While the Nashville community-at-large recognizes Joseph Interrante as the CEO of Nashville CARES, Tennessee’s largest HIV/AIDS service organization, providing services for more than 60,000 Middle Tennessee residents infected and affected by HIV/AIDS, his resume is a long list of LGBT advocacy dating back to the year he came out in 1976.

From working with the editorial collectives at Radical America and Gay Community News, helping to found the Boston Gay and Lesbian Oral History Project and attending the 1979 March on Washington, Interrante says “AIDS work was a logical extension of these activities.”

Out & About Nashville chatted with Interrante, in advance of his HRC Equality Award, about his two-decade tenure at Nashville CARES, the organization’s future plans and what the LGBT community needs to in a new generation of HIV/AIDS. 

Out & About Nashville: You are not only HIV-positive yourself but have personally cared for your partner, who passed away in 2012- when did you know that HIV/AIDS was your life’s work?

Joseph Interrante: Actually that occurred in two “stages” beginning in 1983, when my first life partner was one of the first diagnosed cases of AIDS in Boston. During the six months between his diagnosis and death, Paul became involved with the AIDS group that was forming at that time and I became involved with him. That experience left me with a commitment to AIDS work, which I continued on a volunteer basis for five years in Boston and then, Cleveland, Ohio.

The second “stage” came in 1988 when I was volunteering with the AIDS group in Cleveland as a board member coordinating community education. The organization decided to hire its first program staff, so I joined the agency as its HIV educator and became Executive Director the following year. I held that position from 1989 to 1994 when I came to CARES. I met Sandy in Ohio in 1987, and we were together for 25 years until he died in 2012.

O&AN: You joined the staff at Nashville CARES in 1994. Can you share the background on coming to CARES?

JI: I came to CARES to take the job as Executive Director, now CEO. Those were somewhat tumultuous times for CARES, I later learned, due to some dissatisfaction in parts of the gay community with the search process that was underway.

I learned about the job opportunity in the second stage of that search process. I was very impressed with the scope of CARES’ work at the time and what CARES was trying to accomplish. I was equally impressed with the level of engagement with HIV by the Nashville community-at-large. I brought experience as an openly gay man and person living with HIV who had led a comparable organization through a significant process of growth and diversification. Obviously it turned out to be a good fit, and I’ve never regretted my decision to join CARES.

O&AN: Surely, there have been climates changes between 1994 and 2014 in not only CARES but also the community? Can you talk a bit about your time at CARES?

JI: The most significant change has been the introduction of protease inhibitors and combination therapy in the mid 1990s along with the subsequent refinements in treatment. It fundamentally changed the meaning of part of CARES mission.

In CARES’ first decade, when AIDS had a 70-75% mortality rate, “improving the quality of life for people with HIV/AIDS” basically meant helping people die with dignity, knowing that they were loved and not alone. With combo therapy, it started to mean helping people really to live with HIV, for an open-ended number of years. That promise of living has a lot of contingencies—the high level of adherence needed for treatment success is not accomplished easily or simply, especially if you’re dealing with any material or psychological survival needs—but it started a strategic realignment in CARES’ work.

I would caution that this change in mission was more an expansion than a “shift,” since Sandy’s death in 2012 reminded me that, for some people with HIV/AIDS, we can still in the end only help them die knowing they are loved and not alone. Fortunately that is a much smaller number of individuals, but it is still an important part of what we do.

With the more recent science documenting that treatment is also prevention, there was an additional realignment that closed the circle of HIV work by linking preventing new infections to helping those infected live with HIV. The addition of other so-called “biomedical” prevention strategies is fundamentally deepening and enlarging our approach to HIV prevention. We now talk about a “toolbox” of strategies, with our job being to help each individual (or couple) choose the specific combination of tools that they can use effectively and consistently. 

My own work as CEO at CARES has also changed tremendously over time. It has increasingly focused on strategic leadership and public policy work, along, of course, with fundraising and community relations. I’m lucky because CARES has a really good staff, some of whom have taken on the role of managing operations which has freed me to focus on those other things.

I have a high-caliber team who work with me on strategic issues. CARES also has a great board, and it’s my job as CEO to support the board in fulfilling its governance and fundraising responsibilities. It’s really all of us together—board, staff, volunteers—that have given CARES its strong reputation nationally and regionally as well as within the Nashville nonprofit community.

O&AN: CARES celebrated some of its most successful events in the recent years, notably a 2013 record-breaking Dining Out for Life- what does the future of Nashville CARES look like?

JI: We are currently completing a long-overdue strategic plan that formalizes these strategic realignments in mission and purpose. Once you focus on health outcomes, it becomes increasingly difficult to “silo” HIV off from all the other issues or needs that research has shown directly affect people’s ability to stay HIV-free or to live successfully with HIV. That doesn’t make us any less specifically focused on HIV/AIDS as CARES’ mission. It just recognizes that working toward an AIDS-free generation requires us to address things that are not exclusively or even specifically HIV-related. So you may see CARES adding STD testing to our HIV testing services, and offering more counseling for gay men/couples who are not HIV-positive but dealing with a range of concerns that can impact risk. It could also mean increasing our satellite locations inside Nashville and outside Davidson County and providing for co-location and better integration of medical and social services.

New initiatives take money of course, so we will want to build on recent fundraising successes to increase and diversify non-governmental funding in particular. These initiatives will also represent a clear prioritization reflective of the goal of ending AIDS so that we use our resources wisely and strategically.

O&AN: Do you think there will be a cure found in your lifetime or possibly the next generation’s lifetime?

JI: At the risk of being viewed as pessimistic, probably not in my lifetime—certainly not a cure that I think will be uncomplicated, affordable and widely accessible. Though I would love to be proven wrong about this. However, we can make HIV infections rare, and help people who are infected live full, productive and rewarding lives. We can create the conditions for a truly AIDS-free generation. We’ve already taken some important steps toward that new world. So, I actually am far more optimistic about our progress than I was even a decade ago.

O&AN: Some will argue that the apathy of a younger generation is the biggest obstacle facing the LGBT community in terms of HIV/AIDS. What is the biggest issue, in your opinion, facing the LGBT community in terms of HIV/AIDS?

JI: I don’t believe it’s fair to blame young gay men for their alleged apathy about AIDS, if that’s what it is, when they don’t see AIDS discussed much within the gay community. The simple fact is that HIV/AIDS has not been a priority issue for what might be called “mainstream” LGBT organizations for years—an unanticipated consequence of the success of combination therapy. When AIDS stopped being (or at least feeling) like a crisis and calamity, many gay men and GLBT organizations moved on to other issues. These were long-standing and important issues, but the “trade-off’ in attention was unfortunate.

However, that neglect has begun to change especially this past year—the joint statement on gay men and HIV issued at GLBT Pride in 2013 and the recent Creating Change conference are two recent examples.

I’ve spoken in the past about our need to recognize that HIV is still a gay disease—not in the simple and simply wrong way that somebody like Stacey Campfield says it’s a gay disease, but in the fact that gay men remain most heavily and disproportionately impacted by the disease.

In 2012, 46% of the new cases of HIV in Greater Nashville were found in gay, bisexual and other men who have sex with men. Equal numbers were white and black men. But only one-third were younger gay men under age 25; most new cases were in men in their 30s and 40s (and some even older). So it isn’t just the “apathy” of a younger generation that is driving the epidemic here. Each generation of gay men has a somewhat different relationship to the epidemic, though it is worth noting that if you’re a gay men under age 40-45, which is where almost all of new HIV infection is occurring, your entire existence as a gay man has been played out against the scrim of HIV. Blaming any of these men for being apathetic or simply careless doesn’t begin to address the complexity of what I think is going on.

That’s why I believe the re-embrace of HIV as a priority issue by GLBT organizations and the GLBT community is so important. Effective use of that prevention toolbox I mentioned earlier requires us to be able to talk as a community about HIV in the context of our needs and desires as gay men. That will make HIV prevention what it needs to be: less a list of rules and more a menu of possibilities. If the battle over “don’t ask don’t tell” should have taught us anything, it is that a policy based on silence, on not speaking, simply leads to suffocation. So I hope that revival of the issue will lead once again to open, authentic, honest, and supportive communication among us.

O&AN: You’ve received many honors and awards throughout your career, any words about being the 2014 HRC Equality Award recipient?

JI: As a friend said to me when they heard about it, “It’s a big deal.” I am deeply touched and honored. I’m acutely aware at this stage of my life of my need to pass on my understanding of our history and nurture a new generation of leaders. Hopefully, the award can be part of that process and hopefully it will propel this renewed interest in HIV and in ending the disproportionate impact of HIV on gay men.