Men’s Health Foundation Podcast Episode 8 Transcript

World AIDS Day: How Far Have We Come?

David: We're back with the Men's Health Foundation Podcast. Today we're doing a really special episode on World AIDS Day, recognized annually every year on December 1st since 1988, making this the 36th year of honoring the lives of those affected by the HIV epidemic and raising awareness on HIV/AIDS. Today, we're really lucky to have two really important guests with us here.

Today we have our Senior Director of Public Programs, Rob Lester, as well as our Direct To Care Program manager, TJ Griffin. Thank you both so much for joining us.

Rob: Thank you for having us.

David: So I want to just get started by, you know, first of all, I'd love to just get a little introduction, with the two of you who work really closely with this aspect of our organization and really closely with this epidemic and your careers in public health. Just so listeners get a sense of who we have with us here today.

Rob: Sure. My name's Rob Lester. As I said before, I've been working in the HIV field in some capacity since 95. A lot of that was just, you know, volunteering for various different, being, you know, treating people with HIV, helping educate educators, you know, teachers about how to care for gay children or LGBTQ kids, students.

And then for about the past, 12 years, I've been here in Los Angeles working with a variety of different organizations. usually management programs that are designed to help people access health care or to engage in health care, peace management services, sort of a whole spectrum of supportive services. We have to assist people with, you know, staying engaged in care and, and addressing whatever barriers they may have.

David: So important. T.J., I'd love to ask a little introduction for you. I know you're a new member for us here at Men's Health Foundation. We're lucky to have you here.

T.J.: Thank you. Hi, everyone. My name is T.J. Griffin. my pronouns are he/him, they/them, or whatever, respectively. I am originally from Florida. I started my work here in the ESL community about 2018. My practicum was at the Florida Department of Health and the HIV/AIDS Minority Coordination. and kind of from there just took off. I went to grad school in Atlanta, at Clark Atlanta, and then I started working on my first AIDS service organization as a full time employee. From there, then I went to Houston and worked for more AIDS organizations there as well.

And now here I am at MHF doing the same thing.

David: So, what I want to start with talking about World AIDS Day. You know, taking it back to, you know, the beginning of World AIDS day in 1988 and just the experiences you both have had so far personally, professionally. What are some of your first or strongest memories of this event of World AIDS Day in the past?

Rob: I was thinking about World AIDS Day a little earlier today and my, I guess the memory I sort of went to isn't really one of World AIDS day. It's actually a pride march that I was, participated in in '95. This was in little Rock, Arkansas, where I was living at the time. We were marching around the state capital.

There was probably 50 of us maybe. Maybe a little more. We had, it wasn't, there wasn't a parade. There was no floats. There was no bands. There was no...it wasn't celebratory. This was '95. It was the height of the AIDS epidemic. 60,000 people would die of HIV that year. That was the highest, annual death toll ever.

And, you know, we were, we were marching. Arkansas State Police were there to protect us, which isn't really, which isn't really a feeling you usually got from police at that point in that place. And of course, the obligatory protesters who had their signs, and that was a really rough year for a lot of people in the community.

And, we made it through it. It was hard, but we made it through it. And as a result of what we went through, we as a community developed a lot of unity, a lot of resilience and a lot of, a lot of self-confidence and our ability to affect change meaningfully in a way that benefited members of the community.

And I look back over what we've done over the past, since 1980, but, you know, since 95, you know, 30 years, 21 years ago. And I'm just impressed and really amazed at the amount of work that has gone into addressing the epidemic. We're so far, we've come so far. You know, we had medications that...medications weren't even effective at that point.

And now we have, you know, we developed medications. Now we have a single pill a day, we have injectables. And, you know, the current research coming on the pipeline is just even better options for treatment. And so I was just I was thinking about, like, the context of, a larger context about how much we've done and how far we've come.

And, you know, what a bright future we have going forward.

David: Wow. Yeah. I mean, that really puts it in perspective, I think. And, you know, I want to just, you know, acknowledge, of course, you know, what the Men's Health Foundation and the work that we've done here, since we've been established and since, you know, the Southern California Men's Medical Group was established in 1999. Just to think how much has changed, maybe even in those couple of years. Yeah. You know, TJ, I'd like to ask you about, you know, some of your first memories or experiences with World AIDS Day or with this cause.

T.J.: Yeah. I don't think mine date as far back as Rob's, but, definitely starting early. One of my first memories was, well, after COVID, it's kind of when my career started, like it started during COVID, but it was during COVID. And so we were able to do the first AIDS walk that was in Atlanta at the time. And I remember like scouting for agencies, like which one I wanted to work at, and then coming to the AIDS walk, and I saw all of them there, and it kind of put in perspective to me, like Atlanta had a really a culture of kind of like competing when it came to like AIDS service organizations.

But coming together on that day just made me realize, like, we all have a similar goal. Like, I would see all these people that I've, I've worked with, that I've collaborated, that I've done different things with, people I've seen in meetings on Zoom, and now I see them in person. We're all kind of like enjoying this space, like advocating for the same things.

And it felt really good and safe to be in a space where I didn't have to explain, like, why I'm here. We have to explain like what this is, or how to come into a space and, and teach people all the time. We were able to just be and we're all under the common goal of like, we were wanting to move forward the needle and end of the epidemic, and it just felt really special to me.

And I think that World AIDS Day and all the other days that we celebrate, whether it is like a Women's Day or any of the other days that are geared toward this particular cause just makes me feel really special in those spaces, because it's like a one time that I can breathe and get that, okay, everybody else here gets it.

Marc: That makes sense. Speaking of like, community in Atlanta, and this question is for you too Rob, what, if any, were there like particular experiences or people in your lives that kind of drew you to this type of work? Because we do work at a health nonprofit that focuses on gay men and people living with HIV. So was there anything that drew you specifically to this type of work?

T.J.: Yes. So myself, obviously, me and my community, but really, it was my best friend up there at college who, we were kind of like Frick and Frack. We were the Doublemint Twins. We were just, like, always together. And then one day, I came home from school and he kind of just put a note on my, on my lap, and I opened it up and it was the HIV test, and it was reactive.

And prior to that, like, we would have conversations about it, but it just seemed so far removed from us. Like we were just, you know, just living our lives. I mean, I was obviously a lot more sexually active when he was. And so I was like very cognizant. But he was just kind of like quiet, small, like it, like just kind of like the yin to my yang[ME1] , just the opposite.

And for this to happen to him just changed our perspective on things in general. And it was like this ground shaking moment for our relationship because this is like, this is one thing that we don't have in common. This is one thing that like, I can be there for you, but I'm not sharing this entire experience with you.

And so he felt really isolated, felt really alone. And that kind of changed my perspective on my career about college. I changed my major and everything because I wanted to navigate my life, to dedicate and get to this work and from that day I was like, well, listen, we're going to figure out whatever this is that we have to get through together.

I may not have the same diagnosis as you, but like, I'm going to get on PrEP because if you're taking a build every day, I'm going to take a pill every day. If we're going to like, learn about this thing we're going to learn about this thing together. And so he has kind of always been like the ignition to my, to my drive in this space.

And I'm always reminded about him and other people who may not have those support systems, or may not know where to go because they don't always have a best friend, they don't always have a twin or somebody there that's going to pick up on that. And so I kind of wanted to be that for the community if I could.

Marc: Wow that's amazing! Thanks for sharing.

Rob: Like TJ, I have sort of a similar experience. I was, in the early 2000s, I was living in Dallas, Texas, and, I was 25 or so, and doing things that 25 year old gay men often do.

T.J.: Well, what is[ME2]  that? I'll leave it to the imagination. And around in that time period, or, say, a 5 or 6 year period, I saw a lot of people who really struggled with substance use, whether it's alcohol or drugs.

I saw people who seroconverted to be HIV positive. And there was just a remarkable lack of resources. And I know now, having worked in this field for quite a while, that there actually were resources available, but we just the public health department or the public health field and the AIDS service organizations in Dallas at the time did a remarkably poor job,

from my perspective as a young person, of letting us know that there were options, there were treatment options available, that, you know, you could access substance abuse treatment services. And I was able to sort of get out of that environment because I had a lot of help from my family. I was lucky I had, as for family, I had access to financial resources that allowed me to move when I needed to in a different place.

I was able to go back to school, you know, I had sort of ability to do that. and I saw a lot of people that didn't have that. And what struck me is fundamentally unfair was that your ability, people's ability to get out of that situation, to get sober, to get off drugs, to get HIV treatment, whatever, whatever they needed, had so much to do with the financial status of their family, rather than the amount of work they were willing to do, or whether they were a nice person, you know?

And, that kind of pissed me off. And, so, you know, I wound up going back to Arkansas, finished my undergraduate degree, wound up going out here to UCLA for master's school, for grad school. And, that experience of, like, seeing people not be able to get access to the services they need, especially knowing later on, the services were actually available, that really steered me into this field because I just, I felt like I could do, I could make a difference in helping people understand what their options were and getting access to care, getting engaged in care and overcoming just all the barriers that people face, taking care of themselves.

David: I want to take a second to, just ask a little bit about how that works at Men's Health Foundation, because, you know, of course, as you're describing this, I just want to, you know, bring that in, to let people know who are listening, just the ways that we can help with that.

Rob: Yeah. The Public Programs Department of Men's Health Foundation provides a range of support services to help people, you know, get health coverage, get engaged and care for PrEP, get healthcare coverage or prepare some special state programs for that. We provide case management services for patients living with HIV. We have an HIV/STI testing clinic, also does STI treatment.

So for people who are diagnosed positive or they have their initial reactive test, then, we can lead them to care with our MCC program, which is the case management services, for patients who have been in care and slipped out because of whatever, whatever barriers they face. We have the Data to Care program, which T.J. runs. So we have this sort of we built this, this, suite of services that really is able to help people in almost whatever phase they're in.

We have something they can, we can reach out to them, provide them help. And, you know, whatever their barriers are, help them understand what the barriers are, identify solutions of barriers, implement those solutions, or help them find somebody who can help them with that particular thing. And so, I'm very proud of the work we do here of, of having all that support for patients and also having the best medical care for people living with HIV and people in PrEP in the city.

T.J.: Absolutely. And we don't mind bragging at any moment in time I'm absolutely for that.

Rob: Truth is not bragging.

T.J.: Yeah I completely agree. I think that just recently in addressing things we have started to acknowledge the existence of social drivers or social determinants of health. And we've realized that that impact is a lot larger than we were giving it credit for. And so like he was saying that people are far too often not aware of the lack of accessibility for a number of different reasons. And so with us having the MCC program, having DTC, having AOM and having all the other services to allow people to have access to the great care that we offer here is just super beneficial because it allows them to kind of come into a warm hug of experiences and care when they come in, because it's not just like, okay, you have insurance, we're giving you pills and that's it.

No, it is like what is going on outside of this to ensure that this is not the determining factor of your life, that this is not the reason why you are not going to take care of other things, or that this isn't going to impact in ways it ultimately shouldn't if you didn't have those other determinants of socioeconomic status or family support.

David: You know, speaking of that, I think about, you know, for a lot of folks, through COVID in the past couple of years, they became more aware I think of public health in a different way, in a more in a way that maybe hadn't touch their lives as, as directly before. And acknowledging the difference here between like, a pandemic and an epidemic and the idea of HIV/AIDS, especially in the United States and, having a way of disproportionately impacting certain communities, I'd love to just talk a little bit about, you know, your own perspective of the factors that went into that.

And, you know, the some of those challenges and where those challenges came from, throughout this, throughout this epidemic, as far as, you know, the communities that are being impacted and, what was preventing them from getting care better, faster.

T.J.: Okay. Yeah. So this is like my jam because this is my life. This is my perspective. This is kind of my thing. because focusing on minority populations and just the most impacted is just so important to what's happening. And I think that I always use monkeypox as a parallel to HIV because the responses were so drastically different. We saw that when this first happened and the first cases were coming about, the response to that was to go into the communities of color, going to the communities of MSM, the MSM communities, and also include those of different identities into making sure that they had access to these things first, so they had access to things without barriers or pay or barriers of care or location.

And we made sure that we went to rural communities. We made sure that we partner with agencies that were already serving these communities like ourselves, so that they would have ease of access to getting vaccines for this and able to, you know, access care for these things. And we saw that response made a huge difference in how the spread of monkeypox was narrowed down very quickly and how we were able to kind of contain it.

And it became something so different than the response originally was for HIV. And then we saw that, you know, early on, things like the GRID and calling it the Gay-Related Immunodeficiency, like those things increased the stigma around HIV so much that it was able to be put under as not important because the population, the communities are not all queer.

We know that we're a minority. So we know that, okay, just a small subset of people that this can impact. And these are impacting the Four H's is what they called it. But people who are receiving blood transfusions, people who had Haitian or Haitian backgrounds, patient- people who were heroin users, and of course the homosexual community.

So with them thinking initially that these are the four only communities that can be impacted. These are people that are, you know, our society historically has cared a lot less about anyway. It's always easy for them to just ignore something until some of those first cases came along and they were like, oh my gosh, people who have vaginas or people who have heterosexual sex can also contract this.

People who are who may not be using heroin can also contract this. And now we realize that this is a threat to more people. So now we need to act. And I think that just really created such a difference in how this was able to invade these communities and invade populations and really, focus and center on, you know, the people who already had a lack of access to health care, that people who had a lack of access to education, the people who had a a lack of essentially everything, right, and then let this impact them to this degree to where but when it comes to affect the more affluent, we've already figured everything else out. And they have the first access to whatever remedies we can at the time even if that's ABT.

David: What's your take on that Rob, talking about your own perspectives and experiences seeing the way that HIV/AIDS has impacted certain communities and where those challenges, how those challenges have been developed.

Rob: Yeah I think TJ articulated very well sort of where we're at, what the epidemic looks like, it's been like, you know, for the past 5 or 10 years, I think back to the 80s, one of the things that sticks out to me was that there was such remarkable lack of support from so much in public health infrastructure. You know, we, the community definitely had some allies at the FDA and the CDC who were pushing.

But that's, you know, in America, so much of the public health work we do is on a state or local level. And so having those, you know, important, the few allies of the federal government wasn't able to address, you know, an epidemic as widespread as HIV was. But the gay community, the LGBTQ community, we were able to respond in a way that addressed a lot of that.

We could never replicate sort of the, you know, larger health care systems of the United States, but, you know, gay men, lesbians, trans people, you know, we came together, we came out, we supported each other, we built Gay Men's Health Crisis, we built AHF, we built, you know, amfAR. We built one organization after another, you know, and those organizations are much different now. But, you know, back in the beginning, these were, you know, 4 or 5 guys sitting around, like, the doctor, a nurse, you know, some guys who were just living with HIV and, you know, didn't really have any health care experience taking care of people, being sure people had access to care. And, my mind very much the past few days has been on the resiliency of our community.

And so when I look back and I think of that, you know, that it reminds me that whatever adversity we're facing, that if we come together, if we, if we lock arms, if we hold hands, if we put our backs into it, then, you know, our community can overcome a tremendous amount of adversity. And I think it's important that as we're dealing with these challenges today, that we bear in mind that we have a long history of making remarkable progress and making remarkable strides and do remarkable things for our community.

Marc: Exactly. And speaking of the progress, I want to talk about activism and medicine a little bit. So we've seen a lot of milestones come from those two things. So what are, some milestones that you think are really important to share? And how do you think those milestones have, taught people more about HIV and helped shift perspectives about HIV as things have progressed?

Rob: I think the three biggest ones, are the development, of highly active antiretroviral treatment in 1995. Before that, all the drugs we had to combat HIV were what we call non-nucleoside reverse or nucleoside reverse transcriptase inhibitors. And in '95 we developed a new class of drugs called protease inhibitors. And that was the first time we had medications from two different classes that allowed us to attack HIV at two different points in the application process.

It's kind of a mouthful to say, but that was the first time we could really effectively treat HIV. Before that, somebody would go in a pill. We often used super high doses. It would be very toxic and it would fail after six, nine, 12 months. and once it went through the 3 or 4 medication you had available, then that was it.

And so beginning with the introduction of protease inhibitors in that highly active antiretroviral treatment, for the first time, we had an effective tool to combat HIV. The challenge with that was those initial protease inhibitors were, they were really hard on people's bodies. They would cause a lot of, lipodystrophy. So your fat would wind up in different places than where it was normally supposed to be.

It had a lot of, it affected people's looks and so people who were on HIV or people living with HIV who were on these medications would have sort of physical characteristics that were often easy to pick out, and the dosing regimens were just, were very challenging. You might have, one medication you were taking every four hours and one medication you took every six hours, and one medication could be taken with food and one couldn't be taken with food, you know, and, and I'm sure everybody's taken an antibiotic at some point in time, you're supposed to take like, every eight hours and you're like, I'm not waking up at three in the morning to take a pill. Like, that's stupid. But when your life depends on it you have to do it. And it's not just for 10 or 20 days. It's forever. And so that was, it was, it was amazing. And the number of deaths declined precipitously, which was remarkable. But it was still a very rough experience with HIV.

And then, in 2006, I believe, Gilead released a triplet, which is the first single dose pill. And for, for the first time, people could take one pill once a day, treat HIV. And that was, that was a game changer. Also, they by that point, they developed some additional class of drugs. So it didn't include this Proteus inhibitors that were so hard on people's bodies.

And then the third thing was PrEP. We up until that point, HIV prevention had been you should use a condom. You know, and what it translated to in the real world was oftentimes you should only have sex with people who look like they're clean, who look like they're this look like they're that so people would make a lot of assumptions about who had HIV and who didn't have HIV, and that really contributed to the stigma.

You know, people were afraid and that fear led to them making assumptions to take care of themselves. You know, I don't, I don't want to come down on people who did that. They didn't have tools to understand better. And so a lot of the prevention was just sort of, you know, stigma and it was assumptions and bias, and it was condoms, which nobody liked.

We, today, we're still required as part of our contracts with the CDC to encourage, to make condoms available to everybody we work with. But condoms were never super popular, and they were really never going to be the thing that stopped HIV. And so when we came up with PrEP, there was finally something people who were HIV negative could do to protect themselves.

And I think that was just a remarkable change. People were so much more empowered to, to take care of themselves. There was so much more power to make changes that allowed them to live the life they wanted to live, but also still be safe. And so when you talked about landmarks or, you know, inflection points, I see those three as like the big ones.

T.J.: Yeah. yeah, I, I completely agree. I think that Rob put it very eloquently that just the transition from where we were, pharmaceutically to where we are now has just been light years. But our people, like, as a community, has just been so resilient throughout because they have seen every wave of this and they have really pushed themselves to just figure it out, you know, without the concept that we've had and without the constant trials and the research trials like we have here, we wouldn't be able to figure these things out.

We wouldn't be aware of how these side effects looks about like, you know, the lumps that we may have had that come from the fat distribution, about different things that happens to the body, like the yellowing. A lot of those things, we wouldn't be able to find out if we weren't able to do research. And I think that one of the most important things that came from research was, U=U, which was kind of like a game changer for the community, right?

Because I'm on the social work side of things. And I saw how that impacted the psyche of our clients, how it empowered them to take the medication every day. Because even with taking it like, yes, life is obviously more important, right? You get to live longer, you're healthier. But also it was a, almost like a subhuman version of life that we were offering them because they weren't able to love who they wanted all the time.

They weren't able to engage in things that others were able to engage with. They weren't able to feel as though this, this thing that is inside of them ever doesn't exist at a moment in time. And then once, U=U became, not only existed because it always existed, but once it became endorsed and that we have clinical trials after that prove these things, we were able to empower our clients and our people and our friends and our loved ones like, please accept this as the new normal and accept this as like, you still have power within this.

It is not lost. It's like not all hope is lost. You still have options like you are in a space and to where you are still in charge of your life. And that was so much more powerful to them now, to take that pill every day, or to see their provider every 3 to 6 months, or to participate in their health because they felt like, yeah, as long as I know this, I not only know that in my life that this is working right, like I'm not doing this in vain, but also like, I can take the guilt off of me because we had a lot of, a lot of legislation that was put out there that was in place for people that made a lot of burden and guilt upon people who may seroconvert or may have transmitted these things. And so U=U  empowered them in so many ways that it just allowed us to be able to give our clients their lives back in more ways than one.

David: And just to ask, how would you describe U=U  to someone who hasn't heard of it before?

Rob: Yeah, so U=U, it goes you means undetectable equals untransmittable. And what that means is if, by the varying definitions, but if your viral load is undetectable by the test that is typically run in these cases, that means the virus is so low in your system that is not detected by those tests, meaning that there's not enough of the virus to pass along.

Now, this is not a new concept. There are a lot of other, viruses that have similar methods. So this is not new. This is just new for HIV. This is something that has been discovered for HIV, understanding how little those copies have to be in your system. But we see that being on that regimen, taking that medication daily, you're able to achieve that undetectability if your body responds the proper way and that, that your orifices or the secretions or whatever things that may come out of your body that you feel like, quote unquote “might be contaminated” or that might carry a dosage of this virus, they no longer have those things.

Now that you can feel safe knowing that, as long as you're taking your medication daily that you're not, you're, the virus is not what we would consider active in your body, and you're not able to transmit it to those who you’re with.

David: Wonderful. And wonderfully said. Thank you. I think that's such a huge part of this conversation. I'm so glad that you brought it up. Rob is there something you are maybe going to add to that. I wasn't sure as far as U=U.

Rob: No, I think T.J. did an excellent job of summarizing U=U.

T.J.: Thank you.

David: So one of the things I wanted to ask is certainly where do you see that we still have left to go as far as, you know, where we're at medically, where we're at with advocacy, as it relates to the HIV/AIDS epidemic. What are some of the issues that we're facing right now? What's being discussed in the public health space?

Rob: Yeah. I would say that, with the technology we have right now in terms of pharmaceuticals, we have the tools we need to end HIV, we can end HIV tomorrow. If we, if everybody who are living with HIV, are on medication in the United States and everybody who are at risk, were taking PrEP, we could end HIV within a year.

The barriers to doing that aren't technical. They're not pharmaceutical. They're not, they're not biomedical. The barriers we have to implement that is people's access to health care. It's stigma. It's, people have unstable health insurance. So, you know, they, they enroll in care and they're out of care. You know, maybe this month, you know, this year they make this much money and they’re in Medicaid, and the next year they make a different amount of money and they're supposed to be in a different type of health care coverage. For people who are in really challenging phases of life, for people who are doing very well, and very capable and say, very familiar with the medical care system because you work and may be part of your job is even getting people connected to care.

Health insurance is still confusing, and it's still a pain. And it is. It's just very, it can be mind numbing trying to deal with it. And that complexity is a real barrier for people getting access to care. Stigma, you know, for, you know, for gay men with, you know, upper middle class gay men who live in urban environments with a gay village, you know, that's a very different experience than somebody who's living in rural Alabama or, you know, Idaho or wherever, or even in different parts of the city.

There's still just a tremendous amount of stigma. And so even if people have health coverage and they have access to a provider who's qualified to provide HIV care, you know, they face violence, they face discrimination, they face exclusion, you know, and so helping people overcome that so they can, they're free to access to care that's available to them.

And also educating the medical profession, there's still a lot of doctors who are deeply uncomfortable having conversations about sexual health with people. Given all the conversations doctors have with people, you'd think they'd be okay with that. But people still doctors still find it challenging to ask people who are you having sex with, how are you having sex, and how can I help you have safer sex? I think those are the barriers we face. There's socially constructed barriers that we can, we have to overcome as a society. They're not something we can technology our way out of.

David: Hm, well said.

T.J.: I agree, I absolutely, I, I would just like to piggyback that the education piece is so important, because the doctors have a way of communicating with clients, or with patients like even that in different like in, in social work, we call, we call them clients. And then in the medical practice they call them patients. And that just says a lot in how we communicate differently. And so everyone is not seeing a ASO they're not always seeing CBOs, like community based organizations like ourselves that have people who are of the experience working or people who understand or people who have a passion about this.

They have people that went to school for medical reasons and they are giving medical services. The cultural piece is almost completely escaped on that. And I think that causes such a rift in where we're trying to go, because he's absolutely right. Like it is not technical anymore. It is not pharmaceutical anymore. Like the, the next steps for us, the cure, is a vaccine, but we're so close that the problem is completely socially constructed.

It is completely in our systems. It is completely in the way that we approach these things and how we treat the people that experience these things that need to be broken down.

Marc: Going into the future. Like you said, Rob, we have a clear path and you both are going to be continuing on this journey. Are there any personal things that you've witnessed or personal experiences that have, that you've internalized to help encourage you to continue this work into the future that you can share?

T.J.: Sure. I think one of my personal experiences was before I actually ever was getting paid to do this work, I was just doing it, volunteering. And because I saw how important it was with my friend group and people who look like me, because the marketing and the information that came down the pipeline that would get to someone like Rob and that would get to someone like me, was quite different.

And it's a quite a lot longer to get there. I didn't come from a family that had a lot of money. I didn't come from a family. I have come from family who has always benefited from government assistance, not because they wanted to, because they had to. And so my information about medical things was very limited, and so were all the people all around me.

And so I would try to encourage them. I would try to do what I can from my seat, where I was to educate my friends and peers and have testing parties at home and like, pay my pizza and stuff. I'm like, everybody just go get tested. Like, don't bring your results back here. Just go and do it.

And then we'll come back and we'll drink and we'll do whatever at the house, whatever we can do to know that it's like safe. But I once I started doing that, I realized that people will start to see me as a, as a resource for HIV. And then I would get phone calls or I’d get text messages or messages on Facebook at the time of people or even Jack’d when I was out there in the world. Okay, when I'm out in the streets, I would get messages from people who would see my face or me and see me from campus and they would say like, “Hey, I'm scared. My boyfriend just told me this, like, I have this. I don't know what to do. Where do I go?” And once it got to the point where it was like people that I did not know and like people would say, like I knew somebody that knew you, that told me that you would know this and that you wouldn't tell anybody.

I just realized that, like, my existence, my role in this space is important. As minute as I may feel like it is, like the days that I don't want to come to work and like the days that I don't want to be here, the days that I feel like…the days like two days ago, where I feel like all hope is lost, I realize that it has been a lot harder in the past for a lot more people, for Sylvia and for Marsha and for Joanne, for the millions of people that fought early on it was a lot harder for them, and yet they've still found a way for me to be in a space that I'm in now. And so walking through there and walking that purpose with them and walking, trying to fill their shoes and it’s a possibility, and saying that I'm actually making a difference kind of motivates me to fill out that time card every day.

David: I just want to acknowledge, too, that we're recording this on, November 7th. Just for the context of, oh, yeah, just this is two days after the election. And I so appreciate you all having this conversation now, and I thought earlier about the comment that you made, Rob, about this, the resilience and the impact of the community coming together with or without, federal government support or with or without, sort of the resources made available to prioritize the communities impacted and, having said that, again, thank you for having this conversation now.

And I want to ask, you know, you know, similar question to Marc, for you, Rob, if there were moments, whether they were recently or earlier on that really stuck out to you as, something that kind of gave you a sense of, you know, why we're doing what we're doing and the resilience that, that's possible and that you've seen for yourself, in the communities in this fight.

Rob: Yeah. I think, one of the previous jobs I had, was working with, trans and gay people in Hollywood, most of whom were homeless or unstably housed. They were doing sex work. And I was, I was managing programs that point, but I was I was very much client facing in that management role. You know, my desk was, it was in the front next to, like, the, the receptionist desk.

So everybody who came out, I would see, you know, if somebody was out, if they were on the field, I was there taking care of the clients. And I met people who were objectively in very, very challenging situations. Oftentimes people who were engaged in behaviors like substance use that made their situation much worse. But the people I worked with had such a remarkable sense of resiliency.

I can think of one patient in particular, one client rather, in particular, you know, and they would come in and they were gender fluid. And so their gender identity changed sometimes from day to day. Which was a new experience for me at that point. And also somewhat challenging because they, they were homeless, so they didn't really have the money to have different sets of clothes.

So their, outward signifiers of that day's gender identity were basically the same every day. So it forced me to have this conversation with this patient about, like, really, like really meet them where they were, or client rather, and really meet them where they were and like, try to understand, like, okay, where are you at today? And, one thing I took away from that experience is that, you know, people can look like externally, it can look like people are hopeless but oftentimes they're not hopeless. And if you meet people where they are and you try to understand a little bit about their perspective, you know, that can go a long way towards making things that appear irrational, rational, you know. I think everybody's rational within their own frame of reference, you know, and so, you know, everybody's, everybody's actions make sense to them in the moment.

Usually, or almost everybody, you know, and so understanding other people's frame of reference or understanding their perspective, understanding where they're at in their life, and you can start seeing like, this is why you don't feel you can do that or this is why you think you can do that. And this is why it just feels very closed off and impossible to you.

And once you start understanding somebody's perspective like that, then you can work with them to really open up those, the range of possibilities. and just that experience was very uplifting for me. Even though I was dealing with people who were in, again, very challenging situations, you know, but they had a level of hope and resilience.

And it felt to me like it was, it was, dishonest or fraudulent or it was, unbecoming for me not to approach life and approach the situation with the same level of optimism and confidence that they had. And that that experience has really stuck with me.

David: Oh, gosh. Thank you for sharing that.

Marc: So I think we're wrapping up here. So last question is, what are you most excited about in our next steps for our fight for healthcare equity and against HIV? And what do you think is our best hope in overcoming the challenges that we have right now?

Rob: I want to be honest. There's nothing that really excites me. We're about to come out, Gilead and some of the pharmaceutical companies are working on, injectable HIV treatments that will last for six months.

That's really exciting. But like we discussed earlier, the barriers aren't technical and they're not something I don't think that are going to be resolved or fixed by any grand single strategy. We have to change society's perspective about HIV. We have to change people's perspective, their internal perspective of what it's like for their HIV risk, of what it's like, you know, what's their ability to take care of themselves.

And that change occurs one single person at a time. And so there's not a single drug or strategy or program that we're going to implement or develop or release that's going to change everything. It's going to be, it's slow, it's hard, it's methodical, it's expensive and time consuming. But we have to reach each person out there in a way that that person is able to be reached. Respecting where they are at that point in their life, and communicate to them what we need to communicate to them so they can be the best advocate for their own health care.

T.J.: Yeah. Yes. I agree, like we're moving so swiftly in the right direction and all these things are great. But really, what really excites me are just, are the things that are in the hands of the people that matter the most.

I started this conversation talking about my inspiration for getting into this was my best friend, and that role was, that role was kind of rough. It was rocky, right? And like, even with accepting the status after years, it was still even with me working in the field, he was very removed. And there would always be like these moments where we'll be in a shared space and somebody would say something off the wall about HIV or somebody went, just throw something out there.

And then I would see a part of his light just dim, and he'll just shrink to the corner of the room. And then now I'm like stepping in like, okay, hold on. I know that he like, he and I are having a silent conversation about these things. And I would always encourage him, like you are an amazing person.

You are a different face of what this may look like for a lot of people, because they think that everybody is super on, like they're on drugs, they're super sexual. They're these people who are wild, they think these things. You're the opposite of all those things. And so you could be a voice if you wanted to, but he just was not in that space and wasn't ready.

And with me working through the field, I would always kind of encourage him. But it's like at your pace at your time. And there was a point where, like he had lost his job and I was like, there's an opportunity like, you know, if you would like to. And we prepped him, got him ready for to interview at my job.

And he ended up getting the job coming on as a tester, like, we all start our careers as, I know I started my career as a tester and then moving up. And now he is the program coordinator for our HIV outreach prevention program that is back in Atlanta. And he speaks outwardly, has done national campaigns about his status. And it's just like, it makes me emotional just knowing that I was there from the first day to seeing that person who was filled with so much stigma and shame around something that was almost completely out of his control, to now being a face and being an advocate and now like, openly and honestly and proudly just speaking about this experience. And I think that him and Rock Hudson being the first and, and Magic Johnson like these people are what make me excited. Those people who can speak and build up the lived experience are what gets me out of my seat, gets me riled up, because the more humane we make this, the more real it is to those others, like the more people that speak up and say like, I'm living this.

They take those numbers off of the sheets, they take those statistics off of the polls, and they make them real. They have full lives, they have friends, they have families, they have pets. They got problems that they take with them that are, that are so much more than HIV number that we're reporting to Ryan White or HIV case we’re reporting to the CDC.

They are actual people, and those are the ones that are going to move the needle. Those are the ones that are going to make the social change. So when those things happen, when I can lift those people or when I see another voice come from the shadows and say like, hey, I am, I am this, I am proud, I am this person, that’s what excites me.

Marc: Oh, amazing.

David: Yeah.

Rob: It's worth being excited about.

T.J.: I think so, yeah.

David: Anything you want to close with before we wrap up the conversation?

Rob: I just want to reiterate that every person out there has the ability to take care of themselves, to take care of their own health. if you're here in Los Angeles, reach out to us. If not us, if we're not the right organization for you, reach out to the LGBT Center or APLA.

Whatever works for you and wherever you are. If you need help, reach out to somebody because there are tools available, and there's a tremendous number of people who are absolutely willing to help. So don't, if it doesn't feel like you're being supported, don't just accept that. Find support, advocate for yourself. You know, be empowered.

T.J.: Absolutely. Make a way and I think that we brag on Men's Health Foundation not only because we work here, but also because we actually believe in it. Like I think that we are the best because I know it, but also just I think that we're the best, and I think it's one of the best roles I've had because yes, we all have our issues, have our problems, and this work is going to be difficult regardless.

But Men’s Health Foundation is one of the only places where if I point something out, like action happens, we listen and we actually act on it. So that is a place that you want your medical care to be. You want doctors, you want providers, you want people who are in the background who are going to listen and act like that's what should move us into doing this thing.

So I think we're doing great work here for many reasons, but I really appreciate that about where we are and who we are as a people, because we really listen to those things and we don't mind. We have some ridiculous people here like Rob, who like literally just don't care. And they will, if you say something to them, they will actually bite the bullet and do what they need to do to hear out and see what solutions we can have.

David: Well, TJ and Rob, thank you both so much for everything that you do at Men's Health Foundation, thank you for sharing all the stories that you did today in this conversation. And Marc, anything you want to close?

Marc: No, just thank you again for your insights.

Rob: Thank you for having us.