Access, Engage, & Activate: Centering and Recentering Key Populations

2023 – 2024 Chair’s Challenge: Access, Engage, & Activate: Centering and Re-centering Key Populations

Dave Kern, NASTAD Board Chair

I am the Deputy Commissioner for the Syndemic Infectious Disease Bureau at the Chicago Department of Public Health. My team and I provide support to our city's HIV, STI, mpox, viral hepatitis, and TB responses. I got my start in HIV work in Chicago in the late 1990s and was hired by the Chicago Department of Public Health for the first time in 2000.

In 2004, I attended my first in-person NASTAD meeting, and I was so impressed with the quality of the content and the connections that I made – it was eye-opening to know that I wasn't alone in the work that I was doing. In 2006, I moved from Chicago to join NASTAD as director of prevention and lead the organization’s work in HIV and viral hepatitis prevention.

In 2010, I moved to Washington State to lead the state's infectious disease prevention programming before finally moving back to Chicago in 2016 to take on my current role. Together, these experiences have given me an important perspective on the work from a local, state, and national level, and while I've moved around quite a lot in my career, NASTAD has always been a consistent presence in my professional life. Now, as Board Chair, I feel like I have come full circle.

Over the past few years, NASTAD’s Board Chairs have issued challenges to the membership. However, I honestly struggle to ask people who work at health departments to do more right now. I want to take a moment to recognize that many of us in the public health field are tired, deflated, and at times overwhelmed. Despite this, I know that NASTAD’s membership still feels inspired to do more and to do better for the communities that we serve because that's who we are as leaders – people who always want to do better despite the constraints we're experiencing. So, the first part of my Chair’s Challenge is to NASTAD – we need the organization to continue centering its membership and help us take care of ourselves and one another better.

So now let's talk about the people and where we must do better to end the epidemics and to honor our moral obligation as public health servants to ensure members of our communities are appropriately protected and cared for. For my Chair’s Challenge, I am asking us to center or re-center:

  • Persons of transgender experience
  • Persons who use drugs
  • Persons aging with HIV
  • Gay, bisexual, and other same-gender loving men, Black and Latino men in particular

Within these populations, BIPOC individuals are disproportionately impacted, so we must prioritize efforts to increase access and services for these communities, in particular. I am also calling for whole-person approaches for engaging these populations with humility and long-term commitments, for focusing beyond HIV and hepatitis, and for being okay sitting in places of discomfort. I want to remind us that syndemic approaches marry very well with the centering and re-centering of key populations given that syndemic approaches strive to address the impact caused by infectious disease, drug use, mental health, and the social determinants of health that put these populations at increased vulnerability for poor health outcomes.

Persons of Transgender Experience

Our transgender communities are under attack in many parts of our country. I wish there were a concise challenge that I could put out to our membership but there's not – this is going to be a fight and this fight must be fought on all levels. I call on everyone reading this to learn as much as you can about our trans and non-gender binary communities, to take every opportunity to educate others about trans lives, to advocate and vote against anti-trans legislation and policy, and to convince as many people as you can that what is being done to trans people is cruel and wrong.

As health departments there are many low threshold actions that we can take, some suggested during an excellent discussion on trans health at NASTAD’s 2023 Annual Meeting. Engage trans communities by convening townhall-style meetings and listen, learn, and work with those partners to create solutions. Continue to use gender-affirming language in your formal and informal communications. Begin or continue to create gender-affirming workplaces. Find opportunities to engage trans youth by paying them to be liaisons to their communities. Create safe mechanisms for input like digital suggestion boxes. Assess and make available to the trans community institutions that are trans-affirming like substance use disorder treatment and housing facilities. And fight within your organizations to do what's right.

Persons Who Use Drugs

We need to re-envision our commitment to persons who use drugs. In many of our jurisdictions, we have long-standing programs that have saved countless lives over the years but I believe we must do more to call on members to explore opportunities to advance comprehensive systems of care in our jurisdictions that provide harm reduction, including clean needles and syringes and naloxone, and also integrated medical and behavioral health care. I know that some states and cities can do very little because of political barriers, so continue to do what you can through programs that are flexible like prevention, care and housing.

Persons Aging with HIV

We need to be forward-thinking about the systems of care and support individuals are going to need through the end of natural life. Programs like Ryan White have wrapped arms around our communities, but we can't allow their future to include later-life care that doesn't honor their dignity and identity. We must ensure communities receive compassionate and appropriate care later in life including services in assisted living, skilled nursing care, and other long-term care facilities. And we must address the non-HIV clinical aspects of aging like hypertension, diabetes, heart disease, mobility and other geriatric conditions and psycho-social concerns including isolation and depression. We've made meaningful, and in some cases lifesaving, differences for people with HIV over the years so we must get this right for our community members aging with HIV.

Gay, Bisexual, and Other Same-Gender Loving Men

Finally, we must re-center gay, bisexual, and other same-gender-loving men in our syndemic infectious disease responses. The recent mpox outbreak, continuing primary and secondary syphilis burden, periodic outbreaks of shigella and hepatitis A, and more call on us to approach engagement of services for this community using a syndemic, whole-person framework. When we look at national, state, and local data, we're not making the difference that we need to with this population. These men continue to be on the leading edge of

the HIV epidemic, as they have been for decades, today still representing seven of ten new HIV diagnoses nationally. We won't end the HIV epidemic if we don't accelerate reduction in HIV transmission in this population, particularly among Black and Latino men.

I know we're all tired, but I believe we can begin to make incremental changes for these populations that will be meaningful. Thank you to my fellow NASTAD members and the NASTAD staff for everything you do – I am looking forward to a productive and successful year as your new Board Chair.