Where Race, Disparity, and Pandemic Collide: COVID-19 USA

Podcast by Oni Blackstock

By Blackstem - Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=89460901
By Blackstem – Own work, CC BY-SA 4.0

On today’s podcast, EIC Brandy Schillace interviews Dr. Oni Blackstock, Assistant Commissioner for the NYC Health Department’s Bureau of HIV. Dr. Blackstock is also a primary care and HIV doctor, as well as a researcher focused on the experiences of women and people of colour in healthcare. Dr. Blackstock joins us to speak about social justice, Black Lives Matter, LGBTQ+ rights and the way the COVID-19 crisis has unequally affected marginalized communities.

As death tolls and infection rates climb (even while states reopen), US COVID-19 response can look both hopeless and horrific. But on the ground, health providers—and especially those organizations that listen to and work with at risk communities—are taking strides to stem the pandemic and mitigate its consequences. What happens, for instance, to the HIV patient (and once again, the disparity of race and economic status is clear) cannot get to appointments? Or loses a job and cannot afford medications? Dr. Blackstock describes her response, the growth of tele-services, and her own experiences as a front-line physician in Harlem, NYC. Join us for an incredibly powerful discussion of where health, race, and disparity collide in the midst of pandemic in the US.

Listen to the podcast on Soundcloud.


Dr. Oni Blackstock is Assistant Commissioner for the NYC Health Department’s Bureau of HIV where she oversees the city’s response to ending to the HIV epidemic. She is a primary care and HIV doctor as well as a researcher. Her work is focused on the experiences of women and people of colour in healthcare and she is an advocate for LGBTQ+ rights. During the COVID-19 pandemic, she has been advising on sexual health to slow the spread of coronavirus disease. Her Twitter handle is @DrOniBee.



BRANDY SCHILLACE: Hello, and welcome back to the Medical Humanities podcast. We’re really excited today because I’m going to be speaking with Dr. Oni Blackstock. Dr. Blackstock is Assistant Commissioner for the New York City Health Department’s Bureau of HIV, where she oversees the city’s response to ending the HIV pandemic. She’s also a primary care and HIV doctor, as well as a researcher, and her work is focused on the experiences of women and people of color in healthcare. She’s also an advocate for LGBTQ+ rights. And during the COVID panic, she’s been advising on sexual health to slow the spread of coronavirus disease. I’m excited to have her with us, partly because here in the United States, we’re seeing an incredible rise in the outbreak of COVID-19. And our responses are somewhat mitigated by problems around the different states and with different laws and the way that leadership has been handled. So, I wanted to bring her on today to talk a little bit about what it’s like on the ground, particularly in New York. Welcome, Dr. Oni Blackstock.

BLACKSTOCK: Thanks so much for having me.

BRANDY: I wonder if you could start off by giving our listeners a little bit of information about yourself. I’m familiar with your work and deeply impressed by the things that you do. But I know some of our listeners are in the UK and places around the globe, and I just wonder if you could say a few words about what you’ve done in the past and how that is informing what you do today.

BLACKSTOCK: So, the past several years, I have served as Assistant Commissioner at the New York City Health Department for its Bureau of HIV, where I’ve led the city’s response to ending the HIV epidemic. And what that entails is really collecting a lot of HIV surveillance data so that we can track the progress that we’re making and supporting both community-based clinical and non-clinical organizations in providing HIV prevention and treatment services. Additionally, as we’ve dealt with the pandemic, we’ve supported organizations in pivoting to telehealth. And then we’ve also developed guidance as well for people living with HIV and also just for the general public around sexual health and COVID-19. And we’ve also switched some of our really popular programs, such as HIV home testing and our condom program to be able to deliver to individuals’ homes. So, we’ve really tried to innovate as this pandemic has evolved.

BRANDY: That’s really interesting. And I think something else to mention here, which not too long ago, I was interviewed, and I was asked about what are the historical antecedents for the current crisis? And I had talked about the pandemic flu, the 1918 flu for obvious reasons, because it kind of, some of the symptoms and also some of the spread is similar. But, of course, we’ve been dealing with epidemics much, much more recently in time, and HIV is one of them. How would you compare both the relevance, the kind of the way people are aware of HIV versus how they are aware of COVID and response times?

BLACKSTOCK: So, with the HIV epidemic, particularly, I’ll speak to the epidemic here in New York City, in the United States, I think that people will see a number of parallels between sort of the federal government’s response to HIV and what we’ve seen with COVID-19. And that has created, I think, a lot of anxiety for folks who’ve survived the AIDS epidemic and seeing the government sort of at large’s response as inadequate or delayed. I think also when we look at what groups are most impacted, similarly with the HIV epidemic, initially it started out as I think primarily people thought it affected white gay men. Actually, we knew that people of color, Black people in particular, were affected early on, but that wasn’t in the news. But as the epidemic has evolved, similar to the COVID-19 pandemic, we’ve seen increasing racial/ethnic inequities in who is impacted.

BRANDY: Right.

BLACKSTOCK: So, I think just like with any epidemic, we often say that epidemics track along the margins of society. And so, we see that the most vulnerable groups are affected.

BRANDY: Right. And here at Medical Humanities for BMJ, we’re very much focused on social justice. This is one of the things that we try to bring to the conversation about intersections between health and humanity. And of course, this is a social justice crisis because as you point out, it always, whenever you have these kinds of afflictions, you had people claiming, “Oh, I’m upset because I can’t go get my haircut.” But that’s not thinking about the people who are forced to work through the pandemic because they don’t have a choice, and therefore, they’re put at greater risk. They have to make a choice between paying the rent and exposing themselves to disease. So, I just wonder, in social justice terms, how are we to grapple with something like this? I think some people are just realizing that there’s disparity for the first time!

BLACKSTOCK: Mmhmm. Yes. No, I agree. I often think of it as like the COVID-19 cascade. So, in HIV, we have a similar sort of treatment or engagement cascade. And so, with COVID-19, I think about first, you know, exposure, right? How do people to decrease their risk of exposure? We don’t have a vaccine yet. So, if people are able to work from home that, and able to socially distance, that helps. But we know a lot of our frontline workers here are not able to do that. We have very small numbers of people in particular who are Black and Latinx who are in jobs that allow them to work from home. The vast majority are not able to do that. So, in terms of preventing exposure, that’s very challenging to do. And then when you go to think about when people are concerned they have been exposed, can they get tested? There’s data that shows that Black people who were presenting for testing for COVID-19 were less likely to receive a test compared to white patients.


BLACKSTOCK: And then you think about what is the risk of severe illness when someone does have COVID-19? And we know that the prevalence of lots of chronic medical conditions, such as chronic lung disease, heart disease, high blood pressure, that those conditions have a greater prevalence among people of color, primarily Black people. And a lot of that has to do with, in part, lack of access to quality care. And also the chronic sort of stress of racism that has a direct impact on one’s health.

BRANDY: Yes. Yes, That just reminds me, I remember with women’s health, I was doing some work with birth and death rates and infant mortality and maternal mortality and how racism radically skews the numbers so that Black women are at much, much greater risk. And I think there’s invisible privilege. I am a person who typically scans as white. I’m also a mixture of things. But we just have these privileges. We don’t see the racism that’s eating away and that’s constantly going on in the background in everyone else’s lives. And so, I do think that some, it seems to me that some of the response to COVID, particularly the angry—I hate to say this—but the angry white response is people are unhappy that they’re suddenly aware of these disparities. It’s almost like we don’t want to be forced to acknowledge these disparities. When I think that is maybe the most critical thing that could come out of this.

BLACKSTOCK: Yes. No, I agree. I do think for many people, as you mentioned, they are now becoming aware of these striking inequities that exist. But I think, in large part, some of the protests that we’ve seen in other parts of the country have really been because for the first time, many people don’t have the freedom that they’ve had before to be able to be out in the world, sort of uninfringed upon.

BRANDY: Mmhmm.

BLACKSTOCK: Whereas when we look at Black communities, Latino communities, these are heavily policed communities.

BRANDY: Right.

BLACKSTOCK: People are used to not having the freedom to move around.

BRANDY: Right!

BLACKSTOCK: So, I think that is a large part of these protests. And I do hope that it is the start of a really authentic, candid discussion about what we need to do to address the inequities that we’re seeing.

BRANDY: Absolutely. And I want to talk briefly about Black Lives Matter and the protests that we’re seeing, not just the United States, but around the world and how and why those protests following coronavirus are important.

BLACKSTOCK: Yes, I mean, I think, you know, it’s interesting. The Black Lives Matter movement started I think back in 2014 during the Obama administration. But I think just with people seeing the disproportionate impact that this pandemic has had on Black communities in particular, and then people are losing their jobs. People are losing their health insurance. I think people are sort of realizing just the uncertainty and instability. We’re seeing these large corporations that are bailed out while people are suffering.


BLACKSTOCK: And I think people are really waking up to these realities. And then obviously, in rapid succession and killing of Black people, either by the police or people who have been deputized to be sort of community police.


BLACKSTOCK: That has, I think the coalescence of all of those things has really brought Black Lives Matter back out really to really the, and reintroduced it to the public, to many people who weren’t involved in the movement. And I think people are really coming together and unifying and really seeing that it’s not just, it’s Black lives matter, but that, you know, sort of white supremacy culture really affects everyone. It’s associated with transphobia, homophobia, sexism. It’s linked to a lot of, the studies of oppression that really impact almost everybody.

BRANDY: And Black trans people are one of the highest risk categories, both health wise and from police brutality, am I right in assuming that?

BLACKSTOCK: Yeah. So, Black transgender women in particular, there is data to suggest that life expectancy is early 30s for Black trans women in the United States. And there’s been—I don’t know if this is anything new, but—Black trans women and trans women in particular tend to be victims of gender-based violence. And so, even just over the weekend, which you may or may not be aware, there was a huge Trans Lives Matter gathering here in New York City, that was like thousands and thousands of people really showing their support for the trans community, particularly Black trans women, who I would say are very marginalized, are not protected. And so, I’m really hoping that people, you know, people are really focusing really on the health and well-being of trans women, Black trans women, and that we’re starting to see a change.

BRANDY: I think for those of us who are in the United States, we’ve been living with these, what I would say, horrors for a long time, right? We have no socialized medicine. There’s not a safety net. The 1 percent has most of the resources. We know these things. We grow up with these things. But for people out in the rest of the world, some of these features of the United States are suddenly writ large, right? It’s really, really obvious. And the incredibly high numbers of infection cases and death tolls in the United States has kind of driven this home through coronavirus. And I read an article not too long ago kind of saying America seems to have given up on the virus and on trying to contain it. And so, I would like to hear, because I know you’re deeply invested and involved in trying to help stop the spread and also that your commitment to helping people of color and also LGBTQ community to show people that actually, individuals in the United States care very much and are trying really hard to address these issues. And since you’re in New York City, I wonder, can you say a bit about how this is attempting to be changed, contained? How can we flip the script, and how can we show people that, in fact, the American people at least are very much interested in trying to change what’s happening in the United States?

BLACKSTOCK: Yeah. So, the York City Health Department, where I work, has a lot of expertise in contact tracing, for instance, for infectious diseases. So, we are helping to support our public hospital system in a very expansive trace, test, and treat initiative. And so, we are very much invested in this work, and we are providing a lot of support and particularly, prioritizing and using an equity lens to do this work in the community: so, working with community-based organizations that are really on the front lines that can tailor messaging to their specific communities and make it really digestible and accessible. So, we are getting feedback from a community advisory board of members from community-based organizations throughout the city to help inform how we are really carrying out this trace initiative. And we’re also prioritizing certain neighborhoods, neighborhoods that we know have been disproportionately impacted, Black and Latino neighborhoods for testing. And so that we are really trying to address a lot of the inequities that we have seen result from this pandemic.

Also, in my role as Assistant Commissioner, I’m doing a number of panels and webinars to talk to people specifically around, for instance, the intersection of COVID-19 and HIV. You know, people living with HIV are experiencing a lot of anxiety, wanting to know, does having HIV put me at increased risk? Do I need to do something different? And we’re slowly finding out from our data that it looks like people living with HIV are not over-represented among cases of COVID-19. So, they’re similarly represented as they are, among the cases, as they are among the general population. However, there may be differences in outcomes. So, we’re really sort of digging deeper and trying to understand what’s going on. And we are really privileged to have the robust data to be able to communicate that to community.

And then also how this is impacting LGBTQ folks. We know that people who are queer-identifying and trans-identifying are already at the margins in terms of experiencing economic disparities. Many, many folks who are LGBTQ are in the service industries that were most likely either to be front line or to be laying people off. So, people have been doubly- and triply-impacted by this pandemic. And really being able to share this information and also share resources with community.

BRANDY: And I think that’s another point to make. We just had a really excellent SCOTUS—Supreme Court—victory, which now extends the fact that you cannot just fire someone because they’re LGBTQ. And on one hand, I celebrate that. On the other hand, it’s 2020, you know. We just seem so backward in so many ways in this country in terms of the rights of minorities and of basically anyone who doesn’t sort of scan as white majority. And so, how do you feel about that? How do you think, I mean, going forward, some people were saying, “Oh, I wish things would get back to normal.”


BRANDY: And I was just speaking to Alice Wong in a previous podcast. And she said, normal wasn’t good. [laughs]

BLACKSTOCK: Yes, agreed. As I mentioned, Black communities had already been used to being overpoliced. And so, what’s going on now probably isn’t a huge change in terms of the stressors that many were experiencing. Not to say it’s any easier, but yeah, no, many people were fine with the old normal because they weren’t really being impacted by any of the inequities that we have. But now I think what’s interesting, you know, in addition to people’s freedom being infringed upon, many people from various walks of life are being directly impacted by the pandemic and losing their jobs. And I think people are realizing we have no safety net! There’s not a huge safety net, right.

BRANDY: Right. Surprise! [chuckles]

BLACKSTOCK: And although, when you look to other countries, particularly in Europe, that do have a safety net system. And so that when you lose your job, you’re not devastated, that you do have support from the government. So, people are seeing this and really demanding more, and more accountability. And as we see funds going to big businesses as opposed to individual families, communities, to small businesses, people are being understandably outraged. And obviously, folks who, you know, you mentioned Alice Wong, who I know is a big advocate in the space of people with different abilities, I think this is a time where people are really listening to the voices of people who are from the most marginalized communities. And we need to continue to elevate and amplify their voices and also to support organizations that are on the front lines of providing services to many these communities.

So, at the Health Department, for instance, my bureau supports transgender and gender-nonconforming-led to grassroots organizations. So, we support them in building their foundation and helping them to expand services. And this is huge because many of these organizations provide employment to people who are trans and gender-nonconforming. We know that trans women often have to, many, many have to resort to sex work or exchange sex in order to support themselves. So, we’re helping to provide employment opportunities and also really culturally-responsive services for people with trans experience.

BRANDY: One of the points that we make frequently here at MH is that it’s not enough to hear about communities. It’s important to hear from them. And so, one of the other reasons that I’m really excited that we can talk to you today is that you are living in a community that is deeply impacted. Can you say a few words about your own personal experience in the middle of all of this, as someone who works in health and is yourself in many ways on the front lines? Can you say a little bit about your experience?

BLACKSTOCK: Right. Yes, so, I live in Harlem, which many people who are listening probably have heard of or have heard of the Harlem Renaissance. And so, this is a community that is very much in transition. We’ve had people living here who’ve lived here for generations, who primarily identify as Black. And then we have newer members of the community, as the neighborhood is being gentrified who are more affluent and white. So, we sort of have that dynamic going on. And I have the good fortune to be able to see patients at Harlem Hospital where I work in the HIV clinic there. So, it’s really exciting. I get to bump into my patients on the street. And so, during the pandemic, I’ve actually been doing tele-visits. All that to say is, so many of my patients have lost their jobs. Many of them who’ve not lost their jobs are front line workers where they’ve had to, during the peak of the pandemic, had to continue working. Many who already struggled with taking their HIV medications are now struggling even more. So, this has, I think this has been really challenging. We’ve had to be more creative in some ways. I get to talk to my patients actually more often because I need to check in on them and remind them and see how they’re doing and see if they actually need to come to clinic to be examined. So, in some ways, I feel almost more intimacy and more closeness with them. But also, you know, I think it’s this situation of sheltering in place has made it challenging for people who are already marginalized or are having difficulty accessing services. Yeah.

BRANDY: Right. And then there’s families, people who have children, which makes it much more complicated as well.

BLACKSTOCK: Exactly, right. With schools closed, having to find family members or friends to take care of your children. And here in New York City, we did have, for frontline workers, the City did set up childcare for frontline workers’ children. So, that has been a huge support for many. But, of course, people are still concerned, obviously, bringing their children out in the middle of this. So, I think it’s been challenging for everyone, I think particularly people who don’t have a lot of resources.

BRANDY: Mmhmm. Right. And that, I think, is one of the most upsetting things and one of the things that seems to shock my colleagues around the world when they look back at America is that the U.S. seems to have so many resources, and yet the average person often has very few resources. And so, there’s a real disparity in terms of who has and who doesn’t have in this country, which I think COVID has really brought to the fore. And as a result, we’re seeing these kinds of responses, which it’s not…. Protests are a useful thing, I think. And it’s good to see them because we’re finally hearing voices, as you say, that often get ignored.

And so, any final words for us before we sign off today?

BLACKSTOCK: I would just say to the listeners to continue to really amplify voices from folks who are marginalized and to support organizations that really sort of advocate for the rights of people who are often marginalized in their respective communities. I think this is like a global movement, and we’ve seen people in almost every single country on the globe be part of it.

BRANDY: Mmhmm.

BLACKSTOCK: And this is really a time to, I think, harness all of this goodwill and desire for change into something different. We don’t have to go back to the old normal, and that we can make a new normal that is much more equitable for everyone.

BRANDY: Right. Right. And though many of the protests have centered around George Ferguson, I think the point is to remember that all of these people have names and that all of them should be remembered as leading to this moment of change, if indeed this is a moment of change. They are all martyrs to that cause, and I think unwilling martyrs to that cause—

BLACKSTOCK: Exactly. Agreed.

BRANDY: —but should be remembered and lifted up as a result.

Thank you so much for joining us, Dr. Oni Blackstock. Again, please, listeners, don’t forget that we do have transcripts available. You can reach them from our blog, which will contain a summary as well as a link to this podcast. Thank you again for joining us, and as always, for being part of the conversation.

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