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.

First, I preface with an assumption that while the public option is being discussed almost as though it is a supplement to current insurance coverage, it is likely to be an immediately significant player in the healthcare world. Additionally, based on the current provisions in the law, I cannot see how it will not over time become more, rather than less, influential.

And, based on my understanding of government and its current track record, that gives me concern. Here are the specific reasons why:

Federal Privilege

The federal government does not apply to itself the rules that it readily applies to citizens or private industry. Although it may seem unfathomable that lawmakers would specifically exempt themselves from the burdens they place on you and me, this is quite often the case.

And the federal government does not fall subject to state laws in regards to employment and non-discrimination. So exceptions made for the federal competitor would be exempt from state law requirements.

Let me give you a real life example of how the federal government, even in the way it reacts with private industry, exempts its rules from state overview.

Currently, companies in states like California are required to offer to their gay employees the same benefits they offer to straight employees. However, due to federal ERISA rules, most big companies do so entirely at their own discretion.

Morrison and Foerster explains:

The May 15, 2008, California Supreme Court decision held that same-sex spouses must be treated the same as opposite-sex spouses for all purposes under California law. This applies to employers with California employees to the extent that California law applies generally to them. However, the majority of employee benefit programs maintained by non-governmental employers are governed by ERISA. ERISA broadly preempts state attempts to regulate the operation of employee benefits, and as a result, it does not appear that state law could require employers to modify their benefit plans to provide additional rights or benefits to married same-sex couples.

While Congress seems seldom reluctant to direct the actions of private business, it sees restrictions on the “people’s business” to be contrary to the best interest of the citizenry. That attitude is unlikely to change any time soon.

Federal Tax Dollars and Controversy

The healthcare reform bill passed with a very small margin. And essential to its passage was an amendment banning the use of federal dollars to pay for abortion services. Whether or not one approves of abortion, this vote tells us something important about the way in which the Public Option will be administered. The provision of controversial services will be subject to the political whims of whoever is in majority.

Issues such as abortion, contraception, in-vitro fertilization, sexual health information, HIV and AIDS care, HPV vaccination, and a host of other issues that are deemed “controversial” will be decided based not on medical need or even on what is best from a long-term health care perspective, but rather on political ideology.

More conservative lawmakers will, with conviction and determination, argue that it is unfair and un-American to tax the citizens in order to pay for things which they find abhorrent. Such as health services that reward sinners for their abominable behaviors.

Government Lag

When it comes to the provision of equality and decency to gay and lesbian employees, the private sector far outpaces the federal government. Currently, HRC has found that 99% of the employers they review provide employment protections on the basis of sexual orientation. The federal government does not.

The President has some leeway with which to assert protections for gay employees, but those change with each administration. And they do not apply broadly across all areas of the government.

In fact, in some areas of government – most particularly the military – private contractors, such as Halliburton, doing jobs identical to federal employees have orientation based protections against discrimination where their government counterparts may have official policies requiring discrimination. It is accurate to say that the only significant employer in the country with an anti-gay employment policy is the federal government.

And with poll after poll showing that large majorities of Americans support non-discrimination laws and open service in the Military, it is difficult to see the federal government on the forefront of protecting civil rights. When the voters in Kalamazoo, MI, have endorsed employment protections before the federal government, you know that there is a very significant lag.

Republican Antipathy and Democratic Apathy

There are segments within the Republican Party that, as a matter of policy, oppose any and all efforts to treat gay citizens equal to heterosexual citizens. And these segments have been so successful in their anti-gay efforts that they have made antipathy to our concerns a “Republican value”.

It is considered “pro-family” to actively seek out ways in which to discriminate against gay citizens and to make our lives difficult. These are not limited to “protecting the definition of marriage”, but often extend to bans on adoption, exclusion from public view such as public library offerings, and pretty much anything else they can think of.

Far too often, the unspoken answer that elected Republicans give to, “You are hurting my life”, seems to be, “Yes, that’s what I am intending to do.”

And while we can count on opposition from Republicans, we cannot count on the Democratic Party to come to our defense.

Recent actions taken by the party clearly illustrate to us that the Democratic Party leadership sees us as a secondary priority. Our equality will be considered only when it is convenient, incidental, and comes with no cost of political capital.

So we are a people at the mercy of the whims of political expediency. Within the federal government structure, our rights are frequently bargaining chips to be used in the negotiation of benefits for the real priorities of politicians and lobbyists.

So What Can We Expect?

Should the Senate go along with the establishment of a Public Option:

• A large segment of the healthcare industry will be moved outside of state and local protections. While Kaiser or Blue Cross may be subject to state law which disallows discrimination in employment, the Public Option likely will be exempt. Further, such spousal benefits as may be provided by private insurance companies will not be provided to the employees of the Public Option in accordance with DOMA.
• There is a good chance that the pro-gay provisions in the House bill will be removed during reconciliation with the Senate version of the bill.
• It is likely that Republicans may regain control of one of the houses of Congress in 2010. If not, it is almost a foregone conclusion that the House will have a majority of members, both Republican and Democrat, who are socially conservative and unlikely to support gay rights. If Republicans gain control, one item high on the agenda will be revision to this healthcare reform. It is reasonable to assume that anti-gay provisions will be proposed.
• Future exclusions from health care provisions are likely to include limitations if not and outright ban on “federal tax dollars” spent on (i.e. the Public Option providing healthcare for):

  HPV vaccination for boys
  Gay specific preventative health care
  Sexual health programs which include mention of same-sex health
  Health data collection for the LGBT community
  Policies which include same-sex spouses/partners in health decisions

• And I do not think it beyond possibility that an administration of someone like Mike Huckabee would be pro-active in “preventing the spread of HIV” or in denying services to someone they deem to have “taken deliberate risks”. And should some new “gay plague” come down the road, I am not confident that any administration would not respond with punishment before care.

I hope that my concerns are overblown. I hope that I am just being reactionary. I hope that the federal government will not seek under any administration to advance conservative social policy by means of meddling in the health provisions of a significant segment of the population.

But in the midst of the euphoria that much of our community is expressing over the Public Option provision of healthcare reform, I hope that we can consider the possibilities that can arise and recognize the risks that are inherent in a federal government run health company.

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.

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.

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:

Click here to view the embedded video.

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:

Click here to view the embedded video.

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.

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.

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.

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.

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.

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.

Gay and HIV advocates rallied at the state Capitol in Sacramento, Calif., on June 10 against draconian cuts in HIV funding proposed by Gov. Arnold Schwarzenegger and under consideration by the Legislature. Wockner News photo by Charlie Peer/Outword Magazine

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.