Interview with Yoshiaki Yamasaki

REED: All right, so we're starting. So, my first question is pretty broad. But can you just tell me a little bit about your background, your early life?

YAMASAKI: I'm originally—I was born and raised in Mexico. Mexico City. My father's Japanese. My mother's Mexican-French. It's a whole combo. I came here originally to study at Penn [University of Pennsylvania], I'm a grad from Penn. I'm a psychologist by profession, and I came here in 1992. And I started directly working with HIV even before I came to the United States. I was working with HIV. My first job was at Congreso. Congreso de Latinos [Unidos]. I started as a case manager and a tester. 00:01:00And then soon after, I became the director of the program. I worked there for about four years and a half. After that I worked for the city health department. I worked for the HIV commission back in the day. I was on the CPG [Philadelphia Prevention Community Planning Group] and the Health Planner. And then after that I worked for the Health Federation [of Philadelphia]. I worked at the language interpretation project. We used to certify the interpreters in hospitals and clinics. And after that I work at TPAC [The Philadelphia AIDS Consortium] since 2000. I was involved with TPAC from the beginning since 1992, as an organization that received funding from this organization. And later on I became a board member. You were 00:02:00a board member if you received funding. Later on everybody got kicked out of the board, as it became conflict-of-interest-free. And so because I was not working any longer with Congreso, then I became conflict-of-interest-free, so I stayed on the board automatically. And in 2000, the board kicked me out and they started to hire me as a staff. That is why they had to kick me out. So in 2000 I became Director of Special Programs. And after that, Deputy, and now the Executive Director for the last decade. In 2006 I became the Executive Director.

REED: When you came to Philadelphia to go to grad school did you think that 00:03:00you would stay here?

YAMASAKI: Never in my life. And I'm still thinking that after 25 years.

REED: So you think you still might leave?

YAMASAKI: Oh no—well, that's a good question. With this particular political environment, it crosses my mind for my retirement to be in the beaches of the Riviera Maya. [laughter] But the work that we're doing here is very important so it keeps me grounded. But, yeah.

REED: What work were you doing in HIV before you came to Philadelphia?

YAMASAKI: I was working with—I was studying psychology. So I was working in the prison system, I was working—my final thesis I did in the women's prison system. So I started to work with some people that were newly diagnosed, back in the day, and didn't know what to do. It was early on, there was HIV-related dementia, and they saw a lot of… Some of my work was clinical in the San Bernardino Hospital, just to start exploring 00:04:00the beginning of the impact of what was happening with—suddenly these people, they were having this rare infection, and they were having some dementia. They didn't know what to do with them, and they didn't know how to treat them, they didn't know how to work with them. So very early on, it was very confusing. And there was an early work on just trying to treat them with respect and just—the whole idea of touching and stigma was so strong back in the day, that it was about just being human to other humans. And that was really, pretty much at the beginning of my career. I was a very young, 22 year old back in the day. Recently grad from college. And I was trying to figure things out and why friends were dying. 00:05:00So we were trying to just cope as much as we can. And I started working with the dying issues, at sort of the beginning. We were looking at how to live, whatever time they have left, how to live with this disease and make it the best of it, when you have no options. You knew that you were not gonna last more than two, three years, four max. So early work was just about meaning of life. And what you wanted to do with it, and what you wanted to do with—would it last. So it was about making plans and making kind of lists of—wish lists 00:06:00of what you wanted to do before your time comes. When I came here we started support groups and nobody believed that support group make sense or that they should exist, or that they will have an impact. So I always got—I came here with a completely different mentality, maybe because I came here with a different culture and different language, it was kind of a new thing for them. And a lot of resistance. They never thought that Latinos could have a support group. And so this is my 25 year, and we're still running support groups. And we still have support groups in North Philly. And they're still running in Spanish and even though I have lost the count of all the people that we lost, some of them, they're still alive. And some of them, they're still friends of mine. After 25 years, who was your client back in the day, fighting for life, and they survived because the new medications came. They turn part of your life, and they 00:07:00became friends of mine, and they're still around, and they still volunteer and they're still doing their thing. Right here, outside the door. So I'm very proud of that. That after 25 years of a fight here for me, some of them survived and some of them they continue to be alive and kicking.

REED: Do you remember the first time that you heard about HIV?

YAMASAKI: Yeah, I was in college. And it changed the dynamic of my learning as well. Because it was unknown and there was a lot of stigma and it was the "gay" disease, and all this kind of stuff. So it changed my life completely. Some of us, we were pushed out of the closet because of it. And so there were good things and bad things that came with this. I think for the first time we gave voice to being gay. 00:08:00It was a negative voice, but we gave voice. And so that's a positive aspect, strangely enough. It brought to the front to talk about sex, to talk about sexuality. I did a diploma in Mexico in human sexuality education—that's why I ended at Penn, because they have the Sex Ed program. And that's what brought me here. So it brought up and opened a lot of questions and lot of windows and a lot of doors that we needed to kick in, just to be able to talk about sex and to talk about prevention. And to destigmatize that it was not a gay disease. For me, early on, we knew there was not a gay disease. A lot of the people that we were working in North Philly were 00:09:00being infected because of injection drug use, sharing needles. So, for us it was a no-brainer. It was not a question about it. It was about how we fight back, and how we destigmatize the disease and make it what it is today, that affects all of us. Early in the day it was very difficult. Because Latina women became one of the largest groups infected and there were no voices. There were no people talking about it because it was a gay disease. And so the Latino community suffered a lot, just to fight back and saying it's affecting us all. And we got kids infected, and we had everybody fighting together and it was a difficult time. A very difficult time, at the beginning. Just 00:10:00fighting for the funding, it was ridiculous. People throwing chairs, and fighting off, and everybody was in conflict because everybody wanted a part of the pie, and there was such a reduced pie that it was so crazy. We have—I never expected that as an immigrant, as a person that didn't know how politics work in Philadelphia. I was always the token, I felt very used—tokenistically speaking. "Oh, this is a Mexican-Japanese! Oh, he covers two categories! Let's put him on the board, let's put him on the commission, let's put them in these places so we have an Asian voice and we have a Latino voice," and all this kind of stuff. And I'm like, "What? How? And why?" So sometimes the fact 00:11:00of being educated and having a Masters and having a licensure in my country in psychology, didn't matter much. It was about who I represented and not what voice, or what information I can give, or my experience or anything like that mattered too much. It was about—the money goes where the epidemic is. So we needed to have voices from different races and from different ethnicities so we can actually get the money and do the services that we need to do. So it became kind of a fight, every day. Meeting was a fight. Politics was horrible. People fighting for the same money, everybody dealing with their own issues. And everybody has their cases, and everybody has their stories. And how people was dying and—so, who do you provide the service to and how do you convince them that you are the ones in most need? So who writes better proposals and who doesn't? Meaning it was like a really— 00:12:00and it hasn't changed that much, the problem is it hasn't changed that much either. But back in the day there was a sense of urgency, because people were dying. And the thing is that they continue to die, but we've been silenced in different ways now. And some of them they were co-opted by the system and the advocates were swallowed by the system. So some of them lost their voices. I stay always on the outside, I believe, being inside. And maybe just because of who I am and where I come from. I'm a little bit older and more cynical now, so I can say things that before I couldn't.

REED: Did you feel that you were expected to not make waves?

YAMASAKI: [Sighs] It's a good question. Because you were on the inside, with the expectation that you need to make waves. Because now you're a token, you represent this community, you need to be a voice, you need to pull out your—whatever it is—tools that you have and bring it in. And sometimes you get attacked for no reason. And if you were a target, suddenly you have people speaking about you, talking about you because you have something to say. And when you had something to say, you needed to be silenced. So it depends on what part of the day, and what part of the political nightmare that we were living:you were going to be quiet or you were going to be talking 00:14:00 loud.

REED: And are you talking about the time that you worked for Congreso and you were on the board of TPAC in its earlier iteration?

YAMASAKI: Yes, absolutely. When I was in Congreso, you were a recipient of funding from TPAC, so TPAC had like 64 different board members. And they were all fighting for the money. And I had to give kudos to Larry Hochendoner. He was the executive director, back in the day, that was brought in by the commission, and by TPAC at that time, to fix the problem. By design—it was not the fault of anybody—by design we set up a system that it was meant to fight each other. Because we set up a system where if you were an entity, a commission, a body that will distribute funding, the government was telling you, "Your board 00:15:00needs to be constituted by the clients that you serve, and by the organizations—the providers that are serving.

YAMASAKI: So they need to represent into this commission, that is going to distribute the money to the same people." What were they expecting?

REED: So each organization was on the board, had a representative on the board.

YAMASAKI: Mhmm.

REED: And were the representatives kind of all the same—at the same levels from their organizations? Was it the—

YAMASAKI: Some of them.

REED: It varied by organization?

YAMASAKI: It varied.

REED: And so, it was this same board who were representatives of the organizations who also made the decisions about the receipt of funding?

YAMASAKI: Mhmm.

REED: Do you have an understanding—I know TPAC was established in ‘89, so that was before you got here, but do you know—just through its history why it was set up that way?

YAMASAKI: It was part of the 00:16:00federal government, when they decided to create Ryan White [HIV/AIDS Program], they wanted to have inclusiveness of the community that was gonna be served. But that's very, very, very, very poor planning. Very, very, very, poor health planning. Because it didn't matter expertise, it mattered who you represented. While it's really important to have the voices of the people, like We the People, it also was important to have the knowledge of health and the epidemic, and what was happening with everybody. Because everybody from inside the table came with emergencies. And everybody thought that their organization was doing this. So TPAC was created by five of these organizations. They say, well we need to distribute Ryan White funding, we cannot do it, so let's create a consortium. And this consortium will take care of Ryan White funding. And that's what it did. And it did a really great job, but it was 00:17:00immersed into an epidemic of a disease that there's no cure. What were they expecting? Meaning, how did they expect to develop—into what? It was a short-term fix. Everybody gets immersed, and everybody gets a share and everybody acts like there's no problems. Really? Where people was dying left and right, "I want more money. I want to take care of the burial arrangements, I want to take care of the AZT at that time, I want to take care of their housing, I want to take care of their food, I want to take care of their rent, I want to be able to give them some quality of life." Well everybody's fighting for the same thing. We set them up, this system was set up not to live long, and here we go, 30 years later—we're still trying to figure it out.

REED: And so you had all of these organizations 00:18:00and some did education work, and some did prevention, some did treatment, some did social services for people living with HIV, and those groups were supposed to allocate the money. In addition to that you had racial tensions that came in, and kind of old rivalries—is my understanding from the interviews. Is that a fair assessment?

YAMASAKI: Um, I think we just—and today it's a very good lesson to learn—we never should follow high-risk groups. They don't exist. 00:19:00What we have is high-risk behaviors. And that should have guided the process from the beginning. From the moment that we created high-risk groups, we were generating all kinds of cumbersome situations: if it was not race it was gender; if it was not gender it was orientation; if it was not orientation it was identity; if it was not identity it was youth versus age. Meaning, we created so many groups, and so many needs, and it was poor planning, again. We should have concentrated from the beginning in modes of transmission, in high-risk behaviors: how to address those issues, how to address the behaviors. Okay, it belongs to some groups, it belongs to some people, but that is the part that will have us united, not separate us. And we started wrong.

REED: How do you think that would have worked, if it had been focusing—

YAMASAKI: On high-risk behaviors?

REED: Mhmm.

YAMASAKI: We would be focusing on what would prevent it from transmission. What do you have? What did you need? You have a family? Is it a family, do you have—what is your risk? Is it a needle? How many years it took us to get Prevention Point [Philadelphia] to be accepted by the federal government, to receive funding. Because it was not about sharing needles, it was about "those drug users," and we stigmatized them from the beginning. It's our fault. If we focus on the needle, if we focus on what saves lives, it would have been way, way, way less time to get a push to government and get the federal government approval.

REED: Were there any organizations at that time that worked well with drug users? That had drug user representations?

YAMASAKI: All of them.

REED: All of them.

YAMASAKI: We were trying to make them be as inclusive as 00:21:00we could. And it was not—and again, that's the point—it was not just a gay disease. And that's why we had We the People. We had a lot of groups representing the organization. We have BEBASHI [Blacks Educating Blacks About Sexual Health Issues] back in the day, Congreso, PHMC [Philadelphia Health Management Corporation], Family Planning. We have a lot of groups that were divided by race, no? And by the services that they provide. But because race was the largest umbrella that you can put it, so under that umbrella you have MSM [Gay, Bisexual and Other Men Who Have Sex With Men], that didn't exist, the term MSM in the past, so it was—you were gay, or you were IVD [Intravenous Drug] drug user, you were women or you were 00:22:00children. So it was a whole… grouping categories—within those organizations. So that's how it was organized back in the day, and still is, in so many ways. We haven't departed from that that much.

REED: And when TPAC would meet before, they made the funding decisions. And then what else, what were the other activities that the board engaged in?

YAMASAKI: There was an allocation and a priority-setting process. So there was a priority setting first, and there was a lot of meetings talking about how to prioritize the services based on the need. So there were focus groups, there were needs assessments, there were all kinds of stuff happening. The revelations based on that—there were a list of priorities and there were community decisions of how to do the priority setting. And after that there was allocation procedures and— 00:23:00the services are not cost the same. So even though it could be ranking a "priority one" on case management, because medication was not as important at that point because there was nothing, but yet medication could cost way more, because the medication was more expensive. So even though it helped less than case management as a priority one, it needed more money than the other one. And with that, with every service, depends of the cost of the service, it doesn't matter the priority. So the allocation process was very important as well. Just to not fall through the priority saying, "This is priority number one, but it's really unexpensive. So why are you gonna put all your funding and flood that service with money that is not necessary?" So part of the allocation process was to calculate the cost of the service based on their priority and do the allocations process.

REED: How did decision making work?

YAMASAKI: Chairs being flung— [laughter] people hitting each other, cursing at each other, attacking each other. That was a normal board meeting.

REED: And can you describe an example where a chair might get thrown? Like what the argument would be about?

YAMASAKI: Oh god, really? [laughter] Ask some other people that you already interviewed. They are the ones. [laughter] You can tell them that, they know who they are. [laughter] But, it was almost out of the blue. Like if somebody felt like you were saying something that it was going to affect their service, they would just start screaming at you and they will start yelling and say, "Oh, you are discriminating and you are doing this, and you're doing that, and nobody leaves this room until 00:25:00we figure it out." And they will throw a chair and people will start getting angry and all kinds of stuff.

REED: How was it supposed to work? Where did the decision making authority reside, was it—

YAMASAKI: There were chairs.

REED: Okay.

YAMASAKI: And then there were voting and there were kind of—staff had to mediate the whole situation and do their best to calm the waters.

REED: And so is this—was your involvement in TPAC, early on, is that when you first became acquainted with We the People?

YAMASAKI: Yes. Yes, back in the day.

REED: And what are your memories, your earliest memories of We the People? Either within those meetings, or not in those meetings.

YAMASAKI: Meaning, my—now I laugh about it, but it was rough. It was rough. It was rough. 00:26:00I think they always respect me, and I always respect them, not the same with other people. They were very rough on the edges. And I don't know if I am doing a disservice or not, by talking about how this was. Because they did what they needed to do at that time to make sure that the money was distributed. So at that time, well who was it? David Fair was Executive Director, and Joe…

REED: Cronauer?

YAMASAKI: Cronauer. And so they were — 00:27:00they were great humans. And I love them and I care for them. But they were bitches too. I'm sorry—maybe I will edit this later. But—so you know. I don't know if it was right or wrong. The jury is still out for me, in my head. I just think they need to do what they did because that's what they thought it was correct? And maybe it was. I don't know. I happen—I'm a psychologist. I happen to believe that there's different ways. And there's different alternatives. But in this environment where people are dying, it's very difficult to separate the emotion from the fact, and the emotion from what is supposed to be, and the emotion what is the right thing or not. You don't know. So I cannot judge, I cannot criticize too much. I wish 00:28:00I had the brain that I have today back in the day, and the years that I have. Maybe I would have done it differently. And probably that was also part of my saving grace—that I was very young. So—they were not so young. They were more—they were older than I was, probably. Back in the day.

REED: By maybe about 10 years, would you say?

YAMASAKI: Maybe 10, maybe 20. They conserve themselves very well, but they're old farts like now I'm becoming to be. [laughter] But yeah, they're probably 15 to 20 years older than I was back in the day. They were probably in their 30s, maybe early 40s, and I was in my early 20s. I was a recent grad, and I was going to grad school and stuff like that, so. Back in the day I was like, really 00:29:00like a scared puppy, finding my way in a different country. So at that point I couldn't believe what was I seeing at that time. It was sometimes scary and very stressful. I lived a very stressful life in the beginning. 'Cause that was the politics part of it, but when I was going to work, and I was going home, I was going to hospitals every day. Our former director at Congreso back in the day, he was struggling with the disease, and we had to go and see him. And he was fighting dementia, and he was fighting a whole bunch of stuff, where we didn't have to work and go and fight and hear people screaming and yelling. And then going to the hospital and try to normalize what shouldn't be normalized. 00:30:00So that's why sometimes I believe that what we were doing was the right thing. For the government to hear, for each other to hear each other, and sometimes I think we were unfair. And I'm talking in plural—I don't think I—I don't have regrets in my life. You would never hear me screaming and yelling in one of those meetings. Never. It was never me. So I witnessed, but I didn't participate in attacking somebody or yelling at somebody, because of it. That was not my style. And probably that's why I became staff, 00:31:00and I became part of the system, in a way that it was never antagonistic. I never have a yes or no or fighting anybody. So I still believe that today, we could have done it differently. But it's there. It's part of the history. I cannot erase it.

REED: Is there anything that ran smoothly at the consortium?

YAMASAKI: Staff was fantastic. Staff were very patient and they were—before Larry Hochendoner became the executive director it was those fighting and screaming and yelling and all the stuff with these 64 or more people at the board. When Larry comes on board, he comes in an interview process that the whole commission hired him, basically. And the first thing— 00:32:00one of the first things he did, he said, "The problem is inherent to the existence of the organization as it is right now." So he said, "In order for us to make the process smoother and less aggressive, and less controversial, we need to listen to the diversity as it comes, for sure." And he got screamed at and yelled at, and everybody was going at it and taking a piece and calling him whatever. He was always so smooth. And the decision was, eventually, that if you were in conflict, you should not be part of the board. You should be part of a commission, 00:33:00on the side, that can bring their points and discussion points and everything, and their needs. But the commission should not be the one making the decisions of allocations, or priority setting. That should be an independent process, happening on the side. Bring in independent people, from other states, from other organizations outside of the area where we're giving funding, so we do it a conflict-of-interest-free process. And then everybody that is sitting on the board, they need to get out. They need to go and write proposals like we are doing now. And entering into a process where you're writing a proposal and it's gonna be reviewed by an independent review panel. So we can actually have a conflict-of-interest-free process. Which is now what the federal government uses. So from something bad, something really good happened. And so 00:34:00everybody on the board was kicked out, basically. Except few people that we remained because we had no conflict. We were not getting money from TPAC. So those who we remained started a nomination process and started looking at people that have no conflict. And so that's how the new TPAC got formed. And obviously all the people that left TPAC because they had to, because they were in conflict, they grew that resentment against the organization. Saying, "Oh, you kicked me out of the board, and now I'm going after you," and that kind of stuff. It created a whole different nightmare where people is fighting for the same pool of money. A lot of people started attacking the organization, and started attacking the leadership, and it was a nightmare. But conflict-of-interest-free.

YAMASAKI: At last.

REED: So the original consortium structure, that wasn't unique to Philadelphia. That was—so that exact structure was required—

YAMASAKI: By the federal—yeah.

REED: Okay. It wasn't just, "You need to make sure that you have representatives from the community—"

YAMASAKI: There were in the guidelines.

REED: "—in whatever way you see fit." It was mandated, that structure.

YAMASAKI: Yeah.

REED: Nationally.

YAMASAKI: Yeah. At least 50 percent of your commission should be positive individuals, and the other 50 should be providers of the services and things like that. And racial and gender and all those permutations were part of the representation of the commission. Imagine that.

REED: Was it hard to maintain that balance of 51 percent being people living with HIV?

YAMASAKI: Yeah.

REED: Would you say it's the case that 00:36:00organizations became increasingly run by and staffed by people who didn't have HIV? Or is that—

YAMASAKI: No.

REED: No. That's not the case.

YAMASAKI: No. I—well, I think it was the other way around. A lot of the organizations started to be staffed by people with HIV and AIDS. And because then you have two in one.

REED: So that balance, that 51 percent was easier to achieve over time.

YAMASAKI: Yeah. Because then you have a provider that could be HIV positive and there were two ways there. I appreciate that. HIV became very personal as a disease. Very unique. With pros and cons, with that uniqueness. That uniqueness gave voice to LGBT communities, 00:37:00but at the same time it created a big disservice in terms of the stigma. Today they're trying to eliminate it, right? Now everything is streamlined, medical and—let's forget about all the cultural aspects and the stigmatization of the disease. But all the money's going out to medications, right? It feels unfair. Because that's not what it was originally designed for. The permutations of culture and diversity and language had a voice. It was a chaotic voice, but it had a voice. For the first time, we talk about LEP [Limited English Proficiency] issues; we talk about culture; we talk about language; we talk about discrimination based on language, based on origin, based on race, based on orientation, based on your identity. We gave voice to all that. But it came with a big cost. Us fighting each other. We still do.

REED: Do you think that those voices will ever be foregrounded again?

YAMASAKI: Meaning, like if they're gonna be heard again, or?

REED: Mhmm.

YAMASAKI: I don't know. I don't know. I don't think they have been unheard. I think we're becoming more cynical. I hear you, but now I use you against you. I hear what you're saying and now I'll have to use it against you. It's like a—it reminds me a lot of relations of power from Michel Foucault. Talking about how to gain control, and how you're gonna do it. Are you gonna do it by making you feel that you are in control and then making you do what I want you to do, or am I gonna do it with direct confrontation, or am I gonna do it with data and push the data with the kazoo into your brain? How am I gonna do it? Am I gonna influence you that I am this 00:39:00saint that is gonna save you from everything? We all use the different techniques to try to get what you need, it hasn't changed. It just specialized.

REED: You talked about—earlier—meetings with We the People. And when you think back on the organization then, what was unique about the organization? What differentiated them from other organizations at the time?

YAMASAKI: It was very organic. It was very organic, very well represented by minority populations. I think that there was a beauty of 00:40:00We the People. Has a very strong leadership. Very vocal.

YAMASAKI: And it brought up to the scene a group of people that was very disenfranchised and unheard. So I thought it brought up a lot of minority populations that didn't have a strong voice then. So that was unique about them. [pause] It was—back in the day—strange for me. Because it was about being gay, bi, a drug user—it didn't matter. Like, doesn't matter now. So I think that's one of the incredible things that happened. You were 00:41:00there because you had a disease and you were dying. It didn't matter if you were—how you got it. So you have a gay case manager providing services to a person that uses drugs for the last twenty years and get infected through a needle. Or vice versa. You have suddenly these rough guys that they were so homophobic at some point and all this happening, and suddenly, "Wow, the people that is saving my live is a gay guy, and I don't know how to deal with this." And they start coming into an understanding of differences that, it made it so beautiful in some aspects for—suddenly diversity was okay. And being a minority was okay. And being—suddenly you realize that you have points in contact where 00:42:00you have been discriminated and you have been pushed around for different reasons, but at the end you were discriminated. And at the end you were pushed around. And so it brought together diverse groups of people, that before they couldn't see each other. Not face to face like that. Because now you have to talk about sex. Now you have to talk about drugs. You cannot hide the monster any longer.

REED: Do you think that the composition of We the People was more diverse than some other organizations—and I don't mean diverse in the traditional sense of the word, I mean diverse within the organization about who attended the programs, and who staffed it and who ran it.

YAMASAKI: Very different though. Very different. You think about David Fair, with a group of African American drug users, or Joe Cronauer—these two white guys. Running pretty much what looked like a Black organization, 00:43:00from the outside. It was interesting. So, no. Different. Later on it started getting more mixed and you started to have more diversity in the staffing, and you had more diversity in the population that you're serving, precisely for the reason that I just told you. But that became kind of clear for all the organizations. Meaning, I could speak more intimately about Congreso because I was there, but I had as many Latinos as I had African American as I had Caucasians or Asian and Pacific Islanders. Even though ASIAC [AIDS Services in Asian Communities] was there, just my name allowed, "Oh, he's Asian. Send the—whatever person speaks other languages other than English, send them to Yoshi." I'm like, "Huh? Why?" But yeah, you're the token. So, let's send it to the token Latino Asian. 00:44:00It was kind of—whatever you could. So, yeah.

REED: So all of the organizations over time became more diverse within themselves?

YAMASAKI: Yes.

REED: Okay.

YAMASAKI: Again, you had to exist with a name of Congreso de Latinos, so you had to exist with We the People, or you had to exist with BEBASHI, or you had to exist with Family Planning, and you see the name carries what they supposed to be serving, and the target population they're supposed to be serving. And then you have the Circle of Care, and you have Family Planning consult with Title IV and stuff like that. So, it was the population that they were serving, in their name. But yet again everybody could eventually diversify their applications and their funding if they serve not just their target population, but if they serve every population with HIV. Because obviously if I wanted to go to— 00:45:00and serve the kids, Latino kids or Latino families, that they were not served by Title I or Title II, I need to go to Title IV which is for families and apply. So I could not just focus on one particular group, I needed to diversify and if it was funding for minority—what kind of minority? If it was funding for African American, "Oh, I have African American." If it's funding for Asian and Pacific, "Oh, I have three Asian and Pacific Islanders for the last ten years, but they're here." So you do what you needed to do in order to make sure that you serve that population that you were serving. So all the organizations became very much like that.

REED: Do you think at that point it would have been better service provision if some of the organizations had merged and become more geographically based? Since they were all theoretically 00:46:00then serving similar of those demographic groups.

YAMASAKI: I wish that question was raised back in the day. Um, yes. Absolutely.

REED: I know that's easier thought of in concept than implementi—

YAMASAKI: Implementation.

REED: Yeah.

YAMASAKI: Absolutely. It was impossible at that time. Merging, oh! [laughter] Later on, small organizations tried to merge but it was very difficult.

REED: I wanted to ask, going back to We the People, are there are any people that you remember who were involved in the organization? You mentioned Joe Cronauer and David Fair. Is there anybody else you remember from—

YAMASAKI: Yeah—well, I remember a lot of people, but hmm—his name just escaped me. 00:47:00It will come. Umm… But those two were the most vocal. A lot of people were involved with We the People and they had a lot of representatives that they were part of the community, and they were very vocal as well. And I got a—she was not involved with We the People. That's very interesting, it was more males than females, absolutely.

REED: Any thought about why?

YAMASAKI: I guess just in terms of the number of infections and the people who were—the cases that we were having. Probably was more focused on that.

REED: Are there any organizations that did strong work with women early on?

YAMASAKI: Well, Family Planning Consult and Circle of Care. Congreso. Who were like—had more females than males sometimes in the caseload. But, again it was kind of unheard of. And they were getting infected sexually, not necessarily by drugs. So I think the Latino population—the Latino community back in the day kind of knew clearly that it was coming from sex not just from men who have sex with men, but it also heterosexual transmission. 00:49:00And a combination of intravenous drug use and sex and that kind of cofactors were always kind of company. But yeah, it will come to my mind, if I remember some more people from We the People.

REED: And, so you were on the board and then you transitioned to staff in 2000. And then what was your role early on as a staff member again?

YAMASAKI: I was the Senior—I was the Director of Special Programs. That was—we got an AmeriCorps grant. And that AmeriCorps grant brought me on board to run it. It was funny—to be in AmeriCorps you had to be a citizen, I was the only director of a program that is an immigrant that couldn't be part of the program itself. [laughter] [content removed]. But yeah, that's why I started 00:50:00as a staff, back in the day, to run the AmeriCorps program. I had experience on the commission, and I had experience with the Health Federation, to start looking at and running the volunteer program basically, the AmeriCorps program. After that I became the deputy director of the organization.

REED: I've always thought of TPAC as—and maybe it's because most of the conversations I've had with people have been about kind of the early—

YAMASAKI: The early TPAC?

REED: -years. And so conversations about TPAC were around those years. I didn't realize that—until recently, that TPAC had other programs, its own programs. When did that happen? Did it happen after the new Executive Director came in?

YAMASAKI: Yes.

REED: Okay.

YAMASAKI: Yeah. Absolutely. The 00:51:00initial format of TPAC, as I told you, was completely full of conflict. And it was—the main functions were to be the grantor. So it was a large organization with project officer, project analyst, everybody that it was coordinating and dealing with the contracts. So you had the contract analyst dealing with the contract with different organizations—we funded We the People—and other organizations that were part of this big board. So the staff was very much concentrated in working as a grantor. Later on, when we became conflict-of-interest-free, it becomes more that we needed to exist, not just as a grantor. But in the magical health planning of Pennsylvania, they decided to remove Title 00:52:00I from TPAC, early on. And give it to the creation of AACO, AIDS Activities Coordinating Office, and Title I went there. So for many years, at the beginning TPAC was both Titles I and II. Then in the—I was not here—but in their crazy planning they decided that they wanted to separate them, Title I and Title II. So Title II became more like covering the gaps and stuff like that. So Title I went to the City. So Title II operated through TPAC for a long period of time, and very successfully. Did very well. And in the—around 2006, 00:53:00TPAC was able to convince the state to do two-year contracts instead of one-year contracts so their providers didn't have to be constantly fighting for the money or writing grants every year to continue their contracts. So we finally convinced the state to do two-year contracts. And that's when they decided to take Title II completely and give it all to AACO. That was in 2006, and that was a nightmare. Cause they didn't know how to, so a conflict-of-interest-free organization that it was nicely operated, become again a conflict. But now the people in the commission is that same people that gets the funding. And that's why they wanted to do it, because it—once you get kicked out of the organization, you needed to have a finger into the funding. You don't want to lose it. So let's eliminate TPAC, let's give all of the funding to the City because the commission, it's all the providers that get the money. 00:54:00So we get back into the old kind of functioning to be able to do and have our voice heard and have a finger into the funding, without having to. And now we can do it now, because now we have two years. So as soon as they happened at two years, they said we will be protected in the transition because we will have another year. It was very poorly done, but very smart.

REED: So what happened over that year period?

YAMASAKI: So they thought TPAC will close, cause they didn't know that TPAC—we have the AmeriCorps grants. So we continued to function as AmeriCorps, and we had other grants from the [U.S. Department of Health and Human Services] Office of Minority Health. We started doing direct services, we started doing counseling, testing. And we had, traditionally, a certification program for prevention counselors. And we had a TA function from the beginning. So we continued to certify until now, we still coordinate with AACO and we're still doing the certification program for linkage to care and testing. Originally 00:55:00counseling and testing and referral, now it's linkage to care. And so we continue to do it, we're still collaborating and we're still doing the certification program for prevention counselors. Now they're just testers. But we had those functions already, and we were providing technical assistance to other organizations that they needed to start their own 501(c)(3), or they have some issues about evaluation or quality assurance, or how to do a priority-setting process, and how to do a program evaluation, and how to do a board kind of nominations process—because we started to do it all. We were renewing ourselves, and so we went through all these processes and we learned how to provide those technical assistance so we continued to operate with 00:56:00a rich history of TPAC about technical assistance, certification programs, the language interpreting program that I came with from the Health Federation. So there were a lot of direct service programs that suddenly we realized that we were doing already, so we said, "Well, we're not in conflict anymore." The board originally had some by-laws, guidelines that say you're never gonna compete with—the own people that you provide service, that you have contracts with, and we had that by-law for a long time, and we were like, "We cannot compete with all the people that they are competing for grants, so how are we gonna survive? So we went for the federal grants. So we never went for the city grants, because we couldn't compete because we had a by-law that forbid it. [laughter] But it helped us. Because it kept us—we suddenly had federal grants that were not… When we were— 00:57:00when they take the funding and send it to the city of Philadelphia, they thought they were dismantling us, because suddenly we don't have the funding, the administration cost that it was—that make the organization to operate. So we lost the grantor functions and we had to let go a lot of our staff. [coughs] I'm sorry. We had to let go to a lot of our staff, but with the federal grants that we had, we were able to sustain the organization. And so we continued to do direct services. Now, we became experts on diagnostics for HIV, Hep C, syphilis. Because we were the first ones who introduced rapid testing into the entire country.

REED: Oh really?

YAMASAKI: Yeah. The testing kits are all Pennsylvania-based. They were made in Bethlehem. OraQuick is there, that was—their alma mater [motto] is "Pennsylvania, 00:58:00for the world." So they approached TPAC early on, because we were the certification agency, certifying prevention counselors, so we introduced it originally in Philadelphia. There's a beautiful part of history there that nobody knows. TPAC is the first organization who introduced rapid testing. And we did it internationally, later on. With other countries, like in Chile and Venezuela. Mexico. So, it took a big chunk of our umph as an organization, and a lot of people wanted to close. But we survive, and we strive, and we maintain. And for me, it's 17 years later and we're still doing it. And I'm very proud of the people that we have, and our volunteers are the same volunteers, and the staff is the same staff that we've been together for many, many, many years.

REED: And do you provide technical assistance now to 00:59:00many of the organizations that were originally, you know, represented in TPAC?

YAMASAKI: Yes. We continue to some technical assistance to—for more new organizations than old organizations. So old organizations, they have their stuff together. But new organizations that they go and started and they want to have the initial kick-off and umph in terms of what to do; how to do it; how to do their by-laws; how to do their manuals; how to do nominations process; how to become conflict-of-interest-free; how to do representation; how to evaluate your board; how to do all kinds of stuff. Your strategic planning. Things like that for a new organization was very helpful. So we became like an incubator for other organizations to start doing their thing. And we continued to do the other organizations 01:00:00that we were funding before this Americorps program. Not until the last three years, we finished in 2015. That program lasted for 15 years. That was a long run of AmeriCorps.

REED: 'Cause they're only supposed to be 3 to 5 years?

YAMASAKI: Yes. So we were able to renew it for 15 years. And year 15 we could do it again, I was like, "Ah, I don't think so." It's very, very taxing. It's a very intense program and it's very difficult. Very difficult, not easy to run. They have a lot of guidelines and a lot of… When you become an older program you have to match dollar per dollar. So if I'm fundraising three hundred thousand dollars in AmeriCorps grant, and I have to fundraise for three hundred thousand dollars, hey—you know what, I can just fundraise the three hundred thousand dollars. I don't need AmeriCorps program and I can run it the way I want to. So it was a lot of stuff that it was coming. I'm very thankful, because I learned a lot about the federal government 01:01:00and how they operate and how the program runs. And we had a beautiful program, I loved it. It was access to care through service. So it was people from the community that we had already been part of the organization, to now have a sense of belonging to a program and to call the AmeriCorps and get a stipend and get an educational award. And that was really great, because then a lot of the people that were living longer with the virus, they become part of the AmeriCorps program. And we have 12 sites, in five states.

REED: Oh, wow.

YAMASAKI: So we came for national direct program and some of the organizations that we funded before they were part of the program. The AIDS Care Group, Philadelphia FIGHT, MANNA [Metropolitan AIDS Neighborhood Nutrition Alliance (now Metropolitan Area Neighborhood Nutrition Alliance)], the Freedom Writers Foundation in California. And New Jersey. We had a program 01:02:00in New Jersey and then we had also the AIDS Care Group. There were 12 different programs, and we had faith-based programs as well at some point. Turning the Tide and we had the Baptist Church. It was very interesting. Very interesting. And we were funded also through the Office of Minority Health to run some of those faith-based programs. So we did—we continued to have a direct relationship with organizations that we were funding before. Positive Effect [Outreach] Ministry—I love them. It's a small organization. Liz Minor. That's another voice that you should hear. Very eloquent woman, very strong. Big voice. But fair. She was always fair, and I liked it. I liked that of her. She was one of the people that, when they were attacking TPAC back in the day, 01:03:00she said, "I cannot live with myself if I don't do the right thing. This is crazy!" And I respect her for that. And we're talking about 20 years, no? I respect that woman. So, yeah, we have different organizations that we provide funding to through volunteers, through Americorps members. And we did it for 15 years. Now the relationship is completely friendly in terms of what we do, and we interact and we have some MOU's [Memorandum of Understanding] and things like that with some of them—but it's more about the service that we share and we provide to each other. More than anything else. More than funding.

REED: And when the Title II decision was made in 2006, up until that time what was the relationship 01:04:00like between TPAC and We the People?

YAMASAKI: I think it was not with We the People, I think it was with the directorship. I think it was of respect, I think even though there was so much screaming and yelling, I think they respect each other. As individuals.

REED: And did TPAC provide funding to We the People over that time period?

YAMASAKI: Throughout the whole process, yeah.

REED: And so that whole time, organizations had to apply every single year.

YAMASAKI: Yeah, until the last cycle that we were able to get two years—two-year process. We should have known, right? That something like that could have happened. Not surprising.

REED: And any other memories about We the People? Either what the organization did, or 01:05:00the role they played, or—

YAMASAKI: I think they played a very important role, back in the day, of being kind of a leader organization as representing people with HIV. That would have been so much a positive voice, if it was kind of that. Just as an advocacy issue, that was important, I think. That was very important. It was like an icon organization, right? It was one of the first ones to show—it was to hear about We the People, in my head I hear "advocacy." And I hear "fighting for the rights of people with AIDS and HIV." 01:06:00So that's a positive voice that I hear in my head. Putting besides all the crap that came also from it. But, it's not all bad.

REED: And—I'm just going to shift to talking about present day. What do you think is most needed in Philadelphia today to address AIDS? You spoke about this a little bit.

YAMASAKI: That's a very good question. We still have an impact, and we still have people dying. We need to re-specialize again. We need to be very focused on what is needed and how it's needed. I think we have made a mistake in terms of streamlining everything into a medication, and trying to eliminate case management services, trying to eliminate peer services. All that kind of stuff is what brought people in the first place, 01:07:00to adherence. It's what brought people to care. People were not accessing medication by themselves. It's not that you went to your doctor and get your pill and you get your prescription, you fill it out, you take it. It's not that simple. Unfortunately it's not that simple. We are simplifying—we're making it like that is the case, in order to eradicate the stigma and streamline the disease into the healthcare system. I wish it was that. But we have 30 years of fuck-up. Where we now need to fight back and to help people to understand medical system, understand insurance companies, understand how to access services, understand how it's not just people with insurance— 01:08:00we have a lot of people without insurance. We have a lot of people would not qualify for insurance. We have a lot of people that speak other language other than English. We cannot just eliminate supportive services and think that everybody's just gonna go and take their pill. I think that's one of the biggest mistakes that we're doing. We're eliminating prevention and we're making it all care. So now if you're doing testing it's a screwed up—big screwed up, what we're doing that. "Oh, it's linkage to care. Now linkage to care." Test people are linked up to care, really? No counselor? No, no counselor. We're gonna eliminate all that counseling bullshit and we're just gonna do it, and we're just gonna make it focus on the test itself, with no stigma. Oh really? And we'll erase it from everybody's brain. Like we didn't do already a disservice. Ask somebody what they think if you get tested now for HIV. What would you do? 01:09:00I'm just gonna test you, right now. And I'm gonna give you your result. What you gonna do? How are you gonna feel? Who cares? If you're positive they say, "Go to your doctor and get your medication." Really? Really? How you gonna tell your partner? How you gonna tell your family? Are you ready? You're ready to do all that? Because if I test you right now, and you're positive, I need to contact the city of Philadelphia, Partner Services. You're ready to talk to them? You're ready to give your names of the family members or whatever who might be at risk. Anybody you had sex with, anybody you shared needles with. You're ready? Forget about that. We took all that. CDC doesn't 01:10:00care. They care about the numbers so I can give you funding. How many people you tested? How many positive? So we're doing big disservice to our society right now. And we call it health planning. We call it taking the stigma out. Really? That's how you take the stigma out—by cold feet? And just put people on fire. If you tell me right now you're ready to get tested with nothing—no thing—I just test you, and give you your result, that you ready to deal with it. 01:11:00It doesn't matter that there's treatment that prolongs your life. People still think, "I'm gonna die." We need to learn to teach people again, to normalize it and say, "Hey, there's treatment. There's new treatments. There's new ways of doing things. There's PrEP, all this kind of stuff." We need to be able to maintain some of these services to make sure that people, when they get tested, they're ready to find the results. So at least they can leave with saying, "Yeah, I'm ready. I'm gonna contact my doctor. I'm gonna do this, I'm gonna do that." And they can have a plan. To have to do it. But if you eliminate all that, as we are doing it right now, how many people is gonna access services? "Oh, that's why linkage to care is so important." Yeah, but if I traumatize you with an information 01:12:00that you were not ready to deal with—basic knowledge is, if you have a trauma of a new disease in your life, the first stages of trauma is denial. For how long is that person gonna deny the results that were given until they start to normalize and adjust and said, "Okay, I'm ready to do something about it." But in the meanwhile, I didn't tell my husband, I didn't tell my wife, I didn't say anything, until I'm ready to. While I'm putting myself and the person that I'm with at risk again. But I'm not ready to tell. I don't know how they're gonna react. If I am a domestic violence situation—poof. It's not gonna happen. Oh, but let's do public testing. Let's bring them to the parks, let's bring them out there, let's bring it to their homes, let's test them. Massively test them. 01:13:00Check how many domestic violence cases we have. We are—well, what can I tell you. I believe in psychology, and I believe in counseling. And I believe people getting ready. My staff—I'd rather not have them test somebody and lose the number then to test somebody that is just demanding to get tested because they wanna find out, so they know if their husband is cheating on them or not. I don't know how you're gonna react. How you gonna normalize this situation. "Oh, well I'll just kill myself." Really? "Here, let me test you." If the counselors are not finding out anything about these people, how are they going to do it? How irresponsible. So there's a lot of things 01:14:00to be done, and there's a lot of things not to do. And one of the things that we need to stop, is to stop looking just for the numbers. We need to normalize it, and we need to bring it back to people. As it should be healthcare. Healthcare should be about the patient. And it should be about a need, it should be about prevention. It's way, way, way cheaper to prevent somebody from getting infected, then to have to cure and do treatment for the rest of their lives. We keep forgetting that. So those are the things that I would not do anymore. I will try 01:15:00to stop it from happening. But, hey—we're doing it. CDC is doing it. Organizations—it doesn't matter how responsible their leadership is. If they need to exist by showing how many numbers they have, they're gonna jump, skip, pull anything they need to in order to get the money. And I don't believe it—I have survived since 1992 that I got here. I've survived with organizations without having to be health irresponsible. For calling it something. I believe that there's a health responsibility that we all have. And that we need to continue to adhere to it. If not, switch. 01:16:00Go to Gilead, go to Bristol, go to whatever—Johnson & Johnson.Go and work for the people that produce these medications. Make money that way. You don't have to touch your heart. But if you believe in healthcare, and you believe in universal care, you need to stick to your morals and stick to good care. Stick to prevention. Stick to healthy living, holistic approaches. You need to stick to those things. If not, switch careers. Truly. People ask me, how is it I've been doing this for so long? And that's the magic formula. Don't ever stop being human. I still cry when I think about my friends that died. I still cry when I see my patients—I don't cry with them, but I cry on my own, on my time. When they're suffering, when they're dealing with pain— 01:17:00I could stop seeing them. I could just do the administration and writing grants, and doing the stuff that I do on the side. But that takes me away from being in touch and having my feet on the ground. And thinking that, "Hey, I'm still able to feel the human pain and try to do something about it." Without burning yourself out. One time we will talk about vicarious traumatization in this system. It's horrible. It's horrible. But, that's why we need to keep ourselves with your feet in the ground, and making sure that you're able to go in and out in a healthy way.

REED: Anything else you'd like to talk about?

YAMASAKI: I could talk 01:18:00for days about these issues. But, anything else that you think? I don't know. I think I measured myself as much as I could without having to curse too much and mention people and say how bad they were.

REED: Well thank you for—thank you for being interviewed.

YAMASAKI: My pleasure.