Dr. Russell Brewer currently serves as Research Associate Professor at the University of Chicago Medicine and Director of Community Engagement at the Chicago Center for HIV Elimination. He recently joins the CCHE team from New Orleans, Louisiana.

Dr. Brewer is CCHE’s new Director of Community Engagement. He was kind enough to sit down and speak with me about his past work, current passions, and overarching thoughts on what it will take to end the HIV epidemic. It takes only a few minutes of talking to Dr. Brewer to see the utter compassion and joy that drives his work ethic. Our conversation hopefully provides a window into the energy he is going to bring to CCHE’s work.

The transcript (edited for clarity) can be found below.

Introductions and Background

Sarah Nakasone: I guess we’ll just get started with a little bit about you! So if you want to talk a little bit about your background, whether that’s academic or professional –

Russell Brewer: Sure. I went to school in Oklahoma and pretty much all my education from bachelor’s to doctorate was in Oklahoma. I have a background in public health, so I got my Doctorate in Public Health from the University of Oklahoma. After I was done, I had academic job offers at the time to go to be an assistant professor, but at the time there was an opportunity at the Robert Wood Johnson Foundation and that just really spoke to me. So, I ended up going into philanthropy when I was done with my doctorate. But while I was in school I was also working at the health department. So, I’ve worked in local and state health departments as a health educator and a diabetes educator. The opportunity to work in philanthropy was new for me and it was just my calling at the time. I had never really been to New Jersey and I remember going for the interview and I just walked through the doors and there was just absolute silence in my head. And that had never happened before (laughs)! A lot of times, there’s a lot of noise going on in there! But there was just silence and I just felt this calm, and I was just like, “Wow, I need to come here, I need to be here!”

So, I ended up taking that job as a program associate at the Robert Wood Johnson Foundation. It was great because I had the opportunity to work with health departments and governmental public health agencies and look at how we can improve their performance and impact in communities all across the US. That was a great three years working there. I got to meet a lot of amazing people doing this work. And then that’s kind of when I started becoming interested in HIV. I applied for a job in DC, working with what was, at the time, AED – Academy of Educational Development – there in DC. That’s a global public health-type agency. The position I applied for was a program manager position to manage a national effort to build awareness and support for HIV vaccine research. That was new for me! I knew the basics about HIV from some of my work in the health department days, but now a HIV vaccine as this modality to end HIV was new and something exciting for me. I ended up getting this job and working there in DC for three years at AED, which is now, the name has changed, FHI 360. It was a really big growth experience for me. I was working with national organizations and local organizations doing amazing work around HIV. That was so inspiring.

And then at that time, I became interested in research. I’m like, “I have this doctorate degree, right? So how am I using it?” There was an opportunity with the HPTN – that’s the HIV Prevention Trials Network. There’s an opportunity for folks to apply for a fellows program – the HPTN Scholars Program. I applied for that. So, you have this protected time to work on one of their research studies that was going on and also network with other folks who are affiliated with the network and attend the national conference. I did that for two years and that’s kind of when I started doing work around the intersection between HIV and incarceration, specifically among black men who have sex with men (MSM). I looked at data – secondary data analysis – from one of the studies that was being conducted at the time, the HPTN 061 Study, and really looked at how incarceration affects black MSM. And that’s kind of where I kind of got into the HIV research space.

And then, there was this opportunity in New Orleans to grow and serve as the director of an HIV/STI program. So, now I was going into a non-profit at a state level. I remember when I was approached about the job; my initial thought was, “Oh no, uh-uh.” It was an H-to-the-no (both laugh). I was like, “The South? You know… Do I really want to do this?” I was like, “You know what, Russell, just be open.” That was back, I think, in 2011. I had been in DC for about three years in a manager position. So I was like, you know, “Just be open. You were open about the New Jersey experience. You went for the interview and look what happened, right?” So, I went for the interview and I was like, “Wow.” There was a lot of need, and there was an opportunity to build. It hit me again, right? I’ve got to do this! So I took that job and it was – you could be as innovative as you wanted and it was flexible and I loved that. I got to meet some amazing people again and organizations that are doing great work in Louisiana.

I was there about six years, from 2011 to 2017. Because my passion is really looking at how we can address some of the social/structural barriers that really impact people’s ability to access care, to stay in care, and to achieve viral suppression if they’re living with HIV. So there were several funding opportunities where we were able to build on the work: looking at criminal justice systems, looking at how we can address HIV stigma, looking at how we can address housing discrimination. It was exciting to co-create some of those programs and work with the community, folks whom we’ve traditionally not worked with before. For example, civil rights organizations and historically black colleges and universities, to really engage them in this work and discussion around how can we create programs that address some of the factors outside of the health care system that impact people’s health. Especially for me, young black MSM, persons living with HIV, and criminal justice involved populations. And then while I was doing all of that, I met John (chuckles) and, you know, we talked and there was the opportunity here to really expand the work in a sense, because he’s doing similar work in Chicago, but then also look at how we can continue to do some of the work in the South. Because I’m still passionate about making a difference in the South.

So that’s it kind of in a nutshell, right (laughs)?

SN: Yes, it was! There’s a lot to ask there, too. I’ve read the research you did with the HPTN trials and I was curious because, in the work that came out of that and in your papers, you say that this commonly held belief we have – that people are getting infected inside the criminal justice system and then coming out and bringing that to the community – isn’t necessarily true. I was hoping to talk a little bit more about that.

RB: So, some of those were studies not in my particular study. Yeah, a lot of infections are occurring in communities where people live and many times, if you’re entering a closed setting, a jail, prison, there may not necessarily be testing. Or, maybe you don’t want to get tested because you don’t want to have to deal with whatever you’re going to have to go through in a closed setting: if it’s around disclosure, if it’s around stigma or how people will treat you if they should find out that you’re living with HIV or you have an STI or something. So, in fact, folks are infected before they enter a closed setting and then, if there aren’t services there in the setting, then really, folks are not getting the treatment that they need.

The HIV Epidemic in the Southern US

SN: Could you speak a little bit more about the epidemic in the South, which… There’s a lot to say there, especially now.

RB: There is, there is. We know that the South is disproportionately infected by HIV. And we know that certain populations, such as MSM, specifically black gay/bisexual men, are the most impacted, especially in Louisiana. And, for me, a lot of it is to do with some of the social and structural factors that impact access to health care. For example, high stigma, issues around transportation, and discrimination – some of those things do impact access to care, in Louisiana particularly. So, there are a lot of those issues and it’s not easy to have a handle on some of those issues. And, how do we address them long-term? It’s not going to happen overnight. So, there are so many different strategies and approaches that we could, in a sense, implement to get to zero new infections in the South.

SN: What would you want to see some of those be, given all of the funding that you needed?

RB: Oh wow, yeah. One is, how do we look at addressing stigma and discrimination? If a person’s really diagnosed with HIV, there’s that initial ‘dealing with your diagnosis,’ internalized stigma that you have to deal with. So how do we support folks in their journey from initial diagnosis to accessing to care to wanting to stay in care? How do we support them in employment? How do we support them in housing and transportation so that they’re able to get the care and stay in care? And also, for folks who are entering closed settings, how to ensure they get the care that they need?  And especially the transition period when they’re coming out, some of those things around employment, housing are going to be essential to staying in care. And how do we expand PrEP? Especially among young black men, just getting them educated about it, and, if they do choose to use it, how do we expand their access to it?
I was actually working on a program in Baton Rouge with a community based organization. We developed – it was more of a holistic health education type curriculum. And then PrEP was a component of that curriculum. So, we trained a group of young black MSM to, in a sense, educate their networks about PrEP, right? But also broader health. What does it mean to be a healthy black man in the South? And what do you need? And how can you the care that you need? Part of the education was around referring the participants. So, you could go back to your apartment and invite a group of guys, your friends, to have a little discussion at your apartment about this. We kind of wanted it to be more of a home-grown kind of thing. So that was more of a pilot and there might be opportunities to really look at how we can expand that in Baton Rouge, for example.
SN: What were some of the things that really excited you, coming out of that pilot?

RB: One was – so we had regular calls with the guys who were part of the project – and just to see their interest and their engagement and wanting to do more. As a result of this project, they are more engaged in the activities of the organization we partnered with, the Capitol Area Re-Entry Program. So just to see that we’re building the leadership of the next generation to do this work, you know? We need more young leaders to do this because they have access to their network, to their friends, and they can talk about this. We want it at a point where they’re able to talk about this; they’re comfortable talking about this. And they’re able to refer their friends to services in Baton Rouge or where ever it might be.

SN: How do you think the political climate as of late, whether that’s on the national or the local level, has affected our ability to fight the epidemic in the South?

RB: I think we’ve seen a lot of progress. In Louisiana, for example, we have Medicaid expansion and that was a huge victory. I think, at the end of the day, our partners are like, “We have to do this work, regardless of the political climate.” And there are foundations – local foundations – that support the work. There might be other sources of funding at the national level or whatever to support this work. So, the folks on the ground have to make it work, regardless. But, we might have to come up with ways that we can be smarter about making this work. If it’s how can we expand, if it’s telehealth or other ways that we can reach people, what are some of the tools that we can use to reach people? And it’s tough, kind of, keeping track of all those tools. Because there are a lot of research studies around – apps, and some of these things, right? But then, after they’re done, how are we sharing them with the community? So, my goal is to really look at, one, how we share the results of our study with community members, how we engage community members in the research. For example, in one HIV stigma study, we supported – we had two amazing ladies in New Orleans and Baton Rouge living with HIV. They were leading this study on the ground. And we trained peers who were living with HIV to conduct interviews with other people living with HIV, to document their experiences with HIV and discrimination. Just being engaged in that work, they loved it and they wanted to do more. We ended up interviewing 300 individuals living with HIV in both New Orleans and Baton Rouge and that’s where we found that there was high internalized stigma and there was opportunity to develop some local solutions. So now the groups are in that process of looking at some of those solutions and how we can implement them. But we have to get funding. We have to be creative. It’s a constant battle. But I think, at the end of the day, folks living in those communities are the ones who are going to have to work to end the epidemic. In a sense, we can’t wait around for government or whoever it is to help us. It would be nice if there was more funding and all of these things, but the reality is we’ve got to push through.

SN: We hear a lot about the barriers the South has toward ending the epidemic. You had touched on one advantage they have, at least in Louisiana, of Medicaid expansion. What other advantages do you think that area has when it comes to ending the epidemic?

RB: When I think of HIV and AIDS and just the folks working in HIV and AIDS, I think we have so many amazing people that – you know – put their heart and sweat into really working to end HIV. And we have those in the South, also. I think in the US and globally, there’s just that oomph to want to do this work – it’s not easy work – because HIV is one of those things that touches on those social issues that we don’t want to deal with. And it’s not easy. I think there’s the commitment and just being open to working with different partners you may not have traditionally worked with. And I think folks are being creative. They have to learn how to share resources. If I have a resource for testing and maybe someone has a resource for something else, how can we connect and collaborate and do this work? I think it’s the partnerships and the strength of the partnerships that, to me, are really the stuff that I’ve noticed working in the South.

Work with the Louisiana Public Health Institute

SN: You talked about the stigma project, the general health project with PrEP you were doing… What other projects did you really enjoy working on in Louisiana?

RB: So initially it started off with – it was called ‘Positive Charge.’ We looked at basic, patient-centered interventions. So, for example, health navigation, linkage case management, a pre- and post-release case management person who actually goes in to the jail and works with individuals living with HIV. It was really linkage-to-care interventions. And we looked at using these different patient-centered interventions to link folks into care. Because we know that when we talk about the tool box for HIV care and prevention, the more options people have, I think, the better it is. Let’s give folks options so they can choose what they want. So we looked at these different patient-centered interventions and over a three, four year period, we enrolled close to a thousand people living with HIV. Many were newly diagnosed or at risk for falling out of care – maybe they were unstably housed or they didn’t have employment or anything. Our success rate was more than 80% that were linked to care within three months. So from that work, we really started building on the work.

The next project was the Louisiana Re-Entry Initiative where we focused specifically on formerly incarcerated individuals because we saw that they needed a little bit of extra help once they were getting released from jails or prisons. So that was the second project. And then the third project was really honing in on some of those social and structural factors, like stigma and housing discrimination and working more with formerly incarcerated individuals. But really creating more of an integrated center. We had more than 12 partners in New Orleans and Baton Rouge where they represent different centers. So maybe some were affiliated with a community health center, others were affiliated with a historically black college or university. How do we bring these partners into a space where they can talk about and look at doing this work at a community level? So that project was focused specifically on young black men, young black MSM living with HIV but also at risk for HIV. How do we get them the care that they need? And then, the stigma project kind of branched out of that, and we started doing stigma work. And then PrEP branched out of that because we saw the need. So we’re really just trying to build on what we learn, how can we continue to do the work? And we had to be creative. I mean, some of those projects were done on a shoe-string budget, I’m serious. We had to go knocking on some doors. I don’t know how we did it but we did it. So when I told my partners I was moving here, they were sad. They were like, “But… you’re still going to continue to do work in Louisiana.” I mean my heart is – part of my heart is still in Louisiana.

SN: I worked in South Africa on PrEP so, even coming back here, all of my thoughts are there.

RB: Yeah, yeah. So, I actually grew up in Africa.

Motivations and Future Work

SN: I was going to ask about that! I’m a military brat, and my views on what I owe to my community and things like that were all shaped by growing up in different places.

RB: My dad used to work for the World Health Organization (WHO). I was actually born in Liberia and then we moved to the Seychelles – East Africa – when I was six. So my dad took this job with WHO and that’s my first exposure to public health. I remember World AIDS Day in Seychelles. Dad used to come home with tee-shirts. You know, at the time, we were like, “Oh, okay. That’s cool,” right? But then I really… I wanted a profession where I could impact people’s lives on a broad level, a population health level, and that’s why I went into public health. I went to school in Kenya, high school in Kenya. Living overseas, I was exposed to people from different backgrounds, languages, and it really made me appreciate people, just wherever they are and however they present themselves. I value that so much because it’s helped me working here, meeting different community members. At the end of the day, we’re all people and we all want to be treated with respect. I certainly wouldn’t trade it!

My goal this year is being more intentional. Because there’s just so much- we can get pulled in so many different areas, right? So how do I be more intentional with my time and really focus on things that I think would really make an impact? Because I don’t want to get worn out. Because in this work, a lot of folks get …

SN: Burnt out?

RB: Yeah, burnt out. And we certainly don’t want to lose them in this work. We’re going to need everybody in this fight. So, really my goal, my New Year’s resolution, is around intentionality. It’s going to be interesting how I balance working here in Chicago and getting to know folks and community members and the work that’s going on but then also staying connected to the South and Louisiana and the relationships that I’ve developed there.

SN: I know it’s almost your lunch time, so I’m going to wrap up. But I wanted to ask, what is your vision for your time here? What would you like to see happen? What are you excited to explore?

RB: I would anticipate continuing to explore some continuing work as it relates to some of the social-structural barriers and how that impacts communities here and how we can develop interventions to address that. Not just here in Chicago, but in Louisiana. And what can we learn from both places to inform our work?

SN: Final question, what do you think we can be doing better as an HIV prevention community when it comes to community engagement?

RB: Over here?

SN: Anywhere. You can take that in any sense.

RB: (laughs) What do we need… I think one is, we have to understand that this work is bigger than us. I think we have to be open and to pursue, outside our doors, working with folks who we don’t normally work with. I think we’re going to need all hands on deck. And it’s not just going to be folks from care centers or maybe the education system or criminal justice; we have to be able to bring all those folks together and really look at how we can address this. And we’re not going to treat ourselves out of the epidemic. We really need to look at what are some of those underlying issues and how can we develop programs to address some of those things? And it’s not going to be overnight and it’s not going to be easy. The work is going to be messy. But if we know that it’s not working, why not change it and try something else? We just have to be creative. And we have to continue to value community and what they bring to the work but also folks who are affected or infected with HIV and how they can take leadership roles and mentoring the next generation to become part of this work. Mentorship is important to me and I was doing a lot of that work in Louisiana and I’m excited to see some of the young men – they’ve risen and they’ve gotten great jobs and I hope to continue to do that here, in Chicago.

SN: Well thank you so much!

RB: Thank you! Thanks.