Box Turtle Bulletin

My Concerns about the Public Option

This commentary is the opinion of the author and does not necessarily reflect that of other authors at Box Turtle Bulletin.

Timothy Kincaid

November 9th, 2009

On Saturday, the US House of Representatives voted for the Affordable Health Care for America Act, a healthcare reform bill which has been the highest priority of the Democratic Party leadership since the party took control of the presidency and both houses of the legislature. There are a number of very positive inclusions in that bill, including some that deal specifically with the GLBT community.

Probably the most specifically significant to our community is the incorporation of the McDermott/Ros-Lehtinen bill to remove the special ‘gay couples tax’ on spousal benefits provided by an employer. Currently, heterosexual spousal benefits are provided tax free and employers may claim them as an operating expense, but same-sex spousal benefits are considered to be part of the employee’s taxable income. This can result in thousands of dollars of tax demanded from our government solely because the spouse of the taxpayer is the same sex. Removing this tax is a tremendous relief on gay taxpayers.

Also included are changes in treatment for HIV patients, heath data collection related to the LGBT community, new sex education rules, and non-discrimination language.

However, the bill, as passed by the House, also provides for a “public option”, or insurance provision by the federal government. This government run health care mechanism is by far the most controversial aspect of the bill. And, depending on where you fall on the right/left scale, you may well have strong arguments either for or against such a move.

But while I have opinions in general about the decision on the part of the government to compete in the world of service provision, that is not the point of this commentary. Rather, I wish to express specific concerns about how this effort may impact our community negatively.

Continue reading after the jump.

CDC: “Down Low” Men Not Responsible For HIV Among Black Women

Jim Burroway

October 16th, 2009

African-American women make up 61% of all new HIV cases among women in the U.S., and they are 18 times more likely to become infected than White women. Until now, it was believed that this exceptionally high infection rate was due to bisexual African-American men. But a new statement from the Centers for Disease Control and Prevention throws cold water on that theory:

Heterosexual black men with multiple sex partners — not bisexual men who secretly have sex with men — are responsible for high rates of HIV among black women, according to a senior CDC official.

“We have looked to see what proportion of infections is coming from male partners who are bisexual and found there are actually relatively few,” said Dr. Kevin Fenton, director of the National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention. “More are male partners who are having female partners and are injecting drugs or using drugs or have some other risks that may put those female partners at risk of acquiring HIV.”

…”What we’re seeing is a concentration of the epidemic among the poor, among ethnic minorities and racial minorities in the United States,” Fenton said.

Among gay men, African-Americans are bearing a disproportionate brunt of HIV infections. In the most tragic example, Black teens make up only 13% of the nation’s teen population but they account for 69% of new HIV/AIDS cases for those among the 13-19 age group.

HIV Vaccine Results Called Into Question

Jim Burroway

October 14th, 2009

Remember that HIV vaccine story we were so excited about? It turns out that it may not be so promising after all. A Wall Street Journal article over the weekend determined that unreleased analysis of the data suggested the trial might have been a statistical fluke:

The second analysis, which is considered a vital component of any vaccine study, shows the results weren’t statistically significant, these scientists said. In other words, it indicates that the results could have been due to chance and that the vaccine may not be effective.

The additional data were available to the researchers on Sept. 24 when they announced the trial results, but they chose not to disclose them, said Jerome Kim, a scientist with the U.S. Army who was involved in the study. News of the second analysis was first reported on the Web site of Science magazine, but the story didn’t provide specific data. Full details of the trial are to be aired at an AIDS meeting in Paris that starts Oct. 19.

A group of 22 scientists who were critical of the study when it began in 2004 wrote that they feared that “one price for repetitive failure could be crucial erosion by the public and politicians in our capability of developing an effective AIDS vaccine collectively.” The WSJ article suggests the Army, the Thai government and the U.S. National Institutes of Health rushed to put a positive spin on the study. The AIDS Healthcare Foundation is calling for an independent review.

Who Are We Without the Wall?

Gabriel Arana

September 25th, 2009

Yesterday, major media outlets reported that for the first time an AIDS vaccine has had partial success in humans. In trials, it was about 31 percent effective. This is a far cry from the 70- to 90-percent effectiveness typically required for a vaccine to be licensed, but it shows that a vaccine is possible and represents the first-ever major breakthrough.

Since the announcement, I’ve allowed myself to consider seriously what a world without AIDS would look like. I was born in 1983 and remember the late ’80s, early ’90s television reports on the devastation wrought by AIDS in the U.S. The reports were terrifying, and it is odd to look at them in retrospect, knowing what they foreshadowed:

Since then, even as medical advances have made AIDS a chronic illness instead of a death sentence, contracting HIV has been one of my biggest fears, which goes to show that the stigma associated with it remains. I fear hearing, “you’re HIV positive” more than being told I have an inoperable brain tumor, which I know is irrational. I’ve had probably five HIV tests, and for all except the first one, the anxiety of waiting a week for lab results has made me run to the nearest rapid HIV testing site and get an answer in 20 minutes, which is also excruciating.

I grew up understanding that gay = AIDS, an equation that I realize is outdated and perhaps prejudiced. But part of me fears that being infected with HIV would confirm all the dire predictions made for me by reorientation therapists and concerned family members. I’ve often felt the pressure to defy these predictions by leading an exemplary life — which I of course haven’t, and won’t. But the point is that AIDS has been framed as the natural “consequence” of homosexuality.

Perhaps the best-known piece of writing on the social meaning of AIDS was written by Susan Sontag, “AIDS and Its Metaphors,” in which the author talks about the ways in which we imbued a virus — which is inherently indifferent to human feelings, morals, and motivations — with exactly those attributes. AIDS was cited by people like Pat Robertson as divine retribution for sinful sex, an understanding that reversed the natural inclination to view the afflicted person as a victim. People with AIDS were “guilty,” or earned it, or something like that. You “get” AIDS; you don’t “get” a brain tumor. HIV in the blood is a “poison,” AIDS a “plague.” As dehumanizing as terminal disease is, even more dehumanizing — and disempowering – is how moral, religious, and political leaders talk about AIDS and its victims.

On the other hand, the AIDS crisis galvanized the gay rights movement, and many of the advances in equality were made during the late ’80s and early ’90s. The AIDS crisis was the tipping point for social acceptance of homosexuality, a change that is reflected in the language. It’s no longer politic to call gay people “homosexuals” or refer to the homosexual “lifestyle,” but in the ’80s these were standard phrases used by newscasters:

A lot of the momentum of Act-Up has waned, but AIDS consciousness still permeates gay culture. Gay people will tag “be safe” (code for “use condoms”) to a goodbye at the end of an evening. I’ve been accosted more than once at a New York gay bar by an awkward grad student wanting me to fill out a survey about my sex life, which includes transparent questions about condoms, meth use, and depression (I can save you the work: gays who are reckless with drugs are probably more likely to have sex without condoms, and are probably more likely to be depressed). Public health officials obsess over how to “reach” us and set up condom stands at every LGBT event imaginable. And we’ve been Riding For The Cure forever. What happens when the finish line appears beneath us?

We thought the wall would stand forever,
And now that it’s gone we don’t know who we are anymore.

The Hedwig quote probably implies a nostalgia for AIDS that I do not intend, so let me be clear: the day the AIDS crisis ends — whether it’s a gradual process or an all-at-once medical achievement — will be a great day, the end of suffering for millions around the world. But it will mark the beginning of a shift in the culture. Will condom use plummet? Will the rate of other STDs rise? Will it change the forms our relationships take?

Probably.

The brief window of worry-free (or at least more worry-free) sex ushered in by the discovery of antibiotics, the pill, and abortion would open again — to the chagrin of social conservatives who have made the regulation of  sex, reproduction, and sexuality an essential component of their agendas. It would deflate many of the biological justifications for religious arguments (or maybe we’d just be cheating God?).

Whereas earlier gay rights activists wanted nothing to do with heterosexual marriage, the shift has been toward assimilating and adopting marriage, which some people think is good and other people think is bad (I’m on the fence). Part of this has come from increasing social acceptance and support of gay couples, but it would be silly to deny that the re-medicalization of sex had anything to do with the rise of monogamy in the gay community. Will the end of AIDS reverse this trend? I am not saying that bathhouses will reopen their doors and meth-fueled orgies will mark the scene until the next pandemic comes around, but de-coupling sex and relationships from the fear of death, disease, and social stigma will change the dynamics. In a sense, though, sex will always be fraught with anxieties: the virgin won’t stop wondering whether he or she will be good for their partner, and people will still feel the sting of betrayal when they find out they are being cheated on.

I’ve hesitated to use the word “freedom” or “liberation” in discussing the de-medicalization of sex. There is something mundane about equating this with human freedom. It seems a rather nihilistic, ’60s-’70s understanding of it. I have no idea what it really entails, but I doubt that freedom just means you have nothing left to lose.

This commentary is the sole opinion of the author and does not reflect the opinion of Box Turtle Bulletin’s other contributors.

HIV Vaccine Results Encouraging

Timothy Kincaid

September 24th, 2009

Eventually it had to happen. Eventually one of the promising vaccines trials for HIV had to provide at least some protection.

And it has. Partly. The trial showed that a vaccine was about 31.2% effective. (NY Times)

“I don’t want to use a word like ‘breakthrough,’ but I don’t think there’s any doubt that this is a very important result,” said Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, which is one of the trial’s backers.

“For more than 20 years now, vaccine trials have essentially been failures,” he went on. “Now it’s like we were groping down an unlit path, and a door has been opened. We can start asking some very important questions.”

This is not the vaccine that will announce the end of the era of AIDS. But it is the first vaccine that has shown any effectivity at all and it allows researchers an opportunity to build upon this start to find something that will really work.

Researchers Discover Antibodies Which Block HIV From Developing AIDS

Jim Burroway

September 4th, 2009

According to the journal Science via the Los Angeles Times:

After nearly two decades of futile searching for a vaccine against the AIDS virus, researchers are reporting the tantalizing discovery of antibodies that can prevent the virus from multiplying in the body and producing severe disease. They do not have a vaccine yet, but they may well have a road map toward the production of one.

A team based at the Scripps Research Institute in La Jolla reports today in the journal Science that they have isolated two so-called broadly neutralizing antibodies that can block the action of many strains of HIV, the virus responsible for AIDS.

Crucial to the discovery is the fact that the antibodies target a portion of HIV that researchers had not considered in their search for a vaccine. Moreover, the target is a relatively stable portion of the virus that does not participate in the extensive mutations that have made HIV able to escape from antiviral drugs and previous experimental vaccines.

Infection rates in gay/bi men

This commentary is the opinion of the author and may not reflect that of other authors at Box Turtle Bulletin

Timothy Kincaid

August 28th, 2009

Those leading the fight against AIDS and anti-gay activists sometimes have a common goal: portray the incidence of HIV in gay and bisexual men in the most frightening terms. This appears to me to be what is happening as the result of a presentation at the National HIV Prevention Conference (Southern Voice)

Gay and bisexual men account for half of the new HIV infections in the U.S. and have AIDS at a rate more than 50 times greater than other groups, according to Centers for Disease Control & Prevention data presented at the National HIV Prevention Conference this week in Atlanta.

That’s a pretty frightening statistic. But perhaps the raw numbers give it some perspective.

Dr. Amy Lansky of the CDC presented research at the Aug. 24 plenary in which the CDC estimated in the U.S. there were 692.2 new HIV cases in 2007 per 100,000 men who have sex with men (MSM).

In other words, the rate of new infections in the population of gay and bisexual men in 2007 was 0.69%. Or in 2007 one out of every 144 gay/bi men seroconverted.

That still is very high. And it is consistent with our calculations that about 12% of gay/bi men (or about 6% of all gay/bi people) are infected with HIV. (So play safe kids… or better yet, find someone to have and hold from this day forward.)

But, in those terms, perhaps it isn’t quite as scary as the somewhat meaningless announcement that “MSM are 50 times more likely to have AIDS than women and non-gay or bisexual men.” I think most of us already know that sexually active gay men, especially those unpartnered, are at a much higher risk of HIV than Grandpa Joe and Grandma Sally.

And I wonder at the wisdom of making announcements of such comparisons. Provided without context, this quote can seem counter-intuitive. A gay man with both gay and straight friends might think that such ratios do not reflect their observations. And using language that feels out of sync with the realities of the experiences of gay men will not encourage better behavior; rather it will cause the target audience to dismiss the information.

Further it may distract from the fact that HIV transmission is not homogeneous within the gay community; some age, ethnic, and geographic subgroups need and deserve much more attention and focus in our battle against HIV/AIDS. Making statement that sound as though “HIV is a gay disease” misses the picture and downplays the tragic way in which this virus has devastated some gay communities – especially minority and economically challenged subsets – far worse than the “Will and Grace” gay man.

Such declarations also run the risk of providing a false sense of security to others in the non-gay-male category who live in communities which are disproportionately impacted by this disease. And it may encourage those responsible for shepherding resources to overlook, for example, sexually-active single black women in specific urban settings.

So while I strongly support that accurate information be presented and disseminated as widely as possible, I’d caution those who make statements about this disease to consider that their words not only be factually correct but also convey messages that are not confusing or counter-productive.

Lack of Clarity in Reporting on HIV and Circumcision of Gay Males

Timothy Kincaid

August 26th, 2009

Several studies have shown that in African and Asian nations heavily impacted by HIV, circumcision can reduce infection rates in males by 50 – 60%. Now a CDC doctor has announced that while circumcision is effective in reducing female to male transmission during vaginal sex, it does not assist in resisting infection between gay males during anal sex. (U.S. News & World Report)

Circumcision “is not considered beneficial” for gay men concerned about lowering their risk of becoming infected with HIV, Dr. Peter Kilmarx of the CDC told the Associated Press. He released the study findings at a conference on Tuesday.

The finding are at odds with some studies conducted in Africa, which have suggested that circumcised males may be less prone to HIV infection during heterosexual sex. But circumcision may not offer the same protection when it comes to anal sex, Kilmarx said.

In the study, the CDC team tracked the HIV infection rate of nearly 4,900 men who had anal sex with an HIV-infected partner. The researchers found an HIV infection rate of 3.5 percent — whether the men were circumcised or not.

While this may appear informative to a heterosexual, this reporting leaves more questions than it answers.

• Were these 4,900 tops who engage in insertive sex only? Because if not, how could the circumcision of a bottom (passive partner) possibly impact HIV transmission?
• Does the 3.5% infection rate reflect a bottom to top transmission? Was this 3.5% in a year, a decade, when?
• Were these “partners” in relationships or just sex-partners?
• Or did they just say, “Here are some cut men and here are some uncut men. Let’s see to what extent they seroconvert”?

This story is but another illustration of why it is important that gay men and women are included in reporting stories that effect our lives. It would be interesting to know the extent to which bottom to top HIV transmissions occur and whether circumcision of the top could impact this transmission. But reporting like this tells us nothing of much use at all.

Black Gay Men, AIDS, and No Community Support

Alvin McEwen

July 6th, 2009

Alvin McEwen found an article about Black gay men and AIDS hitting really close to the gut. He posted his reaction on his blog. It’s a perspective we never talk about. I’m re-posting it with his permission. — Jim Burroway

AIDS is killing off black gay men and lack of LGBT community support may an unfortunate factor:

Black gay men have less choice when it comes to sexual partners than other groups and, as a result, their sexual networks are closely knit. These tightly interconnected networks make the rapid spread of HIV more likely. In a study looking at social and sexual mixing between ethnic groups in men who have sex with men, H. Fisher Raymond and Willi McFarland, from the San Francisco Department of Public Health in the US, show that social barriers faced by Black gay men may have a serious impact on their health and well-being.

. . . Black gay men are the least preferred of sexual partners by other races. Black men are perceived to be riskier to have sex with, which can lead to men of other races avoiding Black men as sexual partners. They are also perceived as less welcome in the common social venues of gay men in San Francisco. As a result, Black men are three times more likely to have sexual partners that are also Black, than would be expected by chance alone.

In the authors’ view, the combination of attitudes on the part of non-Black gay men, friendships and social networks that are less likely to include Blacks, and the environments found in gay venues serve to separate Black gay men from other groups.

So the personal ad phrase “no fats, no olds, no fems, no blacks” is now taking on sinister proportions. It’s not that I’m passing judgment on people’s personal dating choices. But it does go farther than that. The LGBT community can sometimes be consumed with the gay ghetto clique mentality. And as you can see, it’s killing those who are generally not allowed to be in the “clique.”

But hey, at least the black community supports us . . . when we seem to be at death’s door. That’s when folks make these lovely speeches about “it’s not just a gay disease,” and “let’s not stop until we find a cure.”

I got an idea – how about giving us a little support while we are healthy. How about not isolating us or making our lives seem dirty by using the word “lifestyle” like it’s a pooper scooper.

So both the LGBT and black community have work to do. I can only hope the work gets done before too many LGBTs of color suffer.

California HIV Emergency: Schwarzenegger, Legislature may slash HIV funding

Rex Wockner

June 10th, 2009

[The following is a guest post by journalist Rex Wockner, cross-posted at his web site. This very important story is reprinted here with permission and at his request.]

California Gov. Arnold Schwarzenegger has proposed, and the California Legislature is considering, draconian cuts to all types of HIV-related funding in the near-bankrupt state.

In the worst-case scenario, which is still not off the table, slashes to the AIDS Drug Assistance Program could result in thousands of Californians who make less than $41,600 per year losing access to the state-provided drugs that suppress HIV and keep them alive.

In the apparent best-case scenario, not all HIV drugs would be available via ADAP and patients would have to pay part of the cost of the ones they could get. That is problematic because some HIV-positive people have developed resistance to some HIV drugs, and need access to the full arsenal of therapies to stay alive.

Further, the current plan apparently completely eliminates state funding for the tests that determine if a patient is responding to treatment — such tests as CD4 counts, viral-load measurement and drug-resistance monitoring.

These tests are essentially mandatory in HIV treatment. Doctors use them so they can change a nonresponsive patient’s drug combination to another combo that works in that patient — before the patient’s immune system breaks down further and the patient develops a life-threatening opportunistic infection.

The current plan apparently also dramatically slashes funding for education, prevention, counseling and testing programs.

Some 35,000 working- and middle-class Californians who don’t make enough money to pay for their own treatment could be adversely or dangerously affected by the possible cuts to ADAP and elimination of monitoring testing.

Gay and HIV advocates have strongly denounced the budget proposals, and a large rally was held at the state Capitol in Sacramento on June 10.

Rethinking HIV Testing

This commentary is the opinion of the author and may not reflect the opinions of other authors at this site.

Timothy Kincaid

June 3rd, 2009

There is no good reason for any American becoming HIV positive today.

Which is not to say that there are not a lot of very understandable explanations why an individual might become infected. Social pressures, education, self perception, culture, diminished self worth, drugs and alcohol, and even trusting the word of a careless liar all play their part in the instances and circumstances that lead to poor choices and HIV infection.

And so infection rates stay consistently high in the gay community, and astronomical in some sub-populations. A study of HIV infection rates in Chicago found infection rates of over 17%* of gay men in that city. When looking at subgroups, the statistics become even more troubling:

Thirty percent of gay black men in Chicago tested positive, the study showed, while Hispanics and white men had rates of 12 percent and 11.3 percent, respectively.

A quarter of blacks aged 18-24 tested positive. More than 37 percent of blacks aged 25-34 – the highest of any age group – tested positive. The numbers are similar to national figures.

These are rates of infection that are simply unacceptable. And there’s no reason, no justification, for 37% of any ethnic or age group to be infected with a virus that is detectable and preventable. Considering the weath in this nation and the billions spent on bailing out bankers and car makers, that black gay men have rates this high raises hints of racism, homophobia, and elitism.

But there is an explanation, one that makes sense to me; these men didn’t know they were infected. Half of the infected gay men – and two-thirds of infected black men – were unaware of their HIV status.

Why?

Because they didn’t get tested. They were “worried about the result.”

I understand that worry about what it means to be HIV positive can be a strong disincentive to get tested. As long as you don’t know, you don’t have to deal with it.

But I think this report, like all those I’ve seen from the AIDS establishment, misses a component that is present with every HIV test that I or anyone I know has taken.

It isn’t just finding out whether one is HIV positive. It’s also going to some clinic (when they are open), filling out questionnaires, being grilled about the intimate details of your sex life, and then sitting in a waiting room where you are sure everyone is staring at you before being called into an office and being told by a total stranger whether you have a life-changing disease and, if so, reporting your name to the government.

It’s an unpleasant process. And frightening.

And I think it might be time to begin considering a change. I think it’s time to consider allowing people to test themselves in the privacy of their own home.

I know there are strong objections to this notion.

There is fear that inexperienced users will make mistakes and get false conclusions from improperly handled tests. There’s also fear that at-home tests would not be sensitive enough to assure accurate results or may be too expensive.

But the current oral swab tests are pretty darned easy. If some scared teenage girl who missed her period can pee on a swizzle, surely a gay guy can run a swab over his gums.

Also, the oral tests are over 99% accurate. And there’s little reason to think that they would be significantly less accurate in one’s home than in the clinic. And if we as a city, state or nation, can afford to pay the clinic administators to provide free testing, I’m sure we can come up with some scheme to get the prices on tests affordable by those who need them; it just makes economic sense.

I will concede that some guys will ignore the fact that these tests only tell you whether you were infected before a three month (or so) window. Some will assume that a negative test means “100% negative today”. But this is also a misconception that can occur in a clinic and can be mitigated by careful packaging.

But the biggie reason given for opposition to the public availability to HIV tests that one can take and home and get immediate results is that in a clinic setting those who test positive can get counseling.

I appreciate the need for counseling. I’ve even argued the merits of this approach.

But it’s not working, folks. There are still thousands of guys out there that have been infected and do not know it. And they are not going to come into your clinic to find out. And maybe, just maybe, it’s because they don’t want to be subjected to your counseling.

I have come to believe that many of these “I don’t know” guys might know their HIV status if they were able to anonymously purchase a little kit at the drugstore, take it home, and know the results in 20 minutes.

Yeah, some will freak out. And panic. And there won’t be a counselor in front of them.

But they will at least know their HIV status.

And if they were provided with the option to immediately call a hotline for information and counseling, they might do so. Or they could go to a clinic. Or go online.

But they would know. And there’s a very good chance that they would not then go out and infect someone else.

And this approach would be useful not only to unknown virus carriers, but to those they come in contact.

I think that many a gay guy – or black woman – would say, “Yes, I know you say you’re ‘clean’. But put this in on your gums and get comfortable because nothing is in going in anything for the next twenty minutes.”

It’s is bound to reduce infections better than the “baby, just trust me” method.

I don’t doubt the sincerity of those who wish to keep HIV testing in carefully controlled environments. And I am sure that some readers will object to this proposal, fearing that it would be a catastrophe.

And I’ll even grant that I may be wrong. Perhaps allowing people control over their own HIV testing would result in more problems than it solves. Maybe I’ve understated some concern or forgot some consideration.

But with infection rates – especially unknown infection rates – as high as they are, it’s time to look for new solutions. It’s time to ask the question. And it’s time to start the conversation over whether personal access to HIV tests could help bring down the incidences of unknown infections and help stop the spread of this disease.

- – -

* Though higher than our estimates of about 12% of gay men, this is consistent with our estimates. HIV infection rates in black gay men is far higher than other ethnic subgroups and with a population that is 37% African American, this skews the local average higher than the national average.

Addendum: This commentary does not attempt to address the specifics of the African-American community. I’m not qualified or adequately knowledgeable to address the exact circumstances leading to disparity in infection rates between ethic subgroups or to advance targeted solutions. Rather, this commentary seeks to start a discussion and new thinking about the lack of testing in infected populations of all races. For more information directed at HIV/AIDS in the African American community, see the Black AIDS Institute or the Minority AIDS Project.

Researchers Catch HIV Infection In The Act

Jim Burroway

March 27th, 2009

The Telegraph reports:

Researchers found that the virus is transferred from infected cells to healthy ones in a previously unknown way. It is hoped that the discovery will help researchers create a vaccine to combat the virus, which has led to the deaths of more than 25 million people.

The study was made possible after experts created a molecular clone of infectious HIV and inserted a protein into its genetic code which glows green when exposed to blue light. This allowed scientists to see the cells on digital video, and capture the way HIV-infected T-cells interact with uninfected ones.

They noted that when an infected cell came into contact with a healthy one, a bridge was created between them, called a virological synapse.Researchers were then able to observe the fluorescent green viral particles moving towards the synapse and into the healthy cell.

The US study has broken new ground by revealing that it is the synapse through which the viral proteins are gathered and moved into uninfected cells.

… [P]revious efforts to create an HIV vaccine have focused on priming the immune system to recognise and attack proteins of free-circulating virus. The new video footage indicates that HIV avoids recognition by being directly transferred between cells. Dr Huser said: “We should be developing vaccines that help the immune system recognise proteins involved in virological synapse formation and antiviral drugs that target the factors required for synapse formation.”

The study’s findings are available in advance of publication ($15) at the website for the journal Science. The journal has made eleven movies available online for free here.

Jamaica’s Anti-Gay Laws Lead to Increased HIV

Timothy Kincaid

March 20th, 2009

Jamaica, perhaps the most homophobic spot in the Americas, still retains anti-”buggery” laws. And, unlike some countries who have laws that are more for message than for punishment, Jamaican society enforces these prescriptions by means of mob violence and murder.

Needless to say, fear of exposure is not conducive to steady, monogamous, mutually-supportive relationships. Instead, those societies that threaten the lives and freedoms of gay persons lead to hidden individuals furtively seeking sexual release and then fleeing into the shadows. Many seek to hide behind a public heterosexual front and live a double life.

This is healthy for neither the individuals nor the society. And Jamaica is a prime illustration. According to a 2008 study by the Caribbean HIV & AIDS Alliance (CHAA) (Jamaica Gleaner):

31.8 per cent of gay men in Jamaica are living with HIV. Another 8.5 per cent were found with chlamidia, 2.5 per cent had gonorrhoea and 5.5 per cent had syphilis.

These are shocking rates of infection. And the reason for them does not lie solely in the secret, furtive, shameful nature of the brief liasons. Rather, they are compounded by a society in which seeking medical care in an honest fashion can gat you killed. As a UNICEF worker reported in 2007,

Beaten, stoned, thrown out and even killed are the prices some people face just for being HIV positive in Jamaica.

CHAA lays the blame for the shocking rates of HIV and other infectious disease at the feet of homophobia and mistreatment. Not only are MSM frightened to seek medical care, they are fearful of HIV/AIDS groups that seek to help them. This leaves gay men, in particular, at great risk for transmission of a potentially life threatening disease (MedicalNewsToday).

Devon Cammock, the targeted intervention coordinator at the Jamaica AIDS Support for Life, said that MSM tend to hide their sexuality even from other members of the MSM community, which makes it difficult to conduct programs that are needed in the community.

Should there be among you some so callous as to think that this is just a “gay disease” and that they are just getting what they deserve (an attitude that is not limited to places like Jamaica), you may wish to consider that homophobic laws and culture are a danger to everyone.

In Jamaica, only those who are most brave (or most suicidal) dare identify as gay. So to track health issues they use the term “men who have sex with men (MSM)”. And CHAA has found that MSM are indeed living a double life – and a dangerous one :

Some 27.7 per cent [of MSM] reported having two or more sexual partners in the last four weeks; 25.9 per cent had a new partner in the past four weeks; 28.8 per cent had a female partner in the past four weeks; 15.9 per cent live with a female partner; and 33.8 per cent had two or more female partners in the past 12 months.

But Jamaica’s culture of violence and hatred is not softened by unknowing victims. Rather, their homophobia is so strong it spreads to non-gay persons who have become HIV infected. Take the story of 20 year old Katie.

In the year and a half she has known she’s infected, Katie has struggled through a lot. When she discovered her status, the boyfriend she was living with threw her out along with her daughter, who is currently four and whose father tragically died the same year she was born.

After being thrown out by a boyfriend she went to live with her father, where the situation got worse. There, her step-mum spread rumours that she had AIDS and would point her out on the streets, a very dangerous act considering the destructive discrimination she could face.

Although it’s still a mystery how she got infected, it’s one Katie is in no hurry to solve, “it really doesn’t matter to me anymore because I have my daughter and it would really hurt me and her if I started searching for who I got infected by”.

Katie gets little sympathy in Jamaica. Those persons who are gay and invested with HIV get none.

Unless the Jamaican leaders – be they civil, religious, cultural, or community – become willing to let go of their own fear and hatred and say, “enough is enough”, this nation will continue to wallow in crime and disease, clinging only to its animus and self-righteousness, until the freedom-loving nations of the world want nothing to do with her.

HIV Gene Therapy Trials Begin

Jim Burroway

February 3rd, 2009

Human trials are about to begin on a form of gene therapy that could immunize people against the most common type of HIV. Recruiting for the human trials began yesterday.

According to Wired.com:

Since the discovery that a small portion of people who are exposed to HIV do not get infected, scientists have been working to discover the secret to those people’s resistance and how to make others resistant as well.

It turns out that most people have a gene called CCR5, which makes them vulnerable to HIV infections. The naturally resistant people have mutant CCR5 genes that inhibit HIV.

Previously, scientists found that by cutting the CCR5 gene out of white blood cells involved in the immune response known as T-cells, they could protect a tube full of human cells from the virus. The gene editing technique relies on proteins called zinc finger nucleases that can delete any gene from a living cell.

Zinc finger nucleases are compounds that can slice open molecules. This one is is designed to go after the CCR5 gene. The treatment calls for removing CD4 T-cells,the immune cells affected by HIV, treating them with the drug, and re-infusing them into the patient. The hope is that these damaged cells will multiply and give the patient an immune system which is resistant to HIV.

The human trials are being conducted by Sangamo BioSciences, Inc., a California biotech company. The first phase is meant to look at safety and tolerably of a single infusion. The first people to receive the new treatment will be six patients who have developed drug-resistance to HIV and six other patients who are currently responsive to their existing drug regimen.

Saddleback’s New Definition, Courtesy Of Dan Savage

Daniel Gonzales

January 28th, 2009

Gay sex advice columnist and author Dan Savage isn’t known for holding back against people he views as enemies of the LGBT community. Angered by anti-gay comments made by former Senator Rick Santorum, Savage named a rather disgusting and previously un-named phenomenon relating to anal-sex after him. Performing a Google search on “Santorum” turns up Savage’s definition as the top item.

And now we get to Savage’s recent anger with Rick Warren of Saddleback Church. What is a “Saddleback” exactly? Savage wasn’t sure it had any definition so he took it upon himself to create one. After polling his readers Savage has announced his new definition of Saddleback / Saddlebacking:

From the new website Saddlebacking.com

Savage finds this new definition apropos because of Warren’s ideological promotion of abstinence-only programs which not only don’t work, but result in teens substituting anal-sex and oral-sex believing they aren’t “real” sex.

CDC Reports Significant Declines In HIV Infection Rates

Jim Burroway

January 17th, 2009

According to the Centers for Disease Control and Prevention, the number of people living with HIV and AIDS continues to rise as antiretroviral medication continues to prolong lives. In fact, we reported on a study last summer which showed that life-expectancy for those infected with HIV is now approaching normal. While nobody likes to see the number of people living with HIV/AIDS continue to increase, we also noted another CDC study which showed that the number of new HIV infections has remained relatively flat over the past ten years, a finding that is consistent with the fact that new AIDS cases has actually been declining slightly over the same period.

Now the CDC reports some more good news which sheds some light into how the number of HIV infections have remained so flat: The infection rate has been steadily declining since the 1980’s:

Researchers found that the HIV transmission rate has declined dramatically since the early days of the epidemic. In 1980, for example, when the disease was still undetected, the transmission rate was 92 percent, meaning there were 92 transmissions per 100 persons living with HIV at the time. After the identification of AIDS, and later HIV, and the implementation of HIV testing and other prevention efforts, transmission rates began to decline.

Since the peak level of new infections in the mid-1980s, just prior to the introduction of HIV testing, the transmission rate has declined by approximately 89 percent (from 44 transmissions per 100 persons living with HIV in 1984 to five transmissions per 100 persons living with HIV in 2006). Over the last decade, as prevention efforts have been expanded and improved treatments for HIV became available, the transmission rate has declined by 33 percent (from an estimated eight transmissions per 100 persons living with HIV in 1997 to five in 2006). Five transmissions per 100 persons living with HIV in 2006 means more than 95 percent of persons living with HIV did not transmit the infection that year.

The large fluctuations in the graph prior to 1980 are due to the relatively small numbers of persons living with HIV at that time and the limited surveillance structures that were in place.

The analysis, conducted by Drs. David R Holtgrave, H. Irene Hall, Philip H. Rhodes, and Richard J. Wolitski, will be published in an upcoming edition of the Journal of Acquired Immune Deficiency Syndrome.

[Hat tip: Michael Petrelis]

Dallas County Overturns Condom Distribution Ban

Jim Burroway

January 14th, 2009

Dallas County, Texas — yes, that famously conservative Dallas — has voted to overturn a 14-year-old ban on county health care workers distributing free condoms. Republican Maurine Dickey joining Democrats Jim Foster and John Wiley Price, to overturn the ban on a 3-2 Tuesday morning.

Republican Commissioners Kenneth Mayfield and Mike Cantrell, both of whom supported the ban in 1995, voted against overturning it, saying they feared it could lead to condoms being distributed in schools. But Dickey, who wasn’t on the court in 1995, said she was more concerned about the high cost of treating people with HIV/AIDS.

According to a report prepared by the county’s Health and Human Services Department, which recommended overturning the ban, the lifetime cost to treat someone with HIV is more than $600,000. “I think we need to put the taxpayers first,” [Commissioner Maurine] Dickey said. “If we prevent two people from getting AIDS in Dallas County, we will have saved over $1 million of the taxpayers money.

Warren’s Counterproductive AIDS Efforts in Africa

Timothy Kincaid

January 7th, 2009

Last month, I commented on how Rev. Rick Warren’s efforts to fight AIDS in Africa seemed to be more of a means by which to influence religious doctrine and public policy in several African nations than a charitable effort. My analysis seems confirmed by an article for the Daily Beast by Max Blumenthal, in which he investigates Warren’s AIDS efforts and finds them closely tied to anti-gay political activists and driven by dogmatic ideology.

In addition to the Anglican Bishops that are seeking to destroy the Church of England and remold it under their personal control, Warren has aligned himself with an evangelical pastor in Uganda, Martin Ssempa. This pastor quickly became interested in AIDS prevention after the US allocated 15 billion dollars (the PEPFAR program). While taking a salary from US taxpayers, he implemented efforts to remove condom use from Uganda’s successful ABC (abstinence, be faithful, condoms) anti-AIDS efforts.

By 2005, billboards promoting condom use disappeared from the streets of Kampala, replaced by billboards promoting virginity. “Until recently, all HIV-related billboards were about condoms. Those of us calling for abstinence and faithfulness need billboards too,” Ssempa told the BBC at the time. A 2005 report by Human Rights Watch documented that educational material in Uganda’s secondary schools falsely claiming condoms had microscopic pores that could be penetrated by the HIV virus and noted the sudden nationwide shortage of condoms due to new restrictions imposed by on condom imports.

Due in part to these efforts by Ssempa, HIV began to increase in the country.

AIDS activists arrived at the 16th International AIDS Conference in Toronto in 2006 with disturbing news from Uganda. Due at least in part to the chronic condom shortage, HIV infections were on the rise again. The disease rate had spiked to 6.5 percent among rural men, and 8.8 percent among women—a rise of nearly two points in the case of women. “The ‘C’ part [of ABC] is now mainly silent,” said Ugandan AIDS activist Beatrice Ware. As a result, she said, “the success story is unraveling.”

This should have given concern to those most familiar with AIDS in Africa. However, Rick Warren did not seek to return to the success of ABC. Rather, he took personal action to continue the program that had been shown to increase HIV infection – abstinence only.

In February 2008, Rep. Tom Lantos sought to reform PEPFAR to lift the abstinence-only earmarks.

His maneuver infuriated Warren, who immediately boarded a plane for Washington to join Christian right leaders including born-again former Watergate felon Chuck Colson for an emergency press conference on the Capitol lawn. In his speech, Warren claimed that Lantos’ bill would spawn an increase in the sex trafficking of young women. The bill died and PEPFAR was reauthorized in its flawed form.

But Ssempa was not content to put his anti-sex agenda ahead of the AIDS-prevention efforts of his nation. He also used his political connections and US backing to advance a harshly homophobic political atmosphere in their nation.

August 2007, Ssempa led hundreds of his followers through the streets of Kampala to demand that the government mete out harsh punishments against gays. “Arrest all homos,” read placards. And: “A man cannot marry a man.” Ssempa continued his crusade online, publishing the names of Ugandan gay rights activists on a website he created, along with photos and home addresses. “Homosexual promoters,” he called them, suggesting they intended to seduce Uganda’s children into their lifestyle. Soon afterwards, two of President Yoweri Museveni’s top officials demanded the arrest of the gay activists named by Ssempa. Terrified, the activists immediately into hiding.

The more I learn about Rick Warren’s AIDS efforts in Africa, the less I respect him. He has endorsed policies that he knows are not the most effective and he has befriended and supported some of the most homophobic religious leaders in Christendom in their anti-gay political actions.

It is commendable that Rick Warren feels compassion for those suffering from AIDS in Africa. It is not commendable that he has used this suffering as a way to get a political and religious foothold in the region or that he capitalized on – and encouraged – hatred against gay people in the process.

AIDS Skeptic Dies

Jim Burroway

January 3rd, 2009

Christine Maggiore, a Van Nuys woman who was an outspoken skeptic of the science behind the Human Immunodeficiency Virus (HIV) as the cause of AIDS, has died of AIDS.

Maggiore, 52, was founder of Alive & Well AIDS Alternatives to challenge the “common assumptions” about AIDS. Her group advocated shunning AIDS medications for expectant HIV-positive mothers. She wrote the book, “What if Everything You Thought You Knew About AIDS Was Wrong?”

Maggiore had said that she did not take antiviral medications during her pregnancy and that she did not have her daughter, Eliza Jane Scovill, tested after birth. Eliza died in 2005 of AIDS-related pneumonia after Maggiore and her husband, Robin Scovill,  refused AIDS treatment. In 2006, the Los Angeles County district attorney’s office decided not to file criminal charges against Maggiore.

World AIDS Day 2008

Timothy Kincaid

December 1st, 2008

Today is World AIDS Day and while you may have few options for changing the global situation, here are a few suggestions of things you may want to do locally to commemorate the international event:

• Get tested. Make it an annual event whether you need to or not.
• If you are positive, this might be a good time to review your meds, make an appointment, read up on new treatments, join a gym, or dedicate some time to thinking about and planning your health.
• Contact a local AIDS service group and find out whether you can volunteer some time. While due to advances in medical care many HIV positive people live very normal lives, for some 2008 is no better than 1998. Food still needs cooking and delivering, dogs need walked, and sick people need a caring ear.
• Write a check.
• Tell the truth. Many people – gay and straight – are misinformed about this disease and its impact on our community. Today is a good day to help eliminate myths. Yes, most HIV patients can manage the virus through a strict regimine of medicines, but not all can: so play safe. And no, not all gay people have -or will get – HIV; only about 12% of gay men and virtually no gay women have the virus.
• Think about whether you have a unique talent that could be put to good use. If you are a member of an ethnic minority, you may have access to the hardest hit communities in ways that no ‘white guy in a suit’ could ever reach. We each have our own skills and advantages; find yours.
• Pray. If you are a member of a faith-based group, ask others to join you in your appeal to the divine.
• Take a moment to remember those whom we have lost to this horrible disease and honor their memory.