The data, presented at CDC’s 2010 National STD Prevention Conference, finds that the rate of new HIV diagnoses among men who have sex with men (MSM) is more than 44 times that of other men and more than 40 times that of women.

That certainly sounds frightening. And it lends itself easily to anti-gay activist who argue that gay men and women do not deserve equal rights under the law because gay men are crawling with disease. (Iowa Independent)

Homosexual activity is “more dangerous for individuals who engage in it than is smoking,” and because of this, state lawmakers need to pass a constitutional amendment overturning last year’s Iowa Supreme Court decision legalizing same-sex marriage, according to Iowa Family Policy Center President Chuck Hurley.

Naturally, anti-gay activists like Hurley fail to distinguish between “individuals who engage in homosexual activity” and individuals who engage in unsafe sex. And, having only the vaguest of notions about those same-sex couples who marry, he leaps at a conclusion that is out of his reach.’

Unsafe sex significantly increases the odds of seroconverting. And considering that the CDC lumps all men who have sex with men (MSM) together regardless of their relationship status or sexual practices, single gay men who whoop it up sans condom with a stranger tonight have a FAR MORE than 44 times likelihood of becoming HIV positive than does a heterosexual dude that does the same. Which is one reason we should encourage relationships and responsible sex.

But setting aside the lunacy of opposing committed relationships so as to stop promiscuous behavior, let’s look at the numbers themselves. And let’s consider the responsibility of the CDC and those who use their statistics to report them in a way that is meaningful and useful rather than pointlessly frightening.

Yes, “44 times that of other men” is scary. But what does it mean?

For that we have to look at the following paragraphs.

The range was 522-989 cases of new HIV diagnoses per 100,000 MSM vs. 12 per 100,000 other men and 13 per 100,000 women.

The rate of primary and secondary syphilis among MSM is more than 46 times that of other men and more than 71 times that of women, the analysis says. The range was 91-173 cases per 100,000 MSM vs. 2 per 100,000 other men and 1 per 100,000 women.

Unpacking the medical language, this is what we find:

There were about 33,750 new cases of HIV infection in 2007. Assuming that gay/bi men make up about 4% of the population, this number is about three quarters of one percent (0.75%) of all gay/bi men.

For syphilis, the number is about 5,900 cases and an infection rate of about one tenth of one percent (0.13%).

Previous analysis suggests that about 12% of all gay/bi men are currently living with HIV. As syphilis is treatable, the total number of gay men living with syphilis is less easy to determine.

Further, if we wish to be credible, we have to recognize that the gay community is not homogeneous. HIV and syphilis infections impact certain demographics far more than others. Factors such as race, location, education, and self-worth can have almost as much a factor on one’s likelihood to contract HIV as sexual orientation.

Too often we can read alarming headlines and think, “why fight it, it’s inevitable.” This isn’t true. Most gay men don’t have HIV and never will. And while these frightening statistics can remind us to be careful, they should be taken in perspective.

When we hear “HIV diagnoses… 44 times that of other men” or “2000 times higher than repeat blood donors”, we have to remind ourselves to step back and take a better look at the numbers. We need to recall that the purpose of information of this sort is to fight the virus, not the people who are infected. And we need to understand that we each are individual and not a statistic.

It wasn’t until 1983 that the HIV virus was identified, and a method of testing for the virus wasn’t established for another two years.

In 2006, the AABB, America’s Blood Centers, and American Red Cross jointly asked the FDA to reconsider these rules. They argued that continuing the ban was not justified by scientific advances since the ban was implemented.

AABB, ABC and ARC believe that the current lifetime deferral for men who have had sex with other men is medically and scientifically unwarranted and recommend that deferral criteria be modified and made comparable with criteria for other groups at increased risk for sexual transmission of transfusion-transmitted infections. Presenting blood donors judged to be at risk of exposure via heterosexual routes are deferred for one year while men who have had sex with another man even once since 1977 are permanently deferred.

Current duplicate testing using NAT and serologic methods allow detection of HIV- infected donors between 10 and 21 days after exposure. Beyond this window period, there is no valid scientific reason to differentiate between individuals infected a few months or many years previously. The FDA-sanctioned Uniform Donor History Questionnaire was developed recognizing the importance of stimulating recall of recent events to maximize the identification of donors at risk for incident, that is, recent, infections. From the perspective of eliciting an appropriate risk history for exposure to HIV and other sexually transmitted infections, the critical period is the three weeks immediately preceding donation since false negative NAT and serology reflect these window-period infections, and the length of these window periods provide the scientific basis for the deferral periods imposed for at risk sexual behaviors.

The FDA refused.

They argue that as gay men have a higher concentration of HIV infection than some other demographics, this justifies a blanket ban on all donations by all gay men.

Men who have had sex with men since 1977 have an HIV prevalence (the total number of cases of a disease that are present in a population at a specific point in time) 60 times higher than the general population, 800 times higher than first time blood donors and 8000 times higher than repeat blood donors (American Red Cross). Even taking into account that 75% of HIV infected men who have sex with men already know they are HIV positive and would be unlikely to donate blood, the HIV prevalence in potential donors with history of male sex with males is 200 times higher than first time blood donors and 2000 times higher than repeat blood donors.

This week, Senator John Kerry, along with several other Senators, sent a letter to the FDA requesting that they reconsider their rules.

“Not a single piece of scientific evidence supports the ban,” the Democratic senator said in a statement. “A law that was once considered medically justified is today simply outdated and needs to end, just as last year we ended the travel ban against those with HIV.”

I doubt that this will be effective. If the FDA refuses to listen to those who know the very most about donation, testing, infection, and the blood supply, why would they listen to John Kerry?

But Kerry’s action does allow us as a nation to re-question why the ban is in place. Is it a matter of heath science or a matter of mistrusting (or disliking) gay men?

The FDA argues that any increased risk of tainting the supply is unacceptable. And that allowing gay men to contribute would unquestionably increase that risk.

But is that true? Does the ban effectively increase the safety of our blood supply? Or does it actually do harm?

To answer these questions, I think we need to look closer at the ban and how it functions.

1. The ban is only as effective as it is perceived to be reasonable. Remember, the ban is voluntary; by that, I mean that the only thing which stops donation is a questionnaire and the donor’s decision to answer honestly. If a gay man is determined to donate, he will only be persuaded not to donate if he believes that the criteria of exclusion is based on reason and not on bias.

2. We must assume that only a psychopath would choose to purposefully donate HIV infected blood. And no questionnaire is going to stop a psychopath. Therefore, this purpose of the questions is to eliminate those who are unknowingly infected.

But who donates blood? According to the Red Cross, only 3 out of 100 of Americans donate. And this 3% is not representative of the population as a whole.

Yes, blood donors come from all races, ages, political affiliations, and economic situations. But they have one thing in common, they are motivated by altruism or a belief that it is in the common good that they donate. They donate because it is the “right thing to do”.

And let’s be practical here for a moment. The type of person who donates blood is not generally the type of person who is irresponsible. If you are a ‘give blood’ type of gay man, you are probably also a ‘get tested’ type of gay man.

So the only unaware HIV-positive infected gay men who are likely to be prevented from donating are those who have good reason to believe (falsely) that they are HIV-negative. That’s not a very big demographic.

3. The FDA does not exclude other demographics who are infected at higher rates than the population at large. For example, over half of all new HIV infections detected in 2007 were in African Americans. While many of those infected are also MSM (men who have sex with men, a term used by the infectious disease community), many are heterosexual. Over 60% of women with AIDS are black. (AVERT)

The estimated lifetime risk of becoming infected with HIV is 1 in 16 for black males, and 1 in 30 for black females, a far higher risk than for white males (1 in 104) and white females (1 in 588).

There are many reasons for this (and for godsake let’s allocate more resources to stemming this trend) and I’m not trying to make comparisons or demonize anyone. But it does demonstrate that the FDA’s banning policies seem inconsistent.

The screening does seek to eliminate those women who might have had sex with a MSM or intravenous drug user in the recent past, but it does not issue a blanket ban based on race (nor should it). However, the “ever had sex at any time in your friggin’ life” definition effectively serves as a ban based on orientation.

So while the FDA does not say that the President of the United States is banned from blood donation based on his ethnicity, it does prohibit donation by Rep. Barney Frank.

4. Not all gay men are equally at risk. Homosexual activity does not create HIV. It is a virus, not a consequence of specific sexual acts. Only about 12% of gay men are infected with the HIV virus.

Yet the FDA treats my friends, a couple in their 40’s who met in high school and have been together ever since, the same as it does some gay man who is single and has an active and diverse sex life. Ironically (and amusingly) it considers ex-gays like Alan Chambers to be no less of a risk than the man whose fetish is to be the recipient in unprotected anal sex.

The FDA clumps gay men into a single demographic and assumes that all gay men are at a higher risk than all heterosexuals.

While statistics indicate a rising infection rate among young heterosexual women, their overall rate of HIV infection remains much lower than in men who have sex with other men.

But clumping in this manner is a foolish and rash policy. Contamination is more likely to come from a young single heterosexual woman who relies on the pill than it is from a gay man in a committed relationship who uses condoms regularly.

5. While the ban on gay men donating does not – in my opinion, as discussed in the points above – serve to diminish much risk of contaminating the blood supply with the HIV virus, it is quite effective at something else: labeling all gay people as dirty and diseased.

This universal ban says, in effect, that all gay men are suspect, a cause of concern, human rats carrying contagion. It feeds the myth that gay equals AIDS and lends credence to the anti-gay activists who market in fear and animus.

But is lifting the ban the answer?

I would argue that a full lifting of the ban is not a wise decision. That would increase – at least in some tiny measure – the risk of taint to the blood pool. Rather, I would advise to change the policy in a way that not only increases the blood supply and to reduces stigma but which also could serve an additional medical function.

Obviously the screening questions need to eliminate the risk of undetected recent infections. But such risks should be based on actual behavior based risk, not on stereotyping of communities. This may even serve to reduce the risk of accidental taint from gay men who ignore the current policy as being nothing more than bias.

Science-based periods of either long-term monogamy or sexual abstinence would likely be respected as reasonable and appropriate. Few gay men would argue that every gay man, regardless of sexual history or responsibility, should donate blood.

And revising the rules for donation to match the requests of the Red Cross would certainly be better than the current policy. But I recommend a different approach.

I recommend that all persons who have any risk of HIV transmission – be they gay men, single heterosexuals, or anyone else who could be at risk – be required to take an HIV test as a step in the donation process. Those persons who tested negative and who had no sexual contact for the previous six months (or whatever restrictions are reasonable) could be treated as acceptable donors. The oral swab tests are non-intrusive, give a response in 20 minutes, and are more than 99% accurate.

The current controls over the blood supply do an amazing job at detecting and removing infected blood. But implementing a screening method that is based on measurability rather than voluntary deferral would effectively eliminate unknown carriers, gay or otherwise.

And it would also reach a population of potentially at-risk citizens who might otherwise go undetected.

The single largest contributor to the spread of HIV is unknown infection. Granted, as I discussed above, those gay men who are most likely to donate blood are also among those most likely to be tested regularly. But HIV testing at a blood donation site could provide access and a safe friendly environment for non-gay people who might be a bit intimidated or uncomfortable asking their doctor or going to the testing center in the gay part of town.

The first study from the Netherlands followed 4612 newly diagnosed patients between 1998 and 2007. The study excluded those who start antiretroviral therapy (ART) less than six months after diagnosis or who already had an AIDS-defining illness in the first six months. The researchers then calculated the mortality rate of 0.67% a year:

This mortality rate enabled the researchers to compute life expectancies. For a patient diagnosed at the age of 25 the life expectancy came out at 52.7 years – in other words they would die, on average, at the age of 77.7. This was scarcely different to the life expectancy for 25 year olds in the general Dutch population – 53.1 years.

…Men and women diagnosed aged 25 could expect to live just five months less than HIV-negative people and men diagnosed at age 55 would live 1.3 years less (women 1.5 years less). For patients diagnosed with HIV (but not AIDS) symptoms the figure was two years shorter for men and women diagnosed at 25, and six and 7.5 years shorter for men and women respectively diagnosed at 55.

The second study was a much larger one of more than 80,000 patients from 30 European countries. This study didn’t just follow the newly-diagnosed, but all patients who had been on anti-retriviral therapy (ART) since 1998. It found that men who were not injecting drug users and who had a current CD4 count over 500 were no more likely to die during the follow-up period than their HIV-negative counterparts.

The key was maintaining a CD4 count of over 500 for at least three years. Over all, when those with lower CD4 counts were included, people with HIV had a 50% higher risk of death. But when injected drug users and people with CD4 counts lower than 500 were excluded, the mortality of people with HIV was virtually identical to those who were HIV-negative.

Although a Christian missionary group, their focus is more pragmatic than dogmatic. They deflect criticism about providing needle exchange or condoms to gay Africans and make no pretense that “abstinence only” is going to rid Africa of AIDS.

And they are not at all pleased with the proposed Ugandan Kill Gays bill. (Seattle Times)

World Vision, the Christian relief agency which has worked in Uganda since the mid-80s, said the legislation could undermine its work by stigmatizing people in communities it targets, according to Rudo Kwaramba, World Vision Uganda national director.

“Uganda is one of the first countries in which we started HIV education and prevention programs,” Kwaramba said in a statement. “One of World Vision ’s prevention models aims to reduce any stigma which may deter people from seeking to know their HIV status.”

Click here to see BTB’s complete coverage of the past year’s anti-gay developments in Uganda.

Reporter Zoe Alsop describes a talk that MP David Bahati, the prime sponsor of the anti-gay bill, gave before a cheering audience at Makerere University in Kampala (subscription required):

Before ceding the podium, Bahati had one last point to make. “This is not a Ugandan thing”, he said, his chest swelling with indignation. “Homosexuals are using foreign aid organisations to promote this. If an organisation is found to be promoting homosexuality, then their licence should be revoked.”

Shoulder to shoulder with Bahati’s supporters a half dozen or so Ugandans listened quietly. Several were doctors who had spent much of their careers toiling against a disease that has taken the lives of more than a million Ugandans. Their faces were stoic as they contemplated the implications of Bahati’s bill for the fight against HIV/AIDS not just among gay men but also among the wives and children of men who also have sex with men. They considered the long, lean years that had been spent quietly setting up networks to disburse information on HIV/AIDS to lesbian, gay, bisexual, transgender, and intersex Ugandans.

“As a doctor, the law infuriates me”, said one general practitioner, who is much sought after by sexual minorities for his willingness to treat them, and who asked that his name not be used for fear that he would be arrested for working with sexual minorities. “We are only now getting to a point where people understand there is a problem. This law is going to erase all of that.”

Zoe reports that in much of Africa, where AIDS is predominantly a heterosexual disease, many people including doctors believe that it’s impossible for gay people to become infected with HIV. Bahati’s proposed legislation, which would impose draconian penalties including death on anyone who is gay, would have a chilling effect on LGBT people seeking medical care from health authorities. And the bill’s provision requiring anyone who knows someone who is gay to report them to police within twenty-four hours would only serve to reinforce those fears among Uganda’s gay community.

All of that is only compounded by another provision of the proposed bill which punishes anyone who “promotes or in any way abets homosexuality and related practices” with seven years imprisonment. Medical doctors providing safe-sex information or who simply treats someone who’s gay can be seen as promoting or abetting “homosexuality and related practices.” These proposals have already had a chilling effect on HIV/AIDS workers:

In past years, Wamala says, Icebreakers (Icebreakers Uganda is an LGBT HIV/AIDS service organization) travelled around Kampala to meet with sexual minorities and sex workers. They offered counselling, condoms, lubricant, and medical referrals. This year, though, has been different. People seen attending meetings were blackmailed by neighbours, who threatened to report them to the police. “Nowadays, people are hiding”, Wamala said. “The blackmail and the arrests skyrocketed and we saw that it was not safe. At meetings we saw the number had really fallen, and even for those who came we were not sure whether we should be able to come the next time.”

Other groups say they have been able to work as long as their activities are carefully disguised. Thomas Muyunga, a doctor in the Most at Risk Populations Network, says he always makes sure that testing and counselling events include people who are heterosexual. “Originally we wanted to go to these people directly”, Muyunga said. “We realised that it was impossible. So the disguise is to address that. That’s why we have managed to even work today.”

Click here to see BTB’s complete coverage of recent anti-gay developments in Uganda.

“I’m holding my nose as I say this, but I miss George W. Bush,” said Gregg Gonsalves a long-time AIDS campaigner. “On AIDS, he really stepped up. He did a tremendous thing. Now, to have this happen under Obama is really depressing.”

The change in focus is being denied by Dr. Eric Goosby, the new global AIDS coordinator and chief of Pepfar, the man who also refused to consider whether the Ugandan “Kill Gays” bill should be considered when putting millions of taxpayer dollars under that country’s governmental control.

But the blame is being laid on perhaps a more powerful voice in the White House.

AIDS advocates complained bitterly that they had been betrayed and that the Bush administration’s best legacy was being gutted — and they blame a doctor and budget adviser who is also the brother of the White House chief of staff, Rahm Emanuel.

And, indeed, the new policy does seem to adopt some of the assertions of Dr. Ezekiel J. Emanuel.

Some advocates for overall global health — in contrast to those lobbying for AIDS — expressed regret but said the administration was being practical by shifting to buying goods that save more lives for less money, like water filters, oral rehydration packets and generic antibiotics, rather than putting adults on antiretroviral drugs at a cost of $35 to $2,000 a year.

That was the position advocated by Dr. Emanuel in a paper he published in The Journal of the American Medical Association in November 2008, just as Mr. Obama was being elected.

Entitled “U.S. Health Aid beyond Pepfar,” it argued that spending $48 billion more on the $15 billion program first proposed by Mr. Bush in 2003 was “not the best use of international health funding.”

Paying for “simple but more deadly diseases, such as respiratory and diarrheal illnesses, the U.S. government could save more lives — especially young lives — at substantially lower cost,” he wrote.

Although the Bush administration must be credited for introducing and funding a response to the international AIDS pandemic, it is not without criticism. Tied to the humanitarian aid was a lot of social manipulation designed to impose the morality and culture of American social conservatives onto foreign populaces.

Yet it is disappointing that the Obama administration’s plan is not taking clear steps to correct these problems.

It is nearly silent on several controversial issues: how much Pepfar will emphasize abstinence, whether and how it will get condoms to patients of the many missionary hospitals that refuse to issue them, whether it will support women’s health clinics that also do abortions, whether it will support giving clean needles or methadone to drug addicts, whether it will require groups working with prostitutes to oppose prostitution, and whether it will cut off countries that criminalize homosexual sex.

But we already have the administration’s answer on the last item.

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.