Public Health Matters Video: The Pharmacist's Role in the HIV Space, Removing Barriers, Racial Disparities

In this special episode of Public Health Matters, Dr. Christina Madison and special guest, Alsean Bryant, discuss Bryant's work in addressing health and racial disparities within the HIV community. They also highlight Bryant’s journey to becoming a PrEP provider as well as the intersection of pharmacy, public health, and music in his life and career.

Christina M. Madison, PharmD, FCCP, AAHIVP: Hello, everyone, and welcome to another incredible episode of Public Health Matters, part of Pharmacy Times Pharmacy Focus podcast series. I'm your host, Dr. Christina Madison, and I am so excited to bring another incredible guest to the podcast. Someone who I admire, someone who I think is just so inspirational, has so many talents—which I am hoping to get him to tell us a little bit more about—but if you want to go ahead…also your first name is so lovely, I just love that, it's just very beautiful, and I don't know if there's meaning behind it…So, yes, if you want to just kind of tell the audience a little bit about yourself, and then we'll dive into some questions that would be fantastic.

Alsean Bryant, PharmD, AAHIVP, HIV PCP: Sure, sure. Thank you so much, Christina for the opportunity. What's going on everybody, I am Alsean Bryan, and I have to give thanks and a shout-out to my parents for that name. There's no specific meaning to it other than the one that I am creating for brand-wise, which is being a creative clinician [who] is committed to community health equity and the arts. And so, to your point, pharmacist by day, creative around the clock, quite frankly, I feel like my life has always kind of met at the intersection of medicine and music. So, I’m originally from South Georgia—Waycross, Georgia to be exact—and [I] attended college in Florida Agriculture and Mechanical University (Florida A&M) College of Pharmacy. So, I did that for 6 years and that's when I really had my introduction to public health and the agencies based on HIV space doing our rotations. They're awesome. I had an opportunity to go to Ghana for a summer fellowship program in a national research fellowship. And so, I did that for 2 and a half months—I want to say—and that was a true introduction to what it really meant and what type of impact that could have. And so, I brought all of those skills back to college and I said, “You know what, HIV public health, community health is something that I’m really passionate about.” Then I started really making my journey, and curating my journey such that it would fall in alignment with those things. So, it led me to DC where I completed my PGY-1 residency at the DC VA hospital, after which I transitioned into nonprofit management as a director of CMS Health Initiatives, which is an organization that utilize pharmacies to address health disparities in the DC metropolitan area, and there was a lot of grant writing and figuring out what the needs were and underserved communities and how we could you know, create programming to help cater to those needs. And so, we did a lot of collaboration with the DC Department of Health, HIV/AIDS Administration…then I transitioned to where I currently am at the AIDS Healthcare Foundation, where I served most of my time as a clinical pharmacist, but very recently over the last 2 or so years, served as a PrEP provider. So, 1 of the first here actually, in that area…to be a pharmacist who was running around a wellness clinic in regards to PrEP…And that's me in a nutshell. We can get into the entertainment stuff pretty soon.

Madison: So, first of all, shout out to VA, I'm also a VA resident trained…I did my residency at the VA Health Care System in Albuquerque, New Mexico. So [I] worked really closely with UNM Hospital, did a lot with students and trainees, that's actually where I got the teaching bug before I went into academia. So, shout out to that for sure.

And then also, [it’s] amazing that you're working directly with health departments, because I say this all the time, that like that is an untapped amazing, possible career path for pharmacists. And obviously, I'm partial, but if I was able to rule the world, there will be a pharmacist and multiple pharmacists in every health department in the country, because 1 of the things that people don't realize is that most of the clinical services are run by nursing. They don't understand they don't realize that most of the clinical services are run by nursing, and so much of what we do in public health is medication-directed, right? All the communicable disease management is all medication, so it makes zero sense to me why we don't have pharmacists in literally every health department in the country. So, I think that's awesome that you started off working with them. But there's still ways that we can collaborate with public health, even in a community pharmacy setting, so we can talk about that too.

But tell me a little bit more about your journey to end up in the HIV space. I know you kind of touched on it a little bit, working with the health department, but I think it's a very specific thing, but it's also a calling. I feel like it's kind of like pain and palliative care and in hospice, like, I really do feel like you have to a passion for that work to really want to stay in that space and to continue to advocate for that population, just because there's so much stigma and trauma associated with the diagnosis, and even with how you can become infected. So, I'm curious, how did that how did that pathway look for you? I can obviously tell you my own journey, and I think…I don't know exactly how long you've been doing this, but…my very first patient that I saw, [I have this] vivid memory of this gentleman…looking like he was 9-months pregnant in our AIDS ward—because we had AIDS wards at the time, this was in 2003 [working at] my county hospital—and seeing this man, and then he also had a bunch of opportunistic infections, that is a vivid memory[for me].

Going from that to now having an injectable that you can take every other month, and that we've got not just 1 medicine, but now 3 medicines that you can take for prevention, and we have DoxyPEP,,,my mind is blown.

Bryant: You raised some really, great points. And I think for me, my interest was ignited with 1 of my professors through my infectious disease course when I was at Florida A&M. I loved his passion so much for the work that he was doing in the HIV space. I loved it so much that I really wanted my rotations to be in Tallahassee, and so I really kind of fought for that, so that he could be one of my preceptors. I was able to do my ambulatory care through the Leon County Health Department…

Madison: Which is literally 1 of the only offerings… when I was first doing public health and I was actually at a health department, that was 1 of the only programs in the country that I even knew about that had pharmacists, I researched it. Because at the time, we didn't have…they didn't know what to do with me. They were like, okay, we can bring in a pharmacist. Because I was working through the university, they had a free pharmacist, and they didn't know what to do with me. So, then I was like running around trying to find examples of pharmacies in health departments, and I basically just had to create it from scratch because they do a lot of chronic disease management. They don't do as much with communicable disease management, and really the focus where I was with STIs, HIV, family planning, tuberculosis, so it was slightly different than what your core was.

Bryant: Yeah, for sure, for sure. I'm so grateful to have had that opportunity to, for him to preset me through that, because that's when I really started leaning into HIV, when I started leaning into health disparities and what that really meant in the context of where I was at the time, that's when I really leaned into what syringe exchange really was. And through all of this exploration, I really started finding my passion for that work, right. And so, I talked to my dean about it and he was also working with the commissioners on different initiatives. So he said, “Well, how about we work on presenting some data to them or some information about syringe exchange programs and the impact they could have if you were to develop 1 for Leon County.” Because at the time, we didn't have any in Florida, it was something that was almost unheard of. And so, I really started to dig in and do research about some syringe exchange programs and I was also afforded the opportunity to present that information in front of them. That was something that was really special to me and really kind of put me into the space that I'm in. I said, now that I have hands-on experience within the health department and understanding HIV medications, understanding driving direction, understand the [comorbidities]…and then being able to talk to people on the legislative side, on the political side about how it can impact and on a grander scale, I was sold.

Madison: I love it. You're like, “This is for me, this is my people!”

Bryant: It is my people, and I looked for nothing else. Because I knew that that was the call.

Madison: So, why do you think it's so important for non-HIV providers to know ways that they can help protect their patients? Because I feel like that's the part of this pie…you've got the passion, I've got the passion, the people we work with get the passion, but the problem is why we haven't been able to like really move the benchmark, and why we haven't really been able to put end roads and the end the epidemic, is because the non-HIV providers that think that it's specialty care, and not everybody care, don't understand the reason why we need to help people to protect them against HIV. What is it that you feel we should be telling them? How do we bring them into the fold?

Bryant: Like you said, I think the take home message is [that] everybody cared, and [we were] really figuring out ways to integrate it into the primary care mode so that testing isn't something you do because the patient requested [it], it is part of the actual the panel that we [have]. I think the more that we integrate that into the primary care space, and we normalize the conversation about sexual health, at baseline, then it’s something that becomes second nature for people that we can break down the barrier of peoples’ discomfort. And I think that 1 of the challenges that we face in the health care space—especially with getting more people involved in a board—is this is this is an area of practice where people didn't necessarily lean into whenever they did your training, so it's this whole [different] situation that I'm going to have to learn and commit to my practice, and it was like, okay, just give it that time and space, because it's a disparity that is screaming for attention. So, I think that if we were able to really kind of get people into the uncomfortable within primary care, integrating it into primary care, and then I think that it will help normalize sexual health conversations, which I think is the foundation upon which everything else.

Madison: Yeah, I couldn't agree with you more…when we did that panel…we all need to start getting comfortable talking about sex, because that's how we all got here, that is the reason why we are on this earth, like…why are we still uncomfortable? Part of the reason why I feel like primary care isn’t talking about this, is because they’re not comfortable talking about it. So, you have to be comfortable as the provider yourself being able to have those conversations.

Part of it too, is I think that somehow [providers] feel like they're going to be told something that they don't know anything about or that they're not familiar [with]. It doesn't matter. It's [about] having the ability to allow for someone to talk about their lived experience, be able to disclose to you in a non-judgmental space, and to allow people to feel like they can trust you with their story. The other thing too—I tell people this all the time—you can know your provider, you can even like your provider, but do you trust them? And that trust factor is literally the difference between them telling you everything—like who they were with, if they had a substance, if they are maybe engaging in some sexual practices that are maybe not as safe—it's the difference between [patients] telling you that.

Bryant: Absolutely, yeah, it's a huge issue in the community, let alone it being in the Black community, and then you compound that with HIV in the southern states, right? So, you have the challenge of perspective there, too. And all respect to everybody everywhere, but I think that the lived experience is a little bit different there, I'm coming from South Georgia too, so, I kind of have empathy in that space to kind of understand where that challenge or discomfort may come from. And [I’m] grateful to have been able to be here in [this] area for a while to, you know, be in the communities to where these conversations are normalized so that I can have that added skill set in addition to the empathy to have conversations. But people in the south really kind of struggle with that trust issue as it relates to their providers, particularly because the disproportions of mistrust in that community.

Madison: Oh, you can just say it, honey, it's called racism and historical trauma…I am the product of a southern grandmother from Virginia, and that is a hard place to live and to feel like you can be open and talk about, not just your sexual health, but—God forbid—your mental health, because you can't be depressed, you know, [there were] people who were slaves…you should pray on that.

Bryant: [There’s] nothing wrong with prayer, I believe in the power of it, but at the same time, yes… there's some added things that are in place for us to take advantage of to help us navigate through those things. You know what I mean? So, I understand it all and thank you for giving me the space to talk with this…you opened that door, so I appreciate that.

There's a lot, going back to the challenges in the primary care space, they’re amplified there in the southern states for these very reasons that we haven't talked about.

Madison: So, obviously, we can joke, and we can laugh, and we can have this very jovial conversation, but ultimately, what do you feel like is necessary in order to really push [these] initiatives forward for ending the epidemic? I can tell you my perspective, and [that is] very much rooted in the science, which is you can't control peoples’ social behavior, so if we can't get everybody who's infected in [HIV] care, the only other thing that we can do is we can give people medicine to prevent if they're exposed. Because the thing is, half of all of our new diagnosed cases are from somebody who do not know their [HIV] status, and until we can make it easier for people to access care and to be retained in care, we're never going to be able to really…because U=U only works when we only way that that happens is if we make it easy for people, and we don't make it easy for people, we make people who go through so many hoops and so many different things just to get access to their medication. We can’t keep doing that. We just can't.

Bryant: Yeah, and that’s such a loaded statement and there's so many different ways we can address that. We can address it from the political context, we can address it with socioeconomic context as it relates to disparity in different areas of a city, a state, a region within the US…there's so many ways to kind of break that down, but I think ultimately there are boots on the ground, policy is 1 thing, but a lot of people—particularly when it comes to politics—are like, “Okay, I see you told me to vote, how's that gonna affect my household? How's it gonna affect [me] making sure I have food on the table?” And so, we can transfer that idea or that perspective to this. It's like, “Okay, we talked about the science, but what is the science going to do if I don't have access, or the visibility of knowing that these types of things, or the education, or the wherewithal?” So, then we talked about [addressing] access to care, how things are marketed to people [so they] know that this supplement is for them, right?

Madison: Don't get me started…you can see every [single] commercial…I’m like, “Where's me? There’s no [representation] in this commercial.” It’s all a bunch of White gay men, and I know that—in particular—Black women are disproportionately impacted, and it's not from being with multiple partners, it is literally 1 partner…and nobody talks to them about prevention. They’ll come in, they'll get diagnosed, and then we'll say something, and they'll [say], “Oh, what do you mean? I didn't know I could take a medicine and prevent this…nobody ever told me about PrEP, nobody ever told me about [DoxyPEP] because I just assumed that my partner was mutually monogamous.” Which, by the way, is a lie, a lie we tell ourselves.

Bryant: I just had a patient come in about 2 weeks ago. Black woman, middle-aged, and she was coming in for post-exposure. So, as I'm talking to her about medication, I said, “Well, you're going to take these medications for the month and then when you’re almost done with it, I'll circle back with you because you will most likely be a candidate for PrEP. Have you heard of PrEP?” She said, “Well, I didn't hear about it until just now as I'm getting this medication or [while I’m] seeing the doctor here for post-exposure. And I said, “Okay, so you're just hearing about this,” and she said, “Yeah, and I wish I would have known sooner...”

Madison: This is quintessential, that is exactly why we have this problem because we're leaving an entire group of people out of the conversations that are being disproportionately impacted. Even just the thought process of PEP to PrEP, which I love that you're doing, so we need to talk about [that] more as well. So, we talked about PrEP a lot, really don't talk enough about PEP to PrEP, and the fact that that transition, and not having any kind of a gap of time in between when you transition somebody from that 28 days right to PrEP. We don't talk enough about that, I don't think.

Bryant: And there’s so many nuances to that. You have a patient who comes in and don't have insurance, right, there's still a way for [them] to get PEP, and after the PEP, [they] still don't have insurance, there's still a way to bridge that emtricitabine-tenofovir (Truvada; Gilead Sciences) over to PrEP. There's so many different ways that we can kind of talk about this and the education piece from both a clinician and non-clinician standpoint. As you said earlier, there's so many ways to cut that pie, and I'd also say that the thing that I kind of thought about for a while is…she was a patient of mine up here in DC, in Metro DC where we have an abundance of funding and resources. Imagine women in an area in rural America, who don't have the luxury that we have here…And this lady being here still did not know [HIV prevention medication] was for her. To multiply that by—I don't know how many times—there's a lot of work that needs to be done in that space.

Madison: Yeah, kind of pivoting and kind of piggybacking on what you were talking about, legislatively, what do you think the profession of pharmacy should be focusing on, especially as we are now in a current election year? I know that’s a bit of a loaded question, but as somebody who is an active provider and is in a state that allows for you to do that, what do you think we should be focusing on?

Bryant: Well, I can say, that's a that's a wonderful question, I can say that I've been fortunate enough to be a provider through a collaborative practice agreement, and basically for those listeners who may not be aware, that is an agreement between the pharmacist and an entity or a doctor to provide services under the umbrella of the doctor. And so, through this collaborative practice agreement—and this is just kind of like the short story of it—I'm able to provide PrEP services, I'm able to order labs, consult with patients, prescribe medication for PrEP, do follow-up visits, things of that nature. One of the challenges of collaborative practice agreements is, although it does give you kind of that autonomy and a sense to be a provider, there are challenges when it comes to payment and being paid for the services that you're rendering. And so, that can be a roadblock for some people who might not be in the type of environment that will allow them to do these type of things and still be okay on the financial side. So, I do think that what collaborative practice has done for me is opening my eyes and assess [how to] push the needle forward to not only to be a provider through CPA, but how do we get paid for the service equitably? So that not only we're just paid, but we're paid at the same rate that any other provider would be paid because we're doing some of the same work and providing even further knowledge and counseling [to patients]. I do think that there's a conversation to be had about equitable payments for services that are rendered as pharmacists.

Madison: Now, have you been part of some of those discussions? I know, APHA has done some work specifically around HIV prevention services led by pharmacists, and that they've met with some people on Capitol Hill. I don't know if you've been part of those conversations, but I feel like, as someone who is walking the walk and talking to talk—which some of us aren't able to do, some of us can talk about it, but we're not actually in the trenches like you are—do you feel like those initiatives are going somewhere? I guess that’s what I'm getting at.

Bryant: Well, I think that I'm excited now, because I think that there is momentum, I think that the cat’s out of the bag and people are talking. I think that COVID-19 really paved the way, even though pharmacists have been doing this amazing work for forever, I think COVID-19 really put a spotlight on our capacity and what we can do, and even more so. And so, adding to that momentum over the last few years has been great to see. I do commend the American Pharmacists Association (APhA), I commend the National Pharmaceutical Association (NPhA)…we're really kind of in the trenches in finding out ways to explore how we can have this type of impact in those communities as well.

So yeah, I do think that the conversations that are being had and the actions that are [occurring] are great. I can’t speak on behalf of the Washington DC Pharmacy Association WDCPhA), as we adjusted our president last year, we have been moving the needle forward here in the district as far as provider status and equitable reimbursement for the services that are rendered. So, I do think there's some really, really good buzz behind everything, and I hope that under the umbrella of APhA and NPhA, we're able to continue those conversations.

I think that one of the challenges that pharmacy has always had is everybody works in their silos, so they're doing double and triple work, but I think, well, my hope is now that the spotlight is on these organizations now to really kind of take the torch and help us push it forward as a unit. That's my hope.

Madison: Well, I do want to give you just a minute to talk a little bit about what you've mentioned before, this intersectionality between medicine and music. Because I do think that that is something super unique and special about you, if you maybe want to touch a little bit on that as we wrap up our conversation.

Bryant: Sure, sure, life has always met me there and I actually attended Florida A&M on a partial band scholarship. So, [I was in] pharmacy school, but [part of the reason] I was there was because of music. One interesting story that I always think is important to tell is 1 where being a musician and a writer—I started writing poetry when I was young—you know, so being in the creative space all of my life—going to Florida A&M and then having to make the sacrifice to get out of the marching band was something that was huge for me, because I knew this scholastic achievement was my priority there. Fast forward, I graduated pharmacy school and came up to DC, and I had the opportunity to play in the drumline for the Washington Commanders for 6 years. And so, to sacrifice it back then and then come back on the radar and on a totally different platform in the NFL…and then from a writing standpoint, I am a songwriter, a licensed professional, so I have music that has been in TV shows and movies, Netflix, ABC…so I’ve done quite a bit of writing for those spaces as well as for artists to tap into submitting for placements…Listen out for my [music] please.

Madison: And currently available for booking!

Bryant: I’m currently available, yes, go to seanbexperience.com.

Madison: We'll put that link in the show notes.

Bryant: There we go. Thank you so much, Christine. Yeah, just recently—this past December—I released an album as a solo artist called “Christmas at Home”, and it was truly a labor of love that has received some really, really great feedback and I'm grateful for that. We had an ad in Times Square—a few ads in Times Square—and it was mentioned in an article in Vibe magazine and some people that I really look up to…and so, it's been a really great experience, and so I'm riding that time now and looking to see what's next.

Madison: So, I always like to end my interviews with this question. If there was something that you could tell your younger self, what would it be and why?

Bryant: I would tell him [to] keep going because all things work together for you. It might not make sense for you now, young man, but keep dreaming those dreams that you're having because 1 day, it’ll all make sense for you.

Madison: Yes. I am a firm believer in the big hairy audacious goal. [You’ve] gotta dream big.

So, if people want to connect with you, want to find you, want to see what things you're up to, what would be the best way for them to connect to you, and what are your current social media handles?

Bryant: Absolutely. So, if you want to connect in the pharmacy world, LinkedIn would be the place and you can just find me, Alsean Bryant. If you're interested in knowing all things music, you can reach out to me via my website, and that is seanbexperience.com…and I'm also available on Instagram [using] the same handles, @seanbexperience.

Madison: Awesome. Well, this has been a fantastic conversation. I'm so glad that we finally connected, [I’m] so grateful for your time and all of the work that you're doing in the HIV community and in the Black community, and just keep shining your light keep being an amazing beacon of hope. I really appreciate the fact that you are taking a very deliberate stance to the work that you're doing and that you're continuing to innovate and to inspire, and I'm just thrilled to see what your next steps are—whatever those may be—I'm looking forward to continuing to follow your journey and I really hope that our paths crossed again. Maybe at MPHA again.

Bryant: I definitely plan to be there, so I hope to see you there, yes, well, well with that, I will go ahead and wrap things up again.

Madison: Well with that, I will go ahead and wrap things up again. My name is Dr. Christina Madison, also known as the public health pharmacist,. I am your host, and this has been another incredible episode of Public Health Matters. Please stay tuned for more episodes, subscribe, check out other options and other opportunities to continue to follow along. Pharmacy Times has posted multiple articles on the pharmacist’s role in HIV prevention and care and is really dedicated to expanding this space so that we have more people offering these life-saving services. And with that, remember, public health matters.