July 10, 2014

Q: Do you remember when you first realized a career at the intersection of public health and policy was a good fit for you?

I was a policy wonk before I knew what that meant. For some reason, I no longer recall how this came about – I never took the typical high school government courses because my teachers knew that I learned most of that stuff on my own. Instead, while others were studying government, I was spending time in the library doing independent study projects. For a while in college, I thought I wanted to become a physician, but I realized that my real interest was not treating patients, but using government policy to help people.

Q: What was your path to the O’Neill Institute?

I was working at the Georgetown Health Policy Institute, now part of the McCourt School of Public Policy, when the O’Neill Institute was established. A couple of us from the Health Policy Institute were given joint appointments with O’Neill. I left to join the Obama Administration when the President took office and I came to O’Neill full-time in late 2012. Now, I direct the National HIV/AIDS Initiative, as well as our newly established Hepatitis Policy Project.

Q: What excites you most about your work?

What excites me is that we have begun to talk about ending the HIV epidemic in the United States, and while we have a lot of work to do to get every person with HIV to learn their status, get them in care, and support them in staying on effective treatment, collectively we have started to do this hard work.

I came to O’Neill having served in the Obama Administration as Director of the White House Office of National AIDS Policy, sometimes informally called the AIDS Czar, as well as Senior Advisor on Disability Policy for the Domestic Policy Council. There, I led the development of our country’s first comprehensive National HIV/AIDS Strategy. At O’Neill, I see our role as pushing forward the implementation of the Strategy from our unique perch at a highly-regarded Washington-based research institution. The initial Strategy, a five-year plan, was just recently updated in July of this year to guide the Nation’s efforts through 2020. As part of that, we are examining policies that best allow us to scale up a new tool, pre-exposure prophylaxis (PrEP), that involves giving high-risk HIV negative people, such as gay men and people in partnerships where one person is positive and one is negative, a lower dose of HIV medications to prevent them from become infected with HIV. These medications are highly effective. Witnessing expansions in access to insurance coverage, watching the deployment of exciting research advances, observing a renewed commitment to fighting HIV domestically and the amazing progress we are witnessing on LGBT civil rights…making it easier for the public at-large to value all people at risk for HIV, including young gay men and transgender women gives me a lot of hope for the future. We have a specific and special role at O’Neill to push, cajole, and encourage the policy changes needed to keep making progress.

Q: How did working in a high profile position in the White House shape your work style?

It sounds trite, but working for President Obama is surely the most significant professional privilege of my life. It wasn’t always easy and the environment produces certain unique pressures and stresses, but I think everyone that gets the honor of working at the White House wakes up every day and thinks, “I hope I make the President proud today.” But, working at the White House is not always about making people happy. Governing is about making choices, and we can’t move the country forward if we don’t make hard choices. In my HIV policy world, what I think I learned was to try to listen…really listen…as much as possible. Convey to people what you heard them saying. And, be as honest as possible about what you think. I often felt like I was risking pushback by being more open and honest than a lot of people in these types of roles. There were times I did not agree with everything outside advocates or government officials, for example, would say to me. But, then, like now, we always want the same things: We want to help people, we want to reduce HIV infections, we want to support all people with HIV. So, you try to be honest with people, and even if they disagree, I think people feel respected when you are direct.

I also think it is important to work at being mentally flexible. I might start a conversation telling someone why I think something. While part of the job is to explain that thinking, another part is to consciously make an effort to revise your thinking based on new information.

Q: You’ve placed a premium on inclusion when developing policy. Was there an earlier professional experience that made you realize how powerful inclusion can be?

HIV in the United States always has been concentrated among marginalized groups. You cannot build the trust or support you need to do anything meaningful on HIV unless you have the support of those affected. When I started focusing on HIV policy in 1994, I worked at the National Association of People with AIDS (NAPWA), first as an intern. After I couple of years, I became Deputy Executive Director. Working at NAPWA gave me a deep appreciation – not just that some people are marginalized, but how deeply marginalized some groups or communities are. As an HIV negative white gay man, I was exactly what they did not need. Certainly, the organization whose purpose was to provide a voice for people living with HIV should have people with HIV speaking for them. I saw how powerful this was, and I was also surprised at how rare it was even within the HIV community, which was and is far more sensitive to issues of diversity and inclusion than most others. Moreover, an organization like NAPWA easily could have sent me packing because they needed someone else who better reflected those they were serving. But, they made it clear to me and others, that they needed everybody. They wanted me to contribute to their cause, but they also wanted to make sure that we all were focused not just on giving our voices to the voiceless, but helping others to speak. That has shaped my career, including my time in the Obama Administration.

Q: Who inspires you?

HIV is most heavily concentrated in the US among young, Black gay men. There is a whole group of young Black gay leaders that is stepping forward to lead us forward. I will get in trouble by mentioning some and not all, but Daniel Driffin is a young activist I met in 2009 and watching him develop as an advocate in encouraging. Charles Stephens is an intellectual who I keep telling needs to get his PhD and get into the academia. Noel Gordon is working to better align HIV and LGBT advocacy. Da Shawn Usher, Marvell Terry, Blake Rowley and the men at the Young Black Gay Leadership Initiative all inspire me. Honestly, there are so many passionate, thoughtful, and caring young people – HIV positive and negative – who really inspire me.

Q: What’s the next book on your reading list?

I read a lot of historical fiction. One of my favorite authors, David Liss, has a recurring character, Benjamin Weaver, so I am currently hoping for another novel. Similarly, I love this author, Stephanie Merritt, writing under the pen name SJ Parris who has written a number of novels about Giordano Bruno. I am waiting for another one from her as well.