Box Turtle Bulletin

Pennsylvania School Turns Away HIV-Positive Student

Honestly, I had to look at the calendar to make sure it wasn’t still 1985 when I saw this one:

The Milton Hershey School was founded by the chocolate tycoon as a school that “nurtures and educates children in social and financial need to lead fulfilling and productive lives.” But it seems that fulfillment won’t be coming for a 13-year-old honor student from Delaware County who is infected with the virus that causes AIDS. “I feel no other teenager should go through this, being denied just because they have HIV,” the boy said in an exclusive interview with NBC Philadelphia’s Denise Nakano.

He is suing the school in U.S. Federal District Court, alleging that the Hershey School is in violation of “multiple anti-discrimination laws.” The school has, in effect, admitted as such in a particularly ignorant fashion:

Milton Hershey School released a statement Wednesday saying in part that “in order to protect our children in this unique environment, we cannot accommodate the needs of students with chronic communicable diseases that pose a direct threat to the health and safety of others.”

Except he doesn’t pose a direct threat to the health and safety of others. He’s not a walking HIV virus, eager to infect everyone he comes in contact with.

“Over 28 times more likely to get anal cancer”

When traveling this year, consider the following:

• The second largest weather killer in the United States is a lightning strike.
• You are over 100 times more likely to be hit by lightning in Florida than California.

Makes ya think, doesn’t it? Perhaps vacation should be at Disneyland rather than Disney World.

But would it help you put things in perspective if you knew that the odds of getting struck by lightning in the US are about 1 in 500,000 and that only 40 to 50 people per year are killed here by a lightning strike? When you know the facts, then all of the above ceases to give you concern and instead you feel manipulated.

Keeping that in mind, look at the following condom awareness psa being aired by New York City:

When you get HIV, it’s never just HIV. You’re at a higher risk to get dozens of diseases, even if you take medications. Like osteoporosis, a disease that dissolves your bones; and dementia, a condition that causes permanent memory loss; and you’re over 28 times more likely to get anal cancer. It’s never just HIV. Stay HIV free. Always use a condom.

Scary!!

But is it true? And, as importantly, is it in perspective?

Osteoporosis is directly related to bone mineral density (BMD) and it is the measurement of BMD that is used to identify and – more or less – define who has or does not have osteoporosis and likely future fractures. And it is, indeed, true that HIV positive persons have higher rates of both osteoporosis and osteopenia (a similar but less sever condition). The reasons are, at present, undetermined.

So, yes it is fair and accurate to warn that HIV can, on average, increase one’s likelihood of osteoporosis (as can being a short white woman). And this condition is common enough that an increase in incidence is material and worthy of discussion.

But it’s not quite all of the story. The handsome young man whose bones were dissolving before our eyes is rather unlikely to have osteoporosis for decades, if ever. Osteoporosis (which primarily effects those over 50) is fairly easy to both treat and forestall, so this young man may need to take extra precautions (e.g. adequate calcium and vitamin D) but he is not going to wake up one morning and find that his skeleton has dissolved to soup.

Dementia is more common in people with HIV than without. Indeed, before HAART, dementia was a common consequence of HIV infection and was often the first qualification for an AIDS diagnosis. Currently it is less common, but still a major concern, especially as HIV infected persons age. (caregiver.org)

Before the arrival of highly active anti-retroviral therapy (HAART) in the second half of the 1990s, estimates of the percentage of people with AIDS who would develop HAD ranged as high as two-thirds. Many specialists, however, believed that the true figure was closer to 20 to 30 percent. More recently, experts have estimated that less than 10 percent of people on HAART develop HAD. However, because people with HIV are living longer than ever before, a greater number could ultimately develop the disorder, perhaps in its milder forms.

So far, I don’t necessarily quibble with accuracy of the psa, though the imagery suggests that these possible consequences are likely to be onset in early life, a false implication. But now let’s turn to one of my pet peeves, the ooky-spooky (and mostly bogus) anal cancer scare.

Yes, anal cancer exists. And yes it has higher rates in gay men than straight and even higher in HIV positive men. But the inclusion of anal cancer as a “higher risk” and the “28 times more likely” language tells me that this psa has no credibility whatsoever. It is not designed to inform, but to frighten.

The anal cancer scare is a favorite tactic of anti-gay activists. And it is irresponsible and immoral behavior when they seek to demonize gay men by claims that “”homosexuality is by its very nature dangerous to those who practice it.” It is no less irresponsible and immoral to use this scare tactic in the advance of a noble cause like encouraging condom use.

Anal cancer is very rare. In the US, about 5,260 people per year get this disease, of which about 40% are men (so, as you can see, women are 50% more likely to get anal cancer. Beware!!). About 720 patients die. Anal cancer is highly associated with HPV infection (though the vast majority of those infected with the HPV virus never develop anal cancer) and a vaccine is available which eliminates this risk factor.

Gay men, who are more likely to have become infected with HPV in their anus than are heterosexuals, experience anal cancer incidence of about 35 in 100,000. HIV infected persons, as are other persons with a suppressed immune system, are more likely to develop this cancer, but we still are talking tiny tiny numbers, maybe around one tenth of one percent.

Yes, HIV seroconversion is a life-changing experience. While most HIV positive people live relatively the same life as HIV negative people, there are more risks, rules, and precautions. Drug regimens must be adhered to, lifestyle choices have to be made, and health complications of some sort are almost unavoidable.

There are, indeed, many many good reasons to avoid infection with HIV. But fear of anal cancer is not one of them.

I support the dissemination of information that clarifies and warns about avoidable health risks. But I do not support bogus fear tactics that seek to deceive and manipulate, even if the goal is admirable. And this psa is one of the most deceptive manipulation tactics that I’ve seen.

And we cannot blithely suggest that the end justifies the means, when there are real victims of this false impression of HIV. This psa stigmatizes HIV positive persons in ways that are unnecessary and cruel. Viewers leave with the impression that HIV positive persons are about to fall over dead or go stark-raving mad.

And, in the mind of many, the ails of HIV positive people reflect on gay people as a whole. Psa’s that warn of dementia or anal cancer in HIV infected persons translate to many viewers that gay people are diseased and insane. We all, HIV positive and HIV negative alike suffer the consequences of such presentation.

And, besides, they are wrong. Yes, most people with the virus will also have other issues that result. But it is not true that “It’s never just HIV.” For some few, an HIV infection will not result in any medical consequences. I can’t say exactly how many, but it may be more than those who get anal cancer.

GLAAD and Gay Men’s Health Crisis have joined forces to ask the city to pull the ad. I wholeheartedly agree.

News Report: Uganda Parliament Proposes Death Penalty in New HIV/AIDS Bill

Update 5/20: Warren Throckmorton was able to obtain a copy of the proposed legislation. It appears that the news report below is in error. There is no death penalty provision. There are, however several other problems with the bill, which I will investigate further when I get a chance to do so. One of the first things I noticed however is that this provision criminalizing intentional transmission of HIV is remarkably different from the similar provision in the Anti-Homosexuality Bill. Whether you agree with the intent to of the HIV/AIDS Prevention and Control Bill or not, it is instructive that there is at least an attempt to define intentional transmission, an attempt that is entirely missing from the Anti-Homosexuality Bill.

Please feel free to look over the bill and add your own observations in the comments.

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This looks uncomfortably familiar to those of us who have been following the Anti-Homosexuality Bill. Details are sketchy:

The long awaited HIV/AIDS control bill has been tabled in Parliament for the first reading today morning.

The bill seeks to penalize deliberate spread of HIV/AIDS, with death as the maximum punishment.

This bill however has been widely criticized by the International community as it is likely to increase stigma against people living with HIV/AIDS.

The chairperson of the comiittee (sic), Beatrice Rwakimari tabled the bill including the certificate of financial implications.

The Speaker of Uganda Parliament, Edward Kiwanuka Ssekandi referred the bill to the Social Services committee for scrutiny.

This provision appears similar to one of the death-penalty clauses in the Anti-Homosexuality Bill. That portion of the bill reads as follows:

3. Aggravated homosexuality.
(1) A person commits the offense of aggravated homosexuality where the

(a) person against whom the offence is committed is below the age of 18 years;

(b) offender is a person living with HIV;

(c) offender is a parent or guardian of the person against whom the offence is committed;

(d) offender is a person in authority over the person against whom the offence is committed;

(e) victim of the offence is a person with disability;

(f) offender is a serial offender, or

(g) offender applies, administers or causes to be used by any man or woman any drug, matter or thing with intent to stupefy overpower him or her so as to there by  enable any person to have unlawful carnal connection with any person of the same sex,

(2) A person who commits the offence of aggravated homosexuality shall be liable on conviction to suffer death.

(3) Where a person is charged with the offence under this section, that person shall undergo a medical examination to ascertain his or her HIV status.

Clause 3. (1) (b) was often cited to support the claim that the Anti-Homosexuality Bill would impose the death penalty for the “deliberate” spread of HIV, but it is important to note that the bill contains no requirement that the intent be deliberate at all. In fact, the third subclause would suggest that the death penalty would apply upon receiving a positive serostatus result from an HIV test, which might very well be the first time the charged individual would know he or she was HIV-positive. Alternately, if the accused already knew he was HIV-positive, the proposed bill provides no acknowledgment that the accused’s partner may have known about it and entered into a consensual relationship.

Health care professionals worry that the effect of the entire provision would be to discourage people from learning their HIV status.

A few weeks ago, the Monitor, Uganda’s largest independent newspaper, reported that a Cabinet subcommittee tasked to examine the Anti-Homosexuality Bill recommended that portions of the bill be passed as amendments to other pieces of legislation. Until now, speculation mainly centered around Clause 13 of the bill which would criminalize the “promotion” of homosexuality, which the subcommittee decided should be passed. It is unclear what recommendations the subcommittee offered with regard to the death penalty for people with HIV.

We currently don’t have the text of the new proposed legislation but are seeking it from anyone who may have access to it.

Update: Human Rights Watch reacts:

“The bill contains measures that have been proven ineffective against the AIDS epidemic and that violate the rights of people living with HIV,” said Joe Amon, Health and Human Rights director at Human Rights Watch. “The HIV epidemic in Uganda is getting worse, and this bill is another example of misguided, ideological approaches and lack of leadership.”

The bill as currently written codifies discredited approaches to the AIDS epidemic and contains dangerously vague criminal provisions. Contrary to international best practices, the bill would criminalize HIV transmission and behavior that might result in transmission by those who know their HIV status.

The bill would discourage voluntary HIV testing, while making testing mandatory for pregnant women, their partners, suspected perpetrators and victims of sexual offenses, drug users, and prostitutes, in violation of fundamental principles of consent. The bill also allows medical practitioners to disclose a patient’s HIV status to others, breaching confidentiality standards. These provisions could potentially endanger those who are infected by exposing them to stigma, discrimination, and physical violence.

HRW’s statement doesn’t mention any death penalty provision in the earlier drafts of the bill.

Indonesian Province Proposes Chipping People With AIDS

William F. Buckly famously wrote in a 1986 New York Times op-ed that “Everyone detected with AIDS should be tattooed in the upper forearm, to protect common-needle users, and on the buttocks, to prevent the victimization of other homosexuals.” Paul Cameron also proposed a similar solution along with quarantines.

That was more than twenty years ago. Skip ahead to 2008, where the Indonesian province of Papua is considering a 21st-century solution:

Legislators in Indonesia’s remote province of Papua have thrown their support behind a controversial bill requiring some HIV/AIDS patients to be implanted with microchips – part of extreme efforts to monitor the disease.

Health workers and rights activists sharply criticized the plan Monday. But legislator John Manangsang said by implanting small computer chips beneath the skin of “sexually aggressive” patients, authorities would be in a better position to identify, track and ultimately punish those who deliberately infect others with up to six months in jail or a $5,000 US fine.

Of course, no one can say how they intend to define “sexually aggressive.” Indonesia has one of Asia’s fastest growing HIV rates, fuelled mainly by intravenojus drug users and prostitution. Papua has been hardest hit.

Nancy Fee, the UNAIDS coordinator for Indonesia is concerned about the impact the legislation would have on prevention efforts.

“No one should be subject to unlawful or unnecessary interference of privacy,” Fee said, adding that while other countries have been known to be oppressive in trying to tackle AIDS, such policies don’t work. They make people afraid and push the problem further underground, she said.

Local health workers and AIDS activists called the plan “abhorrent.” “People with AIDS aren’t animals; we have to respect their rights,” said Tahi Ganyang Butarbutar, a prominent Papuan activist.