CDC: not enough doctors are prescribing PrEP
November 25th, 2015
As I have discussed in a series of articles, obtaining pre-exposure prophylaxis (PrEP) for HIV is not simply a matter of asking your physician. Depending on your health insurance, it may be extremely difficult to get a prescription for Truvada, the medication that with proper use prevents HIV infection. For example, for the 10 million residents of Los Angeles County, there is only one clinic that provides PrEP and accepts Blue Shield HMO coverage.
It would appear that this scarcity is not limited to Los Angeles, and this concerns the Centers for Disease Control. (http://www.cdc.gov/nchhstp/newsroom/2015/vital-signs-prep-press-release.html)
“PrEP isn’t reaching many people who could benefit from it, and many providers remain unaware of its promise,” said CDC Director Tom Frieden, M.D., M.P.H. “With about 40,000 HIV infections newly diagnosed each year in the U.S., we need to use all available prevention strategies.”
“PrEP has the potential to dramatically reduce new HIV infections in the nation,” says Jonathan Mermin, M.D., M.P.H, director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. “However, PrEP only works if patients know about it, have access to it, and take it as prescribed.”
The CDC is now recommending that about 25% of gay men take PrEP, based on a number of criteria. It has awarded about $216 million to organizations that are targeting at risk communities.
NYC aggressively attacks HIV using PrEP and PEP
November 25th, 2015
There are about 3,000 new diagnoses of HIV infection each year in New York City. And the City has decided that this is far too much. (Gay City News)
The plan, which was first proposed by leading AIDS groups in 2014, relies largely on using anti-HIV drugs in HIV-positive and HIV-negative people to reduce the number of new HIV infections in New York State from the current roughly 3,000 a year to 750 annually by 2020.
The tools are there. With pre-exposure and post-exposure prophylaxis, along with antiretroviral medication for HIV positive persons, the transmission of the virus is preventable. Even in the heat of the moment. Even if drugs or alcohol are impeding rational decision making. Even if a condom breaks.
Moving on the Plan to End AIDS, the City Council will spend $6.6 million to fund pre-exposure and post-exposure prophylaxis programs and efforts to aid people with HIV in staying on anti-HIV drugs so they remain non-infectious.
While $6.6 million is a large number, it is nearly negligible in the City’s budget. And if this allocation can cut HIV transmissions by three-quarters in five years, it is an investment that is well spent.
DeMaio’s accuser sentenced
November 23rd, 2015
In the final weeks of the 2014 election, the battle between incumbent Scott Peters (D) and gay challenger Carl DeMaio (R) was intense. DeMaio’s chances looked promising, until nasty accusations began to fly.
A story was leaked about a former staff member, Todd Bosnich, a straight man who was allegedly sexually assaulted by DeMaio. Although DeMaio denied any impropriety and insisted that Bosnich was fired for plagiarizing, local media seemed to buy into the ‘gay men are sexual predators’ stereotype, and their bias bled through in news reports.
In the last week of the campaign, Bosnich produced an email which he said had been sent to him anonymously but which he thought was from DeMaio. It made threats that Bosnich would never again work in politics and implied that DeMaio would buy his silence. This appeared to be the smoking gun that Peters’ camp needed. When Bosnich gave Peters’ campaign the email, they “took it to the police” (after a little trip to the local media).
It seemed proven now that DeMaio was a liar and a predator and he lost the election by 3% of the vote.
But while the email may have been the item that convinced the public that DeMaio was lying, it was also Bosnich’s error. This was a tangible item and, as such, had a traceable history.
Further, the threats implied in the email were sufficient for San Diego Police to turn the email over to the Federal Bureau of Investigation, which opened an investigation into the matter. Had DeMaio made threats of this nature, it could have been a serious issue.
Throughout the investigation, Bosnich insisted that he had received the email anonymously and that anonymous emails were a common means that DeMaio used to attack political threats. But when he was finally confronted with evidence, Bosnich admitted that the email was created by himself and sent to himself in order to give the appearance that DeMaio was threatening him.
Federal prosecutors brought Bosnich up on charges of obstruction of justice and he admitted his guilt. He has now been sentenced.
A former aide to Congressional candidate Carl DeMaio was sentenced to five years of probation Monday for using a phony email account to make it appear DeMaio or one of his associates threatened him.
While he avoided jail time, Todd Bosnich will also have to complete 240 hours community service, to take part in a mental health treatment program and to pay a $2,500 fine.
Bosnich will have this felony on his record for the rest of his life and will never again work in politics. DeMaio lost an election over false accusations. The voters were unduly influence and voted based on information that wasn’t true. Peters (who responded to the admission of fakery in the nastiest way possible) now has a tarnished reputation. And yet again, it has been proven that accusations against gay men are believed true until proven otherwise.
There are no winners here.
Sadly, I suspect this is a model that we will see used again against gay candidates. The stakes are high, and probation seems a low price for slandering a candidate enough to throw an election.
No, Syrian refugees are not a gay issue
November 23rd, 2015
It seems to me that sometimes gay activists confuse causes, assuming that their worldview is the only valid perspective that can be held by a gay person and thus that any cause they support is a gay cause. And those who disagree can be immediately and vehemently denounced as self-loathing homocons and quislings, worthy of derision and scorn.
But not all gay people have the same experiences, perspectives, or lifestyles. And competing interests or different values are not resolved by a shared sexual orientation.
We may see disputes over resource allocations or military action without demanding uniformity or laying charges of homophobia. But when it comes to social issues, there is often a presumption that all gay people must lean left and that failure to do so is betrayal of the gay community.
This is irrational. There is no logical basis for demanding conformity among the gay community on issues that do not have a direct or largely disproportionate impact on gay people.
Abortion is not a gay issue. Immigration is not a gay issue. Gun control is not a gay issue.
There are within each of these areas some arguments that speak to the community. Asylum based on sexual orientation, for example, is highly relevant and specific to the community. And as we get closer to identifying genetic markers for orientation, we may find ourselves facing difficult questions about abortion.
But, as a matter of belief and policy, there is nothing about orientation that dictates ideology. And gay=liberal is a false narrative that not only leads to disappointment for activists, but does a disservice to the roughly one-quarter of gay citizens who hold more conservative positions. (And I suspect that for some of the more vocal activists, the number of LGBT persons in disagreement soars to large majorities.)
To get around this fallacy, they propose another: that because some gay people are impacted by a policy, then therefore their response is the gay response and any other position is homophobia.
Because some immigrants are gay, we must support open borders. Because some gay people are coal miners, we must support a strike. Because some gay people are Palestinian, we must oppose the state of Israel.
What never is mentioned is that gay people are also on the other side of those issues.
Yes, some immigrants are gay, but so are some of the existing residents of nations. Some gay people are coal miners, and some are customers or in management. Some gay people are Palestinian, and some are Israeli.
Obviously, some gay people are impacted positively or negatively whichever way a policy goes and championing one position does not make it any more the gay position than championing its competitor. And it is dishonest to see gay people only on one side and not the other.
Further, we should understand that these efforts can serve as a disservice to our community. They are not steps to protect gay people or to advance our common cause. Rather they are an exploitation of our community, an effort to harness our connections or our political power and employ it for a cause that does not serve all gay people equally.
In the worst of instances, it’s cynicism and self-serving. Activists who can “deliver votes” from their community gain power, influence, and financial advantage. If an activist can turn out gay support, it may be far more advantageous to them personally than to the gay people they claim to represent.
But irrespective of motivation, activists employ it far too frequently. And the latest example, a rather extreme one, comes from Michelangelo Signorelli.
On Friday, the House of Representatives voted to slow the President’s plan of resettling in the United States 10,000 Syrian immigrants fleeing the regime of President Bashar Hafez al-Assad or life under ISIS.
The House vote on the Syrian resettlement program, passing 289-137, reflects shifting sentiment on an issue where emotions have run deep in the aftermath of a deadly terror in Paris last week which left 129 dead. The House bill would require the FBI to create a background check of any refugee who spent time in Syria or Iraq after March 1, 2011.
The measure also called for the heads of the FBI, Department of Homeland Security and National Intelligence to personally vouch that those admitted aren’t a threat, a requirement the White House in its earlier vow to veto the measure called “untenable.”
Among the 25% of House Democrats who voted for the bill were three members of LGBT Caucus: U.S. Reps. Sean Patrick Maloney (D-N.Y.), Jared Polis (D-Colo.) and Kyrsten Sinema (D-Ariz.)
In statements released, the lawmakers indicated differing levels of concern, but mostly took positions that were not in opposition to immigration but rather focused on the assurance provided by greater scrutiny.
“Our nation has long stood as a beacon of freedom, but after the events of the last few weeks some leaders have given into fear and turned their backs on refugees,” said Maloney in a statement he released after the vote. “These actions are reprehensible, and present a false choice between our values and our security. It’s understandable that people are scared, and Americans have a right to know that the process we use to screen refugees will keep us safe. I have faith in our system, and I don’t believe these refugees — the overwhelming majority of whom are women, elderly, and children — threaten our communities or national security. So instead of slowing the program or pausing it, the administration should agree to immediately certify refugees if they pass the current extensive screenings and we should all refocus on actual threats.”
But this response has been deemed entirely unacceptable by Michelangelo Signorelli.
Totally shameful and Victory Fund & Institute should dump them just as it doesn’t accept anti-choice, racist candidates even if they’re LGBT. Equality should be litmus test of anyone in “LGBT Equality Caucus” in Congress. And realize that these individuals voted against desperate LGBT Syrian refugees — there was hope 500 of the refugee spaces would be set aside for them. Congresswoman Kyrsten Sinema is the worst: She was actually an attorney for an Iraqi refugee in ’07, arguing that his vetting was taking too long, over 2 years, discriminated against based on his nationality. Now she votes this way. She’s a total fraud. We don’t need these people folks. Let’s get pro-LGBT, real progressives (on all the issues), gay or straight, in office.
To Signorelli, because “equality” means accepting 10,000 Syrian refugees into the country without personal assurances from the heads of the FBI and Homeland Security that each immigrant has been vetted, this is a gay issue. It’s a litmus test issue which Victory Fund should use to determine whether gay candidates receive support.
That is absurd.
The majority of Americans, perhaps as many as three-quarters, are skeptical about the government’s process of review when it comes to controlling access to the country. And this cannot be simply written off as religious bias – all polls show a vast majority of citizens think that any refugees accepted should not be given preference based on their religious faith, that Christians and Muslims should have the same access.
And among that large majority of Americans who are concerned about possible terrorists infiltrating the refugees are gay people. Real living breathing gay people. And some of them are Democrats and progressives.
But but but there are “desperate LGBT Syrian refugees” so this is a gay issue!
And Equality California has jumped on board.
“Last week’s vote was a victory for ignorance and fear. We are deeply disappointed that the list of ‘ayes’ included members of California’s congressional delegation, including members who have been champions of LGBT civil rights, and several LGBT members of Congress outside of California.
Among the millions of Syrians fleeing their country in fear for their lives are thousands of LGBT people, who face even harsher cruelties if they were to stay than the others, who are fleeing already unspeakable atrocities.
See, it’s a gay issue!!
No. The resettlement of Syrians fleeing the Assad regime or ISIS is not a gay issue. Even if some of the refugees are LGBT.
Though no doubt some here will disagree with me, I do not see this issue as a simple matter.
On the one hand it seems callous and selfish not to come to the aid of a fellow human in distress. On the other, our government has not shown itself to be singularly skilled in detecting and preventing threats. And some, including members of the LGBT Caucus, wish to help those in need but do not find it unreasonable to expect that each refugee be vetted so as to weed out someone who might shoot up a shopping mall or bomb a restaurant.
So how do we respond to those like Signorelli and EQCA who seek to co-opt the gay community for their position?
First, we should look at this in perspective.
At a dinner I attended last year, Equality California announced that would be shifting some of their focus from gay issues to more general progressive issues such as opposing barriers to immigration and seeking greater power for labor unions. Seen from that perspective, EQCA has narrowed their voice from a representative of gay Californians to speak only for the progressive segment of the gay community.
And Signorelli has clearly illustrated that his greater loyalty is “real progressives (on all the issues)” rather than to inclusion of gays and lesbians among the people’s representatives. As is his right.
Or yours. You have every right to think that only one position is reasonable or humane or just.
You just can’t claim that you speak for all gay people or even that gay people should agree with you because they are gay.
Victory Fund was correct in dismissing Signorelli’s demands. Their purpose is to support the campaigns of LGBT candidates for public office, not advance progressive policies. They are non-partisan and do not base their support criteria on how whether an individual office seeker is in complete agreement with Michelangelo Signorelli, or any other activist.
And policies around the resettlement of Syrian refugees are not a gay issue.
Getting PrEP: Step One
November 20th, 2015
After several weeks of effort, I was able to find a doctor within the Blue Shield HMO plan who prescribes Truvada as Pre-Exposure Prophylaxis, PrEP. The source of my primary care is now through APLA Health and Wellness at the Gleicher / Chen Health Center in Baldwin Hills.
This feels a bit ironic to me. For years I’ve sporadically supported AIDS Project Los Angeles. I’ve participated in the AIDS Walk from time to time and contributed to various programs but they weren’t particularly applicable to my life. They were just a “good organization” with whom I didn’t much interact.
Thursday evening was my first appointment. There was almost no one in the waiting room and the staff was more than pleasant. The employees seemed to be genuinely enjoying their work and their interaction with patients. The office, which is only a year old, was spotless, well lighted, and comfortable.
I didn’t see my doctor yesterday.
Before Truvada is prescribed, a series of tests needs to be run. There was blood work taken for two HIV tests (one which identifies more recent exposure), a liver test, as well as the usual lab work. Urine and swab samples were taken to indentify any sexually transmitted infections. And, of course, there were questions about recent sexual history and practices.
The nurse-practitioner was friendly, informative, and willing to answer questions. She was aware that some personal questions are uncomfortable and made the process feel professional rather than invasive.
We discussed the changes in care and protection over the years and the hopes for the future. Although we both celebrated the changes we’ve seen, she expressed concern about how a younger generation sees HIV like it sees diabetes, not terribly serious. A long time AIDS care provider and community advocate who has lost many friends to the disease, she’s disappointed that more people are not availing themselves of PrEP. I share that feeling.
But now I wait.
In two weeks I will return for my results and, if everything is proper, I’ll get my prescription and join the ranks of those who are proactively protecting themselves from the HIV virus.
Utah judge orders lesbian couple to give up child
November 11th, 2015
Direct to you from the 1990’s comes a 2015 judge’s idiotic ruling (Salt Lake Tribune)
A Carbon County judge has ordered a lesbian couple from Price to give up a child they have cared for as foster parents, declaring the infant would be better off with heterosexual parents.
April Hoagland and Beckie Peirce, who are legally married, told KUTV the order from 6th District Court Juvenile Judge Scott Johansen was issued Tuesday.
The Utah Division of Child and Family Services now has seven days to remove the child from Hoagland and Peirce’s Price home.
This ruling has roughly zero chance of withstanding appeal. And the Division of Child and Family Services is looking into appealing this judge’s decision.
As for his thinking,
An attorney who represents the child’s biological mother, whose parental rights are being terminated by the state, told KUTV that Johansen said his decision was based on research that found children reared in same-sex households do not fare was well as those raised in heterosexual households.
A copy of the order was not publicly available Wednesday, but a court spokeswoman did confirm its contents.
It will be interesting to find out whether that judge will provide his “sources” for his research. As there are no modern resources in the child advocacy world that support his conclusion, it will prove to be anti-gay religious advocacy on which he’s relying.
Not surprisingly, Judge Scott Johansen got his law degree from Brigham Young University, a private university owned by the Mormon Church.
Continuing the hunt for PrEP
November 10th, 2015
First I eliminated the doctor who practices in Santa Paula, 70 miles away in another county. That’s a bit too far to drive every three months during office hours and I certainly wouldn’t want a primary physician that far away.
Then I called the doctor who doesn’t do PrEP at all; he only does HIV testing. Which I do myself using OraQuick, the at-home testing kit.
Next was the doctor who does do PrEP, but not through my insurance. He only accepts patients with my insurance if they are already HIV positive.
Finally, I called the last number (the two remaining doctors practice together). I was transferred to a voice message of someone who I believe said that he is the PrEP coordinator for APLA.
So there is still some hope that this final contact will come through and I will finally have access to the program.
I heard back from the PrEP coordinator and it turns out that the doctor does take my insurance, administers PrEP, and is accepting new patients. He’s 6 miles away and only about a half-hour drive, so I’ve changed my primary care doctor and have an appointment for next week.
This has not been an easy process. But it has proven to be possible, something I was not sure about for a while.
The PrEP quest continues
November 7th, 2015
On Thursday I shared with you the surprising difficulty of finding a doctor within my health network that will prescribe pre-exposure prophylaxis (PrEP), a proactive approach to avoiding HIV infection.
Since then I’ve received help and suggestion from several sources, including in the comments here at BTB. Thank you.
I dropped by the new West Hollywood outpost of the Los Angeles LGBT Center and, though it was after hours, the young man at the desk sought to be helpful. I’m not sure that I was able to adequately explain that I needed to know whether they would honor my insurance or that I needed to find a primary care physician, but he did provide me with the main number of the Center.
I also had a response from a pharmacist who was able to recommend two sources: the LGBT Center, which he warns has a two month waiting list, and an HIV treatment center 25 miles away. Neither of these options seem ideal.
But yesterday I did hear back from Blue Shield. And they were able to provide me with a comprehensive list of all of the doctors in the network who offer PrEP service in the Los Angeles area. There are a grand total of five.
Now I need to see if any of them are willing to add a new patient.
The Mormon apostasies
November 6th, 2015
Apostasy is the act of rejecting one’s (former) religious beliefs and denying the teaching of one’s church. It’s not simply a matter of disagreement on issues, doubt about doctrine, or failing to apply specific teachings to one’s life.
A Catholic family can quietly go about utilizing contraception without being apostate. They can march in protest when their local Catholic School fires a gay teacher. They can question whether restriction on priests’ gender is based more in misogyny than in revelation. But if they reject the doctrine that the sacrifice of Jesus Christ provides redemption for sin, then they are denying the central tenet of the Catholic faith and are in apostasy.
Religions and denominations respond to apostasy with a wide array of reaction. Protestant Christians will probably do little more repeatedly tell you that they are praying that you get right with God. In some Muslim sects, they will stone you to death.
Mormons, whose communities are largely built on interconnecting family ties, may find that rejecting their faith comes with a high cost. Being viewed as apostate can leave one with little social or family network to rely on as exclusion from the daily activities of one’s religion is often the same as exclusion from one’s social and family circle.
For many denominations, apostasy is ill defined. Just how far one can go without becoming apostate is a bit nebulous across the vast diversity in religious belief.
But the Mormons make it very simple. And in their latest revision, they list the five things that one can do which are apostasy.
1. Repeatedly act in clear, open, and deliberate public opposition to the Church or its leaders.
Okay, that seems pretty standard.
2. Persist in teaching as Church doctrine information that is not Church doctrine after they have been corrected by their bishop or a higher authority.
Again, that makes sense.
3. Continue to follow the teachings of apostate sects (such as those that advocate plural marriage) after being corrected by their bishop or a higher authority.
Yeah, I suppose following apostate teachings makes you apostate.
We’ll skip #4 for a moment.
5. Formally join another Church and advocate its teachings.
Well now this is getting downright boring.
4. Are in a same-gender marriage.
Of all the possible things that one could do as a Mormon that flies in the face of church teaching, only one is so grievous as to be specifically and exclusively declared apostasy? And that one thing is gay marriage?
Oh silly Mormons. And you wonder why it is that the world around you thinks that you are a bunch of raging homophobes.
My quest for PrEP
November 5th, 2015
Today Larry Kramer, the grandfather of ACT-UP, released a scathing indictment of the current status of AIDS research. And though he was in parts incoherent (gonorrhea statistics don’t speak to AIDS research funding), his frustration has merit. Bureaucratic structures don’t lend themselves well to efficiency and as decades slip by with the oft-promised cure remaining just out of sight, it becomes easy to agree that the National Institutes of Health are “more interested in Alzheimer’s than AIDS and Congress is not interested in AIDS at all”.
Kramer is the king of rage. His anger has propelled a life-long fight against institutional power, even as Kramer has gained access to levels that most of us could never achieve. And though many of his demands over the years have been met, his bleak view has never been at loss for a target of his fury.
But, frankly, a life lived in outrage is exhausting. And my temperament doesn’t allow me to see the world through the prism of loss and lack.
Like Kramer, I lived through the years of fear and frustration in the 80’s and 90’s and have lost friends to AIDS, though likely not on the same scale. And I too have seen Very Exciting Breakthroughs For A Cure that turned out to be anomalies and overblown wishes. I now approach each new cure-around-the-corner claim with the skepticism of the man who discovers that he did not, after all, buy the Brooklyn Bridge.
But I have experienced the arc of the epidemic. I recall when nothing was known about Gay-Related Immune Deficiency (as it was first called) and then when the Human Immunodeficiency Virus was identified. I know the growing panic during the two-week response period. I remember the breakthrough of the mid-90’s when the “drug cocktail” of antiretroviral treatment caused the death rate to plummet. And since then I’ve watched a plodding but steady progression towards management and sustainability and prevention.
There has been amazing progress.
Yes, HIV continues to impede the full potential of lives. Even in the best of cases, it brings a tedious drug regimen, social stigma, and the fear of unknown possible side effects.
But unlike Kramer, I just can’t see the glass as half full and draining rapidly. Irrespective of whether the NIH appoints a new head of the Office of AIDS Research in a timely manner, I still see the glass as three quarters full with a steady drip increasing the level.
And one of the more recent developments that has given me hope that the viral endemic can finally be beaten has been the two pronged approach of undetectability and insusceptibility.
For most (but not all) HIV infected persons, current drug treatments reduce the level of virus in the body to such a point that it cannot be detected. And the practical reality is (though officials are hesitant to stake this claim) those with undetectable levels of HIV are not transmitting the virus to others.
And more recently, within the past couple of years, it has become evident that pre-exposure prophylaxis (PrEP) in the form of a daily dose of Truvada can cause an HIV negative person to be virtually immune from contracting the virus. By virtually immune, I mean percentages in the high 90’s, a better success rate than condoms. Though anecdotes do not speak definitively, at this point the collective street-knowledge of PrEP is nothing short of astonishing. As a small example, an acquaintance of mine who is seriously dedicated to condomless receptive anal sex and who was one of the early participants in PrEP tested negative again yesterday after a couple years of regular “unsafe” sexual practice.
In combination, these two therapies may not be the cure that Larry Kramer and the rest of us hope for, but if correctly targeted and implemented, we could see HIV in America go the way of tuberculosis in a generation.
Of course, that requires thoughtful and committed leadership. And I do have skepticism about the commitment of government to properly design or implement such a plan.
I suppose it’s possible that a driven and charismatic leader will be appointed to the Office of AIDS Research who will throw political expediency out the window and press towards targeting the communities that most need regular and thorough testing and who is willing to buck powerful elements of the AIDS industry who have a vested interest in opposing PrEP. I suppose someone could don a cape and come to our rescue.
But the history of the AID epidemic suggests otherwise. For the most part, power and government have impeded rather than advanced response. It has been mostly gay men, and their allies (let’s never forget how lesbians stepped up to a crisis to which they are least directly threatened) who have been on the forefront of knowledge and power, who played personal guinea pig, who recrafted the social acceptability of practices within their own community, and who fought in the streets for the right to take drugs that would save their lives.
So I suspect it will be up to the gay community to create a culture in which all of those who HIV positive are tested and place on appropriate medication (and fight for the funding to make this a reality) and all those who are sexually active outside of a monogamous relationship and who are negative go on PrEP (a likely tougher funding fight). We will have to be the ones who make “Truvada whore” a badge of responsibility and sexual freedom.
Yes, we will need to be conscious of possible side-effects and aware that all drugs impact different bodies differently. But – at least so far – it appears that until a cure for AIDS is discovered, PrEP is a promising approach to personal protection and community health.
So it’s time to do my part. It’s time for me to join the Truvada whores, time to take PrEP.
Over the past months, several of my friends have gone to their doctors and signed up. They are all happy with this choice and found it to be a painless process. I’m not so lucky.
My employer provides me with health insurance through Blue Shield of California (for which I am appreciative). My plan is an HMO and though that is more limiting than a PPO, it hasn’t really impacted me much. Until now, I have no complaints. Or, not many.
When the plan was implemented, Blue Shield assigned me to a primary care physician based on location. And as I live near Koreatown, my doctor operates out of an office which caters primarily to older Koreans.
I’m not Korean, but the diplomas were from reputable schools and as my medical history is not complex, I figured that any doctor can provide basic care and I had no reason to change. And, frankly, it felt a bit prejudiced to discount a doctor’s ability to treat me simply because I’m not in his target demographic.
And for the most part, all has been fine.
Yes, there was the time he pressured me to become vegetarian (ummmm, no!). And, as I discovered in the waiting room, I’m not a big fan of Korean soap operas. But he was attentive and personable and I just don’t see a doctor that much.
On my last visit, I told my doctor that I was interested in PrEP. He had no idea what I was talking about so I asked him to look into the subject so that we could pursue that direction. He said nothing.
Finally, having waited for months without a response, I called my doctor’s office and explained to the receptionist that I’d like to see the doctor and would like to discuss PrEP with him and could he please be ready for this. She said she’d ask the doctor.
The receptionist called me back. And said I should find another doctor. One that deals with HIV. Because my primary care physician wouldn’t want to give inadequate care.
It’s probably only my imagination that heard “go away, go away, don’t touch me”.
But fair enough. I’m certain that his knowledge of his community allows him to be aware of cultural particularities which give him greater insight into the care of his specific demographic. And I probably would be better served by finding a doctor who is familiar with the trends in the lives of gay men and specific medical issues of which to be aware.
Besides, I live in Los Angeles. There are more than 25,000 doctors in this county. How hard can it be to find one that specializes in gay health (or “men’s health” as it is sometime euphemistically called)?
As it turns out, it’s not so easy.
My insurer’s website easily allows you to search for another primary care physician. You can search by gender, language spoken, medical specialty, or name. You can even put in other search terms. But gay and LGBT had zero results.
So I turned to Yelp. Here, results were more promising. Several reviews discussed whether the doctors were welcoming of gay men and women. Some even discussed PrEP. Best of all, Yelp’s ad generator gave me the names of medical groups who specialize not just on gay men but on getting them onto PrEP. Yay!
Back to the website I went. The most prominent men’s health group didn’t show up. But fine, another did. So I submitted my change request and waited.
So back to the website I went and sure enough, my primary health group is still the Korean group.
This time I didn’t rely on the doctor’s name showing up in the grid to mean that I could select that doctor. I called or emailed the doctors instead. And it turns out that none of them accept Blue Shield HMO. Zero success.
Back to online searching. Viola, there are handy guides to tell one just who does administer PrEP in LA County. But sadly, they seem to either be upscale and take PPO or other high end insurance plans or else they cater to those less fortunate and take Medicare. For someone who has (what I’ve assumed to be) a perfectly fine but no frills plan, there seems to be nothing.
In desperation, last night I called Blue Shield. And the lovely young women who handled my call agreed to search their database for doctors in LA who take my insurance plan and who specialize in PrEP (who knew it had to be a specialty?). After 20 minutes holding, she came back to tell me that she had no success. But she promised to keep trying and to call doctors until she found me one.
However, I’m not over-confident of hearing back. Because when I suggested that she broaden her search to include gay health or men’s health she became flustered and confused. I’m guessing that in whatever culture she live, one doesn’t say the words “I’m a gay man” out loud.
But I’m not giving up. I do have some leads.
One of the doctor’s offices – one that doesn’t take my plan – generously came up with some names of others who might be able to direct me. And the local LBGT center is a resource that I can approach. Word is that they’ve opened a new outreach office in West Hollywood whose sole purpose is to get gay men on PrEP and I’m hopeful that they might be able to help.
I am confident that eventually I’ll find a doctor that takes my insurance plan who is willing to provide this regimen. I live in a city that is, for the most part, inclusive and welcoming of gay people. I have many many options and opportunities.
But I cannot imagine trying to go through this process in a red state. Or in rural California. Or in a city without an established gay community.
So maybe Larry Kramer has a point. PrEP should be available to every gay man – or every other person in a high risk demographic – through every doctor in the country, not just the handful who “specialize” in gay health. We would not find it acceptable if this level of difficulty were faced by those who sought preventative measures for anything else? Why is it acceptable that doctors can turn away patients simply because they “don’t deal with HIV issues”?
Maybe Kramer’s right. Maybe it is time for a little rage.
The last we hear about Andrew Shirvell (I hope)
November 2nd, 2015
It’s been more than five years now since Andrew Shirvell began to entertain us. Combining prissy manners with rants about “radical homosexual agendas” and a personal obsession with University of Michigan Student Body President Chris Armstrong, Shirvell seemed more like a character from Saturday Night Live than an assistant attorney general.
We watched as his boss, Attorney General Mike Cox, first defended him and then gave him leave before booting his butt out the door.
And then there was the lawsuit in which Armstrong accused Shirvell of defamation. In a glorious moment of legal comedy, Shirvell served as his own attorney, questioning himself and giving himself answers under oath, before admitting that he hadn’t bothered any other gay activists or school administrators and had, instead, obsessed on Armstrong.
We watched his sad attempts at countersuing Armstrong and Armstrong’s lawyer. Both were tossed.
He had a moment of happiness when a court ruled that he was entitled to unemployment payments. But then an appeals court decided that being batpoop crazy and cyberstalking citizens from government computers was a legitimate cause for being fired.
Then the jury awarded Armstrong 4.5 million dollars, which a generous appeals court cut down to 3.5 million.
And now comes, I believe, the final chapter of Andrew Shirvell’s public life. (Detroit Free Press)
The Supreme Court has rejected an appeal from a former lawyer for the state of Michigan who lost a defamation lawsuit filed by a gay student at the University of Michigan.
The justices on Monday let stand a lower court ruling that upheld a $3.5 million jury award to Chris Armstrong, a former student government president.
I don’t know what Shirvell is doing these days. I doubt that it’s practicing law, as he has shown a remarkable inability to understand either its application or administration. But who knows.
All I hope for him is that he resolves whatever it is that compelled him to lurk outside Armstrong’s home, read his Facebook posts, and follow him around. And I hope that this closes the final chapter in Andrew Shirvell’s public humiliation.
Church of Norway bishops unanimously support same-sex marriage
November 2nd, 2015
Nevertheless, baptism, confirmation, marriage and burial in Norway all have strong religious associations. And for that there is the Church of Norway, an Evangelical Lutheran body that was, until 2012, the state church.
About three quarters of Norway’s population is on the Church of Norway’s roster, mostly due to automatic enrollment of any child who has a parent in the church. And roughly two-thirds of infants in Norway are confirmed in the church. So this body may not be particularly representative of the people, but it is relevant to them.
In 2014, the church’s synod rejected a liturgy for same-sex marriage. This was not received well by the Norwegian people, the vast majority of which support gay marriage.
At that time, the bishops were split, with some opposing the practice. Now they have unified in policy if not in theology. (yahoo)
Church of Norway bishops said Friday that they were unanimously in favour of allowing gay couples to marry in religious ceremonies, a hot-button issue to be decided on next year.
After a meeting lasting several days, the 12 bishops called for the synod — the church’s governing body — to adopt new rules allowing the same rights to apply to both heterosexual and homosexual couples when it comes to marriage in the church.
The new policy would allow individual pastors to opt out of performing same-sex marriages. The synod vote will be in April 2016.
Paul Ryan elected speaker
October 29th, 2015
As expected, the representative from Wisconsin’s 1st Congressional District, Paul Ryan, has been elected as Speaker of the House of Representatives. But although most of the Republican Party rallied around Ryan, some holdouts from the tea party fringe withheld their support. (USA Today)
He received 236 of the 432 votes cast. Minority Leader Nancy Pelosi, D-Calif., received 184. Rep. Daniel Webster, R-Fla., got 9 votes. A handful of other people got a total of three votes.
I think that perhaps the factious nature of Webster and the other tea party extremists may result in Ryan feeling that he owes less loyalty to their agenda. And that is a good thing for our community and the nation.
Paul Ryan likely next Speaker
October 22nd, 2015
Paul Ryan has said that he will take up the job of Speaker of the House and is expected to win handily in next week’s vote. So yay! Because Paul Ryan is “the homosexual lobby’s trojan horse”. Just ask Eugene Delgaudio.
Well, no, he isn’t of course. Paul Ryan is not an ally of our community and has a string of anti-gay votes to prove it.
But Ryan also has shown support on a few specific issues. For example, he voted for the Employment Non-Discrimination Act in 2007 and in 2013 indicated his tentative support. While he might or might not favor a specific bill as drafted, he has said that “someone should not be fired because of their sexual orientation”.
This is important as we go into debates over religious rights. Some on the right see “religious rights” as a vehicle by which to codify discrimination against gay people. And it seems unlikely that Ryan will champion legislation that targets gay people for denial of basic rights.
Additionally, Ryan has changed on issues relating to gay couples. In 1999, as a new Congressman, Ryan voted to ban adoption by gay couples in Washington DC. However, in 2013 he told a group of constituents that he has long since changed his mind and now believes that gay people can provide children with a loving home.
This does not suggest that Ryan will be championing our rights or fighting for our causes. But it does suggest that he does not hold significant animus towards gay individuals, sees gay people as a part of the Nation’s fabric, and recognizes that gay relationships have value. I don’t anticipate that Ryan will be significantly different from John Boehner on gay issues.
So I’m a bit relieved that the choice now clearly seems to be Paul Ryan. We certainly could have worse.
Italy edges towards equality
October 21st, 2015
Italy is the only nation in Western Europe that does not offer some form of recognition for same-sex couples. However, that appears to be about to change. (thelocal.it)
Italy’s parliament began debating a civil union bill for gay couples on Wednesday, kicking off a hotly-awaited rights battle championed by Premier Matteo Renzi but expected to drag on for months.
While attempts by previous administrations to change the law have been thwarted by parties with deep ties to the powerful Catholic Church, this time the majority of opposition parties have said they support the bill.
The bill has significant popular support and changes in the tone of language from the Holy See suggest that opposition from the Church and her faithful will be less vehement than in the past.