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