For the last 25 years, Joe Interrante led Nashville CARES. In April, he stepped down as CEO, and by May he had worked his last days. Just before his successor arrived in Nashville, Interrante sat down with us to look back over his career.

For those readers who may not be aware of your history, can you tell us about how you first became involved in HIV education and advocacy?

I first got involved in 1983. The immediate reason for that was personal. I was living in Boston at that time and teaching. My former life, people may not know, is that I was a college teacher. I was involved in progressive politics and LGBT politics. Among other things, I worked on these magazines called Radical America, and Gay Community News... I was involved in helping to helped create the Boston Gay Oral History Project, things like that. And, doing some community organizing in the late ‘70s, when all that anti-gay stuff started emerging in response to the early victories of the gay movement."

In 1983, my partner at that time, Paul DiAngelo (we had been together for six years), was one of the first people diagnosed with AIDS in Boston. That was a time when the way you found out you had this disease was you got sick, because they hadn't identified a virus... It was simply the cluster of conditions, one or more of which gave you this diagnosis.

Paul decided to be public, and got involved with the group there that, like CARES, was a group of people trying to build some sort of response around community education and providing some support to people who were living with the disease. As he became involved in doing media stuff, I got involved with him around that. His progression from diagnosis to death was literally six months, which was not atypical at that time.

I stayed involved with what became the AIDS Action Committee of Boston. For me, along with a couple of other friends from Gay Community News, we approached it as community mobilizing and organizing. Because of my background, I started working on community education that that group was doing.

Two years later, when they had identified what they thought was the virus and had developed a test, I took it and tested positive in 1985. Quite frankly, I think I and other folks, were living 'as if' we were infected so it didn’t come as a surprise.  But there was absolutely nothing you could do with that knowledge when you had it.  No treatments to control the virus, not even any tests to monitor the virus.

Joe Interrante, photo courtesy of Nashville CARES

Some of my closest friends from graduate school were professors at Oberlin College.  I took a short term teaching position there. Slowly I tracked down the organization in Cleveland doing AIDS work and started volunteering with them. And then they made the fateful decision, I think it was '88, that a lot of organizations, CARES included, made to begin to hire staff. Because this issue, and the number of people who were being impacted, was just growing at too fast of a rate to be effectively managed strictly by volunteers. So I became their education department. And then a year later I became their executive director and was with them for seven to eight years.

What was the name of this organization?

It was called the Health Issues Task Force. Such was the nature of the issue at that point that they didn't have the "A-word” in the name, although they later became the AIDS Task Force of Greater Cleveland.

I think I was the third staff person - they had a receptionist and a director. Within a year, I built the education department into a team of four. We hired our first social workers to help to provide services to people who were living with the disease.

It was late 1993 when a notice for this job in Nashville, Tennessee came across my desk. It probably just hit at the right moment. After eight years, I was thinking that the Taskforce had gone through so many changes and growth, that it was perhaps time for this the organization to have new leadership. And I felt that maybe I was ready for a change.  So I sent in an application, and one thing led to another.

CARES had been founded in 1985, so it was eight years old at that point. There had been an initial run of candidates that they had reviewed, and there were some people in the gay community that who were concerned that there wasn't a candidate who was gay among the finalists. They were also concerned because one of the candidates was the person who was the head of the state AIDS program when just two years the state had eliminated anonymous testing, and made HIV reporting mandatory.

In any case, they reopened the process for a variety of reasons. And that's when I found out about it. I was, at that point, openly gay and, openly HIV positive. I think that my openness on both was both attractive, and also perhaps a little scary because of uncertainty among some about what that openness meant. So we went through an important dialogue about what that meant and didn't mean. And how change doesn’t happen because of one person but takes a team.

One of the things that surprised me, living with my own stereotypes, was that I felt that the level of community engagement around HIV as an issue in Nashville was better than what I was dealing with in Cleveland at that point. One of the things that I always credit is the involvement of the Ingram Company. They got involved, for example, in the discussions under then-Mayor Bredesen that led to the creation of an outpatient clinic, which we know as the Comprehensive Care Clinic, in part to avoid the kind of overwhelmed hospital ERs people saw on coastal cities... So I was surprised in very positive ways around that: I had to confront my own stereotypes about Nashville as “Music City, USA” and what that meant, and didn't mean.

For me, HIV/AIDS has always been a personal issue, obviously, as well as an issue of community mobilization. And I think we've seen success in mobilizing the community’s rise and fall at different points over the last 25 years.

Was there much resistance to having somebody from the outside come in?

No, I don't think so at all. I think, if anything, it was almost the opposite.  I think I needed to disabuse some people that suddenly the problems they thought were affecting CARES were going to be solved, because I was showing up, and I was who I was, and people having expectations about what that meant.

There had been a series of highly critical articles about CARES at that time in the gay paper called Xenogeny. I think CARES was not unusual, in that many AIDS organizations were in a process of trying to mainstream the issue and create an understanding that this wasn't just a gay disease, but something based on behavior that could impact anyone. That's a tricky issue to navigate, to make sure that you don't leave the gay community feeling that it's been marginalized. And I think that there were some people in the gay community here who felt that they had been marginalized as a result.

So suddenly, you know... Joe is openly positive and openly gay and is going to fix all of that. So, I had to disabuse people against falling into the trap of the “savior” complex, because that's a terrible and unfair burden to place on anybody. I watched that happen to the person who hired me in Cleveland, who they hired from Washington, DC, and lasted about a year, partly because of these expectations.

I was asked by a colleague who's also living with HIV, how important I felt it was that the director of CARES be gay or HIV positive. In 1994, it was important given some of the issues I’ve described, but now?  I think today CARES has a very clear understanding how HIV continues to be a gay issue and not a gay disease at the same time and a commitment to people with HIV as strategic partners in the work, as staff as well as clients. These are woven into who CARES is and how we do our work from the board to the front line of service delivery.  So you don’t need somebody in my position to be gay or HIV positive for those commitments to continue.

Joe Interrante, photo courtesy of Nashville CARES

So you've been in this role for 25 years... What are some of the sort of the big milestones, some of the biggest changes that you have been involved in or overseen?

I think the entire advocacy wing of what we do... that we really started doing that. And that took a formal discussion on the part of the Board to become proactively involved in advocacy work. That started in 1999. That is one thing that I would say probably more than anything else I specifically was involved in building in a real hands on way.

We started focusing on federal policy, because, at that time, Tennessee had no state funds that were used for HIV specifically. It was all federal dollars that came through the Department of Health and then went out to the community. State funding started in 2004. Between 2005 to and 2007, we moved into state policy as well.  That was when we started our state Advocacy Network to bring people throughout the state into working on state policy. So I say that that advocacy and TAAN, the Tennessee AIDS Advocacy Network, is certainly one milestone.

More recently, our strategic planning process, between 2012 and 2014, when we looked at what had happened in terms of developments around HIV and the tools that we had, including the fact that we now knew that treatment was prevention, and that PREP was effective as a biomedical prevention strategy. It was in that strategic planning process that we felt that we could say with honesty that ending the epidemic was an achievable goal.

We always had talked about being committed to ending AIDS, and working to put ourselves out of business.  But that's a long time in the future, even with the tools that we have now. Providing support to people living with the disease, so that they can maintain their success at remaining virally suppressed, doesn't end tomorrow, even if they discover a cure. But I think actually changing our mission was really significant because it changed the way we thought about why we were doing what we've been doing. And that made us really look at the services that we're providing, both in terms of prevention and support, and to consider what we really want to help the folks that we work with achieve, in order to move toward these goals.

Another milestone was the convening of a group of African American gay and bisexual men to create Brothers United in 1996.   Because of HIV reporting we had the data to show that this is was a growing epidemic within this community. And this was a community that was dually marginalized: it was invisible within the African American community, and it was invisible within the gay community.

We convened them together to figure out, in that context, what we needed to address their needs around HIV and other health issues. The group created Brothers United and we hired Dwayne Jenkins, who was one of that original group that came up with the concepts and the design, to manage and grow the program, I .think that was an important milestone.

There's actually a line that goes from the creation of Brothers United, and its expansion into the Brothers Network of Tennessee, through the strategic plan to the creation of My House. In our strategic plan, we wanted to create a place where medical care and services and prevention were integrated under one roof. We didn't want to do it all ourselves. So My House was the perfect expression of that, and the partnerships that we have that are helping to make that a reality. My House is managed by and its vision comes from African American gay bisexual men. Our long-term vision is that My House will be a place where any gay men in Nashville, regardless of background, can address their health needs, and their education needs.

The final milestone was mobilizing the Mayor's Office and the leadership in the Public Health Department, to convene a group that created a plan for Nashville as a whole to end the epidemic in Davidson County...  I think it was a logical extension, of our strategic plan. We have had a lot of success, but there's only so far you can go within the bounds of your own agency, even if we are serving the largest number of people impacted by the disease. So it was necessary for us to go outside of CARES to achieve that. And I think that what I'm particularly proud about is that we were able to mobilize the political and public health leadership of the city to drive this process. There are lots of places that have worked on plans like ours that have not taken that approach. They've had to then go back and try to engage that leadership. But we did it from the beginning.

What are some of the things that you had hoped to achieve that maybe are still on the table, or that you see as opportunities for future growth?

One of the things that we worked on over the last couple of years, and I think a lot of organizations are challenged by this, is that the population of people living with HIV is aging. You know, 25% of the people who are living with HIV, and clients of CARES, are over the age of 50, or 55. That's because of success: people living longer, that's a good thing! But the nature of this disease is that with every advance or success, a whole bunch of other issues also open up.

Aging issues and HIV tend to intersect with one another in a way that makes the sum is greater than the parts... HIV tends to accentuate, or speed up, the onset of certain geriatric medical conditions. I also think the population of older adults living with HIV is different than the general senior population in Nashville.  For example, something like twice as many older adults with HIV live in single households than the senior population in Nashville as a whole.

We had put together what I thought was a great concept, to mobilize a portion of the older adults who are living with HIV, to work with us to identify what the services are that they need, rather than to have us guess. We have three social workers who are working on elder issues, in part to understand the kinds of system of senior services that exists in Nashville, so they can help clients link into what they need. But given the uniqueness of that population, I think that there's an entire list of psychosocial, emotional, and material issues that we need to think about.

Some organizations that are a little further ahead on the curve on this issue, like Gay Men's Health Crisis in New York, have gone back to some of the first programs they had, like the Buddy Program. And they revived it with a specific intention of providing that type of practical and emotional support and cutting down on the isolation of this population. I would like to see that kind thing. We've had made a couple of unsuccessful attempts to find the funding to help to do that. I hope CARES continues to work on that, and hopefully the organization will move forward with it.

From an advocacy point of view, I hope CARES will continue to work on reforming the HIV criminal exposure laws in Tennessee. Tennessee has two laws and they're both horrible. They do nothing toward helping to end the epidemic.  Sensationalist mainstream media accounts play into stigmatizing notions, presenting people with HIV as irresponsible, as predators, and all this other stuff which is completely untrue, of course. We know from CDC studies that these laws actually provide incentives for people not to be tested, because if you don't know you are positive you can't be convicted for not disclosing it.

We've been working for a number of years, but as things happen with legislation, there's a slow process of needing to educate the stakeholders around this. And this issue, in particular, it's not a simple one to get people beyond the stereotypes that they have that drive these kinds of laws. That has been a priority issue, and I hope will remain a priority issue for the next folks, both the CEO and the policy director, to work on.

Finally, creating the body that is going to oversee actual implementation of Nashville’s end the epidemic plan, so we avoid the pitfall of simply creating a study that looks nice sitting on a shelf and gathering dust. I think everyone in this community is committed to that not happening. And I know that the Mayor's Office is working slowly to put together a group that can do that.

You're stepping aside as CEO of CARES, but you're not leaving, so what are your plans?

Well, my immediate plan is that I have a whole bunch of personal items that have been on hold that I need to take care of, things that I should have done a while ago, but I haven't. So it's time to do them!

I need to get into a rhythm of a new schedule, obviously, and decide what I want to do. Before I got involved in doing AIDS work, as a historian, one of the things I was really involved in was LGBT history. There was a whole network of historians on the East Coast in the '70s that I was part of... maybe I'll do a little bit of that? John Bridges is very involved in it. And we've actually had conversations around some of the stuff that he's doing, around identifying landmarks and other sorts of things. It's certainly an interest of mine. Now that I have the time I’d like to read some of the oral histories at the Public Library that the Brooks Fund collected.

I need to make sure that I separate myself from CARES, because you need to give the new leadership at an organization the time to make the team their own. So I will remove myself even from volunteer work with CARES, which will be intentional, and not because I don't care, not because I have any issues, but because I think that's what you need to do.  I think that Amna Osman is a great successor, and will bring experiences and skills that I think are exactly what the organization needs at this point.

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