Taking the helm at Chicago’s LGBTQ-serving Howard Brown Health—A conversation with Dr. Travis Gayles

The past few years have been rocky at Chicago’s LGBTQ Howard Brown Health (HBH), founded in 1974. Federal funding cuts contributed to a $6.6 million funding shortfall (of a $145 million total budget in 2021) that in turn led to the closing of two of its nine clinics. The organization also had to pay $1.3 million in a settlement to more than 50 workers who claimed it had illegally laid them off without bargaining with their union; additionally, other workers went on strike twice in 2023 before reaching a contract agreement the following year.

And now, like many other LGBTQ-serving federally qualified health centers (FQHCs) around the country, HBH also faces the prospect of even deeper cuts in federal funding from a right-wing Congress, and potential scrutiny from a Trump administration 2.0 that is targeting transgender folk and programs meant to close gender and racial disparities in care.

Amid these challenges, Travis Gayles, MD, MPH, joined the organization as CEO in early March, replacing interim Robin Gay, DMD, who resumes her role as the organization’s head of dental. Gayles previously headed Hazel Health, a school-based telehealth provider, as well as health departments in Maryland and D.C. He also trained in HIV and adolescent medicine at both Chicago’s Lurie Children’s Hospital and Northwestern University’s Feinberg School of Medicine. 

On March 26, Gayles spoke for an hour with POSITIVELY AWARE about getting his sea legs in a workplace that’s only recently stabilized from various crises, how he intends to uphold Howard Brown’s inclusive mission while creating fiscal sustainability in the face of federal funding threats and how he maintains his own self-care—a topic he feels passionately about.

Dr. Gayles, thank you for talking with us today. What has the first near-month at HB been like for you? What are you focusing on?

This is only Week 4 for me, so, like any new person coming into an agency, I’m in the learning process, getting to know the people, the processes, the history, and starting to build relationships. I think that’s important when it comes to having to make tough decisions related to the health and sustainability of the organization. Even before I officially started, I visited all the different clinical sites and met with all the senior leaders both collectively and one-on-one. So I’ve been focused on getting to know the place from the inside and starting to think about what our goals and priorities should be.

Also, my arrival here is happening in the context of a lot of significant changes at the federal level that impact the work of organizations like HB, both in terms of Medicaid reimbursement [about one-quarter of Howard Brown’s roughly 38,000 patients are on Medicaid or Medicare] and clinical issues around providing services in HIV and gender-affirming care as well as driving changes in health equity. It’s been challenging following what’s happened overnight [the termination of the Adolescent Trials Network, a research center for HIV and young people] and being able to factor that into the work.

What’s been the shape of a typical day so far? Do you work remotely, on-site or both?

It’s been mostly in person, including going out to all the clinical sites to normalize the staff there seeing the CEO come in, so that when I do, it isn’t like, “Oh God, what’s happening?” I’ve also been meeting with a lot of our partners and donors. So it’s been a lot of movement.

Will you have an open-door policy where anyone can come in to talk to you?

I’m still learning the organization chart and the reporting structure to see if it makes sense or should be adjusted. I’ve been having a lot of open conversations with folks to learn about how to create spaces to have both formal and informal conversations. What that will look like in the long term is still TBD. I did karaoke with the clinical staff at two of the clinics

What made you want to become a doctor in the first place?

Growing up in Virginia, I was fascinated by history, law and civics, but also by the science of the human body. In high school during the summer, I participated in a program where they brought 30 of us to the local med school to shadow physicians for six weeks. I learned how health care providers can make people feel better. That pretty much confirmed my interest. Then when I got to college in the late ’90s, I discovered health policy and loved the interface of health and government. So fast forward, I did a program at the University of Illinois where you could get a PhD in any of their grad departments to go along with your MD, so I got a PhD in biomedical science.

Then I had to decide what kind of doctor I wanted to be. I’ve always enjoyed working with kids and I found pediatric pathophysiology far more fascinating than adult medicine. And I think children have a high level of resiliency that we don’t give them credit for. So I went into pediatrics.

You had two big jobs before coming to Howard Brown, one helming Hazel school-based telehealth and one helming public health services for Montgomery, Maryland, just outside of D.C. What skills did you learn in those posts that you’ve brought to HB?

The health department job is where I learned how to manage a large organization with a large budget—well over 600 employees with a budget close to $100 million. I learned the nuances of the organizational chart and of different departments. And because it was a public job, I had to interface with other government officials and electeds around health issues that were also political. It was a public-facing job where we were accountable to the public. When COVID happened, I learned how to be a crisis manager—standing up vaccine clinics on short notice, using data to drive decisions and provide recommendations to electeds on how to act, communicating messages to your team and the external public, and learning how to integrate clinical medicine with population health, business principles and politics.

Was COVID the biggest challenge of your public health tenure?

COVID and opioid overdoses were big issues but the larger issue was folks never really understanding what public health folks did. Because when health department officials do their jobs, you never really hear from us—we’re doing it behind the scenes to keep people safe. When COVID hit, we really hadn’t had a public health crisis in the U.S. since anthrax hit in 2001. So because of the lack of understanding of what we do, even before COVID happened, budgets were cut in a lot of key areas. And we’re still seeing the fallout from this lack of understanding, significant cuts to public health agencies and health officials being put on the defensive around things like vaccines.

At the telehealth job, I hadn't worked in the private sector before but I was still working for a company whose mission was to improve services for kids who needed it most. There, I further honed the skill of marrying clinical with business interests, learning how to be a socially driven mission but also making sure it’s financially sound and sustainable, which is a big part of my new role at HB. Also, because it was a tech-enabled service, it helped me develop a sophistication around how to leverage tech to extend service delivery, which is something that I think any entity is going to have to become more savvy and nimble about. HB has certainly leveraged telehealth in recent years.

What drew you to Howard Brown? 

I was interested in the opportunity to bring together the components of my past experience—clinical, public sector, being in a quasi-political environment, and also the private sector perspective of balancing all that with fiduciary discipline. I also wanted to be able to give back to my local community [Chicago, where he’d moved back a few years earlier while working for the telehealth company] and the different communities [like Black and LGBTQ+] that I’m a part of.

After the election in November, I asked myself, “Am I doing enough with the skills I have to be able to represent the communities I live in and am a part of?” So it was almost a kind of reality check and call to action for myself. Because now, in this new job, the very work we do is in the cross hairs of the feds. So now I’m part of an effort to ensure that care is not compromised, that we’re doing the best we can to make sure that as many people as possible have access to high-quality affordable healthcare, regardless of who they love, what ZIP code they’re in or what language they speak at home.

Howard Brown has had some turmoil the past few years. What do you think was the source of that?

I’m not going to get into that because I wasn’t here. We all know there’s a history that hasn’t been perfect. And my role now is to acknowledge and learn from it but to keep us moving into the future.

Since your arrival, does it seem as though that turmoil is settled and Howard Brown is stabilized?

So, you’re not only sorting out the past, you’re facing a perilous future with this new administration. Has the Trump administration contacted HB directly about any issues related to trans care or anything else?

In the few weeks I’ve been here, no one from the administration has reached out that I’m aware of. A lot of the issues we’re facing are not unique to us but to FQHCs nationwide, in both urban and rural areas. It’s sometimes forgotten that many of the cuts that would impact us would also impact providers in rural areas that are more politically conservative. Some of the biggest issues are the overall attitude of this administration to public health—shown in their cuts to agencies like the CDC and the NIH that will manifest in lower grant funding for different topics.

And will there be cuts to Medicaid? That will impact us, as well as rural areas, many of which are already healthcare deserts. And then there’s the question of what resources will be available to agencies [such as state health departments] to do preventive health like vaccines. We’re seeing measles outbreaks in Texas and elsewhere. FQHCs and health departments do that work.

Finally, there’s big issues around what words this administration won’t allow to be stated—DEI, women’s health, trans health, LGBTQ health.

Trying to close racial disparities in health.

Yes. When you have an environment like that, how you stay committed to doing the work while also trying to thread the needle for federal grant requirements—that’s a tricky challenge.

I just read this morning about the grants for LGBTQ+ health research that were cut. Were any of them for Howard Brown?

We’re a site partner for a number of grants held at other places, and at least one of them has experienced some cuts in their funding.

If you, or a place like Howard Brown, has a program aimed especially at increasing healthcare engagement for, say, transgender women, how do you continue to message that program, advertise it, when you’re not allowed to say the word transgender?

Part of it is staying committed to the values we have, the services we’re providing, and in some cases just leaning in and using that word and saying “it is what it is.” But it also requires us to investigate what are other avenues for funding, so that if we lose it from the feds we can find it elsewhere, so we don’t lose our sense of mission.

There’s a lot of anger at Columbia University for what many people call caving to the administration’s demands on things like protest rules and extra oversight of certain academic departments in order not to lose $400 million of federal funding. There was an op-ed saying it was creating a terrible precedent for other schools and that universities should crack heavily into their endowments to “save themselves” by not caving to the administration. Does that idea, between caving and taking the hit to preserve your integrity, apply to a place like Howard Brown?

You should never rely too much on one source for funding. I think the best thing to say is that we’re committed to the services we’ve historically provided, we look forward to continuing all of them and we’ll use our partnerships creatively to protect their integrity and scope.

Are you having conversations with development [fundraising] at Howard Brown?

Yes, but those are conversations that should be happening regardless of the current administration. Here’s an example of what I’m talking about: our leading diagnosis across all our sites is diabetes. We excel in not just HIV and STI care but primary care including diabetes management. Now that people are living long lives with HIV, we should be treating the whole person.

How does that connect to opening up new funding streams?

If you’re an agency that only gets funding for HIV care, that’s important, but what about special funding for nutrition, obesity, diabetes management? That mindset makes you look at other potential grant opportunities that can still help you take care of the person sitting in front of you. Another example is both longstanding [like condoms] and biomedical [like PrEP] tools for HIV prevention. But we can also look at job and educational opportunities, because when people are meaningfully connected to them, those things are protective against HIV. They give people more access to housing, more food security, and they also help them be more compliant with their meds.

Final-ish question: What do you do for self-care amid your very busy job?

I appreciate the question. Everyone calls me a self-care policeman because I ask them all the time, “How are you as a human?” My niece would say I’m in a midlife crisis age group [late forties]. I call it a midlife evolution. So I’m paying more attention to my health and wellness. I prioritize working out in the mornings and I’m an avid tennis player. I’m a part of the GLTA, which was founded as the Gay and Lesbian Tennis Association, which is a network of groups around the world who host tournaments, and each one adopts a charity of some sort.

I’m also a person of faith so I go to church on Sundays. That’s important to me. I like binge-watching TV, going to the theater, exploring a new part of the world and trying new food.

What’s your favorite food?

Probably Indian. But I think the food in Chicago is the best in the country, whether you’re talking Michelin-starred or a greasy spoon. My favorite Indian food is probably Essence of India in my neighborhood [Lincoln Square]. •

Tim Murphy has been a New York City-based journalist writing about HIV/AIDS and LGBTQ issues for 30 years. He is also the author of novels including Christodora, a New York City AIDS epic, and of the Substack The Caftan Chronicles, featuring interviews with notable gay men “of a certain age.”