September 19, 2013The Honorable Kathleen Sebelius
Secretary of Health and Human Services
200 Independence Avenue, SW
Washington, DC 20001
Dear Madame Secretary:
The National Black Gay Men’s Advocacy Coalition (NBGMAC) commends your exemplary leadership in the development and ongoing implementation of the Patient Protection and Affordable Care Act (ACA) and your steadfast commitment to President Obama’s vision of extending access to quality, affordable heath care to all Americans. NBGMAC was established in 2006 prompted by governmental inaction in response to dire statistics on HIV amongst Black men who have sex with men (MSM), to advocate for federal policies, research, resources and programs that promote the health and wellness of Black gay men. Years of neglect demanded vocal advocacy for dedicated research and innovative programmatic efforts. NBGMAC has also called for analysis of the allocation of resources to combat HIV in this population. As the epidemic continues to deepen and concentrate in our communities, we are requesting your leadership in accelerating the response to the epidemic in Black MSM.
In 2008 the NBGMAC Policy Agenda strongly supported the HIV/AIDS community’s call for the creation of our nation’s first comprehensive National HIV/AIDS Strategy (NHAS). We were deeply gratified by President Obama’s swift actions in office that led to the development and implementation of an evidence-based NHAS with clear strategic goals to reduce new HIV infections and respond to populations hardest hit by the epidemic. Today, NBGMAC is concerned about reports from within HHS of resistance and demonstrably slow progress being made to affirmatively redress years of neglect, and the inadequate programmatic and resource driven response to HIV/AIDS amongst Black gay men.
The anticipated NHAS implementation based on scientific evidence and sound epidemiological data is falling dangerously short. While we commend HHS on holding its November 2012 Summit on the Impact of HIV/AIDS on Black gay men, the report from the consultation and its very sound recommendations have not been moved to action. Two years ago, the Presidential Advisory Council on HIV/AIDS passed a resolution on addressing the health disparity of HIV among Black gay men that affirms many of NBGMAC’s recommendations and we strongly support its implementation. We request that the department endorse and implement the recommendations of the resolution and summit report with dispatch. Distressingly, across HHS agencies, NBGMAC continues to observe roadblocks to NHAS’s stated commitment to a heightened, targeted response. In 2011 on World AIDS Day, President Obama said that “the lives of Black gay men matter.” That profoundly important statement signaled to Black gay men that the Obama Administration would demonstrate the truth of the statement through its actions. Unfortunately, the department has not evidenced a swift resolve to redirect and apply scarce resources to the populations most impacted by the epidemic, especially Black gay men.
Lastly, we write to bring to your attention to the increasing lack of diversity and representation of Black gay men within your department in senior leadership positions. In 2009 our policy agenda identified concerns about the lack of sufficient Black gay leadership across HHS agencies. At the time, Drs. Raynard Kington and Kevin Fenton held unique leadership roles at the NIH and CDC respectively and Mr. Christopher Bates was the Executive Director of the Presidential Advisory Council on HIV/AIDS. Today, both Drs. Kington and Fenton are gone and there is, yet again, a dearth of Black gay leadership across the department.
Madame Secretary, NBGMAC calls for your leadership to undertake the following actions:
- Create an interagency task force to implement recommendations from the September 2011 PACHA resolution Requesting Federal Activities to Eliminate HIV Health Disparities Among Black MSM and November 2012 HHS Summit on HIV and Black Men Who Have Sex with Men.
- As the co-chair of the HIV Care Continuum Working Group recently established by the President, use your authority to develop an inter-departmental initiative to create innovative new models of educational support, employment training, job placement, health care access and utilization, and stable housing to promote the health, wellness and social integration of Black gay men living with and at high risk for HIV.
- Partner with corporate and philanthropic leaders to fund an Institute of Medicine report to examine and synthesize the available evidence around social and structural systemic barriers to health care access and utilization for Black men with emphasis on the HIV related health disparities among Black gay men, and make clear recommendations on how to eliminate these systemic disparities.
- Fast-track the recommendations of the Office of AIDS Research Black MSM Workshop held in October 2011 and demonstrate your strong support for continued and increased investment in research focused on enhanced understanding of HIV vulnerability and resiliency among Black gay men, including the impact of trauma resulting from exposure to childhood sexual abuse, interpersonal violence, connection to the criminal justice system and poverty and to identify interventions that can be effectively scaled up in local communities.
- Instruct HRSA to initiate a strategy with model program goals that successfully increase the number of Black gay men living with HIV who are able to access and be retained in high quality, HIV care and treatment through the ACA, Ryan White and other HRSA funded programs—especially in areas that have delayed Medicaid expansion and other components of ACA implementation.
- Request that the Agency for Healthcare Research and Quality initiate a federal analysis of how Black gay men access primary care including HIV services and the relative quality of care they receive based on their health needs.
- Direct SAMHSA to expand HIV screening throughout the mental health and substance abuse prevention and treatment delivery systems with the goal identifying, engaging and connecting HIV positive Black MSM to care and treatment. Such steps should build upon SAMHSA’s current ACA implementation strategy and be coordinated with HRSA and CDC.
- Ensure that safety net, health care services for recent immigrants and undocumented individuals will continue to be accessible through community-based health systems and Ryan White health care organizations for those living with HIV/AIDS.
- Invest in sustaining culturally competent health care service capacity in African American communities that is welcoming to Black gay men. Survey and analyze current capacity of community based organizations and health care providers to deliver culturally competent care to Black gay men. Utilize the National Culturally and Linguistically Appropriate Services (CLAS) Standards in Health and Health Care to inform these efforts.
- Establish an HHS wide strategy and coordinated guidance that promotes effective implementation of Pre-Exposure Prophylaxis (PrEP) with integration of behavioral and structural HIV prevention interventions targeted to gay and bisexual men in order to optimize uptake and adherence to PrEP and other emerging biomedical HIV prevention tools.
- Require state and local public health and mental health authorities to establish goals and actions steps, in consultation with Black gay leadership and in alignment with the NHAS’ fourth goal, to reduce HIV infections and to improve health outcomes among Black MSM as a core funding requirement.
The Administration has rightly focused the nation’s attention to the hope of an AIDS-free generation. We share that vision. However, it can only be achieved if a focus on the HIV epidemic among black gay men is a clear priority. As representatives of Black gay men, the most disproportionately impacted population by HIV/AIDS in the United States, NBGMAC asks for your expedited review of our concerns and your earliest consideration and response.
Most respectfully, members of the Executive Committee
Ernest Hopkins, Chair (and correspondent)
San Francisco AIDS Foundation
1035 Market St #400
San Francisco, California 94103
National Minority AIDS Council (NMAC)
South Beach AIDS Project
Chicago Black Gay Caucus
Dr. Ron Simmons
Us Helping Us, People Into Living
Dallas/Fort Worth Pride Movement
New York, New York