Tonia Poteat's Career Started With a Piece of Folded Paper

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When a person is a well-established leader in their field, it's easy to forget that, once upon a time, that was not the case. There was a point in that person's life when they hadn't yet made a name for themselves; when they were still figuring out what direction they wanted their life and work to take.

Tonia Poteat, Ph.D., PA-C, M.P.H, has been one of the HIV care community's most-respected providers, researchers, and teachers for over a decade. Poteat is among the most prominent HIV health professionals tackling issues regarding LGBTQ care and health disparities, with a particular focus on transgender health.

Now an assistant professor of social medicine at the University of North Carolina at Chapel Hill, Poteat spent two years during the Obama administration with the Office of the U.S. Global AIDS Coordinator as a senior technical advisor focusing on key populations. After she left the office in 2014, she was an assistant professor at the Johns Hopkins Bloomberg School of Public Health for four years before shifting to the University of North Carolina in 2018.

Looking back on Poteat's professional arc, it can appear as though her path toward a leadership role in HIV care was always clear. But as she explained in a recent interview as part of our in-depth video profile, there have been plenty of twists -- and for a long time, she had little idea where she would end up.

Here, in her own words, are a few brief snapshots of key milestones in the late 1980s, 1990s, and 2000s that ended up being formative parts of Poteat's evolution into a leading HIV care provider, scientist, and mentor with a powerful focus on LGBTQ needs.

The following transcript excerpts have been edited for length and clarity.

Photo courtesy of Tonia Poteat

1987-1991: College Years

I grew up in North Carolina in a small town called Graham. I didn't know much about HIV. I had heard about Rock Hudson -- I think everybody had heard about Rock Hudson. But this was even before Magic Johnson had openly disclosed his HIV status. So, very little.

I went to college at Yale University, and in my first year at university, there were table tents, these little folded pieces of paper that give you information about things happening in the community. There was information about a local AIDS service organization, AIDS Project New Haven, having an orientation for new volunteers teaching people the basics about HIV and inviting them to volunteer. I was interested in going and learning more.

While I was there, I met people who were very passionate about HIV. I learned about the disease and its connection to social justice. And it seemed like an opportunity for me to use what little I did know to help.

There was a buddy program where you could be paired with a person living with HIV and help them do things like get their groceries and attend appointments, things like that. But I didn't have a car and I wasn't familiar with New Haven, so I couldn't do that. I ended up volunteering in the office, sort of assisting the director of the organization. She was a huge influence on my learning around the social justice aspects of HIV.

I ended up learning about how where the HIV epidemic is really raging tells us a lot about where there is injustice in this country. And it really inspired me to do something about it.

Photo courtesy of Tonia Poteat

1991-1993: First Steps in Atlanta

After I graduated from college, I wanted to go back to the South, so I started looking for work in Atlanta. I ended up at the Feminist Women's Health Center, and there was an opportunity there to apply for funding to start an AIDS hotline specifically for women. I ended up co-directing that AIDS hotline with a colleague.

In order to run an AIDS hotline, you have to have information to give people who call. We did a lot of research and accessed information to have available for the volunteers to share. We worked the hotline ourselves sometimes, so we learned about what kinds of questions people had when they called in.

Interestingly, the people who called the hotline didn't tend to be people living with HIV. The people who called tended to be people who wanted information. Sometimes it was students who were trying to write a report, or people who had family members that were living with HIV, or people who were afraid they might have been exposed to HIV.

That was actually not personal enough for me. That is one of the reasons I decided to go back to school -- to get medical training -- so I could provide care directly to people living with HIV.

Photo courtesy of Tonia Poteat

1993-1995: Becoming a Physician Assistant

In choosing to become a PA, I really wanted to do something that other people were afraid to do that I wasn't afraid to do. There was a lot of fear -- I think there still is now -- but there was a lot of fear in the '80s about HIV and HIV transmission and HIV risk. And people who were living with HIV often got shunned by their families, sometimes kicked out of their homes, and even health care providers would refuse to provide care for them.

I wasn't afraid. I felt like I had the information I needed to not be afraid. From what I had learned at AIDS Project New Haven and from the friends and people in my life who were living with HIV, I didn't see any reason to be afraid. And as my spouse always tells me, I have a strong empathy bone. So I tend to think about what it might be like to be in another person's shoes, and that tends to move my actions.

I wanted to do something more. I wanted to provide care for people, and I wanted to show other health care providers, I guess, an example of how to be a compassionate care provider who wasn't afraid of people living with HIV. So that was really my motivation.

Photo courtesy of Tonia Poteat

1996-2001: Moving Across the Country, and Across Specialties

I worked [in New York City] at a methadone maintenance program, in their HIV clinic, for several years through my National Health Service Corps scholarship. There was an LGBTQ health center in the community, and I volunteered on Saturdays. One of their Saturdays was [devoted to] transgender health and education. I didn't know anything about transgender health -- or transgender people -- other than the stereotypes, but as somebody who's part of the LGBTQ community myself, I knew that often people have stereotypes about you that aren't true, so I was open to learning.

That LGBT health center later became Callen-Lorde Community Health Center. When they bought their new building and became an independent health center, I started working there full time and I left the methadone maintenance program.

I worked there until my partner at the time got a job in Kansas. Then I moved to Kansas City.

While I was in Kansas City, there was a pharmaceutical company that was offering one-year hepatitis C training programs for nurse practitioners and PAs. They would pay your salary for a year to go work at a practice that specialized in hepatitis C care, and that way you could get training. I did that for a year and developed an expertise in hepatitis C treatment.

It's all connected. I worked at a community health center that took care of people, regardless of their ability to pay. The amazing thing about that clinic is -- my friends called it "that socialist clinic" -- everyone who worked there made the same amount of money. The medical director, the person who cleaned, the people who answered the phones. All the health care providers made the same amount of money. And doing that allowed us to provide care for people who were very low income and weren't able to pay. That was an amazing job.

We saw people with almost any medical condition. I saw a lot of people with HIV get their care there. A lot of transgender people got their care there. I was able to bring together two of my passions.

Photo courtesy of Tonia Poteat

2001-2018: Back to the South -- and Into HIV Policy Work

I missed home. I wanted to come back south, so I got a job at the Grady Health Center Infectious Disease Program in Atlanta, moved there, and worked there for seven years.

When I started working, they didn't have a hepatitis C–specific program. I was really eager to bring that to the practice. They were great in allowing me to set up that program; it had an educational component, a care component, and we tried to track data so that there could be a little bit of an evaluation -- sort of a research component.

The Southeast AIDS Training and Education Center was also in Atlanta, and I had been approached by them a couple of times to do hour-long sessions at various conferences or trainings that they were doing. One of the beautiful things about training is you get an opportunity to not only impart information, but also to model empathy for people -- [share with them] ways to engage with people that are less stigmatizing. It seemed like a beautiful opportunity to bring together my nerdy, science-y side with the desire to spread empathy and compassion as best I can.

While I was working at Grady, it was right around the time that PEPFAR was happening -- the President's Emergency Plan for AIDS Relief, which was the [U.S.'s] largest investment in HIV in Sub-Saharan Africa and other parts of the globe. I was eager to jump in and help if I could. I ended up talking with somebody who was at the Centers for Disease Control and Prevention who was deeply engaged in setting up their global AIDS program. I ended up working for them full time, and then part time over the years.

[Because] I was working at Grady, I felt like I had some things to bring to the table based on my years of experience providing HIV care. [But] what I also learned is that public health can be very hierarchical, and if you don't have an advanced degree, then you don't actually have a seat at the table to help make decisions.

I didn't have training in public health at the time, so I went back to Emory [University] to get a master's in public health. I went back to my job at CDC and I was doing exactly what I was doing before -- which was great, but [I realized it] wasn't what I wanted to be doing. I was also interested in doing research; I knew there were questions that I had around the social aspects of HIV that I didn't see the answers to anywhere. And that's when I decided to go back to school and get a Ph.D.

I applied to many schools. I ended up deciding on Johns Hopkins. I sold my house in Atlanta and moved to Baltimore -- and it changed my life.

Photo courtesy of Tonia Poteat

Path to Today

I don't think I thought cogently about stigma as a health problem until I was in my doctoral program.

I was working at the local community health center, which had a large LGBTQ population. Being a person [also] living in the community, I experienced that many of my friends in the LGBTQ community would talk about challenges that they had accessing and engaging in health care. Then I would go to work, and I would be working with these amazing, great people that seemed really nice and wanted to provide care, and I was wondering where the disconnect was. That sort of generated my dissertation project around, "How does stigma work? And how does it impact health?"

After I left the Office of the Global AIDS Coordinator, I joined the faculty at Johns Hopkins in the Department of Epidemiology with the Center for Public Health and Human Rights, where I worked for four years and had an amazing experience. And there's, I think, a time in most of our lives where it's time to go home, be where my parents are, and be ready for that stage of life.

That time came for me. So I moved to North Carolina, and I'm working at the University of North Carolina School of Medicine. I'm now affiliated with the Center for Health Equity Research.

The beautiful thing about being in a school of medicine now is that all of those things are well-integrated. The students that I teach are the future doctors. I get to bring a perspective that they may not be exposed to in other biomedical classes. I get to continue to provide care for patients in the [infectious diseases] clinic at UNC, and I get to continue my research. I can really do all of those pieces together.

I think the beautiful thing about being alive is we don't know what is around the corner next. If someone had said to me 20 years ago that I would be in Durham, North Carolina, working at the University of North Carolina, doing research on HIV with transgender women, I would wonder how that could possibly happen. It's been great.

I feel like I've had so many amazing experiences and opportunities in my life that I can't even describe. I feel very, very fortunate.