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Interview

Why NYC's New HIV/AIDS Chief Took the Job -- And What He Plans to Do With It

August 7, 2014

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How do you see your relationship with the Ryan White Planning Council? And how do you see your relationship with the Prevention Planning Group? Because historically the assistant commissioner would come to one or two meetings a year, and that was kind of it.

I think there are some people who think, "Oh, these groups, they're legislatively mandated, but maybe they should just go away. And you just do what we tell you to."

Right. You'll have to ask me this question when I'm there for longer than, like, a minute. But I've always felt like you have to listen more, and speak less, when it comes to the community. And I feel that community presence for a leader in HIV is key and what differentiates a leader in HIV from a leader in, like, food handling.

I'm sure there is a very strong community presence for food handling and for whoever gives you your grades at the Department of Health. But I feel like HIV is unique, in that the community tie is critical.

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There are going to be moments where I'm not going to be popular with the community. I'm going to have to make decisions that are based on some fiscal realities, and some political realities, that aren't going to be popular. But my perspective is to listen more and speak less, so I can learn.

I think it would also be important to not forget that there's a reason why the Ryan White Planning Council is legislatively mandated.

Oh, yeah. Oh, no, no, no, no. For sure.

Because there was a time where people with HIV were not allowed at the table.

Yeah.

For various reasons. And they fought for that space, to be able to be part of it. And they made sure it happened legally.

Coming from a clinic environment and from a research environment -- and also, frankly, a CBO [community-based organization] environment, with my time at GMHC -- being in touch and in really close and clear contact with a community advisory board is a very familiar experience. And, in effect, these are just giant community advisory boards, with very significant say in the direction of where funding goes. So I feel like that's not a foreign experience to me. And it's not legislatively mandated just to appease anybody. It's mandated because there's a role.

Can I speak about the timing of my meetings with them? I really can't yet. But do I want to have a presence with them? I think that the answer is, "Absolutely." And I want to, again, listen more and speak less so I have a sense of what's going on.

Because I know what I think is important. And every time I think I know what's important, I always learn something from my patients, or from someone in the community, that I'm missing a piece. And so that's really the point that I get.

I know how to prescribe PrEP. I think I know how to make PrEP better. I know how to do HIV care, and to refer people to services. I know what services people with HIV need -- at least from the perspective of a provider -- but listening to people who are living with HIV, or who are major stakeholders in the community, is critical in guiding it. This is why I think it's good to not be a public health lifer coming in. Because I'm coming from the perspective of listening to people who are living with the disease every day.

I wish I could answer the question and say I'm going to meet with the committees every week. But I don't know the answer to that. But am I going to listen to what they're saying and not just pretend to? Of course I am. That's super-important.

What is your macro goal walking in? What is your initial vision, or hope, or goal, for your new role?

It's the same goal I had when I was 20 years old, staring at the people coming in to look at the quilt, the same exact goal -- which is to figure out a way to have fewer people get HIV, and fewer people get sick from it. And when I had that thought in 1994, there was nothing I really had in my mind to offer. HAART [highly active antiretroviral therapy] wasn't really there. People were getting sick. Prevention was only condoms. People were still getting HIV. There was nothing really to offer.

So, now, my macro vision is to leverage what is a really significant amount of political goodwill nationally, on the state level, and locally in the city, to really achieve that adolescent dream that I had at 20, of figuring out a way to have fewer people get HIV, and fewer people get sick from it. For me, that really means being a little bit iconoclastic, in terms of how we look at treatment and prevention -- and, again, to acknowledge that we now need to enter a brave new world of it being one continuum.

So that's my macro vision -- which is to try to inspire change, whether it be through policy, whether it be through funding, or whether it be through detailing providers and making face time with people who are major stakeholders, clinically and in the community, to really get everyone to understand that. Academics, science, public health, the community need to all work together. And everybody has specific strengths and specific weaknesses. But they tend to have some harmony. So that's my global vision -- which is that we have the tools, and we have all the right people at the table, and that I just have to be a good orchestrator to make it happen.

In the last year, ACT UP has been a little tough on the city health department. At this time last year, there was a demonstration. You talk about the community, and stakeholders, and having conversations. Where do you see groups like ACT UP and VOCAL, or the activist personalities, in this conversation?

From my perspective, there's really a specific role that activists do, and that's to push an agenda -- which is really important. So very often to push an agenda, especially now, in this world of malaise and fatigue around HIV, you have to do it in a loud, and very clear, way. There has to be a level of drama and attention. And it's something that I respect from all activist groups. I've done it. So I know.

And so my reaction to where does ACT UP fit: It fits exactly where it fit 30 years ago -- which is, to push the agenda. And so it's amazing that the agenda that is being pushed now is really one that in many ways is being supported by political will, but will require activists to have a loud voice to make it actually achieve the goals it needs for the community.

Ultimately, I can sit here and say we need to implement PrEP better, or we need to make PEP more accessible, or we need to remove some of the lines between HIV and STIs [sexually transmitted infections] so we can achieve the goal of a more unified system. I can say that, but then I need to hear not only community voices from the setting of a community advisory board, but also some voices that are more radicalized. Because somewhere in there is the truth -- whether it's your mild-mannered community answer, your public health government answer, or your more radical voice. All of them somehow participate in the truth. And so you have to listen.

It's the same thing I said before: Listen more, speak less.

When's your first day at work?

Sept. 8, I think. Theoretically.

Well, good luck to you. And congratulations on your new job.

This transcript has been lightly edited for clarity.


Copyright © 2014 Remedy Health Media, LLC. All rights reserved.
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