN THOSE SITUATIONS BUT WHEN WE FEEL THEY ARE IN A MONOGAMOUS RELATIONSHIP
OR NOT CURRENTLY IN A RELATIONSHIP IT’S DIFFICULT ON SAY YOU SHOULD BE ON PREP FOR SOMETHING
THEY FEEL IS PROBABLY NOT A LARGE RISK FOR THEM.
>>I THINK AS FAR AS PREP, I THINK WE HAVE GOOD EFFORT AROUND FLEP OUR OUTREACH PROGRAM
— AROUND PREP IN OUR OUTREACH PROGRAM. I DO FROM TIME TO TIME BUT I DON’T HAVE A
PLATE THAT I CAN ACTUALLY GO OUT AND PRESENT PREP AND I GO OUT AND TALK ABOUT PREP, AND
EVERY TIME SOMEBODY IS INTERESTED. AND ALSO WEFER GET A LOT OF — AND WE ALSO
GET A LOT OF PEP, PEOPLE THAT HAVE BEEN EXPOSED, AND A LOT OF TIMES WE’LL GET THEM TO START
THAT WAY. BUT I REALLY FEEL THAT THE ISSUE FINANCIALLY,
IT’S PROBABLY THE SAME IN DC, WHAT I SEE IS WE NEED MORE COLLABORATION.
AT THE END OF THE DAY, WE’RE ALL STAKEHOLDERS, WE’RE ALL HERE FOR THE SAME REASON, TRYING
TONED THE EPIDEMIC. SO THAT MEANS TO ME THAT IF MY COLLEAGUE HERE
HAS SOMEONE INTERESTED IN GETTING ON PREP AND HIS OWN RELATION DOESN’T DO PREP, NEEDS
TO CALL MR. KIRK SO I GET THE PERSON ON PREP. THIS IS HOW WE HAVE TO THINK.
NOW, IF ORGANIZATIONS ARE GOING TO START GIVING OUT PREP NEXT YEAR OR WHATEVER THEY DECIDE
TO DO THAT, THAT’S WONDERFUL. BUT IN THE MEANTIME, WE’VE STILL GOT TO SAVE
LIVES. SO WE NEED TO COMMUNICATE TO EACH OTHER FOR
ME AS A COMMUNITY OUTREACH NAVIGATOR, ADDICTIONS COUNSELOR, RECOVERY COACH, I’M A LOT OF THINGS,
BUT ALL THAT GOES INTO I WANT TO SAVE A LIFE. SO IF FAMILY MEDICAL IS PROVIDING THE SERVICE,
OF COURSE I’M POINTING THAT WAY. BUT IF FAMILY MEDICAL DOESN’T PROVIDE THE
SERVICE, I HAVE CONTACTS EVERYWHERE IN THE CITY.
A PERSON CAN’T COME TO ME AND HAVE AN ISSUE AND I CAN’T HELP THEM.
I DON’T GO TO BED LIKE THAT. I NEED MORE PEOPLE TO FEEL THAT WITH ME AND
THEN WE CAN KILL THE EPIDEMIC.>>I JUST WANT TO ADD ONE POINT REGARDING
UPTAKE AND I THINK ABOUT IT IN REGARD TO THE 90, 9050 PLAN THAT MICHAEL SPOKE ABOUT EARLIER
WHERE IT HIELS THE NEED FORM 6,000 INDIVIDUALS WHO ARE IDEAL CANDIDATES FOR PREP TO ACTUALLY
UPTAKE PREP, RIGHT? SO WHEN WE THINK ABOUT THAT IN TERMS OF NOW
MOVING SOMEBODY ALONG THE STAGES OF CHANGE ESPECIALLY FOR A YOUNG BLACK GAY MAN OR A
BLACK HETEROSEXUAL WOMAN THAT MAY PERCEIVE THEIR RISK AS LOW, OR THEY MAY EVEN HAVE SEASONS
OF RISK, THEN HOW DO WE EQUIP THEM WITH THE TOOLS THAT WHEN THEY ARE MAYBE ABOUT IN THAT
SEASON OF RISK TO ACTUALLY THINK ABOUT PREP AS A METHOD OF PREVENTION, BECAUSE THINK ABOUT
EVEN HELPING US, OUR STAFF ARE ON AND OFF PREP, RIGHT, BECAUSE THEY’RE LIKE OH, I BROKE
UP WITH HIM, I’M NOT EMPLOYING GOING TO BE HAVING SEX FOR TWO MONTHS, WHY AM I GOING
TO KEEP TAIK THIS PILL, THEN THEY FOUND SOMEBODY AND THEY START TAKING THE PREP AGAIN, RIGHT?
SO THINKING ABOUT THE DIFFERENT METHODS AND THE WAYS THAT WE CAN, YES ENCHTS GO YOU APPROVED,
BUT THINKING ABOUT ON DEMAND PREP OR EVENT BASED PREP AND THINKING ABOUT HOW DO WE ACTUALLY
COMMUNICATE WITH COMMUNITY ABOUT THAT, RIGHT? SO AGAIN, ONE, IF WE’VE BEEN ABLE TO GET THEM
TO THINK ABOUT PREP AND SEEING THAT RISK, RIGHT, AND THEN MOVING THEM ALONG THAT CONTINUUM
FOR PREP. BUT AGAIN, I THINK IT’S EDUCATION, EDUCATION,
EDUCATION, FOR NATIONAL HIV/AIDS AWARE NGS DAY, WE SPOKE US SPECIFICALLY ON HPCU’S THIS
YEAR SO WE DID EVENTS ON MOVING YOU FORWARD AND WE HAD A COMMUNITY ON US HELPING US AND
JUST HEARING THE FEEDBACK FROM THE COUNSELORS WHO WERE TALKING WITH STUDENTS WHO DID NOT
KNOW WHAT SYPHILIS WAS, WHO DID NOT KNOW WHAT GONORRHEA WAS, WHO NOW THEY’RE ASKING THEM
TO COME BACK FOR PANELS SPEAK IN THEIR DORMS, TO ACTUAL NOW MAYBE HAVE PREP LIKE IT WAS
LIKE, WELL, HE CAN HAVE MY PRESCRIPTION, IT’S LIKE — BECAUSE HE DIDN’T WANTED IT TO GO
ON HIS PARENTS’ INSURANCE. RIGHT?
SO THINKING ABOUT ALL OF THESE DIFFERENT THINGS AND NOW WORKING WITH PHARMACY TO SEE HOW CAN
WE WORK WITH INSURANCE COMPANIES WHERE IT DOESN’T GO ON PARENTS’ INSURANCES, SO REALLY
NAVIGATING THOSE PIECES, SO I GUESS ALSO WITHIN THAT IS MY ADVOCACY FOR THE NEED FOR COMMUNITY
BASED ORGANIZATIONS OR AT LEAST WHERE YOU’RE GOING TO HAVE TO HAVE THOSE INSTITUTIONS THAT
ARE GOING TO SPEND MORE TIME, THAT ARE GOING TO GO INTO COMMUNITIES AND BUILD THAT RAPPORT
AND RELATIONSHIP AND THE NAVIGATION TO A CLINICAL PROVIDER.
BUT AGAIN, THEN WE HAVE TO THINK ABOUT WHAT DOES THAT PARTNERSHIP LOOK LIKE AND HOW DO
WE ACTUALLY INVEST NOT NECESSARILY HEAVILY BUTTER NUTRITIONALLY AND — BUT NUTRITIONALLY
AND HEFTY, RIGHT, BECAUSE AGAIN, IT’S A BURDEN FOR THE COMMUNITY BASED ORGANIZATIONS TO DO
A LOT OF THIS HEAVY LIFT AND ONLY GET 2 PERCENT OF MAYBE WHATEVER THE PULL OF FINANCIAL RESOURCES
TO KEEP THE ORGANIZATIONS AFLOAT.>>SO TO THESE SOMEONE THE HUNTINGTON HEALTH
DEPARTMENT IN WEST VIRGINIA JUST STARTED DOING A PREP INITIATIVE.
I DON’T HAVE THE DATA ON IT, BUT AGAIN, IT’S TARGETING PRIMARILY WHITE HETEROSEXUALLY IDENTIFIED
INDIVIDUALS WITH SUBSTANCE USE DISORDER HISTORIES AND THAT I THINK WE NEED TO DO MORE OF THAT.
AND WHAT COMMUNITY EDUCATION GROUP IS DOING AND WE’RE LAUNCHING IT IN MARCH, ACTUALLY
WE’RE GOING TO LAUNCH IT ON MARCH 10 OR ON NATIONAL WOMEN AND GIRLS HIV/AIDS AWARENESS
DAY IS THAT WE’RE DOING A PROGRAM TO GET ORGANIZATIONS TO DO NATIONAL GIRLS EVENT BUT ALSO TO DO
SCREENING AND/OR TO DO PREP EDUCATION. I THINK MR. PERRY IS 100 PERCENT CORRECT,
WE HAVE TO DO THAT IN COLLABORATION. SO WE HAVE TO DO THAT IN COLLABORATION WITH
PHARMA WHO HAS SOME MORE EDUCATIONAL TOOLS AND RESOURCES FOR US BUT ALSO WE HAVE TO DO
THAT IN COLLABORATION WITH LOCAL HEALTH DEPARTMENTS, WE HAVE TO DO IT WITH LOCAL ORGANIZATIONS
AND WITH OUR FEDERAL PARTNERS IN ORDER TO GET IT DONE BECAUSE THERE IS A BURDEN, THERE’S
AN ECONOMIC BURDEN TO IT, MANY OF US ARE NOT FUNDED TO DO THIS LEVEL EDUCATION AND AWARENESS
WORK TO GET PREP INTO THE MINDSET OF INDIVIDUALS AS A PART OF THE CONTINUUM OF CARE AND THAT’S
WHAT YOU’RE ASKING US TO DO IF YOU WANT US TONED THE EPIDEMIC WITH A BEE OH MEDICAL MARKER,
IS TO SAY PUT THIS AS A PART OF THE CONTINUUM OF CARE BUT THOSE RESOURCES THERE TO EDUCATE,
PREPARE A COMMUNITY TO RESPOND AND ACCEPT AN UPTAKE OF BIOMEDICAL RESPONSE ARE NOT FREQUENTLY
THERE.>>SO WE HAVE TWO MORE QUESTIONS, CLARK AND
JUSTIN AND I THINK WE’LL JUST ASK ONE OF THE PANELISTS TO RESPOND AND THEN WE’LL SEE IF
WE CAN — OR WE CAN SQUEEZE IN ROBERT. KIRK FIRST AND THEN JUSTIN.
>>YES, THE PANEL, I’M TAKING A SPOT FOR OUR CHIEF MEDICAL OFFICER AT SAMHSA, I’M A MEDICAL
OFFICER MYSELF AT SAMHSA, GOOD TO SEE YOU AGAIN, TONI, BEEN A WHILE.
ONE OF THE THING THAT STRIKES ME, I’M ASKING YOU BUT I’M ALSO ASKING MYSELF AS A SAMHSA
EMPLOYEE AND THAT IS AND MY FLAG HASN’T BEEN THERE FOR A WHILE, BUT EDUCATION, I KNOW MR.
PERRY YOU MENTIONED EDUCATION AS AN IMPORTANT PIECE OF THIS, IT STRUCK ME AS JUST A PATTERN
WHEN IT COMES TO PEOPLE OF COLOR, SOMEHOW WE’RE ALWAYS FALLING BEHIND WHEN IT COMES
TO GETTING THE MESSAGE WHEN IT COMES TO HIV, WHEN IT COMES TO PREP, WHEN IT COMES TO JUST
THE RISK FACTORS INVOLVED. WHAT ARE WE NOT DOING AND WHAT COULD WE DO
AND WE STARTED MENTIONING SOME OF THE CONCRETE THINGS, SOMEONE MENTIONING ASSOCIATION WITH
SBCU’S, TONI YOU TALKED ABOUT NATIONAL WOMEN’S DAY AND WHAT YOU WERE DOING.
I WOULD LIKE TO HEAR MORE I GUESS ABOUT THAT BECAUSE I WOULD LIKE TO BE ABLE TO SHARE THOSE
THINGS WITH OUR SAMHSA GRANTEES, WHAT THEY COULD BE DOING AT THE COMMUNITY LEVEL WHEN
IT COMES TO EDUCATING PEOPLE OF COLOR WHO HAVE KIND OF MISSED THE MESSAGE TO A GREAT
EXTENT WHEN IT COMES TO PREVENTING HIV.>>I’LL JUMP IN, YOU MENTIONED MR. PERRY,
BUT I THINK THAT THERE’S A NUMBER OF THINGS THAT NEED TO BE DONE AND I THINK IT’S ALSO
IN THE ADVENT OF THE BIOMEDICAL INTERVENTION ITSELF, RIGHT, AND THAT YOU ACTUALLY HAVE
REPRESENTATION AND INCLUSION OF INDIVIDUALS WHO# CAN BEEN — WHO CAN BENEFIT MOST
FROM THE DRUG SHES RIGHT? SO IF WE TALK ABOUT THE LOW PARTICIPATION
OR LOEWEN ROLEMENT NUMBERS IN PREP TRIECIALTIONZ AS A MEMBER OF A MARGINALIZED COMMUNITY I
MIGHT NOT THINK THAT’S FOR ME. RIGHT?
SO I THINK WE HAVE TO BE INTENTIONAL IN SAYING AND INCLUSIVE OF SAYING THIS IS FOR ALL, RIGHT?
SO WHENEVER NEW THINGS ARE ROLLED OUT OR APPEARS THE MESSAGING COMES OUT THAT LTS INCLUSIVE
OF ALL POPULATIONS, RIGHT? SO WE THINK ABOUT THE WONDERFUL COMMERCIALS
THAT ARE OUT BUT IF YOU LOOK AT THEM IN TERMS OF BLACK MEN, THEY’RE EITHER PLAYING THE SCORE
OR BORDER DANCING, NEITHER ONE OF THOSE RELATE TO ME.
WE HAVE TO THINK ABOUT HOW THAT MESSAGING COMES ACROSS AND HOW WE CAN BE INCLUSIVE,
ALL RIGHT? SO THINK ABOUT IT IN THAT SENSE.
AND THEN AS I MENTION MED FROM THE VERY BEGINNING, I KNOW WE’RE NOW TRYING TO INCREASE OR AT
LEAST NOW GO BACK AND DO STUDIES AMONG WOMEN, RIGHT, SO NOT THE BLACK FIELD FOR BLACK MEN
OR SOMETHING, JUST THINKING ABOUT WHAT’S GOING TO BE A TANGIBLE PIECE WITH I THINK COMMUNITY,
TO THINK THINGS ARE FOR US. ESPECIALLY WHEN WE’RE TALKING ABOUT THINGS
FROM THE MEDICAL COMMUNITY. SO LIKE OKAY, WELL, WE THINK NIKES ARE FOR
US BECAUSE JORDAN WON, RIGHT? LET’S GO GET NIKES.
SO JUST THINK ABOUT DIFFERENT WAYS IN WHICH TO ENGAGE COMMUNITIES.
>>WITH THAT, UNFORTUNATELY WE’RE GOING TO HAVE TO CUT TO OUR BREAK, BUT I WANT TO THANK
OUR PANEL VERY MUCH FOR JOINING US. [APPLAUSE]

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