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The Numbers Dont Lie

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Numbers_Numbers Dont Lie.png

The infographic below shows the stark reality of HIV in Black America. The statistics are mind numbing. At current rates of infection, 50% of black gay men will have HIV by the time they are 35 (8% of white gay men are infected). I've been accused of caring more for the black community then I do for my own people. I love being Asian and I will always be concerned about my community, but the numbers don't lie. As an Asian gay man, I am fighting for black gay men because it's the right thing to do. I am fighting for black gay men because like the civil rights movement, it's going to take a rainbow of people fighting together to make a difference.

February 7 is National Black AIDS/HIV Awareness Day. We come together to once again draw attention to HIV's devastation of America's black community. How many more awareness days do we need in order to understand that we've failed black gay men? Nowhere in the world are there communities with a 50% infection rate. We have also failed African American women when they are 20 times more likely to be HIV infected then white women.
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In the fight against HIV over the last 30 plus years, the statistics for the black community were always known. The social determinants of health are often sited as the reason for the big difference. According to the CDC, "The social determinants of health are the circumstances in which people are born, grow up, live, work, and age, as well as the systems put in place to deal with illness. These circumstances are in turn shaped by a wider set of forces: economics, social policies, and politics." America has poor people of all ethnicities, so why aren't the rates of poverty equivalent by race? The color of your skin should not determine your health outcome, yet all the indicators reveal the opposite.

The HIV community cannot solve all the world's challenges, so what is our responsibility? A recent Lancet article notes, "33 percent of HIV-positive black MSM were retained in care, compared with 51 percent of white MSM; and only 16 percent of black MSM were virally suppressed, compared with 34 percent of white MSM. If black MSM achieved the same degree of HIV care as white MSM, the racial gap in new infection rates would be reduced by 27 percent. If black MSM with HIV had 95 percent diagnosis, or 95 percent retention in care, or both, the reduction would be 27 percent, 25 percent, and 59 percent, respectively."

In other words, if we're able to retain HIV positive African Americans in care, we can significantly move the curve. It's not enough to link people to care, all PLWH need to be retained in care.

NMAC challenges health departments and community based organizations to move quickly and aggressively to link/retain all PLWH into care. Since it's not enough just to link into care, we need implementation research to understand how to retain PLWH in care. AIDS United published an interesting study on the use of smartphone apps to support PLWH in care. A panel from the International Association of Physicians in AIDS Care has 5 recommendations on how to retain PLWH into care. NMAC thinks it may be time to look at incentive programs for either the PLWH or healthcare providers.

NMAC challenges the Centers for Disease Control, health departments, and community to re-examine the use of data. There is too much lag time between collecting the data and reporting on it. As a result, decisions are being made using data sets that can be 4 years old. How helpful is it to make decisions in 2015 based on data from 2010? This year the White House will release an update on the National HIV/AIDS Strategy, yet the data from the report may have been collected years earlier. It's very difficult to get a good picture of the epidemic if we don't have good data. NMAC asks health departments to create advisory committees made up of people living with HIV, activists, community based organizations, elected officials, healthcare providers, civil rights attorneys, researchers, and others to discuss the use of data. Policies that were put in place at the beginning of the epidemic may no longer be relevant. Making good decisions depends on good data. Data should be the foundation to determine how to spend limited HIV resources.

Viral suppression and when to begin treatment should be the PLWH's decision with support from their healthcare provider. Health literacy for all people living with HIV is essential in order for individuals to make informed decisions. NMAC calls for impactful, culturally intelligent health literacy programs to be made available to all PLWH. Differences in viral suppression based on race should be closely monitored with timely transparent reporting. Using viral load data, NMAC recommends that money and resources are prioritize for "hot spots", communities with a large numbers of PLWH who also have a high viral load. The money needs to follow the epidemic.

The color of your skin should not determine your risk for HIV infection, viral load, or mortality. On this National Black HIV/AIDS Awareness Day, let's commit to retaining everyone living with HIV into care.

Building Healthy CBOs

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This is a guest posted written by The National Minority AIDS Council, Director of Capacity Building Assistance Division, Kim M. Johnson, MD

For decades, NMAC has worked within communities of color, targeting community-based organizations, to build healthier communities.
Community-based organizations represent the backbone of the public health sector and play a vital role in eradicating HIV/AIDS. Today, community-based organizations (CBOs) are facing a rapidly changing health care landscape in which they must be able to adapt and change in order to be sustainable and viable. Now more than ever before, the principle of survival of the fittest is paramount.

The public health and health care systems are undergoing a paradigm shift fueled by the implementation of the Affordable Care Act, advancement of the National HIV/AIDS Strategy, medicalization of HIV services and biomedical advances. In this rapidly changing landscape, only healthy organizations will survive. Healthy organizations have "the capacity to learn and keep changing over time. They have the ability to align, execute, and renew themselves faster than their competitors can, that is, adapting to the present and shaping the future faster and better than the competition."

In order to improve the viability, sustainability and relevancy of CBOs in this dynamic environment, NMAC will provide capacity building assistance that works to build healthy organizations.

Healthy organizations have the following characteristics:
  • Organization alignment
  • Capacity for execution
  • Strategic partnerships
  • Capacity for change and renewal
  • Market-focused
  • Invest in people
  • High quality leadership teams

To that end, NMAC's capacity building assistance will work with CBOs to:

the infrastructure and culture within their organizations

strategic collaborations and partnerships

High Impact Prevention interventions and client-centered services

CBOs to effectively navigate and lead change

Aligning organization infrastructure and culture

Building on its landmark Organizational Effectiveness Series (OES ), a 15 volume set of organizational development manuals, NMAC will develop four new manuals focusing on Strategic Management, Organizational Change Management, Financial planning, and Resource Development and Marketing. Each manual will be in workbook format with web-based interactive components designed to enhance learning.

Creating strategic collaborations and partnerships

Given the changes buffeting the worlds of healthcare and CBOs, we are seeing more serious discussions of partnerships between CBOs and the healthcare sector than ever before. We're not referring here to short-term arrangements between a clinical provider and a social service nonprofit to collaboratively offer a program in response to a specially funded initiative, but rather to healthcare providers formally integrating networks of CBOs into their care delivery systems, and payers viewing CBOs as reimbursable providers of services that were previously the sole purview of clinicians. For partnerships between CBOs and healthcare providers or payers to be successful over the long term, both parties must be clear about their own interests, their assessment of what the other party brings to the table, and why working together is better than going it alone.

NMAC will host a series of consultations for CBOs and healthcare providers to discuss collaboration and partnership options and strategies. While the initial impetus for many of these discussions may be the big environmental shifts noted earlier, the best of the partnerships that ultimately form will be much less about a path to survival for the partnering organizations and more about a way for them to better serve their target beneficiaries. For healthcare providers, these partnerships offer an opportunity to actually improve the health of the individuals and families they serve rather than just treating them when sick, and to do so with a cost-effective approach. For CBOs, these partnerships may allow them to secure more sustainable sources of funding for their work and to scale up and serve far more persons than they might have previously imagined possible.

Executing High Impact Prevention programs and services

Many CBOS work with patient and peer navigators to engage PLWHA. In collaboration with the CDC, AIDS Project LA and the Denver Prevention Training Center, NMAC will host HIV/AIDS Navigation Services trainings. This training program aims to hone the knowledge and skills of navigators in HIV care, as well as provide them with the tools necessary to assist PLWHA in navigating the complexities of HIV care. The training program's format will be a combination of didactic sessions and interactive group exercises, including case studies to translate knowledge gained into courses of action driven by HIV AIDS navigation service protocols.

Equipping CBOs to navigate change

While facing the challenges of navigating the rapidly changing landscape, community-based organizations have a unique opportunity to establish a new niche for themselves by building upon their strengths and assets and learning how to successfully navigate change. Organizational change, however, is inseparable from individual change. NMAC's change management CBA program, focuses on building the capacity of CBO senior and mid-level executive leaders to lead change in their organizations and communities. The Building Leadership for Organizational Change and Sustainability program (BLOCS) and the Main Essentials for Mid-level Executives (MEMLE) program, build the capacity of CBO leaders to improve their change management skills and decision-making processes to effectively manage organizational change in a shifting healthcare environment. The programs offer in-person training, DiSC assessments, executive coaching and access to online change management resources.

Race Header_web.pngI grew up, literally and figuratively, in the HIV/AIDS movemevent.

The vast majority of people working to end the epidemic are good, honest, impartial  Americans who have committed their lives to
this fight.  They are not racist, they are progressive people who are trying to change the world.  That's why it's so perplexing, in a movement
committed to equality, why health outcomes are so different for gay men of color and African American women?

PK Email-02.pngIn 2015, the National Minority AIDS Council (NMAC) will talk, train and fight for racial justice. The ACLU defines racial justice as work that addresses issues that have a disproportionate and negative impact on people of color. Race Forward defines racial justice as the systematic fair treatment of people of all races, resulting in equitable opportunities and outcomes for all. At NMAC, we are going to look at racial justice through the lens of health equity. Our belief is that the color of your skin should not determine whether you are more or less at risk for HIV infection and that all people living with HIV deserve quality healthcare. NMAC will work to advance racial justice through advocacy, research and leadership development. Our measure of success will not be the number of people reached, it will be positive changes in HIV/AIDS health outcomes for all communities.

PK Email-03.pngHIV/AIDS most often occurs at the intersection of race, gender, gender identity, income, geography and sexual orientation. Among other things, addressing HIV/AIDS also requires frank discussions about about sex and drug use, at multiple levels including at the individual, family, community and societal levels. Addressing any of these issues is difficult, and to look at their interconnectivity seems nearly impossible. Even with the progressive politics of the HIV movement, black women are 20 times more likely to become HIV infected when compared to white women.  While alarmingly, some studies estimate that one in four Black men who have sex with men (MSM) will become HIV positive by the age of 25 and 60% by the age of 40.  What are we doing wrong?We don't want to be that angry organization that always brings the discussion back to race. We also don't want to be naive and never talk about race because its too divisive. Somewhere there has to be a middle ground. That is the space that NMAC is trying to reach, teach and empower.

Race MAtter image.pngThis month NMAC's 5 Divisions will share their 2015 vision and priorities, with an eye towards finding a middle ground on these issues and that maximizes broad and in-depth participation among stakeholders and constituents. This is not just for communities of color, but should be inclusive of all races. There is intrinsic value in diversity as an integral part of the discussion. In fact, it is essential that all people, regardless of race, be given the opportunity to contribute. NMAC's programs will address race directly, but we will also get to 'race' by addressing other challenges in the HIV/AIDS movement. For example, our treatment program will work to improve health literacy for all people living with HIV, but we will inevitably target communities of color more, given both the disproportionate impact of the epidemic coupled with disparities in educational attainment.

If we are committed to ending the HIV/AIDS epidemic, then we also need to commit to racial justice for all people living with HIV/AIDS. It's not possible to end the epidemic in just one community. We are too interconnected and interdependent.

Now it is up to us...

Yours in the struggle,



Paul Kawata

Executive Director

How I Vote Matters, #HIVMatters

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The following is a guest post by National Minority AIDS Council (NMAC) Director of Outreach and Public Affairs, Kyle Murphy.

HIVMatters-05.pngToday may be Halloween, but we're more excited for Nov 4: Election Day! But as communities gear up to turn out voters, others are still trying to make sense of new voting restrictions being pushed in states across the country. Since the Supreme Court struck down Section 4 of the Voting Rights Act last year [Shelby County v. Holder], several states have been emboldened in their push for laws to suppress turnout and disenfranchise voters, all in the hopes of gaining a slight edge on election day. Tactics range from reducing early voting periods, to requiring government issued photo ID, or eliminating same-day registration. But across the board, they hit communities of color the hardest.

Show that we won't be silenced! Learn what your state's requirements are to vote and see all our graphics at

HIVMatters-02.pngWhile national media focus on the undeniably important races for control of the U.S. Senate, perhaps more significant for our community are the gubernatorial, state assembly and city council races across the country. The people elected to these seats will determine the future of the very voter restrictions that are wreaking such havoc this year. They will also decide whether your state will cooperate and/or participate in Medicaid expansion, determine how state prevention and care funding is distributed and what types of sexual education is made available to residents.

Those communities that have borne the brunt of the HIV epidemic are the very ones that have struggled the hardest to secure the right to vote. From ratification of the 15th and 19th amendments, which extended voting rights to former slaves and women, through the passage of the Voting Rights Act in 1965, our nation's progress has been closely tied to the ability of marginalized populations to vote. Now, even as issues that will impact the health and lives of people living with and vulnerable to HIV are center stage, these very same communities must contend once more with questions about how and if they can vote.

Elections should be won on issues, not voter suppression. Stand up and speak out! Get to the polls on Tuesday and vote on the issues that matter to you! Share our images and tell us why or how you voted with #HIVMatters.

The following is a guest post by National Minority AIDS Council (NMAC) Deputy Executive Director Daniel C. Montoya

Few things expose a society's inequities like a crisis. In America, periods of conflict, or social and economic upheaval, reveal the best and worst of our collective nature. From our founding document, which enshrined racial inequality into the Constitution, to Japanese internment camps during World War II, America's most celebrated moments are often blemished by our imperfections. The early years of the AIDS crisis were no different. We witnessed terrible displays of bigotry and fear, but also incredible examples of generosity and heroism. Like so many crises before it, the HIV/AIDS epidemic forced us to confront the impact of the inequities that had persisted since our founding, including our history of racism and marginalization of impoverished communities. But unlike previous crises in our country, this one forced America to confront its treatment of an often-invisible minority, the gay community.

While communicable diseases have no gender, race or sexual orientation, and hold none of the biases that so many people do, they will often impact specific populations differently according to various epidemiological processes, as well as social dynamics. In those first years, just as today, HIV was predominately focused in the LGBT community. And while the modern gay rights movement started 12 years earlier at a small inn and tavern in New York City, it wasn't truly set ablaze until the 1981 report of five cases of Pneumocystis carinii pneumonia (PCP) among previously health young gay men in Los Angeles - the very first cases of AIDS ever published.

LGBT individuals have been present through the entirety of human history, helping to shape our world. But as a movement, ours is relatively new. While there have always been brave gay men and women who stood up against hatred and injustice, the larger movement for LGBT equality did not emerge until 1969 when a police raid of the Stonewall Inn sparked a riot and a battle for equality that has raged for 45 years. Activists like Bayard Rustin and Harvey Milk nurtured the nascent movement through the next decade, but when AIDS began ravaging gay centers from San Francisco to New York our struggle for fairness transformed into a battle for our lives.

As movements, the LGBT and HIV/AIDS communities have always shared a common history, and so it should be no surprise that June, officially recognized as LGBT Pride month, is also quite important to the HIV movement. Friday, as it does every year on June 27, our nation marked National HIV Testing Day, an annual observance that coincides with the anniversary of the Stonewall riots, which began this night in 1969 and lasted well into the next morning. On June 5, 1981, the first reported AIDS cases were published in the Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report. And just last year, on June 26, the Supreme Court struck a massive blow to those who oppose marriage equality by striking down Prop 8 and gutting the Defense of Marriage Act (DOMA).

We have made great progress in our fight for equality and an end to the HIV/AIDS epidemic. Today, our movements are making major strides at a rate that our founders could never have imagined. In the year since the Supreme Court handed down its gay marriage decisions, courts in 20 states have ruled against gay marriage bans, with the most recent coming down this week in Utah. In January, the Affordable Care Act came into full effect, with total enrollment surpassing the White House's goal of 7 million by the end of March - despite widespread conservative obstruction. Last month, the CDC published official guidance to health providers on pre-exposure prophylaxis (PrEP). And just one week later, the CDC made history with the release of its new social marketing campaign "Start Talking. Stop HIV," the first federally funded HIV education campaign exclusively focused on gay men of various races and ages, and also the first to feature the prevention benefits of treatment.

As our nation marks National HIV Testing Day and the anniversary of the Stonewall riots, we must remember that just as our histories are closely intertwined, so too is our future. Despite our multitude of policy successes, we have failed to make any real progress in reducing HIV infections within our community. Gay and bisexual men are the only population facing increasing rates of infection, with young black gay men experiencing the most severe spike. We cannot truly achieve victory in our struggle for equality until we have also achieved LGBT health equity, including an end to the HIV/AIDS epidemic. Our history has demonstrated our capacity to accomplish amazing things, and making this terrible disease history will be just such an achievement. But we cannot do it separately. As we close out another LGBT Pride month, lets commit to making this the closing chapter of our AIDS history.

Whose Culture Is It Anyway?

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Last week I had the privilege to watch Larry Kramer's The Normal Heart on HBO. This week, I saw Terrence McNally's latest Broadway play, Mothers and Sons. The first was about the early days in the epidemic and the later examines life after the epidemic's wrath. I cried, I laughed, I remembered. I hope they both sweep the awards season. However, I am concerned that this cannot be the only narrative of our movement's history. 

Both the movie and the play are about beautiful, rich, white, gay men who live in New York. Not that there is anything wrong with that, it's just that our story is so much bigger. Where are the stories about women and AIDS? Who's writing about black gay men? When will we get the definitive biography about the trans community and their struggle to end the epidemic. Why aren't there stories about injection drug users who lead the charge on needle exchange? What about all the gay men who don't live in New York, San Francisco or Los Angeles. 

Don't get me wrong, Matt Bomer in The Normal Heart was a revelation. Tyne Daley in Mothers and Sons reminded me of my mother, except with much better comedic timing. It's just that we all of us don't have homes in the Pines or apartments with views of Central Park (you will have to see the movie and the play to understand these references). I don't begrudge these talented writers, directors and actors. I am just concerned that their stories will define and limit our epidemic. I'm asking Hollywood and Broadway to do more. 

The HIV epidemic cannot only be defined by the Normal Heart, Mothers and Sons, Angles in America, Falsettoland, Philadelphia, Dallas Buyers Club, Longtime Companion, And the Band Played On, We Were Here, or How To Survive A Plague. Wouldn't you love to see a movie where Lupita Nyong'o plays a lesbian AIDS activist fighting to help her gay brother living with HIV? Making his big screen debut as the gay brother is Pharrell Williams! The score for the movie could be composed by Frank Ocean

Philadelphia was released in 1993 at the height of the epidemic. Tom Hanks gave the performance of his career. He opened a window to our fight. For some people, he was their first exposure to the epidemic, other than the often inaccurate and stigmatizing nightly news stories. He helped to translate the compassion, courage and strength it took to fight AIDS in those early years. The disease was no longer about "them." Mr. Hanks was a familiar face and a beloved actor. He made us human in a world that felt like it had lost its humanity. Twenty years later, it's time for some new heroes. All of us need to give voice to what it means to fight an epidemic. One day I hope to write my story, not that its special. I am not sure how to adequately capture the pain, loss and sorrow of the early years, I just know that our stories and our heroes need to be remembered in all of their diversity. 

Yours in the struggle,

PKawata Signature.jpg

Paul Kawata
Executive Director
National Minority AIDS Council



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