THE VOICE OF CHICAGO'S GAY, LESBIAN, BI, TRANS AND QUEER COMMUNITY SINCE 1985

At the same time, those on the front lines in the battle against AIDS are voicing concerns about how to keep up the fight against HIV when it is increasingly—and depressingly—clear that those who are vulnerable to HIV today are those who were dying 30 years ago: gay men, people of color and those living in poverty. Meanwhile, a fast-changing health care landscape under Obama's health-care reform law is making it less certain where the much-needed dollars for prevention, outreach and education will come from.

In appointing Brooks March 24, Obama said in a statement that Brooks was "well-suited" to the job of director of the White House Office of National AIDS Policy ( ONAP ). It was not hyperbole. Brooks served most recently as senior vice president for community, health and public policy at Justice Resource Institute ( JRI ), a health and human-service agency based in Boston. He holds an MSW degree, is a licensed clinical social worker, and has extensive managerial and programmatic experience in implementing HIV programs both domestically and abroad. As an openly gay African-American man living with HIV, Brooks will also serve as something long missing from ONAP: the face of the epidemic.

The White House Office of Communications declined a request to interview Brooks for this article. But in interviews with leading HIV advocates and policy makers around the country, a consensus emerged of the community's expectations of Brooks: They want to see strategies put in place that address an array of HIV-related issues beyond advancements in HIV research and biomedical science to stigma, discrimination, and criminalization to unemployment and poverty to mental illness and substance abuse.

HIV/AIDS service care providers, activists,

policy experts' voice hopes, concerns

"What I hope is that under Douglas Brooks' leadership, the federal response to the epidemic will devote as much effort to addressing stigma—through meaningful empowerment and engage of people with HIV—as they have been devoting to promotion of biomedical prevention strategies," said Sean Strub, HIV/AIDS activist and author of a recently published Body Counts: A Memoir of Politics, Sex, AIDS, and Survival.

Strub added that he was "doubtful" that the United States would be successful at winning the battle against AIDS by relying on increasingly sophisticated medications—a strategy known as "treatment as prevention."

"There is no pill or potion that treats stigma. Reducing stigma—which is the number-one reason why people at risk are reluctant to get tested and why people who test positive are reluctant to seek treatment—is accomplished only by empowering the stigmatized," Strub said. "That means we need to support networks of people with HIV and prioritize more highly the human-rights aspects of the epidemic that include patient autonomy, strong confidentiality protections, the right to keep one's private medical information private, treatment literacy, discrimination and criminalization."

Kali Lindsey, deputy director of the public policy office at AmfAR ( The Foundation for AIDS Research ), said that Brooks "embodies what is possible" for people living with AIDS. But Lindsey cautioned that the next two years, during which the Affordable Care Act ( ACA ) will be implemented, are critical ones for those fighting HIV and AIDS. The ACA programs that hold the most hope for those living with HIV—namely an expansion of Medicaid that would give many of those living with HIV who currently do not have access to health care, the opportunity to get desperately-needed health care and HIV medication—need to be set "on a strong foundation, addressing barriers that continue to restrict meaningful access" to health care insurance for those who have long gone without it.

David Munar, president and chief executive officer of Chicago's Howard Brown Health Center, echoed Lindsey's concerns about ensuring that the ACA's promise of expanded health care access is fulfilled. But he added that he would like to see "focus from the White House on articulating a vision for AIDS organizations, particularly non-clinical ones and how to maximize the resources that we have."

Munar, who has worked for AIDS-service organizations for two decades, pointed out that "access to insurance does not does necessarily mean people's health will improve." One of the key functions of AIDS service organizations, he noted, was to give people the support they needed to stay connected with health care providers by assisting with critical needs like housing, nutrition, and employment.

"We need to harmonize those different assets and different layers of infrastructure, including the multi-billion dollar investment from the federal government. And an AIDS safety net—harmonize it with new insurance opportunities to make sure people get enrolled and ensure that they utilize and benefit from their coverage," said Munar.

The Rev. Stan J. Sloan, CEO of the Chicago House and Social Service Agency, was more blunt: For most people living with HIV, their major concern is not HIV. "Their major issue is poverty. And we, as a nation, don't talk about that," he said.

"I think we are at a place where new infections will be on the decline, and we are in fact seeing this," Sloan said. "We keep talking about HIV like it is a major health concern for the average American, and it honestly just isn't. We can keep trying to make it a crisis … or we can actually start talking about what it is: a chronic disease that people with money live with relatively easily, and people with no resources are affected by."

Suraj Madoori, of the HIV Prevention Justice Alliance ( PJA ), said that there needs to be a concentrated focus on "creating more economic opportunities, jobs and empowerment of people living with HIV."

"We want to see Douglas Brooks in his new role take active steps and follow-through in addressing social drivers of HIV through proven structural interventions such as employment policies and programs targeting people living with HIV," Madoori said.

He said his organization's "aim is to actively shift the national conversation, and policies, from poverty to creating economic opportunities, jobs and empowerment of people living with HIV."

Earlier this month, HIV PJA launched its HIV Economic Empowerment Campaign ( www.preventionjustice.org/work ), which, the organization said, would significantly impact the health and lives of people living with HIV in the U.S. by bolstering employment rights and addressing the needs of people living with HIV who are economically marginalized, according to a press release.

Altogether the efforts aim to shift the conversation along two fault lines, from poverty to income, from economic instability to security and independence.

HIV/AIDS funding and

HIV incidence at a glance

Funding under the Ryan White CARE Act, the largest federally funded program in the US for people living with HIV/AIDS, rose to $2.352 billion in fiscal year 2012, up five percent from 2009. The law provides funding to improve availability of care for low-income, uninsured and under-insured victims of AIDS and their families.

But Ryan White provides for care—not prevention. In fact, only three percent of all HIV funding in the U.S. goes to prevention. At the Centers for Disease Control and Preventions, or CDC, its prevention funding stood at $790 million for fiscal year 2012.

Altogether, Obama, on April 14, requested for fiscal year 2014, an estimated $29.7 billion for combined domestic and global HIV/AIDS initiatives, according to Kaiser Family Foundation fact sheet, with $23.2 billion for domestic HIV/AIDS and $6.5 billion for global activities.

In the U.S. overall HIV incidence, or rates of infection, has remained stable since the mid-1990s—about 50,000 infections per year—according to the CDC. And yet HIV disproportionately affects certain groups, including African-Americans, Latinos and gay and bisexual men of all races and ethnicities. Transgender women are also disproportionately impacted, although they are not tracked in U.S. statistics.

Perhaps most alarmingly, new infections among the youngest MSM ( aged 13-24 ) increased 22 percent, from 2008 to 2010, according to a December 2012 CDC fact sheet, with young Black MSM continuing to bear the heaviest burden. They account for 55 percent of new infections among young MSM. Young Black MSM now account for more new infections than any other subgroup by race/ethnicity, age, and sex. Altogether, there was a 12 percent increase in HIV incidence among MSM overall, from 2008 in 2010, according to the CDC.

Despite the disproportionate burden of HIV among MSM, particularly Black MSM, HIV prevention largely targets heterosexuals and other risk groups, according to analysis at the Boston-based Fenway Institute. One Wisconsin case study, for example, showed that while Black MSM accounted for 58 percent of HIV diagnosis in that state for 2009, only 19 percent of targeted tests and 11 percent of HIV prevention clients were funding targeted to MSM.

"We want to see more of the prevention money going to prevention among gay and bisexual men," said Sean Cahill, Health Policy Research director at Fenway. "That's a top priority."

Cahill also pointed to the role of ONAP in "moving forward" the "HIV treatment cascade."

An arm of the White House Domestic Policy Council, ONAP coordinates ongoing implementation of the National HIV/AIDS Strategy and the HIV Care Continuum initiative, at the same time working together with public and private partners to advance the federal response to HIV/AIDS.

Key components in stemming the rates of new infections involve several stages: HIV diagnosis, medical care and antiretroviral drug treatment to suppress viral load to very low, if not undetectable level. When a viral load is suppressed, it becomes much more difficult to transmit HIV from one person to another.

In December 2013, CDC estimated that almost one in six, or 15.8 percent, of the 1.1 million people living with HIV in the United States are unaware of their HIV-positive status.

For Carl Sciortino, an HIV-positive gay man who recently assumed duties as executive director of Boston-based AIDS Action Committee, this fact alone makes the work of outreach and education a top priority.

"We need to continue doing the work of finding those who do not know they have HIV and getting them connected to care. We need to work with those who know they have HIV and keep them connected to care," he said. "HIV intersects with other social justice issues such as racism, poverty, homophobia, and transphobia. It is hard to take your medicine every day if you are struggling with issues related to poverty such as unstable housing and poor nutrition. We need the resources to provide the social supports that help keep people connected with health care."

Sciortino also points to President Obama's July 2010 "National HIV/AIDS Strategy for the United States," a 45-page document that articulates a vision, as well as an aggressive plan to lower HIV infection rates and get those who are already living with HIV into care.

Accordingly, "It is incredibly important that we continue a very public dialogue about HIV and AIDS," said Sciortino. "Stigma continues to be a horrible issue for many of those living with HIV. Gay men who fought to be out have survived only to build new closets around their HIV status. This is unacceptable. The only way to end the stigma is to continue to force the conversation."

©Copyright. Chuck Colbert. All rights reserved.

More info about Brooks is online at www.WindyCityMediaGroup.com .

Chicago enthusiastic about Brooks

By Matt Simonette

Officials from Chicago-area HIV/AIDS organizations responded enthusiastically to President Obama's appointment of Douglas Brooks as director of the White House Office of National AIDS Policy.

"AIDS Foundation of Chicago [AFC] thanks President Obama for appointing Doug Brooks as director of the Office of National AIDS Policy," said John Peller, interim president of AFC, in a statement."

David Munar, the new president of Howard Brown Health Center, said he was "thrilled" to see Brooks in the position.

"He's a superb selection," noted Munar, who was honored alongside Brooks at the Bayard Rustin Community Breakfast in Boston April 12. "He has been working, thinking and living with HIV for years, and has done a lot of work on the ground. He also has the policy gravitas for the job, and represents the populations most affected by the crisis as an HIV-positive African-American gay man."

According to Jeff Barry of Test Positive Aware Network, "The appointment of Douglas Brooks to head the Office of National AIDS Policy demonstrates that the Obama administration is committed to realizing the objectives of the National AIDS Strategy. Gay men, and particularly young, Black, gay men, continue to be among those communities that are hardest hit by the HIV/AIDS epidemic."

See related coverage at:

http://www.windycitymediagroup.com/lgbt/SIDEBAR-White-House-declines-Brooks-interview/47524.html

http://www.windycitymediagroup.com/lgbt/Douglas-Brooks-heads-White-House-office-on-AIDS-policy/47514.html

www.windycitymediagroup.com/lgbt/New-AIDS-czar-HBHC-CEO-honored-in-Boston/47528.htm