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Posts for February, 2016

PrEP has first failure

Timothy Kincaid

February 25th, 2016

There has always been the assumption that a person on pre-exposure prophylaxis could become infected with HIV if they had sexual contact with a person who had a large viral-load of a strain of HIV which was resistant to each of the drugs in Truvada. Now there is a documented case. (Poz)

Researchers have for the first time documented a case of an individual contracting HIV, a multi-drug resistant strain, while apparently adhering well to the daily regimen of Truvada (tenofovir/emtricitabine) as pre-exposure prophylaxis (PrEP). The scientists concluded that it is indeed possible for individuals who are adherent to PrEP to contract HIV when they are exposed to a virus that is resistant to both drugs included in Truvada.

While this case is concerning, experts in the PrEP field suggest that such failures of PrEP will likely remain rare.

There have been strains of HIV identified which are resistant to tenofovir and strains resistant to emtricitabine, but random sample testing has not, until now, identified any strain which was resistant to both. Such virus is very rare.

An HIV strain may become resistant to a medication if the person infected uses medication in a sporadic manner allowing the virus to combat low levels of the medication until mutations occur. This person had a virus which was resistant to several medications.

While this is only one case out of tens of thousands of PrEP users (each of whom is tested quarterly) highlights the importance of using PrEP as an added layer of protection, not as a magic bullet.

Italy Senate passes civil unions bill

Timothy Kincaid

February 25th, 2016

fireworks-rome

Italy has finally taken steps to join most of the rest of Western Europe in recognizing the validity of same-sex relationships. (AP)

Italy’s Senate voted Thursday to grant legal recognition to civil unions, as the last holdout in Western Europe took a compromise step to give some rights to gay couples after a bitter, years-long battle.

It passed 173-71, well over the threshold necessary.

In a nation heavily influenced by the Catholic Church, this has been a difficult process and is a break-through. The Catholic hierarchy has spoken in opposition to the bill and religious affiliation had caused a rift in the ruling Democratic Party.

Italian Prime Minister Matteo Renzi has been increasingly desperate to get a civil rights bill on the books. To ensure passage, he made the bill a conscience vote, one in which a failure to pass would result in his removal as head of government.

Even so, the bill was headed for defeat before it was amended to exclude an adoption provision which did not have the necessary support in the legislature. The bill originally allowed one partner to adopt the other partner’s natural children (couple adoption of non-biological children has very little support).

As the final product was not as anticipated, the bill is not being met with universal jubilation. It is, nevertheless, a significant and important step towards equal rights for gay Italians.

To become law, the bill must now pass the lower Chamber of Deputies.

Israel joins the PrEP revolution

Timothy Kincaid

February 23rd, 2016

Haaretz

The Israeli Health Ministry has for the first time approved pre-exposure prophylaxis that will help prevent HIV infection. The PrEP process, as it is called for short, involves taking drugs that substantially reduce the chances of contracting the immunodeficiency virus that causes the infection.

Specifically, the PrEp protocol calls for using the same drugs that are administered to carriers of the virus, and prevents its development in the bloodstream. Taking these precautions when one is HIV-negative effectively prevents possible infection.

Knott still thinks she’s above punishment

Timothy Kincaid

February 18th, 2016

knottLast September, a dozen or so good Catholic school alumni were out for a night of getting drunk and having a fine ol’ time when they decided that it would be awfully fun to gang up on a gay couple and beat them while screaming homophobic slurs. Having had their jollies, they left the couple bleeding on the sidewalk, and all set off to celebrate at a bar, big smiles on their faces.

But as this was 2015, security cameras abound and soon three of the assailants were in custody.

Two of them pled guilty, expressed remorse, and agreed to community service. But Kathryn Knott, a blond pretty daughter of a local police chief decided that she’d fight the charges. Surely a jury would take her word over that of a couple of, well, you know.

The jury listened to her character witnesses tell of what an angel Kathryn is, her dramatic “I’m sorry for what happened to you” to the victims, and her protestations that she was only there to break up the fight. They also heard and the testimony of the victims, witnesses who saw her swing punches, and her history of homophobic and other hate-filled tweets. In the end, they decided that not only was Kathryn Knott guilty, she’s also a horrible person.

Her counsel had argued that she shouldn’t receive punishment because people had already said mean things about her, and surely that’s punishment enough. But the judge was equally not a fan and on Monday, the 8th, gave her sentence. (6ABC)

Common Pleas Judge Roxanne Covington questioned how then-hospital worker Kathryn Knott walked away from the victims as one lay badly injured in September 2014.

She also ordered the 25-year-old Knott, whose online posts have insulted gays, non-English speakers, Middle Easterners and hospital patients alike, to get anger management treatment and stay out of Philadelphia during two years of probation.

“While these were homophobic slurs that started this incident, it could have been any type of hate speech,” said the judge, who said she herself might have been attacked walking with her girlfriend or sister. “It could have been anyone.”

She sentence Knott to 5 to 10 months in jail.

But, as we already know, Knott isn’t fond of being punished for her actions. And it’s just not fair.

The other two who admitted their guilt, expressed remorse, and negotiated their punishment received a lesser sentence. Surely Knott, being blond and pretty, should be able to have a do-over and now accept the same deal she had already rejected.

Or how about this, instead of going to jail, Knott could go on TV. There she could tell everyone that it’s a very bad thing to beat gay couples and leave them unconscious on the ground with a broken jaw.

How’s that? It could be two-fer. Not only would she not be in jail, but people might start to like her instead of say all those meany mean things about her. (Philly)

As an alternative to being locked up, attorney William Brennan suggested that 25-year-old Knott could perform a public-service announcement “where she could take the infamy of the arrest and maybe heal some wounds.”

But if Knott wanted to heal wounds, she could have done so right after she caused them, while her victims were laying there in front of her. And television celebrity is not punishment for inhumane and criminal behavior.

Justice Scalia found dead

Timothy Kincaid

February 13th, 2016

Antonin Scalia

The Supreme Court has been a body in political balance with three liberal justices, three conservative justices, and Justice Kennedy who, in the middle, often swung the majority. But there has been concern for some time that a few of the more liberal justices are aging and may soon wish to retire and, depending on the President at that time, this could shift the bench’s direction.

But I don’t think anyone expected this: (San Antonio Express)

Associate Justice Antonin Scalia was found dead of apparent natural causes Saturday on a luxury resort in West Texas, federal officials said.

A federal official who asked not to be named said there was no evidence of foul play and it appeared that Scalia died of natural causes.

Scalia was a constitutional originalist in that he held that the protections in the Constitution should be interpreted by the original teachings of the Roman Catholic Church. Or so it seemed to me.

A man never deterred by compassion or decency, Scalia was quick to denounce those of whom he disapproved in scathing tones. Among such were gays and lesbians who his judicial review never seemed to find in the inclusive language of the Constitution. For Scalia, “all men” came with an asterisk (*except the homosexuals).

He will not be missed by our community.

Happy Chinese New Year

Timothy Kincaid

February 8th, 2016

Year of Monkey

To celebrate the new year, I’ve included a poster designed by Lehu Zhang, a San Francisco based Chinese graphic designer. This year is the Year of the Monkey.

While I appreciate Zhang’s minimalist style, clearly we have different esthetics. I’m having trouble seeing the monkey.

Anyway, however, you celebrate, here’s wishing you a happy new year. I think I’m celebrating with kung pao chicken and hot and sour soup.

Greenland’s marriage equality finally passes last hurdle

Timothy Kincaid

February 5th, 2016

GreenlandIceberg

Last May I noted that Greenland’s legislature had passed marriage equality. At that time I believed that it was to take effect October 1, 2015. I was mistaken. It seems that some law in Denmark needed changing.

But all that is done now. (Perchy Bird)

Following unanimous approval in both the Greenlandic and Danish Parliaments, the same-sex marriage and adoption bill was given the ceremonial Royal Assent on Wednesday.

The island’s new Civil Code will become gender-neutral and couples will begin marrying the day the law comes into force on April 1st. Greenland’s Bishop had been looking forward to couples being allowed to marry in the local Church since the bill was first proposed in 2014.

Ex-Gay therapy moves to Israel

Timothy Kincaid

February 4th, 2016

The United States has become increasingly unwelcome towards organizations that purport to change sexual orientation or, as they often couch it, to increase masculinity and resolve unwanted homosexual attractions. Some states have banned such practices if directed towards youth.

Famously, Jewish ex-gay group JONAH (Jews offering New Alternatives to Healing) was ordered out of existence in December 2015. But it appears that they could find a much more welcoming attitude were they to set up shop in the Levant.

Israel is by a long long shot the most advanced nation in the Middle East when it comes to gay issues. But it also has a very strong religious community in which opposition to homosexuality is fierce.

An article in Philly.com does not take up JONAH, directly, but discusses how other ex-gay groups fare in Israel.

At least four men’s support groups meet weekly in Jerusalem, said Jerusalem psychotherapist Adam Jessel, who has worked with hundreds of people looking to overcome their homosexuality. Some Israeli organizations also promote therapy.

The U.S. group People Can Change runs a seminar in Israel, the U.S. and Europe called Journey Into Manhood, which it says helps men “resolve unwanted homosexual attractions.” About 50 men participated in a seminar last month at a confidential location in northern Israel.

My apologies to the people of Israel. At this point in history, we do seem to export our worst attributes around the world.

PrEP use 90% higher than last estimated

Timothy Kincaid

February 4th, 2016

truvadaLast month, AIDS Healthcare Foundation issued a smirking attack on the Centers for Disease Control, mocking the low number of people who are availing themselves of pre-exposure prophylaxis.

“…according to CDC only 21,000 people are on the drug in the United States. Any objective observer has to conclude that most patients don’t want to take Truvada and doctors are not recommending it.”

Although there are dozens of references to this estimate, I have not yet been able to find the source. However most appear to be in November 2015, and use language like “currently” to discuss the number of total participants.

But, irrespective of the exact date in which 21,000 was a valid estimate, it certainly is no longer so. The following is from Gilead’s Quarter Four 2015 conference call which took place on Tuesday:

Public health programs to prevent HIV transmission are also underway, including efforts to raise awareness about the use of Truvada for prep. Today more than 40,000 patients in the US are receiving Truvada for a preventative indication.

In other words, PrEP use is about 90% higher than when last reported/estimated.

I very much doubt that participation doubled in the last two months. Likely, the estimates were based on older data and were understated to begin with.

But I do think that this illustrates something that I’ve observed and which I’ve heard discussed; It appears to me that there is a very sharp upturn in people becoming aware of the benefits of PrEP and choosing to avail themselves of this added protection from HIV. There is a cultural upswell which has changed the issue from fear to hope.

There have been several pivotal moments in the fight against the HIV/AIDS pandemic. The identification of the virus in the 80’s allowed for the first wave of protection, condoms. The discovery of anti-retroviral treatment in the mid 90’s, with it’s every increasing fine-tuning made the fight one about the value of life, not about survival. As viral loads became undetectable, Treatment as Prevention (TasP) became the next wave of protection and transmission prevention.

I believe that PrEP is equally revolutionary. This is the third moment in the fight which we will look back upon as there being a before-PrEP and after-PrEP way of life. This is the first time in the lives of many gay men my age in which there is no longer a component of fear in every sexual encounter.

Good news from DC

Timothy Kincaid

February 3rd, 2016

Over the past several years, the city government of Washington, DC, has dedicated itself to a comprehensive and concerted effort to reduce the number of new infections of the human immunodeficiency virus (HIV). It appears that the effort is working. (Blade)

A preliminary version of the city’s annual HIV/AIDS Surveillance Report shows that newly reported HIV cases in D.C. during 2014 declined for the seventh consecutive year.

The report, which the D.C. Department of Health released on Tuesday, shows there were 396 new HIV cases in 2014, a 29 percent decrease from the 553 new cases reported in 2013.

Whitman-Walker Executive Director Don Blanchon said the declining number of new HIV infections in D.C. reflects the value of community wide testing, treatment on demand and prevention efforts that include pre-exposure prophylaxis or PrEP, which involves providing a daily “prevention pill” to people who are HIV negative.

“Simply put, it is saving peoples’ lives and reducing new infections,” he said. “Today’s update reaffirms that we are on the right path to getting to zero new infections in a given year.”

We appear to now be in possession of the tools that we need to end the HIV/AIDS pandemic. Combining testing with TasP (Treatment as Prevention) and PrEP (pre-exposure prophylaxis) and treating the virus as a public health matter instead of a behavioral matter are the steps that are working in the nation’s capital. As the social acceptance of PrEP increases (as it has tremendously in Los Angeles over the past year), we should expect to see even more improvement in the upcoming year.

Congratulations, Washington!

HSBC bank wants you to plan for your life together

Timothy Kincaid

February 1st, 2016

HSBC
We have reached the place where the benefit of being seen as supporting equality far outweighs any disgruntlement from social conservatives. Sure the handful of men who call themselves One Million Moms will likely protest, but everyone else – including those who think as they do – will either smile or shrug and go on with their lives.

Corporations, who spend big bucks on market research, know this well. Perhaps someone ought to let the GOP presidential candidates in on the secret.

(thanks to Ben for the tip)

Marriage in Mexico – update and Jalisco victory

Timothy Kincaid

January 26th, 2016

Map Mexico statesMexico’s same-sex marriage status is complicated.

Marriages occurring anywhere in the country are recognized throughout. So, since December 2009 when Mexico City legislators voted for marriage equality, same-sex couples could travel to the capital and have their relationship recognized upon their return.

However, other than in six states, locally conducted same-sex marriage is illegal. But these are not laws without a solution. A couple can go to court and request an amparo (a sort of civil rights ruling) which states that the law is unconstitutional and which would allow that couple (but only that couple) to marry.

The outcome is assured; the Supreme Court has established that all such efforts result in approval of the marriage. So any same-sex couple can marry in any state – though it takes a lawyer, about $1,000, and a month to go through the legal process.

Additionally, after five identical amparos have been granted in one state, precedent is set and that state then will recognize same-sex marriages without any need for additional amparos. So for about $5,000 per state (about $125,000 total) and less than a year, marriage equality could be universal across the nation. Considering that in the US the legal battle cost tens of millions of dollars, this is a bargain and activists are implementing a plan to grind through the ampero process.

Meanwhile states are individually chugging along towards equality, some through non-amparo means. Currently Mexico has six equality states (out of 31):

Quintana Roo (Cancun) – In December 2011, local officials realized that the law did not mention the gender of those seeking marriage and that there was no restriction on same-sex couples.

Coahuila – In September 2014, Coahuila became the first state to enact marriage equality by means of legislative vote.

Chihuahua (Juarez) – By mid 2013, the required five amparos had been issued. The state legislature did not act, and couples asked the Supreme Court to order the state to comply. So as to avoid such a ruling, in June 2015 the governor announced that the state would no longer enforce the unconstitutional law.

Guerrero (Acapulco) – also in June 2015, the governor of Guerrero announced that it would not enforce the marriage ban. This was proactive as the state had not processed five amparos. The governor has presented a bill to the state legislature to change the law.

Nayarit – In late December 2015, the legislature voted 26 to 1 in favor of marriage equality.

Jalisco (Guadalajara) – today. This one is a pinch more complicated. Whenever a state law is published in Mexico, opponents have 30 days to file an action of unconstitutionality with the federal courts. Jalisco had recently made an unrelated change in its marriage laws and had republished the marriage code. This opened a window in which activists could challenge the limitations as to gender. The Supreme Court heard the case and today ruled 11 to 0 that Jalisco’s ban on same-sex marriage is unconstitutional.

AHF exports opposition to PrEP to the UK

Timothy Kincaid

January 22nd, 2016

In the United Kingdom, PrEP is not yet available through the National Health Service, the nationally subsidized health care system. This means that those people choosing to protect themselves from potential HIV infection by use of pre-exposure prophylaxis must do so out-of-pocket.

The NHS is considering approval of Truvada for PrEP and the BBC ran a newsnight special about this consideration. Supporting making PrEP available was Dr Michael Brady from the Terrence Higgins Trust. And, as it appears that the only opponents to PrEP-based HIV prevention on the globe may be the AIDS Healthcare Foundation, speaking in keeping PrEP unavailable was Jed Kensley, senior director of the AIDS Healthcare Foundation.

Kensley presented absolutely no logic or justification for his position. He just stated it and then tried to talk about people using it contrary to the guidelines of the US FDA (which, as far as I know, does not dictate UK policy).

There is no reason for AHF to interfere in UK policy. Except to try and discourage any further acceptance of PrEP overseas which could, in turn, encourage use in the US.

And as much as AHF claims that it supports PrEP for those “who have multiple partners and never use condoms”, they went on BBC to support the NHS’ policy of providing PrEP to no one at all. Tis far better, in the minds of the directors of AHF, that those “who have multiple partners and never use condoms” in the UK continue at risk for seroconversion than that someone who uses condoms – well, most of the time – has the chance to protect themselves further.

The more I hear from AHF, the harder it is for me to believe that they want people to stay uninfected.

AHF files complaint against Gilead

Timothy Kincaid

January 21st, 2016

michaelEarlier this month, AIDS Healthcare Foundation and its president Michael Weinstein issued a press release accusing Gilead of creating a direct-to-consumer advertisement which encouraged situational PrEP use in violation of FDA guidelines.

As we illustrated, it was filled with falsehoods and insinuation and made claims that even at the most casual glance proved to be false.

Well now AHF has gone one step further. They’ve issued a letter of complaint against the maker of pre-exposure prophylaxis (PrEP).

On Thursday, AHF sent a letter to Dr. Stephen Ostroff, M.D., Acting Commissioner of the U.S. Food and Drug Administration (FDA), alerting him to the fact that Gilead financed a video ad campaign promoting situational use of its AIDS treatment, Truvada, for PrEP, misleading viewers into believing that Truvada is safe and effective for use on a situational basis, despite knowing that the drug is not FDA approved for such off-label use.

Box Turtle Bulletin, along with other sources, has debunked AHF’s claims. Frankly, it just wasn’t that hard.

So why does Weinstein and his organization continue a campaign of deception? I think there is a purpose behind the complaint.

As anyone who actually watched the video knows, it did not promote off-label use. And it wasn’t launched by Gilead. So that’s not the issue. AHF knows that their letter does not reveal any wrongdoing and I don’t think that’s their intent.

Rather I suspect that Weinstein is hoping that the theme of the video (“I like to party”) will frighten the FDA and will elicit a fear based response along the lines of “you can’t promote drug use!!!”

This isn’t about truthful marketing, it’s about punishing Gilead and hindering the advancement of Truvada as a tool against the spread of HIV. And if Weinstein can imply that Gilead tacitly supports the use of illicit drugs, that might be sufficient to push politicians to apply pressure.

So this is where Weinstein’s recommendations for punishing Gilead become interesting:

In contravention of statute and regulations, Gilead launched an ad campaign to mislead viewers into believing that Truvada is safe and effective for use on a situational basis despite knowing that the drug is not approved for such use. Consequently, the ad campaign constitutes impermissible off-label promotion, and we urge the FDA to take immediate action to (1) require Gilead to cease and desist all such off-label promotion; (2) require Gilead to publically [sic] correct the misinformation disseminated by the ad campaign; and (3) impose any sanctions permitted by law.

But Gilead hasn’t performed any off-label promotion which it can cease or desist. And sanctions would not hold up in any court. So what would this mean in practical terms?

A clue is found earlier in the press release:

Gilead, which we believe has been deliberately mounting an under-the-FDA-radar, guerilla-style marketing and media campaign for PrEP for the past three years by funding scores of community and AIDS groups across the nation to promote PrEP…”

AHF wants to put pressure on Gilead to cease funding other community and AIDS groups. Yes, it appears that Weinstein and AHF want to reduce the funds that community groups across the country use to fight transmission and treat those infected with HIV. That is unthinkable, but that is what they are asking.

And as despicable as this seems, it might not to be a novel attitude for AHF. They have been accused by many AIDS activists of a long pattern of seeking to diminish funding for other groups so as to funnel more funds, more program support, more connections, and more political power to AHF and Weinstein.

And as it is primarily community based HIV activists who are encouraging and driving the effort to get those persons at high risk for HIV transmission on the preventative drug regimen, these are the voices that Weinstein and AHF need most to silence in order for their campaign against PrEP-based HIV prevention to succeed. That these local activists are the front-line warriors in the fight against the HIV pandemic is immaterial, and the message seems clear: they must be taught that standing up against Weinstein and AHF comes with consequences.

I’m beginning to think that “vile” and “abhorrent” are adjectives that need a revival.

Mobile Alabama reopens marriage license window

Timothy Kincaid

January 8th, 2016

On Wednesday, following Alabama Chief Justice Roy Moore’s pronouncement that no marriage licenses can be issued to same-sex couples in the state, Mobile County stopped issuing marriage licenses altogether. Now they have resumed. (Fox6News)

The Mobile County Probate Court will re-open marriage license windows Friday morning, Mobile County Probate Judge Don Davis said in a statement.

Davis’ statement says, “In an abundance of caution, the Court wanted an opportunity to review the order, and to have legal counsel research the matter. The Court is now satisfied, on the advice of counsel, that the appropriate action is to open the window and resume issuance of marriage license.

Poor Alabama. It’s a sad state of affairs when the state’s judicial officers just ignore the instruction of the state’s Chief Justice.

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