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We're gonna start the morning with Dr. Marisela Gomez. But first, I wanted to let Dr. Susan Sherman and the chair of the community, which is advisory board, greet us for a moment. >> Well, good morning everyone, and thank you so much for joining us today as we explore the roots of HIV disparity, poverty, race, social injustice. This is a subject, these are subjects that are near and dear to my heart. In the City of Baltimore, where we live, where we work, and where we play, 1 in 42 people are HIV positive. And in this zip code, where all of these wonderful researches sit in the midst of this absolutely fantastic medical facility, 1 in 20 people are HIV positive. And we wonder how could this be. Could it be that stress and poverty are indicators of how well somebody will do with viral suppression? Could it be that in high poverty areas, the epidemic is double that of the generalized epidemic? Could it be that our brothers and sisters face educational issues, transportation issues, employment issues that keep them from living well? And that is why we are here today, at Hopkins to talk about some of these issues. So, we look forward to exploring with you today, as we look at race, at social justice, at inequalities. We look forward to talking with you about moving from areas of transaction between each other to areas of transformation and working together. So, we're excited to have Rashod Robinson with us. We're excited to have Dr. Gomez, Dr. Chuck. And we are excited that you are here to do your part in the eradication of HIV and AIDS. So, we thank you for joining us this morning. >> [APPLAUSE] >> I'm just here to welcome you to Hopkins. My name is Susan Sherman, and I work with David Holtgrave, and we lead the Baltimore Collaboratory, and have the honor of working with Jordan. I always say one of the best things I've done in the past 17 years here was hire Jordan White. >> [APPLAUSE] >> Because we are very blessed to have Jordan. I'm really impressed that the CPAB decided this would be the theme. It's really sad, 30 years later, we're still having these conversations. I just was thinking back to the roots of my work when I started AIDS work in San Francisco and Oakland, California, and these were conversations that needed to happen, and since we didn't have them for so long, it's kind of now entrenched. Because if we had been addressing issues of poverty around HIV, maybe we actually would have done something about poverty and discrimination, and lack of access to jobs and whatnot. But it's really great that we're taking this on today and I welcome you. Thank you. >> [APPLAUSE] >> So, as we make our transition to our first speaker Dr. Gomez. Dr. Gomez as many of you know is the author of Race, Class, Power and Organizing in East Baltimore. A book that really looks at and dissects many of the issues that we are talking about today. She's a well-known speaker in the community, she's a staunch public health advocate. I was excited that we were able to get her here today to set the tone and give us a dose of some of the conversations that we don't get to always have in the academy. And she'll be talking to us about structural inequity this morning. And if we have time, we'll address a few questions. I did get a few emails about that, but without further ado, Dr. Marisela Gomez. >> [APPLAUSE] >> Good morning everyone. >> Good morning. >> It's great to see you all here, and it's great to see all the black and brown faces. >> [LAUGH] >> I think I make a point of saying that because wherever I go and I participate in a city that's majority black, many of the audience seem to be majority white. And it's a reflection, I think, of the status that we're dealing with today in every kind of illness. Because really, illness is simply a symptom of the structural inequalities that exist. And when we get to the symptom, we've been doing it wrong for a long time because the symptoms show the effect of the systems. And so, when we're dealing now with the symptoms, it means that we've been neglecting the structures, the systems. And that's what I want to talk about today. I'm thrilled to be here. Hopkins is my Alma mater. As much as I write about them and give them hell, it's like family, right? If you don't do the work inside the house, how can you really do any work outside the house, right? And so, it's a call to justice I think, when we look inside and try to figure out how to transform the inside. It's interesting, I first came to Hopkins in 1990, to do a PhD, and my work was in HIV. I had been told my brother was HIV positive, so that was a big deal for me. I decided to not do research on what I had intentionally decided to do research on. And I switched to doing HIV work, that was 24, 25, actually 26 years ago. I know, I don't look it, right, yeah. And what I found though was that looking at HIV in the lab and trying to figure out how to make molecules to target the penetration of the virus into the cell, that was not sufficient. We needed to get out there and look at systems and structures that created the difficulties where people would even be exposed to the virus. And then, when they were exposed, how they were treated. And so, I certainly left bench work, and I haven't visit the bench for probably, I don't know, 18 years or so, and I've been more involved in public health and advocacy around race and class, particularly around how racism and classism affects everything else in society, particularly our health. So, I'm going to contextualize, HIV and equity, because I think that's how we really need to start thinking about it. That HIV infection is inequitable distribution of disease. And I probably won't do justice like our first speaker would have, but I'll try to add a drop to that stream. You'll see some slides that you think have absolutely nothing to do with what I'm presenting, and it's an invitation to stop and just breathe. Something we don't do enough of in the process of doing the work. So, what is structural inequality? So, we have structures and systems that are created by policy, right? People make policy, politicians make policy. But politicians are also effected by private interests. We live in a society where money speaks volumes. And it speaks volumes into the public sector as well. So really, public policy in the systems that we have and that we work in, it's really created by people who have resources and the people that we elect to represent us. So, these policy in effect is what, they create the systems that will provide access to health, will provide access to housing. Will provide access to education, so the policy in effect is what starts out the whole process. And so we have to start thinking all these upstream ways that results in how we access care and why we have health and equities. Public policy in effect is a social determiner of health, right? It's a determinant of health because depending on the policy is gonna depend on how structure is framed and therefore, who has access to what. When someone gets infected, how do they get resources? Who are they, the color of your skin, their gender, their sexual orientation, whether they're rich or poor determines really how they access healthcare. It's as simple as that. But it's not even that superficial because it also determines in effect, whether or not they're going to be exposed to illnesses. Whether or not they're going to be exposed to the chronic stress that was mentioned this morning. And we'll talk a little bit about that. So, public policy really is not only itself a determinant of health but it also determines, The other factors that will allow us or determine whether or not we'll have access to care, right? And so when those distribute systems and structures inequitably, then it's going to have an effect on who does that. So I'm really planting that seed, right. I'm really establishing and I'm hoping that you're buying it that public policy, in effect, is a determinant of health, directly and indirectly, in the way that it affects all the structures and the systems in the way we access healthcare and healthcare resources. So just sort of tapping into the existing way that we talk about social determinants of health because we're yet to really talk about public policy and political economy as much. Some people do, Navarro here does, but it's not as much a big thing in public health yet. We still don't touch the whole political economy part as a determinant of health, but we're getting there. I mean 10 or 15 years ago, we wouldn't talk about racism as a determinant of health. We're only now, in the last eight years, jumping on board at that. Health disparities only became vogue 10 years ago. I remember 20 years ago, when I was first here, trying to talk to someone about that, there was no reception for it. So we're still not there yet as far as looking at the bigger structures as determinants of health. But we talk about race as a determinant of health, we talk about class as a determinant of gender. And more recently, we've been focusing on place as a determinant of health, that is, where you live, work, study, play, pray. These places, they congregate factors that determine our access to care, our exposure to stress. As you know, especially in Baltimore, we've also been talking about, in a place-based manner, that the zip code you live in determines how long you're going to live, all right? So you can live five miles apart, and you can have a difference in life expectancy of 20 years. So if you are born in Madison-Eastend or Middle East Baltimore, which isn't as much now in Middle East because it's becoming very gentrified, it is a different race and class of people that are inhabiting it. So it's place, but it's also place determined by who's occupying the place and the space, right? So if it's a zip code that has high poverty indicators, low education status, not that many people graduating from high school, low income earners, all these factors determine and make up the place. And, therefore, now we talk about a place-based determinant of health, especially now that we're seeing across all our cities the discrepancy between where people live and their life expectancy, that there is this correlation. And I think that was tapping into that when just this morning you said 1 in 20 people in this area, in this zip code, are HIV positive. Whereas 1 in 44? >> 42. >> 1 in 42 across the city. So, again, we have to think about that. That's a real great, clear example of a place-based determinate there. The zip code is determining the difference in the HIV, probably exposure, access to care, and all the other factors around it when someone becomes infected. What are the steps that allows them to get that care they need? There are many steps involved, and mapping out those steps is part, I think, of how we're going to go about addressing this illness. This is a slide from Nunn et al, who was one of the first people to talk about place-based HIV infection. This is, I think, this is her New York work. But this is just to, I don't know if there's a pointer. Is there a pointer? No pointer, okay. This is to give you an idea, just if we look at the bottom, the blue map, you see that if you look at the darker blue areas, these are percentage of higher African-American populations, okay. And then if you go up to the green map, if we're trying to just look at the correlation between race, socioeconomic status, so you kinda see where the darker shades are. And then if you now look at where you're seeing the highest prevalence of AIDS death, and of HIV, or people living with HIV, you're seeing that there's a correlation. Oh. >> Great. You see the correlation here around these areas where you're having high High numbers of African-Americans, high levels of social economic depravity, AIDS, HIV, right? So she was one of the first people who started talking about, as a population basis, that HIV is correlating with places where people of color are living and where there's poverty. She's not the first person to talk about place-based illness. But she's one of the first people to put it out there and then to also say, in the way we address HIV and strategies and treatment, we have to start thinking of a place-based model, meaning we have to go out to those areas differently than we do with the rest of the populations. So I'm not gonna spend a lot of time on their EPI because Doctor Chalk here will do that for us. But I wanted to just show here in Maryland, so this is from the HMH data, the number of cases here, and this is percent numbers here, and how it differs according to where you live. So this is statewide level data, right. But if you look at Baltimore City, and if you look at some of the other counties, and then you come on down here to Prince George's County, right, you see Montgomery County. Look at where the greatest percentages is showing up, right? So this is just to kinda give you a correlation around what Dr. Nunn is talking about. I think we'll hear more about the Baltimore City level information. Racial-wise, if we look at the breakout from within our race and ethnicity, you see our rates, how our rates break out here. Again. It's really important just to notice who's becoming infected. I mean, I think everybody in this group knows that already, but we always try to wait for the data. And usually science catches up with people, unfortunately. But once we have the data, we have to use it, we have to use it to look for how we get our resources and direct our resources. Okay. Now, this is some of the same, but we're just looking here at, what is this one? This is time for care from diagnosis. So this is just a little snapshot of the difference in who's getting access to care after becoming diagnosed, right. So if you look at, again, who's getting the quickest access to care and who's not? >> Right. Now, this is some of the city-level data, and again I'm going to run through these slides because I think those will be presented in much more detail. But this is a slide of the Baltimore City HIV diagnosis. This is 2009 to 2011 data, and this is for diagnosis of HIV. And the arrows up there are showing you the areas of highest prevalence, right, for diagnosis. And the slide on the right, or the graph on the right, is showing you it's kind of a snapshot of socioeconomic status. Right, unemployment, people looking for work. To kind of again, trying to bring home this place space understanding right here in our city. So places where we have the highest rates of folks looking for work, they're correlating, right, with places where we're having our highest HIV diagnosis. So, and I do that with the next few slides. It's the same graph on the left, it's just different indicators of who's occupying those spaces. All right, so this is by race now. Previous one was SES, this is by race. So you see where African Americans are populating or living and where we're getting our highest prevalence. And I just point out two places. I didn't go through but just to give you a sense, a snapshot. Another SES, this is less than a high school diploma. And you see a snapshot too, right. Where the same places are the places we're seeing folks without work, folks without high school degrees. Which are, if you don't have a high school degree, you don't get to access the spaces that will allow you to continue up that economic ladder to success as we say in this country. This one, this is life expectancy. So the lowest life expectancy is the lighter shade, so we're also seeing some correlation, right here. The same places, the arrows are the same and over here, Madison-Eastend, which is really right next door to us. It's like what, five blocks away? Greenmount East, that's right next door. This is where we're seeing the lowest life expectancy. Just take a look at where the least HIV is. I always pick on Roland Park area because it's easy. But because it's a really huge disparity in this community where there is majority white. If you look at the socioeconomic status and now you look at rates of HIV, you see here, and then you look at the life expectancy there. So we're seeing correlation, now I know correlation is not cause, and we can be clear on that, but we're seeing enough correlation on these population level data, not just in Baltimore city, but in many cities. And so I think it's an indication for us that we need to get the data more clearer, so we can say yes, there is cause and effect here. And we know sufficiently that there is cause and effect, but we need to connect the dots more, I think. This is mortality by age. So this is a very typical one, right, infant mortality. We always use this as our indication of what's the health of a population. So what we see what percentage, less than a year old. So it's the same picture. I think you get it now. The places are telling us information. What do we do with that information? And this is just a quick breakdown. Again, I didn't want to spend much time on this because I know this will be revealed in more detail. But who is getting HIV? Men having sex with men, 31%. And IV drug users, 33%. So how did we create these places of poor health? So the only way that you can fix something is to figure out how it got to that state. And so we have to be really clear in why we're living in the statuses that we're living in today. And that is part of the structure of how we created America. So we have a whole system of separation and segregation based on race in America, started with slavery, then there was Jim Crow. And there was massive housing segregation, urban renewal, just jumped on board of that, gentrification, which continues into today right here in our backyard, this very institution and its participation in that. And serial forced displacement, which is something that Dr. Mindy Fullilove and the Wallaces write and do research on how the systematic displacement of people over the years, through these different processes of movement. Housing segregation, people move, urban renewal, people move, gentrification, people move, mass incarceration, people move. People are moving out of their homes and their communities. So they talk a lot about how this affects the ability of someone to be resilient and bounce back, so when they're faced with some illness, how do they bounce back from that? How has their immune system been weatherized to be able to respond to every challenge they face? Especially when you compare it to a group of people who haven't had the same kind of challenges as people who have been serially displaced over and over again. So these are real things that we have to start thinking about when we think about HIV. Because it's unfortunately the same group of people who keep getting displaced. African-American people of color, poor and low income folks. Which results in the communities becoming fragmented and being at risk for diminished health. This is some of Dr. Mindy Fullilove's work, which she was generous to let me have a few of her slides. Just showing this on a timeline from slavery, through Jim Crow, through urban renewal, to the industrialization, through gentrification which continues on if we continue this. And the processes that have been occurring, which she calls Black Upheaval, resulting in serial forced displacement and the effect of that on our health. And that's some of the work she is engaged in in doing more on looking at all the chronic ways, chronic illnesses that come from this whole pattern of movement. Now this is just to give us a picture of how this might have been happening, so just kind of trying to keep it place-space, kind of drop that really into the consciousness. So this is a redline map of Baltimore city, so everybody's aware of redlining, that was one of the processes that resulted in such segregation. So redline was the area that was considered not worthy of investment by the banks. And not just by the banks, but by Federal Housing Administration said no, we won't approve loans, and we won't give you the funds to distribute funding for housing in these neighborhoods they claimed were not sufficiently intact. Those neighborhoods happen to be black, a majority black. So these are the areas that were deemed not worthy of development. And I use those words really intentionally, because we struggle as a country to face racism, and that is what we have been building this country on. And I'm not Ta-Nehisi Coates, but I certainly understand when the brother talks about why we need to start dealing with racism in a very real way. Because slavery didn't just kill people back then, the legacy of slavery continues to kill people today. And that's what we in public health study. And so to try to separate the history of what we're dealing with today in our public health work will never address fully the cure, will never stop and prevent these things. The only way we're going to do it is to dig the root up. And the root comes from way back here, before this root comes from slavery. And so we have to understand how that process, this is not to cause shame and guilt, cuz shame and guilt is ineffective. It doesn't allow us to move forward. But what knowing our history does is allow us to use those facts, so we use it in the way we design treatment and care today, taking into consideration how we got to be where we are today. If we don't start doing that, we're just playing. Getting nice research grants, establishing centers for this and that. But until we do things like y'all are doing today, which I'm very impressed with, that you're actually focusing a whole symposium on disparities on the social causes on inequities. The parts that dissecting under microscope will never get at. This is the part we have get at, the structures how we got to where we are. So when you look at this, and you look at say, today, where African-Americans are living in Baltimore. So, it's interesting, right? Because the process of gentrification and urban renewal has resulted in the group of people who are living in these core areas that were considered bad have moved out. But most of them didn't move out on their own, some did. Those who could leave at the times when it was the worst, especially the industrialization process, did. But the majority of black people who were moved out from this inner core were moved out because of serial force displacement, some kind of gentrification process, some kind of urban renewal process. So, the process of how we move people around and how we see this in effect is really important in how we look at how we're going to target treatment, build programs, do outreach. How do we talk to people? Who talks to people? I've seen in my own research that when a black person knocks on a door in a black community and a white person knocks on a door in a black community there are two different stories that come out of that interaction, two different stories, right? And there's research on this. Scott, an anthropologist talks about the hidden transcripts, meaning that there're transcripts that are spoken, when it's a group of people who are disempowered, or historically have been disempowered. It's a very different transcript than the transcript, the public transcript he describes is a transcript that happens when we talk with the people who are in power. So it's two different conversations. So he speaks of it after doing research in other countries, but he shows it links from the times of slavery, and really how the Seoul revival lasted was the way that the transcript, the discourse occurred in people who were enslaved, and the discourse that occurred when those who were enslaved spoke to the masters. So one occurs because one has to survive. That's the one that we have when we speak to people who have power over us. We say what we need to say. We have different kinds of conversations. And then there's a different conversation that occurs with people who we feel are more like us, who understand us, and who we feel have empathy for us. And so until we can bridge that gap, which is what this is about, bridging that gap, where we feel like we can have the same discourses no matter what the color of the skin is or the person who we're sharing with, we're never gonna really get full access to what is it that's really gonna be effective in taking care of ourselves. And so because a majority of the people who do research and do outreach, do healthcare, because of the historic ways that people have had access to education, we have to look at that. So I challenge a lot of the research that has been collected by non people of color from people of color. I think we really need to do a good looking at what would happen if we went back and did some of those same studies with people of color, matched by race. Would there be a different discourse? That's what I'm finding in my research. I imagine everyone else would find it, no matter what the topic area is. This is another one of Dr. sides, showing what she also, and Rob Wallis, calls the synergy of plagues. Basically, it's the same thing as what starts to happen when these processes that result in fragmentation of community occurs this continuous serial displacement that we talked about. The War on Drugs and the whole mass incarceration that's certainly a huge way that community fragmentation is occurring. When half the black men in the community are locked up, who's building community? Who's there left to continue what the ancestors brought? And gentrification and the process of what kind of plagues we have been seeing as this has been occurring, right? And here we are with AIDS in the early 80s. Okay, so here back in Baltimore, as far as displacement, we have our history, we have public policy that funded uneven development. That's what we talk about in political economy. Public policy on the west side. We had the Highway to Nowhere where we had displacement of sev- >> [INAUDIBLE] >> Oh, yeah, people know about it, huh? >> [LAUGH] >> I hope you all laugh on the next two bullets. >> [LAUGH] >> On the west side of Highway to Nowhere, 700 families displaced. And this is just the data, this is the data that says we do have serial forced displacement. This is it, right? I mean this is the connecting the dot part. And then we have public, private partnerships. Again, remember the beginning slide about government and private interests are really the folks who are making public policy? And so right here we have in our own backyard. Well, we have Hopkins' expansion in the 1950s. That was 59 acres, this project. >> It's still there standing. >> And then. [LAUGH] >> [LAUGH] >> And the East Baltimore Development Project in the 2000. Which collectively these two projects, these two expansions, displaced over 2,000 families, right. So what I would love to do if someone would fund me. >> [LAUGH] >> [LAUGH] Is to trace these 2,000 people, okay. Because this is how we would really start to get the stories, the narratives that would inform us, right? Because people will always say well, you don't really know the right cause, you can just say, right? I mean that's what we do when we don't want to look at what we're seeing. And then the Greater Baltimore Committee which is a committee in the city which has since the Inner Harbor and downtown development. This is a great example. These are great examples of public private partnership that make policy. When people say, well private people don't make policy. Not so. Not so. They do. They influence policy because of relationships from very powerful funding in ways we don't even know that occurs. People who decide what gets developed, who benefits, what amenities and resource goes into which community, how do our taxes get redistributed? These are very important questions. These are public health questions, okay? These aren't just political questions. This is the Highway to Nowhere. Folks were living here, okay? Those 700 families, they all got displaced for this highway and fragmented communities, right? Fragmented communities, people had to go. There's a play now going on, actually, might have just happened on the Highway to Nowhere. This is a compound. This was after Hopkins' 1950s expansion. There was a public housing here, okay, Broadway Public Housing, people had to leave, because we won't be able to look at poverty cuz we don't want to do anything about it. And instead there was a building for staff. Named the compound by residents because now they weren't allowed to walk through it. So there's all kinds of fragmentation that happens when we do these kinds of policy decisions. We don't think about the health of that. We don't think about what's the health of that. This is the current project. I'm sure you all know this. This is the new student dorm on Wolf, the fabulous 929, right? But people were living there, right? I worked with people and organized and struggled with people who challenged this project. And when people say, I don't feel good about having to move so they can put a seven-acre park or a building for Hopkins students, that has effect. I mean what's the self worth of a population of people who continually get displaced based on what they look like and the amount of money that they have in their pocket or whether they went to college or not. Those have traumatic effects on the body's ability to weather adverse, everything that comes against them, or to them. This is some work by Dr. from school public health. Racial segregation creates different exposures to economic opportunity and to other community resources that enhance health. Enhance health produces differential exposures to health risk. So these ways that we segregate people into communities of less resource impacts our health directly and indirectly. But this is an interesting quote, this is Dr. King in 1960. Depressed living standards for Negroes are not simply a consequence of neglect nor can they be explained by the myth of the Negroes and their incapacities, or by the more sophisticated rationalization of these acquired infirmatives. They are a structural part of the economic system in the United States. Okay. This is not new, folks. We might be renewing ourselves to the reality of it in public health, more recently, but this is not new. So, basically, I think, I've been saying this over and over again. So what we have to do: policy in housing, economic development, education, transportation, recreating, criminal justice, health. Everything has to have heath in it. We have to think of health in every policy. APHA's meeting this year, it's theme was health in all policies. This is some work by a nun, where she puts the call out to say, if this kind of process of infection was happening In the white community, it would be a very different outcome. There would be a different way we'd think about it. And she really advocates that the approach then, is to go door-to-door and to the places where people are congregating with HIV, meaning basically she's talking about place space modality of treatment and access to care. Right. Where you live and the color of your skin should not impact your risk for contracting HIV, but it does. But it does. This is Housing Works in New York City, which I'm a little bit familiar with. But they're interested in the sense, that they look at housing specifically, and other resources specifically, for folks with HIV. So it's not just like, we'll look at social service if you need it. One of its main focuses is housing people. That's why it's called Housing Works. And so they've, you see this? They've offered housing for 20,000 homeless. And I think this is the kind of thing we have to start thinking about. The social determince, housing, people are on the street. The war on drugs' policies is also another place-based strategy. Remember in the line of displacement and fragmentation. So Cooper, in some recent work that I just did, we showed that increased police violence, occurs out of these kinds of policies, these war on drug policies. Increased community fragmentation through stress occurs, and Cooper has shown, and others have shown, that police violence directly effects a person's ability to use a needle exchange program, because they get beat up by the police. They did this work in New York City. So people aren't going to use a needle exchange program, they're not going to clean their needles, because they don't want to be seen. Because they become targeted, they're seen as a druggie. So, there is all these ways that being poor, living in poor places that are stigmatized, that the police targets these communities and everyone who lives there. And that's some of the work I've shown is that, people are afraid to congregate on the corner. People say, right here in East Baltimore, even if you just stand on the corner, whether you're involved in a drug trade or not, you'll get pulled over by the police. And so this is one of the ways that a policy, such as the war on drugs, results in community not coming together. Community fragmentation is not a good protective factor for any health benefit. When people don't talk to each other, it fragments the community and people won't share information. If you don't share information, that's the social network, the social cohesion, the social capital of communities, affects the health outcome. So I think I've been saying all along our policies need changing, employment, we need living wages. People don't have money to buy a house and live stable in a community, they're gonna be pushed into communities that are very poor. We know in those poor communities, people don't have the money to invest. So it´s a cycle of determination living wage, right. Housing, we have to have affordable housing. Especially because of the gentrification that the city´s going through. We´re seeing more and more unaffordable housing and people becoming homeless. People have to have healthcare access, we have to have parks and recreations for the kids. If there is nothing for the kids to do, they're gonna do what's available to them. So how do we think about that, when we think about how they get exposed, or the potential to become infected with HIV. So we have to be smart in the way we think about eradicating this disease. Education has to culturally competent, and I think that comes with some of the things I'm saying about the hidden discourse, and the public discourse. And so how does a white person become culturally competent in the way to talk to a black person about HIV? I'm just putting it out there. That's a whole day symposium, right? Because that's about undoing racism, that's about white privilege, that's about how we hold our privilege, and how we bring our privilege into interactions with others. And if we don't even know how we carry privilege, we're spilling it all over the place left and right. And I work with enough researchers to see how that privilege get spilled over, poured over, all in the process of doing good. So it's a huge thing how we bring ourselves into spaces. Community economic development. Tax incentives. Who's getting pulled into cities? Who's getting encouraged to come into cities? Is it people who are just going to treat low income or black folks terribly? Because they think that's what's needed to make a community better? Transportation, we have to address transportation. People can't get work. They can't get to work if they have to take three buses, and then they're late, and then they get fired. Or we move a bus stop, because we're gentrifying an area. It doesn't serve the new people that are coming into the community. They don't need the bus. But we have a circulator bus that's free, that runs around in circles into certain communities. We have to rethink our policies. Where are we spending our money? So we change government, cuz I'm a big activist. We've looked politicians up who are not effective, and not listening to the people who vote them in. We need to change the city mayoral government. The mayor decides everything, you have to have a really huge consensus for the city council, to veto anything that she says or signs. We increase transparency and accountability, and we set term limits. We've got people in office that have been there way too long. Don't we? And we have to organize community. This is a huge, huge issue. Our communities are fragmented because of this whole process of dislocation and displacement. We have to make an effort, if our communities were more organized, our communities wouldn't be so ill. Look at the communities that are healthy. They're organized, they have processes in place. If they want something, they know who to go to. They go and they talk to their city council people, and their city council people actually listen to them. That's because they have power, that's because they're organized. Our communities of color and low income we're not organized. We can have ten community organizations in a block, and if you all do work here or live here, you know that. That is a fragmented process, that does not allow power to take and do what it needs to do for that community. And once communities are organized, they have to have decision making power. We have a lot of processes, this whole community based participatory research. It's a great thing in words. But if people aren't actually making decision and directing what gets done, it's really just another superficial level of engagement. People have to make decisions. We cannot just put community faces, and black faces on boards, and then show them to funders so they can get funding. It's not right. It's an injustice. And people have to start thinking about the morality and the ethic of public heath, that's part of it. Doesn't justify it, because you get funding. If you're gonna engage community on the board, they have to have decision making power. And if they don't understand the information that's there, that is being discussed. Then there needs to be an educational process, so they can become fully informed so they can make informed decisions. It's not enough to say to quickly get a decision shake your head. These things don't work, we've been doing that for years. How do we do this? We organize. Right? This is an example of the Hopkins employees working or challenging Hopkins for a living wage. So like I was saying at the beginning, we start right in our house. If Hopkins isn't paying their employees a living wage, how could we ever expect the social determinants of health are being addressed in our own health institution? It's incredibly ironic and we're okay with that. So, every single person here who works or has some engagement with Hopkins should participate in making sure that the institution pays its employees a living wage. Because a living wage is a determinant of health. So, how can you advocate for living for health if you're not willing To challenge your own institution to walk the talk. It doesn't make sense, right? It's not personal. It doesn't make sense. Why are we having this symposium today if we're not willing to look at those hard issues? If not, I'm just wasting my time. You're just wasting my time, and I'm wasting your time, and we can have this symposium every single year, and I won't come back anymore. Not that that matters, right? But really we have to organize, right. And,I like this because this is doctors and students rallying with community, with low income workers, saying that it's right, it's time, we gotta do the right thing. And this is not new. Civil injustice in our institutions have always been there. It's just wether or not we're willing to take it out. This is hard to see, but it's a schematic sort of finally saying that it's really the economic capitol, the political capitol, the social capitol. All these things within here, really determines a presence and access to what we normally think of health access and healthcare. Whether or not we have equitable employment, whether we have safe places for our elderly to be able to exercise. These are all determined by this whole process, this structure, these systems. In effect it determines our health, our lifespan in our neighborhoods and whether or not we're going to be exposed, or feel pressured to do the things that might expose us to acquiring HIV. Thank you. [APPLAUSE] >> Does anyone have any questions for Dr. Gomez? Reverend Hickman. >> So Dr. Gomez, I really, truly enjoyed your presentation and it's very, very real. But, I don't know if this is a question or a statement because as you were talking about having power and not being oppressed, is there such a thing as self suppression today and is there a study that actually is showing how to balance out the inequalities with the opportunities that our communities have had and still not have taken them. In the span of three short years that our organization has existed here in East Baltimore, what I have witnessed is, is that there are communities that have leaders that have been in place for so long that they are the problem and not so much the power. And, I've witnessed the fact that there are political leaders that have responsibilities. And we could go back and count the millions of dollars, probably the billions of dollars, that have been infused into our communities. But people that look like me that had power, have not utilized that power to its people or its communities, and I think if we're going to have power today, we need to understand the inequalities from the white man as well as the inequalities from our man, and how it has suppressed its own people, and how our people have become sleepy in the process and they almost are living without hope. And so they don't strive to actually do the best that they can. Instead they play some game that's self-destructive. >> Thank you for that. I think that's part of the internal journey. The part where we look at our stuff. And I think there's a roll, one of the reasons I mentioned voting everybody out. If you look at our city council, there's a lot of black folk on that council who've been there a long time. What have they been doing for our community? How did they sell out our community? And so how to individuals participate in that? But I also think that we have to, and the reason I talk about the structure, is that, the structures create the systems that we play in. And so why do people, why is there so many fragmented communities? Why is there a block that has two community associations? Why is it that people feel the need to hold on to power like that, and claim power like that. It comes out of a history. And I would put forth that, that history has a lot to do with trauma. And there is a whole research literature on the effect of trauma from racism, from slavery, from a history of oppression that people haven't healed. And I think there at least needs to be whole lot of healing in our communities, within ourselves. And I think the same healing needs to occur for white people as well. Because racism doesn't have an effect on black folks, or folks of color. Racism is so inhumane that there's also literature out there that speaks to how the ability to segregate and make decisions that discriminate has an effect on the psyche of an individual. And being part of a white system that consistently discriminate, that has an effect on the humanity of people as well. So not only are the perpetrators effected, it has a health effect, but also the people that receive or the other end of that discrimination, that racism, that classicism, whatever it is, are having an effect as well. So I think it's a very relevant question. I think it's one that we in our communities of black and brown need to challenge ourselves. We can't be afraid. We've been this space where well we haven't had any, so we'll, it's okay for us to do. Now you're bringing up. I always get on about misogyny. The way in black and brown communities, we treat women of color. I have a real issue with that. How we don't step up and say, no, we can't do that because we're still living that past of how we feel the black man was enslaved. So, I completely understand what you're saying. I do think, though, that the structure of the system that is in place holds everything, it's like a glue that holds everything in place. And until we start to opening up that system, and looking at the causes, and dismantling it, it's going to be really difficult for the people embedded in that system, that have acquired some of the ways, the personality, the traits, that they have today because of the way that system was structured. Right. And that doesn't remove just kind of the inherent lackadaisical way some of us are. Because that's that. We are humans and we are not enlightened yet. So we still have our own personal stuff. But the structure that puts in place on top of our own personal foibles or insecurities, those are the pieces I think that as a professional who's doing this work, we have to get into. >> Thank you >> You're welcome. >> Any other questions? Curry and I came late, so if you already addressed this then were talk after. >> Okay. >> I'm curious about, I'm kind of thinking about the non profit industrial complex and how it's motivated by similar structures that we need to deconstruct right? So. I wanted to hear your thoughts about who are the actors and initiators and the people who have sustained this level of change? Is it possible that it will be our non-profit agencies, even though they are deeply dependent on money resources, political capital, power, and all of those things. Or is that going to have to take place with another group of people, a more grass-roots kind of people? >> You don't really want me to call names, right? [LAUGH] I mean I have the names but, I think. Well first of all, I feel we are the change that we're waiting to see. I inherently believe that, and that speaks of what you're saying is, as we are part of the problem, we are part of the solution. That said, again getting back into the structures, no, I don't feel that the non-profit sector is going to be the one that take us out of this, because that's again this reliant and this white savior mentality, and it could be a black head of that organization. Whatever, it's still set within a structural system of white privilege and white supremacy. So that whole system needs to be eradicated, you know putting faces of color. And, here I can drop some names, but I will not do that. Into places of position of power doesn't alleviate the problem, right? We have to get at it at the structures. The non-profit sector, the non-profit industrial complexes, as you say, data shows what they do with that funding. Cuz we gotta think about the philanthrophies. Where have their monies come from? It usually comes out of some kind of capitalist exploitive system. Now there's more who say the kind of capitalist work and ventures they're doing, that they're investing more wisely, more humanely, green this, all that. But when you still look at it, there's some process of exploitation occurring. Capitalism says we have to exploit people. We need dispensable pool of workers. That pool of workers happen to be the people who are most vulnerable in our society. That happens to be black and brown and poor people. So we have a system in place that will always perpetuate that. Philanthropy money comes out of a system of exploitation. So first we just gotta get that right, we just have to understand that. And then once we understand it then I think we have to look individually at some of our non-profits. I mean the non-profits in Baltimore, Annie Cayce Foundation, I mean they've participated in this whole gentrification process, right. They use their name and their good status as a family and childrens program and process to bring status to Hopkins even though Hopkins had a reputation for doing gentrification in the past. People thought oh, the Cayce Institution is involved so this must be a good thing. I think that's a great example how the non-profit sector gets used and allows itself to be used in order to continue it's role in this capital framework. Because, you know, they have board members who are very rich people who donate money. We gotta look at where they're getting their money from. So the short answer is no, I don't think that they will be. The longer answer is, I think they're as much a political animal as any sector, they just happen to have the non-profit status. They need to start paying some property tax and they need to start paying some money into the city. >> Yeah >> Because if we actually assess the amount of money the city would get from all the tax benefits and loopholes that non-profits get, and there has been some data to show how much that is, we would actually be a little further ahead. But that's my short answer. >> [LAUGH] >> Thank you so much. What a powerful talk. As we started off this morning talking from moving from a series of transactions between community members and researchers. To talking about transformation within the context of full community by looking at things like housing, unemployment, education, transportation, race, we need to talk about these things. And that's why we are here today on Hopkins campus. I read, last night, I was reading the DC Blade and reading a little bit about the trans community in DC. And I know we could say the same thing for the trans community here in Baltimore, 51% unemployed. A third engaged in sex work. We know that if somebody's engaged in sex work, they're 48% more likely to become HIV positive. We know, and this is where I think my heart was breaking as I was reading this, that our trans friends have high rates of assault and harassment. 74% verbally assaulted, 42% physically assaulted, 35% sexually assaulted, and as I was thinking the context of walking in today, we are here as a part of this community to do our something. And, to figure out what our somethings are and do it well in collaboration with each other. We cannot go at this alone. And so as we talk about those social determinants this morning, we're gonna talk and transition this afternoon, talk about real models and real people that are doing things about addressing inequality, racism, models of addressing poverty. And it goes on here in Baltimore, people that are choosing to make a difference and choosing to do their something because they have been placed here for such a time as this. You are not here by accident. So as I introduce our next speaker, Dr. Patrick Chaulk, the assistant commissioner of the bureau of HIV and STDs for the city of Baltimore. He co-chairs the HIV commission, the planning group. He's a member of the Greater Baltimore HIV Health Planning Services, a pediatrician and the list could go on and on and on. But I believe, more importantly, is that we talk about different politicians or elected people here in Baltimore. We have a man that is here that serves us, that wants to see all people restored back to community. And I am so grateful that not only can I call him a colleague, the assistant commissioner, but more importantly a friend. And so with that I would like to introduce Dr. Patrick Chaulk as he talks about contextualizing this work in the city of Baltimore. And how we can, and we are here to talk about these things and brainstorm together about ways to move forward. So with that, I'd like to have Dr. Chaulk come up and join us. >> [APPLAUSE] >> Like this one. >> Yep. Well, good morning and thank you very much. Where is Jordan? I'm gonna kill him. >> [LAUGH] >> He makes me follow her, an old white guy. That's just not gonna work folks. I'll try my best though. I'm supposed to provide contextualizing view of the city but I'm probably going to stray a couple times with how I put this together because I really want to build on Dr. Gomez's points. It's a very provocative presentation, so thank you very much for what you did. Give you some numbers, the 2013 census shows that the city of Baltimore has a population of a little over 620,000. African Americans account about 65 or 64 percent of that population, but the sad note is that 85 percent of the HIV infection in this city that's diagnosed, is among the African American population. And most people don't know that 49% of the people infected and living with HIV are over the age of 50. So, we're seeing a real change in the demographics of the city. Both in terms of the effect of good treatment, which is allowing people to live longer. But we're still seeing people, new infections, in their 60s and 70s every year in the health department. So we have to think about when we wanna work on prevention and messaging, that we don't think about a limited population, but we talk about everybody. Actually, this says 13 4, but it's probably more like 14,400 people living with a diagnosis of HIV in the city. And probably 15% of the people who have HIV really don't know it. So they're poised to be a real source of infection among other people in the city. The state estimates that that's about 8,000 people so we really have a lot of people that we need to reach by testing and linkage to care. Ryan White which is the federal program that provides coverage for those who are uninsured or underinsured. About 9,000 people in the city of Baltimore receive those services. So that's a really important program in terms of serving them. Their needs are diverse, as was mentioned. Temporary housing, because they have unstable housing quite frequently. Mental health needs, substance abuse needs, emergency financial assistance, food assistance and copays for their insurance. Even though we think we've got the insurance thing figured out, we really haven't. So a lot of those tend to be really strong and tough issues for us. This is a trend I think everybody's seen, that the really important trend has been a decline in the number of new infections among the injection drug using population, and that's largely because of our syringe exchange program, which this year is in its 21st year. We work in 14 different neighborhoods around the city. It's a mobile program, it's in vans, we make 23 visits to those cities. Our staff has really developed relationships with each of those communities which are among the poorest in the city, the most underserved, blighted areas that we continue to support somehow. But at least our syringe exchange is out there meeting their needs. We also try and provide things such as wound care. We provide family planning, and reproductive health services, and immunizations during the flu season, particularly on the block where the commercial dancers really don't have access to a lot of other services. So the other trend of course is the new increase in HIV infections among the the gay men, or men who have sex with men, primarily among young black men. So that's a really important issue for us in the city. You've seen the cascade, we have about a third of the people in the city who are HIV infected with suppressed viral loads. Meaning, they're where they should be, they're gonna be healthier. We have to do a much better job at that. With the Ryan White population it's mostly around 60%. So Ryan White seems to be doing a pretty good job about getting people to suppressed viral loads. I give these numbers with some reluctance because we forget what these numbers are really all about. We tend to say, well we want to see those numbers improve. We don't want to see the numbers improve, we want to see the people improve. A British statistician once when asked what a statistic is said, it's a human being with a teardrop removed. That's really what it's about, so when we run through these numbers and get focused on our calculations and our regression analysis and all that kind of stuff, this is really about people, and we're talking about the poorest people and the most marginalized people in the city. So that's why this conversation is really important. I'm not gonna go over these goals. I wanna talk about two testing strategies to lower the number of people who are undiagnosed but have HIV infection. There's two main strategies for testing. One is targeted, for high risk populations, and one is routine. Routine hasn't really become quite routine yet and we're trying to make that possible in Baltimore. Targeted testing, we realized through focus groups with our outreach teams and with our partner service interviews, partner service workers are the people who go out and interview newly infected folks to try and find out who their recent partners are so that they can be screened and served as well. The information was that many gay and transgender youth were unaware of how to access testing in the city, despite the fact that we think we're providing testing all over the city with our vans. HIV positive clients did not seek care for fear of stigma. That should come as no surprise. HIV still has stigmatizing issues with it. Sexual and social networks were frequently linked to what is called the House and Ball Community. And the House and Ball Community is basically, who were a group of folks who were disparagingly in the 1920s and 30s called drag queens in New York. It's been around for a long time. It's primarily East Coast, New York, New Jersey, Philly, Baltimore, and DC. There is some on the West Coast. It's comprised of, basically, gay men of all ages who compete in balls for prizes and status. And they compete for costumes. They compete for look. They compete for a number of things. But they belong to different houses, which are usually named after cosmetic or other sort of, like Dior and places like that. And so they tend to be people, the houses are virtual, they're not real. And they are a group that we really wanted to engage in the city. I first became aware of the House community back in 94, 93. We had an outbreak of TB in one of the local clubs, Club Buns. And in doing the investigation we found out the dancers were in Baltimore, then they moved up to Philly quite soon, then up to Jersey, and then up to New York City. So from a public health standpoint it was an absolute nightmare to figure out how do you work across these jurisdictions to identify people that were exposed, should be tested and treated? Well, we did and things came to a good conclusion. But it was largely because of the staff that we have who know how to interact with just about anybody and are very trusted in the community, so it worked out actually very well. But that's when I first got exposed to them and then I didn't realize it again until I came to the health department and now we're really working with a large House coalition in the city. So we created what was called Know Your Status Mini Ball. And the ball was designed to get people to get tested and know their status. And it started in 2010, we'll have our sixth ball next Saturday the 21st. The ball has a competition part but we provide testing for HIV and STDs. We provide linkage to care. We provide certain social services such as housing assistance, healthcare. Access Maryland does enrollment for insurance, college info. And then surprisingly, this last year we actually had the police department there. Not to be police, but they actually had a table. And they revealed their latest LGBT outreach team, which was created in response to the three murders we had in the transgender community last year. And we're also offering opportunities for people to find out about jobs at the police department. So that's pretty amazing, I think. So this whole ball has been really a great opportunity for us to reach into this community. You've referred about doing community engagement and community outreach, this is one of the opportunities where we're really trying to do this. This is also important from a testing standpoint. If you look at our testing at the STD clinics, in the emergency departments, in CBOs, the positive rate's about 1% or 1.1%. You can see here that the new infection rate is between 4% and 7% each of the years that we've had this. These people were then immediately linked to care. We provide same-day transportation for newly infected folks once they get their diagnosis. So it was important for us to provide the proof that we really felt was important for you to be in care, and that we were gonna help you do that. Also out of this came the status update campaign, which they created themselves. They worked with Mika to do the advertisement on this. They had their own focus groups and research conversations about how they wanted to do this. The overall themes were really to connect with the ballroom community and promote, again, knowing your HIV status. So there were nine models who posed for these different posters and they were placed around the city. We wanted to put them on the city bus and originally they said yes, but then when they saw the poster they said no. And then we did the cabs, and they said yes and then when they saw the posters they said no. The person at the stadium TA said well have balls, get tested, that's a terrible phrase. >> [LAUGH] >> Well, actually it was their choice, okay? That's what they wanted to use. So not too long after this rolled out, then Commissioner Barbo gets this call from a local priest. Couple of you have heard me tell this before, but I'm going to tell you again. And so they gave it to me, gave it to he's the HIV guy. And so I said hello, and he said this is Father so-and-so and I just wanted to comment that I'm really not very pleased with what you're doing with this, I'm really trying to get our youth not to have sex. Good luck, and so we talked a little bit longer and he said this is just encouraging people to go out and be more promiscuous. And I said well, here's my offer to you. I'll take these down if you'll do something for me, and he said, well what's that? And I said if you'll go through the poorest inner city neighborhoods in the city of Baltimore and remove all the liquor ads that are up on those billboards that have women barely clothed and men drinking snifters, and the obvious messages is get liquored, get laid. And those billboards aren't in my neighborhood. But you know where they're at, and I think it's, again, this place matters comment that you're trying to get at. So he said, okay, no thanks, and that was kinda the end of that conversation. But I think it talks again about how we look at this stuff. This is a prevention message. That other one was not a prevention message. This is one created by the community it's intended to reach. That other one was created by the community it's intended to reach as well, but they're different messages completely. So here's Status Update. We have a website for this. You can go to it. It's called baltimorestatusupdate.com. And it has all the upcoming balls. Information on HIV prevention and testing, STD prevention and testing. And there's a Facebook on there which I don't know what that is cuze I don't have Facebook. And then, routine testing is a new project that we started about four years ago. It's called Protect Baltimore. We do that with the Hopkins Center for Child and Community Health Research. And it's an innovation grant from CDC. It involves a couple of components. HIV mapping throughout the city, and identifying what we call high-transmission areas. And that calculation's essentially based on prevalence, incidents and viral load. The overlay of that is we mapped physician practices, and created testing kits to take out to the private physicians in those high transmission areas. The testing kits have everything you want to know about HIV, what the tests do, what the tests mean, how do you counsel people? It had a map of their community that showed what HIV looked like in their community. And that was a kind of an eye opener for them because most people thought HIV is some place else but no it's right in our back yard. It also had a component for billing. So the outtake has been that we've used public health detailers, which are like pharmaceutical detailers except we're actually bringing a good bill of goods and not just drugs to the physician's office, and visited all the physicians, family practice docs, and internists in those high transmission neighborhoods, which is about close to 200 physicians that we reached. And this is a map of the high transmission areas and very high transmission areas. And so what you see is essentially that 50% of the census tracks in Baltimore are either high or very high transmission areas. It speaks a lot about what we have left to do. And I'm glad you presented the data because I didn't want to have be the one to present that [LAUGH] which we always do all the time. So thank you very much. I also had a map that looked at poverty and HIV and I couldn't find it cuz I actually put these together last night. But as you might guess HIV laid right over on top of poverty. And if you look at those zip codes, it's all the stuff that you talked about, poor housing, low employment, low educational status. So we're talking about, it's place that we're concerned with that we wanna turn the needle on any of this stuff including HIV. We have two new grants I wanna talk about just briefly. We have a PrEP expansion grant that is allowing us to focus on PrEP among young, gay black men. Right now if we look and see who's using PrEP, not very many people are, it's almost all white, gay men. And when we interview the young, gay black men they don't know about it. They don't know their HIV status cuz they haven't had access to testing. If they get tested and they're positive, they're less likely to be linked to care. If they're in care, they're less likely to stay in care. So there's a lot of reasons for that, most of which relate to the mistrust of the healthcare system and how it's perceived that they will be received when they go into services. Is it gonna be a welcoming environment for them or is it not? Odds are that it's not gonna be that way. So this is intended to really begin to create a much more PrEP friendly environment for gay and transgender people in the city of Baltimore. This is what this looks like for this grant. It's a collaborative. It's really, we think, the first time that we've actually seen a city-wide collaborative of the major players involved in HIV in this city, both the providers and the non-profits. We have a social marketing strategy. We brought on a social innovator, who's already doing a lot of really creative stuff. Comes from the private sector before, but a lot of public health work. He just finished training at MICA, and its helping us begin to think about how do we address stigma in the community. How do we create messages that can resonate with the community? Who's the messenger? We can create great messages, but depending upon who the messenger is, not going to make any difference. So we're trying to think through all of that. There's another one that's a PrEP wraparound. That's the same thing, focused on young, gay, black men and transgenders. But it brings much more in the way of social services, thinking about housing, mental health, substance abuse, other needs that these people might have. So the outcome of this over a four-year period is a hope that we'll actually reduce transmission in this population. We hope to hire, not we, but the partners will hire about 65 people from the community to be part of this. Peer navigators, linkage to care people who will come from the target community and be part of this. We realize that a lot of these folks probably are not gonna have a very strong or solid work background. We're gonna provide work skills training and job training to make sure that they stay in the job that they get into. So that the leave behind will be that these guys will be ready to take on some other job after this is over with. And that they don't just fall off the chart again and become lost in the system. We've also identified a number of ethical issues that are involved in this. So we've brought on an emphasis from the bioethics division at Hopkins. She's a pediatrician. She's looked at some of these issues, we've had some great conversations with her and we're beginning to talk about things that we're going to have to address as part of this work. We've brought on an attorney from the Maryland School of Law to help us with some legal issues that we think are gonna come up. So we are looking at this very broadly. This is not what we would consider a standard grant going into the community and doing stuff. We're trying to engage the community, bring the community into the decision making. We have to create a community advisory board. So we've got an awful lot of work ahead of us. But I think it's been thrilling so far, from the standpoint that everybody that's in this really seems to be in it for the right reason, and seem to be committed to strong outcomes for the work. So, there's another Baltimore that we should talk about. We've already heard a little bit about it from Dr. Gomez, but I wanna make sure that I talk about this. So the census again, same people, 621,000 people. But if you look at the Baltimore city health preparedness report card that was produced in 2013 the all cause mortality was significantly higher for the city wide than it was for Maryland average. All conditions specific mortality for 11 conditions were significantly higher than for the Maryland average. Racial disparity, and you lay that over this shows significant obviously outcomes on that as well. And we unfortunately are the number two city in homicides this year right behind Saint Louis. So again, place does matter. It matters an awful lot. Life expectancy varies significantly by neighborhood. You have some neighborhoods that have life expectancy of a third world country. Others by Eastern European industrialized company, countries. And in 19, excuse me 2013, six zip codes alone accounted for 50% of the new infections in the city of Baltimore. So, if we're gonna get real about doing something with HIV, we've really got to follow what Dr. Gomez says and walk out of here, and actually continue the discussion and do something. Cuz this isn't gonna get solved by sitting in this room and hearing some conversations and presentations by people. And then we walk out and go by Starbucks, and get our coffee, and go home. This is really important stuff. And I think if we take HIV as the tip of the iceberg, we'll see that underneath it are all these things that you've heard this morning and we'll hear in the next presentation as well. So I really wanna thank you for giving me a chance to speak with you today, and I'm looking forward to another presentation from the next speaker. And thank you Dr. Gomez. [APPLAUSE] Thank you, Dr. Charles. Does anyone have any questions? Easy questions. [LAUGH] I just had a question about those zip codes. Yep. How it accounts for 50.4% of the new infections. I don't know if you know those zip codes, or where I can find that information. Well, I don't have it in my head, but I can get it to you. Okay. Yeah. [CROSSTALK] Well, you can get. Yeah. Yeah. And it's actually of course, a focus for our work as well doing a lot of follow up in there and I think the theme of this conference really should be place matters, because all of this stuff is geared to where people live. And unless we think about that, we can create a unique service to reach somebody, but that unique service will not get to the bottom of the real topics that are involved. I would just add this, medical mistrust is a huge, huge issue. I had the opportunity in a previous life to work with some immigrant and minority neighborhoods around the country. And that issue came up a lot. I was doing a TV project in Seattle that involved Ukrainian, Bosnian and Somali communities. And we did a lot of work to enter those communities, working with community associations. And we were trying to sell the message that they needed to be screened and skin tested for TB, because that's where most of the TB was coming from in the city, the active TB. And we did some focus groups, and these were people that came from refugee camps in Somalia. And one of the guys said, because they felt fine, why are you testing us? They told us in Somalia after we took our chest x-ray that you don't have TB. Well, that was the wrong thing. They should have said you don't appear to have active TB. But his comment was, now we understand what people meant when people told us that doctors in America like to experiment on people. So that came from somebody in Somalia. So think about when it comes from somebody in East and West Baltimore. So those issues on how healthcare systems is perceived, and I worked with Haitians, Caribbean folks, African Americans, Mexicans, East Africans, it was all the same thing. Everybody had raised questions about how much trust do we have and how we're gonna be perceived and treated when we go in for care. So we need to be thinking about that with the project that we're talking about now. Just having PrEP available and giving a message out doesn't mean these folks are gonna say, oh, I guess I gotta go on PrEP. We have to figure out what the mistrusts are that have been there for decades that we need to address and talk about openly. So you didn't ask that, but I thought I'd use the opportunity to say that. I see another question. My name is John, and I was going to ask you the same question you just answered. So, sorry. You can ask a different one. So if you want to take another bite of the apple, let me phrase the question a little differently on the same subject. You're a physician, I presume, if you would give a prescription today to the folks in this room about improving trust levels in our services, what would you tell us what are the top three things? Well, for me, the first one is you have to be very open and honest. People could sniff that out in seconds. And so that's the way I was with the communities I worked, and it worked very well. And I always would say if this old white guy can come in here and do this, it's gotta be pretty obvious. So I think that's really important. And it's like relationships and other things. It's your job. I mean you've gotta be able to be open to a certain extent and be honest. And if you can't do that then anything else you do is going to be jeopardized by doing that. And if you promise something you better deliver. In the neighborhoods I worked in if I said we're gonna do something I made damn well sure that I did it because I'd only get one shot at it and that would be it. And I think you need to be willing to work with people where they are. My work was more about trying to help them solve their problems, and not tell them how to do it, and not throw money on the table, and be responsive to what they thought they really needed. Lots of times the issues are on building capacity in these organizations and communities. They've been disinvested for years and grant makers wanna come in and throw a grant on the ground, and everybody's scurrying around to figure out how to get the money. And then they make it grants-competitive, and so it goes against building partnerships and building trust in the community. We've had that for so long in Baltimore, you can't get people in a room who wanna say we're willing to kinda work together on this issue because they've been forced to compete in the past and that's something new. So, I don't know how well that answers, but that's the way I would see it. Any other questions? Carmen? Sure, I have some questions. I'm one of those people that put the first presentation with the second presentation, and sit back here and question, and don't, I'm not putting anybody on the spot. First I want to just applaud both Dr. Charles and Dr. Gomez for incredible presentations. And the way they lined up together the question comes, so where are the programs for women? And let me back it up to Dr. Gomez's presentation where the slide was put up. And it said, 31% transmission rates among men and MSM, 33% amongst IBU, it wasn't mentioned, the 31% amongst heterosexual transmission, and then Dr. Charles put up that having PrEP that's targeting MSM and transgender. Dr. Gomez said though, said though that 50% of the men in the black community are locked up. So why are we targeting people, and I'm looking around this room? So even at the makeup in the room, where are the programs for women who are bearing burden, who are bearing the burden of people being locked up, of being out of jobs, of having children where there's no child support, of finding homes when you can't get loans, of doing double jobs and not being able to pay daycare? Where are the programs with all of the money that's coming in that's targeting women? [APPLAUSE] I guess I should let the women answer first. [LAUGH] Even though these grants don't support directly PrEP for women, that's clearly part of what we want to do, because with discordance couples and their Both sexes. We want to make sure that's an option for a woman to protect herself. So we've been talking with family planning for example which is not funded for this but we're gonna talk about at least providing training on prep there so that the young women who come in can be aware there is the opportunity for them to be prep recipient as well. Certainly we've worked with senior centers on HIV testing and that's included lots of women and my story on risk in Baltimore involves we had a sex and seniors conference like three years ago at The Waxter Center. We had about 300 people show up which was surprising. It was about 50/50 40/60 something like that. And during the break an older African American woman came up and was talking with me and saying it was really good that we were reaching out to the seniors and to the older women. She said I was married for many years. My husband was struggling with an illness and finally died. And like after a year and a half I just wanted some companionship. So she started dating this guy from her church. And they didn't use protection and she got infected with HIV. So I think the issue of raising the women's issue is extremely important because they may be among the most vulnerable because their male sex partner may not just be their only partner, or you might not be his only partner. So I think that's why we've been talking with family planning and also department of social services. About a third of the people in Baltimore actually go through the Department of Social Services each year. We've been having a hard time getting in there to provide training though. I think there's a new director and so we're going to try and revisit that again. But I think that what we don't want to do is by emphasizing what I said that we're going to drive a wedge between groups. That's the worse thing that can come out of this. This is a community issue, it's a city issue, it's tied to all the things that were said this morning, well beyond healthcare so I think you should be continue to push that issue so that we don't forget it, so it doesn't fall on the back-burner. But we're gonna get there I think, I'm really hoping that through conversations like this that we can generate some action, not just a response, that something good will happen. That's the guy's answer. >> I think we have one more question in the back and then we'll have to transition. >> I'd like to just reiterate what you said because we don't want to drive wedges between- >> [COUGH] >> [INAUDIBLE]. That support from all of affected areas, particularly in the city. I hope we're basing that support based on the data and the numbers, speaking from the MSM community and from the number of young black men, particularly in this city who died over years and decades and we're finally focusing our efforts and support on trying to reduce those numbers. But also recognizing that other effected areas, particularly with young and older African-American women and how they're effected, and how we can address that cooperatively as we move forward in addressing this. For all of us and hopefully programs like and others as we continue to research, it will help us to do that [INAUDIBLE]. >> Yeah, and I think that the political experience of this country is, when the government doesn't want to support what you're doing, they try and break you up into groups. And that happens all the time. It's every year, it doesn't change. So I think we need to stay united on this and not leave anybody behind. [APPLAUSE] >> Thank you so much. I see your questions, I think you can grab him at lunch time if that's okay, we need to move on. Thank you so much Dr. Shock for your presentation. And Carmine, you need to meet the woman right in front of you who is running an outstanding program for single moms with kids between the ages of 18 and 24 addressing homelessness and housing. So Hillary, Carmine you guys can get together afterwards too. So I would like to introduce. A dear friend of mine, Carlton Smith, who will introduce our next speaker. Carlton is the vice-chair for the Johns Hopkins Center for AIDS Research Community Participatory Advisory Board. And the chair and executive director for the Center of Black Equity. And more importantly, my friend. So come on up Carlton. >> Thank you. [APPLAUSE] Thank you, Mayor. I was gonna use that. >> Okay. >> Thank you. That's okay. I'd like to introduce the next speaker. He's a good friend of mine as well. We've know each other for quite some years. Matter of fact, I met him as a program director of when he was working for GLAAD. And now he is the executive director of Color of Change. I'd like to introduce Rashard Robertson. Y'all can put your hands together for him. [APPLAUSE] He is also the only black gay man that's running a civil rights organization. I'd like to put that together. [APPLAUSE] Mr. Rashard. >> [APPLAUSE] Thank you for that Carlton, and it's a national, the only openly gay leader of a national civil rights organization, just in case there's like anyone here that's like I know a person! But thank you to that, thank you to Jordan for the invitation and his leadership and to all of you. It's great to be here in a room with people who are dedicated towards action and new discoveries. And just as much dedicated to promotion and stewardship of what we already know. People dedicated to delivering the best quality and smartest healthcare solutions from what we already know. And what we should be providing, fighting for those solutions, and fighting for what works for who needs it the most. So I believe in a color of change, we are a community of over 1.3 million black folks and their allies of every race. We take on major actions around the country, bringing people's voices to make our democracy and our economy work. And we believe that one of our greatest challenges of today is that we have not realized a true culture of care in this country. And so therefore so many of our solutions and recommendations and arguments don't have nearly enough momentum behind them to get us to where we want to go. It is why we concentrate so much on momentum in our campaigns. Especially being clear and uncompromising about our failures on race and gender and what we need to do about it. Having enough momentum. For us, that's a question of cultural power. In system wide social change work, the scale of our impact is greatly influenced by the degree of the shifts in our overall culture. We cannot solve problems absent of larger cultural problem solving, which motivates the symptoms, everyone participating in forging solutions. You cannot truly deliver healthcare to all those in need, let alone prevent the need for acute care in the first place. Absent a larger culture of care in which everyone is always looking for opportunities to challenge inequity and solve for it. Always looking to make all people healthier. The culture of care must be prismatic, both expansive and inclusive. Seeing LGBT concerns and black concerns as connected, because in so many instances they are the same people. Seeing people of color concerns and women concerns is connected because black women and brown women have concerns on both accounts, just like immigrants are also disabled people and their families have needs on both accounts. All of us have so many colors running through us. It's amazing how many needs our system can fail all at once. Bold actions on the part of some can pave the way and help set new standards and new roles for how to move forward. To show what the future should look like, to illuminate an end goal vision. But incentives are truly what motivate people to move in the direction at scale. Everyone here is an agent of change. A force providing health care related to HIV and AIDS without the type of delays and red tape and restricted resources and racial and gender bias. That is factored so greatly into keeping HIV alive for so long, while millions of people die. But there are big historical, cultural and very profitable forces that are in our way. I would ask you plainly, as you look at conditions today, what incentivizes a public official with budgetary power to not care about black people? And therefore not to invest in black people's health because that is what's happening. What incentivizes a drug company with the power to cure not to care about black people and therefore not invest in black people's health. What incentivizes some hospitals with the power to care, not to care about black people and therefore not to invest in our health, because that is also happening. We know that money is an incentive that And enforced laws are incentive, reputation is an incentive. But social pressure is also an incentive. We have to influence what people in authority value and devalue. And they have all points of influence. The cues we all send about what's okay and not okay, how we react to things and how comfortable we are ourselves in talking about race publicly versus how much we avoid it. How much we own our own power, how often people stand up, and what we do at Color of Change is we help people stand up at the right time. When their voices can have the most influence and serve as a power incentive. Our members at Color of Change are constantly demonstrating their power. There's this organization called ALEC. It's a right wing shady organization called the American Legislative Organization. It's a secret political organization with corporate controls. A group that introduces extremely dangerous corporate and anti-progressive legislation through its members, and state legislatures around the country. Laws like the discriminatory immigration law, voter ID laws, stand your ground laws, all of those come from ALEC. ALEC was so successful that their state legislatures would introduce bills in the states and forget to take ALEC's logo off the top of the page. We fought, and we won with ALEC. Getting over 100 corporations to withdraw their membership, and lessening ALEC's influence, leaving them with a $1.5 million budget shortfall, and forcing them to have to end their work on voter ID and stand your grounds. But we did that by making ALEC a liability for corporations and changing the incentive structure. We changed the political culture in a way. The corporate funders of ALEC, the Fortune 500s, they weren't sure who we even were at first. Some of the people who worked at corporations, who would end up leaving ALEC, told me afterwards that our campaign really worked to build trust, but it also worked to build fear. Our pressure gave sympathizers on the inside the power to move things. They kept saying how much more savvy, how much more prepared and organized our campaign was compared to the ALEC campaign on the other side. We would get on the phone with corporations, and go back and forth, and they would say, we give a little money to the right, and we give a little money to the left. And we'd say, that's great, but there's not really two sides to black people voting. So, you're gonna have to think about a different way to handle this. An organization that was 40 years old, and had been so successful, but that speaks to the power of organized constituency. The power of everyday people making their voices heard and collectively holding those in power. Pushing back at the right time, in the right way, is the way that we win the David and Goliath battles of our time, and change the incentive structures of those in power to force them to have to care about the people that they should be caring about. In addition to our official work roles here, all of us here probably think every day, well, how do I know, how well do I know the inside of organizations I want to move? Is there an incentive that I myself have control over manipulating for good, something that would shift bad practices to good practice. Something even in my own daily context which I may be missing, an opportunity to gain leverage. I would also love to hear maybe during the question time, what kind of power do you think outside groups have which we may not be using yet. Or not using well enough, that could reorient the incentive structures in healthcare and create a more equitable system. I was talking to a black medical student this weekend and she reminded me that while doctors take the Hippocratic Oath, hospital administrators don't drug manufacturers do not. Health insurance executives do not. All sorts of people who make decisions about our health, and determine who's health is important and who's health isn't don't take it. The oath might not seem very powerful as an accountability mechanism. And I'd agree. But not having even this very simple ritual to infuse this very core value across the healthcare landscape certainly says something. And it signals the incentive structure we have today. We can all talk about fighting for justice, but we must remember that justice is an outcome, not a strategy. Our strategy has to work at the level of culture. To do this work means making black people more powerful. Powerful enough to effectively tell our own stories. Fight our own fights. And yes, ultimately tell our own stories. In order to influence the way people think about us. The level of investment they feel in their gut for us. And all of us must feel invested in black people. Invested in women, invested in immigrants and all others. We know what opens up when that happens. And how hard it is to get anything done when it doesn't. Right now on race, we're not even moving, we're moving backwards, we're not even moving forward in that regard. So I applaud you all for taking racial inequity head on. For understanding the connection between the systemic disinvestment in black welfare across the board, and how it feeds on itself. From housing to healthcare, from policing to employment, from Hurricane Katrina to what I call Hurricane SCOTUS, the decision by the Supreme Court to block access to the voting booth. One solution is clearly greater investment, through shared empathy, shared leadership, shared resources I believe in our shared fate. When we talk about race or don't. And through all of our actions and decisions big and small, we're either forging the sense of a shared faith and investment or letting our differences, our different faiths, seem separate. Where this investment by those in power makes sense. When I say investment I'm talking about in terms of real material investment that is outcomes based. Not investment of time in the conversation of a loan. Not investment in the form of resources towards actions we don't know will work. Remember how the right wing used to hate talking about AIDS? Yep, until they fell in love with it, because then, by taking up AIDS as their favorite topic, they realized they could get tons of money for abstinence-only education. For religious based outreach, money to talk about anti-choice agenda. They turn cultural presence of the issue into their cultural power, into their agenda. Just because we talk about race does it mean the right people will benefit from that conversation. It depends on how we talk about it, and what direction it's heading in. And that's why who's leading the conversation is critical when black people, when people of color are not leading. We get this wrong, we get the wrong kind of attention and misdirected action, it makes people more vulnerable, not less. The act of disinvestment in black communities we've seen over decades has made us less safe, not more. We saw it right here in this City of Baltimore as my organization worked with organizations around the city to mobilize their voices in the aftermath of the Freddie Gray tragedy. And so we cannot be fooled by the attention racism is getting today, and think that we're on our way to a new culture. To change the pattern of disinvestment to real investment, shared fate and shared humanity. This is the difference between cultural presence and cultural power. Black people are very present in the media. Even in positions of authority the President of the United States and you turn on your TV, you listen to our music. Race and so called racial issues are very present in society. You see Jon Stewart and Bill O'Reilly debating race. It's on the news, it's on cultural reference, hot topics over dinner, but that presence that our issues have, or that we have as a people, does not translate into our powers as people. It does not translate into the leverage we need to tackle structural racism effectively in all its forms. It does not translate into the power. We need to make life fairer and better for black people, or any people of color. It does not translate automatically into the power to create justice. If a black girl cannot sit in a classroom, or if a black woman cannot sit in her car without potential of police violence potentially ending her life, how could her everyday health possibilities be secure, or valued, or even a priority. For a black girl, or a woman, can be abused or killed in those situations. But on top of that malign and blame for her own harm or death. How? How can we have possibly expect to create a culture of care with respect to her health or even truly value her health at all. Since according to these warped values we're seeing in our political debates, she doesn't even deserve to be healthy. Not only do we all deserve to be healthy, deep down we all want to be healthy. And I even think that we all want everyone else to be healthy as well. Unless we come across the unchecked value system perpetuated by self interested parties with a lot of profit to make. Who incentivize many of us to turn on ourselves to see others as unworthy of care. That is the only reason we wouldn't want equitable care. It's dehumanizing and we must change this environment. Culturally speaking we are to used to black pain in this country, too used to grieving black mothers, too used to failing black people, too used to unrealized black dreams. We have learned to expect these things will happen as if it is natural. We may think others sounding an alarm, one that is motivating for action, but others hear that same sound as somber church bells, merely resigning them to a sense of the inevitability. We are not only expecting the worst for black people, we expect the worst from black people. And we have to challenge that in all of us. We do see black people as the problem in this country, or can we see black people as the solution? Do we believe, truly, that we are all vulnerable people that we care about? Be the solution, we can be the solution rather than merely standing to symbolize the problem. We can believe in the history of black people and other people as a history of leadership, innovation, collaboration, and peace only when black leadership and power make sense. Only with black leadership in power activated and strategic will it be able to change how things work. Our role is to build the power that can change the incentive structure. And to break the cycle of reinforcing practices that lead to racial disparities along all the metrics we care about. Which we see growing out of control today. But again, each of us is responsible and capable of disruption. Not just in our policy recommendations, but in our every day lives. In the support we drum up for protests and strategic campaigns and at the tables where we negotiate, all of which we need more of to win. The demand at the end of the racial inequity are louder today than they have been in a long time. The analysis of the life and death consequences of racism in policing and mass incarceration in health in many domains of life in the United States today. In 2015 we shouldn't even be debating these issues, but we are. That analysis needs to be well researched, well articulated, highly sharable, and incredibly persuasive. But it's not enough, it's not enough to know what's wrong if we are not powerful enough to put in place what is right. And so our challenge is to understand at Color of Change, our members needs and passions. Use culture and technology savvy to create the spark that fires up their participation. And then for all of us to aggregate and amplify their voices in targeted, strategic ways. To create real leverage over corporations, government, and other decision makers who impact our lives. To make everyone, including organizations and leaders within our own movement, have more human, real, and compassion and understanding of the black experience, and of the progressive power of black leadership. So it's a pleasure to join you today in your efforts to create new knowledge, and embed that knowledge in an outcome-based practice at scale. I invite you into our efforts, to take on our work as your own mission, and ours is yours. To create greater power among black people and all people of color. So that we can sustain a system of care in which knowledge matters. Your discoveries reach all people who need them. And we can create the radical shift to translate the presence we have in this world, into the power to actually get something done. Thank you. [APPLAUSE] So I'd like to take a little bit of time for some questions. We are in a huge moment of cultural change where media, technology, the economy, are disrupting things in really interesting ways. And at Color of Change we are trying to sit at the intersection of that and give everyday people the power, the ability to be more powerful to those who have the ability and opportunity to change how we live. And so I am not an expert on HIV and AIDS, and so, but I like to see myself as an expert on organizing and building power. And so that is the space in which I will be able to answer questions and sit inside this conversation with you all. [LAUGH] >> So my question is this. I've worked in similar, in the past in both criminal justice work and stuff and also in HIV. And I think one of my frustrations to be frank, is just not seeing. So even amongst the kind of more black, progressive national organizations, there's a way in which HIV is still completely silent and off the radar. >> Uh-huh, uh-huh. >> In ways sometimes, even when it is the most obvious, right? So we're in a situation where just here in Baltimore, I don't know if CDC will soon release data that the death rates from HIV are highest in Baltimore than any other city in the nation right? That's Atlanta, Baton Rouge and Miami being closed at times. So my question is, and I'll ask sometimes people, sometimes say academics or progressive black folks or national organizations, if I'm in spaces or on panels with them. Who'll come up to me on the low and say, I'm glad you brought up HIV because my cousin. Or sometimes they even call me personally when they have family members in crisis around an HIV diagnosis or housing, a range of things, but will not make it a part of their political work. So my question is, at what from your vantage point would it take to make organizations actually engage HIV as part of the social justice issue for black people in the same way that they do criminal justice and other kinds of like state violence. >> Yeah that's a great question and my colleagues might not like my answer to this, but I actually think that folks have to cause disruptions at organizations and force people to do it. And this is my whole point around all of this work is that disruption is important. The reason why I am here is because I believe that this has to be part of our long term work. And in order to get there, we have to create disruptions in government, disruptions in corporate places to force to change the incentive structures. But just like we have to change incentive structures, inside of government, corporations, we have to change incentive structures inside of our movement. And Color of Change has had a history of sometimes disrupting inside of more legacy and traditional civil rights bases and pushing back when we felt the incentive structure was off. And I don't think that, folks. Folks may come around eventually and start doing the right thing, but I do think that behaviors have to change and I don't think they change without disruption. And so, my advice is for folks who believe that we have to change some of the ways in which our institutions look at these issues. I think, pushing at these institutions and changing the incentive structures are gonna be necessary. And I know my colleagues who run all our other organizations probably will be really mad at me for saying that. But I think that even inside of my own organization, when we've moved or changed on things, sometimes it has been because something has been disrupted. >> What role do you think social media and the Internet has played in both the cultural crises of race lately and how that can be translated into. >> Yeah, that's a great question. So I think that social media trending these platforms of our time is exactly how we've mistaken presence for power. That we have seen things being talked about. We see people more aware. We see folks sharing. We see people clicking on things and we mistake that for sort of changing something systemic or the presence that actually, or the power that actually changes anything long term. And so I think social media and so much of the awareness can sometimes work to the detriment, particularly of black people. Black people, who are seen so often as symbols, symbols for what's wrong with our education system, symbols for what's wrong with our culture, and are used that way oftentimes by the right. To symbolically make a case for something larger, a case for disinvestment, a case for how we change how money flows in this country. And black people are used that way and social media platforms can in many ways, they are not good or bad in of themselves and anyone who says like Twitter is going to get us free. Remember that Twitter is a platform that is in Silicon Valley that refuses to hire black people. Color Of Change has been campaigning against them for the last year, just forcing them each time to release their diversity data, and we think it's gonna get better, and then it's still at 1%. And in the 1%, they count security guards, cafeteria workers, and a bunch of staff who are fighting for a living wage on their campuses, they include in the numbers to make us think that it's like 1% of people who are being paid are part of the Silicon Valley boom. And it's not even 1%. Of that, and they say it's because of STEM and most of the jobs at Twitter are marketing and HR and you tell me you can't find black folks in Oakland to come and work at Twitter in HR? I say it to say that so much of what's happening in social media space can trick us into thinking that we've done something that we haven't done. And so technology is a tool. I think we have to think about it that way. In the 60s the Student Non-Violent Coordinating Committee installed something called the WATTS line at their Shore University office. And they installed the WATTS line, it was a precursor to the 1-800 number and the WATTS line allowed for folks to bypass the Ma Bell operators. When you made a long distance call at the time, you called, they transferred you to the next person and the next person until they got you where you needed to go. And the operators were largely controlled by the White Citizens Council. And so calls that SNCC was making were getting intercepted, and information was not moving. And so they installed this WATTS line because it was cheaper and they could move calls much quicker. Did not change their theory of change, it did not replace the fact that they needed to have a healthy, strong, and robust organizing strategy. They needed to be connected to the issues and the people. The technology allowed them to do it quicker and cheaper and it allowed them to move information. So, in so many ways, I believe, I look at Twitter, I look at Facebook as modern day WATTS lines. They allow us to move information better. But make no mistake, they in of themselves are not going to get us free and if we solely rely on them, we are in this situation of presence, not power. Oh. >> Oh. [INAUDIBLE] >> I think that, it's about being really concentrated on changing incentive structures. Developing campaigns that actually do that and bring people to the table, creating problems for the real targets. Whether they be corporations or those in power. And forcing them to have to make a different set of decisions. I think about this just in terms of our criminal justice work right now. And I often times get really frustrated when people say to the Black Lives Matter movement, where are your policy demands, where's your policies? And I'm like it's already illegal to kill black people. I'm like yeah, and do we need another set of policies that still won't be enforced? We actually need to change the incentive structure so this year Color of Change is launching a campaign to go after district attorneys. And creating a new set of, because in many ways district attorneys are making these decisions about what to do and what not to do in these situations. There are 2400 district district attorney seats around the country. They come up, some will coming in 16, 17, 18. We don't know much about these races except that about 75% of them are uncontested. That most of the time when a district attorney seat changes over is because someone retired or ran for higher office. And so in some ways, if we're simply trying to put more policies in place and not concentrating on the enforcement, it's like we're operating on the kidney when the liver is the problem. And so from my perspective if we are working to build power to multiply voices in moments of outrage and translate that to real things to do, we have to think very clearly about the folks that we're holding accountable, how we're holding them accountable. So that we're not just creating more awareness about our issues, we're not just sharing and reposting articles in social media, but we're creating real consequences for those in power and moving that energy so that over time, folks that hold onto levers of power feel like they have to be accountable to black people. They feel like that something will be different if they're not accountable to black people. And I believe that we are in this moment now where as much as we are inside this moment of deep presence, we haven't yet translated to the power where folks feel like they have to do something for black people. We're getting closer, President Obama doing what really was an executive order, but an executive rule, around ban the box is getting us closer right? We've seen all these executive orders for other communities, for the LGBT and immigrant rights and black people are part of those communities as well. But him having to do something for black people as black people. Something that was clearly seen as a black issue, not an issue for another community, is moving along the way. And how we are building that power and forcing a different set of rules is one of the ways I believe that we translate presence. People knowing about something versus people feeling like they have to do something as a result of knowing about it because there will be consequences if they don't. >> Are faith communities playing a positive role, negative role or no role at all in this in this change, and how could they play a positive role? >> Faith communities, like so many communities, play a role, and sometimes it's positive and helpful and sometimes it's not. And I will say that we're talking about presence and power, but the word above each of these is culture. And how we are situated inside of our culture, in our beliefs, in our systems is so important to how I think about presence and power. And faith plays such a critical role, not just in terms of what we believe but then who we interact with as a result. How we are socialized and then how we act on that. Those that hold leadership with inside of faith traditions have a tremendous role to play. And always had a tremendous role to play in creating a new future for us. And so there are times when, it being on the ground in so many of the uprisings that have happened over the last couple of years, I have witnessed and experienced the just tremendous leadership of so many in the faith community who have been there and have stood up. And then at times I see a mega church industry that is giving black people in other communities as well an idea of money and wealth and materialism that does nothing but incentivize corporations to gain more and more power over our lives and our politics. >> Thank you. >> Just as an example as far as what the faith based community is doing to talk about presence and power. For instance, my church that I attend, my pastor is very pro black in a sense of creating, helping us as people that attend church to have power. And one way that he's doing that is with our buying power, and having us to kind of boycott things like Black Friday. And instead of spending our dollars in these big corporation companies like Walmart, we are to, he has kind of mandated us to now spend our black dollars on black-owned businesses. So that our black dollars can circulate within the black community. So that's an example of how- >> That's a great example. >> We put presence into power with regards to how our dollars are circulating. Within our own community, the black community. >> Great, that's great. >> Well we thank everyone for all your questions and answers. >> [APPLAUSE] >> And as we are getting ready to move on to our next, thank you Rashad we appreciate you. We are getting ready to go into our next, the first time Red Ribbon presentation. Doc, you ready? So I'd like to introduce Dr. David Hargrave. He is the co-director of the Baltimore HIV Collaboratory, and chair, and professor, Department of Health and Behavior and Society, so Dr. Hargrave. >> [APPLAUSE] >> Thank you very much. I'll only say two things quickly this morning. The first thing I wanted to say very briefly was, something that's weighing heavy on me today and I just wanted to share this with you. It's striking to me today that about 129 people in Paris have been killed by homicide and the world has been an outpouring of support and attention. And recently the Russian airliner with 224 people were killed by homicide. And if you add those two numbers together, which the world is very focused on, that's 353 people killed by homicide. But so far this year in Baltimore we've had 304 people killed by homicide and barely a peep in media and attention. And I just wanted to say that I hope we all join together today in thinking about how if we can somehow change the global society. Where 304 homicides in Baltimore, largely in African American communities matters as much as 300 homicides across the world, I think on that day we will have cured HIV. So I wanted to share that this morning. >> [APPLAUSE] >> And I also just wanted to take a second to very much thank Aaron and thank Carlton and thank Mr. Smith. For the tremendous leadership that they've shown in the Community Participatory Advisory Board, we're extremely privileged that the Center for AIDS Research at Hopkins to have their leadership and all the leadership of everyone who's joined the CPAB, or Participatory Advisory Board. And these bridging the gap conferences wouldn't be possible without their leadership and without their passion in this area. And so it was with really great enthusiasm that we heard that the CPAB was very interested in presenting these two very important red ribbon campaigns and I'm delighted to turn the podium back over to Mr Carlton Smith, to present the Red Ribbon Campaign. >> Sure. >> [APPLAUSE] >> Thank you, Don. >> [APPLAUSE] >> Well, I have very nice, very, very, nice remarks for this young lady. She's been a friend for so long for 20 years. We first met at City Hall when we were forming the Ron White planning council and I took hold to her. Because it was like, wow, getting ready to get into something new. Something that engages, something more than outside of yourself. You're helping a community in such a way. Just as when Ron White legislation was just coming into Baltimore and along with herself and so many other are founding members. And now, the planning council is into its 25th year. So we wanna give her and others a round of applause for them. >> [APPLAUSE] >> I also know her for her strength, I know her being a woman of God. And I like to say that, because that's very important doing the work that we're doing. Because if you don't have the God in you, you surely can't be about the God about people. And I always wanted to say to her, I see the God in you and I appreciate you so much and so many others. She's also the Executive Director of Sisters Together and Reaching. Wow, how many years now? 25 years. You all give her a round of applause, it's not easy. >> [APPLAUSE] >> I also wanna thank her for being an ally to the LGBT community. It was her son who helped us with marriage equality. It is her who still preach about equality that God's love is for everyone. And that takes courage, even out of your own church. And sometimes you get a little cross-eyed, but we appreciate that. Sometimes people don't even say thank you, we say thank you. So I had an ah-hah moment, so I was like, woo. If I only knew. >> [LAUGH] >> So I wanted to share something from my ancestor, Maya Angelo and it reads like this. I think of a hero as any person really intent on making a better place for all people. Ladies and gentlemen, I'd like to introduce to you the Reverend. Put your hands together. >> [APPLAUSE] >> [LAUGH] That must be Donald Birth. >> That must be Donald Birth somewhere in. Hi, Donald, we recognize you. [LAUGH] >> Good afternoon, everyone. So this is the most challenging session, because it's right after lunch, your bellies are full. So if you need to stand up and stretch and wave a little bit to keep to yourself going, we totally understand. But didn't we have a great morning this morning? >> Yeah >> Fantastic. So it's time for us to transition over to talking about people that are doing things in Baltimore, people that are on the ground, people that have a heart for community and seeing the full community restored. And so as we think about what we're gonna be talking about this afternoon, we're gonna be looking at a couple of different panels. This first panel is on poverty and HIV in Baltimore City. Our second panel is on healthcare access, linkage to care and progress and our third panel is on community perspectives on HIV healthcare and healthcare access. And so we invite you to join us in this discussion and we are so thankful that you have stayed through the afternoon. I am going to take just a few minutes and introduce you to some of my colleagues and friends doing absolutely fantastic work as we talk about poverty and HIV here in Baltimore City. I want to remind the panelists that we need you to speak into the microphones, as well. And I'm gonna briefly introduce them, all of them have resumes that are very, very long. So what I felt like would be a productive use of our time is if I gave them a very quick introduction and then I gave them each two minutes to talk about their own organizations. And then we're gonna move into a series of questions and comments as we look at some of the holistic need that our HIV positive friends have here in Baltimore. So I'd first like to introduce Tom Bonderenko, the executive director and CEO of Movable Feast. Tom has over 30 years experience in the social service field including a diverse public and nonprofit experience in developing housing and supportive service programs for individuals who are homeless and those with low incomes. Since February, 2008, Tom has served as the executive director of Movable Feast. He's also the cofounder of the greater Baltimore Washington Residents Services Council and the founder of the Coalition of Service Providers, a member of the Food is Medicine coalition and the Maryland Food Access and Nutrition Network and the Care Coalition. In 2014, Tom was appointed by the mayor as a member of the Baltimore City Commission on HIV and AIDS planing group. And so thank you for joining us, Tom. John Katov on the right. John is the founder of Open Table after colliding with a homeless man on his church outreach mission in 2005. John's efforts to build a board of directors around his brother and develop a business plan for the next year of his life resulted in the founding of an organization called Open Table John serves as the CEO of that organization. Prior to leaving the business sector and developing the open table model, John has worked 20 years in the business management and marketing experiences and worked with people from all over the US. He serves as a member of the Bishop's Strategic Advisory Committee for the Southwest conference of the United Methodist Church and lives in Phoenix, we're happy to have him here. Hillary Sigismondi is Program Manager of the Geraldine Young Family Life Center located in West Baltimore. Throughout her career, she has written used curriculum for youth developed and presented teacher, parent and volunteer trainings and workshops. Organized hundreds of volunteers at an intensive tutoring program for children experiencing homelessness living in shelters and hotels. She is also a trained facilitator of the circle of security parenting model and has brought that to families of the Geraldine Young Family Life Center. And last but certainly not least is Clair Watson, the Director of Programs for Maryland New Directions. Clair has been working at Maryland New Directions for over four years and is responsible for the day to day management of the organization and oversees all training activities for their clients. Clair was instrumental in developing the organization's first industry specific program which now enrolls 75 people a year. She has presented various topics on workforce development at conferences throughout the region. So thank you team for being here. This is a conference that looks at HIV and poverty, social determinants of health and how they interact with HIV. Many times, we think about HIV as just a medical condition without thinking about the holistic needs, the spiritual, the social, the physical, the emotional needs of our brothers and sisters. One reason, these wonderful members have been selected as a part of this panel is because they see the whole picture. So my dear panel members, would you please take a moment to describe your organization and what you do before we hop into a series of questions and answers? Tom, would you tell us a little bit about Movable Feast? >> Hi, everyone. Thank you for the opportunity to be here. Movable Feast is a 26 year old nonprofit. We serve Baltimore City, five surrounding counties, and the Eastern shore of Maryland. In 2014, serving nearly 800,000 meals to about 5,400 households across the state. We are a home delivery food and nutrition program for most of those individuals. Some though, take part in our medical transportation program. We run and operate a medical transport for people with HIV and AIDS in Baltimore city. We also operate a food service training program, a work force development program, where we train people in food services with the specific focus or interest in medical institutional preparation of foods and then help them find employment in the community. Last year, 95% of the clients we served of the 5,400 households lived on incomes of less than $11,000. Most of the people we serve are poor, critically ill and sick people or very, very low income. >> Thank you, Tom. Hillary, would you tell us a little bit about the Geraldine Young Center as it's a part of AIRS. >> I would love to. I´m Hillary Sigsamondi, and I work for AIRS, AIRS is our umbrella organization and stands for Aids Interfaith Residential Services. AIRS has permanent and transitional housing programs, for both adults and youth. The Geraldine Young Center is part of the youth programming, which is under the City Steps. We are located on 1621 Druid Hill Ave, right next door to the Druid Hill YMCA in West Baltimore. We are a transitional housing program. Our women can stay with us for up to two years. We do serve women between the ages of 18 and 24 who are experiencing homelessness. What I think is very special about our program is what we say is we're not just about surviving, we're about thriving. Many of our residents or applicants that come to us, that's what their world is about, and we'll work with them, whatever it takes to actually save money, pay rent on time, so that they can have the experience of thriving. We do have the privilege to be able to offer them a housing choice voucher, 18 months, which is pretty amazing, which has them move into their own permanent housing. I also want to say that we are trauma informed, and I think that is a lot of what I'm hearing today. I haven't heard that but I think that it so important. We're recognizing that A, just being homeless is a trauma in itself, and many of them have experienced trauma all their lives, and we're out to recognize that, and honor that as we work with them. >> Clair, would you tell us a little bit about Maryland New Directions? >> Sure, Maryland New Directions has been around for 42 years. We started in the 70s as New Directions [INAUDIBLE] serving displaced homemakers, helping them get back into the workforce or into the workforce for the first time. In the 80s, we started working with both men and women and providing primarily career counseling services, job readiness training, job placement assistance. Today, we have two training tracks. One is a two-week job readiness training program where we're equipping any Baltimore city resident, primarily adults 21 to 60 years of age, with the skills they need to have an effective job search. Everyone is matched with a job coach that works with them for up to two years or as long as they stay engaged, it could be longer, to really help them identify their career path. Sometimes in that career path journey, people need to be connected with a survival job, or something in the meantime, while their making the steps they need, or the preparation they need to find that job or career path they're passionate about. The second training track is in industry specific. Maritime training program, specifically training individuals for the maritime industry. A lot of us are wearing clothing that's coming from somewhere else in the world, and so we're really giving people the knowledge for a growing industry. Primarily, we're really helping people get back to work, and I think one of the things that separate us from a lot of other workforce organizations is that we identify that counseling is a really large component. When people lose their job, they forget who they are, we tie our identities to our job, and so we incorporate a lot of mental health counseling into the training that we're doing to make sure that individuals are really equipped to get back into the workforce and to stay employed. >> Thank you, Claire. John, can you tell us a little bit about Open Table? >> Hi, everybody. My name is John, and I think that as somebody, a person of faith in a movement that the first and most important thing for me to tell you is that, I'll speak for my own beliefs and I will respect the beliefs of all others gathered here. I am somebody who drove by poverty and people in poverty for the first 40 years of my life and I think the story of many people of Open Table is quite similar. I collided with a homeless man and I realized that I was in much greater poverty than he because I was not in a relationship with my brothers and sisters, and sharing my intellectual and social capital, my community networks, and I was not allowing them to share a relationship with me. Open Table has really become a way to build new communities. We work in faith communities and we provide a model that faith communities can use to develop these boards, we call them tables, after the communion table, where all are welcome. They partner, a group of six to ten people, with somebody experiencing poverty. They share a relationship. The person they are serving is in charge of the table. They make all the decisions about the table, all the decisions about their lives. And the people around the table, through relationship, through mutual relationship learn that no matter who you were in a relationship with, they can help heal you. This is a call back to the core of our communities to be connected to each other and to share what is most hoarded in our society, which is intellectual and social capital. How to give to people, who we are, what we've learned, to help them build [INAUDIBLE] human potential. >> Thank you very much. I'm gonna run this session by asking a series of questions and then we'll open it up to anybody on the floor. If you hear something that sparks your mind, feel free to write it down on a piece of paper and then during the question and answer time, we'll go ahead and reach out to everybody for their questions. As you've heard, throughout this morning, the theme of the social determinants that affect how somebody may or may not live well with their HIV. One of the things that Tom is bringing to the table is this concept of food as medicine and food and how that interacts with poverty. Tom, could you talk to us a little bit about that? >> This concept of food as medicine, Movable Feast has promoted this as part of our philosophy for more than 26 years. A very simple understanding, in some ways, that despite your illness or how gravely sick you may be, if you eat well while you're sick, you'll still be healthier during your illness than you would be otherwise. For years, we have reported food as medicine and I would say in the last two or three years, especially with the induction of the Affordable Health Care Act, this has become a popular concept now. Even here at Johns Hopkins, we have a partnership with Bloomberg School of Public Health, did a white paper study in the past year. It should be released at the end of January. Which will have looked at the lives of close to 60 HIV positive individuals who are on service compared to the lives of those who are not being serviced. It's a study to look at what was their overall quality of life? What was some of the soft scale qualities of life, such as did you have more energy in the morning when you woke up? Were you able to go out for a walk today? Did you exercise at all? Do you feel like you have better mental acuity? And other much more solid outcomes, such as how often did you access the emergency room, were you hospitalized, and if so, for how many days? Did you have a better relationship with your primary care provider because you were able to make appointments rather than miss appointments when you are feeling ill? The study looks at that and I think so far, Hopkins has been so impressed with it that they assigned a preceptor to this paper as well as a research team to further analyze the data. We're hoping in the spring to have a Food is Medicine conference for the city here just to share that awareness enlightenment with the community. But our premise is that if you eat well, you stay healthy and so making sure that people have healthy choices in food. Making sure that Food as Medicine is not only about the physical tangible food but in our program, our food is always personally delivered to an individual. Because our philosophy is also that if we get to your door, we can check on you in a sense, even if it's just saying nobody's touched you in a month. We've had a clients who called and say your driver gave me a hug today and I've been positive for six months and nobody has touched me in six months. Sometimes Food As Medicine for us is about doing advocacy and education and outreach, especially about continued stigma even in the gay community at times around HIV and the stigmas that happen there. So for us Food As Medicine takes a very broad approach. There are about 60 other similar programs to move nationwide that have come together recently in the past few years to inform the Food as Medicine Coalition. We're an active advocacy body built on the federal and on the states to educate and make people aware of the importance need and benefits of seeing food as medicine. Not only for building a healthier community, for keeping individuals healthy, but also helping to contain healthcare costs for those individuals. One last thing I'll say about that is that there are three studies already done. One with Harvard University, with Qualitative Community Services in Boston. One with Olympia University in New York, we thought we delivered and one with University of Pennsylvania in Manna. All demonstrating that for people who are HIV positive, if they keep laundering their illness, they have fewer hospitalizations, fewer opportunistic infections, if they are hospitalized they are hospitalized for fewer days. That they use the emergency room much less frequently than those who are not malnourished, and that overall their healthcare costs are reduced by 33%. We're hopeful, we're optimistic that our paper will show and demonstrate the same thing in the Baltimore area. >> Thank you, Tom. I'm just thinking a little bit about how this concept of food as medicine can be addressed, if we have access to food issues. And before we move on, I think we need to talk about, just can you address those access to food issues for me, because we know that many of our brothers and sisters in many sections of Baltimore have a hard time finding food in the first place, healthy food. >> Sure, so certainly finding healthy food, even in a food desert, or in an area where movable piece is located here in East Baltimore, to get to the closest grocery store you have to take two buses and the local corner stores do not have food. So, actually just recently, the good news is that we met with the Maryland Hunger solution and we had the opportunity to have what we provide healthy, nutritious food in grocery stores. Even it means that that grocery store gets 15 bananas this week, and 20 oranges, and some leafy greens. We know that if that's available, people will use that, but right now, that is still a serious issue that impacts people eating healthy in the community. Money to purchase the right foods, what is the cost of healthy foods for individuals in the community, and do folks have access to that if SNAP benefits are reduced. And people have to make choices between doing their laundry and buying laundry detergent this week, or perhaps paying their electric bills or whatever. Those issues play in. Just the basic of what I said when I started out, that of our 5,400 clients last year, 95% of them lived on less than $11,000 a year. What do you do with $11,000 a year? That's a challenge in itself. I think other simple challenges that we deal with, and we see all the time, we're a home-delivered meal program. You find out, you get to somebody's home they say, my stove doesn't work. Well look, our meals are delivered frozen, how are you gonna cook your food? Or I don't have a microwave to cook this in. Or the refrigerator's been broken for two years. Things like that that we take for granted that people have, have access to it, or working, that really impact that. The other thing I think that impacts it is in our healthcare system, being sure that when people are going home, whether it's after a surgery in a hospital, being diagnosed with HIV positive, starting Medicare, that the healthcare professionals are asking, how will you eat? Where is your food coming from? How will you afford this? What are you eating? I think all those things impact people who are poor and need access. >> Thank you so much, Tom, for sharing. I think about your statement around a stove not working, refrigerator might be broken, the microwave might be inoperable and Hillary, you talked about what some of the work that you do through Geraldine Young. Access to housing, access to thing like refrigerators, microwaves, all of those pieces are just so important. Can you talk to us a little bit about some of the creative things that you are doing within the housing sector at Geraldine Young to address some of, maybe these issues that Tom was talking about. >> The first thing I wanted to point out that our grocery store is the Dollar General on Pennsylvania Avenue. And I actually understand that that's one of the most lucrative Dollar Generals in the state. [LAUGH] I don't know how I knew that, but I knew that. So that speaks to that then. So as I said earlier, we have the conversation at our center. It's not just about surviving, it's about thriving. That's a huge conversation to have. That's a whole like, paradigm shift. Many of our residents when they come in, they kind of look at me like I'm a little crazy. Then they'll say, no offense Mrs. Hilary, but you really do know what you're talking about. They say those things to me, and I love that they say that to me, and we have that conversation. But we work at being in partnership. We're in partnerships with Hope Springs. We have a Let's Thrive Financial Literacy class that we have. It's not just your same old, same old. We get them in there, we have mentors that they work one-on-one with someone who's really a stand for them. We also have our circle of security parity program, which we feel is making a huge difference in the future of the children. That's what I'm all about, the children having whole different lives because their parents are gonna have whole new futures because they're gonna begin to reflect on what their upbringing was like, what kind of care-giving they received. And that makes a huge difference. But the biggest piece that I've connected with the food is all about making these choices. We have something we do at our center where we reward residents who actually come in and make good choices and make sacrifices. They'll come in and say, instead of buying soda, I bought fruit or something like that. So we actually give them, we have, we celebrate it. It's not just them, it's the whole staff, we're all in this together. It's not just we're the staff and we're teaching you, we're all in this journey to eat better. Live better, save money so that we can actually not necessarily be robbing Peter to pay Paul. So the plan is when our residents leave in 18 months, we can refer them to their own Section 8 voucher which I think most of you know, is like gold. Gold. And we want them, we had a resident who left recently, she was receiving SSI but she had $3,000 saved, she had paid her security deposit, and she had a little chunk of change, in case something came up, right, in case of a life situation had come up. So, those are just a few of the things that we're doing. >> I do want to bring up the issue of SSI and SSDI and I want to direct this at Clair. Piggybacking once again off of what Tom said with 95% of the clients living on less than $11,000 a year, knowing what an issue it can be for our brothers and sisters to find employment of some kind. And what happens when people make just a little bit too much where they would start losing benefits, but not enough to get by. Claire, can you address how Maryland New Directions through it's job training program is looking at things like that. And then what you're seeing in the field of workforce development. >> Sure, so we at Social Security have a program called Continue to Work and we are an employment network. So we work with individuals that have SSI or SSDI and they're ready to move, as they call it from dependency to self-sufficiency. And so we provide the same job readiness training, but with these individuals, we really have to take a look at the whole picture, and for some of them qualify for a 9 month trial run period. So some of them do get called individually, it's an individual processes, everybody's benefits are different. And we find out exactly how working will impact their benefits, whether that's medical benefits. And then you sit down and you have a conversation with that individual and their job coach to find out if they're willing to, if they make over $750 a month, then they're benefits would be impacted, and how will that impact your life. And then our responsibility is ultimately employment. So how can we help them secure employment, full time employment that, making that decision to let go of their benefits is easier than difficult, but it really is a difficult choice. And it's not for me, it's for the individual as long as they have as much information they can. They have the training needed to secure employment. And they have the support system, like our agency, to help them while transitioning into employment. Then they're able to make that decision to really move to full time, move to self sufficiency, so to speak. And really let go of the benefits. But It is a really difficult choice. And I think sometimes we, in the workforce world, are caught between a rock and a hard place because we receive funding to provide direct services, not always supportive services. So sometimes there's funding to help the transportation, and sometimes there's not. Sometimes there's funding to help with or to refer for housing, and sometimes there's not. And so there really has to be more done to address some of the social support services that are really, really needed so that some other client doesn't have to make the decision between coming to training today or because they need that $4 to get on the bus, or they need to find something to eat that's healthy. >> John, as you're listening to Claire maybe talk about social support services, and thinking about that in the context of the community or in the context of the faith community, can you talk a little bit about how the community can be effective in addressing and transforming some of these poverty-related issues that people face? >> Well, I speak to what I've experienced in the faith community and what's missing is we in the faith community living into our purpose. Public programs have an expiration date, grants have an expiration date, foundations have an expiration date. All of the majority of the services provided to our sisters and brothers in poverty have an expiration date. There's a certain time that they must exit and meet us in the community, but we are not there to receive them. Coming into the community requires a connection to intellectual and social capital. How will I navigate it? What relationships do I have? Suppose I fall back, how will I be resilient? Who will catch me? [COUGH] When people enter into the community as an isolated individual, they will not stick, they will not sink roots. Our society has lifted up a transactional response to poverty. We look like Safeway, transacting and pushing people down that conveyor belt when we know what we're called to in our faith community is what is preached, what is our purpose, what we were baptized into is relationship. And we've got to stop defining poverty only in the terms of economics and start looking at it from a relational point of view. I probably won't fall into poverty, even if I lose my job next week, because I have relationships in my church, with people in my community, people that I know. I will know how to tap into that. When I go to my church and say I've lost my position, help me transform, they will be there as a community. But when somebody in poverty comes to our church and they ask for transformation, we give them our old blue jeans. We have created the largest system in the world for the distribution of used stuff, of things that create the greatest society of poverty maintenance that has ever been known to the people who are on the other side of the wall. We are now in a place of fear in many faith communities that we are truly called to walk to the margins. We will UPS to the margins, but we won't send ourselves. And we are the missing God piece in this. >> [APPLAUSE] >> One thing that each of you has touched on a tad is the stigma and discrimination that so many of our brothers and sisters face. Claire, in your work with Maryland New Directions, with training, with placing people in positions, or looking for employment, how have you been able to work with those that you serve to overcome some of the stigma and discrimination pieces that they may face walking into an employer? >> I think a large part of stigma, individual stigma for ourselves is belief in ourselves, so I am not my situation. This is just a part of my life journey at the moment. And so a lot of the training, we help our clients really identify their personal strengths, their skill set, and rebuilding their confidence so that they remember they are not their situation. This is just a part of the journey that they're going through. And I think that has a lot to do with really just reinforcing their values, what's important to them and letting them know they are on equal playing fields as the employer. The employer is looking to hire someone, and they are looking to bring value to that employer, so really helping them remember who they are. And that they are not, like I keep reiterating over and over, they are not their situation. That's not what they are attached to. That's just a part of the process, a part of the journey that they're going through right now. I think that, more than anything, which is very difficult to measure, but very, very important to helping ensure that someone really overcomes their own individual feelings, because the world will do what it will. They will think what it will, but really, building the individual self-esteem, I think is most important. >> Building the individual, focusing on relationships, some of the words that we have heard. As Tom and I were preparing for this, he read a little statement here and said, healthcare professionals don't ask, how will you eat when you get home? How will you take your medicine when you get home? Those I think speak to the relational aspects that are so important, so, so important. I wanna open this time up for questions, as you have heard different snippets from our panelists. Does anybody have any questions for them around their work? Yes, go ahead. >> [INAUDIBLE] Year of transition is for 18, is it for mothers and babies? >> I'm sorry, it's 18 to 24-year-old women, mothers, who are experiencing homelessness. >> Okay, so they can have children. >> Absolutely, they have to have custody of their children to participate in the program >> Okay. >> And I just wanna add, we have 12 apartments they can stay in for two years. It's not enough. I get ten calls a day, and I have a waiting list. It's about a year long. >> A waiting list. >> So and I didn't say this before, but would it effect them if placed them from the relationship piece. We made sure from the minute I get that phone call, we'll spend an hour with a woman. If she's not eligible for our program, we'll do everything we can to find one that she is. But again, there's not many. So that to me is a really more, there's actually from what I'm hearing, a push to eliminate transitional housing programs. That's not the way to go, but. >> Hilary, are you hearing any innovative ideas or breakthrough ideas in the housing sector? >> Well, I saw that question, Erin. [LAUGH] I was kind of like, nope. I know our organization has Restoration Gardens. I don't know if you're familiar with Restoration Gardens. It's for youth experiencing homelessness, a permanent housing program. But I really don't know. I don't think there is enough of the transitional housing programs, especially for women, young women. They're there. And the other piece I wanted to mention is I may have someone call, a youth call me, who is going house to house. That's actually a form of homelessness is category two. I'm category one, so you need to be in a shelter or on the street. So many times, I actually will coach someone to go to a shelter. And that's kinda messed up, that it's like you're actually gonna have more services if you're homeless or in a shelter. I do try to work with them. This actually could be a first step to getting back on track and not, so. >> I think this is good for us to hear as professionals as we sit in a research institution where sometimes we forget about the needs and the real life situations that the people that we work with, that our friends face. Do we have any other, yes, go ahead, Anna, and then. >> At this time I'm aware of a program, and blame it on my age, I can't remember the name of it. But it's a program that actually offers incentives and trains people to go into a community and teach people how to shop intelligently. And I'm wondering has Moveable Feast considered using that with some of their consumers, because teaching someone to fish instead of giving them a fish will help them sustain themselves a lot longer. And this program was excellent in that it taught them how to read a label, to distinguish whether it was better to buy a fresh or frozen or a canned something. And once they were trained, they gave them $10 to go shopping so that they could learn to shop better and to eat better in our food desert. So are you aware of that program? >> I am aware of that. Actually we did a private project around that, in Howard County actually, three years ago. It was as challenged there as it actually has been here in the city, for a number of reasons. Everything from transportation, to people So I'll tell you what we found. So we take people out to go grocery shopping. They're gonna meet us at the Safeway or wherever we're going, to that particular grocery store on that day, and we're gonna say now, let's look at the labels here and understand the labels. The first thing we found is that people can't read. So some of the individuals we're dealing with, well, first we need to go back and do some reading skills. So for us, it became a much more complicated program. So we weren't able to continue it after the six months. I don't know if it still exists in the city. >> Yeah. >> Does anybody know that now? >> Yeah, okay. >> The reason I brought it up, I do know. >> Yeah. >> They did a presentation. >> Yeah. >> I can't think of the name of it, at Chase Brexton, and they offered us the opportunity to have a in-house training without taking them to the market. >> Yeah. >> So that we could spend more time showing them what to look for on the labels and how to choose appropriate food. >> Yeah. >> But we could do it at Chase Brexton and have so many consumers come in at a time. >> Sure. >> And have certain people trained to do this. >> So we do that with our clients, we will do that our clients now, and we have three registered dietitians on staff who do take time to do that. We do home visits with our clients, and that's part of what we do is train them how to eat well or to understand what they're eating. So for our own clients, we do that but as a community program we have [INAUDIBLE] to something like that. >> John, do you want to talk about how the model that you use is able to address some of these issues? You, as in volunteers. >> Sure, all the wealth is on the community. It's not coming from anywhere else, and so I'll give you a couple of examples. So, one of our tables or Board of Directors, was serving [COUGH] excuse me, a working, poor woman with two children. And they met around the table, and they had their weekly meetings, tables meet for a year, or every week, but they socialize together and build a relationship. [COUGH] And it turned out that the woman said that she was taking her family to Wendy's every night. And, of course, the people on the table were thinking, well, this isn't healthy, or this is a bad decision. And so somebody from the table had coffee with the sister, and they learned that she had not learned how to cook. Her parents were not at home, she was left alone as a latchkey kid. It was food desert where she lived. And so this woman who had coffee with her offered to take her to the supermarket, and she taught her what she knew about preparing meals. How to prepare large meals and freeze them and make them twice a week and be able to feed your family. So in this process, the lady that she was serving learned how to do this for her family. Her children were around the table, her shame turned into pride. But the lady who met with her and had coffee with her and got into the habit of this, they prepared meals together, and this relationship continued. And this is the power of the community, healing both of those people, no funding needed, no expiration. And in the case of housing, it's a housing desert too, I think we all know that. But faith communities know how to raise capital. We know how to come around an idea, we can understand how to run a profitable bake sale or cookie walk. >> [LAUGH] >> And so many of our congregations in that first year at the table, they will raise money to buy down the rent, so a family can live in a safe neighborhood. They might ask the family to pay a little bit more, which goes into a savings account. But the community has the power to rearrange the economic strata, the social strata. We can rearrange everything because we're coming around the shared purpose of one individual who is gonna change us radically. >> Felice. >> I don't have a question, but more of a comment regarding Hilary's presentation. So you mention that you all have 12 apartments for the young ladies, and obviously it's not enough, you have wait lists and things like that. And so, as cold as I am in this room, but when I heard you say only 12 apartments, and they need warmth. I started thinking about the really dumb idea that everybody keeps talking about doing a dirt bike arena for kids that are stealing bikes, where you'll have places for the young ladies that are trying to make it. And we're just so screwed up in this city. I mean, all you have in I just don't understand, and I know nobody in here could have an answer, or maybe they do, nobody want to get in trouble, but anyway. >> [LAUGH] >> I just, I honestly think it's ridiculous, and I don't live too far from where our work location is, but it's just ridiculous. I mean, first we do the race car thing and tear up the street, and then we can't even find an apartment for some kid, and that's so ridiculous. [CROSSTALK] >> Everybody's aware that there is no place in the country where a person can have a two bedroom apartment and be making minimum wage at 40 hours. It doesn't exist. These are the options of my residence, it's the way they see it. Section 8 so they're on the waiting list, you all know people who might be on the waiting list, that's years and years, you're on the waiting list. Now our program we are gonna actually give you a voucher at 18 months, otherwise what are the other options? My daughter right out of college can't afford to live on her own without roommates, many of us. One that I didn't mention that I wanted to is, are you familiar with St. Ambrose housing? They have a wonderful program called their homesharing program. I mention this to all my residents, and I haven't had one yet be interested. So if you don't know about it, it's a great program. You can get a beautiful apartment or a home and share a home with somebody for about 300 to $400, in speaking of unique ideas, St. Ambrose. >> So Hilary, it's been over 15 years ago that Carroll County had a program called the Brewery that was just for women. It was a former brewery, and it was an old warehouse building that they made into five floors. The fifth floor was to house the women and their children. On the fourth floor, if I'm remembering correctly, there was the Department of Social Services and the Department of Education. On the third floor was job development, skills development, and on the first floor, there was a Goodwill shop. I thought it was one of the most phenomenal programs that our state has ever had, because women could stay there for upwards, I believe, of 18 months. In those 18 months, they had to make certain that within a week of coming to the shelter, that their children were in nursery or in school in the community, and that they had to obtain a job in the community where they got paid. They got to keep 10% of their income, but the rest of their income got banked. And they also were taught, Tom, how to cook, and how to read the labels, and all those things. And several commissioners ago, I brought that concept back here to Baltimore to say, we got enough warehouses vacant in Baltimore City that we could do the same. Because I believe, and I'm not sure of the outcome or why they're not open today, but I thought that it was a phenomenal concept because the women not only got in touch with each other and were able to network, but they got in touch with social services that were able to help them work out all of their isms and schisms that they had. They got to work in a job, and they got to shop for the apartment that they got assistance to locate. So that when their 18 months was over, they had an apartment, they had it fully furnished, and their kids could maintain themselves in a community that they had become familiar with. And I think that that's something that's worth considering, and I think that that's something that the Abell Foundations and others might be interested in. Because we do really need some housing, and people should not have to quote, unquote house share with someone that they're unfamiliar with. And you got two different dynamics going on. I know somebody would not want to live with me. >> [LAUGH] >> Therefore, you would take me. So Patrick wants a old black woman. I'll take a old white man. >> [LAUGH] >> But the bottom line is that- >> And a husband be across the street. >> And the husband will be across the street. >> [LAUGH] >> [LAUGH] And Tom says, I wanna drink Martinis on an [INAUDIBLE] budget, so I'm thinking that there's somebody out there that will listen to this concept and help to develop it. >> Thank you. >> Innovative ideas. As we're all sitting here listening to this, what we need to be thinking about is innovative ideas. Because our discussions together can bring them about. We are here talking about some of the issues that we all face. And it is time to bring these bright ideas together and think outside of the box, cuz I think that's what it's gonna take. I wanna, yeah, go ahead. >> I have a question for Claire. >> Mm-hm. >> So I learned from some of my clients who are dealing with HIV that they can find jobs, but oftentimes, they've lost their jobs because of substance use or chronic pain or other health situations. And this can be really frustrating for them, so I was wondering if you have any support or services to help people in these situations? >> Once a client, always a client. So we work with individuals, as long as they stay connected to the program, they are able to work with their job coach. Everyone has a Assigned a job coach because sometimes life happens. When you have a disability or you have a life threatening illness, there could be a possibility that something could happen to prevent you from going to work. So the coaches and the counselors on staff work with every individual to help them kind of manage whatever barrier or challenge that they're facing at the moment and then get them prepared for employment. Really connecting with them, following up every month. We follow up every month, every three months, and every year up until whenever, just to make sure that they're still stable. And if they're not, that they could be engaged with us and make sure that there is a maintained connection to them. Because life happens, people lose jobs. And so our goal is to get them employment and help them to maintain employment, but we know that some people may lose it so they can come back to us for those services. >> Okay, thank you. Does somebody else wanna address that piece? >> I'd just like to address that from the point of view of the faith community, is that even in 100 person faith community, there is a network to more than 1,000 potential jobs opportunities. People who we work with, our connections with service providers, even to my own family. And often we're able to network and help create a job or go with the brother or sister that we're helping and help the employer to understand that the faith community is walking with them. And maybe that employer could co-invest with the faith community. And maybe we can let our little consumer market and our faith community know that that employer has made this contribution, leveraging the intellectual and social capital in the community to create change. Not hoarding that stuff, but letting it flow out and using it and leveraging it. And I didn't get to see this was up there, but this is what an open table looks like. You'll see a brother and sister at the head of the table. They're the boss and then people from the congregation occupy these chairs. They don't have to have any expertise in the title of their department. They just have to have no call reluctance, to pick up the phone and say, hey we've got a business plan for one of our friends who was helping on this table. The church is involved, would you like to co-invest? Would you like to provide legal services, dental services, medical services? These tables network and achieve thousands of dollars of contributed service from community members namely because they ask. >> Yes, in the back? >> Yeah, I just wanted to add to that last question in regards to that because a lot of times when it comes to contributions, you do have quite a bit of preconceived notions in regards to the community in which we work with. And recently I've led a lot of discussions and talks in getting the new face of homelessness, particularly as we reflect around the HIV AIDS epidemic. And because of the economy and the way which our economic system is, that kinda has, at least within the past 10 to 15 years, we're now experiencing a lot of people who have lost incomes, lost their jobs due to the economy, who are quite well-educated, who had very successful careers. Who just happened to be HIV positive, who were well managing their disease and due to the circumstances of the economy, are now having to seek social services. And are running into quite a few barriers based on their knowledge base prior to coming into the service areas. And they're now having to seek these services. So I just kind of wanted to, many of us who are sitting in here are services providers, to keep that in mind as we work with these people and how we can effectively work against some of those barriers. >> Anybody, comments? >> I would just respond to that. And Karen, I know that you're not a panel member, but since Hope Springs has really pioneered this table movement out here and in Baltimore nationally, with people who are HIV positive and in poverty, I wonder if you could talk a little about the flow of intellectual and social capital into the people that Hope Springs people are serving just to provide a local example. >> Sure. Two years ago, my husband and I joined the table, to serve on the table. Our brother had been trained as a hairdresser, he came out of the foster care system. He was a twin. He was in the faith community. He came out as a gay man, was booted from his faith community, his family. The amount of stigma and isolation that he faced, decided to go back to California away from Baltimore. Became positive, came back to Baltimore and was isolated and alone. I met with his case manager at the Jacques Initiative, the local HIV clinic on the other side side of town. And I went to them and said, I'm willing to take a risk, because I'm isolated, I'm by myself. I have a job, and I make about $11,000 a year, but it's just barely enough for me to live, to get by. And as we began to meet with our brother, we discovered some fantastic things that were going on in his life plan. He decided that he wanted to go back to school and get a degree in Human Services so he could serve other youth just like him who had gone through similar experiences. And we know from working with youth, that many have had similar circumstances bouncing from house to house, not a great support system, and the foster care system. So my brother was making less than 11,000. In order to go to school, and he was eligible for a Pell Grant. Unfortunately, he had never paid his taxes, because he really didn't need to, right? I mean, make barely enough to get by, and the Pell Grant system and the IRS are tied together. Since we're looking at our table, we're saying, well, we have tax guys that we use. Who can we utilize in our network? And our tax man agreed to do his taxes, all of his back taxes, for $1. He started meeting with the finance chair. The finance chair was just a retired guy, had no expertise in finance. They started budgeting, looking at some of his payments, to work at paying off his taxes, right? Each month we all looked at our social network combined and said you know he's a hairdresser, and we increased his clientele. Well, really easy social marketing, >> [LAUGH] >> Facebook. All right, yours is great. As a matter of fact, some of you have been commenting, if you've known me for a while, my hair was really short. >> LAUGH] >> Even was my professor, and my husband who is the one in the long hair, but fantastic. So we were able to increase his clientele through that. Now he gets back into school, right, cuz he gets through that FAFSA stuff. It just so happens that our transportation and insurance person just happened to have a wife who was a math teacher, and my brother was really struggling to get by with that, as he was back in school for the first time in a long time. And so they're starting to meet about doing math work, right. And as we discovered throughout the course of this year, it wasn't about serving, it was about being in relationship with each other and in mutuality. I think it's these type of innovative models about seeing what our assets are, what our gifts are and how we can utilize them. As you all sit in here, many of you are professional people, right? You have a skill set that maybe some of you are looking to volunteer or maybe to use. And here we are with a plethora of fantastic organizations that are working on health care, job development, food access, housing, teams with life plans. And as you're sitting here saying, well, maybe I'm doing my something. Well, what is your something outside of the work? Can you use that work life experience to serve somebody who might be facing these different challenges? Anyways, all this to say my brother did get his human services degree and moved out to California. And the key to all of this spells relationship. You know, as Thomas said, at the end of the day when you go home, do you have anything to eat, right? By being in relationship with others and looking at what we have to offer, I think there's so much more that we could be doing by connecting with great organizations like this. I don't know that I really addressed the question or response, but it's a little bit of a story. Any other questions? We're getting close to our end, so if each of you take 30 seconds to say your final word as we move on to our next panel. >> I just wanna share an experience I had this weekend. We had a resident who graduated from. We had a graduation. She's living in her own housing, she doesn't have a job right now. She's very active with the Freddie Gray situation. She knew Freddie, she'd taken video. It's become her passion to be an advocate in her community. She's so inspiring. So she came to the office Friday night, it was six, I was tired, I was ready to go home. She's like can you get me some flyers, this newsletter that I'm sending out? And I'm like, sure, and then I'll look at it, in my mind, I'm like, there's spelling errors, stuff like that, but I'm like, who cares? She invited me to this forum on Saturday that she organized with a bunch of people. I didn't wanna go. I went on Saturday, it was from 11 to 4. I was never so moved and inspired in all my life, the people that she brought together. Gentleman had just gotten out, he was incarcerated for 42 years, was there speaking. I mean, it was amazing, and I share that just cuz I want to make sure you're effluent of how inspired I am everyday by the work that I do working with the women that I work with. And I still learned a lesson this weekend like who am I to think that that wasn't gonna be a meaningful day? It was absolutely amazing. So I just wanted to tell you about that day. >> Could you show this picture that I have there? That's me and Ernie, he's the first brother that I collided with about ten years ago. This is our first selfie in a Walmart Supercenter. >> [LAUGH] >> What we like to do best is go to the Supercenter and spend about three hours there. And we just walk around and talk about where our lives are, what's hurting us, what's making us joyful, what we're each trying to do in our lives. And we're in the shoe department cuz the only place in a Walmart Supercenter that you can sit down is in the shoe department. >> [LAUGH] >> So it's important to look like you're trying on a lot of shoes, so you can maintain your position. But every morning, Ernie texts me HAGD. Took me a couple of years to figure out that meant have a good day. And so I text him back HAGD. In the evening, I text him HAGN, have a good night, and he returns that. But this connection is so important because we're saying to each other I exist, I know you, I'm in relationship with you, and we will never lose this connection together. We will heal and save and keep each other moving forward. And this opportunity is available to all of us. It is our purpose, I believe it's why we're created. Not for our own human potential, but to ignite the human potential in another. So if you're thinking that maybe you're missing three hours a month in Walmart Supercenter, come and talk to me. >> I think for us, people don't see jobs as a cause so to speak. It's something like we all have to go to work. We're all raised, we go to school, you have to go to work someday. We don't ever think that we need other people to help us get to work. And I think it's really, really important, we never think about it. That's what makes it so difficult sometimes to fundraise, because I really wanna feed someone with HIV, or I wanna help someone find housing, or I wanna serve homeless people, but I really wanna help someone get to work? Do I really need to do that? And I think we really need to think about, yes, we have a responsibility as part of our relationship to help people, that's the whole picture. We don't have a job, you don't have food, you don't have housing, you don't- >> And people wanna work. >> Exactly, people want to work. So I just want to leave you with a thought that it is something. It is a cause, it is something to really help your brothers and sisters. It really makes a difference in the lives of all of us. I mean we all, most of us work that are here, so really think about how can you help someone get to work? That's what I'll leave you with. >> When I work at Moveable Feast, I always think that food or nutritional services or transportation or culinary training is just the excuse we use to get into people's lives. Because really, the healing, the wellness, the health of the individual, I've see is transformed more once we have that embrace with them, not even from the food or anything else. We have a client who's been on service with us for 18 years. Who was just diagnosed with stage IV esophageal cancer, which is not a good cancer to have, and she can no longer take services or anything like that. But she left me a message this week, and it really brought home to me and reminded me about what is the core of what we really do. And she said Mr. Bonderenko, I woke up at 4 o'clock this morning, I couldn't sleep, and I was so scared cuz I'm starting my radiation tomorrow. And I just listened to your voice telling me how much you were concerned about me and if there was anything you could do for you to let us know. And we have volunteers from Hope Springs, actually, who go and bring her to radiation now and brought her to all her doctor's appointments. But through her tears, she said, there's nothing more important to me right now than knowing that I'm loved. And on one level, I thought, how sad that this woman is calling someone in a program like Moveable Feast, saying thank you for loving me. And on the other part, I thought how grateful that I was that we can be there for her in this moment. That's what it's about. The food is the excuse to get in to give that person a hug that day, let them know that they're loved. >> We are called to be in a restorative relationship. And for all the research, for everything that we do in our daily lives, it is about restoration and seeing people as truly who they are. So let me end there. Thank you so much. >> [APPLAUSE] >> Can we give everyone here a round of applause for giving us the opportunity to discuss and meet with us today? >> How's it going? Feeling all right? All right, good. So my name is not Jamal Hailey. That's the name that's in here, pretty sure. My name is Michael Franklin, I'm actually a close colleague of Jamal's. He's my boss at STAR TRACK and one of my mentors. He is actually spending time today in his pursuit of getting his PhD in counseling psychology at Howard which is fantastic. Black man doing the work to be a PhD person and indeed our research and access for our community. So we excuse him from not being here today, and I hope you understand. So we're gonna be talking about healthcare access and the in progress. And I'm gonna give you a brief description about who I am, just really quickly, so you have a sense about who I am and what I do. And then we'll have our panelists all introduce themselves as well and then get into some discussion. We're going to follow the same format as the previous panel. Any questions that you have, please hold until the end, and we'll definitely address those as they come. So my name is Michael Franklin, and I'm here on behalf of STAR TRACK. STAR TRACK stands for Special Teens at-Risk Together Reaching Access, Care, and Knowledge. It's a very long acronym, there's no test for that acronym. So what we do is we do injury prevention, treatment, support, and advocacy for young populations in Baltimore between the ages of 12 and 26. Really focusing on four specific populations. Focusing on young men of color. Focusing on homeless and transient youth. Focusing on commercial sex workers. And then also focusing on LGBTQ communities. And we choose those communities cuz they are some of the hardest to reach. They're the hardest to access, the hardest to gain trust. Some of the most vulnerable and marginalized, especially when it comes to structural oppression. And just where you're looking at the HIV epidemic and where it's falling. We really do a pretty good job, I think, about hiring folks from our communities to serve our communities, to make sure that we're doing the best work we can to get folks access to their health, and just access to in general. We've been around since 1989, and adjust that. And so today we're gonna be talking about really is thinking more about healthcare access around racism, around racial justice, around systemic oppression. Cuz really, if we really think about it, HIV work and health work in general, especially in the context of Baltimore City, the place where we are currently doing our work. You can't really be doing HIV work unless you're also doing racial justice work and social justice work. Those two are intimately linked, and that's part of the reason why we're saying HIV epidemics are where they are is because of structural oppression and systemic violence. And so really thinking about how we can each individual agency to attack that, and get folks better access to healthcare, because based on structural pressures and systemic violence. We'll be addressing that and then also talking little bit about some valid historical and current concerns in black and POC communities around medical mistreatment and medical mistrust and how we can tackle that in our own practices. So I'd love each panelist to introduce themselves briefly and just your name, a little bit of your background, and the current work that you're doing in Baltimore. >> Okay, so I'll start. My name is Jill Crank, and I'm a family nurse practitioner at Chase Brexton Health Care. I've been working there for about eight years now, and I was asked to come on the panel to speak about free exposure prophylaxis for HIV prevention. At Chase Brexton, we've been around since 1979, providing care to HIV positive individuals for a long time. Now also serving, for several years, HIV negative individuals. And we've been doing PrEP for about two years. And we're about to explode on that front with some Some recent grants that have come in and maybe I'll be able to give some information on that. But I've been pretty central in creating the program at Chase Braxton and trying to educate others on how to do so as well. >> Thank you, good afternoon everybody, my name is Danielle Skye. I'm a registered nurse with The Star Trek program which is a adolescent program that Michael [LAUGH] works for. He just talked about the program and everything that it does. But more specifically, part of why I was hired is because we are focusing on the health care of transgender adolescent young adults. And we know that transgender adolescents are part of the more likely group and are more likely to experience discrimination and homelessness, joblessness. And also have higher rates of HIV prevalence within the transgender community, too. So a part of my work is to help reduce barriers to healthcare access within that population. >> Hi, I'm Reesha Irvin, and I'm an Assistant Professor in the Division of Infectious Diseases. I see patients clinically at our specialty clinic in the Blalock and there we treat Hepatitis C patients with strong focus on co-infected patients. My research interest is really around looking at kind of barriers for care for both HIV and hepatitis Cs and building interventions to address those. I also direct Generation Tomorrow for seat bar and work with many of you here. And in that program, we train both students and community members in HIV and Hep C education testing and counseling. >> Good afternoon my name is Emeril Fields. I want to apologize in advance, I have to leave at 2:50, so if I can get everything I have to say out in 40 minutes or so. But I am an assistant professor at Johns Hopkins also. I'm in the department of pediatrics. And I work as an analyst of medicine provider and HIV provider in the pediatric, adolescent, and young adult program in the department of pediatrics in the Arab Lane clinic. So, I see patients who are HIV infected and affected, from 13 to 25 years of age. We also provide prep services in our clinic as well so we do some of that. In addition to my clinical I'm also an HIV researcher. I focus specifically on young black gay bisexual and other men having sex with men and HIV prevention in that population. And really, a large part of my work is really focused on health disparities and the fact that the disproportionate rate of HIV that's carried by these young men really does represent a social justice issue. If you look at just a map of Baltimore City, where you see poverty, where you see other health problems, we see drugs, we see crimes, we see violence, you see structural inequality, you also see HIV in those areas. So that really speaks to the, to the fact that this is not equal opportunity disease, unfortunately, in our society. >> Thank you, and so a number of things came up and barriers was one. So I'd love each of you to just take a moment and talk about some barriers that some folks have to accessing health care. We're gonna hear a lot from Doctor Shaw, and Doctor Gomez earlier talking about sort of over arching barriers that our communities might face. We're gonna just talk more about specifically what each of your practices and fields, do you sort of see are the biggest barriers to folks accessing healthcare? >> So Chase Preston focuses also on LGBT care. So I think that that alone is a big barrier for trust and discrimination among healthcare providers against people in the LGBT community. So I think that keeps people out of the healthcare sector for fear of discrimination, not being able to be open and honest about their sexual practices. So I think that's a huge barrier that ties directly into HIV prevention and infection. So we pride ourselves on taking very good sexual health histories and promoting sexual health in a positive manner to make a safe space for people. >> So in speaking about the transgender population, I just wanna talk and just focus on that. Because a lot of the talk today was focusing on men who have sex with men. But I wanna talk more specifically about the transgender population and what that looks like for that group of individuals that have barriers and access of care. So something that I came up with this is just about the beliefs and attitudes that we have about transgender and gender nonconforming individuals, which is the major barrier in my perspective. Most of society basically only thinks of things in black and white and we see things as either male or female, we don't see. I'm sorry, so we see things as black and white or male and female and providers or people who are servicing populations who encounter a transgender person are faced with internal and external discrimination of that individual which may happen thereby creating a barrier in accessing care. So for instance a transgender person walks in and their telling you that they identify as female. But then you might make a mistake and call them male. That may create a barrier right there because they may not feel safe and confident that you will provide them adequate care for them. And so we need to look at beliefs and attitudes. And where we are internally and externally about the barriers that we present to our transgender clients when they're coming to us to access care. >> So I'll talk about it a little bit from the perspective of hepatitis C. So what we know from research studies that many of our HIV infected patients are co-infected with hepatitis C, and the rates for research say about 10 to 30%. We had some recent emergency department data and their HIV screening programs that suggest maybe about 50% of the patients that we see here that are HIV positive are also co-infected with Hepatitis C. >> And since we've had great advancement in treatment for HIV, Hepatitis C has become a major contributor to mortality and morbidity amongst HIV patients. So when we think about kind of access to care to hepatitis C kinda treatment, we've had a lot of changes, in this last few years or so. And so one of the barriers that we've encountered on both a patient and provider side is just the legacy of interferon. There's a lot of information out in the community about how awful interferon was and the fact that it didn't cure many people. And so patients still had that perspective, but also many providers. And they don't necessarily even refer for people to get hepatitis C treatment. The other issue we have in terms of access to care is that some folks do need a referral from a primary care provider and there's this whole issue of substance use. So if people are still actively using, whether that be injection drug use or alcohol, there are some providers that won't refer. And we've heard that from patients who have either called our clinic or patients who have come in saying they've had to change doctors to actually get a referral to be seen in our clinic. Our clinic has been very aggressive with working with people around substance abuse issues. But more so that we know, for instance, that alcohol and hepatitis C together can contribute to your liver progressing even more faster, so we feel that those are the people we should actually be aggressively treating. So our clinic has taken that stance, to aggressively treat substance abuse. There’s other issues we’ve had in terms of workforce shortages for hepatitis C in that there’s actually not enough providers in Baltimore to treat the burden of hepatitis C we have. So, we’re working on kinda issues around that. And then the final thing, I think this is a point that we need a lot of advocacy around, is about who can get treatment. So the current Medicaid guidelines are based around staging your Hepatitis C and covers people, it ranges from f0 to f4 right now covers people who are f2 and above. So if I have a patient that has low level disease by staging and they have Medicaid it's very hard for me to access treatment for that patient. There are some patient assistance programs, but some of those have been based on staging as well, so it's still very hard for us to access treatment. CMS has issued guidelines telling states that they should not be using this in their Medicaid guidelines, but those were just issued the other week so we'll see how that changes the landscape. But those are some of the barriers that exist right now for hepatitis C. >> Dr. Urban, do you mind talking about interferon a little bit, cuz I just thought that maybe that went a little over my head >> Oh, sure, so, interferon is the old way that we used to treat hepatitis C. And, it was an injection, and made people really sick, and you had to take it for a long time. And, so there's a lot of information out there in the community about that. And, even a lot of my patients bring it up. Now some of that is starting to change. So last year in 2014 we got all oral regiments, so pills that people can just take by mouth. Most people have to take them about three months, some longer and with very few side effects. But that information is not necessarily out in the community. So part of us is just kind of educating people on kind of what their treatment options are now and that it's very different from how it used to be. >> Thank you. >> So I'll focus a little bit on youth and young adults, so there's generally speaking, most of the youth are of the age of 18 and before they turn 25 are going to be treated in adult settings. And the research are starting to show that adolescents and adult settings don't do very well in those settings, they tend to require a lot more. Almost a fourth of adults do in terms of making sure they get to their appointments, making sure they're able to save for their medications, making sure that other aspects of their lives are attended to. So they tend to do poorly in those settings, even they were doing well in a pediatric setting, when they get transitioned to an adult setting they tend to do more poorly in those settings. So that's a huge barrier for youth in the city. We fortunately have several programs. Our program's in Star Track that focuses specifically on youth and young adults and HIV treatment. In our, point we have a number of different, we have Ryan White funding, we have Title X funding, both of which sort of lower a lot of the financial barriers here that many youth and adolescents may face as well. But they also have some of the things I've already mentioned. So they have a lot of competing priorities in their lives. Many of them may have housing instabilities so they're worried about where they're gonna sleep at night and not necessarily worried about taking medication. Many of them have children, and so they have to take care of those children as well. They don't have jobs, they may not have finished high school, so there are a number of things that are more important to them in the immediate future. And that's also very typical of adolescence, and not very long-term in their thought processes, so they're very focused on what's in front of them, what they have to handle at the moment. So that can be a huge barrier as well, but I think a barrier that really is cross-cutting beyond adolescence. It's still the significant stigma when it comes to HIV. So oftentimes I have patients that either, they don't want to think about the fact that they have HIV. They don't wanna talk about the fact they have HIV, they don't want a pill as a reminder that they have HIV, they don't want to see the doctor as a reminder they have HIV. I have a patient that was in our clinic as an adolescent, just a healthy adolescent and was screened positive in our clinic, and have been coming to that clinic her entire life and now it just feels uncomfortable being in that setting, cuz she's reminded of her status when she comes in. So those are fairly significant barriers. I think that the reason why people don't want to think about having HIV is because HIV is a bad thing and people still think very badly of it. And they think badly of people who have HIV, unfortunately, so that's a big barrier for youth to overcome. >> That really triggered a lot for me, so thinking about, you talked about sort of the base line needs that folks have and just really trying to make sure that their basic needs are met before you can actually attain some higher level needs right. It just brings me back to Maslow's hierarchy of needs, right, and that making sure that you actually have food, water, and shelter. So it's making sure you have other things, your basic needs met. If you're not able to have those basic needs met, then how are you able to actually think about your health care, how you actually have think about your HIV status? That's gonna be something much more further down the road to be thinking about, worried about being discriminated against meanwhile into a facility where you don't have any really awesome access to employment. And so those are really key things to be thinking about, and thinking about holistic services around HIV prevention and healthcare, and making sure that folks get access to what we want them to be, which is healthy and well, but can't be there if they're facing these alone, right? And a lot of those basic needs not being met is actually intricately tied to things like structural racism and systemic violence. So black folks have been systemically mistreated by the government in a number of ways. Looking at sort of redlining in housing, which Dr. Gomez talked about earlier. Looking at actual sentient neighborhoods, where white folks were given the money to move into wealthier neighborhoods and get access to loans and then other neighborhoods were left to be impoverished. Drugs, and then crack and cocaine epidemic, and specifically looking at sorta sentencing around criminal justice and the difference between those two. The higher sentencing for black folks when it comes to crack use versus white folks and cocaine use. Looking at education systems, looking at our medical systems. It's all sort of really intricately linked. And so as we consider the socio-political climate in the US around race, do we think that health care providers in Baltimore are actually able to address medical mistrust as it relates to health care for people of color? And that's a question for the panel. >> Okay, I'll talk about it. So I had these questions the other day so I had a moment to think about these questions and then answer them accordingly, so that I wouldn't be sitting here stumbling over the questions because I wanted to sound smart. So first of all, I feel that we need more advanced level practitioners who will provide high-quality cost-effective care in our communities. So I kind of have these biases against managed-care organizations that pop up in our communities and I'm not going to name names, but I'm all about even if we still have to provide care on a budget. Let's do it in such a way that it provides high-quality outcomes because these are still people's lives that we're dealing with, and as healthcare providers we ought to be seeking the best quality outcomes from our clients. If not, then we're doing them a disservice and we're further doing the community a disservice. Also we need to remove barriers so that there are more providers of color and also provide and apply cultural competence to all providers who services people of color, to ensure that we are meeting the needs that are respective to the culture in which the providers are practicing in. So if you are a provider and you're coming in from Ohio because there's a big push to bring primary care providers into the inner cities. Well then you need to take a moment and figure out where you are culturally about people who live in the inner city and how we talk about each other and even how people in the inner city view health and how health is important to them. And so these things are all important as we talk about this question that you just provoked. >> Great, I completely agree with Danielle. I also, in terms of pre-exposure prophylaxis, one of the main things is actually finding the people who are at-risk, finding the high-risk negatives in the community and educating them on what PrEP is and how we can provide it, and I think that the link to that is our community navigators. And so the new, there are these grants that have been funneled down through the CDC to Baltimore Health Department and then to 13 partners of the city. And we are going to have 26 PrEP navigators that can be pushed out to the communities and the cities, and find people and educate them and bring them back into the clinics to access PrEP. And so I think that there is a lot of room for improvement, Danielle's completely correct. So one way to hopefully fix that is to really put the trust and responsibility in our navigators to bridge that gap between finding the people at risk and then us as providers. >> I want to echo Danielle's comments about health care competency. I think that it's super important, not only in terms of racial and ethnic, cultural differences, but also things with LGBT populations. Medical writers are not trained in cultural competency period, specifically not for LGBT populations. And that's actually why we want to put the medical students on that, because that's really what they're asking for. I think now compared to an earlier decade or so ago, healthcare providers are really interested in being able to take care of patients from different perspectives but they don't have the training to do so. So I think that's an interesting area, but getting back to more sort of your question. I think Hopkins has a complex relationship with the community that's changed over time and hopefully is improving, but there certainly is still a lot of medical mistrusts from many patients that we take care of, and I'm certainly encountering it in the patients that I take care of. And I think looking like my patients has helped but also having a relationship with the patients and not simply seeing them as the next folder in the door. And the fact that if they are able to see that and feel that and see that you actually care about them as a people, then the institutional stuff that's happened in the past is no longer relevant. What's really relevant is your relationship with your doctor and the doctor's relationship with the patient. >> So I just agree. I think the issue of medical mistrust is huge and, as Errol said, I think we have to acknowledge the relationship that our institution has had with the community before and all kind of strive to make that better. I think in our specialty clinic we've kind of worked around that area in terms of cultural competence, but also trying to make sure that we're very transparent with patients about their treatment plan. Making sure people want access to the medical record that they can get that, so they can see what we're writing about patients in their medical record. We also have a great RN who was just hired to really work with patients on treatment adherence and kind of walk them though that whole process. And I think what people really want to know is that we care and that we're being very transparent about everything. In terms of Generation Tomorrow, which I direct, I think for our students we have lectures on cultural competency and how you engage in the community. But I think the biggest thing that they get is actually working with organizations like Star, and working alongside them and kind of learning from them kind of first hand about the community. So I think that's really important as we think about our kind of training for both doctors and kind of public health professionals kind of moving forward. >> Yeah, makes that training really happens across the board, right? So, doctors looking at nurses looking at front deks folks looking at editorial staff looking at just everyone in the healthcare setting, right? Cuz that one moment, that one piece of prejudice and discrimination can actually make that person walk out of that door and never come. And that's just a really huge reality. I see that hand and I'm totally, you're going to be the first person I grab during the questions. And also, thinking about some of the internal organizing inefficacy we can deal with in our own institutions, right, so like making sure that we have the community navigators, making sure that we have the culture competency, but also making sure that there's hopefully access to employment opportunities, not only that are entry level, but higher level for the folks that we're serving every singe day to make sure that folks have access to the incomes to be able to be building [COUGH] and living healthy, secure lives. So, as we're talking access and healthcare access, healthcare expansion happened, right, the Affordable Care Act. How has that improved or not changed or what does that look like for you as far as your service you provide to your clients? Looking at healthcare expansion and how it's impacted your practice. Any thoughts and questions on that? >> Do you want to go before you leave? >> [LAUGH] >> So I think that we've certainly seen, we've seen an improvement in patients' access to healthcare insurance since ACS implemented. We again, have the benefit of having Ryan White funding. So, if patients are uninsured or don't have access to their insurance, something I'm gonna talk about in a second, then we're able to provide them with care through our Ryan White funding. The problem that I've seen, one, is that many of the patients who are on Medicaid have to, for some reason, and I'm unclear on the timing. But it seems like every few months they get kicked off their insurance and have to start the whole process over again. And so, that's been a huge barrier in terms of, even though, we have funding to pay for labs and visits and even medicine, sometimes that's still is a barrier if patients think they're uninsured they may not come in to be seen. We also have again, kind of getting back to the stigma, patients who can stay on their parents’ insurance until they’re 26, but they don’t want to use their parents’ insurance because they haven’t disclosed their HIV status to their parents, and they’re worried about bills going home to their parents or HIV viral load or what have you. So, that’s been a huge barrier that we haven’t quite figured out how to get around yet at this point. Some patients have sort of left their parents insurance and gone on Medicaid, but that's not ideal for a number of reasons, some of which I just mentioned. So that's sort of the conundrum that we're in in our study. >> So, in Hep C, it's been huge for us because we don't have a medical safety net kind of built-in. So, health care expansion has really provided a lot of people with kind of access to our treatment. Again, our major issue is just in terms of being able to actually provide treatment once people are there in terms of what's covered in terms of their medication, for Medicaid right now. And even some of the private insurance companies have limited who can have access to treatment as well. >> So, at Star Trek A&B Treasure To Help program, we are seeing more adults being able to provide wraparound services, which is essentially how I was hired as a nurse care coordinator for someone to specifically focus on a patient population which is the care of transgender individuals. And we know that this group of individuals is more likely to experience homelessness, joblessness, harassment. They're the group of more likely, they experience it all. And so we are able, through Ryan White funding, which is through a dual diagnosis program because people who are transgender, have a diagnosis of Gender Identity Disorder and, or dysphoria, along with their HIV ems. That's how we're able to get SS Healthcare Dialers, to be able to provide wrap around service, which will ultimately enable them to be engaged in care and to ultimately be better managers of their care. >> So, Chase Preston has always had a sliding scale fee program where you don't have to have health insurance to come to us. That being said, when you're uninsured as a provider there's little that I can do when I don't have the support to provide certain medicines or refer you to a specialist. So, it was very exciting when about, I think, 35% of our uninsured went down to 15 or 18%, so that's really great. In terms of prep, Medicaid, we had no one be declined approval of Travota to use for prep, so in terms of Medicaid. So, that's been fantastic and has really helped out a lot. But there are three other programs that are available to cover the cost of the medication, Travota for prophylaxis. I think, I wrote down the same thing. It's great when you have insurance. It goes off and on. I don't know why, and my patients miss visits or come to the door and they don't stay cuz they can't pay if they get a bill. But also just the simple, actually, signing up for the insurance is not very easy. And I've had a lot of people with low health literacy. They have no computers, they don't have a phone. And they're on hold forever. And they talk to someone, and they tell them to, hey, go download something. And they don't even know what download means. I mean, there's the whole gamut of it. So, I think it's fantastic, but really the sort of nitty gritty of rolling out the access to the insurance is still a very real thing that my patients face every day. Luckily, we have a fantastic strong case management department with lots of navigators that are excellent, and you can walk in at any time and talk to one of them. They can sit there and walk you through it. >> We're currently in open enrollment for the ACA now. So, you should access one of these folks up front to make sure that your folks are getting access to health care. So, the topic of this symposium right, is called Exploring the Roots of HIV Disparity, Poverty, Race, and Healthcare Access in Baltimore. And so, that title alone acknowledges intersectionality and that we're more than just a race, a gender, a sexuality, or all these things all at the same time. We'll always be thinking about all of the people, who we are, who we bring into the room. So, what do we need to know about the intersections of the clients that we serve? Especially among poverty and race to improve health care access. >> Okay. >> [LAUGH] >> Yeah, so, it's interesting. Lisa Bowlig who's a researcher out of Philly wrote a paper based on the quality of patients and the title of it was, once you've, I'm going to get it wrong, but it's once you've made the cake, you're unable to individualize the ingredients of how it was. So, basically, they wrote the ideas that people have multiple components of themselves. And it's not an additive thing, it's really complex. So, for instance a patient, a young black gay male who's under the age of 25, who comes into a clinic has on each individual level, so you mentioned the barriers that you've had to health care. I've mentioned in terms of their gender, males are much less likely to seek out health care than females are. African Americans have a sorted, complicated history with health care, we've had recently, within the past decade, the IOM Report is still the best report, has said that they're still getting unequal treatment in healthcare settings. And then, you put work poverty into that and that's a huge barrier to take care of as well. So, an individual who has all of those characteristics is gonna have much more barriers than anyone who has those individual characteristics, in terms of their ability to access care. So, really that intersection of those multiple oppressed [COUGH] identities really complicate the picture and it's something that you have to be cognizant of in taking care of those patients and really understand how those different barriers exist and how they interact in their authentistic terms of limiting access. >> So, I think for this question, we have to look to public health, and also really look to the history of this country. It always amazes me, the whole dialog about the masses kind of pulling themselves up by the bootstraps. When we're really one generation, post de jour legal segregation in discrimination in this country, so my parents were raised under Jim Crow. And so, it always amazes me that we kind of forget the history of our country. After that, then we essentially had de facto segregation, which kind of permeated every part of American society, educational school systems, whether or not you got loans, where you could live, so there's this kind of legacy and history in our country. And then, you lay on top of that what we had, the decline of industry which used to offer jobs to people who didn't have as much education, but a good paying job. You've had the drug epidemic hit. You have poor educational school systems. So, the whole notion of pulling yourself up by the bootstraps if you don't even have the educational foundation is just a little bit preposterous. And so, when we kind of take a step back and think about how we can improve healthcare, all of these factors kind of are directly related to healthcare. As Doctor Phil said, when we look at the map of kind of where poverty is, those are the same places you see HIV and hepatitis C. And all of that impacts kind of healthcare and so, I think this day has really been about looking in different areas. And it's going to take really a multi-component approach. It's gonna take clinical providers to do their part, but it's gonna take public health and community agencies, and really all of us to work together and think about some of these other areas. In terms of housing, in terms of transportation as well, to really kind of attack this issue. >> My answer is a little short and sweet, Basically I feel that, we need to know that race and poverty go hand and hand, is what we need to know. And, with regards to who is more likely to experience it, and that health is not merely the absence of disease. And that it includes a person's mental environmental, spiritual, social, and emotional standpoints. So when we are caring for people, we need to be more applying of a holistic approach to the needs of people. Because people are showing up with various parts of themselves that are broken, that need to be fixed. And that health is not nearly the essence of them having high blood pressure, or simply them having a chronic condition such as HIV. It could be the fact that they have homelessness, or that they have joblessness. And so we need to show up as providers with a holistic mind frame, to be able to provide care for these people, so that we can make sure that we´re meeting their needs. >> Wow, [LAUGH] you guys, I feel everything you just said. I think that the only thing that I can add is that there's young African American MSM. There's stigma in their community, not wanting to tell family or friends, or their church members that they are gay, or questioning, or questioning their gender. And I hope that we can reach out and improve that, and somehow help these young men to feel empowered. Or to find someone to trust and to feel that their sexual health is actually also part of health. And that there are things they can do to protect themselves. And it doesn't become just an act they do, when they're frustrated or they, you know, or are leading home. And so I just, I really, in terms of prep, I just hope that in addition to granting HIV, we can just empower people who are vulnerable to be responsible for his actual health, and also know that we're not judging you. [LAUGH] For having sex. We want to tell you how to protect yourself. Awesome. I just want to add to that really quickly as far as intertionality is concerned. Just acknowledging the strengths and assets that our communities have, right? We've been talking about deficits for quite a minute now, but just acknowledging the power to exist is huge, and the bravery to exist. The fact that we're not only talking about focusing on race, gender, sexuality. We're talking about mothers, we're talking about sons, we're talking about folks who may love sports, we're talking about all these multi-dynamic people, right. Just really acknowledging that resilience and strength, that people bring to the table as well. So with that, we want to open up maybe to some questions, and then we'll get some final statements after our questions from the group. So any questions from the audience about what they've shared so far? Yeah. >> Okay. Thank you Ray. So, I'm Danielle Doreen. Many of you know that I run a HIV behavioral surveillance study in Baltimore. And what I, sort of, think of it as is a way to collect information that is hopefully helpful to people who are looking for information to advocate [COUGH] and the >> You want to speak up just a little bit. >> What's that? >> Speaking up just a little bit. >> Oh, sorry, yeah. So, essentially in the spirit of attempting to continue to ensure that we're collecting information that is useful and relevant for people who are doing work related to HIV. That what a couple of you mentioned about insurance and the sort of bouncing in and out was really strengthening to me. As currently, I know that we justice, actually ask people if they have insurance, and what type of insurance, and then we're able to report public/private and we're able to look at that over time. It sounds like that's not quite precise enough, and that maybe we should be thinking about something about the longevity or that bouncing. Is that something you would recommend, or are there things that would be more helpful to have information around in regards to people's insurance coverage that would be worthwhile? >> Yeah, I just want to point out that with insurance, it just depends on if you're working, then you have private insurance. And most of the folks that we're servicing are unemployed and so they're going to fall in the Mecaid category, right? And so a part of my job, with regards to the transgender community, is to remove barriers, and help to find those organizations who are out doing the work, enrolling folks in healthcare, insurance, and in medical insurance. Because you need it in order to even see a provider, or see even Excel services at the University of Maryland School of Medicine. So, I would say that it's a two-fold situation, but more importantly, it's just finding the organizations who are already doing the work. With regards to pointing people in the right direction, so that they won't have any barriers when it does come time for them to have to get insurance. Whether if it's through Obamacare or through private insurance. Yes. Sorry. >> Response to the question. >> I was just gonna say Danielle, one thing that might be interesting just in terms of how stable their insurance situation was over the year. Because I know we run into the same situation, like a lot of times we're prescribing the three month course of treatment, but somebody's insurance Medicaid is gonna lapse during it. And making sure that they're not going to have a gap, and we're going to run out of medication, and not be able to get them approval for a whole treatment course. And we do have a case manager that works with folks on that, but I've kind of run into the same thing. That it does seem that several people have to kind of renew, or submit additional paperwork or kind of things. And so it depends on if, also how you're accessing it too. If you're accessing it through the Department of Social Services, I think that those are the cases where, if that case is being handled by a case manager, for instance, through the Department of Social Services. And for instance, the individual has not gone back to the Department of Social Services and turned in work forms, or bank statements, or whatever it is that they are requiring to reinstate them in the health insurance, that that could be a barrier too. So it just depends on, in what capacity the individual is accessing systems to gain health insurance, either if it's through the marketplace, which is the Maryland Healthcare Access, or through the Department of Social Services. And typically, the Department of Social Services has a little bit more constraints on how they re-enroll people and how they check in. It could be once every six months, once every three months. And so that's just something to figure out. You had a question to that? >> So I know that there's been a lot of turbulence as far as emphasis has gone on with Obamacare. And basically, I think my understanding is, they're telling people not to go to social services anymore for insurance. >> No. >> They're telling them to do it on the Marketplace, like you said, is a challenge, if they don't have a computer. And quite often a person may tell you, I have medical assistance, not knowing that it's been turned off until they go to get their prescriptions. Also my understanding is there was some kind of big drop, because we had quite a few people that had lost their insurance. Like we said, for no apparent reason. Or people that have applied for insurance through the marketplace, and for three months were not insured, until we called and called and got a supervisor that found some glitch in the system. So there's a lot there. >> Okay, I appreciate that. >> There's a major need for health literacy with the insurance. You can't just sign people up for insurance. They need to actually know how to use the card once they get the card, and they have to understand that their re-determination dates set in place for the time period from whence you got your insurance, until you allow me to re-determine if your'e eligible to maintain it. And you can't wait until the last minute, otherwise you guys experience writing a three month prescription, and their insurance terminates within a month of your prescription being written. And so, all of our agencies need to make certain that we have someone in place that can actually begin to instruct them and teach them. And if your agency can't afford to have someone in place, the Maryland Womens' Coalition for Healthcare Reform, you can go online. It is a free organization to sign onto. There is literacy there for you to watch the webinars and to actually begin to really understand your insurance and where to file a complaint. There is a consumer complaint board in place for our consumers, and they need to actually be on that board so that they can be a part of it. And especially, there's great advocacy for the HIV Community. >> So I wanna repeat, at the Maryland Women's Coalition for Health Care Reform. >> Yes. >> Okay. Thank you. Great, other questions? Yeah? >> Thanks for a good panel discussion there. My question comes [COUGH] to when it comes to high risk negatives. So if we have a lot of resources from hospices. But when it comes to high risk negatives, we find that there are no So can you talk about, can you discuss about the access to them cuz sometimes a person has to be positive to access housing, to access insurance or different things that they get going through. But how can provide resources so people who are negative, stay negative and still access things like case management, they have access to whatever needs that they have in life? >> So that's exactly what this big grant is gonna do in Baltimore city and it speaks exactly to that. And the PrEP navigators are going to function to connect them with resources, and they're well-trained. If you're a social worker in a HIV department, you know how to resource, get everything resourced in the community. So housing, transportation, food. So I think they're going to benefit when we find them and bring them into our safety net. They're going to benefit from all the already established lifelines that we have. And then, really, the number one thing is sexual health counseling, like I said, health education, building up their self esteem that they can make choices about how they have sex and who they have sex with and how to protect themselves. And then if they're eligible for PrEP, then starting PrEP and keeping them engaged and they're gonna need every three month appointments and so, we're going to be in constant contact with them. At Chase Brexton, we have different grants and funds that can give you bus tokens for transportation. We have funds that can be for medication if you can't afford it. We have sexual health clinic for community members that does cost something, but the health department, has free STD testing, and that's a great service as well. So I think that's what I would say to that. A lot of work to do. >> Can I just say a couple questions to that? So I'm with [INAUDIBLE] and I thank you all other things that we have. This concern of folks who are not accessing care, like who are not health seeking. So how do we reach out to kids who are not thinking that, I don't need to be seeing a doctor? So how are we gonna reach the people who are most vulnerable, and not for the right and disregard they really exists? >> So we're trying to expand our marketing campaign and we're actually looking at apps, dating apps and on websites. We're gonna go into clubs in DC and Baltimore. We're going to partner with other community members, Aids Action Baltimore, and tag to just non-healthcare related venues, to go out and see the people that we're speaking of. We're going to have a mobile HIV testing van soon, and we're gonna, maybe 8 months away, but we're gonna literally go out into the community to find them. Cuz that is the number one problem, is you're right, they're not gonna come to us. They don't even, you're completely correct. So it's a big challenge. But I do think that the grant dollars are gonna support this effort. >> Usually, to add to that, in the youth and young adult population, it's a word of mouth. >> Yeah. >> So it's very much of a buddy system. And so at the STAR TRACK health program, it's an adolescent clinic, essentially is where it's housed out of, and so it's already a free clinic with Title Ten funding. And so we're already doing free STD screenings, free HIV screenings, we do family planning, we have tons of condoms, we have tons of health literature. We're very youth and young adult friendly, especially with our approach to the way that we provide care to this population. So I wanna say it's usually an Each One Teach One situation, when it comes to youth and young adults. And when they find out that there is this cool, hip place that they can go and get care that is non-biased and non-judgemental, then they'll tell their homeboys or they'll tell their homegirls and they'll be all coming to access those services. >> One more thing. I do believe there's a study coming up, or it's already going underway, where the word of mouth is actually sort of is being studied and there's going to be like a, what's the technical word for that, the snowball? >> Snowball. >> Yeah, so the snowballing effect. And so we're looking at exactly that because she's correct, that's how it happens. >> I would say, so my work is a little bit different, but I focus on one part testing and linkage, and so on that side, we're trying to focus on kind of non-traditional settings. But one place where a lot of people, even if they aren't engaged in medical care, continuous medical care, that are seen in the emergency department at some point for something. And so our emergency department's actively been screening for both HIV and hepatitis C, and we're working on kind of linkage secure mechanism there. On the clinical side, in terms of treating hep C, now that we have potential for cure, there's also this risk of reinfection risk with people who have ongoing kind of risk factors that may be high risk. And so I think in that aspect, then we've got to work to build ways to keep people kind of engaged, even post-cure. If they don't necessarily need clinical follow-up, but how do we follow up with them in other ways to make sure that they don't have this ongoing reinfection risk? >> All right, let's get in one more question. >> Yeah. >> I wanted to ask, as far as like HBCU campuses with the youth, is that going to be weaved in as well as far as PrEP is concerned? What do they have on campus and how we're involved in the process of PrEP? >> So I know that STAR TRACK has a huge HBC presence. And I'm not here today to speak on our PrEP roll-out, but Michael can chat about that. >> Yeah, okay. >> [LAUGH] >> Yeah, so STAR TRACK has had some presence on Coppin and Morgan's campus with the Rise program that we've been doing. So they've been writing inter scripts for our Every Day program which is about sort of racism, homophobia, and trans-phobia and how that can create uncertain risk for young black MSM. And so actually one of our colleagues, Cody, is in the back too, he's gonna be on your next panel, he's actually doing some work closely with Morgan State around issues. And so he'll be really intrical to that on Morgan State's Campus and some folks doing the same with that. >> Is it Bowie? >> Bowie? So they're out, they're not in our space, so actually, no. But Bowie is a place we need to be doing more, 100%. You're absolutely right, yeah. Yep. All right, last, last one cuz I saw your hand before. Yeah? >> Can you talk a little bit about what it means to be PrEP eligible in the context of refraining risk and what it means to be at risk for HIV? How all folks can have access to PrEP regardless of risk? >> I know by even just saying, high risk negative, that there's sort of judgment implied in that term, but it's just sort of the words that are used in the research world. So meaning, who says someone's high risk? It's a very personal term to use for yourself. So we, by no means, do not give PrEP to people who come and ask for it. So anyone who comes in, whether you’re a serious courting couple, your partner’s positive, you’re negative, a negative woman who wants to get pregnant and their partner’s positive, heterosexual woman who just had multiple partners. We are very much aware of the need to expand to anyone who is having condomless sex, not using needles for IV drug use, that's pretty much it. But what you're finding from the CDC and the top down is of course gonna be targeting the most vulnerable populations. And so that's why there's the guidelines from the CDC have focused on the IDU and MSM transwomen. It was a good question but I do think when you're in the PrEP community, you do realize that it's really up to the patient to define what their high-risk is. >> There's no eligibility elements that we need to be concerned with? >> No, if you're safe enough to take the medication. >> [COUGH] >> You can come for the appointments. And you eventually do take the medication, you don't not take it, then it's a risk benefit discussion. I just had a heterosexual woman who actually has one male partner, but she's suspicious of something. And that's all I need to know. >> And correct me if I am wrong, but there is like a checklist also that providers use to see if you're someone who is qualified to be on PrEP or not, and that's someone who has multiple STDs or multiple sex partners, so. You don't have to be in the LGBT community to access PrEP. You can be from the heterosexual community to access PrEP as well. So say for instance, if you did sex work and you are heterosexual, you'll be someone who'll be perfectly eligible to be put on PrEP. Just based upon your sexual risk factors. It's really based upon sexual risk factors. And how much of a risk you are of acquiring HIV. >> Luckily, we don't have Medicaid telling us to eligibility requirements for prescribing Harvonis. So it's a really a per patient and provider decision. >> Great, any last statements from the panelists just about any last things you wanna share about the work you're doing and anything, or? I just want to say, it still happens and it breaks my heart that I have new HIV 23 year old African-American MSNs coming in with a new HIV diagnosis and they see a pamphlet for PrEP on the wall, and they say that they wish they had known about it. And so, that's what keeps me motivated to spread this word as much as possible, because it works up to 99% of the time, if you follow the program and take the medication. So I'm very passionate about it, and I'm so glad that finally Baltimore City is getting the attention of the government, and that we are really gonna be able to make a difference. >> As someone who is passionate about vulnerable populations, more specifically, youth and young adults and the transgender population, I just want to implore and encourage each and every one of you to see where you stand with regards to people's gender identities and how your level of comfort is with it. And how you can then go back to your own organizations and do better work around the acceptability of people who are transgender and or gender non-conforming individuals. >> I have to say either we have a lot of work to do and a lot of education around Hep-C, that needs to happen, we're trying to do a lot here, and I just ask you you to help us get the word out. One of the things we're doing is we're training primary care providers across the city that treat Hep-C. So Chase is a part of that program, the Baltimore City Health Department, some of the Johns Hopkins Community Physicians, and a couple other, Total Healthcare is also part of that. So hopefully that will help increase our workforce. Here, we've also expanded our practice to have more providers. We’re opening walk-in hours at our specialty clinic in 2016, because I think we also have to make it patient-friendly and make it a place that kind of fits patients’ lives as well. >> Okay, I thank you each for being on our panel. Can you give them a round of applause? >> [APPLAUSE] >> Good afternoon, everybody. >> Good afternoon. >> Let me try it again. Good afternoon, everybody. >> Good afternoon. >> It is first a pleasure to be here with you this afternoon. I want to thank Carlton, Aaron, Jordan, David Holtgrave for putting together this wonderful opportunity to talk about the challenges in access to care, access to services, based on various inequalities that are out there, and being very up front in talking about it. My name is Cyd Lacanienta, and I’m the president and CEO of InterGroup Services. We provide an awful lot of project management and research support for a number of agencies and government agencies and universities. In my other hats, I’ve provided technical support as Maryland AIDSWatch Coordinator for the National AIDSWatch to train advocates on talking to your legislators on Capitol Hill about what the needs are for people living with HIV, what the needs are for research, what the needs are for additional resources to communities hardest hit. So it is my pleasure to facilitate and moderate this next panel, because what we have here are talented individuals who wear so many different hats as part of just what they do every day. But what they do so well is they clearly articulate strong perspectives based on what they have seen has been the impact of HIV in their part of the world. So it is my pleasure to ask each one of them to introduce themselves. I will start with Bill Palmer. And most of these panelists I have known, and Cody, I have tracked you. >> [LAUGH] >> Based on what Cody is saying. >> [LAUGH] >> [LAUGH] >> [LAUGH] So I'm really, very excited. Bill, would you like to introduce yourself? >> Yeah, I suppose I should use this. My name is Bill Reddenpalmer. I've been in Baltimore for about 20 years now and working in the HIV community, LGBT community, and I do a lot of work in the faith community, interfaith work. And I have done a lot of work in prevention education as well as HIV-AIDS research in a number of areas. So I have many, many hats on as Cyd says, trying to keep them all sorted gets a little complicated but it's important and it's meaningful work. >> Carlton? >> Hi, my name is Carlton Smith. I will start off saying that I've been very much active in the community. Almost as long as Bill or even longer. >> Longer. >> [LAUGH] We've know each other quite some years. We have criss-crossed in doing some work. I'm more of a activist, a entrepreneur, a business person, [LAUGH] and a straight up advocate. I've been living with HIV almost for 30 years. I am very greatly passionate in the work that I do in the community. I've also served currently as the Vice Chair of the Greater Baltimore HIV Planning Council, and I wear one hat with a lot of jewels in it, so that's how I answer that. >> [LAUGH] >> [LAUGH] I don't wear too many hats. I have a lot of jewels in my hat. So I've always been called the rainbow king, so I'm grateful for that. Thank you. >> [LAUGH] Shontae? >> Good afternoon, everyone. My name is Shontae Springs. Wearing different hats is a understatement for me. I was diagnosed with HIV about five years ago. My day job, [LAUGH] that's one of the hats, is I'm an Assistant Vice President for Credit Operations of branch and Citibank. In addition to that, I'm an advocate for HIV as well. I work also with the planning council, and just have been what I consider that magic middle and everyone here has pretty much heard me talk about that. And the magic middle is I'm that population that, I'm heterosexual, when I was diagnosed five years ago, I was married. I didn't kinda fit in all of the categories that we kind of talked about earlier. I was just simply been a wife, so where do I go for care? I don't make quite enough [LAUGH] to just pay for it outright, even though I love Citibank. And at the same token, I don't really qualify for the low-income programs. So I represent corporate America, and then those that are living with HIV positive, but then also yet being productive. That's who I am. >> Thank you. >> Hello, everybody. My name is Coronado Cody Lopez Dyer and my primary job is at the University of Maryland STAR TRACK, where I'm a health navigator. And my second position is at Morgan State University as a program facilitator for the RAPP, the Real AIDS Prevention Project and I also sit on several community advisory boards as a youth member or youth co-chair. >> Thank you very much. Now, my first question to all four of you has to do with research. As you know, this is bringing a lot of researchers here to talk about the most vulnerable communities. And you provide a valuable perspective. You have researchers before you. As advocates, and based on what you have seen, the communities you have served, the planners you have talked to, what are the most pressing issues that you would like researchers to focus their intellectual power within the next few years? Oop, Cody's. >> All right. >> Picking it up. [LAUGH] >> As someone who identifies with MSM, I think some research needs to go into MSM who don't identify as gay or bisexual or who don't engage in the ballroom community. I'm one of those individuals. I necessarily don't engage in the ballroom scene. So I'm missing a lot of those messages and I know there are several men who identify as bisexual who necessarily don't fit in those cases. There are men who identify as straight who don't fit into those spaces, but are still having sex with men. And I think there needs to be some targeted research in how you engage a population that is attempting to be invisible because they still need the messaging. And how do we convey messages to black men in general to de-stigmatize HIV? I think as we continue to talk about HIV as a gay man's disease in most of these gay identified places, we're perpetuating stigma. So when we go out into the community and try to talk to young black men in general, it's, oh, if I talk to that person now, I'm either having sex with men or I have to bring down my masculinity or my manhood and that's not the case. This is men who have sex. I think that that should be researched, not men who just have sex with men. Because we are missing the men who are also having sex with women. So I think that's where research should. Keep it going. >> I'll just go in order. I would just like to say, I would prefer research to go to that category I mentioned before, that magic middle, where when necessarily not consider gay but we're just normal average people. I know we talked earlier about how it is negative but anyone in here living with HIV and we talk about the stigmatism that's associated with it. I used to think that when you can change the face of HIV because, as clearly, we've seen that I have HIV, but I don't think changing the face really does the job at this point. Because when you change the face we discredit those individuals that started in this race. I think what we need to do is add more faces to it. And I think as we continue to show the community that there could be different faces, there could be someone that's homosexual, heterosexual, there could be a pastor, there can actually be a professional, there could be a entrepreneur but still have HIV and guess what? It's not a bad thing. I thought my life was gonna end when I found out I had HIV but to be honest, my life just begun and I'm living life to the fullest. That's what I think we need to target. >> So, I'm in the age group, as I call seasoned men, mature men, the men over 50. [LAUGH] I'm hoping, too, that researchers will do more of behavioral. So now I've lived in the rightful age of being 50, when I was told in my 20s I may not see 30. Different dynamic, different times then. Yes, kudos to treatment and medicine getting us there but you know what? I go out and drink sometime. Why don't you stay there. Sometime I miss my friends. Sometime I feel all alone. Oh is that battle discretion? I just answered. It's not only myself, but many other men. There are many other people who are in the aging. I've lost my friends, lost guilt, I don't go out and meet people like I used to, how do I get involved? It's just not only men, but women are going through this as well. Where do we talk about it? Are there certain places for us? So what are other disparities that also haunt? You have diabetes. You have heart condition. There are so many things as you progress in aging. Glad to make it to the top of the hill, but now how do I continue to live life and all the other cumulabilities and all the other things that may be going on as you age. So that's something for researchers to think about. >> So guys, should also to articulated this will be my 21st year living with HIV and AIDS so I had AIDS diagnosis. I started out with 151 T-cells almost immediately after I was injected. So that was a challenging route. And one of the things is, for someone like me, I've been on just about every regimen there is to be on. And that is a challenge because whenever you hear anybody, whether they do researchers, doctors, or the media, they talk about HIV from the perspective of someone who has been infected in the last couple of years. And that is a very different picture than people who've been infected for 10 or 20 or 30 years, who are dealing with all of the things that these medications and disease have wrought upon their bodies at that time. And then they started reaching age. So then it's like, is it the disease? Is it AIDS? Is it both? But up until now most of everything, the fact that I have kidney failure, I pretty much know is related to the Truvada I was taking. And those kind of things. Now it's getting a little less clear. So it's important that we continue to have novel classes of medication and that we have novel treatments for those people because eventually the people who are newly infected are gonna get down to the point where they're going to need those. But some of us are day to day like I don't have any regiments available to me. I'm praying that before this one wipes me out or I have to stop it for some reason because almost every regiment I've been on has been because the drugs became toxic. They put me in the hospital, they did something bad to me. So I'm hoping this regiment holds on long enough until they come up with some new drugs that aren't just a little variation or a new combination. Those are cute and nice and having one pill a day is okay. But that's not the first priority. It's having stuff that works effectively. I think if I had to pick something I guess that would be my first [INAUDIBLE] >> Thank you. Now, the earlier panelist, Dr. Gomez and Dr. Chalk, talked a lot about HIV inequity in Baltimore City and how specific neighborhoods are disproportionately impacted and how that overlays with race, that overlays with poverty. What have you seen in your travels as advocates, and what is your advice to systems planners such as Dr. Chalk, Dr. Gomez, on how to help those communities in need? So I live in the gay ghettos, y'all don't understand? Okay so let me break it down. >> [LAUGH] >> So I live in Mount Vernon, which used to be called the gay ghettos, but now it's a high rent district. I'll tell you what's the difference. Very very few people of color are in that district. Used to be a mixture of white and black men together. There isn't as much. Many of the, Things that used to be, the stores that used to be open in our neighborhood are no longer open due to other frontier individuals coming through. So I live right around just over the highway where East Chase Street is. So that's a whole different neighborhood, but the addicts, the crack addicts, the heroin addicts, are now venturing over on all but the other sex workers. So we get a mixture of at nighttime. You've got the club kids and you've got the sex workers, and people out with addictive behavior. So what can be done? More information about how to get whatever you need to work with you. Sometime we come to these institutions of knowledge and education and researchers speak over our heads, hello, but I'm here. How do you reach me, how do you talk to me and how to regain employment. Because, if I'm doing sex work maybe I can teach somebody else to save their life. Maybe I could teach them how to, definitely about, not only about conduct but I could tell them about prep. Because maybe I institute the prep. And maybe I could have that conversation and maybe that the young man that come on and meat rack, we don't throw them out. We don't chase them away. But invite them and tell them that somebody loves you and we gonna try to help you out and meet where you're at. Maybe we need to have programs that look and talk like us. I think that's where we can really have a real conversation and see the change. Once we learn how to have the awareness and the responsibility, then I think the change will come. >> [LAUGH] And I would just have to piggyback on what Carlton said, who's the best people that can talk about this? Us, because we live it every day and I think it's pretty much, when I come to Baltimore cuz I live outside of Baltimore. When I come to Baltimore, I can pretty much count on their being a convenient store or what we use to call a corner store and on every end of the street. I would like to see as many places in there as a porn store. Every place that we pretty much can see on every street, every street should have some community based program where we can talk to all facets of people living with HIV. Yes we have high-risk individuals, we may have incarcerated sex workers, we may have adolescents, but what about the people that live in housing What about the people that live in the upscale communities, where do they go? They may not be comfortable enough to go in what we may consider the ghetto, even though they may have been from the ghetto. But they may not be that comfortable going there. We need to create a safe house and a safe place for everyone in the community, whether you're a faith-based organization, or whether or not you're just a simple corporation. One of the things I did in my site in Hagerstown was last year I did one of the first AIDS conferences doing, which was it, World AIDS Day last year. Because I wanted to bring HIV into the organizational city bank, and you will be surprised how many vice presidents came to me afterwards. How many people sent me an email afterwards wanting to know where can I get this information? I don't feel comfortable going to the health department, but I think I'm at risk. No one should feel that way. People should know that even for instance, I was a wife at the time when I found out I was diagnosed. Had I known PrEP was out there, I had some questions here and there about my husband at the time. Had I known that was even available at that time, it's okay for somebody married to take that if they feel as if though that's an option. I feel as though those are the conversations and the places that we need to engage those conversations, to make people of every nature and every facet aware, then we can change the community. >> I think mine pertains to young people. I think two of the systems that we need to address are the higher education system and the housing system. The higher education system will lock you out of that system, we are under 24 if you don't have your parents' information. And we know for a fact that LGBT young people face homelessness at a way disproportionate rate than other young people. So they may not have access to their parents' tax information to fill out that FAFSA to get that student loan. So until they're 24, they're out on the streets doing what they have to do to survive. And I was reading an article in the paper where it's cheaper to buy in Baltimore than it is to rent. And that is doing a huge disservice to young people who work extremely hard to not have a place to stay. To have to live in a one bedroom apartment with six other people just to survive, because your job is only gonna give you 15 hours this week cuz it's getting cold outside, people not coming spending money to eat, like they usually are in the summertime. So these are things we all should look at, we should look at the inequality in the housing system, the private landlords and the public who are charging astronomical prices to rent rooms to young people in unsafe conditions because they just had nowhere else to go. So those are the two systems I think we should address for young people in general. To just have better outcomes in their life, because as of right now I believe it's one in three gay men will have HIV in the next few years, by 2020 or 2030. If we had someplace to live, and didn't have to get on Jack and Adam to have a warm place to sleep. Cuz I know some folks who do that, they don't have a place to sleep, so they will sell themselves just to have a place to sleep, to shower, and then go right back on the streets and do it the next day. So addressing those two situations, the education system, which would give you a place to live and eat while you're getting your degree, and just that housing system in general. We can provide the foundation for stability for a lot of young people that they don't have. >> The only other thing I had is that thinking about how we address transportation in the city. There are areas of the city that really just are inaccessible. I know that just to get to Hopkins from my house, and I live in West Baltimore, I mean East Baltimore, sorry, it takes at least two buses to get here, and a lot of time. So those access to the resources that are out there is not always good. And at some point hopefully have an entree to access when the services are actually available. >> It was a great segue to my next question. The afternoon panelists talked about poverty and HIV and health care access linkage and progress from an advocate's perspective. I'm sure each one of you have your own ideas of what has worked based on what you've seen, and what continues to be a challenge for consumers accessing care, consumers trying to engage in discussions about HIV. Challenges related to getting tested, or whether they're too scared because of the stigma that they perceive. So if you don't mind, share with us a little bit about what you know and what you've seen. >> All right, so I'm gonna address the cascade. You know that we have several people falling out of care. But providers and advocate for people all the time, if you don't feel comfortable with your provider, switch providers. But if you have insurance and go to Hopkins you cannot just say, I don't like this provider, I'm gonna go to University of Maryland. They do not accept the same insurance. You will actually be locked out of that system for an entire year until open enrollment becomes available again. So if you're not liking your doctor, you're not liking the tone of the institution that you're going to, and I'm not pitting Hopkins versus Maryland and Maryland versus Hopkins, I think that they should come together collectively and figure a way around this insurance mess, cuz that's what it is. How can we get people the care that they want and that they feel they deserve regardless of providing how that system is treating me. I just can't go to somewhere else, so as a young person, they might just say f it, I'm just not gonna go. And then you come back a year later they are viral load, they shot up, and they become infectious where they were suppressed, at one point, but because they don't like how the provider spoke to them, or they don't like the front desk staff, or they just don't like the policies that are in place here. They feel locked in that system, and no one should be forced to go to a provider because you can't get out of your insurance. >> I guess I'll take a different spin on that. You were talking about adolescence, I wanna talk about from our perspective. I honestly have private insurance, but as I mentioned before, I stand that risk of one time going through divorce I had two children in college. And the only way I could survive once my little bit of alimony ran out was I had to put myself through college so I can really depend on my refund checks to have extra income. Everyone may not be I guess in a place or position to even think that way, so I can only imagine what some people end up resorting to, because there's been certain times that I had to deal with whether or not I could even afford the copay that goes with my insurance. Can I afford, now since I had the insurance that pays my once a doctor visit, now I have to go back to LabCorp to get blood work again in three months. Oh my gosh, I have a bill with them for $50. Do I pay the $50 bill to get my lab work so I can make sure I'm still good, or do I pay my electric bill? Oh my God, my son needs something in school right now, so as a result, I didn't think it, to be honest, three times. Because I had to decide whether or not it was my health, or do I wanna continue with my way of living? And I think no one should really have to deal with that. And so I think that's somewhere where we need to kinda, as we say this conference as a symposium, is bridge the gap. I should not be in a position where I have insurance and yet I can't qualify for everything because it's a private insurance. And thank God, I was at AIDS Watch one year, and these great people here mentioned to me about MadApp. I didn't even know what MadApp was, but that's something that should have been put up to me in the forefront, that may have prevented me from maybe getting evicted. Or may have prevented me from sometimes my viral load not being good, because I just stopped taking medicine or stopped going to my doctor's care because I had to set off with my children. These things should be at the forefront for every one to know whenever you go to your first initial doctor's visit. These are the programs that are available, so. >> Go ahead. >> So, it is my business as being the vice chair of this great planning council to tell you the resources that are out there. That's what I advocate on. I advocate for everyone living with HIV and AIDS, because I am a person living with HIV. I go through the same thing, it's not pretty. I just wear a mask, and I wear it well. Well what do you mean? There have been days when I've been without food. There's been days when I had to choose between my medicine and my food, and if I'm going to eat this weekend. Or scheduling, or as we said, we put food here, you hoard food, it's a reality. And it's just not me, there's many others who may not be able to talk about that. It's another of not being able to say that you live in the Section 8 housing and you are able to afford it based on what you receive once a month at a SSI or SSDI. It is my business to get out to other people living with HIV to tell them where are the resources. To have a planning committee like the PLWHA to raise your voice, to save from the streets up to make the agenda. These are some of the action items we need. We need providers to know this. I can't pay my insurance, there's a gap, it's a reality. I changed jobs, I'm trying to make ends meet, it's a reality. I have daughters, sons I got to get to school, it's a reality. Now I got marriage equality, my husband just got laid off, it's a reality. Or my significant other has just been laid off. Or I have child care and I have nowhere to put her, my child, man or woman. So these are some of the reasons why it is so important. Not to hoard your resources, but to share it. For a so-called me, by the grace of God. >> Amen. >> And as Tom has mentioned, we've just now noticed the food banks are taking an increase. Why, food deserts. People are hungry, people are not able, let's be real. Let's have a real conversation. Whatever DSS is giving you, $16 for a single person isn't enough to stretch you, for even a day. Now, imagine you don't have a grocery store, so where are you gonna get your fresh fruit? And you know you need to eat. Because it's a terrible thing to have your mind wandering and your stomach growling, or as we say, your stomach pressing against your backbone. When you know you're hungry and you can't concentrate. And, God knows, look at the pills I'm taking. Thank God, they're lower than what they used to be 20, 30 years ago. But still, HIV is a managed chronic disease, not for everyone. There are individuals who has great side effects, who needs care, and let's talk about vulnerabilities. If you're a diabetic, if you're not eating properly, guess what? You're not taking care, you start missing rents. You have high blood pressure, you're not thinking clearly. Your pressure's always up, you're always tense. So these are the things as a person living with HIV, not only myself, but others also go over that, and especially when you're aging. Because it's not turning back the clock, the clock is going forward. So what is it like for me at 52? What is it like for me at 62? What is it like for me 72? Am I going to have affordable housing? Am I know I'm going to have food, just in caring for myself, or even for my family? So these are the things why it's important for people like yourselves and people who are living with HIV and AIDS to be involved. It starts with for planning counsel, it starts with other planning bodies, because your lives do matter. >> Sometimes after 20 years, it gets a little old having the same conversation over and over and over again about certain things. [LAUGH] Some of you know this. So, here's one of the things that really bugs the crap out of me because we've been saying this for a really long time. Whether you're a researcher, or you're a medical professional, I'll give you an example. My partner is a school teacher, and hears all the time, it's all about the kids. You have to sacrifice your personal time, and your stuff, and your money, and whatever you got over to take care of those kids. Unfortunately, that does not transfer in my opinion to the healthcare profession. It is not all about the patients. Sorry, but it's not. Because if it were and if it were researches were all about the patients, there would be doctor's hours and times when patients who have a real job can actually show up without taking time off of work, okay? Let's be real. So my spouse is a excellent school teacher, has a Masters Degree in Education, and works as a Junior Administrator, practically, when there is not a real administrator, they say where is he cuz he knows everything. But guess what? He is not capable of ever being rated as a highly effective teacher because of the number of doctor's appointments at a minimum he has to take off for during the year. And they have told him, I'm sorry. No matter how good you are, you can be the best teacher in the world, you will never be rated as highly effective, because you take off too many days. Because you have to go to all of those doctors appointments. And the doctors refuse to have appointments, and the few that do, he's got one that will do it and will see him. The problem is, that the staff that runs the front desk refuses to create scheduling that allows even one person to stay late enough to check the people in and out. So what happens is, is that he gets submitted to have a new appointment. That appointment never gets made. So he shows up for the appointment the doctor told him to come to, and they say oh, you don't have an appointment, you have to go home and call and try to get something rescheduled. Over and over and over. Even when the doctor went to the front desk staff and said please tell us what we need to do. The supervisor said, well, there's a bin, you leave it in that bin. So the next visit, they walked up to the front desk and said where's the bin, can you please tell us? And the woman said oh no, there's no bin. I never told you that. So that kind of behavior where this administrative staff treats patients with disrespect and we could go on about that all day, those kind of behaviors that happen. And when they refuse to accommodate patients, even when doctors are willing to try. How can you say that the patient's come first? Not one of you can do that. And that is a real problem. Because I cannot go out and get a job. I have so many different specialists and doctor appointments I have to do during the year, that if I were to take off all those days from a job, nobody's gonna hire me. Let alone, that I need flexible hours and I maybe need to take a nap once in awhile and all these other things that I got going on. >> [LAUGH] >> Would just to keep up with my disease, so most employers are like, hm, you want what? >> [LAUGH] >> Sure, I can get a job at retail, standing for hours on end, and then I end up getting sick, and I'm worn out, and they fire me. So, nothing in this system, and researchers. I have gone to research facilities and I've said over, and over, you want to recruit patients, go and create some hours that you can have that bring in. Then they say, well the lab's not open, and this happening over, and there's always, always excuses. >> But it's because the medical systems refuse to even think about serving the patient first. I'll shut up for now. >> We've been given our five minute warning. So I wanted an opportunity to see whether anyone had any questions for the panel. So I saved my best question for last. Rashad talked today about cultural presence versus cultural power. As advocates, I have seen each and every one of your work. And your power to change the perspective of those who you talk to. Tell us how you can empower this group to take cultural power so that the message can come across effectively. And the needs of people living with HIV and those vulnerable to HIV can be met. >> I'm gonna share my message and my message goes directly to young gay black men who are positive who get in this field. When I first got into this field, I started reading a book of young men's experiences. And one of the first stories I read was, a guy who got into the field, his organization pretty much used him. When he was 24 they kicked him out and said he is no longer the face of their organization because he has aged out. And my kind of way for young gay black men to gain their cultural power is to not be a face. No matter who wants to put you in front to represent for an organization, know that you still need to gain skills. And Make those skills be transferable. Don't just work in HIV, don't think that is the endgame. Think larger than that. Think larger than just being a young person doing recruitment and doing outreach. Because there are several other jobs that you can evolve and grow into. >> Thank you. >> I would say as you continue to have resources for individuals, if you first give someone a diagnosis that they're HIV positive, make sure you have effective communicators and counselors available, someone that's really passionate about it. And I say that because as I mentioned before, I thought it was a death sentence for me, but actually the more and more I go out and advocate, whether it’s someone that’s young, I’ve had someone from 19 up until 72 years old find out they was recently HIV positive. It’s the way you position it. And like I said, I thought this was the worst thing that could have happened to me, but now I'm on a train that just doesn't stop now. My children are educated. Every year, I try to learn something different that I didn't know to get before. Citibank still has me after 11 years. And I think people need to know that there's life after HIV, and it's not necessarily something bad. It's just something different. And as with anything else that's different, we just have to deal with it differently. But you still can live. And I think that if we put that little twist on it, and let people know that, hey, one out of every ten could have it, that's going to be our population one of these days if we don't get in front of it. How do we make people aware of it if we're afraid of it? So I think until we start, I guess really addressing, put a spin on it so it's not so much stigmatism, we can't really empower people. And I think the only way that we can really get to this is we empower those that are actually positive. >> So I like to use one of my favorite sayings. And it comes from Mahatma Gandhi and it says, create the change you want to see or you want to be in the world. And yes, I am my brother and sisters' keeper. Thank you. God bless you. And the reason that I say that, one of my outstanding things ever, was to be a part of the planning council, but well better yet to create a program that is now ongoing. And that's Project Leap. And I couldn't do that without the help of Cyd and. We were the first two PLWHA Co-chairs. But now Project Leap is going into their 19th class. It's a beautiful thing to be still on this earth to see your legacy still going on. >> Amen. >> And that it has enriched, empowered and led many people who didn't even have a voice. Who have never thought of themselves to be an advocate but they see what you're doing and say, I can be like him. Or, I can be like her. I can own that. I could be a leader, too. That's so much empowering to be able to go to your Congress people and say I'm a person living with HIV AIDS and I pay taxes. And guess what, you don't do what I say, guess what, I have the right to fire you by voting. Your first thing, community mobilization, get the vote out. Isn't that empowering? Isn't that that you can take charge of something that somebody had taught you. Somebody who's embedded that into you. So, that' s why I say create the change. Or you be that change, or even get back to Michael Jackson, Man In The Mirror. Be that change. That's what, each one of us, have had reflections of. Because as [INAUDIBLE] said you've got the power within you, you just have to expand. >> So, talk to two groups. One is if you're living with HIV and AIDS, you need to do what I was taught many years ago and which worked. Is that the primary characteristic of a long term survivor is to have a sense of mission and purpose. And you find that you can overcome. And you then need to use your voice at every opportunity you have finding the ways that people will listen because that is the most valuable thing. What we know, for example, when people come out publicly about being HIV positive, people around them say, oh you know what, I know that person. It's the same way with people that are gay or lesbian or trans, they come out and people say, hey, I have a real person like that. And then I'm like, maybe they're not so scary. Same goes for HIV. So you have a powerful gift to take what could be less than HIV. It's hard to see as a blessing, but you can make it one. And if you are a person who is working in an organization, in medical care, in research. If you truly believe that you want quality out of your organization, your research, or your medical care, then you will talk. And not just talk, to mostly listen to people living with disease. Once again, after 20 years, we're seeing the same old thing. Do not have them be a token at your table, so that I can say, oh yeah, I have that HIV consultant. That's not what I'm talking about. You really have to have those people, and really listen to what they're saying. And take it seriously, not immediately dismiss every, oh that's not doable, that's not doable, because that happens so often. Or, oh yeah, that's just them, and then let's move on. Every time I go in a room and there's 20 people who have all the greatest intentions about working in HIV work and not one of them is positive but me. It gets really challenging to say come on people, I love this but you're not even trying to hear my perspective and you're creating something that sounds so nice and fancy, but what is it doing for our community? And they don't think about that sometimes. You really have to have that connection and listen. >> Well thank you very much for sitting on this panel. I'd like to ask everybody to give them a round of applause. >> [APPLAUSE] >> I want to close this session because advocates, strong advocates are very good with telling this story. I don't know if you were here at lunch time, when Congressman Cummings' representative talked about those little handprints that were on Congressman Cummings' wall. I've been a community organizer for over 20 years and have had the pleasure of actually knowing the mothers and those babies from whom the hand prints came. And was there when those were provided to Congressman Cummings more than 20 years ago when there used to be AIDS babies who died by the age of two. Their life expectancy at the time was two years of age. I was also there, more recently, when Congressman Cummings was visited by a young lady who just went through graduate school. Hers was one of the hand prints that was on his wall. And I don't think I've ever seen Congressman Cummings's eyes tear up so much as this scene, because his previous stories were those were the babies who died. Because of the work and the research that has been done in this community, the baby with a life expectancy of two years has graduated and is working in the field with HIV. So thank you for all of the work that you've done. And all of the work that you continue to do. And I wish you the best of luck. And again, thank you Jordan for this opportunity. >> Thank you. >> [APPLAUSE] >> So it is about that time, everyone. I want to put a plug in for those of you who have a moment to please stay and speak with some of our Baltimore HIV-AIDS scholars, our young people who are undergraduate students, ask them to keep presenting some of their research in the room right in front of us and we're having a small reception. If there's one word that I would take from today it would have to be power. And it has been so, I feel so fortunate to be here at Hopkins where we can have the discussions and grow and learn in this way together. So, thank you guys for coming. We will be posting these videos to our website in the coming weeks and we'll send a blast out to you all. And we really do appreciate all of you coming out today to be supportive of this work. You being here allows us to continue to do this work and it really means so much to us. And so, thank you from the Center for AIDS Research, and also our community participatory advisory board. Thank you all >> [APPLAUSE] >> Thank you.

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