Jeff Galvin: Well, amazing background and one thing that really stands out: what was it like to speak at the Democratic National Convention? I mean, that's a pretty big deal.

Daniel Driffin: It was a great opportunity. I think the time met the importance, especially as we think about the lasting impact and lasting disparities that we continue to see with HIV across our nation. So, I was happy to bring the opportunity to lift up the importance of testing, treatment, and ultimately stigma reduction opportunities. 

Jeff Galvin: Yeah, it's remarkable really how HIV has kind of fallen out of the public consciousness and of course, COVID had pushed it down even more, but it seemed to me that it had taken a backseat to just life? That somehow, when you went out to the general population and even when I talk to people, they think it's already cured, which is remarkable to me, right? I mean, the advancements have been incredible, right? These long-lasting injectable forms and things like that, the convenience factor is high, the side effects have been consistently lowered, but it's really not cured. You can't say it's cured. People still consider it in their lives.

Jeff Galvin: You know, what do you think the major impact of HIV is on its victims? And I hate to even say victims, I mean that's extreme, but when somebody is living HIV positive, what are the added stresses or inconveniences or whatever that they have to endure that could be removed by a real one and done cure?

Daniel Driffin: Yeah, that's a great question, Jeff, and I love even within your question, you know, you went back and found better language, because I think even as we have seen the progression of modern medication, it provides additional space for folks to thrive and truly tap into life and improve quality of life, you know? So, I think language is always important. 

I think continuing on in the question, you know, a one-and-done, again, taps into that quality of life. I think it is the ultimate stigma removal, especially as people living with HIV or those individuals who are most vulnerable to HIV because I think we see, you know, taking medication and staying in care, once you find the best doctor, the best medical team, care can be achieved. Right? It's the things that create the entire health.

So those things like what we between you and I, you know, we call them structural determinants of health, so how important housing plays into being healthy, how important mental health plays into being healthy, how important access to insurance and access to positive support structures. All of that truly built in the person to be the healthiest that they can be. 

So I think truly adding an additional point like a cure, I think that would be just an additional additive for folks to be the healthiest that they can be without having to worry about HIV again. I think that would be huge.

Jeff Galvin: Yeah, you talk about the stigma surrounding HIV, and you know, so what is the stigma surrounding HIV? Because when you think about it, somebody who's well-controlled on antiretrovirals is no different than anybody else. They are no danger to the people around them, and they're living a relatively normal life. There may be some inconveniences, I get it, but it's not operable, right? Like if you tell somebody, a friend of yours or whatever, "Hey, I'm HIV positive, but I'm well-controlled," of course, that's a lot. That's a mouthful, and it'd be easier to tell them, "I once had HIV, but now I'm cured," right? That would be a little bit easier for them to understand, but it's somewhat equivalent, isn't it, right? 

And yet, there's still this fear of HIV, right? Even sometimes amongst doctors, there are certain doctors that are, you know, uncomfortable treating people with HIV or dentists. I was blown away as I've been learning this.

So tell me the full breadth of, you know, sort of the impact of stigma. 

Daniel Driffin: Yeah, I think we have to remember, you know, stigma impacts everyone, and I think stigma impacts everyone differently. It makes me think, you know, we use one word, we frame it as stigma, but when we truly, like peel the level back, stigma can be felt in multiple ways, right? 

So an individual living with HIV can feel internalized stigma, so like a deeper shame or lesser value of oneself, right? We also then have anticipated stigma, so even if I am impacted by HIV, I will begin to think how I would be negatively hurt as a result of stigma, right? 

And then I think the big ones in this recently came out in a few administrative comments, you know, there's also an acted stigma, and that is stigma built into the laws and policies that we live in every day of the week. So that's like HIV criminalization, you know, and the fact that more than 33 states across our nation still criminalize people living with HIV around the intent or whether or not they disclose their status to someone, right? 

So, we have one word, you know, a six-letter word, but these are huge concepts that we just do not talk about when we think about, you know, stigma. So, it's big.

Jeff Galvin: That's a great description of it, right? Because you really did, you know, you outlined this in a very logical way. There are multiple levels to this, and let's take them one at a time, right? 

Because I could imagine people take a pill and they feel somehow inferior, right? Everybody has some virus. Many of the viruses that are in people's body are way more dangerous to the people around them than HIV if you're well controlled, but at the same time, HIV has just got this kind of heaviness to it for 40 years. 

I think also, you know, it takes a long time to get over the 80s. The 80s were an epidemic where people were just dying horrible, horrible deaths before we had any effective treatment.

Jeff Galvin: That's very interesting to sort of look at just that element, and as you talk to people in your social media and stuff like that, are you seeing that? What kind of percentage of people are like, have that question in their head?

Daniel Driffin: Oh yeah, yeah. No, those thoughts and images, you know, that showed itself during the early 80s, early 90s, are really still prominent in communities, especially as you go deeper into certain communities. I live in the deep south, I live in Atlanta, Georgia. Yes, Atlanta is, you know, we like to say we're the capital of the south, but you know, depending on what community, stigma is still felt. In Georgia across the state, we still see more than 800 folks dying as a result of HIV or AIDS.

Yeah, so like take a pause, right? Oftentimes, those folks are individuals who are less likely to be tested immediately or even access care. 

So going back to your statement of, you know, many people take a medication for something, but if the medication that you are taking has all this heavy guilt, fear, discrimination, violence, trauma connected to it, you know, reduces the likelihood of you going to your pharmacy to pick the medication up, taking the medication home, and then swallowing the medication every day of the week. 

Like it's one thing to have medicine, but if you're not taking the medicine, how do you become better, right? 

So again, like these are the multiple pieces I think that as we are creating interventions and new techniques to keep our communities healthy, we may not always have these types of conversations, but community, the people who are vulnerable and the people who need something like this the most, they think about this all the time. You know, they think about this in the middle of the night. They think about this when they're on the bus going to their doctor's office, and they're thinking about it as they're sitting waiting to get their teeth cleaned at the dental office, knowing that, oh, at some point, it's time I had to check that box on this eligibility for saying that I have HIV/AIDS, and now I have to explain it.

So I think these are the things that we have to remember as we continue towards a cure and just the best treatment for everyone impacted by HIV. 

Jeff Galvin: You kind of bring up a couple of things in there. You kind of slid into the anticipation part, which is kind of the next level of it, but also access to care. Some communities are very proactive when it comes to embracing everybody with HIV because they recognize that it's a benefit to society to help these folks to control their viremia and to live normal lives.

It's a productivity issue. It has an impact on society when we allow people to exist without access to care. It's not free. I mean, these people that start to get symptoms of HIV, where do they show up? Probably the ER. This is a very expensive way to treat symptoms of HIV, right? 

And so, like in New York, I was talking to Guy Anthony. I don't know if you're familiar with him. 

Daniel Driffin: That guy, he’s a good friend.

Jeff Galvin: Oh, that's cool. Yeah, that's cool. So anyway, I was talking to him and he said, "Yeah, you know, he moved from the South up to New York and the first thing they did were like, 'Oh, you're HIV positive. Here's a place to live. Here's a bus pass. Here's food stamps. And here's a doctor that can treat you, right?'" 

Why? Because that actually makes not just human sense - to have empathy with somebody's burden. We do this in so many different ways, right? You know, somebody's in a wheelchair, we're like, "Yeah, we should have ramps for them," right? You know? So somebody's carrying the burden of the stigma or of the, you know, just the responsibility, really. It's a responsibility, right? Of being HIV positive. Yeah, why wouldn't we build them ramps? The ramps are housing, food, transportation, and a doctor. Yeah, and guess what? All of a sudden, that person's a productive member of society, right? And they just feel better.

Jeff Galvin: And that's really interesting. Like, you be in a community like that. So, is Georgia different? I mean, here you are, you're a young gay black man out, you know, HIV positive. Um, so Atlanta seems to be kind of an oasis in the South, actually, maybe the capital itself, but it doesn't vote that way, right? So I'm thinking it's probably a more liberal environment than, say, if you're in Macon County or, you know, I don't even know, for all I know, that's the most progressive part of the state at this point. 

But, you know, personally, tell me what's it like, you know, and then spread it out a little bit, you know, to the whole South. And what's it like, you know, HIV positive is one aspect, but being a young black gay man, right? What is the combination, right? It's not their favorite thing down South, as far as I know, but, you know, how does it impact you?

Daniel Driffin: Yeah, I think you are hitting on all of those important things, Jeff. We think about it, as a nerd that I am, we think about it through intersectionality or the multiple points that make up you and whether or not it helps you to be healthier or it hurts you. 

So living across the South, and I think the South can be grouped, truly being less than an opportune place in comparison to like your New York, like your San Francisco, especially when we think about the wrap-around services. So everything that you mentioned, those, if I do not have to worry about housing, if I do not have to worry about transportation, if I do not have to worry about food, you know, the likelihood of me staying in HIV care to remain undetectable and be the healthiest that I can be increases significantly.

So when we see that those wrap-around services are not offered in the same manner, especially across the South, it's no wonder why we see more than half of new HIV diagnoses occur through the South. You know, it's no wonder when we look at viral suppression, less than one-in-two are still showing signs that they have detectable virus. You know, it's no wonder why we see lower health outcomes connected to mental health as well. 

It's a holistic approach, it's human-centered, so we really cannot have a conversation just about HIV. HIV is one of a handful of pains that creates health across community levels. So we really have to think about what can we do, not only as folks living with HIV, advocates finding the best cure and finding the best technologies for medication, but also our larger community members. What can we all do to create a safer, whole environment for people to thrive?

Jeff Galvin: Yeah, I mean that is really interesting to me. As you're speaking about it, it's almost like the results of what's going on in the South validates the model in New York and California. What it says is that yeah, you can do it better and cheaper and in a more human way altogether. It actually economically pays off. New cases are tremendously expensive to society. 

That's also another thing that I'm thinking about. Here's a problem with our state system. Yeah, so if you might just choose to move to New York, so New York might take on the burden of this nationally. Right, that puts an undue burden on that area when in fact it's economically viable everywhere, and really every statehouse should be considering how do we bring that program here so that we can go ahead and enjoy the benefits of it.

Daniel Driffin: Yeah, you're becoming a doctoral candidate for a public health degree.

Jeff Galvin: That's so funny - which you are, by the way. Is this your thesis? You know, like it seems like it should be a thesis topic. Right, statistically analyze this and economically too. My degree is in economics, so I'm always thinking about efficiency. 

Daniel Driffin: You know, it makes sense if we can not only prevent comorbidities, ultimately we are saving resources that we can prioritize in other places. You know, those resources can be placed in housing assistance. Those resources can be placed in cure research or additional support structures to keep everyone in the community healthy and thriving. Yeah, you're right on, Jeff. 

Jeff Galvin: Well, you're never gonna find a bigger believer than me, and the reason being is like, I support Universal Base Income, right? Because look, HIV is just one thing that could keep you from being a good contributor to society. If we could establish sort of a baseline where you're going to survive, okay, you can be a good citizen, you can start contributing from there. The funny thing is, I'm not a believer that when you give those sort of wrap-around services or safety nets, that people get lazy. Sure, some do, and you can always find the exception that proves the rule if that's what you want to believe.

But the reality is, if you put this in place, not only for HIV-infected individuals, but for everybody within society, you get more economic activity, you get a better society, you eliminate a whole bunch of costs that are unaccounted for because they're not direct costs. 

Daniel Driffin: Right, absolutely. 

Jeff Galvin: Yeah, so I'm glad to hear that doctoral candidates are thinking this way, and I can't wait to read your thesis. I'm sure it's on something fascinating, and congratulations, by the way. 

Daniel Driffin: Thank you.

Jeff Galvin: That's a major accomplishment. Well, cool, and then there's active stigma. Okay, so what's that about, right? Like you said, the next level up is sort of an issue with active stigma. That this is different than anticipated, it's different from self-imposed, you know because of your personal insecurities or whatever, which I think, getting over that first one is probably at least within your control and numerous people that have talked to in the Cure Chronicles have literally found their way out of that thinking.

Okay, do you know Rafe DeRazzi? 

Daniel Driffin: No, I don't know, I don't think so. 

Jeff Galvin: We got one, you know these things take a little while to get out, so his isn't on the website yet, but you're definitely gonna want to tune into that one because, you know, he talks like you do, right? He's just, you know, totally open about this stuff, and he's found a way to say it isn't going to dominate my life. I'm going to do what I want to do, right? 

And that's a great attitude, but let's not underestimate how hard it is to get there.

Daniel Driffin: And how long. 

Jeff Galvin: Yeah, yeah, but it's the right place to be. The right place to be is to recognize that we are all equal from a universal perspective, and you can call that religiously, you know, God looks at us, or you can just say that within the universe we're all the same speck of stardust, right? 

So any way you want to do it, right? There is no reason to feel lesser. We all deal with our own burdens. If you want to see truly unhappy people, just tune into any reality show, right? And you know, you get a chance to see that stuff, and sometimes, you know, I think that a lot of those reality shows are so that you can feel better, right? Like the average person can feel like, "Okay, I'm not really missing anything, right? I am equal with these crazies that come from all walks of life," Atlanta being one of them, right? Real Housewives of Atlanta. 

Daniel Driffin: Well, I haven't watched it. But the question was about enacted stigma, so thinking about enacted stigma, you know, so again enacted stigma is truly the policies, laws, procedures that are in place that govern our everyday living. So here at home, there are more than, I think the last time I looked there are 33 states that still have some negative law on the books around living with HIV. 

So like an individual, if they are not disclosing their HIV status, they could be prosecuted. They can be sent to jail, they could be fined upwards of 20 plus thousand dollars. And let's say they win all of those things, let's say they get out of jail, they can still be labeled as a sexual offender for the rest of their life. 

Many of these laws were rooted in the really earliest days, you know back in the 80s and 90s when we didn't have modern technology, when we didn't have moderate medication to keep people undetectable. And we know that now once someone is undetectable they are untransmittable, so they cannot transmit the virus to their sexual partners. 

Jeff Galvin: Or anyone. That's the point, is that casual contact is impossible to transmit to the people around them in their lives. 

Daniel Driffin: Yeah, absolutely. So we're really just asking our elected officials, we're asking our district attorneys, we're asking folks throughout the process of governing the laws and procedures that we live by you know to remove these HIV criminalization laws. HIV should not be criminalized. We do not criminalize individuals with a code. We do not criminalize individuals you know living with other health states. So why are we criminalizing individuals living with HIV, right? 

Jeff Galvin: It's incredibly ironic when those same states are encouraging people with covid that can be deadly to go out without masks and not get vaccinated, right? It is ironic and if we had a different Supreme Court I'd be like it's unconstitutional too, but I'm sure they'd find it constitutional if it gets up there, so you know a little bit about my politics now so my apologies for introducing that.

Jeff Galvin: Well yeah that's really interesting. Now the criminalization is one issue, what about you know just sort of like circulating in society too? So somebody might recognize you from your blog walking down the street, and they hopefully run up to you and go thank you for all that great information. It's really helped me in my life and to deal with you know my situation. 

It might not be that way, that person might be you know consumed with fear and full of prejudice. Do you see that too? Is that an active form of stigma that impacts people's lives? 

Daniel Driffin: Oh yeah, certainly, and I think that is getting you back towards that anticipated stigma. I think that definitely happens and I think it happens more frequently if you are in smaller locales, especially if you may not have an organization or even networks of people living with HIV attempting to change the norms around what it means to be living or what it means to be thriving with HIV. 

So one of the things that I've done over my public health career is create different support networks and other you know initiatives, not only for individuals living with HIV, but also for the community to take the trip with those people living with HIV. So, it's ensuring that folks know where to get tested, it's ensuring folks know where to access pre-exposure prophylaxis, it's ensuring folks know where to access mental health programs, because again, everything matters when we think about creating a more holistic approach for all of us to thrive.

I think of a rising tide situation. When the tide rises, it doesn't only move the small ships, it moves up the large ships as well, so if we can create a more safer wholer community, everyone will thrive.

Jeff Galvin: I couldn't agree with you more. This is why, I've probably said this before in the Cure Chronicles or somewhere, but this is why humans dominate the planet. It is our ability to collaborate and lift each other up and to create that rising tide that you're talking about. Because no other animals can do it. Because no other animals have the ability to go ahead and create an abstract idea that touches the logic and also the emotions of people, and then big groups can move mountains, right? And everybody benefits from it. Every big positive thing that has happened in society takes a group of people to do it. 

And you know, so you are absolutely right that this sort of embracing everybody in society and for everybody to kind of recreate or refine our trust in one another as Americans, right? And as global citizens, right? That kind of cooperation can do a tremendous amount of good. And every time you see people trying to divide, trying to stoke our fears, stoke our prejudices, whatever, you know it's not going to anything good. 

It usually leads to something that's negative really for everybody. Not even just for the folks that they're prejudiced against, but we all breathe the same air, we all live on the same planet, right? And there's probably not going to be another one for a while, so we've got a lot of common interests here.

Well, that's a really interesting sort of spectrum that you talk about in that now there's another aspect, you know, because it's not just Black people that have AIDS, right? And it's not just gay people that have AIDS, right? But you're Black and you're gay, and I think what a lot of people don't realize, and maybe you can fill us in on the actual numbers here, but although Blacks are only less than 20% of the population, they're suffering more than 40% of the HIV, right? 

And I actually think what's interesting about this is here comes the stigma again. Somebody could be listening to this and go, "Oh, well, you know, they, there's a reason for that, right?" No, I mean, there's always a reason for everything, but it's not the reason they're thinking. The reason is probably access to care, it's probably trust in the healthcare system, it's probably… Oh, what's that? 

Daniel Driffin: I can go home now.

Jeff Galvin: So we get to a certain point, it doesn't mean that the individuals were wrong, it just means that the conditions were wrong, right? Okay, so you know, we have to somehow focus on that community to just bring them back to average at least, right? To full participation, full options to produce, to reach their full potential, and to help raise that tide. 

Daniel Driffin: So, what you're specifically talking about, we have a fancy word for everything, so what you're specifically talking about, Jeff, is called syndemics. There are multiple layering levels of oppression or systematic unjust behavior that disadvantages certain populations. So when you think about the impact of, like you said, not having a doctor's office to go to in your neighborhood; okay, having to catch the bus an hour and a half from your house to see your physician; not having food to eat with the medication that you have to take; also not being in a place where you see other people living with HIV safely and openly. 

All of these things truly create the perfect environment for everyone to be unhealthy. 

Jeff Galvin: A perfect storm, so to speak. 

Daniel Driffin: Yeah, yeah, you know, and again, like going back to those intersections, you know, so like being a young person, being a young black person, being also gay, having not potentially having a stable place to live, those things place folks greatest at risk or in the front of the line for an HIV diagnosis. It's not sexual proclivities or individuals having multiple sex partners. Like when we control for that, infection still doesn't make sense, this past - because I read too much - this past month, the CDC published a report on social determinants of health, and they showed if we provided health access, so health insurance, to young gay men who also are black, we could avert or we could stop 46 infections.

Pause. Okay, pause. 

So if we can stop 46 infections in every city across the South, you know, we literally will be able to see the end of, like definition-wise, an epidemic. Especially across this community.

Jeff Galvin: Yeah, that's interesting that the CDC came out with that report recently. So, Bob Redfield is a friend of mine. He's, you know, was director of the CDC under Trump, and I know that one of the things that he did while he was there is that he looked at the stats and they were able to identify a very small number of counties where 95% of the new infections were occurring, and all he was saying is that if we could focus on them and figure out what they need, we could stop the epidemic just that way. 

Daniel Driffin: Absolutely.

Jeff Galvin: That's amazing, and what they need is the New York plan or the San Francisco plan, right? You know, I think that we could get to that later, but then, you know, when you add up the cost of that, again, it's a mere fraction of the destruction that not taking care of it results in, right? So yeah, but that's good.

So the CDC is staying on that. I know that Bob is a deeply spiritual guy, and he cares about every life. Of course, he's worked for the Trump administration, and he is a Republican, but he really is a humanist at his core. That's one of the reasons that I like him so much, but you know, it's tough in this environment to get things done. Even though it made it to a speech, I've always wondered what came after that. 

Have you seen any activity from the CDC where they're starting to implement any of that stuff? What else are you aware of that's going on there?

Daniel Driffin: That is actually one of the cornerstones of our prevention and treatment program. It’s known as the Ending the HIV Epidemic Plan. Over the next 10 years, different phases will come online at different points in time. But again, it truly is geared to reduce the number of infections across 56 counties and six rural states, Puerto Rico, and DC to reduce HIV. Relatively within the next 10 years, by 2030, we should see more than a 90% reduction of HIV diagnosis.

Again, like we're talking about now, it's connected to access to testing. It's connected to ensuring people living with HIV are on their medication and staying on their medication to be undetectable. It's ensuring that we have the best options for pre-exposure prophylaxis to those people who are indicated to use PrEP. Wrap-around services like syringe services programs, harm reduction messaging, but also using data in real-time to answer what does a breakout of cases look like in Hinds County, Mississippi versus Williamsburg County, South Carolina.

I think you said something really interesting. If we take a New York plan and shop it around, the New York plan may not be the best for Bibb County, Georgia. However, if we sit down with people in Bibb County and listen to them, we can create a Bibb County plan that will be the best for them. So it's really being able to have one-on-one and multiple community conversations like we're having today to ensure that we find the best strategies forward for these neighborhoods that are impacted unjustly by it.

Jeff Galvin: Good point, one size doesn’t fit all. There should be some customization, but I think the core principle of the New York plan makes sense. That it is cheaper to help these people than it is to let this problem fester, and that is coming out in the stats. And I’m very glad to hear that it is continuing on the federal level to make that whole idea happen.

But another thing that occurred to me when you were talking about this, right, because you said, "Oh, real-time data about outbreaks, isn't that a privacy issue?" And then you lump that together with stigma, oh my gosh, you know, like I don't even like telling people what religion I come from, even though I'm not religious, you know, because everybody has an opinion on everything these days, unmoored in science, technology, or theology for that matter, but at the same time, they still have it. It's a gut reaction to stuff. How are we going to get people to just be out, just open about it like you are?

I mean, it's remarkable you're sitting here smiling and you look healthy and happy, and you know this is how everybody, everybody should have an opportunity for this. It's right in what was a Declaration of Independence, right? And so how do we.. it's sort of a balance thing. Is this a really tricky situation, or is it like, "Yeah, I know Jeff, it'll handle itself if we just, you know, if we build it, they will come," right? I don't know, what do you think?

Daniel Driffin: So, I'm laughing because last week were finals for me, and I recently took a public health ethical course. So, like ethics in real-time, and I had to write an essay on making HIV data and privacy issues make sense ethically, so your question brings up my final.

I think some of the things that we had to include is ensuring that there's multiple community stakeholders at the table leading the process, right? So oftentimes when we begin to have the conversation of data and security, the room does not look like people who look like me, right? The room is more maybe the friends of your age who are more entrenched in the science or more entrenched in the epidemiology of it all. But I think everyone should be at the table, you know. 

I think we have to have better communication on not only the importance of surveillance, or specifically with health, being that these things do go to our health departments just like passively, right? But I think our health departments also have to take the trip and leave from their locked doors and come back to the community and say this is some of the data that we receive as a result of laboratory monitoring across the state. As a result of having this data, this is what we're allowed to do as we are creating planning documents, as we're identifying additional resources to keep folks healthy living with HIV, but also to keep folks negative in their communities.

Jeff Galvin: Anything else you want to talk about before we wrap this up? This was really nice of you to spend this much time with me. Any other things on your mind you want to point out? Tell us where we can find your blog and your website and all that stuff.

Daniel Driffin: Yeah, I say I hide in public, so I'm on Facebook, I'm on Twitter under my full name, Daniel Driffin, but you know I actually think these conversations must continue. I think as we continue to drive towards a world without HIV, all communities need that. I think all communities have to be able to lead culturally towards that solution. As we continue to create solutions, ensure those people who will be using the products, who need the products the most, are there from the beginning. And I think that's the thing I would leave this afternoon with for sure.

Jeff Galvin: Look, I appreciate that input, and I also appreciate that we got into a conversation that was broader than HIV. 

Daniel Driffin: Absolutely.

Jeff Galvin: Because it doesn't matter whether it's a cure for cancer or the cure for HIV, and the cure for cancer is something that we hope the cure for HIV will be a stepping stone to, but we want to see the same thing for both of those. We want to see that the people who need it get it and that their background or their situations are not a limiting factor in terms of getting access to these things. There are the realities of where we are, and how long it takes to get to a better world, but focusing on that better world, and that really came across in this interview, is important, and it can be productive if you take it seriously, measure what's important, and it'll make a difference. So, yeah, thanks again for spending this time with us. 

Daniel Driffin: Absolutely appreciate it. 

Jeff Galvin: All right, take care. 

Daniel Driffin: Thank you.