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EP142 HIV Prevention and Global Health Equity with John Meade
Aman Chopra: Folks, welcome back to another episode of the I Am GPH podcast. Have you ever wondered about the world of HIV or what it means to be a racial equity consultant? I mean, or what even is the Peace Corps? What is it like to go in the Peace Corps? Today's guest is a culmination of all these things, and frankly, a lot more than that as well. John Meade is an adjunct here at NYUGPH, who teaches the EPI class, epidemiology class over here every semester. And his work is mainly associated with the AVAC that we're gonna get all into in this podcast. We cannot wait to learn about how his journey has evolved, how he got into this position, and what else is associated with the world of HIV. John Meade, welcome to the I AM GPH podcast.
John Meade: Thank you so much. Thank you for having me.
Aman Chopra: We're glad to.
John Meade: I'm excited.
Aman Chopra: We're excited to have you. I was very excited to talk to you, like I was saying offline before we got started, but I have to know, say I ask a question. Let's just start with who are you? What is your journey like in public health? How did you even get into public health? Take us to the beginning.
John Meade: Okay. Yeah, it all started... I always wanted to be in medicine. I always wanted to be a doctor. I actually wanted to be a pediatric cardiac surgeon. That's like 20 years of school. That's like 20 years of school. I wanted to do it. I went to like a medicine kind of bootcamp in DC when I was in high school. I was all in. So I went to a liberal arts college, Connecticut College in New London, Connecticut, and I was pre-med, right? Took all the biology classes, bio major, everything. Then I took organic chemistry and then my dream got flushed out the toilet, right? I got C's and D's and I was like, what the hell is happening? What am I gonna do? Because if I don't pass this, I will not become a doctor. So that was sophomore year. So I went to my advisor immediately after my final in organic chemistry and I was like, what am I gonna do? Help me. I need some help and some guidance. And she just sat me down and was like, first of all, breathe. You're in college. You are not supposed to... You came in knowing exactly what you wanted to do. I wanted to tell you that you shouldn't have that strict of a plan, but I let you do you so that you can learn that things change, right? So came back and started taking classes that are still related to health, but more related to the social impact of health. So I took a class called Race and Health where we watched "Power of an Illusion", which was like a PBS special that talks about race and how races intertwine into the healthcare system. Then we did a conference, an inequalities conference where Dr. David Satcher, at the time, he was... Not at that time, but before he was the Surgeon General under Bill Clinton. And he was the first person to kind of coin health equity, talking about mental health. He put out reports about mental health and talks about the impact, disparate impact on certain communities, particularly black and brown communities when it comes to all the things in public health. You can name a infection, a disease, and you can trace how it's disproportionately impacted black and brown communities. And he spoke and he spoke about food deserts in the Bronx, where I'm from. So I immediately was super interested because I know the Bronx. A food desert is where there is no fresh organic foods available or people have to travel miles and miles for a grocery store that has fresh fruits and vegetables. In the Bronx at the time, there were a lot of bodegas, a lot of canned foods, a lot of other foods that are not healthy for you. It has a lot of sodium, it has a lot of things inside of it. So he was talking about that and I was like, okay. I was blown away. And that summer, I traveled to South Africa to work at a HIV clinic. I didn't know at the time what I would be doing. It was an internship. I was like, okay, whatever it is, it's gonna be. Got there and I saw... I was in this poor community, one of the poorest communities in the country, and I was dumbfounded by what I saw, right? I was in the triage unit where everyone coming in has to get a pregnancy test and an HIV test no matter what you're in for. I was the person administering the pregnancy test and getting the blood for HIV. Don't do this at home. You're not supposed to take blood if you're not licensed to do so. But in South Africa, they were like, we need help. We need help. We need hands. So I was like, okay. And when I got the results, I was thinking. I was like, the majority of the people that came into the clinic were young women, young girls between the age of 12 and 18. I gave them HIV tests and pregnancy tests. Eight out of 10 were either HIV positive or pregnant or both. And in my mind I was like, what is going on here? Why are these young girls getting pregnant, getting exposed to HIV? What is happening? And then I took that information and I really developed this youth group of these young girls so that they could teach their peers about condom use, about self-esteem, about teenage pregnancy, about HIV prevention. And that's how I got into the world of community health, public health, and kind of backed away from medicine to more community public type of health. And that led me to the Peace Corps.
Aman Chopra: Peace Corps. Before we get into, I am so excited to explore the Peace Corps thing, because I'm sure there's a lot of HIV work that you did at the Peace Corps, right? Before you go into that work, what is HIV to you? So for someone that's hearing this, to me at least even, HIV, it has a lot of stigma associated with it. The first thing that comes to my mind is AIDS. And when you hear of HIV positive or HIV, can you just give us a simplified for a 4-year-old perhaps? What is HIV? How do we understand it?
John Meade: Okay. HIV is an infection, point blank. It's a virus, right? That you can acquire via blood, via fluids that are circulated through sexual contact or from even mother's milk, right? These are some of the main ways that you can... The fluids that can transmit HIV. You're right, HIV has a lot of stigma associated with it. And that's because in the beginning when HIV kind of came on the scene in the 80s, it was said that only certain communities got HIV, acquired HIV. We're talking about the LGBTQIA community. There was... Haitians was another group that... Immigrants was another group, hemophiliacs was another group.
Aman Chopra: What's a hemophiliac?
John Meade: Hemophiliac is blood diseases. So these are things... These are the groups that were targeted or stigmatized because those were the groups that were seen to be spreading this infection. Right? So HIV is an infectious disease, it's a virus, but it has impacted the entire world at this point. I don't know the exact numbers, but millions and millions of individuals across the world has acquired it and/or has died from its later stage, which is AIDS, which is what you mentioned as well. But now there are medications for individuals who are HIV positive, right? People living with HIV. Right? That can have you live longer, more fruitful lives, right? We have this thing called you equals you, undetectable equals untransmissable. Right? If you are on your HIV medication and you're HIV positive and you are on it, you take it regularly, you take it as much as you want, if you have a partner that is HIV negative, doesn't have HIV, it is scientifically impossible for you to transmit that infection to that person because the copies of the virus in your body because you're taking the medication is so low, you can't transmit it. So that is some of the breakthroughs that we've had in science when it comes to HIV. Another breakthrough is pre-exposure prophylaxis, which comes from antiretroviral treatment for HIV positive individuals. So prep is a pill or a now an injection that you can take that when you're HIV negative, you don't have HIV, you could take it and it will protect you if your body comes in contact with the virus through sexual activity, through injection drug use, through any of the modalities that I mentioned. It can protect you 90, close to a 100%.
Aman Chopra: You can get HIV in situations much beyond sexual transmission.
John Meade: Yes.
Aman Chopra: So you said that drug use was one of them. You said breast milk is one of them.
John Meade: So sexual contact is one of the main ways of getting that most people know about. Injection drug use. If you're sharing needles with someone and usually there are particles of blood in that needle that will get transferred to the next person using the needle, and blood is one of the fluids that can transmit HIV. For mothers who are HIV positive, they can transmit HIV through vaginal birth because there's a lot of fluid that goes on when a vaginal birth occurs, and breast milk. But we've seen that if that mother is on antiretroviral treatment, that lowers the risk substantially. Right? So that's why there are so many programs globally. PEPFAR, the President's Emergency Plan for AIDS Relief is about getting medications to all over the world so that we can limit the transmission of HIV.
Aman Chopra: So what is AIDS and what is HIV? So you mentioned earlier that before HIV goes into AIDS, you mentioned that. So what is AIDS exactly?
John Meade: HIV is the virus.
Aman Chopra: Got it.
John Meade: The virus, like a common cold is a virus. It's a virus that you can acquire by all the ways that I mentioned before. When someone is living with... Someone could live with HIV for years. Someone could live with HIV and not even know it. Right? But when it gets... And what it does, the virus enters your body and it attacks the immune system. It's called the human immunodeficiency virus. Right? So it attacks the white blood cells of your immune system. And when it gets... And you have something in your body called CD4 cells, when that count gets so low, your body can't... Your body can't defend itself from anything as small as the common cold. That's when your CD, I forget the number of the CD4 count, but there's a number for when your CD4 count is that low, it will not... You now have AIDS, meaning your body cannot defend itself.
Aman Chopra: Got it.
John Meade: Right? So that's the difference between the virus, HIV, and the late stage is called AIDS.
Aman Chopra: So it's simply a brand name, but it's actually an extended version of the same virus that has taken over your immune system.
John Meade: It's an advanced stage of the virus that has taken... Exactly.
Aman Chopra: So HIV is.. AIDS is an elevated version of HIV that has taken over your immune system and they just call it AIDS. And that's been the stigmatized thing that it will go over there, yet we'll get into that obviously on what it... How you can protect it or how to avoid it and X, Y, Z along those. Okay, well, now that people have an idea of what that might be, let's go back to your time in Peru before we go into the amazing work you're doing right now as well. So what is the Peace Corps? How do you describe that?
John Meade: Yeah, so the Peace Corps is a program that came up from President John F. Kennedy, right? It was meant to broker kind of like world peace, right? It is about bringing Americans to other countries so that they can learn, they can build relationships, and they can learn from that community and vice versa. The community learns from us and our expertise, right? There are three goals of Peace Corps, but the most important goal is multicultural exchange, right? Is us learning from them, them learning from us, right? So I was in Peru for three years. Peace Corps is usually two years. And I was a community health volunteer. I was in a very rural site in the north of Peru where I had two projects. One project was reducing respiratory and diarrhea, stomach infections from little children under the age of two. And the other one was a youth program that was about sexual health, right? So I spent a lot on my passion was the second, which was the sexual health prevention kind of where we built a curriculum. We had a curriculum that talked about what are values? What are your values? What are your... How do you maintain your self-esteem? Because we find when your self-esteem is low, you're more likely to do behaviors that you wouldn't normally do if your self-esteem was higher, right? Back to the young women that was in South Africa, right? If you are 12 years old and your self-esteem is low, when a 19, 20, 21-year-old man, male approaches you, you want that security, you want that attention. So you'll do what you need to do to get that attention and keep that attention. Right? So what I was doing was teaching this group of leaders. It was about 12 youth leaders and teaching them about self-esteem, values, teenage pregnancy prevention, HIV prevention, how to put on a condom, how to build your future. Think about what you want to be in life, right? And what having a baby or acquiring HIV or STIs can do to that future you want to attain, right? So we did that, it was like about 10 modules, and then they taught their peers. They went into their schools and they taught their peers the same curriculum that I taught them, right? Because it's different when you hear it. When your parents tell you something, you tend not to listen. But when you hear it from your friends, you tend to listen more, right? So we're using that kind of philosophy to have them teach their peers. So that was kind of like the whole Peace Corps program and what I was doing in Peace Corps. And then I did another year where I was supervising other volunteers that were building these same youth programs across the country of Peru. So that was my experience in Peru.
Aman Chopra: Can you go deep into... I bet someone watching this outside, maybe someone that might be leading someone in the world when... If someone, their friend has HIV or they've seen it in their life, or even they're going through some sort of experience, what did it look like for the self-esteem thing? What made it a common theme for all these people having low self-esteem and what were some tips that they over used to overcome it? How did you... What did you teach them?
John Meade: I think the low self-esteem comes... It's a lot of factors, right? Home life, right? Do you have someone that's bolstering you up and telling you they're proud of you, telling you they want you to do better or want you to be this or we love you and whatnot. So low self-esteem starts in the home, right? And then also when you get to school, we all know we all went to high school, went to grammar school, and kids could be mean, right? So that also chips away at self-esteem, right? But this program, what it did was try to build that self-esteem. You are a value. What are you... You are a lion. You may see yourself as a cat looking in the mirror, but you are a lion. You are worthy. You are smart in all the ways that you could be smart. There's not one way to be intelligent or to be smart, right? It is really building up and them building each other up, right? Not just me. I'm a stranger from the United States, don't believe me, right? But believe your friends, believe your peers, believe your colleagues, right? And these are what we call the social things that really impact disease acquisition. It is not just the virus and the disease itself. It's all of the other things that are brought into the fold, into the equation that precipitates these infections from being acquired, from being transmitted, from being treated sometimes. So you need to look at the person holistically and not just the thing, which in this case is the HIV, the STI or the pregnancy or whatnot, right? Is try to understand what that person is going through that may have precipitated to take the blame and take the guilt off of that person, because it's not that person's fault, right? There are things that force that person to be in a situation to acquire HIV, to acquire what have you. And in South Africa, this was the poorest township, which is kind of like you wanna say ghetto, right? It is like the poorest part of the town, the township people were living in tin huts and stuff like that, right? So it's like, it's poor. it's impoverished. Doctors don't want to go there because they're like, why am I wasting my time, right? They don't go to school. There's no schools that are there that are functioning. Right? Those things have an impact on the disease acquisition, but also the way they view themselves. They may view themselves like they don't deserve education or they don't deserve the good things in life. So that brings your self-esteem lower and allow you to kind of find validation somewhere.
Aman Chopra: It's very important. I mean, I'm frankly thinking about all those people right now when you were mentioning this and it's so awesome of you to have gone down that path and stuck with it. How did you end up in Peru, in the Peace Corps? Do you get to choose or do you...
John Meade: So no, when I went in 20... When was that? 2011? There was no choosing.
Aman Chopra: Okay.
John Meade: You just... They ask you for your suggestion, but basically the way that they do it is they figure out where there are openings, what your expertise is and match it. Right? So it is less about language 'cause I knew no Spanish going to Peru. I knew nothing. So they do it based on... I had a biology degree. I was in science. I had this experience in South Africa, right? That led me to this time. So they matched me up perfectly. But now if you're doing the Peace Corps now, you can choose. You can say Peru, Columbia, South Africa, and they send your application to those countries for that country team to kind of do the same thing, expertise and what's available and match.
Aman Chopra: And match. Well, that's an awesome program that's created by JFK as well and for a long time ago. My question comes that I... When I was looking up the Peace Corps while researching you as well, I found that a lot of people tend to quit because they find it overwhelming and exhausting. You said it's usually two years and you stayed three years. So what made you stay and stick to that challenge?
John Meade: It wasn't easy. Let me tell you. Peace Corps is not easy. But it brings something out of you that... I'm from New York City, right? I'm from a city. To be put in a town where there are no paved roads, I had to take bucket baths. I had like... Yeah, but the thing that made me want to stay and want to keep working, the people, I've never been in a place that is... The town I was in was one of the poorest towns in the whole country of Peru. They had almost nothing, right? No paved roads, electricity came in waves. It was in the middle of the desert so sometimes we didn't have water. The people were still happy. You don't need material things to be happy. They would... They still had food. I had food on the table every single day. I was living with a host family too. So I had a younger brother, older sister, and another older brother. They took me in like I was one of their own. They took care of me when I got sick. They were my family in Peru. I still talk to them to this day, right? So for a community, they had parties. They had all these things in the community that brought the community together that I found so incredible. I was like, okay, after month three, I was like, I don't care if it's paved roads, I don't care anymore because I feel like I'm a part of this community. And that's what I think what JFK wanted. He wanted the US to get out of their... US citizens to get out of their bubble, to go somewhere else and learn the ways of somewhere else. Learn what it means to be happy with almost nothing. Right? The food in Peru is incredible, right? Incredible. Best gastronomy almost in the world. It wins awards all the time. I still go to Peruvian restaurants in New York City all the time 'cause I miss it. But I did the third year because one, I wanted more experience before going to grad school, before getting my master's in public health. I knew I wanted to continue school, but I needed a little bit more time, right? And I needed to show leadership in what I was doing currently in order to apply successfully to an MPH program. Right? So because a lot of MPHs, they value the experience, not just your college grades. It's like actual experience trying to do this work. Not saying that you're gonna be perfect, right? But immersing yourself in the work like a lot of students did during COVID, became contact tracers, right? They didn't have the degree or anything, but there was a call to action. We need people to go out and help to contact trace the COVID virus and get people quarantined and administer tests and whatnot. Same thing, right? I felt a call to action towards Peace Corps. It was at a time in the US when the economy was... I wasn't gonna get a job because the economy was trash, right? So I was like, okay, let me do this thing, get out of the country 'cause I love to travel. So it was a reason for me to travel, right? And learn something so that I could bring it back to apply to my master's program and then ultimately the career I wanted.
Aman Chopra: Beautiful. It seems like the South Africa work that you did, the work that you did in South Africa in your sophomore year as you were passing the sophomore year influenced your direction to the Peace Corps. And then after that, it seems like the work you did at the Peace Corps influenced what's next. How did that influence your next steps? Where did you go? Where did that take you?
John Meade: So that took me to applying for my master's in public health, right? My director of programming and training at the time had a MPH, right? Is three Americans in every Peace Corps office, a country director, a director of programming and training, and a director of administration. The director of programming went to UNC for her master's in public health. So she became my mentor, right? And she helped me with the application, helped me with my personal statement and everything. And I applied to four schools in the south because I was coming from Peru and I did not want to deal with snow. I wasn't ready to go back to snow. So I was like, I'm gonna apply all in the south. So UNC, Johns Hopkins, Emory University in Atlanta, and Tulane University in New Orleans. Got into all four, to my surprise. I was like, these are some of... All of them are top 10 schools. I was like, oh, okay. And I ended up going to Emory University because I had this practical knowledge, this practice, I was doing it, I was on the ground floor. I was actually doing programs, creating programs, implementing programs. But now one of the theory that goes along with it, right? Why did these programs work? Why some of them didn't work, right? So I wanted to go to back to school. And at Emory, they had a program where they teamed up with the Peace Corps for a fellowship. So if you... Because Emory University valued Peace Corps and that experience so much, they gave every student who's been in the Peace Corps and completed it $10,000 towards tuition. And if you're a part of this fellowship, half off tuition. So I was part of this fellowship, right? And I got to teach other master's students. So the way it's set up, the master's program is two years just like here at NYU. But at the end of your two years, once you graduate, you go straight into the Peace Corps, right? To use your theory to create programs in the Peace Corps. And we had about five, six people actually finish and go into the Peace Corps. So that's how the South Africa led me to the Peace Corps. Peace Corps led me to Emory. And Emory actually led me back to South Africa because my thesis project was looking at HIV pre-exposure prophylaxis, what I was talking about, prep, which is the medicine you take if you're HIV negative, the impact of prep on sex workers in South Africa. So I was interviewing male sex workers, interviewing judges to look at the criminalization sense, interviewing lawyers, doctors. There was such a stigma for... There was a stigma for HIV, but there's also a stigma for sex workers as well, right? So there were sex workers that would go into the clinic to get their routine checkup because they wanted to check their health. That wouldn't get seen because the community knew they were sex workers. The community knew there were sex workers so they were stigmatized and not given treatment, not given tests, not being seen because they didn't agree with what they were doing. So it's all full circle. It started with South Africa and it brought me back to South Africa for something a little different, but it was still the same context.
Aman Chopra: How do you interview these people? It seems like people in political positions in a foreign country, number one, sex workers, How do you find all these... What was that process like for you?
John Meade: So I was lucky because we had a home base. There's an organization called SWEAT in South Africa that does public health and human rights programming for sex workers in Cape Town, South Africa. And they had connections to the health department, to doctors, to nurses, to judges, to lawyers, to all of these people that I got to interview. So I used that network to ask about what would happen, how would the health of sex workers change if sex work was decriminalized? Asking these questions. Because again, the social and political landscape impacts health, right? Because sex work is criminalized, it puts that group at higher risk for HIV, for violence, for death sometimes, for all of these things. So they're placed in that position because of the laws and policies of the country.
Aman Chopra: What are the laws and policies when you think of HIV, not only in the US right now, but what stands out to you around the world as well?
John Meade: So literally this last week, the country of Ghana passed an anti-LGBTQ law that the president has yet to sign, right? Uganda had this happen similarly earlier last year, which the president did sign, right? So these laws are not... Has nothing to do with HIV in print, right? But it affects a group that is disproportionately impacted by HIV, right? So the law says if you are caught or have evidence that you are part of this community holding hands, like having a business that is an LGBTQ club or something like a gathering place, you can be arrested because you're going against the law essentially. We don't want places like that. We don't want people like that in this country. So that impacts health because now that impacts the health system. So if a doctor sees you and suspects that you are part of the LGBTQIA community, a doctor's office should be a cone of privacy, right? But they could then go call the police on you because your lifestyle is against the law of the country, right? And that same thing is happening in this country right now, Braidwood versus Becerra. There's a court case that's having oral arguments right now today about, it's this company, this man in this fifth circuit, which is like Texas, New Orleans, which is the most conservative circuit court in the land, right? It's basically came up and said, I want to deny my employers, certain employers from getting certain preventative medication or preventative measures because of my religious beliefs. So for example, pre-exposure prophylaxis is a preventative measure. He can prevent his employees from getting access to that medication because being gay is against his religion, the CEO's religion, right? And it doesn't only affect pre-exposure prophylaxis, it affects mammograms. It affects all types of preventative measures that could prevent you from getting any host of things. Breast cancer, colon cancer, HIV, all these things. So that case is happening right now, oral arguments, and it's going to go to the Supreme Court eventually. So that is happening in this country and it's happening all over the world.
Aman Chopra: For those of you that are watching this, whenever you're watching this, this is being shot in March 20th, 2024. So that case might be in the Supreme Court right now and keep updated if you're always interested in looking these things up about Uganda and what happened in Ghana last week. I have one question about HIV for those that might not know. What makes HIV such a... People associated with the LGBTQIA community, what makes it so associated with that? What makes everyone's mind go there?
John Meade: It's because of... So in the beginning, in the 80s when it really burst onto the scene, the way that it was communicated, it was affecting predominantly the LGBTQIA community. So predominantly gay men, essentially. Because that was a time where it was more free. I wasn't living in the 70s or the 80s, but it was more free, more sexual liberation, right? So it was impacting this community the most at the time. So that's how it was communicated. It was called the gay disease at one point, right? And that reverberation actually is felt today because we now see that cisgendered women, black and brown women, their rates of HIV are increasing. Exponentially, right? So now cisgendered women go to their doctor and ask them about pre-exposure prophylaxis, the pill or the injection that you could take to avoid HIV and doctors are saying, no, that's a gay thing. You're not gay, so you don't need that. So that stigma from the 70s and 80s are playing still today in 2024, where people are asking for it, women are asking for it, and they're not getting access to it because of some belief that it is a gay disease. That you don't have to worry about that, you're a heterosexual female, you don't have to worry about that. You don't have to... You're not gonna get that, while we see the numbers are saying something different. So that's why. It was the way it was communicated. Health communication is very important because that's the message that you send to society. And at that time, the message was this is a gay disease, this is affecting this population. Stay away from this population because you might get it. Because at that time they didn't... Just like in the beginning of COVID, we didn't know what it was. We didn't know what it was. We didn't know how to get it. We didn't know how you acquire it, how you prevent it. We didn't know anything. So the broad message was like this is a gay disease. Stay clear of gay people because they might have this disease. So that's how the rhetoric or the narrative started with it's a gay person disease.
Aman Chopra: That's very interesting to hear that. How does HIV... So maybe two questions. The first one is, how does HIV come to... How did this virus come to life? So how does something like this even begin?
John Meade: We are still trying to figure that out.
Aman Chopra: Got it.
John Meade: To be quite honest, we don't know. Some people say monkeys, some people say... But we don't know how it transferred over from the animal to human, right? We don't really know how it kind of came about and then exploded onto the human scene. So that question is still up in the air. A lot of people have theories, but I don't think any of those theories are proven.
Aman Chopra: Fair enough. That's great to hear from you as well, someone who's in this world professionally. What is the future of managing this as well? So what are some big policy matters beyond what you mentioned? So you said women also don't have access if they want it. Where do you see the future of handling this infection going for everyone else? How do you see it evolving?
John Meade: So one of the main things that we work on in HIV policy or advocacy is the political realm, right? There are a lot of laws. Ryan White is a law that... An act that was for HIV positive individuals to develop a program that would take care of those who are... People living with HIV, right? Housing support, food and nutrition support and all of that. There currently isn't a program for those not living with HIV. One of my main things is working on a national prep program to making that a reality. Right now, this healthcare system, we all know that the US healthcare system is trash. I think that's safe to say that. Everyone knows that, right? So it is not anything different for HIV negative individuals trying to access this modality. Whether it's a pill, a daily pill you take, or the injection that you get every two months, right? That was just approved two years ago. But people still don't have access to it. Right? People don't have access because there are doctors that don't believe that... That are gatekeepers for that drug, right? For the medication. It's expensive. The pill itself, there's generics now. There's a generic version of the pre-exposure prophylaxis, which is like $30 a month, right? For 30 pills, which is very affordable, right? But prep is more than just a pill. It's a program, right? You have to get lab tests every three months to make sure you're still HIV negative. Make sure your liver is functioning. There's different... Every medication has side effects and could adversely affect parts of your body. Although that has been debunked about the liver when it comes to pre-exposure prophylaxis, but they still check, right? Laboratory, the actual pill. There are other services that people need, as I mentioned. It is not just about the HIV, right? If you are trying to avoid getting HIV and you are unstably housed, you're using drugs, right? You don't have access to nutritious food, right? You're doing sex work. These are all the other things that need to be taken care of. HIV on someone's list might be seventh in priority, right? Because first I have to eat. First I have to get somewhere to sleep stably, right? I need a job. I need all of these things before I even think about HIV. Right? So the future is really developing these programs that can support the lives of these individuals that may... People living with HIV and people not living with HIV, but want access to the pre-exposure prophylaxis so that they don't get HIV, right? One of the talking points we use to Congress and to the White House and to the CDC is it's much less expensive to give a HIV negative person access to prep than it is to continue and have treatment for someone who's HIV positive, who's living with HIV, right? The money, when you break it down, is much more expensive for. So wouldn't you wanna avoid people and the burden to the healthcare system by getting people access to the medication that will prevent the thing that will cost more money, right? When you talk to Congress, you got to talk about money. That's what they care about. How much money are you saving me? How much money am I getting back on my... What is my return on investment, right? And this is the case. If you invest in HIV negative prep, you will avert millions, billions of dollars treating HIV, people living with HIV.
Aman Chopra: You've kind of gone into the next part of what I was gonna ask you, which is equity racism. And it seems like there's a lot of themes along those lines, what neighborhood you come from, the color of your skin, there's so much associated with that. So how do these systems that are currently there impact these people more than what you have... You mentioned a lot about food is a number one priority for those people, that HIV is number seven on that entire list. What are some other things that we should be aware of when it comes to health equity and which is kind of something you're very passionate about as well.
John Meade: So first I wanna define what health equity is 'cause a lot of people might not know what health equity is, right? So imagine you're at a baseball game, right? And you're with two of your friends who are of different heights. There's someone who's 6'0, someone who's 5'5, and someone who's 4'11, right? And you're at a gate trying to look at the baseball game, but there's plywood covering the gate, right? A quality is giving every one of... All three of you one box to stand on, right? So the tallest person can now see over the gate and see the game, but the 5'5 person still can't and the 4'10 person still can't, right? So that's equality, giving everyone the same thing, the same solution, one box, and you say, oh, it's fixed. It's fixed for one person or one community. Equity is looking at the situation and giving the 4'10 person three boxes, giving the 6'0 person one box and giving the 5'5 person two boxes so that now all of them can see over the fence and see the baseball game. But we're striving for equity, but we ultimately want justice. And what does justice mean? It's health justice. It means let's find a way to take away the plywood that is covering the gate in the first place. And the plywood are the systems that are in place that prevent individuals from getting access to the healthcare system, right? We could be talking about racism, which has been deemed as a public health issue by the CDC, by many health departments, many governments, state governments, including New York, homophobia, transphobia, misogyny. There are a whole host of systems of oppression that prevent individuals and place them at risk of getting and acquiring a whole host of diseases, including HIV. Another example. Pre-exposure prophylaxis has been approved in this country for 12 years. 2012 was when the FDA approved the first pill that an HIV negative person can take to prevent HIV. In 2022, the CDC came out with data. 10 years later, a decade later after being approved, the CDC comes out showing by race, denominated by race, so black, Latina, Latinx, and white individuals, breaking it down, of those who could benefit prep, benefit from prep, how many actually got a prescription to prep? Do you know what those numbers were 10 years after prep was approved? In the black community, 13%. 13% of black people who could benefit from prep got a prescription. In the Latina, Latinx community, 24%. So that's 24% of Latina communities. Do you wanna guess what the percentage was for white communities? Take a guess. What do you think it is? 90%?
Aman Chopra: 94%.
John Meade: Wow. The same country. Same issue, same pill, same doctors, same healthcare system. In the same healthcare system, 94% of white people who could benefit from prep got access, while 13% of black folks who could benefit from prep got prep. If that is not racism, if that is not a disparity, I don't know what is. If that's not inequity, I don't know what is. Right? There is no way that in the same country, same conditions, that white people, 94%, while black people 13%. That is what I've dedicated my life to doing in public health is making sure that black communities get access, get a voice, have a voice, have their voices heard when it comes to HIV, when it comes to sexually transmitted infections, monkeypox, all of these things affect the black community more than others. You could name any disease, black communities are impacted disproportionately. Monkeypox, COVID, right? You can name anything. And black communities have been disproportionately impacted. So that is the health equity that we're talking about. It's there is no... And we're striving for justice. Let's take down these barriers, these societal barriers, laws, policies, the arguments that are happening right now in the fifth court circuit about the prep. Let's take all of those things away so that everyone... You're talking about health for all, the healthcare system isn't built right now in the United States for health for all. It's not, and that's the way it was. And that's where we come in talking about white supremacy culture, right? All the structures and systems of this country were built not for black and brown folks. It was built to benefit white individuals, and it's still that way today. And the data I just showed you proves that in 2022.
Aman Chopra: The organization that you work for, what kind of work do you do? So you are a part of this organization. What is your day-to-day like in order to influence these policies or make changes for everyone?
John Meade: Yeah, so I work at AVAC, which is an organization that works to ensure that HIV prevention medications are ethically developed. Meaning you can't do clinical trials and not include black and brown communities as equal as white communities and say that this works for everyone, right? So that's first step. The second step is making sure that these things, when it's approved, goes through the scientific process, gets approved, shown to be efficacious and safe. Once they're approved, they get access. Access is given to the communities that need it the most, right? So my job, I'm a senior program manager for policy. So I use the science to... We want science to inform policy, right? But it seems this day and age, politicians are allergic to science, some of them, right? So we're trying to translate the science into policy, right? And making sure that the policy ensures that access is given to all that need it, especially the communities that need it the most. So my job, like right now, last year the House Republicans, they put into every year... The only job of is to fund the government. That is the only job on paper in the constitution, is to pass bills that fund the programs of the government. Every year there's a delay because the two party, we're in a two party system, both parties argue. This party wants this, this party wants this, doesn't wanna budge. It's a debate, give and take, right? It depends on what party's in power on each of the levels of government, right? So the House Republicans put out... They proposed $770 million in cuts to HIV programming, $770 million in cuts. That's to housing, that's to prevention programs, that's all of these programs I've been talking about this whole time. It affects all of it, right? So my day-to-day job, right now we have a "Save HIV Funding" campaign where we're collecting stories from individuals about how prep saved their lives, right? How taking prep allowed them to not acquire HIV and how this pill and having access to it saved their lives, right? Telling Congress that your constituents want this. This is what they want. You are representing your constituents and your constituents want this. So writing letters, going... March is a big month because I'll be going to DC in a couple weeks where we go and visit these offices of these representatives, of these senators, and bring constituents with us, right? Because I'm from New York, right? New York usually isn't a problem. I don't need to talk to Chuck Schumer. I don't need to talk to AOC that these things are an issue, right? But when you're talking about Tennessee, when you're talking about Georgia, when you're talking about Alabama, Florida, all of these other states, they'll listen to me, but they'll listen more if someone from Florida was in the room going to a Florida representative, if a Georgian was in the room when I'm talking to a Georgia representative, right? Because this person can vote you in or vote you out, and that's what they care about, right? So that's my day to day is really scouring, doing policy analysis of bills that come out next in two weeks, the president, but the president puts out a budget every year, that's coming out in a couple weeks. So we analyze it to kind of look for is HIV mentioned? What is he trying to fund HIV? Use that a basis for our advocacy. The president has this as a priority. That means you should too, right? So that's kind of like the day to day of really trying to, and making sure the community voices are heard in the halls of Congress. That's mainly, in a nutshell, what I try to do.
Aman Chopra: It takes me back to what you did in South Africa. You're educating people and then how hoping they influence their own regions and wherever they can. But now you're doing it at a governmental level from state to state.
John Meade: Exactly. Well beyond that, you not only do that for your work, but you also teach students here at GPH. So those of you watching, John teaches class every semester and sometimes a class switches up as well. So if you're interested in taking a class, look up. If you're at NYU, check out a class that John is teaching. John, we're way over time, which is awesome. That means I can talk to you for another hour or so. And that means for all of you, that's enough for today's podcast. And John, what would you like to leave everyone with when it comes to their own public health journey? What do you think of public health and how can people influence their own journey as we leave them?
Aman Chopra: I think a lot of people come into public health because they see a family member struggle with something, whether it's cancer, whether it's HIV, diabetes, or something and they want to fix it. They want to do something about it, right? My thing is find what drives you. Whether it is... For me, it's passion for my community and wanting to see better for my community and righting the wrongs that my community have experienced in the past, right? For you, it might be, my grandfather died from pancreatic cancer. How can I... Maybe you want to get a PhD and want to find some innovation that can help prevent pancreatic cancer. Maybe you want to advocate on the hill for more funding for HIV, for pancreatic cancer research or screenings or what have you. But find that thing that drives you and that will sustain you throughout your whole career. Don't just do it because we don't do this for the money. Make that clear. We don't do that for the money, but we do it because we're passionate about something. Every public health person has a story about what got them into public health. And once you find that story, it will propel you into the direction you need to go.
Aman Chopra: Beautiful. Folks, if you related with John's story, put something down in the comment of what you learned and what kind of episodes you'd like to see as well. We have this like button over here, so feel free to like, subscribe, share the video with everyone. John, thanks for being on this episode. It was a pleasure having you.
John Meade: I appreciate it.
Aman Chopra: Thanks for tuning in, folks. We'll see you in the next one.
Aman Chopra hosts the I AM GPH podcast at NYU School of Global Public Health. With a keen interest in production, technology, and entertainment, he holds a master’s in Integrated Design and Media from NYU Tandon School of Engineering. Outside of podcasting, Aman is a public speaker and stand-up comedian in New York City.