Among the myriad topics Mayor-elect Rahm Emanuel must confront during his term, which starts May 16, are health issues concerning the LGBT community—including AIDS.
In a conversation with Windy City Times, Emanuel and Chicago Department of Public Health ( CDPH ) Commissioner Bechara Choucair talked about issues such as funding, the Office of LGBT Health and the national AIDS conference that is coming to Chicago in November. However, the talk began with a major announcement involving Emanuel and Choucair.
Windy City Times: I understand that you have an announcement to make regarding the Chicago Department of Public Health.
Rahm Emanuel: Yes. Dr. Choucair is going to remain commissioner. We had a meeting of the minds about what I think the office can do, what I think he can do to carry out the changes we need to make sure we're doing what we need to do as it relates to public health.
Windy City Times: Can you give me an example of the direction you'd like the office to go in?
Bechara Choucair: Andrew, I'm very excited that the mayor has asked me to continue to serve in my capacity as commissioner of the Chicago Department of Public Health, and I look forward to working with the dynamic and diverse group of leaders he's putting together.
As far as direction, I've been in the office for a little bit over a year. We laid the groundwork and I'm really excited about taking it to the next level.
There are three items I want to highlight. First, we need to better collaborate with [ Cook County ] to insure services are available to residents in our city. The second piece is that when you consider a city of 2.7 million residents or so, we have to concentrate our efforts on sustainable policy changes and environmental changes. The third piece I want to highlight is that we have to continue to be innovative in our approaches and, now more than ever, we have to continue to engage our community partners in a meaningful way.
Rahm Emanuel: First of all, I think the doctor is uniquely qualified but he's put together a reform agenda and I don't think he's had an opportunity to see all the reforms and changes through. I want his energy and commitment since he's developed it. If you had somebody else, he'd be implementing Dr. Choucair's policy—and I didn't want that. I want someone who's emotionally and intellectually committed to these reforms that I wholeheartedly endorse. So that's why I've asked him to stay on and to continue to see through these reforms.
Windy City Times: What do you think are the LGBT health issues that are most in need of tackling?
Bechara Choucair: We all know that there are significant health disparities impacting the LGBT community. I know that you're probably aware of the [ U.S. ] Department of Health and Human Services report that has included LGBT-related issues for the first time. The reality, though, is that many of the issues facing the LGBT community are the same issues that are faced by everyone else: obesity, tobacco use, access to care, heart health, HIV, substance abuse. So as we set our workplan, as a department, on these important public-health issues it is really important that we look at it [ in terms of ] cultural competency. That way, we can ensure that the needs of the LGBT community and other communities are being addressed appropriately.
Windy City Times: Will the Office of LGBT Health still be around?
Rahm Emanuel: Well, here's the way I'm looking at it: I want you to know that I'm making no pledges on anything. When I get to the office as mayor, not mayor-elect, [ I'd like to ] have all the departments review the choices we need to make. I'd like to do that, but I think it'd be inappropriate if I made a pledge until I saw the whole picture.
I've heard from the community, and I share their aspirations. But I have to tell the truth and, as a city, we have to face hard truths and hard choices. I'm not making a commitment without knowing the full extent of where we are financially as a city. Our budget today reflects as if we're living in 1995-1996 when, in fact, the economy is not in that position. So the long and short of it is: I share the goal, I'm not ready to make that commitment until I see the totality of our financial picture.
Windy City Times: OK. I was looking at an AIDS Foundation of Chicago survey you completed a while back. You supported a lot of different issues, but as I was going through I was thinking there is a difference between wanting to support something and being able to.
Rahm Emanuel: Let me say it again: I share the aspiration, and I don't have the full budget. Do you know how big the shortfall is?
Windy City Times: Obviously, it's significant.
Rahm Emanuel: I know that, too. I have to get my hands around that. Making pledges I can't keep is kinda worse than telling people the truth. It's a goal I like to share but the question is, "Can I achieve it another way?" If the only way I can do is the office, what are the choices I'm willing to make and the sacrifices I'm ready to make throughout the budget or in the department? As [ President John F. ] Kennedy said, "To govern is to choose." At this point, I can say with all honesty that it's an aspiration and a desire. If I decide to keep [ the Office of LGBT Health ] , I gotta make some other calls where I'm going to make cuts.
I want the public to know [ after I make decisions ] that these are the trade-offs—that's why I'm not ready to make a pledge.
Windy City Times: As of March of this year, more than 36,000 Chicagoans have been reported to CDPH with HIV since the early '80s. Of that amount, 39 percent have died. Did you think we'd be at this point—where there is no cure three decades after the virus was discovered?
Bechara Choucair: I think, Andrew, over the last 30 years much has been accomplished, whether on a local, national or global level. We have seen significant improvement in prevention strategies, treatment and overall policy. We've made a lot of progress. Are we where we need to be? We still have a lot of work ahead of us.
Rahm Emanuel: I want to echo that even further. You can look at from the fair [ perspective ] , "Thirty years later we don't have a cure." On the other hand ... look, I lost a cousin to AIDS. The notion between time of contraction and death is [ longer ] ; we have extended people's lives. But it's not just extending their lives; individuals with AIDS can function in a normal sense. That wasn't true for my cousin.
So, no we don't have a cure; that's the journey we're still on. But when you look where we were when Ronald Reagan wouldn't recognize it as a president to extending people's lives ... . When I think of my cousin, Gary, we are light-years ahead of that on the preventive side as well.
You asked the right question. I think, as any of us who's in the midst of public policy and has been exposed to the public-policy choices [ regarding ] medical care and preventive care, we aren't where we were in 1984, '85, '86—or, for that matter, I remember the battle for Ryan White funding in 1993. To know where you're going, you have to know how far you've traveled.
Windy City Times: The country's largest gathering on AIDS—the U.S. Conference on AIDS—will be in Chicago this November. That made me wonder: How is Chicago handling the HIV/AIDS crisis in comparison to other large cities around the nation?
Rahm Emanuel: The good news is that we have until November. [ Laughs ] First of all, I think it's appropriate that Chicago is hosting that conference. We have a lot to talk about as a city—not just about approaching AIDS as an illness, but as a community. I'll be mayor at that time, and I look forward to hosting that conference and talking about what we've done and what we can learn to do better—and I think everybody will bring those experiences from their respective cities.
Windy City Times: How will the department reach out to certain "at-risk" communities—minorities ( especially African Americans ) , the transgender community and men who have sex with men [ MSM ] —in light of possible reduction of funding?
Bechara Choucair: It's really important to note that we put the majority of our funding out to community-based organizations that do a lot of services for our residents. Actually, 64 percent of our funding goes out to a competitive bidding process for community-based organizations. You know that these three populations that you mentioned—the MSM population has been our highest priority for years. We also have a lot of interest in the transgender community and, obviously, the majority of our HIV funding goes to racial and ethnic minority populations. So we have identified and flagged these priority communities to make sure our funding is targeted appropriately.
Also, keep in mind that we do that in partnership with the community. Two bodies that actually help drive our strategy are the HIV Prevention Planning Group and the Chicago Area Services Planning Council. Walter Mall and Martine Gonzalez from the HPPG as well as Jeff Willoughby and Peter McCoy from the Chicago Area Services Planning Council really help drive the way we invest our resources.
Windy City Times: Is there anything either one of you wanted to add?
Rahm Emanuel: I'm just looking forward to giving the doctor his assignment to get ready [ for the AIDS conference in ] November. Thank you for that, Andrew. I have to be honest: I didn't know about that, and I want to make sure the city is the right type of host.
