How Bill Keeton of Vivent Health Is Helping To Battle One of Our Most Serious Epidemics

Listen to understand. Debate club is great for debate club, but at the end of the day, people want to be heard, understood, and have their experience validated.

As a part of our series about “Heroes Of The Addiction Crisis,” I had the pleasure of interviewing Bill Keeton.

Bill Keeton is Vice President and Chief Advocacy Officer with Vivent Health, a leading provider of HIV prevention, education and care. For more than 40 years, we at Vivent Health have been relentless in the fight against HIV, from advocating for policy change to protecting communities through prevention efforts to welcoming and caring for all who come through our doors. Through a series of strategic mergers, we’ve not only been able to leverage the collective expertise of the organizations that came together to form Vivent Health, but we’ve also been able to make an even bigger impact for more people and communities that need us. We offer people living with HIV the highest-quality care, including wraparound social services designed to support the whole person. And perhaps most of all, we provide a safe, judgment-free zone for everyone we serve, regardless of whom they love, the color of their skin, where they live, or how much money they have. All so we can help people living with HIV live long, healthy lives, and work toward ending the HIV epidemic.

Thank you so much for doing this with us! Can you tell us a bit of your backstory?

Thank you for the offer! First off, I never imagined that I would have a career that had harm reduction advocacy work at its core. I come from a lower middle class family in suburban Western Wisconsin, and was in elementary school at the height of the DARE days. My family certainly had its share of addiction in the form of alcoholism, and varying levels of usually untreated mental health conditions. But growing up, it never seemed like anything out of the ordinary or even problematic. And it never seemed like there was a larger societal or community level issue, especially related to drugs like heroin or cocaine or meth. We were happy DARE kids in our small town trying to ‘just say no,’ while listening to Tom Petty sing ‘won’t back down.’

Growing up, and in college, I was passionate about science, specifically virology and worked in a research lab on trying to figure out ways to disrupt the HIV integrase enzyme. This was the mid 1990s and this kind of research was pretty novel. Aspects of it were fascinating; but it was also incredibly isolating. But I was convinced my ability to positively impact the world was through hard research and the physical sciences.

It was in college that I got exposed to some different perspectives and social and health justice. I quickly realized that my biggest opportunity to make positive change for the most folks wasn’t sitting on a lab stool, but by engaging in organizing and advocacy. The way to solve problems was by working to ensure the solutions that I would have created in a lab setting were available to everyone who needed them.

Is there a particular story or incident that inspired you to get involved in your work with opioid and drug addiction?

I remember the first time I met someone who was open about their journey with drug use and recovery. His name is Scott Stokes, and he was our director of prevention services at Vivent Health, which was then known as the AIDS Resource Center of Wisconsin. He’s been a national leader in harm reduction program delivery and a mentor of mine — although he may not know it. I met Scott soon after I started working in the HIV advocacy space, almost 18 years ago. Scott had, and continues to have, a presence — he spoke openly and honestly about addiction and recovery and was unabashed and undeterred in his work to support the health and well-being of folks who were or are still in the drug use community. And he did so without judgement about their choices. Scott has always seen and been centered on the person.

There were things Scott told me that I think about to this day, and they remain central to what I do and how I approach harm reduction advocacy:

1.) No one wakes up one morning and decides to become a heroin user.

2.) Folks who die from overdose never get the chance to find recovery.

Today, I lead the advocacy efforts at Vivent Health, a leading provider of HIV prevention, education and care. We’re involved in this work because saving lives is at the core of who we are as an organization. Of course, there are connections between injection drug use and HIV — and we know that around 9% of all HIV diagnoses in 2019 were attributed to injection drug use. The prevalence of HIV among people who inject drugs in the US is estimated to be around 14%. Prevention efforts, including harm reduction strategies such as syringe service programs, can be effective in reducing the spread of HIV and other conditions like hepatitis among people who use injection drugs.

But our work is just as much about ensuring that marginalized, stigmatized, and unfortunately, sometimes discarded folks can find a person or a program that doesn’t just say we are here to help, but lives out our belief that all lives have value.

Can you explain what brought us to this place? Where did this epidemic come from?

Understanding our nation’s relationship with drug use and addiction is complicated. From one perspective, it’s critical that we understand trauma, adverse childhood experiences, individual brain chemistry, undiagnosed/untreated mental health concerns and community-level socioeconomic factors that can all lead to feelings of hopelessness. These factors occur across society and regardless of economic class, zip code, race, ethnicity or gender. Further exacerbating this environment is the harsh criminalization and stigmatization associated with drug use.

Looking specifically at opioids, a lot of research points to a combination of factors, including the marketing of prescription opioid painkillers by drug makers to doctors as a way to manage patient discomfort, especially in instances of chronic pain or surgery recovery, the availability of opioids outside of medical settings, and the prolification of cheap and potent synthetic opioids like fentanyl.

In the 1990s, pharmaceutical companies heavily marketed prescription opioids as a safe and effective way to manage chronic pain. This led to a surge in prescriptions, and many patients became addicted to the medication. In some cases, individuals turned to illegal means to obtain opioids when their prescriptions ran out or they could no longer afford them. At the same time, drug traffickers began flooding the market with cheaper more potent opioids like fentanyl, which is often mixed with other drugs like heroin or cocaine to increase their potency. Tragically, this has led to an increase in overdose deaths, as many people do not realize they are consuming fentanyl and are not prepared for its strength.

Can you describe how your work is making an impact in battling this epidemic?

First and foremost, our work is centered on meeting folks who are using drugs where they are at today and understanding what they need to be healthy. The folks we meet are always aware of the risks associated with drug use, but they aren’t always ready to move toward abstinence or recovery — and sometimes they may never get there. But we know if they die — whether by HIV, hepatitis or overdose — they will never have the chance to find recovery. So, everything we do is centered on helping the folks we serve reduce the risk they encounter.

On a systems or societal level, Vivent Health has been instrumental in the passing of several harm reduction bills, such as Assembly Bill 619 in Wisconsin which decriminalizes the use and distribution of fentanyl test strips which is an important tool for helping prevent overdose deaths. We are also working in all the states in which we operate that haven’t already decriminalized syringe service programs to enact legislation to make these life-saving programs legal.

Through our harm reduction work, Vivent Health offers free fentanyl test strips which can be used to identify if a drug is laced with fentanyl. We also provide free Naloxone (Narcan) and training on its use to people who may find themselves in a position to stop an overdose. In 2021, Vivent Health distributed over 61,000 doses of Naloxone, trained 7,400 individuals on how to use it, and saved nearly 2,000 lives. And we helped nearly 500 individuals get linked to treatment programs when they shared with us they were ready to do so.

Can you tell us a story about a particular individual who was impacted by your initiative?

About 10 years ago I had the opportunity to connect with one of our opioid overdose and HIV prevention program participants who had just worked through a recovery program and had joined our organization as a prevention outreach worker. She shared with me that were it not for the programs and services Vivent Health provided to folks who were actively using, she was convinced she would have either passed away from overdose or would have had her life changed through an HIV or hepatitis diagnosis.

Instead, through Vivent Health she found folks who cared about her, were invested in her health and were there for her in ways traditional health care or treatment couldn’t be. And that made all the difference for her, to the point she has committed her career to supporting others through their journeys. Her story, which started as a young, scared and stigmatized 20-year-old grew into a professional commitment to helping reach others. To know that our ability to reach her has been multiplied countless times is the best demonstration of the power of what we do.

Can you share something about your work that makes you most proud? Is there a particular story or incident that you found most uplifting?

I get the opportunity to see every day how harm reduction advocacy keeps people alive and helps contribute to their sense that someone in a world that is usually pretty hostile to them still cares for their wellbeing, safety and health.

Can you share three things the community and society can do to help you address the root of this problem? Can you give some examples?

There are very tangible things we can do — and do in the short term — to help address opioid overdoses in the United States:

• Increase access to Naloxone: Naloxone is a medication that can reverse an opioid overdose and it save lives. Everyone should be trained in how to administer Naloxone just like we learned for rescue breathing, first aid and CPR.
• Increase access to mental health and substance use treatment: Many people who become addicted to opioids started by using prescription painkillers legally. No one wakes up in the morning and decides ‘today would be a great day to start using heroin’ and the root causes of drug use can be tied to things that have nothing to do with drugs. Society can help these individuals by providing them with access to mental health and substance use disorder treatment programs.
• Address the underlying social issues: The opioid crisis is often linked to underlying social issues, such as poverty, unemployment, trauma, adverse childhood experiences, and lack of access to healthcare. Society can address these issues by increasing access to trauma-informed health care, improving economic opportunities, and addressing the root causes of poverty.

The number one thing we can do is commit ourselves to working to eliminate the stigma associated with drug use. Too often, tired tropes related to ‘junkies’ and ‘addicts’ prevent us from seeing the person behind these labels and determine they are not worthy of our compassion, support and health care resources. Instead, we focus on a behavior or condition. No one wants to be judged solely on one behavior or condition, and we should pay that forward not only in our personal interactions, but in how we consider how we create systems of support in our communities.

If you had the power to influence legislation, which three laws would you like to see introduced that might help you in your work?

As a lobbyist and advocate, I feel lucky that I do have the power to influence legislation in several states and in Congress. Of course, in our democracy, lots of other folks have influence too, but if I could wave a wand and enact the following policy changes in the harm reduction space today, I would:

1.) Legalize syringe service programs and safe consumption sites across the country. We can’t engage people in systems of care if they are constantly pushed to the margins of health care and public health.

2.) Significantly increase investment in mental health and counseling. Everyone — regardless of insurance, income or socioeconomic status — should have access to mental health services when they need them.

3.) Ensure community-based and safety net health and social service programs have the investment necessary to reach and meaningfully impact socioeconomic factors experienced by marginalized and at-risk communities. We need to truly start creating the tide to lift all boats — and that means starting with the boats that are already struggling to stay afloat.

I know that this is not easy work. What keeps you going?

Optimism that incremental changes, even in the face of setbacks, are making significant differences in the lives of the people we are reaching. Whether it’s the mom who is worried about her daughter’s use of opioids, or the state legislator who wants to figure out how to prevent more needless overdoses in their district, I am buoyed by the fact that we are moving past stereotypes and criminalization toward responses that will support system-level change.

Do you have hope that one day this leading cause of death can be defeated?

Yes!! But only once we embrace strategies that move past punitive, stigmatizing approaches.

How do you define “Leadership”? Can you explain what you mean or give an example?

Leadership is defining the current reality and then the path to a desired reality for folks you are working with. It’s not about titles or hierarchy — it’s about developing a shared understanding of the environment and determining — together — the ways we want to go about improving that environment. It’s about moving past my solution or desired stated and understanding what I can do to help someone create their desired state.

What are your “5 things I wish someone told me when I first started” and why? Please share a story or example for each.

1.) Be curious. It’s a bit Ted Lasso passee to say it, but one of the most powerful things a leader can do is approach a situation with curiosity.

2.) Listen to understand. Debate club is great for debate club, but at the end of the day, people want to be heard, understood, and have their experience validated.

3.) Work hard and work smart. Having a great plan without steadfast determination to see it through is a wasted opportunity.

4.) Don’t forget that while you may believe you’re on the side of the angels, the other side thinks they are too.

5.) It’s only when you get comfortable in being uncomfortable that you can grow. If you want to grow quickly, seek out uncomfortability!

You are a person of enormous influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be?

See the world and the people and things in it for what they are, not what you want them to be. And then, let all the things you see have value.

Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?

“Don’t treat others as you want to be treated, treat them how they want to be treated.” This approach forces us out of our worldview and our own desires and biases to intentionally understand what someone else believes to be their ideal state.

Is there a person in the world or in the US whom you would love to have a private breakfast or lunch with, and why?

Such an incredibly difficult question! I am fascinated and inspired by people who live their joy and passion. Bruce Springsteen comes to mind as someone who has explored his beliefs, come to understand others and approaches life and art with curiosity and understanding. I’d love to buy the Boss breakfast!

How can our readers follow you on social media?

You can find Vivent Health on Facebook, LinkedIn, Twitter and Instagram.

This was very meaningful. Thank you so much!