Bay Area Reporter - October 16, 2008
Matthew S. Bajko, m.bajko@ebar.com

The activist group had a knack for attracting attention to its demonstrations and seeking out news coverage of its protests.

Yet Roland has taken a decidedly different approach since becoming, in July 2007, chief of the state Office of AIDS within the reconfigured Department of Public Health. Over the last 14 months Roland has largely kept out of the media spotlight as she implements changes to how California tackles the HIV epidemic.

"Not enough people know her," said AIDS activist Michael Petrelis, who suggested that she hold public meetings throughout the state. "I don't think it is healthy for people with AIDS for the AIDS office to be quiet for a whole year."

Roland has also had a quiet presence in Sacramento, so much so that several state lawmakers said they have had little interaction with her since Governor Arnold Schwarzenegger appointed her to the $172,000-a-year position.

"I haven't had very much interface with Dr. Roland since the very beginning when I met with her. My impression is she is still trying to get her sea legs in an administration that is not always clear about the authority the director has or doesn't have," said out lesbian state Senator Sheila Kuehl, (D-Santa Monica) who chairs the Senate Health Committee.

Kuehl said she interacted far more often with Roland's predecessor, Michael Montgomery, whom she recalled as being more proactive in reaching out to lawmakers. The difference in approaches may be due to Roland's style, said Kuehl, as well as stem from the restructuring of the state health department last summer.

"She is very qualified as a clinician and researcher but isn't real practiced in community outreach. The impression from the outside is information coming from her office feels more controlled than it was with Michael," said Kuehl. "To be fair, she was recruited and hired because of her depth of knowledge on the issues and because of the science of it. A doctor is not always about public outreach."

But Kuehl stressed that she has not heard any negative comments about Roland's leadership and that most people have a positive view of her.

"People like her. Even the most critical advocate is really cutting her some slack," said Kuehl. "We can't tell how much is Michelle not reaching out and how much she is on a leash in the Department of Public Health."

Roland, 46, who identifies as bisexual, said it is to be expected that her relationship with state lawmakers would be different than what Montgomery had built up over time.

"He worked his way up in the system; he had a close working relationship with legislators," she said. "I came into a new department from the outside as an unknown quantity."

Prior to joining the Schwarzenegger administration, Roland had been an associate clinical professor of medicine at the Department of Internal Medicine for the University of California, San Francisco's Positive Health Program (HIV/AIDS Division) at San Francisco General Hospital.

She did initially reach out to state lawmakers but said she was instructed not to do so in the future.

"It has taken us all some time to figure out the right balance between going through all the appropriate sorts of reporting structures, and at the same time, not impeding development of those relationships. There have been some growing pains in that area," said Roland. "I met some legislators and offered myself up, then learned very quickly I am not supposed to have direct relationships with them."

A policy focus

The budget for the state Office of AIDS this year is $462,538,000, up from $427,993,000 in fiscal year 2007-08. But the governor cut $5.85 million in education and prevention funding from last year, and Roland estimates that state funding for AIDS-related programs has been reduced by approximately 6 percent.

With diminishing federal and state dollars for AIDS services, Roland made it a priority to examine how her office was spending its money. In May she held an HIV prevention think tank and organized experts around six areas to elicit ideas of what needed to be done and what needs to be changed.

"We see this as a first step in a long process of thinking about how we might want to modify and improve how we are directing our prevention resources," said Roland.

She has convened several working groups with stakeholders from throughout the state to end any divisions between advocates in northern and southern California. And she prioritized adopting guidelines for the state's HIV names-based reporting.

"When I first got here the names-reporting still had emergency guidelines. It was clear to me there were a lot of concerns about the regulations and a lot of pressure to get them finalized, otherwise they would expire if we didn't," she said. "We needed to have a mature HIV names-reporting system if we were to remain competitive for federal CARE funds."

She has also organized a Latino advisory group and a group to look at needs within the transgender community. The gay male community continues to be a high priority as well, added Roland. Each year the state estimates that 5,000 to 7,000 Californians become HIV-positive, with half of those centered in gay and bisexual men.

"We are all incredibly concerned about people of color and men who have sex with men, whether they are gay or not," said Roland. "We have been trying to think about what are the unique barriers in those communities. There is still a lot of stigma and dual stigmas of HIV and homophobia and people not seeking HIV services in traditional health care settings."

One priority in her second year on the job is to form a rural area think tank to target how to provide HIV services to residents outside of the state's urban cores. She wants to look at using telephone services as one way to provide care.

"It would be the first time the state has done anything on HIV with rural health departments," she said. "I am talking to people who do tele-medicine and seeing if that is something the Office of AIDS can do more of. Rural people can't always get to a doctor but can access help via the phone."

Among AIDS officials throughout the state, Roland has so far received high marks. Dr. Darrell Cummings, chief of staff of the Los Angeles Gay and Lesbian Center, complimented her for holding meetings with local stakeholders early on in her tenure and for this summer funding a wellness center aimed at gay and bisexual African American men.

"I think that Dr. Roland has taken over a somewhat thankless job in that there are obviously stakeholders on a national, state, and local level that she needs to be accountable to in addition to the fact she operates in a large state department and bureaucracy that is virtually broke or bleeding red ink," said Cummings. "I think she has done a very good job in a very difficult circumstance where the state government is in trouble financially."

Dr. Grant Colfax, director of HIV prevention in San Francisco, has been friends with Roland since the two trained together at UCSF in the 1990s. He said she has maintained a community-focus since becoming chief of the state office.

"I think that Michelle's background always has been very committed to working with and for the community. She came to her medical training with that perspective," said Colfax. "I think she is working to develop and figure out how we in California move forward in terms of HIV care and prevention in the future. She is working with stakeholders on how to address specific populations most affected by the epidemic."

Since she works for the governor, oftentimes, her advocacy is hidden from the public's view, Cummings said.

"I think Michelle plays her politics close to her chest. The work she was doing as an advocate sometimes is invisible to the rest of us," he said. "That is a stylistic difference between Michelle and the people who preceded her. I am not sure what she is doing behind the scenes and I don't think many people do."

Anne Donnelly, with Project Inform, complimented Roland for putting together working groups to look at how to better integrate services for people with HIV and AIDS as well as how the state funds HIV prevention.

"We definitely need some new approaches. That is all, from what we can see, going in a good direction," said Donnelly. "The state Office of AIDS should be taking a leadership role in pushing for new strategies."

Petrelis applauded Roland on his blog for speaking with him and fellow AIDS activist Hank Wilson recently and for posting documents and public records to her office's Web site after it was brought to her attention her office had very little on its site.

"I think the response to me in the past month since I have been calling and e-mailing Michelle since early August is praiseworthy," he said.

To visit the AIDS office's site go to http://www.cdph.ca.gov/programs/AIDS.

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