[Music]
[Applause]
I’d like to start off by giving you a
little glimpse into my personality in
this first picture you see me as a wee
child at Easter being forced into a
ridiculously staged photograph by my
camera happy father as you can see I am
thrilled to be wearing a stupid frilly
dress and rabbit ears in this second
picture you see me on the sidewalk in
front of our house where all of the
neighbors can see my indignity and
here’s me having had enough I don’t know
exactly what I was saying during this
moment but it was probably something
along the lines of raise that camera one
more time and I will end you Ricky you
can see by this example as I have a
little bit of an anger problem and the
way that I as an introvert yes I am an
introvert dealt with that anger was to
silently seethed with rage until I could
figure out some outlet for that anger
that was more productive than say
manslaughter believe me when I tell you
that figuring out these alternate
outlets has not been easy so how did I
get from infant rage monster to where I
am now well it began in my young
adulthood
I studied preventive medicine in
graduate school and this was a time when
the disease that we now know as HIV and
AIDS was making its mark on the world as
I learned more about this disease I was
also making a wider social network of
friends friends who are gay and lesbian
friends who were directly affected by
this disease because of how many friends
of theirs had already died from it
it struck me that the people who had
died were young they were very young at
this time it also struck me that we knew
what caused HIV and AIDS and we knew how
it was transmitted and
not transmitted but there were still
people who didn’t know this information
there was still people who didn’t have
access to health care there were still
people who couldn’t access the drugs
that could possibly save their lives
because the research pipeline was so
slow and the drugs were so expensive
there were people who were told that
they deserved to die from this disease
and this made me angry actually it made
me furious I was infuriated that people
my age were dying from a completely
preventable disease I was infuriated
that people were dying and the
government in Washington DC was
remaining largely silent about this
epidemic that was when I knew that HIV
prevention was my calling and I knew
that the people that I needed to focus
on in my work were those who are most
vulnerable most marginalized in society
those were my people included in this
new category of my people where
injection drug users injection drug
users are often at risk from HIV from
sharing their needles and syringes their
works their injection equipment often
people will share because they don’t
have access to clean injection equipment
and are desperate to use to stave off
the symptoms of withdrawal by using
clean works every time and not sharing
syringes getting those used syringes out
of circulation people could still use
but be protected from getting and
spreading HIV this is exactly what harm
reduction strategies like needle
exchange do they provide access to clean
injection equipment and get those user
works out of circulation and that’s the
elegant and simple beauty of syringe
exchange and harm reduction addiction is
terribly terribly hard not everyone is
ready to quit using that doesn’t mean
that drug users don’t care about their
health it just means that they’re not
ready to take that in really difficult
next step
and that’s what harm reduction programs
do they meet people at where they’re
where they’re at in their addiction
provide them with services that they
need to protect their health while they
are still actively using drugs until
they’re ready to get that next step for
help
syringe exchange programs are also
highly effective in the time since
syringe exchange programs have been
implemented in the United States the
numbers of injection related
transmissions of HIV have dropped by
over 80 percent as a young researcher I
knew about this literature I was excited
about it I was happy to talk about this
to anyone who would listen that is until
I became a federal employee in a
conservative administration as a program
officer for HIV prevention clinical
trials for injection drug users I would
travel to various places in the world
and meet with our research teams and our
participants and I would talk to
community members who were thrilled to
have these programs in their community
they thought this was great to help keep
the hiv-negative people negative but HIV
positive people needed something as well
and they knew the literature on syringe
exchange they knew about its
effectiveness and they thought that this
in addition to her program was what they
needed to help fight their epidemic and
could I please help them start a syringe
exchange program the problem was that I
couldn’t the administration believed
that syringe exchange was tantamount to
promoting and condoning drug use despite
the research evidence showing no
association between syringe exchange
programs and increased drug use or
increased crime there is also
legislation that forbade the use of
federal funding for such programs and I
as a federal employee could not even say
the words syringe exchange or harm
reduction I was a federal employee but I
was also a scientist and this pissed-off
scientist did not take kindly to being
censored so I’d left that job and went
into policy and advocacy work I would
channel
my anger into changing these policies in
addition to the ban on the use of
federal funding for syringe exchange
there is also a special situation in the
District of Columbia you see despite
this federal ban every state city and
locality had the autonomy to use their
own revenue to support syringe exchange
programs if they so desired every city
except Washington DC which was subject
to congressional oversight DC which in
2007 had a 3% prevalence rate of HIV in
an area of 68 square miles to put this
in perspective a generalized epidemic is
one in which there is a greater than 1
percent prevalence rate in the general
population Nigeria has a 3.1 percent
prevalence rate and is ranked 20th in
the world in terms of HIV prevalence the
US has a point 6 percent prevalence rate
and is ranked 65th in the world in terms
of HIV prevalence if the District of
Columbia were a country it would be
ranked 21st in the world in terms of HIV
prevalence DC in which injection related
transmissions accounted for 18 percent
of the living cases of AIDS in the city
DC in which transmission by injecting
drug use affected the city’s most
marginalized citizens in the city’s most
disadvantaged neighborhoods DC which was
the only place in the United States that
could not use its own revenue to respond
to its own epidemic this was a city of
people being held captive by a law that
was created by legislators who did not
represent them and naturally this made
me angry fortunately I was not alone in
my anger my colleagues and advocacy in
policy and I worked hard to try to get
this language removed so that prevention
services could be available to injection
drug users in December of 2007 President
George W Bush
sighs the 2008 financial services bill
into law for the first time in ten years
this legislation did not contain
language that prohibited DC from using
its money for syringe exchange that
meant for the first time in ten years
DC cos uses its own money to respond to
its own epidemic in early 2008 mayor
Adrian Fenty allocated six hundred and
fifty thousand dollars to the DC
Department of Health to expand syringe
exchange to reduce infection for
injection drug users the money went to
four organizations to create a network
to provide comprehensive harm reduction
services including syringe exchange to
the city’s injectors so I thought this
was amazing
finally we had achieved this victory
this progress but the researcher in me
said we’ve got to evaluate this we’ve
got to see if this change in policy
really had an impact on the number of
new infections associated with injection
drug use when I left the world of
advocacy and joined GW as faculty
writing a grant to answer this research
question was my first order of business
to my great delight the proposal was
funded I assembled a team and we began
our work and here’s what we found in
this graph the blue line the blue wavy
line represents HIV surveillance data
reported by the DC Department of Health
these are HIV infections associated with
injection drug use and we looked at the
period following the implementation of
that policy change that’s the red
vertical line you see up there that’s
when the policy change actually took
effect what the surveillance data show
is that in those two years following the
implementation of the policy change
we saw 176 HIV infections associated
with injection drug use now our team
used mathematical modeling and time
series analysis to estimate what would
have happened had that policy not
changed had the things remained the same
our models
found or estimated 296 infections would
have occurred in that same two-year time
period 296 expected infections versus
176 actual infections this is the
difference of 120 averted infections due
to the fact that DC could use its own
money for syringe exchange to respond to
its own epidemic what does this mean in
terms of cost savings the majority of DC
residents who are receiving HIV care are
doing so through publicly funded
insurance programs that are supported by
taxpayer dollars HIV is a chronic
manageable disease now which is
fantastic but it’s not cheap the Centers
for Disease Control and Prevention
estimate that it costs approximately
three hundred and eighty thousand
dollars for lifetime of HIV care if you
multiply that $380,000 times one hundred
and twenty averted infections what you
get is a cost savings of forty five
point six million dollars in two years
what while this estimate does not take
into account the treatment of Ko
infections such as Hep C and addiction
it does attest to the fact that syringe
exchange not only provides individual
benefit but it provides community
benefit so this is pretty cool right
I think so you’re probably thinking well
Monica there’s no need to be angry
anymore your research has been
successful these findings are cool
they’re great it’s all good right wrong
the anger persists the anger persists
because in this fourth decade of this
epidemic and with much better and more
effective HIV prevention and treatment
options there are still young men and
women being infected with a completely
preventable disease the anger persists
because there are still people in this
country of all ages all races
all genders and all political
affiliations who do not have access to
care or who are at risk of having their
health care be taken away the anger
persists because in 2017 we are still
being told that we deserve negative
health and social outcomes because of
who we are who we love how we worship or
where we’re from the anger persists
because we are living in an age where
science continues to be denied
threatened and censored these are
perilous times for social justice so
what’s my advice to you stay angry my
friends stay angry thank you
[Applause]
[Music]
you
[Applause]
I’d like to start off by giving you a
little glimpse into my personality in
this first picture you see me as a wee
child at Easter being forced into a
ridiculously staged photograph by my
camera happy father as you can see I am
thrilled to be wearing a stupid frilly
dress and rabbit ears in this second
picture you see me on the sidewalk in
front of our house where all of the
neighbors can see my indignity and
here’s me having had enough I don’t know
exactly what I was saying during this
moment but it was probably something
along the lines of raise that camera one
more time and I will end you Ricky you
can see by this example as I have a
little bit of an anger problem and the
way that I as an introvert yes I am an
introvert dealt with that anger was to
silently seethed with rage until I could
figure out some outlet for that anger
that was more productive than say
manslaughter believe me when I tell you
that figuring out these alternate
outlets has not been easy so how did I
get from infant rage monster to where I
am now well it began in my young
adulthood
I studied preventive medicine in
graduate school and this was a time when
the disease that we now know as HIV and
AIDS was making its mark on the world as
I learned more about this disease I was
also making a wider social network of
friends friends who are gay and lesbian
friends who were directly affected by
this disease because of how many friends
of theirs had already died from it
it struck me that the people who had
died were young they were very young at
this time it also struck me that we knew
what caused HIV and AIDS and we knew how
it was transmitted and
not transmitted but there were still
people who didn’t know this information
there was still people who didn’t have
access to health care there were still
people who couldn’t access the drugs
that could possibly save their lives
because the research pipeline was so
slow and the drugs were so expensive
there were people who were told that
they deserved to die from this disease
and this made me angry actually it made
me furious I was infuriated that people
my age were dying from a completely
preventable disease I was infuriated
that people were dying and the
government in Washington DC was
remaining largely silent about this
epidemic that was when I knew that HIV
prevention was my calling and I knew
that the people that I needed to focus
on in my work were those who are most
vulnerable most marginalized in society
those were my people included in this
new category of my people where
injection drug users injection drug
users are often at risk from HIV from
sharing their needles and syringes their
works their injection equipment often
people will share because they don’t
have access to clean injection equipment
and are desperate to use to stave off
the symptoms of withdrawal by using
clean works every time and not sharing
syringes getting those used syringes out
of circulation people could still use
but be protected from getting and
spreading HIV this is exactly what harm
reduction strategies like needle
exchange do they provide access to clean
injection equipment and get those user
works out of circulation and that’s the
elegant and simple beauty of syringe
exchange and harm reduction addiction is
terribly terribly hard not everyone is
ready to quit using that doesn’t mean
that drug users don’t care about their
health it just means that they’re not
ready to take that in really difficult
next step
and that’s what harm reduction programs
do they meet people at where they’re
where they’re at in their addiction
provide them with services that they
need to protect their health while they
are still actively using drugs until
they’re ready to get that next step for
help
syringe exchange programs are also
highly effective in the time since
syringe exchange programs have been
implemented in the United States the
numbers of injection related
transmissions of HIV have dropped by
over 80 percent as a young researcher I
knew about this literature I was excited
about it I was happy to talk about this
to anyone who would listen that is until
I became a federal employee in a
conservative administration as a program
officer for HIV prevention clinical
trials for injection drug users I would
travel to various places in the world
and meet with our research teams and our
participants and I would talk to
community members who were thrilled to
have these programs in their community
they thought this was great to help keep
the hiv-negative people negative but HIV
positive people needed something as well
and they knew the literature on syringe
exchange they knew about its
effectiveness and they thought that this
in addition to her program was what they
needed to help fight their epidemic and
could I please help them start a syringe
exchange program the problem was that I
couldn’t the administration believed
that syringe exchange was tantamount to
promoting and condoning drug use despite
the research evidence showing no
association between syringe exchange
programs and increased drug use or
increased crime there is also
legislation that forbade the use of
federal funding for such programs and I
as a federal employee could not even say
the words syringe exchange or harm
reduction I was a federal employee but I
was also a scientist and this pissed-off
scientist did not take kindly to being
censored so I’d left that job and went
into policy and advocacy work I would
channel
my anger into changing these policies in
addition to the ban on the use of
federal funding for syringe exchange
there is also a special situation in the
District of Columbia you see despite
this federal ban every state city and
locality had the autonomy to use their
own revenue to support syringe exchange
programs if they so desired every city
except Washington DC which was subject
to congressional oversight DC which in
2007 had a 3% prevalence rate of HIV in
an area of 68 square miles to put this
in perspective a generalized epidemic is
one in which there is a greater than 1
percent prevalence rate in the general
population Nigeria has a 3.1 percent
prevalence rate and is ranked 20th in
the world in terms of HIV prevalence the
US has a point 6 percent prevalence rate
and is ranked 65th in the world in terms
of HIV prevalence if the District of
Columbia were a country it would be
ranked 21st in the world in terms of HIV
prevalence DC in which injection related
transmissions accounted for 18 percent
of the living cases of AIDS in the city
DC in which transmission by injecting
drug use affected the city’s most
marginalized citizens in the city’s most
disadvantaged neighborhoods DC which was
the only place in the United States that
could not use its own revenue to respond
to its own epidemic this was a city of
people being held captive by a law that
was created by legislators who did not
represent them and naturally this made
me angry fortunately I was not alone in
my anger my colleagues and advocacy in
policy and I worked hard to try to get
this language removed so that prevention
services could be available to injection
drug users in December of 2007 President
George W Bush
sighs the 2008 financial services bill
into law for the first time in ten years
this legislation did not contain
language that prohibited DC from using
its money for syringe exchange that
meant for the first time in ten years
DC cos uses its own money to respond to
its own epidemic in early 2008 mayor
Adrian Fenty allocated six hundred and
fifty thousand dollars to the DC
Department of Health to expand syringe
exchange to reduce infection for
injection drug users the money went to
four organizations to create a network
to provide comprehensive harm reduction
services including syringe exchange to
the city’s injectors so I thought this
was amazing
finally we had achieved this victory
this progress but the researcher in me
said we’ve got to evaluate this we’ve
got to see if this change in policy
really had an impact on the number of
new infections associated with injection
drug use when I left the world of
advocacy and joined GW as faculty
writing a grant to answer this research
question was my first order of business
to my great delight the proposal was
funded I assembled a team and we began
our work and here’s what we found in
this graph the blue line the blue wavy
line represents HIV surveillance data
reported by the DC Department of Health
these are HIV infections associated with
injection drug use and we looked at the
period following the implementation of
that policy change that’s the red
vertical line you see up there that’s
when the policy change actually took
effect what the surveillance data show
is that in those two years following the
implementation of the policy change
we saw 176 HIV infections associated
with injection drug use now our team
used mathematical modeling and time
series analysis to estimate what would
have happened had that policy not
changed had the things remained the same
our models
found or estimated 296 infections would
have occurred in that same two-year time
period 296 expected infections versus
176 actual infections this is the
difference of 120 averted infections due
to the fact that DC could use its own
money for syringe exchange to respond to
its own epidemic what does this mean in
terms of cost savings the majority of DC
residents who are receiving HIV care are
doing so through publicly funded
insurance programs that are supported by
taxpayer dollars HIV is a chronic
manageable disease now which is
fantastic but it’s not cheap the Centers
for Disease Control and Prevention
estimate that it costs approximately
three hundred and eighty thousand
dollars for lifetime of HIV care if you
multiply that $380,000 times one hundred
and twenty averted infections what you
get is a cost savings of forty five
point six million dollars in two years
what while this estimate does not take
into account the treatment of Ko
infections such as Hep C and addiction
it does attest to the fact that syringe
exchange not only provides individual
benefit but it provides community
benefit so this is pretty cool right
I think so you’re probably thinking well
Monica there’s no need to be angry
anymore your research has been
successful these findings are cool
they’re great it’s all good right wrong
the anger persists the anger persists
because in this fourth decade of this
epidemic and with much better and more
effective HIV prevention and treatment
options there are still young men and
women being infected with a completely
preventable disease the anger persists
because there are still people in this
country of all ages all races
all genders and all political
affiliations who do not have access to
care or who are at risk of having their
health care be taken away the anger
persists because in 2017 we are still
being told that we deserve negative
health and social outcomes because of
who we are who we love how we worship or
where we’re from the anger persists
because we are living in an age where
science continues to be denied
threatened and censored these are
perilous times for social justice so
what’s my advice to you stay angry my
friends stay angry thank you
[Applause]
[Music]
you
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