CHIGAGO FIRE

Chicago Mayor Lori Lightfoot introduces Black Pumas during day one of the 30th anniversary of Lollapalooza at Grant Park in July of 2021

WINDY WINDY CITY CITY WIN WIN

MAYOR LORI LIGHTFOOT

BY NEAL BROVERMAN

With gun violence a stubborn problem and COVID still wreaking havoc on businesses and public health, Chicago got some much-needed good news this fall — a new report indicated that, in 2020, HIV diagnoses dropped to their lowest reported rates since 1987. While o cials with the Chicago Department of Public Health urged caution regarding the data since COVID may have caused some underreporting in HIV cases, the report still signified a victory for the city’s nearly 40-year battle with the virus. “What is really exciting is that decreases are seen across all races, ethnicities, across age groups as well, and genders,” Dr. Irina Tabidze, director of program operations for the CDPH’s Infectious Disease Bureau, said in October.

We recently connected with Lori Lightfoot — the first Black lesbian elected mayor of any major U.S. city and Chicago’s first Black female mayor — to discuss the city’s recent success, what still needs to be done, and how cities can address the disproportionate rate of HIV in some communities.

Former Chicago mayor Richard M. Daley (left) and Mayor Lori Lightfoot leave the funeral service for Chicago police o cer Ella French in August 2021

How has Chicago brought down HIV transmissions so significantly?

We have an opportunity in our grasp to effectively end the HIV epidemic in our lifetimes, and Chicago is committed to reaching that goal.

We’ve seen real progress in recent years because we’ve worked hand-in-hand with members of the community, health care providers, and community organizations to implement programs and services that help accelerate progress toward ending HIV. And, we pull from our history: today’s successes are built upon decades of compassionate service, advocacy, and collaboration.

For example, following a two-year planning process that engaged hundreds of residents, Chicago restructured our entire HIV services portfolio in 2019. We adopted a statusneutral approach, meaning that the services and supports that had previously only been available for people living with HIV would be available to people vulnerable to HIV, as well. We bundled services so people living with HIV and people vulnerable to HIV can access testing, medical care, case management, behavioral health services, and more, all through a single access point. We took on systemic and structural barriers preventing people from accessing or fully benefiting from services by creating programs that hadn’t existed before, like housing for residents who use pre-exposure prophylaxis [PrEP]. These e orts are making an important di erence in how we’re able to deliver care to people.

One of the many Chicago Department of Public Health [CDPH]-led strategic investments is in Population Centered Health Homes [PCHH]. PCHH provides cohesive, comprehensive, and integrated clinical and essential supportive services for both persons living with and vulnerable to HIV. They also provide HIV screening, access to antiretroviral medications and to PrEP, primary medical care, behavioral health care, and supportive services. CDPH funds 12 community-based agencies to implement PCHH not only in the City of Chicago but throughout suburban Cook County and eight-collar counties.

In 2020, PCHH served a total of 14,611 people living with HIV. PCHH works — for instance, 61 percent of all Chicagoans living with HIV were virally suppressed in 2020, but among people connected to a PCHH, more than 90 percent were virally suppressed.

What challenges remain?

The public health challenges we face are borne of more than a century of systemic racism that has disadvantaged Black, brown, and other minority members of our communities. In 2020, HIV diagnoses were down for Black Chicagoans, white Chicagoans, and Latinx Chicagoans of all ages. But of those new cases, more than half occurred in Black Chicagoans — and we’re seeing a similar racial disparity with STIs, such as chlamydia, gonorrhea, and syphilis. We must reduce the gap in new diagnoses between Black and Latinx Chicagoans and white Chicagoans, and, at the same time, reduce the gap in HIV viral suppression between white and Black and white and Latinx residents.

Another challenge we face is the availability of safe, stable housing for people vulnerable to HIV. Housing Opportunities for People with HIV provides supportive housing for people living with HIV, but there are not enough units to meet the need. For HIV-negative persons, options are even more limited. To help address this, we created a new program — Housing Opportunities for Persons Vulnerable to HIV, which has shown incredible success but more must be done. How pervasive is an anti-HIV stigma in Chicago? HIV stigma exists in Chicago like it does in every city across the globe. We are committed to working hand-inhand with community to reduce stigma. For example, Chicago proudly supports the national Undetectable equals Untransmittable [U=U] campaign. U=U means that persons living with HIV cannot transmit HIV to their sexual partners when they’re durably virally suppressed. We also implement a status-neutral portfolio of services. Status-neutral services lead with what people need, like medical care, mental health care, and housing, rather than a person’s HIV status. This helps destigmatize status and promotes access to and use of services that can help people stay healthy.

What can be done to change the disproportionate e ect of HIV on African Americans?

CDPH is committed to following the HIV epidemic, and, in Chicago, that means our programs and services must prioritize Black residents. And, they do. For example, among all CDPH-funded PCHH, 56 percent of clients living with HIV are Black and, among CDPH-funded housing programs, a majority of clients are Black. Once people reach our programs, we work with our partners to ensure they receive the services they want and need, including medical and behavioral health care and supportive services, including housing and emergency financial assistance. We also fund programs that work to change racist systems and structures to create pathways to employment and wealth generation, education, and safety. Beyond current programming, we routinely engage residents, including Black residents, to learn of emerging or unmet needs, so we can adapt or supplement programs to help meet these needs.

Does being a member of the LGBTQ+ community give you a different perspective on HIV or mpox?

I first came to Chicago in the mid-1980s to attend law school, and it was during this time when I embraced my identity and came out. I have many fond and beautiful memories of finding my place among Chicago’s LGBTQ+ community and feeling a sense of belonging for the first time in my life. But I also have horrific memories from those days when I had feelings of helplessness as I watched the federal government ignore the AIDS crisis and let gay men die with no recognition or support.

This experience deepened my commitment to eradicating the HIV epidemic with a focus on equity and dignity. For as long as I am a leader, we will never go back to those days of ignorance, neglect, and vitriol. Rather we are stalwart fighters, making resources, medicines, and education widely available for everyone and especially for communities hardest hit by HIV.

Former President Barack Obama greets Lightfoot at the groundbreaking ceremony for the Obama Presidential Center at Jackson Park in September of 2021