New AIDS Chief Stresses Prevention

New AIDS Chief Stresses Prevention

Dr. Scott Kellerman drawn to NYC by Commissioner Thomas Frieden’s leadership

Three weeks before Dr. Scott E. Kellerman joined the city’s Department of Health and Mental Hygiene, Dr. Thomas R. Frieden, the health commissioner, announced the case of a gay man who was infected with multi-drug resistant HIV and had rapidly progressed to AIDS.

Kellerman, the assistant commissioner for HIV/AIDS Services, heads the bureau that is investigating the case though that work began before his March 3 start date.

Frieden’s announcement was controversial. The department has not found any other cases so it remains a hot topic. Kellerman was pressed on that point during an April 3 panel discussion about the press coverage of that announcement.

“Personally, I think that Tom Frieden did a good job of it,” he said. “I think that the health department did a good job of it.”

The panel, which was sponsored by the National Lesbian and Gay Journalists Association and Gay City News, was sparsely attended so it was not a trial by fire for Kellerman. It was more like a small taste of what life in the public eye in New York City can be like.

Kellerman’s bureau, with a staff of roughly 230 and a $220 million annual budget, oversees the cash that funds many services for people with AIDS, the city’s HIV prevention efforts, AIDS policy and the surveillance and epidemiology of HIV in the city. Dozens of AIDS groups are funded by his bureau.

Kellerman, 42, was born in Connecticut and lived in the Bronx until he was six when his family moved to Florida. He earned his medical degree from the University of South Florida and, after taking a job at the Centers for Disease Control and Prevention (CDC) in 1994, he received a master’s in public health from Emory University.

“I kind of like the idea of public health,” Kellerman said. “I never really saw myself as someone who would hang up a shingle and just see patients. I wanted to think a little bit broader than that.”

He worked at the federal agency for the past ten years with the last five in HIV programs. He spent time working on AIDS issues in Africa and India during his time at the CDC, but his return to New York gets him closer to the fight against AIDS here in the U.S.

“Over the years it became obvious to me that if I was really going to make an impact on [HIV] transmission rates that I’d have to get back to work at the local level,” Kellerman said. “You gotta come to where it’s actually happening. In terms of actually decreasing transmission, it’s really hard to do at the federal level.”

The CDC has experienced a staff exodus prompted by budget cuts, “the upheaval of a drawn-out restructuring” and “concerns about political interference,” according to a March 6 Washington Post article.

All Kellerman would say about that was, “CDC is a federal agency and reflects the administration.”

Kellerman, who is gay, said he came to New York City to work for Frieden, but has arrived roughly six months before the next mayoral election. Mayor Michael R. Bloomberg, who appointed Frieden, may not be the mayor come January 1.

“Tom Frieden has more energy and more vision than anyone I’ve ever worked for before,” Kellerman said. “Pretty much he’s why I’m here. I’d like to think that, whether it’s Bloomberg or someone else, they’re going to recognize the talent that he is and we’ll keep going on.”

Kellerman’s marching orders from Frieden are broad.

“He tends to talk big,” Kellerman said of Frieden. “He’s like, ‘Let’s stop transmission of HIV in New York City.’ I said, ‘Tom, how are you going to evaluate me on that?’ He said ‘Well, if transmission stops.’”

Kellerman’s bureau will also be assessing if the money it spends is producing results. The health department is building an internal effort to measure the performance of its contractors.

“We’re definitely focusing on that,” Kellerman said. “We’re creating an outcomes evaluation team within the bureau to really start thinking about if we spend ten million dollars on X after a year or two or three what did we get out of it? Did it really go to the goal of decreasing transmission?”

While Kellerman said that most of the city’s HIV prevention dollars are being spent by “good, kind, thoughtful folks” the time may have come for “non-traditional” strategies.

“I don’t know what that means yet, but I’m really going to be thinking about what that means over the next six months or so,” he said. “We’re 20 years into this thing. We’ve spent hundreds of millions of dollars in this town alone on traditional prevention efforts and we’re still dealing with 4,000 new diagnoses in this town alone.”

One traditional response is more HIV testing. The department is using the rapid HIV test, which delivers results in 20 to 30 minutes, in its clinics and funding the use of that test by contractors receiving city funds.

The department lags in capturing data about which populations may be seeing increases or decreases in new infections. Doctors and other providers who diagnose those infections are capturing data on age, race, sex and borough, but data on patients’ sex lives, sex partners or drug use is often missing.

“You’re never going to have 100 percent reporting for every variable on every person who is newly infected or newly diagnosed, but we do a pretty good job,” Kellerman said. “Are there places where we need to rethink our approaches? Absolutely. We are catching the new diagnoses as they occur and we’re getting the basic demographics on those folks.”

Indeed, while Kellerman said that new HIV infections were increasing among gay men though he could not say if that was true in New York City.

“I think we’re seeing a resurgence of HIV in the gay community,” he said. “Personally, what I think is going on is we’re going back to powder drugs. The community is going back to powder drugs and crystal in particular.”