A physician with experience providing medical care to urban US populations and international experience in the management of HIV disease. Believes that the causes of poor health outcomes in certain key populations usually lies beyond the realm of most health providers. Improvement in health status and health outcomes in our most vulnerable both in developed and developing settings requires coordination of efforts within the health systems with the support of business and economic interests. In this vein close associations between patient advocacy groups, providers, health payees and business is high on my list of priorities.