06/08/2026
Next week I'll convene an affinity group for anyone curious about NBHRN's work, speak on a plenary with colleagues, and lead a discussion with Toni Smith on Black communities and opioid settlement funds.
My message comes from my years in HIV activism and public health in New York.
I've been reading Dr. Joyce Rivera's capstone thesis, Moving the Needle: The Policy of Change on Syringe Access, New York City and State, 1988–2023. Its most important lesson isn't about syringe access. It's about governance.
When HIV was devastating communities, federal funding came with a requirement: the people most affected had to participate directly in planning how resources would be used. New York City's Prevention Planning Group brought together community members, advocates, providers, researchers, and government officials to set HIV prevention priorities and funding.
I spent several years on the PPG. I can attest that the community planning process worked; it directly reduced HIV seroprevalence among people who inject drugs, their partners, and their babies. It laid the foundation for New York's Blueprint to End the Epidemic, and it shaped how NYC Ryan White CARE dollars were allocated.
These were not listening sessions. This was not extended public comment.
The PPG assessed needs, set priorities, and directed resources. Government and community shared leadership. People most affected by HIV were expected to help shape the response. As Dr. Rivera documents, the PPG became a key vehicle through which harm reduction advocates entered formal decision-making spaces, challenging stigma, changing the language used to describe people who use drugs, and pushing institutions to fund what worked.
Today, opioid settlement funds present the same opportunity. States and localities are deciding how billions will be invested to address overdose. Yet in many places, the people most affected remain absent from the table. I spent much of last year traveling to Black communities in the Midwest and South. I was dismayed to find that where overdose mortality was highest, Black harm reductionists often didn't know the dollars existed, how they were spent, or who decided.
Can you imagine settlement planning bodies that assess community needs, set spending priorities, allocate resources, and include people who use drugs, family members, harm reduction practitioners, recovery communities, and residents of the neighborhoods hit hardest by overdose? Yeah, I know. Hard to conjure.
There is still time to course correct. Dr. Rivera's work reminds us that the most important public health advances emerged when government made room for community expertise and shared decision-making power.
So as settlement dollars flow, we should ask a simple question: what would it look like to apply the lessons of the HIV Prevention Planning Group to the opioid settlement era?
The answer may be one of the most important public health opportunities of our generation.
