U.S. Board Spotlight: Nate Smith

Meet Nate Smith. Based in Atlanta, GA, his wealth of expertise as an infectious disease physician coupled with 25 years of clinical practice felt like an immediate asset to Untold’s U.S. Board. Nate brings a perspective enriched by his experience at the Arkansas Department of Health and the CDC.

Additionally, cross-cultural work is second nature to the husband and father of four, as he lived and worked in Kenya for seven years running a large-scale HIV care and treatment program before his governmental public health roles.

Nate fully lives out Untold’s spiritual approach to holistic care daily as the Executive Pastor at Trinity Anglican Church. He also lends his myriad of talents to other boards, including World Public Health Outreach and a smaller non-profit building healthy marriages in Kenya, after previous stints at the Association of State and Territorial Health Officials and Go Near.

Amid the fullness of his life, he also finds time to take theology classes, work on a Doctor of Ministry and graduate certificate in Old Testament Hebrew, and participate in long-distance running and endurance.

What drew you to Untold’s work?

When we first started our HIV care and treatment program at Kijabe Hospital, we had a community-based program that was trying to meet the holistic needs of our patients. Providing care and treatment was important, but from the beginning we realized that wasn’t enough. Our whole program was focused on building community and addressing stigma. However, I noticed that PEPFAR — the main funding vehicle for HIV care and treatment — become more focused on medical treatment.

When I came to the CDC four years ago, The Center for Global Health was one of the centers under my purview. I became more directly involved in the PEPFAR work, did field visits, and realized that it had morphed into something focused on numbers and clinical outcomes, and had lost so much of what we had started with. When I heard about what Untold was doing, I realized this is the missing piece that should have been there from the beginning.

In your experience, what is the importance of community-based programming in HIV/AIDS work?

One of the main reasons is that people are not whole unless they're in community and relationship with one another. The stigma that HIV has can be particularly isolating and without community support, people can't achieve emotional, spiritual, or economic health.

When I came to Kenya, we started a program preventing mother-to-child transmission. This was before HIV medications were readily available. And so we set up one of the first mother-to-child transmission programs in Kenya and received funding through the Elizabeth Glaser Pediatric AIDS Foundation. My initial thought was we'd have a base of women at the hospital coming in for counseling and testing. In my mind, it was a clinic and hospital-based program. But the Kenyan nurse I brought on to help me with the program said we need to involve the community. As I talked with her, I realized she was absolutely right. And so we started that work with a community focus so people would understand what we were doing, why we were doing it, and that the program would not isolate people in their disease. When we finally were able to do HIV care and treatment, we followed a similar pattern. And our goal always was to connect people with people in their communities, so they were not isolated. And that brings me to stigma.

Stigma was a major issue in our work. During my first few months at Kijabe Hospital, an HIV counselor overheard someone in the community discuss how Kijabe Hospital is a good place to get medical care, but they test for HIV without you knowing and then everyone in the community will know. From there, we realized we had some major stigma-related problems to deal with.

There were two main sources of stigma, the churches and healthcare providers. We worked to get churches and pastors on board with our support groups, and then we destigmatized HIV in our healthcare facilities. Instead of having people come around the back entrance or use code words for their diagnosis, we created an environment where they could speak freely about their condition. And once we attacked stigma coming from those sources, we saw the levels of stigma drop considerably.

During World AIDS Day 2006, we decided to bring together all the people from the support groups throughout our area to have a big gathering at the main church at Kijabe. We had 1,000 people come out! Each support group had their own presentation, whether it was a poem, musical number, or testimony, and it was just overwhelming. And I thought, seven years before, when we had first started the work, no one celebrated World AIDS Day, and if they had even acknowledged it, no one would have come forward to say they were infected. It made me aware of what could be done when you actively work at reducing that stigma.

What do you hope to learn from Untold while serving on the board?

I’m looking forward to learning about the impact that Untold is making up close. Most of my time in East Africa was heavily from the clinical and public health standpoint. There was an interest in spiritual, emotional, financial, and relational support, but those were always a side dish. I’d love to see those as the main focus now. Plus, I’d love to meet the wonderful staff and get to know you all!

Nate and his wife of 33 years, Kim, along with three of their four children.