From Pennsylvania Avenue to Main Street: HIV and Public Health

>> Good evening. On behalf of CDC's Division of HIV/AIDS Prevention and the National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, it is my pleasure to welcome you today to the HIV/AIDS 30 Years of Leadership and Lessons. I appreciate all of you joining us this evening for the lecture. As many of you are aware, this year 2011 marks the 30th commemoration of the first reported cases of AIDS in a Morbidity and Mortality Weekly Report. Today's lecture is one of ten that CDC has posted throughout the summer to raise awareness about the bold strides public health has made in the HIV/AIDS epidemic and provide a platform that examines the successes and challenges over the past 30 years. Today's conversation will focus on the political and social challenges that have impacted the HIV/AIDS epidemic. Challenges of sex education, condom distribution, and needle exchange are topics that have been and are still being heavily debated today. We have invited guests from diverse backgrounds to share their views on the political and social challenges that have helped shape the epidemic in the past 30 years. From the moment in 1986 when U.S. Surgeon General C. Everett Koop publicly called for health education and condom use to combat the AIDS epidemic, to the opinions voiced by U.S. Surgeon General Joycelyn Elders regarding contraceptive distribution in schools, and in 2009, when Congress modified the ban on the use of federal funds for syringe services programs. The range of views, opinions and discourse in the political and social arena have helped shape education messages and resources available for HIV prevention. Our moderator for this evening's lecture is Dr. Jim — James Curran, excuse me, the dean and professor of epidemiology in the Rollins School of Public Health. He holds joint appointments in the Emory School of Medicine, the Nell Hodgson Woodruff School of Nursing, and the Graduate School of Arts and Sciences. Since 1977 — 1997, excuse me, Dr. Curran — has also served as a principal investigator and codirector of the Emory Center for AIDS Research that is funded by the National Institutes of Health. Among his many honors and awards are his election to the Institute of Medicine National Academy of Sciences in 1993, and he has served since 2005 as chair of the board of population health and public health practice. Dr. Curran came to Emory from CDC where he served for two decades. From 1981 to 1995 he was a leader of CDC's HIV research and prevention efforts. Please join me in welcoming Dr. Curran. (Applause.) >> James Curran: So hi, everybody. It's an honor to have all of you and our guest panel here at the Rollins School of Public Health. For those of you who haven't been here, please look around, this is our new Claudia Nance Rollins Building, we've been here for about a year now. And we have not yet started class except for our first year international students, many of whom are in the audience. So we have a group of people here who are international students who come from 30 countries in the first year, so I'd like to have all of us kind of welcome them to the United States. This is their first two days. (Applause.) I guess what I — the reason I'm the moderator has nothing to do with my being the dean of the school of public health, it has to do with my being around in 1981 as the head of the research branch of what was then called the VD control division. And our branch had been doing studies of hepatitis B in gay men, preparing for a hepatitis B vaccine trial, when the first five cases of pneumocystis pneumonia were reported to CDC at the end of May. And I was asked to coordinate a small task force, probably because I had a secretary, no one else in the group did, it was multidisciplinary, and I was detailed for 90 days to work on the problem. And then I retired from CDC 15 years later, after working with lots of people inside and outside government during that first 15 years of the epidemic. And I had 15 years to think about the first 15 years, and to think about the first 30 years, and then to also think about the next 30 years, and so on. There are many of you in the audience who have been involved in working in AIDS also for a long time. Some of you have worked in other countries, some of you are from other countries and work on this. Many of you have had as much or more experience than I do and the others in the panel. But we have a wonderful panel of people who I think are — the two things I think that are great about the group of people is that they're — we have about 150 to 180 years of AIDS experience between us. That's close to 30 years apiece. And we came from — to this problem from a different perspective. And importantly, we came at it either as inside government or outside government, or some of us were both inside and outside government. And sometimes we were activists trying to get the government to do things, sometimes we — and we could have been doing this from the right or from the left, and we were doing this during different administrations. And therefore, we all looked at each other and we all dealt with each other in one way when we first interacted, but the thing that makes us — and so we were different at the time. And those differences led to political discord, and we observed political discord at the time. And I can tell you that the political discord got pretty hot and heavy in the early years of the AIDS epidemic. But what makes us similar is our commitment to the problem. We now have, all of us, 25, 30 years ago, may have seen things differently, but now we see each other as people who have had a long-term commitment to solving the problem. And we've learned about not only what's different about us, but what's similar about us. It's not much fun for us to talk about the good old days and what's similar about us, so we try to tease out some of the differences. And we want to spend maybe the first half hour to 45 minutes talking about some of the problems in the bad old days, some of the political issues, and how we solved them. And I'm going to be encouraging people to tell us — goad them on a little bit about this. But then we want to spend the last — maybe the next half hour talking about the future, and where we think things should go and could go. And then we want to spend the last 45 minutes or so opening it up to you and having a dialogue with us. So I will start off only by saying my view of what 1981 was like. I had worked in STDs for about 10 years. I mean, people used to always say — criticize us by saying how come you don't treat AIDS like other STDs. And I would say I worked in STDs for 10 years, and I know how they were treated. They were ignored. And one of the differences was when AIDS came along, it wasn't ignored. It was a disease, which scared the hell out of people, and killed people. And it resulted in horrible ignominious deaths when it wasn't treated, when we didn't know the cause. There was a real concern, people working on the problem would be exposed to blood, would get a needle stick, and they would wonder am I going to get this horrible disease that I've watched people die from. It was inevitably fatal. It was a horrible disease. And it caused us to put a lot of our feelings aside for a while, to say this disease is more important than anything. For example there was almost never any STD or sex education in schools until AIDS came along, because people said our kids need to know about these kinds of things now. They didn't actually need to know about them with gonorrhea and syphilis. I mean, ironically, you know, our generation, those of us on the stage — all these people are younger than I am, but they're close enough that they're sort of in the same generation — we're the last generation, really, to start our sexual lives when there was no AIDS. Because it's a new disease. Most of you in the audience, not all of you but most of you in the audience, have only thought about sex or started to have sex in an era of AIDS. My parents' generation had syphilis, which was untreatable and killable — killing people. So we're really the only generation to have the beginning of our sex lives that way. And during our generation, we took advantage of that. We had birth control pills, we had lots of sex, we had lots of stuff going on. Gay and straight, we all did this. Except for me. (Laughter) The other people on the panel did this. Probably. And that was the mood during the 70s. 400 gay men a day tromped into the San Francisco STD clinic with virtually every kind of disease. But AIDS changed everything. It changed everything about how we take an STD seriously. However, these were bad times. Jimmy Carter, our president Carter from Emory here, was booted out of office for a variety of reasons, mostly because there was high unemployment, high inflation, and a lot of problems in the country. And Ronald Reagan came in with a sense of optimism and strong support from the Christian Coalition, evangelical groups, and others that were providing support to him. When AIDS first occurred it was mostly in gay men in New York and California. And even by the time the virus was discovered, there were still many states in which there were no cases reported. It was easy for all groups of people to deny that it wasn't going to happen to them. Including gay men. It was only those people from New York, we know what they're like. The black community, it's a white gay disease. The government, maybe not trying to scaring people. Whatever it is, there was a denial that went along with this. And there was a reluctance from my point of view in the part of the Reagan administration to get involved. The first public speech Reagan gave was in 1986, he spoke to members of the NIH and others at an earlier conference that was internal, it was not open to the public. And so there was — And the Band Played On, Randy Shilts made a lot of the Reagan administration neglect. And that was one story, which certainly was a backdrop for activism. Now, working in government, we were all broke. They closed the public health service hospitals, they were giving pink slips to CDC people, people on my task force were walking into their meetings, getting fired. They proposed to take all the doctors from the public health service hospitals and give them to me to work on this. They weren't epidemiologists they were just pediatricians that worked in public health service hospitals, and were clueless, and didn't want to work on this. So there was a lot of problems within government. There was no travel money to do anything. But there was a lot of passion among the doctors, the people I think at CDC, and among some people in the communities to deal with the problem. And then it evolved over time, and we'll talk about some of that evolution now and some of the perspectives and perceptions of the people about what went wrong, and what went right, in government. Everybody is going to speak shorter than I just did now for a couple minutes and then we'll have other people pitch in. So the first thing, let me talk — oh, I've got to introduce everybody. I'm sorry. We have a great panel. Cornelius Baker, on the side over there, has worked on AIDS since about 1980 — 6? 5? >> Cornelius Baker: No, 83, 84. >> James Curran: 83, 84. Since 19 — since 2006 he served as a national policy advisor for the National Black Gay Men's Advocacy Coalition. In addition, from 2000 to 2004 he was executive director of Whitman Walker Clinic, the leading provider of prevention, treatment, research and social services to people with HIV in Washington, D.C. From 1996 to 2000 he served as executive director of the National Association of People with AIDS. And he joined that group in 1992 as a director of public policy. He also, when I first met him, was a President George Bush appointee. And I thought — I was suspicious, actually. A black gay Republican. I said what's going on, here. And he was an aide — I didn't know you were gay. I thought that you were probably black. (Laughter) Don't take me seriously, no one else does. Anyway, he has — this guy has been a fighter, and he continues to fight for 25 years. Debra Fraser-Howze over here second to my right is a vice-president of the government in external affairs for OraSure Technologies, and she represents OraSure with government in policies and issues regarding the company business. She was, however, also president and CEO of the National Black Leadership Commission on AIDS, an organization she founded in 1987. This organization conducts policy, research and advocacy on HIV and AIDS, and that's when she really got involved and started to take a leadership role. She's been widely respected and recognized in the community for her ability to collaborate with community organizations and bring the community to the government, and the government to the community. She's worked in the national, New York State, and New York City level, and she advised two U.S. presidents, Clinton and Bush, while serving on the President's Advisory Commission on AIDS from 95 to 2001, that's Bush 2. Cornelius was with Bush 1. And she was the vice-chair of HIV Human Services Planning Council in New York City, and she also served in the New York State Commission on AIDS. Lloyd Colby, the man in the middle with the white beard, is an emeritus professor of Clyde Health Sciences in Indiana University. Lloyd and I knew each other because we worked together at CDC where he was the founding director of the Division of Adolescent and School Health. And as a respected and professional health administrator and educator, he started HIV education in the schools in the United States. That was not an easy thing to do, because everybody had their ideas about whether it should or shouldn't be done. And of course if it was to be done, how it was going to be done. And then it had to be done everywhere, and it had to be done quickly. Lloyd was I think a remarkable professional who built this group up into something that is very, very strong today, and he did it with seemingly mild-mannered — he looks so innocent and mild-mannered even today, but he has an iron will. Shepherd Smith, on the right. Dr. Smith is the founder and president for the Youth Development, and he's an advocate for HIV/AIDS prevention for over 20 years. I met him when he served and founded the Americans for Sound AIDS/HIV policy, or ASAP, which was a Washington, D.C. based national organization dedicated to limiting suffering from AIDS. Dr. Smith has served on the advisory committee to the director of the CDC, and he advises CDC on policy issues and broad strategies. As we were speaking beforehand, Shepherd came in with very strong connections to the Reagan White House first, and then Bush 1 White House. And many of us inside government, and many people outside government, would not take that as a credential as being on the side of the people with AIDS. So we were suspicious of Shepherd Smith. But we listened to him, because he had friends in the White House. And so we had to develop a relationship of trust over time. And I think his commitment to AIDS is really without — without equal. Gail Wyatt in the red suit. Dr. Wyatt is a clinical psychologist, sex — she really knows sex, I mean, this is — I've been talking about it for 40 years, but I don't know what I'm talking about. She's a sex therapist, and in addition to being a clinical psychologist and a professor in the department of psychiatry and behavioral sciences at UCLA. She's also been an NIMH research scientist career development awardee, and that's something which is limited to a very, very small group of people who receive NIH funding, to be a career awardee. And she's been doing this for 17 years. Her research examines the consensual and abusive sexual relationships of women and men. She has 110 journal articles and book chapters, and she has coedited or written five books, including Stolen Women, Reclaiming our Sexuality; Taking Back Our Lives; and No More Clueless Sex. She's associate director of the UCLA AIDS Institute, and she's testified before Congress eight times. More than most people at CDC have ever done. And related to issues related to health policy. So she represents an academic who has transcended the role to work in policy matters and to work with the community, and looks at this from the point of view of human sexuality, and women's rights, as well as minority health. So I probably misrepresented everybody, they can correct me when I'm done. But Gail, let's start with you. And one of the issues that's come up is that we're sitting in a situation now where half of the cases of HIV that are reported, and more than half of the cases of people with AIDS, are African-Americans in the United States. What was going on, how come we didn't pay attention to this 30 years ago, what do you think happened? >> Gail Wyatt: Well, it's a good question, isn't it, and it's a puzzle to a lot of people. But I don't think it's rocket science, and I'm going to lay it out just like it happened. I was there, I had an RO1, because you know, you hear that there are not any trained minorities to do research. There are fewer than 3 percent of African-Americans funded, by the way, to NIH. Fewer than 3 percent. So when I got my first RO1 in 1980, before the whole AIDS epidemic really drew attention, I was ready to do research. I knew how to do it, I was right at the door of NIH asking for funds to do work with heterosexual black men and women. And let me tell you, there was never a more convincing argument made that the money should all go to San Francisco. And that's where the money went. So to say that we were not there, that we didn't know how to do it, and we didn't have representation, is simply not true. If I — if it had been my world, and it is not, but I like to think that it could be, AIDS is a sex-related issue just as much as it has to do with drugs and all these other factors. When you know that something is sexually transmitted, it takes a completely different perspective. And for public health to have taken this issue as if it's simply a matter of telling people what to do, like put on your seatbelts or don't smoke cigarettes, will completely derail prevention efforts. And that's exactly what happened. We also funneled money to an environment that was very small, very tightly knit, very highly politicized, and very much in unity. They had Tom Coates as their spokesperson, and you can't find a better one. And he was very convincing, that the initial push be where we — where the epidemic was. But you see, in the communities, I heard about AIDS, and we didn't even know what it was in 1980. Because I was funded to do sexual research. But I was not convincing enough, nor were any other researchers or community activists in our community, for decades, for CDC, for NIH, to move the funding, to broaden the perspective. Because if it's sex, it's not just about sexual orientation. It's going to be transmitted to everybody. And I think that what I saw missing, Jim, was the acknowledgment that we in America are very sex-phobic, we weren't just AIDS-phobic when this epidemic was something that we had to address, we were sex-phobic. And we still are. People don't realize that sex was once a very intimate experience that mothers and dads would teach their kids according to what they wanted them to know. And that you didn't really have to know anything, so my mother told me when I was raised, until your husband taught you. And he would instruct you and tell you how to please him. Well, let me tell you, the one man who knows that is not true is my husband. >> James Curran: So Debra, what do you think about this? >> Debra Fraser-Howze: Jim, I think that — >> James Curran: Grab a microphone. >> Debra Fraser-Howze: I think that one of the big issues in the beginning of this epidemic was that, you know, the African-American community heard a number of different mixed messages. In the beginning we heard from the CDC that — the CDC was giving us data that said that this was a white gay male disease. That's what we got. That's what the information showed. Time and time again, images on television, white gay men with sarcoma you know, all the agencies that were starting up, the gay men's health crisis, Larry Cramer on television, it was just over and over and over again, repeatedly. And then, you know, with the backdrop that the disease came from a green monkey in Africa, and then the other backdrop that said that the disease came from Haiti. So while this was a gay white man's disease, black people — the black countries or black things were responsible for it. And then a decade later, the black community got the information that this disease is coming at your community like a locomotive out of control, and you have to own it so that you won't get infected. And by that time we said get out of here, you know. Monkeys? Come on. So I think the public health community set up the black community in a way that we — we couldn't possibly listen to it. >> James Curran: Shepherd, how do you see it? As a middle aged white man. >> Shepherd Smith: Well, tragically, you know, the politics of AIDS has been quite confused and very divisive, very polarized, simply because of how it evolved, as Debra is saying. Unfortunately, this did occur predominantly among white gay men in the beginning, and the attention was on them. And it was difficult also because our focus was on AIDS and not HIV infection. We, not knowing anyone when we formed the organization, simply wanting to help people affected, but also treat this more as a medical public health issue than it was being treated at the time, really searched for data about the epidemic, and the best data we found was with the U.S. military. Unfortunately, because gays weren't allowed in the military, it was really discounted by the AIDS community. In 85 to 88, we saw that among active duty service people, the rate of HIV infection was actually greater among African-American women than among white men. And so we knew at the time that this epidemic was really going to impact the African-American community. And we were kind of a voice in the wilderness back in the 80s saying we really need to look at communities of color. And simply because we had the opportunity to be pretty objective in how we looked at the epidemic. >> James Curran: There's a session on Monday that Kevin Fenton I think is moderating and it's sort of on asking a number — I'm on the panel — a number of us what our regrets are. And I've said for a long time that my biggest regret when I was at CDC is that we didn't take much more leadership in the area of injecting drug use. And from the very beginning injecting drug use and the partners of injecting drug users and the children of the drug users and their partners were predominantly African-American men and women from the east coast from Puerto Rican Hispanics. And that is the very roots of the heterosexual epidemic in the United States. And it was from day one a predominantly black and Puerto Rican dominated disease. And with HIV, since it lasts for so long, it lasts for life, once it gets seated in a community the past is a prologue for the future. So people say why do gay men still get it so often, it's because gay men have it. And so your risk is much higher if you're a gay man. And that's always going to be true, you know. And the same thing was true with the heterosexual AIDS epidemic. And I think that the CDC did not emphasize enough the minority population. And that I think the United States, including New York City and New Jersey, and the country, wanted to stay in heterosexual denial as long as possible. And the heterosexual denial complemented the black and Puerto Rican denial. And it was different for Hispanics on the west coast who were not Puerto Rican and not exposed to the same situation. so it was epidemiologically complicated, and it was also — there was also a concern about I think in government about not wanting to blame people. You know, from our STD point of view, there were some states that wouldn't point — wouldn't put race on STDs, because of shame about STDs. And there's something — there's something shameful, it's not wanting to talk about sex, it's attributing diseases which are stigmatizing and not wanting to add additional stigma. It's a — I can't even get to the layers of it within my own being, but I know that that played a role, I think, as well. But I think you're right about the government not calling attention to it early enough. But let me talk to somebody who was serving in government that time, who has served the Republican administration as a black gay spokesperson, who was Mr. Inside when he came in, and then he went out and became one of the most active, effective activists and lobbyists from the outside. What's it like being inside and outside, Cornelius? >> Cornelius Baker: Well, you know, I actually think, I mean, it's the same. It's a little bit different strategies. I mean, I think that context is important. You know, when the first reports of HIV were made, I was 19, about to enter my senior year of college. And, you know, my background and my — I worked in theater since I was 13, every summer and winter breaks, and both my high school and college majors were in dramatic arts. And my internship was set for the Kennedy Center, which is where I ultimately moved to Washington to work in. And the epidemic began very early on to decimate the arts community. Which was of course a safe haven for certainly gay men, but also for women and others to be employed with some sense of your own self worth and dignity and independence. Unlike corporate America, and much of the rest of America. And so I mean, as well as it's an area that I have genuine love and infection. I realized very early on that even though I completed my internship and worked in the arts in Washington for two years, by 83 the experience of AIDS was becoming so overwhelming, and the death that we were beginning to see, I knew that I couldn't move to New York City. It was almost a paralyzing thought to move to New York. And, you know, I expected to go and work at Lincoln Center. And so I decided to stay in Washington. And I had the expectation, certainly coming from upstate New York where — you know, I grew up in Syracuse, New York. It could snow 30 inches overnight. And the roads were plowed, and the buses ran in the morning, and you went to school. Because there was an expectation that your government worked. And when it didn't work, people were fired out of their jobs. And so my expectation was that we had a new disease, and that our government would work. And that I just took — you know, you do what you're supposed to do. There's an emergency, there's a crisis, I was a gay man, I went to work first at our local government in Washington, D.C. for Republican council member helping to craft the response in Washington, for Carol Schwartz. And then later, through circumstance, I went to work for George H.W. Bush. And with the expectation that we would do what was important for our people. And, you know — and I think I certainly learned a lot in that process. You know, that there were expectations of our government that maybe we can't have. I think there were many things that we did accomplish, and I can talk about later, but certainly my perspective was that you have an obligation as a citizen to do what you can. And my best avenue for being able to do that at that time, and certainly as a Republican, was to go in and work for the government which I had helped elect. And I felt I had a responsibility towards that. Later I felt, and certainly during the 1992 reelection campaign, that that government wasn't the government that I expected it to be. Despite progress in areas like creating Americans with Disabilities Act, which is one of our great civil rights pieces of legislation. That when the President that I had worked for, including in 1980 against Ronald Reagan, was not able to stand up against Pat Buchanan. It was a great disappointment to me. And I felt that the only honorable thing I could do was to leave the administration. Which I did. And I went to work on the outside. Because I felt that the solutions that we needed at the time were not going to come from the inside. And so my own — so my perspective is that, you know, you have to have the view that we're going to end this, that our people's lives are desirable, and to use whatever strategy, access and tactic that you have available to you. In 1985 and in 1989 I had access to people who had been elected into positions that I had helped elect them to, and I felt that I could demand that they responded. When that failed in the second case to be all that I wanted it to be, then I felt that I had an obligation to go out and create other strategies. And I think that that's what you do. >> James Curran: Lloyd, you were on the inside and then you were on the outside. >> Lloyd Colby: It may be an oversimple analysis. And again, I think it should be said that this — this lecture right here, this panel discussion I think is critically important. AIDS really, for public health, set the stage for the evolution of social sciences, of behavioral sciences. It was a vile disease, we learned. There was no treatment at the time. And I remember Jim Curran — I a pretty young man, I was younger than Dr. Curran — sitting me down in his office, because we kept talking about behavioral epidemiology. He said, 'Colby what is this behavioral epidemiology stuff, and how is it related to the epidemic?' I don't know whether you remember that conversation. But it really began kind of this understanding of how to employ behavioral and social sciences in public health. And I think in fact this session is a good example of that. As we were discussing a little bit earlier, this is nice to talk about the past, but what's critical is how you do an anthropological analysis of what happened during the past 30 days in such a way that you can apply it to assure that the direction in which you move for the next 30 years is guided by what we've learned from the past 30. Having said that, I think there are things happening in American society today that are really reflective, perhaps as we have evolved as a culture, or devolved as a culture, in looking at what was occurring that stymied many of our best efforts of those who perhaps had a more liberal — to use that term — and a more conservative approach, and jockeyed in such a way that they disallowed either approach to be moved forward without great foment. We didn't come together and try to solve our problems in the early days, solve our ideological tenets, solve how to integrate our ideas in such a way that we could move forward. Perhaps similar to what's going on today economically in trying to resolve the budget deficit. You know, are we being stymied by this evolution of culture that doesn't allow us to take the both — the best from both worlds, figure out how our culture, how our democracy is designed to bring people together, and employ that. And employ social — >> James Curran: So Lloyd, in our version of the green room you were discussing your interactions with then-Congressman Tom Coburn from Oklahoma. Do you want to recount those experiences? >> Lloyd Colby: You bet. And one of those people sitting here in the panel with us — to make a long story short, as many of you may know, Senator — now Senator Coburn, then Representative Coburn, in the early days invited then CDC director, and after that Surgeon General Satcher, into his office with me and we would have debates with Representative Coburn at the time, Dr. Coburn, physician. Good man. And he would argue with us, and I really felt like he listened. And I felt like we listened. He made two very good arguments to me, and I believed he made them well. He said, Dr. Colby, you're funding all of these NGOs, and every one of them, for — just a simple way to describe it — are very left of center. Or a little left of center, at least. You're not funding anyone that's a little right of center that is interested, perhaps, in increasing delayed sex, delayed sexual intercourse versus condom use. And so there's not an opportunity for there to be a discussion among the people that you're funding, and to move forward. The other thing he said was that you're not addressing STDs. That there may be some STDs that might not be prevented through condom use, and you're not telling young people about that. And I felt he was right on both cases. And in both cases, we worked — on the first case we worked to put an RFA on the street so that we could begin funding an organization that represented the views of those that might be a little bit more right of center. And we were fortunate that Shepherd Smith's organization picked that up, and Shepherd used to come into the lion's den with all these other NGOs, and there was good discussions. There was give and take, and good discussions. And then we began on the second suggestion to integrate our curriculum to discuss her piece, to discuss herpes, to discuss chlamydemia, other STDs that might not necessarily be prevented with condoms. So I think the result of those ideas coming together, both politically as well as substantively, made for a stronger will in the nation, and for stronger programs, interventions. >> James Curran: I was the inside, too, and I think we've heard a couple things about — one thing that the three things would have on the inside, is that being on the inside gave us a cherished and rare opportunity to really be involved with this epidemic in an important way. That's true for all three of us. And I've been on the outside, all of us have been on the outside, we may not have been able to be — have had the privilege to be involved. And we did it as a result — sometimes we sought the job, but we did it as a result of our government service. And Cornelius told us that he did it until he felt he could be more effective elsewhere. Lloyd said that he did it and had to come up with what I would call political and ideologic accommodation. Which you learned something from, but it was also necessary. I mean, Dr. Coburn wasn't going to go away, so you'd better listen to him. And I would say that from my point of view, I stuck around a long time, too, but, you know, I think that there were some issues in which we accommodated too much. And I mentioned already the drug abuse issue, and I think the minority health issue. We didn't — I mean, and probably several others. But I think that if you're inside government, you have to accommodate to the political realities. Gail. >> Gail Wyatt: I think that I was inside, too, being a well-funded — >> James Curran: Oh, yeah, that's right. >> Gail Wyatt: — investigator means that you have the skills, you've got NO-1's, the gold standard of research. But I don't think we're paying attention to, though, is being on the inside and being a minority doesn't put you in the room where all the decisions are made. And that's the problem that exists today. It's not as if we're all friends and, you know, rocking and singing Kumbaya. Black people still aren't at that table. If we had been at that table then, we wouldn't be where we are now. And if we were at the table now, we wouldn't have funded some of the biomedical research that has recently been touted. And everyone is extremely proud of it, but we have not addressed the black agenda then, 30 years ago, and we're still not addressing it now. (Applause.) >> James Curran: I agree, I think that's a very important point. Let me just throw a gay twist on that. In my experience in the — in the 15 years of government I was working at, is that the gay — if you're — generally if you're a woman or if you're black, people are aware of it. If you're gay, they aren't. >> Cornelius Baker: Yes. >> James Curran: No, but they're usually not aware of it. >> Cornelius Baker: Right. >> James Curran: So the gay people that were in government during the Reagan administration and others, operated — >> Cornelius Baker: Incognito. >> James Curran: Silently. And there were many important people in government who were gay, who either did or didn't make decisions that were covert. There were omissions that were covert, and there were commissions that were covert. That I disagreed with, and I was unable to call them on it, because being gay is being an invisible minority. Not if you're open. But many people, particularly in those days, weren't open. And so there were decisions that were made in government that were made — I think they were ill-advised, that were coming from a political perspective that was silent. I'd just throw that out, Cornelius. >> Cornelius Baker: No, I think that that's right. I would just give three short vignettes of things that I found interesting, and this sort of goes to sort of the core question of inside versus outside. You know, I was actually conflicted about taking the position that I took working for Jim Mason, assistant secretary for health in the national AIDS program office, and you know, I had helped during the transition at the White House. And Ron Kaufman, who was the deputy assistant to the President for personnel, we had finished staffing the administration by about August of 89, and he said, well, what do you want to do. And my first thought was to go to the National Endowment for the Arts, and so I told him I either would like to go there, or maybe to the White House Trust to Support Preservation. And so he and Chase Ottomeyer called me into their office and said, well, no, we really actually think that you should go over to HHS and work for Lou Sullivan and Jim Mason, because we think they need you there. And, now, I had not talked about being gay, but that was like — that was sort of what you're saying, you know, that Ron and Chase were like basically saying, are you out of your mind? So this is a moment, and this is where you need to be. And so I did, and so I went over and, you know, talked Tyler Babb who worked for Secretary Sullivan, everything, it went over. But you know, during that period it was very interesting, the reaction to me. And I think that you alluded to some of it. I mean, you know, this idea that instead of seeing that the White House has sent a black gay man over to be an ally, there was constant circumspection. And part of it was — I mean, I'm very clear about this, a lot of it is a plantation mentality. That I deemed not at that time to be a Democrat, and so somehow my political ideology and my authenticity was constantly questioned. I'm okay with that, because I'm very clear about who I am. And so — and I think that people didn't — who actually could have gotten further, often didn't take advantage of it. And so, often — and it was very interesting, because I would see people making alliances with white gay men from the outside, helping to push their agenda, that at times really we could have done a lot better, and things easier. That's the second one. You know, when the Americans with Disabilities Act was moving through — and this is sort of that inside, where you get experience. And the National Business Leadership Council on AIDS wanted us to get the President to come and speak to them. And there was a lot of conflict about whether he should, and I really felt very strongly that the President should go and speak to that meeting. And especially because at the time the ADA was on the floor, Representative Adkins of Georgia had put in an amendment that would have stricken people with HIV, alcoholics, people — a number of other people from the bill. And our goal was to get the President there to talk about, you know, the need for the ADA. And, you know, and that day what we found out was there was going to be a protest at the lunch. And we had looked at the guest list, we had really combed through it, we weren't going to put the President in an embarrassing situation. And a friend of mine, Urvashi Vaid, her partner Kate Clinton was my high school English teacher, you know, I felt that they were, you know, people to trust. And Urvashi was the person protesting. And there was the CBS Evening News, there was NBC, and we thought that was going to be the story. When the story we wanted was the President saying pass the ADA. Fortunately, the next morning the Washington Post front page was the President talking about how people with disabilities, including people with AIDS, deserve respect and support. And that was the photo caption, that was the message. And the amendment went down to defeat. I ran into Urvashi that afternoon in the Safeway on 17th street in Washington and we just had a total scream-out with each other in the produce section. And those are the types of things, experiences that you have. So here I am a black gay man working in administration who is yelling at this Southeast Asian woman who represents, at that time she was the head of the National Gay and Lesbian Task Force. And I'm like, how dare you put your agenda ahead of ours. >> James Curran: So Cornelius, we were talking about this in the green room, and I was relaying my experiences. And I had always taken — I had always tried not to take these things seriously. It's probably because of my background and coming from the dominant majority of white straight men. I always assumed if people didn't like me, there's got to be some kind of — you know, it wasn't because they were discriminating against me. And we had an interesting discussion that I want to call people in about — because, see, what we were thinking about you was not the plantation mentality, we were thinking you were the overseer, you know, holding the people down to their work. And because — and it's interesting to think that through. I mean, I know Lou Sullivan quite well, and he's a hero in many, many ways. But he was also accused of being an apologist for an administration, which was neglectful. And so the question is, to what extent is he a Republican appointee, or is he a black man, or is he a physician who cares. The same thing with Senator Coburn. Is he a concerned physician, is he an arch-conservative Republican, what is he? And can you be more than one of those things? And I think the answer has got to be yes, but I'd like to hear Debra talk about this and then Shepherd talk about this. >> Debra Fraser-Howze: There's no question that Lou Sullivan is first and foremost a concerned physician who served his community well for a number of years. The work he's doing now at Morehouse, the work he's done for years in ensuring that there is a cadre of black physicians to serve the black community. His dedication is undeniable. In making the best of the best to serve their own community. So I don't think that there's any question about that. I think that there was probably a question about his history when he first got into the administration by the other people around him, but the black community always knew who Lou Sullivan was. >> James Curran: He was the secretary during that time of neglect that you mentioned. >> Debra Fraser-Howze: Right, but we knew who he was before he got there. So I think that's where some of the paradox comes into play. And I think this is where some of the paradox comes into play with some of our leadership in general. Where we may embrace some of our leadership because of the — just the basic knowledge of the history. And people may look at them – and we may, you know, do a jaundiced eye with them sometimes and say, you know, you better be careful up there in that House, because that House will get you in trouble. But you know, the world is a paradox for some of us. It's been a paradox for me, when you talk about in-house, out-house. I've served with the Clinton Democrats, I've served in the Clinton White House, and I served in the Bush's White House. I've been in the not-for-profit world and now I'm working for OraSure in the for-profit world. When you do these paradoxes, you know, when you get older, there's one thing that you begin to realize. That your role is not to be there, especially as a person of color, when you have the privilege to be in these situations, for you to serve one man or one human being. You've been given this privilege to serve the community. So you have to start to focus on what do you do in this short amount of time to make permanent changes for the people you've been put there to serve. I wasn't there to serve Clinton or to serve Bush. I was there in that seat, I know I was chosen to be in that seat, Cornelius was chosen to go over there because he was a black man with a certain frame of thought, and they needed some help. So what is the thought — what is the thought process that you bring. When I sat in the seat at the Clinton administration as an advisor, we had the minority AIDS initiative, you know, sort of on the horizon. We had to write a piece of legislation, we had to go to the council and get an agreement to get this thing passed. Part of the role was to get money into the departments, including the CDC, that would outlive the President. To give to communities of color. They're still living now since 1998. That was the role. Not to serve the President. So I think that if there's anything the students here have to learn — and I don't want to — you know, because I know we're going to talk about how we move forward after this. But if we don't leave with this, we'll do a great disservice to you. If you have an opportunity to get into a policy role, don't get caught up with who you — this is no glory. You're going to get beat up, beat down. Somebody is not going to like you. You can't be — everybody is — forget it. So just focus on what can I do while I'm here for the people that I've got to serve. And serve them. There's going to be a bunch of bureaucrats somewhere that's going to outlive whoever put you there. Look to those bureaucrats and help them. Because they're going to be there in that role 50 — they're going to get pensions. And they're going to be there to effect change on the people that you're put there to serve, for decades. >> James Curran: Hey, Debra, tell us that question that they're going to ask you when you get to heaven. Assuming you go to heaven. >> Debra Fraser-Howze: Yeah, I told you when African-Americans go to heaven they have an additional question that they're going to have to ask, and an extra responsibility from their ancestors. Their ancestors are going to meet them at the pearly gate and ask them one question, and one question alone: What did you do with your freedom. And you'd better be able to answer that question. So again, particularly for you guys, who look like me, if you get a chance to sit in that spot, use it wisely. Because you have to answer that question. What did you do with your freedom? (Applause.) >> James Curran: So Shepherd let me — Shepherd, you were — I know you have a comment on this, but let me change it a little bit by saying when you emerged on the scene from the point of view of the government, you were coming at it from the point of view representing a committed person of faith who was very closely connected to the White House and the administration. And a lot of people in the community, who were concerned about AIDS, in the gay community and some of us in government, thought you needed to prove something to us. So tell us how it felt being, you know, in your position. And then say whatever the hell you want to say. >> Shepherd Smith: Okay, well, first I'd like to follow up real quickly on what Debra and Cornelius and others were saying. You can't look at a contagious disease in the context of race, orientation, and I think or politics. You really just have to be very objective, understand the data. And unfortunately, in this epidemic that really didn't happen early on. In respect to heroes in my life, this may tell you something about me, I don't know, but I would put David Satcher and Tom Coburn together at the top. So that's how much I feel about both of those gentlemen. But I want to talk a little bit before about how it felt personally, and I don't want to spend much time on that because you have students here that weren't even born, I think, in 85 when some of these things were happening. But in Atlanta in 1985, the first International AIDS Conference occurred, where speakers who said this was a progressive disease, which indications were, in looking at the Walter Reed staging system, certainly would lead people to believe that it was a progressive disease, and they were booed by the audience. The activists were handing out bumper stickers that said, 'No test is best.' Now, a lot of that was because, again, in this confused epidemic, gay men didn't want their identities known. So there was a bias against testing for the disease. And that's something you just have to — have to put aside when you're looking medically and from a public health perspective at the disease. And the consequence of that is long-lasting. Because we develop policies that focused on AIDS, we weighted the Ryan White Care Act to pay for dead people for benefits for them, as an example. And people in San Francisco were getting twice the benefits of people in rural southern states, for example, who were predominantly people of color. We got into money, and arguments over money. And there was a bias to go after that, and white gay men certainly had an advantage. But what's important, I think, again, is to be able to look at data objectively. And with respect to prevention, I don't think we've done a good job. We have 50,000 new infections every year. We can't be happy with that. And when you look at the biggest predictor of an STD, is number of lifetime partners. More partners you have, the more risk you're exposed to. We have to give messages that is the truth, and realistic to people. I mean, they may not listen, but we have to say something about more partners is more risk. So you've heard a little bit about my feelings, but in respect to coming into this issue, we tried to be objective. We were hammered by not only the AIDS activists who were suspicious of a — somebody who was conservative and of faith, but by our own friends. I mean, I had an aunt who just nearly disowned us because we were dealing in this issue. We had friends that really didn't want to associate with us. So, you know, it's been an interesting road, but we've stayed the course. People don't necessarily listen to everything that we say, but at least we're given the opportunity. And to that I thank the CDC and I think Dr. Curran. Thank you. >> James Curran: So let me just follow up a little bit on what Shepherd said. I think I started off by saying that, you know, your value is measured ultimately in your commitment. It's not measured in where you start and what your point of view is. And your point of view actually adds to the richness of the dialogue. I remember some of the same events, slightly differently since the first International AIDS Conference was my idea and we had it here in Atlanta, and I gave the first talk and I talked about the progression of the disease. And I thought I got applause. But the problem — part of the problem was the suspicion that was so polarized. It reminds me a little bit now of the debate in Congress, which is impossible — impossibly unintelligent. It's all partisan, stupid. And the thing is, we were doing a lot of that then because we didn't respect each other. Now, the way I remember the doctors who got up and talked about the military screening program, the context was that the U.S. military was testing recruits, and then disallowing them for service if they were found to be positive, and then of course if they were homosexual they'd be kicked out and dishonorably discharged. So you have a largely homosexual audience of people who don't see the U.S. military as somebody who is on their side. Now, of course some of the doctors presenting the data might even themselves have been gay, and of course they also weren't — that isn't their point of view. But they did represent an institution. And I remember I think it might have been Andy Nomius who said, you know, this screening policy you're proposing is really good. If we could discharge everybody we found to be positive who can't be treated, who were going to die anyway, out on the street like you do, we could do it, too. >> Shepherd Smith: But they didn't discharge them, though. Active duty — >> James Curran: No, the active duty they didn't discharge. Well until — they did eventually. >> Shepherd Smith: They got treatment from them. >> James Curran: Eventually they did discharge some. Oh, they did. But the point is they were screening them out. So part of it is who says it. It's a little bit like my saying something about black women. It just doesn't fly. Because I'm not a black woman. And it takes a long time for me to have enough trust, particularly in public, to say something where I'm viewed the same. And that's what a little politics with a small P is. But let's talk about the future, and let's try about two minutes each, starting with Shepherd. >> Shepherd Smith: I don't like saying this, but I'm not very optimistic about the future. There are some good things that have been happening, treatment, there's prevention, that's great. But what worries me is the lack of any kind of real behavior change. If we have another disease like HIV that's some kind of ebola HIV thing that came along, and we haven't changed our behaviors, the treatments that we have would do no good. We really have missed the boat, I think, in not focusing on partner reduction as a primary message for all communities. That's not discriminatory, I don't think that's a religious belief, I think it's simply looking at the data and saying what's there. I think that the crises we have in government right now are so severe that everyone is going to suffer as a result. It doesn't really matter that it's this issue, but this issue will, we've seen it already in PEPFAR overseas, my wife's organization, the Children's AIDS Fund has about 50,000 patients in Africa that we have been helping over the last decade. And it's struggling mightily to keep its head above water. So financial constraints are going to be significant. I think the good news is that there's less polarization right now on the issue. I think there's more willingness to come together and listen to each other more than I've seen in the past. And so that's a good thing. But in respect to the dynamics of the epidemic, I don't think we've really addressed them. That you can still go to an STD clinic today and not be routinely tested for HIV, when you're routinely tested for syphilis and gonorrhea, I think that's insane. Thank you. You know, we need to treat this as a medical public health issue much more than we have. >> James Curran: Debra. >> Debra Fraser-Howze: I can't agree more in regard to the testing. Not just because I'm one of the 11 key people who operate the premier company who sells tests in America, but I — >> James Curran: Well, you disclosed, okay. >> Debra Fraser-Howze: Yeah, I disclosed. I left — I retired from the not-from-profit world because of my own — I had a tragedy in my life and I decided that I was going to leave, couldn't deal with any more death. And, you know, the President and this company came along, and I had to really think about what I believed in. And I actually do believe that we can test our way out of this. I believe that we can — I believe that if we give people access to the test, access to testing, in multiple ways, we can get out of this. Some people are not going to go into clinics, some people are. Some people don't want people to know they tested, some people do. Some people — they just need ways to — we need to be more creative about what we're doing. Much more creative. I think that we've gotten stagnant. But I think people knowing their status is critical. I've had girlfriends of mine who to this day — this is 2011 — have told me that the way they know they're not positive — these are black women over 50. we don't have sex a lot. So you should know that. But every now and then. >> James Curran: You don't really need to tell us. >> Debra Fraser-Howze: But they do have sex. Most of them, single female heads of household, raised their children, gone, you know, they work, professional black women, slip up every now and then. Because they're not condom-savvy, they're afraid to — you know. So I'm giving you all the scenarios, the true across the board. They're not unintelligent, they all have several degrees, and they know about AIDS. I'm their friend, so you know they know. I had one of them tell me just recently that the way she knows she's not positive and does not have AIDS is because she's got all the men she's ever had sex with on a board, and she calls their numbers, and if they answer the phone and they're not dead — (Laughter) >> James Curran: So Dr. Colby, what do you think about the future? >> Gail Wyatt: Pretty amazing. >> James Curran: That's hard to follow, Lloyd. >> Debra Fraser-Howze: We're in trouble. >> Lloyd Colby: Yeah. Well, to not be facetious at all, but I think the future is our young people. I think much of the discussion in AIDS always focuses on adult populations. And I think there must be great credit given to young people and parents, and especially the nation's schools. The nation's schools have implemented HIV prevention programs. Have they implemented it to the extent to which we'd like to see it? No. We've seen a reduction in sexual risk behaviors over the last two decades, but most of that reduction occurred during the 1990s, and what we're seeing is flat line at this point in time. To be oversimplistic. I think there's a lot more complacency, our schools are under much more strain at this point in time, and I can easily see schools saying we have much more important things to do, this is becoming increasingly controversial we don't know whether these programs are effective or not, is this comprehensive sex education, should we addressing HIVs and STDs, do we look at only those populations that are at greatest risk. So I think as the HIV plan very appropriately decides to focus on high-risk populations, I think we need to maintain an educated society across the board and assure that the next generation of young people that knows at least as much as the previous generation. And that we keep this epidemic in front of the American people, the parents, the schools, the entire population. >> James Curran: Dr. Wyatt. >> Gail Wyatt: Well, I'm cautiously optimistic. But I must tell you, America needs to claim its history. We are still fighting the Civil War, as far as I'm concerned, in terms of our understanding of ethnicity, race, all of these terms that we've used to polarize ourselves from each other. 85 percent or more of our genes are shared amongst the human race. There is nothing substantive about race. We've created it, and we use it to divide ourselves from each other, and we are denial about this issue. When you look at HIV, you have to look at racism in this country in order to understand why we can't take a hold of this problem. Because we've blamed it on black people. As we blamed everything else you can imagine on black people. And I've been privileged, I would say, to be in certain circumstances where people would drink — I don't drink, and let me tell you, it's a whole experience watching other people drink. But when they start to drink, about two glasses of whatever, in, they begin to talk about race, and who's to blame for this and that. And I've heard these things all my life. I grew up in a segregated America, so this is no — this is not new to me. My children know about racism, and they know about where America has been, so they are racially socialized, and they can deal with it accordingly. Their children — I'm a grandmother, I probably the — no, I'm not. Debra is a grandmother. Very few. But my grandchildren know about racism. Because you've got to know it when you see it in order to understand why things continue to proliferate the way they do. I'm cautious because as long as we think that — and with all due respect, Shep — reducing the number of partners is going to cure transmission, we're just going to miss the boat. You see, because 300 years ago black people couldn't control any number of partners, you see. And we've never really addressed that. We've never publicly said at one point we wanted to control how many partners you had. Now we want you to control how many partners you have. You see, there's a transition there that America has not been willing to make. America doesn't want to accept the fact that there are so many African-American men in prison or dead or not interested in women or dead in infancy that there aren't enough men for African-American women. So the dynamics of them finding somebody and having sex is not the same as what it is with other people. And we're the only group in the world that have these dynamics, but America treats us like this is a one-size-fit-all public health problem. If you just stop having sex at all, which is something that some people have never had control over, given they have histories of rape — if you know my work, you know that I talk about the nonconsensual experiences. They only study the consensual and the interventions that are approved by this country. Only focus on consensual sex. What kind of craziness is this? We're the country that had slaves. And a lot of people are still enslaved, a lot of women are still enslaved. Psychologically enslaved. Enslaved by economics. Enslaved by drugs. Enslaved by low self self-esteem, poverty, poor education, substandard housing, you name it. We've got it and we won't claim it. >> James Curran: We've got — >> Gail Wyatt: I'm not done, Jim. I came 3,000 miles, I've got to say it. (Applause.) And I came 3,000 miles today because I wanted to be here for this. This is very important. But when I say cautious, I mean because you are young and you've got the energy and you've got the future, you see, you have to hear me. You have to be clear about what America needs. I have been talking about mental health and HIV since I got my Ph.D. Mental health is not involved with HIV prevention. It's like you can just do these things, and if you're depressed, or bipolar, or whatever, you can handle it. Because we haven't addressed that, you see. This is a more holistic problem than we are willing to accept. So I'm cautious. But I'm also optimistic, because we have young people. And I think you're right, Lloyd, that's our solution. You're not going to take — you're not going to say I'm just mad, hopefully, and I'm just going to be angry in my little community of segregation that we now call social networks. Because see, people don't even understand what segregation did. Of course you have social networks, you weren't allowed to be out of sight of your community. You couldn't know anyone or date anybody but people in your community. Now it's a high risk for HIV transmission. That's segregation. We didn't do it to ourselves, but we're being blamed for it, you see. We have to clear this up. So I want you to go back to whatever books you read, and if you don't have them go buy them, and learn our history, first of all, so you understand what we need. You can't ask black people to jump over 3 or 400 years. You have to take them where they are. We are an eighteenth century people in terms of what we understand about our freedom, Debra said it, about our bodies, about our minds, and about our ability to make America our own. And if we don't make that transition within our community, nobody can tell us how to do it, you see. Because change has to come from within. So if America, white America, is not willing to empower black people to be their own decision-makers, to be PIs of their grants, to be directors of their own community-based organizations, and to be at the table when they make decisions in the HTPNs — if you know what I'm talking about, those interesting clinical trials that get funded, but we don't always review them, you see. If we're not there making decisions about what kind of national and international approach we should use, when we go to Africa and we involve black people in interventions, and then we find that the medications are effective, then we trot on back home and write our articles in New England Journal of Medicine or Lancet and those poor African people don't get that medicine, you've got to stop it. I may not live long enough, but that's wrong. That's why America has to stand up and claim it. You can't do clinical trials on vulnerable poor people just because they are more at risk for certain kinds of diseases, and not give them the medicine if you find that they're infected. Just stand there and watch, and then report them in the control group, is wrong. It's unethical, it's unprofessional, and it's racist. Because we don't do that in America. We did, when it came to condoms and birth control bills, we did them on African-Americans. But now we've gone all over the world doing it, and that's wrong. So you be the ones to stand up and say I'm not going to just get my degrees here at Emory, I'm going to be an activist. Because you can believe every single one of us on this panel, including Jim, is a stone-cold advocate. Thank you. (Applause.) >> James Curran: So Cornelius, you have the choice of the last word or you can just give up and pass. >> Cornelius Baker: I know. Well, I mean, I would give up and pass except I do want to say a couple of things. Especially because I'm not a public health person, you know, I'm so privileged to work with the people at CDC and other public health advocates. You know, I'm an artist, and a gay man, and my people were dying. And so we did what we had to do to survive. And we were young at the time. And we're not so young now, but that's a good thing. You know, in another month and a half I'll turn 50 years old. In 1981 I didn't think that was going to happen. But we willed ourselves to survive. And what gives — and I have no doubt we will prevail. And the reason I have no doubt is because we changed the drug development process in the United States. I helped organize the Stonehenge meeting on needle exchange for Secretary Sullivan, where there was great division — and particularly in the black community — about whether or not to now clean syringes into our communities. And we've evolved. I remember meetings that we had with the congressional black caucus, where we got great resistance from the men in the caucus. We to be very honest, because it wasn't just Reagan and Bush against us. We've evolved. You know, I live in Washington, D.C. where I chaired the committee that pushed for same sex marriage in the district. A majority black city where our city council voted for it, a majority black city council. So beginning to address the issues of homophobia. And having the black community, which has always lead on justice in this country, also do so for gay people. Because we also have to recognize that the majority of the epidemic in this country has been and will be gay men. And so we have to address the issues of homosexuality. And we have to address liberty, we have to address justice for that community. And we have to be very clear about where we're going on that. You know, the fact that we're alive today, and there are six states in the district that allow same gender marriage, is progress. And so if we really want to get to — and I'm not saying that I'm one of the people who want to get there, but for the people who want to get to one partner for life, and you want to address this epidemic, I want to hear you talk about gay people getting married and having one partner for life. But don't tell them they have to do something, and not give them the social structures to support it. And so I just want — and so I think, you know, so I just want to, I mean, I think conclude with saying that we have made a journey over the last 30 years, but a lot of it didn't start on Main Street, you know, it started in back rooms, it started in discotheque, it started in-house parties, it started with people saying we're going to live through this. And we're going to change the country in the process. And we've kept faith with that. And I think that, you know, we're going to keep pushing until we have a vaccine, until we have drugs that can keep people alive for a long period of time, and until we see the same progress we've made with like mother-to-child transmission of HIV, or blood transfusions. We've made successes, but those successes have come through protests, and through working the system. That some of us did go inside, Jim started with that question. But we weren't confused, we went inside with a purpose. And we got the job that we needed to get done, done. And so — and we will continue to do that. Whether it's inside or outside. We're not confused. And we're not weak. And so we're going to end this, you know, hopefully it won't take another 30 years, but we're certainly going to prevail. And I just really want to thank you all for being here, because that's what will also help make it so. >> James Curran: So Cornelius, I think I always sort of like to summarize and give my opinion then open it up to the audience for Q&A with us. And the reason I like to summarize and give my opinion is that I agree with most of what everybody said, and I think that you all agree with each other. My own pet peeve and concern as a scientist is that the country — because we have a lot of science going on with HIV — is looking for the magic bullet. And we just keep on waiting that there's going to be another magic bullet. It's going to be a microbicide it's going to be prep, it's going to be test and treat. And we're ignoring, as Shepherd would say, the fundamentals. And as Debra would say, what I would call the fundamentals. And I think as what Lloyd would say is the fundamentals. My major concern in the last 15 years since HAART is the lack of awareness generally about AIDS. One of the things that drove behavior change in the 80s, was not only the so many people dying and getting sick, but the constant news — newspapers stuff going on. And it's easy for us to forget that there are 4 million Americans who have sex for the first time every year. I know that not because I count them, but rather because there are more than 4 million people who are born every year. And then there's a million that migrate. So we know that after 10 years, there's 40 million people who had their first sexual experience in a time when AIDS wasn't a big deal, it wasn't in the paper. It isn't just HAART, it's the fact that it's not a big deal. It's not emphasized the way it used to be. The kinds of things that led to community-wide behavior change and behavior norms don't exist as much anymore because it's not talked about as much. The other thing is as an infectious disease person it's very hard to see how, when you have a silent infectious disease that people carry, that there's any reasonable way, if you have a large number of people who are infected and don't know they're infected, that you can prevent it without getting people to know they're infected. And in virtually every study when people are study are tested, they transmit less. And so the fundamentals of testing, which has to really be tied to the scarcity issue of medical care, I mean, I think you can — I'm a hawk on testing. But I'm also a hawk on making sure that these people get care. They shouldn't be on AID app waiting list and they shouldn't be uninsured and things like this. (Applause.) And then finally, this occurs in the context of not only scarcity and poverty, but racism and homophobia. And those things are — and there's sexism, also. But racism and homophobia are at the very center of the AIDS epidemic, in the center of where it is. And it's — I always like to tell a story before we go on, it's one of the most — we all have wonderful stories to tell, people who — a secretary who worked for me who was on disability and was 120 pounds who was almost dead when I left CDC, worked for Ron Valdiserri and I, three years later I went to a party and I heard this booming voice, and there was a guy sitting on a piano. Who had gained his 100 pounds back, who was on HAART, who is still now a preacher at a church downtown for a gay community. Who lived, who came right in at HAART, the perfect time, and saved his life. But then we have the sad story, and the saddest story that I knew was a man who worked with us at CDC in the beginning of the AIDS epidemic. He was an openly gay man, went to an Ivy League school, and helped us in the case control studies. Was an outstanding guy who was openly gay, and that's why he worked with us in New York. And I spent 40 weeks with him in the initial case control studies, and he was getting volunteers from the gay community to be controls. And I kept — he was so good, I said you have to come to Atlanta and work with us, and he said well, you know, being a gay man in Atlanta isn't exactly what he thought was a good thing. Particularly working on this epidemic. Several years later he came and worked in environmental health at CDC. And as you would expect for somebody as good as he was, got promoted very, very rapidly. And I saw him many, many times. I saw him once and he said, 'You act like you think I'm gay.' Well, you were gay the last 20 years I knew you. Maybe you've changed or something, I don't know. And then he was working on a project with me and he was working with one of our faculty members after I came to Emory. And the guy was brilliant, he's a wonderful guy. And I had a call from the head of infection disease in Chicago at a medical school who said that there was a man who mentioned my name who was dying of pneumocystis pneumonia, in the ICU. And he was this guy. In 1999, four years after HAART. He had a couple pills of AZT in his pocket. He had never been tested for HIV, and he never — he never got treated, and he died in that ICU. And I went to his funeral with his family. And here's an Ivy League guy, he was Uncle Jim. 48 years old, never been married. Like me, he was raised in a Catholic family. And I went to gave my condolences to his parents, and I mentioned that it was really sad, and I mentioned AIDS. And they said, oh, no, he didn't die of AIDS, he died of cancer. And we always wondered why he never got married, he was just Uncle Jim, the bachelor. And this guy carried his homophobia in a closet, he was an actively open gay man in New York City for 20 years, in Yale. And we can't put a finger on changing human behavior for some people. It's far more complicated than we think, it's one of the most complicated human behaviors. But we can't also not change the behavior. And had he been tested, he would have been in the audience today. And probably been promoted even higher at CDC. But he died because of this untellable story, almost. And it makes me almost try cry to think about it, because he had every advantage he could have. But having said that, I'm optimistic about the future because of the numbers of people working on this problem and the fact that it's such a big problem. The only bullets that will save us are both a safe and effective vaccine and a cure. So we need those, but unless we have both of those we've got a long row to hoe. But we have White House AIDS policy advisors in the audience, we have people from 30 countries in the audience, we have closeted CDC bureaucrats in the audience. Don't be afraid to show your faces, I see you. Come on up to the microphones and ask questions and make comments. Try to keep comments short and we'll make our answers short. >> Good. Hi, my name is Diana, I'm a closeted CDC person. Dr. Wyatt, this is my perfect world for a minute. So my name is Diana, but I'm going to be frank. When I saw the title of this presentation, I was expecting a little something different. When we were talking about politics and this disease and what's going on, seeing the group in here, the very young people for the most part, I was expect a little bit more about what the current sexually conservative political climate is. What these young folks can do in the next 30 years, in the next five years, in the next 10 years. Where their advocacy needs to be focused. Dr. Wyatt, you talked about a global issue. I didn't hear enough about sexuality education, how it needs to evolve, how we need to be including social media when — you know, in this conservative climate we could use some other newer resources in order to get these messages out. I'm not criticizing, but I wanted to hear some of that. You guys have over 200 years of collective experience in this disease. Come on, guys, let's shake it up a little. I want to see you up there dancing, I want you to see you — >> James Curran: Okay, Gail, go for it. >> No, no, I mean, Dr. Colby, come on. Thank you. >> I have to start first? >> Lloyd Colby: At the risk of sounding academic, but sure for those of you that are involved in an academic program, I think it has everything to do with the new public health. That is to say that as we look at the new public health, it's not going to be CDC, it's not going to be state health departments, and it's not going to be local health departments that are going to do the new public health. Certainly high on the list, not to say the only one, but looking at the nation's schools. How in the future are they going to be addressing this particular problem and other problems. They're already being beat far more than the HIV community than by the obesity community. There's a big push, and the schools have everything they can do, thank you very much, to address the problem. How are you in the future going to create that new public health where we've got agencies across the board, whether they're in education, when one looks at the sexualization of our society. The social determinants. Not just the behavioral determinants, and blaming the victims, blaming the kids, but look at the increasing sexuality — sexualization of our media, of our society, and then tell me we're not going to see an increase in sexual risk behaviors over time across populations. Now, how do we address this epidemic not just with CDC at the lead, but to involve all those agencies. School is just one example, but I think a good one. The other agencies that need to be at the table, as part of the solution. >> James Curran: I think we're going to try to — Gail, we'll give you one minute, but we're going to try to have one from now on, because there's 8 people, 9 people waiting. >> Gail Wyatt: I agree with what Lloyd has said, but I think we need a strategy with the United States in terms of nationalized human sexuality education. The reason that we have so many problems is that America will not claim that it is a sexual country. When other countries do, we have a national strategy, everyone gets educated all through life, and it's just not the issue that it is here. We have let people sort of abandon this issue or deny it with politics, with religion. It has nothing to do with that. This is health, everybody ought to know how their bodies function, and I think that we have to educate the American public. We have people who join the PTA to make sure human sexuality education is not taught. I've developed programs in schools, and I know that there are parents who make it their business to make sure that none of the children get this education. We need to stand up in our nation to say that — and people are afraid to admit it, that we need human sexuality education. We need to educate parents. I have taught parents the same curriculum that I've taught their children. They didn't even know how they got the children that I'm teaching. So it's just amazing ignorance and naivete, and if we don't start at that level and raise a generation of very sophisticated kids, when who when they understand how their bodies work will not allow their bodies be manipulated, especially if they can talk to parents. And then bring the churches in, the religious institutions. We need to start from the ground up. >> James Curran: To the right. >> Hello, my name is Vincent Jones and I'm with the National Black Gay Men's Advocacy Coalition, and I actually had a question written down but it was just asked, so I'm going to ask another one. Oftentimes when we talk about this epidemic we talk about it in the sense of siloed risk groups. How do you address the communities like myself that exist in a number of different categories. Because I'm just as much black as I am gay, and also as a young man, now also living with this virus now. Oftentimes we talk about black people or we talk about gay people, but we don't talk about being the intersection of those risk factors. So how do we get into a more — a detailed conversation around being at the intersection of those risk factors. And aggressively addressing those risk factors. >> Debra Fraser-Howze: I think that the circumstances — your name again? >> Vinton. >> Debra Fraser-Howze: Vinton? Clinton, I thought you said Clinton. I think very often the circumstances opens that discussion, and let me give you an example. Because you are all of those things. I mean, I'm black, female, somebody's grandmama, somebody's — I am all of those things, we are all a bunch of things. >> Right. >> Debra Fraser-Howze: Everybody sitting in this room is more than one thing. But I think that circumstances often determine how those things intersect for you. And how you — how you play them out, and specific policy roles or advocacy roles, when it comes to specific issues. Which is like the issue that we're discussing here today. And let me give you an example. When we were developing the minority AIDS initiative, a piece — a huge piece of legislation, we were working together. The African-Americans, men, women — men, women. Some gay, some straight. And it was a time in this where black gay men and heterosexual black women were at an intersection politically in a very volatile political situation, where we were either faced with pushing a black gay agenda on something, and losing something for the community, or pushing a community agenda and holding back the black gay agenda. And we came to a crossroads, and we had to make a decision. And it was the black gay men in the room who said, pull back the black gay agenda. Not to harm the black gay community, but to win for the whole community. The women, the children. Because we had an agenda on the table for the whole community. And instead of giving that up for everybody, it was all those intersections of who they were that came together as this one community. >> James Curran: Question on the left. >> Debra Fraser-Howze: It's those things that happen to you. And as you move on and mature, that's going to happen more and more. >> James Curran: Question on the left. >> Good evening. My name is William Moore, I'm currently in the field of monitoring and evaluation in HIV and AIDS, and I have to give a quick disclaimer. This question may be a little more serve as inspiration just to hear you all's rebuttal to it. But what do you all feel is the role of heterosexual black men in the fight against HIV and AIDS? It's funny that you guys mention Satcher, you mention Sullivan, and to me they're like anomalies, as straight black men that are in this fight. However, me being a, you know, recent masters of public health graduate and being where I am now, I don't see a lot of straight black men that are necessarily represented to the level of where you all are. Besides, like I said, the novelties, Satcher and Sullivan. So where is the role of, you know, straight black men specifically in the future of HIV and AIDS? >> James Curran: Okay, one answer to this question, who wants it? >> Debra Fraser-Howze: Welcome, brother. >> James Curran: Okay, we'll give you two answers. Shepherd wants one. Shepherd wants one, Gail wants one, take your choice. >> Shepherd Smith: Young black men really need good role models, and as a heterosexual black man you have a lot to offer young black men and youth. Unfortunately, I'm not a black man, and I say that to people to say I'm not the person to go in and talk to young black men. You are. And the need for these youth is to — especially since we have so many father-absent families now, is to really give good advice, develop a mentor role, and help them understand their responsibility and their future, and give them hope. >> James Curran: AIDS is covered with denial, too. When we start talking about who is at greatest risk, we forget that everybody can be at risk. I mean, it's really what you do, it's not who you are, and it's a combination of the risk varies. But it's very easy to say, well, okay, I guess I'm not even counted, what should I do. So watch out for denial. Yeah, over here. >> Shepherd Smith: And it's very much a heterosexual issue on HIV transmission. >> Cornelius Baker: I'm sorry, because I just — I also just think that we have to be very clear about our histories. And I'm not a black straight man, but, you know, Dr. Beny Primm served on Reagan's advisory committee. You know, Jesse Jackson was the first major political candidate who puts the rights of LGBT people in the political sphere. I mean, I think that we have had black straight men — you know, Marion Barry created the first AIDS program in the country. San Francisco gets all the credit. Marion Barry put the first budget together. So I just think that — you know, Mayor Dinkins did a lot in New York City. I think it's a lie. And I think that black straight men have been there at the table from the beginning. I mean, they're whitewashed out of history. And I just don't think we should allow that to stand. And so I think that there are a lot of people who have been there, not enough, but I think — but it's been — you know, Lou Stokes in particular, in Congress, you know, was one of the great defenders of NIH. So I just want to correct that. >> James Curran: Okay, on the right. >> Hi, I'm Kevin harve, a student at Rollins School of public health. I'm happy to — I'm from Jamaica. (Applause.) I'm happy to see the discussion. But — and what the CDC and America does influence the rest of the world. I wanted to comment on the structure of the HIV response in America compared to its external response. But in doing that I want to comment a little bit on the issue of this risk profiling that we're now using to — >> James Curran: You have a minute and a half to do it. >> To talk about marks. I won't take so long. Now, we focus on gay men, we focus on drug users, commercial sex workers, et cetera. But if we look at the epidemic, we're seeing the feminization of the epidemic, and we're seeing that the majority of persons who in fact are infected are heterosexual males with multiple partners who are not using condoms consistently. And when you categorize and you focus on these groups of marks, this is where the money goes. It goes towards man who have sex with men, commercial sex workers, drug users. But the majority of persons, heterosexual males and their partners, multiple partners, the funding is disappearing around that group. And if you're not able to see behavior change in that group, then we're not going to be able an impact. >> James Curran: Any comments, who wants to comment? Debra does. >> Debra Fraser-Howze: I have to answer my friend Kevin. The reality is, and it's a short one, I think it goes back to one of the things that we brought up before. Everywhere in the world, from the beginning of this epidemic, this epidemic was a heterosexual epidemic. Everywhere in the world except America. And we treated it as a homosexual epidemic. Everywhere else in the world — how on the earth we did that, I'm still confused about it. And we didn't see — you know, you looked — the one thing we could never do again is see an epidemic like this and see it worldwide as something else, and decide that we're only going to treat it the way it looks here. >> Gail Wyatt: Let me add to that. >> Debra Fraser-Howze: Oh, no, Jim, now we're going to fight. >> James Curran: I think we have to fight about this. >> Gail Wyatt: Not only have we taken the agenda of one group, we take interventions developed on gay white men and apply them all over the world. That's the sin of it. That's the sin of it. Then we wonder why the disease proliferates. >> Debra Fraser-Howze: And when you look at Africa and the Caribbean and you look at all these countries that PEPFAR is serving now and you look at this heterosexual epidemic gone mad, and then when you look at the black and Latino community, the epidemic gone mad, and then you say to yourself, what is all this heterosexual infection going on — black gay men, too, terribly, but you also see this heterosexual infection, and infection of women that you don't see in all these other communities, how did we allow that to happen? >> James Curran: Well, I agree with you about your solution, which is it's stupid to take interventions that have been shown to be effective or ineffective in one group and apply it to another group. But we have to remember that in every single developed country in the world, the majority of cases that occurred in the first five years, and the majority of cases that occur today in the United States, are in gay men. And you know, epidemiology means something so you can't — it means as much — it means as much for gay men as it does for black men and women. In the United States. >> Right. >> James Curran: In Africa it's different. But you know, I think we can't deny — I mean, the epidemiology of HIV in the United States in gay men has the same predominantly horrible outcome over a lifetime as it does for many people in sub-Saharan Africa. Because of the prevalence. So you can't — it's not — the thing I like about our discussion right now, before you beat me up, is it's an example. >> DEBRA: I'd never beat you up, I've always loved you, Jim. >> James Curran: No, it's an example of the polarization of the problem, and that we can't say it's either/or. I mean, homophobia, racism, prevalence, where the virus is, are all part of the problem. And saying it's a gay epidemic or it's a black epidemic is wrong, but it's also wrong not to point out how to solve it. >> Debra Fraser-Howze: But here's what I'm saying. It's not either/or, it's all of it. That's what I'm saying. And I understand that people will come back and say, but there are fiscal restraints and there are all of these restraints that we've got to look at. And I'm saying if we can take a bomb and pay God knows how much money that we pay for a bomb, and go out to war in all these countries. And if we can drop it one time and blow a hole in the ground somewhere else, and if that money can be used for testing, treatment and care, and if we could wipe this out and we could get our priorities straight, I'm saying that we can do it all. That's what I'm saying. That's my reality in this. And we can look at the other countries that we need to go out here and deal with, and what we need to do in America as well. Do it all. >> Hi. I'm Denise Davidson, I'm a social worker at — social work educator at the University of Georgia. My dissertation was on black feminist leadership and HIV/AIDS communities work. One of the things that came out of that research was that comments — and this was several different women who grew up in the disease, who formed their own organizations that came out and did a lot of work. I was particularly interested in hearing more of the comment where Dr. Wyatt started out talking about being on the inside and not being able to be at the table. Because that's what they said, black women have always known what to do in the community. It's just that when you start really speaking out, you get silenced, you become invisible. And if you would also add how do more of us get to the table. >> James Curran: Dr. Wyatt. >> Gail Wyatt: Well, I think the way that you are approaching it by being in school, getting degrees, being directors and having leadership in community-based organizations is definitely a start. But I think that, you know, when I watched Act Up, if you all are as old as I am, or you've read about Act Up, Act Up was white gay men acting up. You know, in the most inappropriate places. And the academics could just sit back and say ooh, look at them, you know, tsk, tsk. But we don't have an Act Up in the black community, and we need one. See, I'm ready to go out and picket somewhere. Because when I grew up I went to Fisk University, we were socialized by Dr. Martin Luther King to get our plackets and go out there and picket. He told to us do it. I was just 16 years old when I met him, and he said you have to make a difference. Get out there and don't be silent. Don't set by the door. You know what I'm talking about, black people in this room? People who sit by the door, watch a whole lot of stuff go through the door, but they never go. I could use other terms, but you understand what I spoke to you in code. If you haven't lost who you are, you understand what I just told you, right? So don't sit by the door. We have to be loud. We have to be insistent that we do have the talents, we have the knowledge of how to change our community, and we need to take control. Don't let people tell you that there's not enough of us, we're not in graduate school. I have a training program for HIV at UCLA. And the response was, from the people that we're training — four fabulous women, women of color. Well, these women aren't doing cutting edge work. You know what they're doing? They're going out and doing qualitative work first. Because we don't know enough about black sexuality. We have our nerve going out with an intervention when we don't know what people's experience is. And we certainly don't know on behalf of black heterosexual men what their experience is. That's where you start, you listen to people. You don't go out with an intervention that was developed with somebody else in one city, and think that that's going to be the effective method. You have to protest. This is nonsense. And for us to allow it to go on because it's been endorsed by the government means that we somehow are complicit to our own demise. Because it's not working, we're still getting infected. So you have to be loud. I get punished for speaking out. Anybody who knows me will know, I have been punished for not being the kind of quiet, appropriate person that they would expect an educated black woman to be. But I wasn't raise that way. I just told you, Dr. King told me to be loud, my mother told me to be appropriate, and so somewhere in the middle of that is me. You've got to find your way, too. >> James Curran: David Satcher was in premed at Morehouse when Martin Luther King was marching, and he has on his CV, you know, that he was arrested for this. And that there have been people who have questioned him during his career about what this arrest was all about. Dr. Wyatt, you're a shy person, and I wanted to just say that being so shy I can understand how you've had a 17-year career award from NIH. A lot of us who receive money from NIH, as I do now for the last 12 years, or as many people do from CDC, to some extent become complicit because we're receiving the money. And I think this is true for a lot of community organizations, as well. You end up saying I don't really want to criticize government too much anymore. In other words, you sort of get bought off. And there's a risk to that, I think, over time. So that's a great comment. >> Gail Wyatt: Well, let me just say, Jim, I was funded the first time — >> James Curran: But you've done pretty well. >> Gail Wyatt: By NIH in 1980. I was the first African-American, the first person of color to get a K award, if any of you know what a K award is. And the first one to get an RO1 at the same time. First African-American woman to be licensed in the state of California. And the first Ph.D. to become full professor at a school of medicine. (Applause.) So I've stood up, I've been continuously funded since 1980. Even though my work isn't as endorsed as it could be, I'm doing very well. Because I've not gotten tired, I do walk through the door, I don't sit by it. You asked me to come, and I'm telling you from my heart — and from my head, because I do believe that if we're going to deal with a sexually related issue, we have to integrate emotions. Have you ever heard of an intervention where people talked about love, okay? But we have to integrate our heads and our hearts in what we know is right. And that's why I really want to — I'm really happy to be here, so that we have this opportunity to help these young people find their way. This is exciting. >> Good evening. My name is Daniel Griffin, I live and work here in Atlanta now. I know Mr. Cornelius Baker personally, I haven't met anyone else. And my question was going to be how do you all give back to the youth who are coming up. And Dr. Wyatt just mentioned her mentorship program. So I'm wondering do the other panelists have some type of giveback for the youth who is coming up in HIV prevention. >> James Curran: Who wants to answer that one? >> Debra Fraser-Howze: I can. I certainly have — in my career in (inaudible) I have ensured that my staff is young. And in my career at Orasure, we are across the street literally from Lehigh Valley University. And I ensure that interns are brought into my world, and work in the company, all over the company. And I ensure that we pay them, so that they can come in and understand what the world of business is, and what it is we do. >> James Curran: Shepherd. >> Shepherd Smith: Yeah, I'm kind of astonished at young people today, with all the exposure that they have to so many sexual images, so much marketing, that is on — that uses sex to sell products, and yet their behavior is remarkably restrained regarding sexual activity. And I think that we want to continue that pattern, because we know that delaying sexual debut for youth has tremendous benefits long-term. And so in respect to young people, the more mentors we can get out there, the more truth that we can share with them about the pluses and minuses of early sexual debut, I think the better we're going to be able to have a generation that's going to be savvy, smart, and survive. >> James Curran: I'm going to go for four more comments, that is the people standing by the microphone, starting with you. >> A STUDENT: My name is shala pitan, I graduated from Raleigh School of Public Health a few years ago, I'm one of those closet people that Jim Curran just talked about at the CDC. My question is born out of concern. We've talked about several ideas here from the panelists, all the people have made comments about what is happening globally, about the things that are working and the things that seem not to be working in different communities. My concern, however, is that we see what is happening in terms of the financial downturn going on firstly with America, Europe, everywhere in the world. How — I mean, what does this portend for the fight against HIV/AIDS? My concern is are we likely to see a drop in the funding for HIV/AIDS? And if that's going to happen, what are we as activists for HIV/AIDS going to do to prepare the ground for it. Are we trying to focus on, you know, things that work, and things that don't work, you know, what is the preparation? Because like the drum beats of battle is already sounding louder and louder. What are we doing. >> James Curran: So who wants to answer that one? >> Debra Fraser-Howze: Prior to the 3 trillion dollars that this last agreement from the debt ceiling has brought us, there was a real push-back in government when we made cuts earlier, in the last two sessions, on anything having to do with any global funding. So you need to be very, very aware that there has been this real concern at this point, given the nation's current fiscal crisis, that the spend in global funding needs to be curtailed until we — until we, America, gets its house in order. That's not — Congress is not trying to hide that, I mean, that's an open — that's an open discussion on the House floor, you can turn on C-Span and hear that on a regular basis. So I believe that with the debt crisis and the agreements that lead up to this supercommittee coming to make the two cuts that have to be made, I think that you're going to see a drastic cut in public health. I think that you're going to definitely see global health impacted by that. I think that that's going to be part of the second round. I think the prevention fund is going to be first target of cuts, and I think that the cuts are going to be severe. And I think that there needs to be a preparation for that, and I think that the community — the community is already beginning to get together, and the global community, particularly global community funded by PEPFAR, needs to get together now. And start to prepare for some sort of a contingency of what will happen, and start to meet together, and with government, in regard to what their contingency is going to be. >> James Curran: You have a solution, Shepherd? We have three more people that are going to get to speak. >> Shepherd Smith: I just want to quote Greg Gonsalves, who is a gay man, liberal Democrat, who said we need Bush back on PEPFAR. This president has not lived up in any measure to — >> DEBRA: sh-sh. >> Shepherd Smith: That's true. To what we had. >> Gail Wyatt: We're not going to go there, please. >> James Curran: Okay, right here on the right. >> Good afternoon. My name is Michelle Allen, I'm the state STD director. And I would love to hear the thoughts from the panel on bringing STD and HIV back together. I think the separation of HIV into a movement has really been a problem for STD programs. >> Debra Fraser-Howze: Absolutely. >> Surveillance systems are not integrated, there's no data sharing, HIV is behind locked doors, they have their own separate set of laws. We don't have herpes laws, we don't have gonorrhea laws. HIV should be treated like an STD, I think our patients are really, really suffering. I was so pleased when I heard the comment about the mandatory screening of HIV in STD settings. In the state of Georgia our STD burden is actually more pronounced. We're constantly in the top two or three. And our HIV infected clients always have comorbidities of STD. It's just a devastating epidemic that we're seeing in our state. And I just want to close with saying I know what happened for me, I joined this field in 1996. My first HIV case was in a 65-year-old woman, three lifetime partners, never had an STD. Was tested because she came to public health. They've got to come back together. >> See? >> James Curran: Does anyone want to either agree or disagree with that. >> I'll believe you're happy if you clap. >> Gail Wyatt: And I want to agree. >> James Curran: You want to agree? >> Gail Wyatt: I want to agree. I'll go you one further. I think this has all been funding issues. Whose pot — who is going to get the most money. It makes absolutely no sense to divide them. And I know Cornelius has different feelings about it. I also think that women need family planning to be added to the HIV prevention match. I don't believe the treatment is prevention. That assumes that everybody in the world is HIV positive. And we have to just sit by and wait for everybody to get infected, and then give them some kind of medication. Prevention is prevention. That means that when you come in and learn about your body, you ought to be learning about all things that you need to do to keep yourself healthy and that you can transmit to somebody you care about. And it makes absolutely no sense for us to continue this pattern, because it has been so injurious to women. There's a real bias against women in HIV services. They're the first ones to be defunded, and usually this kind of care and attention to their bodies really hurts, because if they are HIV positive, they can't get an OB/GYN to see them in that setting, they have to go across town. Which means that women may then just put that aside and just focus on the HIV, if they are in care. That's discriminatory, and needs to stop. >> James Curran: Go ahead, Cornelius. >> Cornelius Baker: I would disagree. Well, first of all, let me say I don't disagree with the central premise of better uniting family planning, STD, and HIV. I think that what we have to be clear about is that it can't be done the way family planning and STD have been done to work for HIV. And because that's been a failure. And it certainly has been a failure for black men, and especially for black gay men. And when we look at the disparities in syphilis, and gonorrhea, and HIV, black gay men are disparately burdened on all of them. Now, Debra talked earlier about the decisions we made around the minority HIV/AIDS act. I was one of those men, along with Ernest Hopkins, who said yes, we will sacrifice on behalf of our sisters and our brothers. And that we will pull back on gay men being a priority focus, and written into the legislation. But what's not acceptable for us at this stage, given the data — because the data means something — is to not acknowledge that gay men are the only population where HIV is increasing in this country. >> So one thing — >> Cornelius Baker: Now, no, it's not true. So women are affected, they're burdened, we care about them, and we're going to advocate for them. But we're not going to misrepresent the data. The second thing we're not going to do is to create systems that don't acknowledge people who suffer injustice. In this state, Georgia, which does not provide protections in employment, housing, and in other areas for gay people, nor does any state that touches Georgia or any state that touches a state that touches Georgia, as my boyfriend up there, who is a lawyer at Lambda Legal, will remind us. So having systems where people show us up at your house, like in STD, and disclose a lot about you, don't work. Also, having systems where the community is not fully participant in the decisions that affect their lives, doesn't work. And which is why we have rampant gonorrhea and syphilis that is — and you don't have any advocates for it. >> James Curran: So Cornelius — I think what Gail and Cornelius said are extremely important. The history of HIV and STD and the amount of money available will tell you a little bit about why they're separate. Now, I just got appointed to the board of public health in Georgia, and if you just sent up a secret thing and asked the new health commissioner how they might better integrate, I think that's important. Because keeping people healthy, depending upon their own risks and their own needs, particularly when it deals with sexuality, you know, involves pregnancy, STDs, their own sexual health, how they feel about themselves, a whole lot of different things. And it involves homosexuality and homophobia and a lot of things like this. The reason HIV was separate from STD to begin with — and remember, I worked in STDs for 10 years — was that the biomedical model of test and treat, and the STD clinic base, was insufficient to dealing with the behaviorally, culturally based epidemic, which was shown to be a chronic disease. So when I think about HIV, I think about the lack of connections between HIV and Ryan White care programs. Between treatment of people for life with HIV. That's another link that needs to be made. STD clinics have never done a particularly good job with that kind of thing either. So I mean, integrating STD, and of course tuberculosis, which is extremely close to HIV, and dealing with all of the health needs of individuals in the community, may require a model which is neither STD nor HIV, but it does need to bring them all together. But everybody needs to listen to each other, rather than just be jealous of each other. From my point of view, it's always how come they aren't giving us some of that money. Well, here's the guy who is in charge of everything in AIDS in America, from CDC, and he is here to not only defend, but to tell us what's going to happen in the future. Dr. Mirmen. >> Thank you, Dean Curran, that was a false advertisement. But I am Jonathan Mirmen, I work with CDC, and it was really great to hear everybody, I was very excited to hear people talk thoughtfully and passionately, outside the bedroom. So my question is this, is several of you raised the issues that maybe 10, 20 and 30 years ago there was some specific issues that are critical to HIV prevention, where people weren't listening to each other. And looking back, you might have — you might have approached them differently, either with more information, or with the seniority of wisdom. And I'm wondering, looking now, in 2011, are there any issues now that you think are tension points, or points that if we dealt with better we might have a better impact on the epidemic and helping people with HIV live longer and healthier lives. >> James Curran: Dr. Wyatt. >> Gail Wyatt: I think the whole issue of medicalizing HIV treatment is certainly one for me. I think that while some of the new findings are very exciting, the whole approach to research today is looking at the best-case scenario in a randomized clinical trial. Where all things that could be barriers are washed away, and then we find these findings. Which are very encouraging. But the disease is proliferating in the worst-case scenario. Where we have no structural interventions to speak of, where we have high unemployment, and crime in communities, and we still have racial segregation in housing, or no housing at all, and poor education and poverty. And without any intervention and attention to those issues, medicalizing HIV prevention will not be available for those people who may volunteer to be in those clinical trials, but won't receive the treatment. They need to understand how to change their behavior. That's the cheapest way to prevent transmission, and that's something that everybody can take home and claim. We can't control what people do, that's been done in America much too much. And a lot of black people push back when people tell them, now, how to have sex. I mean, we've been told how to do everything else, now we're being told that sexual pleasure has nothing to do with sex anymore, we have to do this or that. Or we have to take a pill. We have to be able to see that change comes from within. This is where being a clinician and a clinical psychologist, and not a public health person, I think really needs to be heard. We have a completely different approach to this. And we need a multidisciplinary approach to what happens in the future. Not just a select few to decide for many, but for representation to sort some of these issues out. That for me is a very scary reality, because I see cute statements like treatment is prevention coming out. When I know in the community that if we don't teach people how to control and claim their own lives in sexuality, they're just going to miss that whole epic. >> James Curran: Any other advice for the head of AIDS at CDC? Debra. >> Debra Fraser-Howze: I think that there are two very specific things in my 29 years in this epidemic. And one thing that I've learned is that this works best when government works best with community and others. And there's not a jaundiced eye. I think this whole panel has been around that. We started out talking about how we all came to the table looking at each other with this jaundiced eye, because we weren't sure who we were. And I know that as we went from the 80s to the 90s, and I started looking at you, I looked at you very differently from when I first saw you at CDC. I didn't trust anybody at CDC. I thought the whole CDC was out to kill the whole community. But then I started looking in CDC and said maybe that one is not so bad. And then, you know, I saw some people of color in CDC that I could talk to. And as it got — progressed, and I realized I could talk to some people, I said maybe they're not trying to kill us. Some of them. Some of them are trying to kill us, for sure. But I — (Laughter) But it was beginning that conversation that I started having with the people at CDC that made me begin to open up to other community leaders. And it was at that point that we began a working relationship. And that's what made things begin to work in some aspect. So we didn't look at you with a jaundiced eye, you didn't look at us with a jaundiced eye, and things started to boom. That's critical. Don't let that go. And now that I'm in industry, I'm learning the same thing. These kind of public-private partnerships, bringing resources to the table for CDC to use, to help expand their programs, I think that that works. That's the one thing that I've learned. The other thing that I've learned, you know, there's Mirmen, you know, you, Jim, there's Tony at NIH, Sandy was over in government. Freeden. Peggy at FDA. They're good people in government. And there needs to be promotion of more of that into the community. The last thing is, tell the truth. When you all manipulate data or put your own spin on it, when you all throw out stuff that sort of that's your opinion — you know, data is king. Let it stand on its own. You don't need to reinterpret it for the community. Tell the truth. And then let the community understand it, plain as it is. And when you do that, that works. >> James Curran: Shepherd, brief comment. >> Shepherd Smith: You know, in thinking could you do something differently in the past, it would be very hard. We were kind of a lone voice at first for the value of early diagnosis of HIV. It took 6, 8, 10 years to get people to see that. But in respect to prevention, things have been done for so long the same way, without the results that you really want, it's very difficult to acknowledge that you aren't getting the results you want, and maybe there's a different way. But then you might have to acknowledge that you were wrong on some things. And that's a very difficult thing to do. So I don't know — I think you have to get outside the nine dots, you have to get some intellectually honest people to come in and say, is there a different way we can approach this. Are there other things that we can do. Because we keep — we seem to keep doing the same thing, we're on this treadmill. >> (Inaudible.) >> Yeah and expecting different results. >> James Curran: The last comment. >> All right, last comment of the night. I had an original question that you guys have been kind of touching on a little bit. First, my name is Dina, I work for a local agency called Living Room, we're an HIV supportive housing agency, one of the largest providers in this area. And my original question was your thoughts on hope for future funding, specifically for HIV supportive housing, but Debra kind of touched on that a little bit. And I wanted to throw out a new question based on her response about having a contingency plan, and maybe what community involvement might be involved in that. For Debra and whoever wants to chime in on that. >> Debra Fraser-Howze: The government right now still has money in these community development grant packages, and my recommendation to you is you should go run as fast as possible and look at those community grant packages, and delve into them and adjust your program, your RFP responses, to focus on health for those community development grants. And a lot of them require that you join these bigger community development packages and provide your health service within, you know, that bigger coalition of services. These are massive grants, like millions and millions of dollars, for a community. So you can provide your AIDS housing services within this massive grant for this particular area or community. And I suggest that you look into who is applying for those, and put your grant within that service package. As soon as possible. >> James Curran: Last comment, Cornelius. >> Cornelius Baker: I think there are two things. One, the first is that we've been in difficult times before. We've had funding challenges, you know, we had a lot of private funding leave us after pills were discovered and people thought, oh, we're all done. Our AIDS walks plummeted after 2001, you know, a lot of our agencies struggled, we had to find alternative sources of funding. We shouldn't only rely on an HIV-related stream of funding. It does a disservice to the people that we serve, and it doesn't acknowledge all of their needs. But fundamentally, and I think that this talk this evening hopefully should also be about another lesson. That we're citizens, and that we have an obligation to be involved in our democracy. And so we're not running just charities and taking care of people. So if you don't have voter registration as part of your intake process, you're not doing your job. Because you're infanaticizing people. And you're not letting them know that they have rights and responsibilities as well. And that they are entitled in the richest country in the world to a better way of life. And so it means also going to your members, from your council member to your county member to your mayor, and being there all the time in their face. And it means getting involved in a campaign. You cannot be a passive observer. Because then you're not a citizen. And so — and you have to hold them accountable. You know, I mean, I have to say I have never had any administration not return my call. And so whether it was, you know — certainly working in one, but even under W, when Ryan White, people didn't think they were going to support it, and I called and, you know, Joe O'Neill was like, well, why didn't people just call and ask for a meeting. Because if you hold yourself to that standard, that you expect your government to respond to you, or you will vote them out, people get the message. But then you have to back it up. You have to be engaged. And so I just think that we shouldn't let that slide off the table. >> James Curran: So I think we have, in the green room I was worried that — I was not concerned about the 150 years of commitment that we had on the panel, I was worried a little bit that though they were passionate, that everybody would be too afraid and be too nice to each other and be afraid not to disagree. And I think that we saw some purity of spirit in our group. And I would like to give the panel a good round of applause for their participation. And mostly for their commitment. (Applause.) >> James Curran: And finally, a two and a half hour panel is a long time, even for students. And I would like to thank all of you for hanging in there with us, and for your interest in HIV epidemic.

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