Ben Plumley and Pangaea: battling HIV/AIDS in Oakland and beyond

Ben Plumley, chief executive officer of Pangaea Global AIDS Foundation, has been on the front lines of the global fight against HIV/AIDS for over two and a half decades. Originally from England, Plumley heads the international non-profit dedicated to combating the epidemic internationally and at home from his office on 14^th Street near Oakland’s city center.

Pangaea currently operates programs in Oakland, China, Tanzania and Zimbabwe as a “technical advising and diplomacy agency,” its CEO said. Plumley’s work consulting on programs has taken him from the negotiating table at the United Nations headquarters in New York, to South African mines and high-level meetings in Geneva, where he has helped shape global health policy.

The non-profit “builds partnerships that improve the lives of people living with and most at-risk for HIV to ensure equitable access to prevention, testing, treatment and care,” according to its website. Pangaea works with partners and key stakeholders from around the world to implement HIV-related programs through research, consulting, policy advocacy and international diplomacy.

Since 2012, the NGO has focused its local efforts on researching and piloting PrEP programs. PrEP stands for pre-exposure prophylaxis, and it is “a way of using an HIV medicine to prevent exposure to HIV infection,” said Plumley. Approved by the FDA in November 2012, the combination drug therapy permits people at very high risk who can’t or won’t use condoms to take a daily pill instead. Studies by Robert Grant of UC San Francisco’s Gladstone Institute and others have shown that the preventive pill protects the vast majority of daily users — 95 percent or more — from becoming infected with the virus, although the antiviral medication may have side effects to the kidneys and other systems.

Representative Barbara Lee, representing California’s 13^th congressional district including Oakland, praised Pangaea on World AIDS Day this past Tuesday, which is observed every December 1 to raise awareness of the global pandemic. She singled out its work in highlighting the problem of delayed testing for HIV, the virus that causes AIDS, among the city’s most vulnerable.

“I applaud the partnerships Pangaea has built with CAL-PEP, La Clinica de la Raza, University of California, Berkeley, and the Alameda County Public Health Department Office of AIDS,” said Lee in a statement. (CAL-PEP refers to the California Prostitutes Education Program, an Oakland group providing risk reduction for vulnerable sex workers.) “By exploring reasons for late testing, these partnerships will improve the health of our community and the quality of life for those living with the virus in Oakland and throughout Alameda County,” she added. 

According to the U.S. Centers for Disease Control and Prevention (CDC), more than 1.2 million people in the United States are living with an HIV infection. The CDC estimates that 12.8 percent of HIV-positive people are unaware they have the disease. Undiagnosed people may not receive timely treatment, and may pass the virus on while unaware of their status.

“AIDS is not under control,” said Plumley. Statistics from the California Department of Public Health Office of AIDS indicate that there were 5,590 people living with HIV/AIDS in Alameda County as of December 31, 2013, the most current data available. As reported by the CDPH Office of AIDS, 4,820 people in Alameda County have died of the disease since record-keeping began in 1983. (The county’s estimated total population in 2014 was about 1.6 million, according to figures from the U.S. Census Bureau.)

“Oakland has an epidemic that is quite similar to epidemics in other cities around the world where we work,” he said. “The problem Oakland faced — and frankly still faces — is that too many people are presenting in emergency rooms with very advanced HIV disease, opportunistic infections that, really, Americans shouldn’t be having.” Opportunistic infections are secondary conditions that set in as a result of the weakened immune system due to HIV/AIDS.

Alameda County declared an AIDS State of Emergency on November 5, 1998 due to the extremely high incidence of the virus among African Americans. As of 2013, the HIV/AIDS contraction rate was still five times that of whites according to a presentation by the Alameda Public Health Department’s HIV/AIDS Epidemiology Surveillance Unit. African Americans are also more likely than their Caucasian counterparts to receive a late diagnosis of the virus, Lee said in her statement.

In Oakland there is limited access to care, especially for what Plumley called “marginalized within marginalized” populations, or those most at risk. That means men who have sex with men in the African American, Asian, and Latino communities, along with sex workers and older African American women. The term MSM, for “men who have sex with men,” is used in public heath analyses because some men at risk don’t identify as gay, including married men who pursue relations with men.

At home in Alameda County or overseas, Plumley is keenly aware of the importance of community ownership over Pangaea’s HIV/AIDS initiatives. “I don’t believe in country offices for Pangaea because I think it’s important that the country owns and leads their programs,” he said. In every location where it operates, the NGO first secures an invitation by the host government and local partners.

“I think most of my time is spent convincing policy makers to adopt strategies either that we’ve piloted or partners have piloted,” he said. Pangaea has success in many ongoing projects abroad. In China, Pangaea is partnering with the Bill and Melinda Gates Foundation in working with the Chinese Ministry of Health to shape its national AIDS plan, aiming to create a sustainable model of HIV prevention focused on at-risk populations in urban centers. Additionally, Pangaea partners with the Clinton Foundation Health Access Initiative, the Yunnan Bureau of Health, and individual hospitals to assist in establishing treatment guidelines and offer technical assistance.

Pangaea was also invited by high-level stakeholders to Tanzania in order to assist with developing a national response to Tanzania’s HIV epidemic among people who inject drugs. Pangaea helped to establish the first medication-assisted treatment program in the country at Muhimbili National Hospital in Dar es Salaam.

In Zimbabwe, where Pangaea maintains its other full-time office, the non-profit is working directly with the Ministry of Health and the National AIDS Coordination Program to scale up treatment and care. It also runs a program supporting HIV-positive adolescent girls through initiatives involving treatment, care, life-skills, education and improved economic opportunities.

Plumley said that a lot of his work in Geneva is what he calls “velvet-gloved health diplomacy” with policy-makers to help sustain momentum. The CEO implores global governments and businesses to fulfill their commitments to long-term investments in the fight against HIV/AIDS.

But he doesn’t shrink from speaking his own mind, saying, for example, that he’s very uncomfortable with the United Nations discussion about ending AIDS by 2030. “We have maybe 15 million people on treatment, but we have a need of another 15 million people,” he said. Plumley said he appreciates the optimism, but the priority needs to be to keep stakeholders’ “feet to the fire.”

“The situation of HIV/AIDS is a situation of crisis in South Africa and Zimbabwe and it’s a situation of crisis here,” agreed Ifeoma Udoh, director of monitoring and evaluation at Pangaea.

However, the organization believes that PrEP drugs have the potential to help curb the spread of HIV/AIDS in Oakland by preventing those most at risk from contracting the disease — even individuals in sexual contact with HIV-positive partners. While by no means a panacea, Pangaea is optimistic that what Plumley calls the “treatment-as-prevention” drug can complement existing forms of prophylaxis such as limiting one’s number of sexual partners and proper condom use.

The new drugs have “re-energized the conversation and given us another tool in the prevention toolkit,” said Udoh, adding that the treatments could be particularly effective in at-risk populations. “We know that [PrEP] works … what we don’t know is if people will actually take it and whether or not they adhere to it,” she explained. As a result, Pangaea’s work has focused on identifying the best methodology for “implementation of PrEP in communities of color and particularly in young men who have sex with men” said Udoh.

Currently, the non-profit is working with the East Bay AIDS Center to evaluate the application of PrEP therapy at partnering community clinics. The goal is to identify ways to maximize HIV prevention among African American men who have sex with men between the ages of 18 and 29, the highest-risk group in the county and the nation — according to both the Alameda County Public Health Department Office of AIDS and the CDC.

Plumley’s journey from the United Kingdom to Oakland has taken him from his origins in a “classic middle class English background,” he said. “My father’s on the parish council. My mother’s a member of the conservative party’s executive committee. So this is a very strange place to end up.”

“The irony was I always wanted to come to the Bay Area after I finished my undergraduate degree,” he said. “I wanted to go to Stanford.” But that didn’t happen.

Following his graduation from the University of Cambridge in 1989, Plumley worked in London for a small Anglican charity. Just as he was coming out as gay, Plumley began witnessing many in the community he served suffer opportunistic infections. He calls his realization a “negative eureka moment.”

“I volunteered in the British Terrence Higgins Trust, which is our main AIDS organization, working with East African clients,” he said. Later he spent five years as director of Positive Action, a global health initiative by Glaxo Wellcome (now GlaxoSmithKline), the world’s leading producer of antiviral drugs to combat HIV/AIDS at the time.

“My big break, if you like, was going to work for the [United Nations] and the newly-formed U.N. program on AIDS. I kept pestering them. They wanted to appoint me as a communications person,” he said, “and I wanted to do — be — more than that.” Plumley’s persistence paid off. “My first assignment was to be the civil society coordinator at the U.N. in New York for the very first General Assembly session on AIDS.”

From behind the scenes, Plumley gained invaluable insights into the ways in which countries negotiated with one another. It was exhausting. “I remember going to sleep in the bowels of the U.N. building, getting two hours of sleep before I had to go back and be the notetaker,” he said. Plumley’s role at the U.N. also resulted in meeting an influential public figure with whom he would work for two years, the late former U.N. Ambassador Richard Holbrooke.

Plumley became founding executive director of the Global Business Coalition on HIV & AIDS (now GBCHealth), which enlists big companies not just to fund, but promote best practices in preventing and treating the epidemic in their workforces. He later returned to the U.N. and joined the United Nations Joint Program on HIV/AIDS (UNAIDS) as director of its executive office where he got the board of UNAIDS to agree on a comprehensive global policy.

In taking over leadership of Pangaea in 2010, and spearheading its move to Oakland in 2011, Plumley has worked to stay relevant to the community by working with local groups and organizations. “I really wanted to send a strong message here that we weren’t the white people in the white coats coming over from the West Bay,” he said.