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EXCLUSIVE: CDC chief ‘totally confident’ in plan to beat HIV by 2030

Redfield promote Trump initiative in exclusive Blade interview

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U.S. Centers for Disease Control and Prevention Director Robert Redfield said he’s totally confident in the plan to beat HIV by 2030. (Photo public domain)

A top Trump health official leading the charge on the administration’s effort to end the HIV epidemic by 2030 said Thursday he’s “totally confident” about achieving the ambitious goal.

Robert Redfield, director of Centers for Disease Control & Prevention, made the remarks during an exclusive interview with the Washington Blade on the initiative and the continued stigma facing the LGBT community in health settings.

President Trump announced the initiative during his State of the Union address, pledging to seek resources to end the HIV/AIDS epidemic by 2030. The subsequent budget request to Congress sought $300 million for the first year of the initiative (while simultaneously seeking cuts to Medicare and Medicaid, programs on which many people with HIV rely).

Top health officials within the administration, Redfield said, developed the initiative and submitted the proposal to Secretary of Health & Human Services Alex Azar, who in turn submitted the plan to Trump in time for his State of the Union address.

“We presented that initiative to our secretary of health, who has fully embraced it as one of his major priorities,” Redfield said. “He was successful in presenting this to the president, who was also very committed and engaged, but I don’t know the actual process of how words get into his speech.”

Although the administration is also seeking to roll back the Affordable Care Act and to cut Medicare and Medicaid, Redfield said he doesn’t think changes to other health programs will affect the main HIV initiative.

“At least for individuals who are at risk for HIV infection or who have HIV infection, these persons will get access to the medical and preventive care independent of other issues they may come about related to the broader health care issues of our nation,” Redfield said.

Redfield, who worked as a medical researcher at the Walter Reed Army Medical Center at the height of the HIV/AIDS epidemic in the 1980s, also marveled at the advancements in treatment and prevention that he said enables the plan to beat HIV/AIDS by 2030.

“[I was] involved in the first trial to ever use AZT, and I remember how ecstatic we all were when we increased survival from 10 months to 26 months,” Redfield said. “Who would believe today that when you’re 20 years old and you get HIV, you can expect to live between the age of 70 and 75?”

Read the full interview below:

Washington Blade: Now that the budget request is out, how confident are you the administration can achieve President Trump’s goal of ending new HIV infections by 2030?

Robert Redfield: I’m totally confident that we’re going to succeed. And, again, I just want to clarify the goal is to end the HIV epidemic by 2030, and so, what that technically means is to bring new infections down to less than one per 100,000, so that would be less than 3,000. Obviously, we would like to do all the way down to zero, but the goal is to end the AIDS epidemic in America by decreasing new infections below 1 infection per 100,000 group of people.

Blade: The president announced the initiative during his State of the Union address. What was the process like to make sure those words would be included in the speech?

Redfield: Well, I really don’t know that process as much other than I can say that this was a very thoughtful initiative that was put together by key principals from CDC, NIH, HRSA, the Indian Health Services, the assistant secretary of health, who really did work together for months to look in detail whether we felt that the targeted initiative, a highly focused initiative could meet the goal of bringing the HIV epidemic to an end.

Once we were confident among ourselves that, as you know well, Chris, we had the tools, whether it’s successful treatment to get people diagnosed and treated, virally suppressed, so not only they can live a full life, but also, importantly, that if you’re virally suppressed that…you would no longer be able to transmit, and if you could couple that with getting people at risk for HIV infections in comprehensive prevention programs, including PrEP, that the epidemic would come to an end.

And the question was how would we do that. And when we looked at the new infections in America that have stabilized around 40,000 and just spotted the infections where they occurred, we noticed that over half the infections were in 48 counties and D.C. and San Juan — which is just 50 jurisdictions out of over 3,000, so immediately if you look at that map, everyone said, “Wait a minute. This is highly focused. We can do this.”

It’s also highly focused, as you know, demographically that most of the new infections that we’re seeing are in men who have sex with men, and not just men who have sex with men, but African-American and Latino men, and not just African-American and Latino men, but men that are between the ages of 25 and 34. So it’s very geographically focused and it’s very demographically focused.

So we came together with an initiative, which we all believed was no longer aspirational, but was practical. We presented that initiative to our secretary of health, who has fully embraced it as one of his major priorities. He was successful in presenting this to the president, who was also very committed and engaged, but I don’t know the actual process of how words get into his speech. Clearly, I do know how the secretary became very committed and made this one of the major objectives of his tenure as secretary and he presented it to the president. He wanted to make it one of the major initiatives of his presidency.

Blade: The president’s budget request calls for $300 million for the initiative. Will future requests seek similar resources, or was that a one-time request?

Redfield: As you know the president’s budget request, as you said, nearly $300 million, $291 million. That was the budget that the experts within the department, the agencies that I mentioned, thought that we needed in Year One. 

This is a multi-year initiative, and people can anticipate that there’ll be additional requests in a second, third, fourth and fifth year. And people can anticipate that those resources obviously will be — requested will be significantly greater than the resources that were in the president’s budget for 2020.

Blade: The budget also requests an $845 billion cut to Medicare and seeks to roll back Medicaid as it was expanded under the Affordable Care Act. Could the administration achieve the 2030 goal if Congress agrees to the cuts as well?

Redfield: You know, Chris, that’s outside my expertise other than to say that I am confident, as are the other leaders, confident that within the president’s HIV initiative, we will have the resources needed to make sure that all — I’m going to keep saying that “all,” because people when I say “all,” they say but what about these people? I say all people with HIV infection we will work to get diagnosed, engaged in care and on retroviral therapy and virally suppressed.

And we did our current calculations with a five-year budget outline and eventually, as you know, it’s a 10-year program, but we did outline the first five years. We did it assuming that there was no significant change in expanded Medicaid and any change in services. The second thing we did is [ensure] all people at risk for HIV infection would get access to comprehensive prevention strategy, including PrEP. 

So, at least for individuals who are at risk for HIV infection or who have HIV infection, these persons will get access to the medical and preventive care independent of other issues they may come about related to the broader health care issues of our nation.

Blade: You were working on HIV/AIDS drug development at the height of the epidemic in the 1980s and 90s. How would you compare HIV/AIDS treatment at that time to what we have now?

Redfield: You know, it’s really been a gift to watch the power of science apply. When I started as an HIV physician in 1983, many of my patients had a limited life expectancy. I learned as a physician just to try to take care of them to the best of my ability, but all too often, that ended in death way too prematurely. [I was] involved in the first trial to ever use AZT, and I remember how ecstatic we all were when we increased survival from 10 months to 26 months. Who would believe today that when you’re 20 years old and you get HIV, you can expect to live between the age of 70 and 75?

When we originally had therapy, as you know, and went through single lymphocyte, dual lymphocyte, then eventually the protease inhibitors came and we had many patients that were taking 20, 30, 35 pills a day, three times a day, significant toxicity, major side effects and frequently at the end of the day, half the patients developed resistance and therapy failed.

There was a time actually when I was involved in Baltimore after I left the military that I was considered one of the doctors of last resort. People would come with multi-drug resistance virus, resistant to three or four classes of drugs. We would try to do the best and keep their T-cell count from falling and just do the best we could. 

Today, the therapy we have is single pill or two pills once a day. I like to use the term it’s pretty bulletproof, meaning the drugs really work and the virus really doesn’t have the ability to escape them the way it did in the old days. Drug resistance is no longer a real threat, particularly with some of the major drugs that are used today. The side effects now on these drugs are really minimal, close to the side effects of water. So today we have really very simple, very successful, very easy-to-take therapy that has minimum side effects, limited toxicity so that people can expect to take them for 20, 30, 40 or 50 years and can expect being able to have a high quality of life.

You know, and you follow this close, there’s even advancements in therapy that are coming beyond that in terms of some of the long-acting therapies, long-acting injectables. It probably won’t be long to some people who don’t even like taking a pill a day to be given an alternative option to take some type of injection, or even people are looking at long-acting implants that will be able to basically provide the treatment that they need.

It’s clear that we will need chronic anti-retroviral therapy to maintain viral suppression. I do think therapy strategies continue to be worked on, science is working hard trying to find ways we can cure HIV infection. I think those days will come. We’ve seen several cases already, but I think you’ll see strategies develop that are actually more applicable. 

So, I think it’s just an amazing testament to the power of science and I’d like to say it to you: A big part of it was obviously the investment and the science that was done in the private sector, but probably the most important investment was the courage of the young men and women and persons in the community that had the courage to participate in the clinical research. 

So that we actually went from a day when most people with HIV infection kind of looked at a difficult clinical course that too often ended in premature death and today we’re looking at actual lifetime, we’re even looking at the ability to tell young people that are HIV infected, we can actually not only help you live a natural lifetime, we can actually make it so you’re no longer infectious to those you care about or those you have sexual relationships with. And who would have believed that?

Again, I know you reach out to a large community, a lot of credit goes to the community, the early community that had the courage to participate in clinical research.

Blade: Why has HIV/AIDS been such a personal priority for you?

Redfield: You know, that’s an interesting question because it really, really has. It wasn’t initially because of any insight. I was asked…my job in the military was to look at infectious diseases…that were viral that might be transmitted by blood, or sexually transmitted diseases. Rapidly, obliviously, it was clear that HIV fit into that group.

When I started prior to the understanding of the cause, taking care of the men and women that were in the military with HIV infection at a time when we didn’t know what it was, I’ll tell you the truth, they rapidly became my friends. It was a real challenge. I went into infectious disease rather than oncology because I didn’t think I could deal with my patients dying all the time. I eventually ended up with HIV [care] and becoming a dominant provider of HIV care. 

Really, until I became CDC director last year, I cared for many, many, many patients and I say initially because I got to see it and I really did believe that, systemically, science could do this. I worked with really good scientists, I got to be part of the team that originally proved the causation between AIDS and HIV. I got to work on some of the earlier therapies as you mentioned. I saw incremental improvement, then it got applied to individual lives and made a difference.

I could still remember very clearly the last patient that I had that missed out on protease inhibitors…If she could have just lived another six weeks, she’d probably be alive today. But I think it was that. And I saw science making a difference. I think that’s why now I want to see those tools I would never believed even 10 years ago, we wouldn’t have been able to dream to end the AIDS epidemic, the fact those tools today, we have them. I think many of us for years were hoping there’d be a historical effort in the United States to do this, and we’re just honored and appreciative that President Trump has chosen to use this as a major initiative, Secretary Azar, and say let’s apply that science and let’s get this thing to the finish.

Blade: Let’s go back to the plan. There’s concern that it addressed the biomedical aspects of HIV/AIDS, but ignores the social determinants of health. What assurances can you make homophobia and transphobia won’t be a factor in seeking to treat HIV patients?

Redfield: Chris, this is a critical, critical point. Succeeding in ending the HIV/AIDS epidemic in America is not limited to the biomedical success. I think the first thing I will say is I feel very strongly that stigma in all its forms are the enemy of the public health. That’s obviously even more critical in the drug overdose, drug use, drug misuse epidemic that were dealing with. I think it’s clear that many of the people that haven’t gotten access to diagnosis or have been linked to care and stay in care, or haven’t gotten access to comprehensive prevention strategies, many of these reasons that has not happened are defined in what you highlight as factors that are really social determinants of health.

One thing I’ll say about this initiative: It’s not a top-down initiative. Each of these jurisdictions are going to have to come up with a different plan and we said it clearly: It’s a plan that’s for the community, by the community, in the community. I will say the community is going to be the most critical lynchpin of this plan because many of us public health leaders, or many of the academic leaders, probably aren’t the critical experts to understand what it is that community needs to get diagnosed in certain communities, or what it is they need linked to care.

I’ll be the first to say that housing is part of the medical issue. I’ll be first to say that there are a number of social determinants, so the community is going to be critical, and groups like your paper are going to be important because probably the most critical group that can help this program be successful is the persons who actually become HIV-infected in the first couple years. 

I think we need to…have a detailed, what I call a social autopsy to understand what was it that didn’t work so this individual didn’t get access to the prevention efforts that we know work. What was it that made this individual’s sexual partner not get access to HIV treatment so they could be virally suppressed and undetectable? It really is building the trust and partnership with the community to be a part of this initiative. When I say this is our initiative from CDC, or our initiative from the U.S. government, it’s our initiative for the entire HIV community to finally bring an end to the HIV epidemic as we know it. 

And the only thing that will prevent it is if we don’t get the full participation of the community, which I’m confident we will as we move forward and build the trust of the community that we’re serious about making sure the community does get — all people can get access to effective therapy, all people in the community can access to comprehensive strategies.

Blade: You talked about stigma being contrary to the interest of public health. Do you think that stigma based on homophobia and transphobia still persists in medicine and do you think the military’s transgender policy, the ban, which is framed as a broad-based medical policy, is evidence of stigma based on transphobia?

Redfield: What I can say is that I do believe that stigma still exists in the HIV epidemic, and particularly, you see it in transgender persons and having clinical settings that people feel comfortable accessing. We clearly see it in men who have sex with men, particularly the African-American and Latino men that have highly religious structures that have seemed to reinforce stigma.

We’ve also seen it, Chris, in one of the areas that I’ve seen in some of the surveys we’ve done about men who have sex with men about their own feeling about themselves. There is sadly still self-stigmatization that people have that we need to get rid of. People need to feel proud of who they are and not feel that they’re stigmatized either internally or externally, so it’s still there. 

I will tell you, it’s nothing compared to trying to confront the stigma dealing with drug misuse and drug use, but it’s there and needs to be confronted and it needs to be peeled away so it doesn’t impact individuals from gaining access to the care and treatment and prevention services that they deserve to have free access to.

Blade: And is the military’s transgender policy an example of that?

Redfield: I really am not going to comment directly on that. I think that what the military’s decisions are — from a public health point of view we need to embrace transgender persons so that they can get access to care and treatment prevention services that they need, and I think you’ll see this initiative accomplish that. We need to embrace men who have sex with men that feel stigmatized so that they can be in clinical settings.

The one thing I will say that’s important that we need the community, all too often we develop these clinical programs where the illness is for the patients to come to us on our terms. I’ve challenged the community and I’ve reached out and I’ll continue to reach for the community to develop innovative ways to provide care and treatment and prevention services to the community where they are and I think, again, central to this, is the importance that stigma has no place in our efforts to bring an end to the AIDS epidemic and the president’s initiative.

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New Supreme Court term includes critical LGBTQ case with ‘terrifying’ consequences

Business owner seeks to decline services for same-sex weddings

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The U.S. Supreme Court is to set consider the case of 303 Creative, which seeks to refuse design services for same-sex weddings. (Blade file photo by Michael Key)

The U.S. Supreme Court, after a decision overturning Roe v. Wade that still leaves many reeling, is starting a new term with justices slated to revisit the issue of LGBTQ rights.

In 303 Creative v. Elenis, the court will return to the issue of whether or not providers of custom-made goods can refuse service to LGBTQ customers on First Amendment grounds. In this case, the business owner is Lorie Smith, a website designer in Colorado who wants to opt out of providing her graphic design services for same-sex weddings despite the civil rights law in her state.

Jennifer Pizer, acting chief legal officer of Lambda Legal, said in an interview with the Blade, “it’s not too much to say an immeasurably huge amount is at stake” for LGBTQ people depending on the outcome of the case.

“This contrived idea that making custom goods, or offering a custom service, somehow tacitly conveys an endorsement of the person — if that were to be accepted, that would be a profound change in the law,” Pizer said. “And the stakes are very high because there are no practical, obvious, principled ways to limit that kind of an exception, and if the law isn’t clear in this regard, then the people who are at risk of experiencing discrimination have no security, no effective protection by having a non-discrimination laws, because at any moment, as one makes their way through the commercial marketplace, you don’t know whether a particular business person is going to refuse to serve you.”

The upcoming arguments and decision in the 303 Creative case mark a return to LGBTQ rights for the Supreme Court, which had no lawsuit to directly address the issue in its previous term, although many argued the Dobbs decision put LGBTQ rights in peril and threatened access to abortion for LGBTQ people.

And yet, the 303 Creative case is similar to other cases the Supreme Court has previously heard on the providers of services seeking the right to deny services based on First Amendment grounds, such as Masterpiece Cakeshop and Fulton v. City of Philadelphia. In both of those cases, however, the court issued narrow rulings on the facts of litigation, declining to issue sweeping rulings either upholding non-discrimination principles or First Amendment exemptions.

Pizer, who signed one of the friend-of-the-court briefs in opposition to 303 Creative, said the case is “similar in the goals” of the Masterpiece Cakeshop litigation on the basis they both seek exemptions to the same non-discrimination law that governs their business, the Colorado Anti-Discrimination Act, or CADA, and seek “to further the social and political argument that they should be free to refuse same-sex couples or LGBTQ people in particular.”

“So there’s the legal goal, and it connects to the social and political goals and in that sense, it’s the same as Masterpiece,” Pizer said. “And so there are multiple problems with it again, as a legal matter, but also as a social matter, because as with the religion argument, it flows from the idea that having something to do with us is endorsing us.”

One difference: the Masterpiece Cakeshop litigation stemmed from an act of refusal of service after owner, Jack Phillips, declined to make a custom-made wedding cake for a same-sex couple for their upcoming wedding. No act of discrimination in the past, however, is present in the 303 Creative case. The owner seeks to put on her website a disclaimer she won’t provide services for same-sex weddings, signaling an intent to discriminate against same-sex couples rather than having done so.

As such, expect issues of standing — whether or not either party is personally aggrieved and able bring to a lawsuit — to be hashed out in arguments as well as whether the litigation is ripe for review as justices consider the case. It’s not hard to see U.S. Chief Justice John Roberts, who has sought to lead the court to reach less sweeping decisions (sometimes successfully, and sometimes in the Dobbs case not successfully) to push for a decision along these lines.

Another key difference: The 303 Creative case hinges on the argument of freedom of speech as opposed to the two-fold argument of freedom of speech and freedom of religious exercise in the Masterpiece Cakeshop litigation. Although 303 Creative requested in its petition to the Supreme Court review of both issues of speech and religion, justices elected only to take up the issue of free speech in granting a writ of certiorari (or agreement to take up a case). Justices also declined to accept another question in the petition request of review of the 1990 precedent in Smith v. Employment Division, which concluded states can enforce neutral generally applicable laws on citizens with religious objections without violating the First Amendment.

Representing 303 Creative in the lawsuit is Alliance Defending Freedom, a law firm that has sought to undermine civil rights laws for LGBTQ people with litigation seeking exemptions based on the First Amendment, such as the Masterpiece Cakeshop case.

Kristen Waggoner, president of Alliance Defending Freedom, wrote in a Sept. 12 legal brief signed by her and other attorneys that a decision in favor of 303 Creative boils down to a clear-cut violation of the First Amendment.

“Colorado and the United States still contend that CADA only regulates sales transactions,” the brief says. “But their cases do not apply because they involve non-expressive activities: selling BBQ, firing employees, restricting school attendance, limiting club memberships, and providing room access. Colorado’s own cases agree that the government may not use public-accommodation laws to affect a commercial actor’s speech.”

Pizer, however, pushed back strongly on the idea a decision in favor of 303 Creative would be as focused as Alliance Defending Freedom purports it would be, arguing it could open the door to widespread discrimination against LGBTQ people.

“One way to put it is art tends to be in the eye of the beholder,” Pizer said. “Is something of a craft, or is it art? I feel like I’m channeling Lily Tomlin. Remember ‘soup and art’? We have had an understanding that whether something is beautiful or not is not the determining factor about whether something is protected as artistic expression. There’s a legal test that recognizes if this is speech, whose speech is it, whose message is it? Would anyone who was hearing the speech or seeing the message understand it to be the message of the customer or of the merchants or craftsmen or business person?”

Despite the implications in the case for LGBTQ rights, 303 Creative may have supporters among LGBTQ people who consider themselves proponents of free speech.

One joint friend-of-the-court brief before the Supreme Court, written by Dale Carpenter, a law professor at Southern Methodist University who’s written in favor of LGBTQ rights, and Eugene Volokh, a First Amendment legal scholar at the University of California, Los Angeles, argues the case is an opportunity to affirm the First Amendment applies to goods and services that are uniquely expressive.

“Distinguishing expressive from non-expressive products in some contexts might be hard, but the Tenth Circuit agreed that Smith’s product does not present a hard case,” the brief says. “Yet that court (and Colorado) declined to recognize any exemption for products constituting speech. The Tenth Circuit has effectively recognized a state interest in subjecting the creation of speech itself to antidiscrimination laws.”

Oral arguments in the case aren’t yet set, but may be announced soon. Set to defend the state of Colorado and enforcement of its non-discrimination law in the case is Colorado Solicitor General Eric Reuel Olson. Just this week, the U.S. Supreme Court announced it would grant the request to the U.S. solicitor general to present arguments before the justices on behalf of the Biden administration.

With a 6-3 conservative majority on the court that has recently scrapped the super-precedent guaranteeing the right to abortion, supporters of LGBTQ rights may think the outcome of the case is all but lost, especially amid widespread fears same-sex marriage would be next on the chopping block. After the U.S. Tenth Circuit Court of Appeals ruled against 303 Creative in the lawsuit, the simple action by the Supreme Court to grant review in the lawsuit suggests they are primed to issue a reversal and rule in favor of the company.

Pizer, acknowledging the call to action issued by LGBTQ groups in the aftermath of the Dobbs decision, conceded the current Supreme Court issuing the ruling in this case is “a terrifying prospect,” but cautioned the issue isn’t so much the makeup of the court but whether or not justices will continue down the path of abolishing case law.

“I think the question that we’re facing with respect to all of the cases or at least many of the cases that are in front of the court right now, is whether this court is going to continue on this radical sort of wrecking ball to the edifice of settled law and seemingly a goal of setting up whole new structures of what our basic legal principles are going to be. Are we going to have another term of that?” Pizer said. “And if so, that’s terrifying.”

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Kelley Robinson, a Black, queer woman, named president of Human Rights Campaign

Progressive activist a veteran of Planned Parenthood Action Fund

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Kelley Robinson (Screen capture via HRC YouTube)

Kelley Robinson, a Black, queer woman and veteran of Planned Parenthood Action Fund, is to become the next president of the Human Rights Campaign, the nation’s leading LGBTQ group announced on Tuesday.

Robinson is set to become the ninth president of the Human Rights Campaign after having served as executive director of Planned Parenthood Action Fund and more than 12 years of experience as a leader in the progressive movement. She’ll be the first Black, queer woman to serve in that role.

“I’m honored and ready to lead HRC — and our more than three million member-advocates — as we continue working to achieve equality and liberation for all Lesbian, Gay, Bisexual, Transgender, and Queer people,” Robinson said. “This is a pivotal moment in our movement for equality for LGBTQ+ people. We, particularly our trans and BIPOC communities, are quite literally in the fight for our lives and facing unprecedented threats that seek to destroy us.”

Kelley Robinson IS NAMED as The next human rights Campaign president

The next Human Rights Campaign president is named as Democrats are performing well in polls in the mid-term elections after the U.S. Supreme Court overturned Roe v. Wade, leaving an opening for the LGBTQ group to play a key role amid fears LGBTQ rights are next on the chopping block.

“The overturning of Roe v. Wade reminds us we are just one Supreme Court decision away from losing fundamental freedoms including the freedom to marry, voting rights, and privacy,” Robinson said. “We are facing a generational opportunity to rise to these challenges and create real, sustainable change. I believe that working together this change is possible right now. This next chapter of the Human Rights Campaign is about getting to freedom and liberation without any exceptions — and today I am making a promise and commitment to carry this work forward.”

The Human Rights Campaign announces its next president after a nearly year-long search process after the board of directors terminated its former president Alphonso David when he was ensnared in the sexual misconduct scandal that led former New York Gov. Andrew Cuomo to resign. David has denied wrongdoing and filed a lawsuit against the LGBTQ group alleging racial discrimination.

Kelley Robinson, Planned Parenthood, Cathy Chu, SMYAL, Supporting and Mentoring Youth Advocates and Leaders, Amy Nelson, Whitman-Walker Health, Sheroes of the Movement, Mayor's office of GLBT Affairs, gay news, Washington Blade
Kelley Robinson, seen here with Cathy Chu of SMYAL and Amy Nelson of Whitman-Walker Health, is the next Human Rights Campaign president. (Washington Blade photo by Michael Key)
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Former Ambassador Daniel Baer explains it all on Ukraine crisis

Expert downplays strategic thinking behind Putin’s move

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Daniel Baer, United States Department of State, Bureau of Democracy, Human Rights and Labor, gay news, Washington Blade
Daniel Baer served as U.S. ambassador to the Organization for Security & Cooperation in Europe. (Blade file photo by Michael Key)

Daniel Baer, who worked on LGBTQ human rights and transatlantic issues as one of several openly gay U.S. ambassadors during the Obama administration, answered questions from the Washington Blade on Ukraine as the international crisis continues to unfold.

Topics during the interview, which took place weeks ago on Jan. 27, included Putin’s motivation for Russian incursions, the risk of outright war, predictions for Russia after Putin and how the crisis would affect LGBTQ people in Ukraine.

Baer was deputy assistant Secretary of State for the Bureau of Democracy, Human Rights and Labor and U.S. ambassador to the Organization of Security & Cooperation in Europe.

The full interview follows:

Washington Blade: What’s your level of engagement with this affair? Are you doing any consulting work? Is the administration reaching out to you at all?

Daniel Baer: I actually think the White House is doing a pretty good job of recognizing that they need to not only have press conferences, but also talk to other people who are trying to figure out how to be constructive critics, idea generators from the outside.

Blade: OK, so you’re being solicited and engaging on this issue. My next question for you is why do you think Putin is doing this at this time?

Baer: So, I guess taking a step back from the whole thing, one of the things about a problem like this is that everybody is searching for the right answer assuming that there is a like comfortable or compelling or intellectually accurate answer, and I actually think we’re just in a really hard moment.

I don’t know why he’s doing it now. And in fact, I think that one of the puzzles that we haven’t solved yet is that all the things that he says are the reasons that he’s doing it — that he feels encirclement by NATO, … or that the situation in Ukraine is untenable — none of those things have changed. Setting aside the fact that they’re spurious, it’s not like there’s been some new move in the last 12 months that has precipitated [a reaction] on any of those fronts that you can say, “Oh, well, he’s responding to the recent meeting where Ukraine was offered membership in NATO, or he’s responding to a change in government in Ukraine that it’s clearly anti-Russia, or any other move that we’ve done.” The explanation just doesn’t hold water, and so I think we need to look for alternative ones.

The best I can come up with is actually just a broad — it doesn’t actually explain this particular moment, but I think you could look at the timing of his life. He has, I don’t know, 10 years left. And during those 10 years, it’s unlikely that Russia is going to grow more powerful; it’s much more likely that it’s going to become at least relatively and probably nominally less powerful. And so, if you’re unhappy with the status quo, and you feel like you’re a declining power, and you don’t have endless time, there’s no time like the present. And you’ll make up whatever reasons you need to in order to justify it.

I also think there’s a tendency on our part to attribute far more “strategery” to Putin than there necessarily is. I mean, he’s a bully and a thug. I think the whole Putin’s playing chess and we’re playing checkers is actually completely inverted. We’re in our own heads that there’s some kind of nuanced position that would mollify him. He’s just a gangster and he’s taking a punch because he has one. And I don’t think it gets much more complicated than that. And so, I guess the answer to why he’s doing this now, because the international conditions are such that he feels like the United States is focused domestically, the Ukrainians are not moving forward with succeeding to build — they’re kind of in stasis on building a European state— and he has, you know, he has the space to take a punch, so he’s contemplating doing it, or he’s already decided to do it. And he’s just extracting as much as possible before he takes it.

Blade: That leads me to my next question: What is your judgement of the risk of out and out war?

Baer: I don’t know because I have two hypotheses that cut both ways. One is that I think Putin is vastly underestimating the degree of resistance. On the other hand, I think that nothing short of domination is satisfactory. And so, I don’t know. I guess I think there’s a 90 percent chance that he does something, and I think there’s a 75 percent chance that what he does is not an all out invasion or ground invasion, at least not at first, but rather something that is aimed at confusing us. So some sort of hybrid or staged or false flag kind of attack in tandem with a political coup in Kiev, where he works to install a more Russia-loyal leader.

The thing with the ground invasion is that Russian soldiers’ moms are one of the only, like, powerful political forces in civil society in Russia. I just don’t see any way that a ground invasion doesn’t involve massive Russian casualties, even if they will be dominant. The people who are going to impose the consequences on him will be the Ukrainians, not the rest of us, and he should not invade, and if he does, we should, frankly, work hard to make it as painful and difficult for him as possible.

Blade: What will that look like?

Baer: I think we should at that point continue — we shouldn’t pause, we should continue to send the defensive equipment and backfill as much as possible their ability from an equipment basis to resist.

Blade: So if we were to look at a model for past U.S. engagements. I’m thinking Greece under President Truman, which was so successful that nobody really knows about it, I don’t think. Is there any model we should be looking toward, or not looking toward?

Baer: No, I guess. I’m not sure there’s any good historical model because obviously, any of them you can pick apart. I do think that one thing that has gotten lost in a lot of the analysis — and this goes back to Putin being a gangster thug, and not being such a genius — is there’s a moral difference between us. The reason why Putin gets to control the dialogue is because he’s willing to do things that we aren’t willing to do — as gangsters are, as hostage-takers are — and so yes, they get to set the terms of what we discussed, because we’re not holding hostages. We’re trying to get hostages released. And the hostage-taker has an upper hand and asymmetry because they are willing to do something that is wrong.

We shouldn’t lose the kind of moral difference there. Nor should we lose sight of the fact that Ukraine is being menaced. And I’m not saying it’s our obligation [to intervene militarily], certainly not our obligation. They aren’t a treaty ally. We have neither a political obligation nor a moral one to necessarily risk our own lives, our own soldiers in defense of Ukraine. But if Ukraine wants to defend themselves, there’s a strong moral case to be made that anything, short of risking our own lives, is something that is morally good. We generally believe that self-defense from lethal threat is a reasonable moral cause and assisting others in defending themselves is too — I think there’s a lot of back and forth that get glossed over whether that’s a provocation or whatever, and I want to say to people stand back, look at this: we’ve got one party that is attacking another. And the question is, does the other have a right to defend itself? Yes. And if they have a right to defend themselves, and they also have a right to have whatever assistance people will offer them in defending themselves.

That doesn’t mean that they get to demand that we show up and fight in the trenches with them, of course, and I don’t think there’s any serious people who are recommending that but it’s a good thing to help them. It’s not like a technical thing. It’s a good thing to help

Blade: Getting into that moral background, one thing I want to ask you was about the significance of what would happen in this concept of democracy versus autocracy. First of all, how much is Ukraine a functional democracy, in the sense that if we’re defending Ukraine, we are defending a democracy, and what signal do you think it would send if that Ukrainian government fell to Russian autocracy?

Baer: I think the institutions of government that the Ukrainian people have are not worthy of the Ukrainian people’s own demonstrated commitment …

They are not worthy of the Ukrainian people’s own demonstrated commitment to the idea of democratic institutions. So the answer is today’s Ukrainian government is a mixed bag and it’s very hard to build, on the rot of a Russian fiefdom, a functioning democracy, so I think it’s a mixed bag. I don’t want to sound like I’m minimizing [the changes], or that they’ve completely bungled an easy project. It was always going to be a hard project, and it was never going to be linear.

But I think that what we’ve seen from the Ukrainian people — by which I mean not Ukrainian people, but people of Ukraine — is that there is a broad part of society that a) does not want to live under a Russian thumb and b) sees its future in kind of European style democracy. And so I think that if there was, there’s no question that the Russian attack would be in part about subjugating the people of Ukraine and forcing them to live under some sort of new Russian satellite. And I think that there’s little space for serious argument that that’s something that the people of the country wish to have.

Blade: But I’m just kind of getting at — you’re kind of minimizing that this is a strategic move by Putin, but if he were to successfully dominant Ukraine it becomes a Russian satellite isn’t that saying like, “Well, ha ha West, you thought the Cold War was over and there’s going to be just be a unipolar world in the future but no, we’re gonna we have this we’re back and we’re gonna create a multipolar world for the future.”

Baer: Yeah, I mean, my answer to the Russians who always raise the multipolar world to me is, “Fine, it’s going to be a multipolar world. What makes you think that Russia is one of the poles?” Poles by definition draw people to them, they are compelling and a pole attracts, magnetically or otherwise, and there is nothing attractive about the model that Russia is pursuing. And if the only way that you can be a pole is by subjugating, to force your neighbors, you are proving that you are not one.

I think the benefits for Russia are far smaller than Putin thinks and I think the consequences for the rest of the world of allowing a violation of international order to go forward are much larger than many people recognize.

Blade: But that was their approach when they were the Soviet Union. They were subjugating the Eastern Bloc through Russian force. They did have, in theory, the concept of their worldview of you know, of socialism, or whatever you want to put it charitably, was going to be the right way to go. Is there really that much of a difference?

Baer: Yeah, however disingenuous it was, they did have an ideology . So you’re right, that was a key distinction. The other thing is that the Soviet Union in relative size — its economy and population etc. — was much larger than Russia is today. And Russia is shrinking, and its economy is less diverse than the Communist one was. I think it’s a delusion to think that they’re going to kind of rebuild an empire, even if yes, because of their willingness to do awful things, they could potentially for a time politically control through violence, their neighbors. I just don’t — in a multipolar world, I don’t see Russia being one of the poles, at least not on its current path.

Blade: How would you evaluate the U.S. diplomatic approach to this issue?

Baer: There’s been very clear over-the-top effort to include the Europeans at every step — meetings with them before each meeting and after each meeting, to force conversations into fora that are more inclusive and stuff like that. And I think that Secretary Blinken is rightly recognizing the need to kind of play a role of kind of keeping everybody on the side while we test whether diplomacy whether there’s anything to do, whether there’s any promise with diplomacy.

I think there’s kind of, sometimes kind of, two camps in U.S. foreign policy circles. One is like: We should give the Russians what they want because it just doesn’t matter that much. War is much worse than anything that we would give them. And another is that we can’t give them an inch and we have to punch them in the face whenever we can. And I think both of those are kind of knee-jerk positions that have become a bit religious for people and neither of them is paying attention to the practical challenge that’s in front of the administration, which is like this guy’s threatening to invade and we need to identify whether there’s any opportunity for a functional off ramp, and that doesn’t mean we do that in a vacuum and ignore the long-term consequences, but our problem is not a religious one, it’s a practical one. And I think they’re doing a pretty good job of threading the needle on that and being not too far forward and not too far back.

Blade: Do you see any significant daylight between the United States and Europe?

Baer: No, I mean, no more than the minimum that is possible. There’s a lot of talk about Germany these days. Look, I think some of the things they say are not particularly helpful, but I don’t actually think that in the long run, if Putin invaded, I don’t think that they would hold up sanctions or anything like that. So I think they’re on our side, even if they’re talking out of both sides, in some cases.

Blade: I am wise to the fact that this is a nuclear power. It might be a little old school, but could escalation get that far?

Baer: There can’t be war. There can’t be war between NATO and Russia. It should be avoided. Obviously, there can be, but it should be avoided.

Blade: How committed do you think President Biden is to protecting Ukraine?

Baer: Reasonably so. I think he’s enough of an old school trans-Atlantist that he understands that this isn’t just about Ukraine.

Blade: I was wondering because he had those comments from his press conference about “minor incursion” and I’m just wondering if you’re reading anything into that or not.

Baer: No, I think that was that was a — I think broadly speaking, everything he says is in line with the kind of view that you would expect. And of course, one sentence can catch [attention]. That wasn’t what he meant. What he meant was that he didn’t want to draw a “red line” that would prejudge policy in response to something short of the most extreme scenario.

I think it is a good caution to not obsess over a single sentence and to look at the broad considered policy statements.

Blade: What do you think if you were looking for developments, like what would you be looking out for is significant in terms of where we are going to be going in the near future? This is one thing to keep an eye out for but is there anything else that you are kind of looking out for in terms of the near future?

Baer: I guess I would look out for whether or not the United States joins meetings of the so-called Normandy Format, which is the France, Germany, Ukraine and Russia grouping, which has so far been unsuccessful, but I think can only be successful as the United States joins it, but the Russians, I think have misgivings with the idea of our joining it.

Blade: I’m not at all familiar with that. What makes this forum particularly so —

Baer: So it was started in the summer in like June of 2015, on the margins of some meeting between Merkel and Hollande. The French and the Germans are very committed to the idea that they might be able to mediate peace between Ukraine and Russia. It was supposed to implement the Minsk Agreement, and it just hasn’t been productive so far. I don’t think that the Russians will do anything — I don’t think the Ukrainians feel comfortable negotiating anything without the Americans at the table. And I don’t think the Russians feel like anything is guaranteed without the Americans at the table. So I just, I’m fine with France and Germany taking the lead, but I think the U.S. has to be there.

And there was a meeting of this group in Paris yesterday, and which the U.S. was supportive of, and so I’m watching to see whether or not the United States gets added in some ad hoc way, whether there are future meetings. I guess the reason I would watch it, if the U.S. were to join future meetings that would signal to me that it’s actually there’s some diplomacy happening there.

That’s meant to be focusing mainly on the existing Russian invasion, the occupation of the Donbas, so that’s not about the threat of the new invasion, but it would be interesting to me if there was forward movement on other parts of Ukraine. The announcement of the American ambassador is one. I think that last week movement of troops into Belarus was a game changer for the U.S., because there are all kinds of new implications if you’re using a third country as your launchpad for war, and so it complicates things and it also looks more serious if you’re starting to deploy to third countries and stuff like that. So I think that was that last week, you noticed a difference in the U.S. tone and tenor in response to that.

So things like that. But in general, like what I would do and I don’t think people always catch this is because there’s a boiling frog aspect to it. There are statements coming out from the White House or State Department. Almost every day on stuff related to this and like last week, there was a noticeable change in the tenor as the U.S. became less, I think more pessimistic about the prospects of diplomacy and those I don’t have anything better to look for in those statements as tea leaves, in terms of what the U.S. assessment is of the prospects of the escalation are, so it’s bad.

Blade: Right. That’s very sobering.

There’s a lot of talk, and I’ve just been seeing some like about in terms of, there’s like comparisons to Afghanistan and making sure that all Americans are able to get out of Ukraine. Is that comparing apples to oranges?

Baer: Yes.

Blade: And could you unpack that a little bit? I mean, I can kind of guess the reasons why. How is that apples to oranges?

Blade: Well, the level of development in Ukraine in terms of infrastructure and transport and stuff like that is not comparable to Afghanistan. I think it would be– if there were a Russian invasion–you would definitely want to, obviously, for safety reasons, it’s not safe to be in a war zone, so you would want people to be able to evacuate and you’d have to plan for that.

A major concern [in Afghanistan] was also that there were tens of thousands, if not hundreds of thousands of locals who had worked for the Americans. The Americans that are in Ukraine are not a departing occupying power. There’s just not the same footprint there — the Americans are in Ukraine or there as business people or young [people working on] democracy assistance or whatever. And it’s just it’s a different context.

Blade: Why do you think the Russians put up with Putin? I mean, this is a country that was a world power and I would think has some economic potential just given its sheer size, first of all, and they do have oil to offer people. So why aren’t the Russians like angry at him for obstructing their participation in the global order as opposed to just putting up with him for years and years and years.

Baer: Successful instrumentalisation of cynicism. The lack of a belief in an alternative will keep you from fighting for it.

Blade: That’s pretty succinct.

Baer: I mean, I don’t think there’s any question that the people of Russia could be better off or different in terms of kitchen table issues, and ease of navigating the world, prospects for their future for their children’s future. The amount of money that Putin has invested into military modernization that Russia can ill afford, while he’s cut pensions and social services and health care. It’s just it’s objectively true that the average Russian person would be better served by a different leader. But he’s done a very good job of effectively selling off the country for profit and persuading people through repression and propaganda that there is no alternative.

Blade: And Putin won’t be around forever. Once he finally goes, is an alternative going to emerge, or will it be the next guy in Putin’s mold?

Baer: I think it’s far from clear that what comes after Putin isn’t worse and bloody. Regimes like this don’t reliably have stable transitions.

Blade: Wow, okay.

Baer: Yeah, we shouldn’t… we should be careful about wishing… wishing for his demise.

Blade: That’s good to know. It’s kind of a frightful note for me to end my questions. But actually before I sign off, there’s one more thing too because I do kind of want to talk about the intersection about your old job in democracy and human rights and then a Venn diagram of that with your experience in Eastern Europe in particular. Do you have a sense of what’s at stake for LGBTQ people in Ukraine or if they’re in more danger right now than they would be otherwise?

Baer: That’s a good question. I mean, my knee jerk reaction is yes. That — as mixed of a picture as Ukraine has been in the last seven years, or eight years — there have been meaningful steps forward, and certainly, in terms of visibility.

I guess, in the sense that Ukraine is better than Russia today, if you’re gay, if Russia is going to occupy or control Ukraine we can expect that it will get worse because it will become more like Russia.

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