okay last one but not least so what I
want to talk about today is diversity so
what is the significance of the labels
that we put on ourselves what is the
significance of the labels that are put
on us from society do they have a
relationship to us in that society and
also from my perspective does it have a
relationship to us in health and
wellness or illness so things like
gender male female transgender are we
African American Latino Asian Caucasian
are we single not man single are we
married or with a partner a read avoid
or widowed are we straight or
heterosexual are we gay or lesbian or
bisexual or any of the other sexual
minorities are we Muslim are we Jews are
we Christians or Hindus re Buddhists I
speak English
yo hablo espanol llamo v Papas ku mana
poly vulture or have we been
incarcerated or are we current currently
in prison
are we foreign-born are we american-born
these are just a few of the many labels
that are put on us by society but then
we also label ourselves some of them are
very easy and well-defined you’re either
married partnered or you’re not or you
were born in the u.s. you or not but
things like race and even spiritual
connection and religion there’s some you
know there’s some kind of subjectivity
to that and these issues really became
an interest of mine so I’m an infectious
disease specialist I take care of people
living with HIV as a focus and I got
interested in working with marginalized
and underserved populations of people so
you may say well what’s that really mean
so these are populations of people that
have problems accessing medical care in
our society either because of the
medical system or because or they are
able to engage with healthcare but they
can’t follow because of lots of problems
so they come to the doctor once and then
they disappear we can’t figure out where
they are and so they don’t benefit from
the health care service and and for
their health and a lot of times the
challenges are bilateral the patient’s
face many barriers there are lots of
issues there’s other things going on in
their lives it’s difficult for them but
a lot of the times the deficiency is in
us the deficiency is in the healthcare
system and many times the healthcare
system actually places active barriers
to prevent certain populations of people
from accessing medical care these types
of issues really became central to us
some of my interests you may ask well
what are different examples of these
populations so I’ve worked in different
countries and I work I work in urban
settings here in Chicago so it’s a bit
different but they may be racial ethnic
caste minorities they mean maybe non
English or non majority speaking
populations they may be win women
because of gender inequality they may be
people who struggle with substance use
mental health issues people that are
homeless people that are from LGBT
populations so there’s many different
ways that you can look at these issues
but the reality is that these identities
do have links to your health and illness
that are very real so let me take you
back in time to the 1990s or so around
1995 1996 in a small suburb of a small
city in Pennsylvania it’s a very
homogeneous place so it’s all white it’s
all middle-class it’s all Christian
maybe there is one person of color and
every year or every other year in the
local high school there’s very few
non-christians and there’s really no
openly LGBT people although there’s a
lot of gossiping going on in the school
about different teachers and people but
there’s nobody who’s really out there
that’s open about it this is the place
where I grew up so one of the things I
remember the most about my child what
kind of my high school and middle school
was I played sports and so we would take
trips to these games for an hour to sit
on a bus you know talk about whatever
you know sixteen-year-olds talked about
and a lot of times we face teams that
were from different backgrounds some
that were in from urban settings in in
the area that we were in and so they
were different than us and I remember
distinctly words that came up words that
were used basically derogatory worms
racist terms things I’m not going to
repeat but you can probably imagine what
they are and you know for some people
those words came very easily but for
other people they just allowed them to
be spoken and I think that in the
context of my community is very easy for
us to not say anything and to label that
other people as others
so anybody different than us because
really we had no relationship with
people that were different from us we
didn’t understand what’s going on and
they weren’t like kind of real to us we
didn’t really have any way to really
relate to them and so it’s easy for us
to do that so after I went to school I
went to college where one distribution
class so like a kind of we call like
it’s kind of like a required
distribution class which ended up being
in Hinduism became an entire major in
the religions of the Indian subcontinent
and by the way biology because I did end
up going to medical school eventually
and so this was something I really knew
nothing about except for maybe this guy
do you guys remember him so Simpsons
were very popular to me when I was
growing up and this is basically what I
knew about India in that part of the
world if you don’t remember him he’s a
poo he’s the kind of stereotypical
Indian immigrant who owns the
kwik-e-mart in Springfield in the
Simpsons so that’s a whole discussion
about what that means is that good that
I knew something or is it not great that
that’s what I thought it was but to to
kind of summarize it I didn’t know very
much so I learned a lot not just because
it was religion it was kind of a very
different thing than the sciences but
also I learned a lot about culture and
history of a place I really didn’t know
anything about so I went to college then
I went to medical school here in Chicago
so I went to a
came to a very diverse city was exposed
to more diversity then went to India for
the first time out of the first trip out
of country then to Bolivia then to India
again then to Namibia and southern
Africa and then after I finished my
infectious disease training I went to
Nepal where I lived for three years and
my focus there was taking care of people
living with HIV in Nepal I experienced
in my face very clearly what social
marginalization was in a way that I had
no concept of because of where I came
from and who I was I saw people living
with HIV be completely socially isolated
subject his discriminate Okin
discrimination in every aspect of their
life kicked out of their village kicked
out of their house lost their job
doctors won’t touch them take care of
them
violence against them and then just very
poor access to medical care and the
thing that one of the things that was so
offensive to me was that health care
workers who were supposedly the most
educated people in society sometimes or
at least heavily educated in terms of
schooling maybe were no different
physicians would send them away
we don’t take patients like you go to
this hospital nurses wouldn’t take blood
from them they wouldn’t touch them and
it was very unfortunate because because
of the chronic neglect both from the
social and cultural aspect but also from
the medical system many of the patients
became what came to us were so advanced
in their disease when really what we
could do for them was treat them like a
human being
and nobody did and this kind of
environment really showed me what this
kind of marginalization could really be
and it was very hard for me because I
was never confronted with that and I
felt alone because everyone else kind of
did it there weren’t very many people
where that were champions for this
population of patients and it was very
frustrating and and discouraging and
some of the young people here may say
well how is this possible like we’re
it’s 2017 how can people be acting like
this in this day and age HIV is not that
big of a deal but those of you that are
older
you that that exact same thing happened
here in the 1990s and only after law and
a lot of activism and other things in
our society here have things changed
kind of because what I’ll tell you is
that it still exists here I still take
care of patients who face this issue
it’s not in your face because it’s
illegal but physicians will refer them
to other people
for services which they could provide
but they don’t under the guise of kind
of a referral to another professional so
those types of issues happen and in fact
in 2013 there were two cases seen by the
Department of Justice about patients in
the United States who were refused
healthcare one doctor actually the
patient said the doctor actually said to
them I don’t take care of patients like
you so this still exists and so you
don’t have to go to some other place but
it’s actually something that we see and
to me HIV was kind of a form an
expression of a type of identity that
the patient had sure there’s medical
issues they have a positive antibody
test of a la blah blah blah blah but
within the context of society there were
implications of being HIV positive that
affected them just like there was
aspects of them being Dalit or an
untouchable or being in a non Nepali
speaking language person or a woman or a
transgender so to me I saw kind of in
that way and I wanted to just take a
second to explain it in this way so this
is an example of how HIV stigma affects
people living with HIV anywhere and I
wanted to explain it because I think
this is an example that really relates
to all these types of identity because
it’s complicated it’s not just about
medicine it’s about the social and
cultural aspects so people with HIV or
people that are part of different risk
groups like sex worker or sexual
minorities people that have substance
use issues or even just women because
there’s such huge gender inequality
issues in many parts of the world they
all are subject to stigma and for some
of these risk groups like for women for
instance it’s like what people would say
it’s like it’s double stigma dr. Andrew
it’s not just that I have HIV but I’m a
woman how am I supposed to deal with
this with both of those things and so
people would say it’s like
double and triple discrimination because
of these issues so they’re subjected to
stigma within society
this creates vulnerability to violence
to isolation to stink to stigmatization
discrimination and everything i heard
all every kind of discrimination can
think of was possible and also poor
access to health services and not just
poor access but poor health care they
had poor when they did finally see
someone that we could see them they
weren’t even providing really the
minimum so the actual quality of their
health care is poor this all these
societal things can then contribute to
poor emotional and psychological
well-being then it can predispose them
to further risky behaviors that then
again predisposes them to other risk
factors they become marginalized
socially economically legally and this
can all relate to poverty because they
lose their job and other things and then
ultimately poor health for me this is an
example with HIV because HIV is close to
my heart those are the patients I take
care of but all these other kinds of
ideas about identity I think are very
similar the circles may be filled in
with a little bit different words and
the pathways may be a little bit
different but it’s complicated it issued
it’s with cultural social all these
different issues are there and the thing
about is is it’s not about just the
identity in Crystal Society today it’s
also about the past and acknowledging
the historical issues that come with
these identities so for instance there’s
this so I don’t know if any of you
recognize this picture this is a picture
of the Tuskegee experiments which were a
public health initiative that was
sponsored by the federal government in
the 1930s to 1970s in which
african-american men in the south who
had syphilis which is a chronic disease
that has you know in the long term as
very debilitating side of side effects
and can be actually lethal of n they
were basically followed to see what
happens when you’re not treated for
syphilis so even though this the
penicillin was discovered in the 1940s
they weren’t given penicillin
so we could study what
since this type of issue is still in the
mind of patients of mine from the
southside of Chicago that I take care of
a certain generation of why they look at
me and kind of are like okay and it
takes time there’s trust there’s other
things that are there and it’s because
we have to understand the roots of these
issues so the identity issues are so
complicated it’s not just about the kind
of graph those issues going on now
but it’s also about what’s happened
before and where that because that that
that affects people’s collective
understanding not just themselves passed
from generation to generation but also
the communities the other thing that’s
interesting is that there’s bias that
happens bias related to these ideas of
identity so there’s things like explicit
and implicit bias so explicitly is is
very easy to understand explicit bias is
a bias that you have or someone has
that’s consciously there you know it you
don’t like green things or you like
yellow or whatever it’s very clear to
you it’s conscious so for instance
during that same period of time this is
a example of explicit bias this was a
sign in Detroit Michigan in the 1940s
from a white community saying basically
we don’t want anybody but white people
here this is a white community we don’t
want any of you other people this is a
clear public display of explicit bias
now you may say again well that’s back
then but I think all of your knows
that’s not really what’s going on
because you watch the news and listen to
what people are saying and really now
it’s just being replaced by a different
message to another group of people
this is a modern example in 2017 of
explicit bias directed towards a certain
group of people in our country so these
things are not new and I don’t think
that they’re going to go away but I
think it’s important for us to
understand these things and what’s
interesting is it’s not just about
explicit bias it’s also about implicit
bias implicit biases bias that affects
our judgment and behavior but we don’t
consciously under theirs very
interesting studies in health care about
this because it’s found been
that implicit bias affects our behavior
not just the practitioner but also the
patient and when the relationship
between the two is so important that is
a really big issue so this was a study
that was in 2010 of first-year medical
students and it looked at their implicit
and explicit bias against gay and
lesbian individuals and the interesting
thing is that no matter what they said
as far as if they have explicit implicit
bias this barred line is their level of
implicit bias so it was the same
regardless of the viewer conscious of
that bias or not very similarly they had
similar bias and so the idea is that how
do we understand these biases and the
reality is from my perspective I think
of this from a medical standpoint but
this is a societal issue this is about
all of us and how we interact with each
other because after all healthcare is
made done by people people that have
biases we have sin sometimes their
systems of injustice but also the
individuals like physicians are in a
position where they can block and access
and allow different accesses to services
health care and all sorts of things and
so these types of biases are very
important so I feel lucky in a way
because I’ve been able to work in a
position with communities where I feel
like I can try to work with these issues
I can serve communities that deal with
these issues and there’s disparities and
I also find I’ve learned the power of
teaching medical students residents
fellows because they will be the future
of our healthcare system and a lot of
these issues like bias you have to be
conscious of the first step is being
conscious of it and then you can
understand oh you know it’s weird I was
busy and I made I did this thing but
maybe that was maybe that was kind of
off why did I do that but I think that
the issues of identity and and diversity
that I talked about today have a larger
context because a lot of these issues I
think of from a medical context but are
really a societal issue and I think that
those issues are very important because
what do we think about diversity I mean
let’s turn on the TV and listen to what
people have been saying for the last six
or eight months
whatever do we believe that diversity
and identity is a positive thing in our
society or do we believe that this is
something that separates each other and
how are we going to deal with these
things and I think that the question
really is to you you are part of this
society in this this country as well
what do you think about diversity and
identity do you think that diversity and
identity and those types of issues are
something that we should that strengthen
us that that really bind us together as
humans because in the end seeing across
diversity is about seeing our collective
humanity or is it just something that
will accentuate our differences from one
another okay I’m done
[Applause]
want to talk about today is diversity so
what is the significance of the labels
that we put on ourselves what is the
significance of the labels that are put
on us from society do they have a
relationship to us in that society and
also from my perspective does it have a
relationship to us in health and
wellness or illness so things like
gender male female transgender are we
African American Latino Asian Caucasian
are we single not man single are we
married or with a partner a read avoid
or widowed are we straight or
heterosexual are we gay or lesbian or
bisexual or any of the other sexual
minorities are we Muslim are we Jews are
we Christians or Hindus re Buddhists I
speak English
yo hablo espanol llamo v Papas ku mana
poly vulture or have we been
incarcerated or are we current currently
in prison
are we foreign-born are we american-born
these are just a few of the many labels
that are put on us by society but then
we also label ourselves some of them are
very easy and well-defined you’re either
married partnered or you’re not or you
were born in the u.s. you or not but
things like race and even spiritual
connection and religion there’s some you
know there’s some kind of subjectivity
to that and these issues really became
an interest of mine so I’m an infectious
disease specialist I take care of people
living with HIV as a focus and I got
interested in working with marginalized
and underserved populations of people so
you may say well what’s that really mean
so these are populations of people that
have problems accessing medical care in
our society either because of the
medical system or because or they are
able to engage with healthcare but they
can’t follow because of lots of problems
so they come to the doctor once and then
they disappear we can’t figure out where
they are and so they don’t benefit from
the health care service and and for
their health and a lot of times the
challenges are bilateral the patient’s
face many barriers there are lots of
issues there’s other things going on in
their lives it’s difficult for them but
a lot of the times the deficiency is in
us the deficiency is in the healthcare
system and many times the healthcare
system actually places active barriers
to prevent certain populations of people
from accessing medical care these types
of issues really became central to us
some of my interests you may ask well
what are different examples of these
populations so I’ve worked in different
countries and I work I work in urban
settings here in Chicago so it’s a bit
different but they may be racial ethnic
caste minorities they mean maybe non
English or non majority speaking
populations they may be win women
because of gender inequality they may be
people who struggle with substance use
mental health issues people that are
homeless people that are from LGBT
populations so there’s many different
ways that you can look at these issues
but the reality is that these identities
do have links to your health and illness
that are very real so let me take you
back in time to the 1990s or so around
1995 1996 in a small suburb of a small
city in Pennsylvania it’s a very
homogeneous place so it’s all white it’s
all middle-class it’s all Christian
maybe there is one person of color and
every year or every other year in the
local high school there’s very few
non-christians and there’s really no
openly LGBT people although there’s a
lot of gossiping going on in the school
about different teachers and people but
there’s nobody who’s really out there
that’s open about it this is the place
where I grew up so one of the things I
remember the most about my child what
kind of my high school and middle school
was I played sports and so we would take
trips to these games for an hour to sit
on a bus you know talk about whatever
you know sixteen-year-olds talked about
and a lot of times we face teams that
were from different backgrounds some
that were in from urban settings in in
the area that we were in and so they
were different than us and I remember
distinctly words that came up words that
were used basically derogatory worms
racist terms things I’m not going to
repeat but you can probably imagine what
they are and you know for some people
those words came very easily but for
other people they just allowed them to
be spoken and I think that in the
context of my community is very easy for
us to not say anything and to label that
other people as others
so anybody different than us because
really we had no relationship with
people that were different from us we
didn’t understand what’s going on and
they weren’t like kind of real to us we
didn’t really have any way to really
relate to them and so it’s easy for us
to do that so after I went to school I
went to college where one distribution
class so like a kind of we call like
it’s kind of like a required
distribution class which ended up being
in Hinduism became an entire major in
the religions of the Indian subcontinent
and by the way biology because I did end
up going to medical school eventually
and so this was something I really knew
nothing about except for maybe this guy
do you guys remember him so Simpsons
were very popular to me when I was
growing up and this is basically what I
knew about India in that part of the
world if you don’t remember him he’s a
poo he’s the kind of stereotypical
Indian immigrant who owns the
kwik-e-mart in Springfield in the
Simpsons so that’s a whole discussion
about what that means is that good that
I knew something or is it not great that
that’s what I thought it was but to to
kind of summarize it I didn’t know very
much so I learned a lot not just because
it was religion it was kind of a very
different thing than the sciences but
also I learned a lot about culture and
history of a place I really didn’t know
anything about so I went to college then
I went to medical school here in Chicago
so I went to a
came to a very diverse city was exposed
to more diversity then went to India for
the first time out of the first trip out
of country then to Bolivia then to India
again then to Namibia and southern
Africa and then after I finished my
infectious disease training I went to
Nepal where I lived for three years and
my focus there was taking care of people
living with HIV in Nepal I experienced
in my face very clearly what social
marginalization was in a way that I had
no concept of because of where I came
from and who I was I saw people living
with HIV be completely socially isolated
subject his discriminate Okin
discrimination in every aspect of their
life kicked out of their village kicked
out of their house lost their job
doctors won’t touch them take care of
them
violence against them and then just very
poor access to medical care and the
thing that one of the things that was so
offensive to me was that health care
workers who were supposedly the most
educated people in society sometimes or
at least heavily educated in terms of
schooling maybe were no different
physicians would send them away
we don’t take patients like you go to
this hospital nurses wouldn’t take blood
from them they wouldn’t touch them and
it was very unfortunate because because
of the chronic neglect both from the
social and cultural aspect but also from
the medical system many of the patients
became what came to us were so advanced
in their disease when really what we
could do for them was treat them like a
human being
and nobody did and this kind of
environment really showed me what this
kind of marginalization could really be
and it was very hard for me because I
was never confronted with that and I
felt alone because everyone else kind of
did it there weren’t very many people
where that were champions for this
population of patients and it was very
frustrating and and discouraging and
some of the young people here may say
well how is this possible like we’re
it’s 2017 how can people be acting like
this in this day and age HIV is not that
big of a deal but those of you that are
older
you that that exact same thing happened
here in the 1990s and only after law and
a lot of activism and other things in
our society here have things changed
kind of because what I’ll tell you is
that it still exists here I still take
care of patients who face this issue
it’s not in your face because it’s
illegal but physicians will refer them
to other people
for services which they could provide
but they don’t under the guise of kind
of a referral to another professional so
those types of issues happen and in fact
in 2013 there were two cases seen by the
Department of Justice about patients in
the United States who were refused
healthcare one doctor actually the
patient said the doctor actually said to
them I don’t take care of patients like
you so this still exists and so you
don’t have to go to some other place but
it’s actually something that we see and
to me HIV was kind of a form an
expression of a type of identity that
the patient had sure there’s medical
issues they have a positive antibody
test of a la blah blah blah blah but
within the context of society there were
implications of being HIV positive that
affected them just like there was
aspects of them being Dalit or an
untouchable or being in a non Nepali
speaking language person or a woman or a
transgender so to me I saw kind of in
that way and I wanted to just take a
second to explain it in this way so this
is an example of how HIV stigma affects
people living with HIV anywhere and I
wanted to explain it because I think
this is an example that really relates
to all these types of identity because
it’s complicated it’s not just about
medicine it’s about the social and
cultural aspects so people with HIV or
people that are part of different risk
groups like sex worker or sexual
minorities people that have substance
use issues or even just women because
there’s such huge gender inequality
issues in many parts of the world they
all are subject to stigma and for some
of these risk groups like for women for
instance it’s like what people would say
it’s like it’s double stigma dr. Andrew
it’s not just that I have HIV but I’m a
woman how am I supposed to deal with
this with both of those things and so
people would say it’s like
double and triple discrimination because
of these issues so they’re subjected to
stigma within society
this creates vulnerability to violence
to isolation to stink to stigmatization
discrimination and everything i heard
all every kind of discrimination can
think of was possible and also poor
access to health services and not just
poor access but poor health care they
had poor when they did finally see
someone that we could see them they
weren’t even providing really the
minimum so the actual quality of their
health care is poor this all these
societal things can then contribute to
poor emotional and psychological
well-being then it can predispose them
to further risky behaviors that then
again predisposes them to other risk
factors they become marginalized
socially economically legally and this
can all relate to poverty because they
lose their job and other things and then
ultimately poor health for me this is an
example with HIV because HIV is close to
my heart those are the patients I take
care of but all these other kinds of
ideas about identity I think are very
similar the circles may be filled in
with a little bit different words and
the pathways may be a little bit
different but it’s complicated it issued
it’s with cultural social all these
different issues are there and the thing
about is is it’s not about just the
identity in Crystal Society today it’s
also about the past and acknowledging
the historical issues that come with
these identities so for instance there’s
this so I don’t know if any of you
recognize this picture this is a picture
of the Tuskegee experiments which were a
public health initiative that was
sponsored by the federal government in
the 1930s to 1970s in which
african-american men in the south who
had syphilis which is a chronic disease
that has you know in the long term as
very debilitating side of side effects
and can be actually lethal of n they
were basically followed to see what
happens when you’re not treated for
syphilis so even though this the
penicillin was discovered in the 1940s
they weren’t given penicillin
so we could study what
since this type of issue is still in the
mind of patients of mine from the
southside of Chicago that I take care of
a certain generation of why they look at
me and kind of are like okay and it
takes time there’s trust there’s other
things that are there and it’s because
we have to understand the roots of these
issues so the identity issues are so
complicated it’s not just about the kind
of graph those issues going on now
but it’s also about what’s happened
before and where that because that that
that affects people’s collective
understanding not just themselves passed
from generation to generation but also
the communities the other thing that’s
interesting is that there’s bias that
happens bias related to these ideas of
identity so there’s things like explicit
and implicit bias so explicitly is is
very easy to understand explicit bias is
a bias that you have or someone has
that’s consciously there you know it you
don’t like green things or you like
yellow or whatever it’s very clear to
you it’s conscious so for instance
during that same period of time this is
a example of explicit bias this was a
sign in Detroit Michigan in the 1940s
from a white community saying basically
we don’t want anybody but white people
here this is a white community we don’t
want any of you other people this is a
clear public display of explicit bias
now you may say again well that’s back
then but I think all of your knows
that’s not really what’s going on
because you watch the news and listen to
what people are saying and really now
it’s just being replaced by a different
message to another group of people
this is a modern example in 2017 of
explicit bias directed towards a certain
group of people in our country so these
things are not new and I don’t think
that they’re going to go away but I
think it’s important for us to
understand these things and what’s
interesting is it’s not just about
explicit bias it’s also about implicit
bias implicit biases bias that affects
our judgment and behavior but we don’t
consciously under theirs very
interesting studies in health care about
this because it’s found been
that implicit bias affects our behavior
not just the practitioner but also the
patient and when the relationship
between the two is so important that is
a really big issue so this was a study
that was in 2010 of first-year medical
students and it looked at their implicit
and explicit bias against gay and
lesbian individuals and the interesting
thing is that no matter what they said
as far as if they have explicit implicit
bias this barred line is their level of
implicit bias so it was the same
regardless of the viewer conscious of
that bias or not very similarly they had
similar bias and so the idea is that how
do we understand these biases and the
reality is from my perspective I think
of this from a medical standpoint but
this is a societal issue this is about
all of us and how we interact with each
other because after all healthcare is
made done by people people that have
biases we have sin sometimes their
systems of injustice but also the
individuals like physicians are in a
position where they can block and access
and allow different accesses to services
health care and all sorts of things and
so these types of biases are very
important so I feel lucky in a way
because I’ve been able to work in a
position with communities where I feel
like I can try to work with these issues
I can serve communities that deal with
these issues and there’s disparities and
I also find I’ve learned the power of
teaching medical students residents
fellows because they will be the future
of our healthcare system and a lot of
these issues like bias you have to be
conscious of the first step is being
conscious of it and then you can
understand oh you know it’s weird I was
busy and I made I did this thing but
maybe that was maybe that was kind of
off why did I do that but I think that
the issues of identity and and diversity
that I talked about today have a larger
context because a lot of these issues I
think of from a medical context but are
really a societal issue and I think that
those issues are very important because
what do we think about diversity I mean
let’s turn on the TV and listen to what
people have been saying for the last six
or eight months
whatever do we believe that diversity
and identity is a positive thing in our
society or do we believe that this is
something that separates each other and
how are we going to deal with these
things and I think that the question
really is to you you are part of this
society in this this country as well
what do you think about diversity and
identity do you think that diversity and
identity and those types of issues are
something that we should that strengthen
us that that really bind us together as
humans because in the end seeing across
diversity is about seeing our collective
humanity or is it just something that
will accentuate our differences from one
another okay I’m done
[Applause]
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