As the HIV/AIDS epidemic carries into the second decade of the 21st century, Keith Green has emerged as a strong contender in the fight. When meeting him it is impossible to overlook his deep respect for the individual humanity of people with AIDS, and his passion for encouraging goodness in those who need it most.
For seven years, Green has been involved with a number of direct, community-based outreach programs, and, this past February, Green was hired as the new director of federal affairs at the AIDS Foundation of Chicago ( AFC ) .
While the face of HIV/AIDS has changed over the past 30 years, so has the complexity of the struggle to combat the disease. Green is a new sort of AIDS health professional that looks beyond traditional treatment methods. "HIV is a symptom of a much larger combination of sicknesses," Green said. " [ Like ] poverty, homophobia, racism, and sexism. I'm more interested in figuring out how to tackle some of those larger issues, in and out of the context of HIV, so that we can really get a grip on the epidemic."
He goes on to say that, while sexual health education is an absolutely necessary part of the overall strategy, people would "throw all of that out of the window if [ they ] don't have anywhere to sleep." Next year Green plans to start work on his Ph.D. in social-welfare policy to further deepen his understanding of the issue. "I went to school to be able to mix the sort of community-based perspective with what I was learning from academia, and pull them together to really drive the work, to help make it better."
When Green started at AFC earlier this year, a new Congressional session was beginning with a strong GOP majority in the House of Representatives. Revising the budget was at the top of the list of the new Congress, and one of the first cuts proposed was the elimination of federally funded needle-exchange programs. Green quickly got to work contacting elected officials and he helped to develop a strategy that eventually kept the needle-exchange programs in place.
While he has many duties as director of federal affairs, Green's primary responsibility is monitoring how federal funds are applied, specifically making sure that Illinois is in alignment with the national HIV/AIDS strategy. Dr. Margo Bell, a pediatrician who has worked with Green for the last six years on various sexual health education initiatives, reports that Green is always asking "Is the fight about money, or is the fight about people?" With strong roots in community advocacy, it seems that, at least in Illinois, Green one of the people who makes sure money for AIDS initiatives gets where it needs to go.
In 2009, Bell approached Green about serving as project director for a pre-exposure prophylaxis study at John H. Stroger Hospital. Dubbed "Project PrEPare," the trial tests the acceptability and feasibility of using Truvada, a powerful anti-retroviral drug, as a method of HIV-prevention in young men in the Chicago area. Dr. Sybil G. Hosek, an expert on adolescent psychology, was the principal investigator on the project.
During the recruitment phase of Project PrEPare, Green informed his research assistants that their time would be split equally doing research and outreach. Although women and HIV-positive individuals were excluded from the study, Green's team did their best to direct people to places in their community where they could get tested and keep them informed about available resources. They even went so far as to escort people to appointments at local clinics and follow up to direct them to treatment, if necessary. Green was very careful to tailor the study to fit the needs of the community. In Green's words, "We built a lot of relationships out in the field, which, you know, is uncommon in research, and is what, at the end of the day, has made a difference for us and for our communityand it's continuing to make a difference."
On Nov. 23, 2010, Gladstone Institutes, a non-profit independent research organization affiliated with the University of California at San Francisco, published data on a similar international study in The New England Journal of Medicine. The results showed that the rate of HIV infection was dramatically lowered with the correct dosage of Truvada.
After Gladstone's Iniciativa Profilaxis Preexposicion ( iPrEx ) data was released; Project PrEPare was put on hold; and Green called a community forum at Center on Halsted to discuss the potentially game-changing results. A major concern discussed at the meeting was about the ethics of giving some participants a placebo when the iPrEx study had such success. After he advocated with the principal investigators, Project PrEPare was reinstated, and all participants taking the placebo were given the opportunity to join the main branch of the Stroger study.
Green also reached out to Dr. Robert Grant, principal researcher of the Gladstone Institutes study, in hopes of folding Project PrEPare into the main iPrEx trial. Concerned about the lack of young people involved in the first cohort of participants, Green strongly lobbied for his work with Hosek and Bell to be included in the larger work. Men who have sex with men in their teens and 20s have one of the fastest rising rates of HIV infection in the country. Green knew that for the study to have the most impact, data from younger people would need to be captured. Earlier this year, Stroger Hospital became an official iPrEx testing site, and Green is now working with the head investigators to translate the information about the study to a younger audience.
Bell enlisted Green to serve as director for another project based out of Stroger Hospital offering evidenced-based interventions to the Chicago house ball community. Made famous by the 1990 documentary film Paris is Burning, the house ball scene is an underground group of primarily LGBT individuals who compete for trophies in different categories based around gender presentation and class. The ball scene is a safe haven for transgender people and gender-nonconforming gays and lesbians. There are formalized groups within the communityreferred to as "houses," headed by a man or woman, termed the House Parent. Members of the Ball scene have been one of the groups hardest hit by HIV/AIDS. In Green's words, "One of the things the house ball community taught me is that poverty is a huge driver of the epidemic in that community. Poverty exists for a number of reasons. A lot of it has to do with homophobia and discrimination against more effeminate men and trans folks."
During a focus group Green and Bell conducted with the House Parents Association, the community leaders said the epidemic had reached the point that they were attending three to four funerals a month within the region. They also expressed concerns about seeking out help, due to their past history of opening their community to scientists and artists, only to be exploited. Green is very sensitive to these issues, and is working to shape his programs to create a sustainable environment for the scientists to get the data they are looking for and the community the resources it needs. For Green, it's not just about the research. It's about being able to give people the tools they have to have to improve their lives and to help them find what it takes to keep going.
As with Project PrEPare, Green is working to translate the resources of the community health system to best help a high-risk community. The project will soon launch a series of interventions that will feature educational materials on the U.S. Centers for Disease Control, food, and guest speakers on topics like stigma and the medical and pharmaceutical options available.
The personal is political
Being involved in community outreach is now an essential part of Green's life and work. He has reached a level of success professionally, holding two degrees, working with at-risk communities, and now with the largest AIDS organization in Chicago; however, it was not always this way. The journey to reach this point was a long one.
In 1994, when he was 17 years old and still a senior in high school on Chicago's South Side, Green was diagnosed as HIV-positive and given roughly 10 years to live. After a few attempts at pursuing the future he had hoped for, Green accepted that he only had a limited amount of time left. He decided to enjoy his remaining time, but largely ignored the disease, forgoing medication or treatment of any kind. For eight and half years Green lived his life and held a variety of jobs, including claims adjustor for an insurance company, bookstore clerk, and roller rink manager.
In 2002, while he was living in Charlotte, N.C., Green's health declined drastically. An old friend of his claimed him as a domestic partner to get him insurance coverage. Blood work revealed his viral load was in the hundreds of thousands, his T-cell count was at 30 and he was 50 pounds underweight. He was immediately hospitalized. At that point he assumed that his 10 years had come a little early, and it wasn't until his doctor gave him a copy of Positively Aware, an HIV-treatment journal published by Chicago-based AIDS community group Test Positive Aware Network ( TPAN ) , that Green began to think about the future again.
Soon after the initial incident, Green moved back to Chicago with a thirst for knowledge, and started attending TPAN meetings regularly. Eventually he began working at TPAN and earned a bachelor's degree in social work from Northeastern Illinois University while struggling with a bad case of immune reconstitution syndrome. During this time, he even had biopsy wounds open up during a final exam. Green's reaction was to retreat the wound and finish the test. He aced it.
While at TPAN, he started community outreach programs that took sex education right to the dance floor of nightclubs in the neighborhoods hardest hit by HIV/AIDS. Green would dance with the crowd and pass out condoms and candy. He also taught classes at the organization to teach people with HIV about the biology behind the disease and the different treatment options available. His favorite class was the ABC's of Anti-Retroviral Therapy. He even became associate editor of Positively Aware.
Green brings out the best in people. When he was struggling to form a picture of his future during his first major illness, a close family friend gave him the encouragement and hope he needed to get back on his feet and build a life for himself. Although he has come a long way since then, Green hasn't forgotten those times or those words. He is busy balancing federal advocacy with the AFC, serving as co-chair of the Chicago Black Gay Men's Caucus, managing a potentially life-saving study and developing educational programs for at-risk communitiesthe normal ups and downs of a man in his 30s. While he is always looking for how he can best help his community next, Green still remembers the power that a little bit of hope can have to inspire someone on the brink of defeat.