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Posts for June, 2011

Thirty Years

Jim Burroway

June 5th, 2011

Today marks the thirtieth anniversary of the Centers for Disease Control’s publication of a mysterious set of illnesses which took the lives of five gay men in Los Angeles. AIDS had been swirling around unnoticed since the 1930s, and doctors in Europe and Africa began to notice that people were falling victim to a host of diseases which are normally curable in the Congo River basin in the late 1970s. But it took the CDC report of a cluster of cases in southern California to signal that the mysterious deaths were somehow related. The rest, as they say, is history, with a whole lot of stigma thrown in.

Karen Ocamb happened to be in the middle of Southern California’s epidemic in the 1980s. She was living in a “glass closet,” as she described it. She was out to select friends. She found herself becoming an AIDS care provider simply because her friends needed her help. She told me via email, “I didn’t come out to family until I had to tell Chris Scott’s mother — the wife of an Air Force General and my godmother who was living at a military retirement community associated with March Air Force Base — that her son was gay, had AIDS, was dying in Intensive Care and she should dash to his side. Chris was closeted, too. I came out to my Aunt Bobbie and then my mother because I didn’t think it was fair that AIDS outed Chris but I could stay in the closet. My Aunt Bobbie said she already knew and my mother basically disowned me.”

Karen has put together what amounts to being a lovely online shrine to the many people she knew over the years along with her memories as an AIDS care advocate and LGBT journalist. You can see her updates by following this tag. She has it all, beginning with an interview with Dr. Robert Gottlieb, who wrote the first CDC report after having noticed the remarkable similarities between four cases of an “apparently new” disease. She continues with some of her own personal memories, activists and allies, early marches, rallying cries, demonstrations, indifferencebigotry and hope. Karen is currently participating in the AIDS LifeCycle, a seven day ride from San Francisco to Los Angeles.

A Self-Fulfilling Prophecy: When AIDS is God’s Punishment

Jim Burroway

March 30th, 2011

When people who are HIV-positive hold a view of God as benevolent and forgiving, their disease progression is significantly slower than for those who see God as punishing and judgmental, according to a new study to be published in a forthcoming issue of the Journal of Behavioral Medicine.  

Researchers at the University of Miami followed 101 HIV-positive people over four years, measuring their viral load (VLlog) and CD-4 counts to determine the progression of their disease. Researchers also monitored other factors which may impact disease progression, including adherance to medication, sexual risk behavior, and other drug use. They also examined psychological measures to determine whether depression, church attendance, social engagement/isolation, or optimism contributed to disease progression. 

After four years, the reseachers determined that a positive view of God was significantly associate with slower disease progression, while those holding to a negative, judgmental and punishing view showed significantly faster disease progression:  

More specifically, the decline ratio shows that those who were low on Positive View of God (at the 25th percentile, score of 23) lost CD4-cells five times faster than those who were high on this construct (at the 75th percentile, score of 30). The increase ratio shows that for those scoring low on Positive View of God (25th percentile, score of 23), VLlog those scoring high (75th percentile, score of 30). Similarly, those who held a Negative View of God as harsh/judgmental/punishing had significantly greater loss of CD4-cells over the 4 years, and significantly worse control of HIV. More specifically, those high on Negative View of God (75th percentile, score of 18) lost CD4-cells 2.52 times faster than those who were low (25th percentile, score of 10.5) and had 3.32 times faster increases in VLlog

The interesting thing is that results like this held true even when the sample was adjusted for other factors. A positive view of God remained a significant beneficial factor even after adjusting for church attendance, health behaviors (adherence to medication, sexual risk behavior, alcohol/cocaine use), coping behaviors, and social support. A positive view of God also remained beneficial when adjusting for mood (optimism, depression, hopelessness). Which means that even if a person held a view of God as judgmental and punishing but was still optimistic, not depressed, socially engaged, taking his or her meds, etc., the person with a positive view of God still held a health edge after four years. According to the study’s authors, “The effects of View of God were significant and substantial.” 

The authors gave one interesting example of how this effect might work for some people:

One of our long-term survivors, Sarah (not her real name) who has a positive view of God, interpreted her HIV diagnosis by reframing it into having been chosen by God for a special purpose—to help the heterosexual HIV community by establishing a community center and place of welcome for them.

Non-belief in God was not examined in this study due to the small number of atheists in their initial sample. They also caution that while there is a correlation between disease progression and a view of God, “it does not imply that View of God causes disease-progression.”

Gail Ironson, Rick Stuetzle, Dale Ironson, Elizabeth Balbin, Heidemarie Kremer, Annie George, Neil Schneiderman, Mary Ann Fletcher. “View of God as benevolent and forgiving or punishing and judgmental predicts HIV disease progression.” Journal of Behavioral Medicine (published online February 22, 2911): in press. Abstract available here.

Malawi Religious Leaders Spurn HIV/AIDS Outreach to LGBT Community

Jim Burroway

March 15th, 2011

Fr. George Buleya, Secretary General of the Episcopal Conference of Malawi

From Malawi’s Nyasa Times, we get this report about statements made by that nation’s Anglican Catholic and Muslim leaders concerning HIV/AIDS prevention, treatment and other outreach programs for the local LGBT community. Fr. George Buleya,  Secretary General of the Episcopal Conference (Roman Catholic) of Malawi said:

“I believe that there are no homosexuals who are born as such in Malawi but if at all there are some who claim to be, they are moved to do so because of poverty. By the way, why are you forcing us to accommodate homosexuals when there are many thieves, adulterers and a lot of people who do evil?

“Christianity does not work on sociology but morality. To us, we cannot punish those caught in the act but God will,” he said.

Questioned that this might as well retard their fight against the Hiv/Aid pandemic because they will not be able to reach out to the minority groups, Buleya said:  “Our effort is to reach out to the faithful and if they are not within our jurisdiction, then, we will not work with them.”

Interesting. For Buleya, the LGBT community isn’t even an opportunity for missionary work.

Muslim Association of Malawi (MAM) Secretary General Sheikh Imran Sharif Mohammed’s position is even worse:

“Homosexuality is sin and is punishable by beheading. The Holy Koran clearly states that any community which indulges in these acts is calling for calamities like those that happened to Sodom and Gomorrah,” said Mohammed, a lecture at the University of Malawi’s Chancellor College.

“Nobody can change our laws which are both in the Koran, as a primary source and Hadith as our secondary source. These people are enemies and there is no way we can condone them in our communities,” he added.

HIV test results in one minute

Timothy Kincaid

December 17th, 2010

The FDA has approved an HIV testing kit that gives results in one minute. The highly accurate (99.8%) test involves a finger prick, three solution process that gives results about as easy to understand as a pregnancy test (one blue dot, negative; two blue dots, positive).

I remember when test results took weeks – long, long weeks – and still now it can be an agonizing twenty minutes even for those who have no real reason to be concerned. And while there are testing vehicles on the street in West Hollywood every weekend, I’m sure that a 20 minute wait negatively impacts their draw.

But with one-minute responses, I suspect that there will be an increase in those who are willing to be tested and a reduction in the anxiety of those who do.

Another Reason For FRC To Oppose Stem Cell Research

Jim Burroway

December 14th, 2010

It may hold some promise for curing HIV. An American  patient in Berlin received a stem cell transplant in 2007 in an attempt to cure his leukemia. That transplant, to the surprise of his doctors, also ended up curing him of his HIV infection:

But these were no ordinary stem cells – a mutation found in just one percent of Caucasians in northern and western Europe causes CD4 cells to lack the CCR5 receptor, a receptor necessary for early-stage HIV to infect CD4 immune system cells. People with this mutation are more or less immune to HIV infection.

Those anti-HIV stem cells took root in the Berlin patient and repopulated there. At the same time, the host CD4 cells that hadn’t been destroyed in chemotherapy and radiation completely disappeared. After 38 months, doctors still couldn’t find HIV infection in the Berlin patient – in other words, it seems by all measures that his HIV has been cured.

This is still a very unlikely path toward curing AIDS, but it does give scientists several avenues for further investigation. This article explains the patient’s gruelling recovery:

The `Berlin patient`, Timothy Ray Brown, a US citizen who lives in Berlin, was interviewed this week by German news magazine Stern.

His course of treatment for leukaemia was gruelling and lengthy. Brown suffered two relapses and underwent two stem cell transplants, as well as a serious neurological disorder that flared up when he seemed to be on the road to recovery.

The neurological problem led to temporary blindness and memory problems. Brown is still undergoing physiotherapy to help restore his coordination and gait, as well as speech therapy.

Friends have noticed a personality change too: he is much more blunt, possibly a disinhibition that is related to the neurological problems.

On being asked if it would have been better to live with HIV than to have beaten it in this way he says “Perhaps. Perhaps it would have been better, but I don’t ask those sorts of questions anymore.”

Scientists are now discussing ways to identify stem cells with the built-in immunity for further research. A group of U.S. scientists have announced that they have received funding to to explore techniques for engineering and introducing CCR5-deficient stem cells.

World AIDS Day 2010

Timothy Kincaid

December 1st, 2010

Today is World AIDS Day, a time to reflect, to refocus, and to address the continuing global epidemic of HIV/AIDS. This day always brings remembrances for me, and I thought I’d share some.

But I’ve sat here and written and revised and amended and started over, and I’ve found that I simply cannot share my personal thoughts on this. I’ve been devastated by this disease, but I’ve also been astonishingly lucky. I’ve lost some very dear to me, but considering that I lived within 50 miles of the Castro for all of the 80’s, my loss is nothing, nothing at all, compared to others.

But regardless of the extent, I find that I can’t personalize AIDS on this site. And yet I can’t just write some impersonal analysis, today. HIV/AIDS is personal, intensely personal to gay men of my age.

It has always been a part of our lives, a backdrop to socializing, romance, love and sex; always an issue, always present. It has been the filter through which we have been demonized, the focus of compassion, the impetus for our activism, and the basis of our shellshock. It’s built bonds between gay men and lesbians and parents and churches. It exposed the world to the existence of gay people outside of “the big city”. And it killed many of our best and brightest – some of whom we loved.

I am encouraged about recent studies – and we do discuss them here – and about the statistics regarding longevity and continued effectivity. But AIDS is not statistics, it’s stories, and that’s where I stumble. You’d think after enough time it would become easier, yet there are still things I don’t talk about.

But maybe you can. Perhaps you have stories to share.

Or perhaps you want to reflect on a future, the increasingly likely hopes for both a prevention and a cure. Or to discuss the international consequences of a disease that is ravishing some parts of the world.

If so, here is a space for your recollections and thoughts.

Some HIV+ Ugandan Teens Choose Religion Over Meds

Jim Burroway

October 8th, 2010

We’ve been documenting the corrosive power of unscrupulous religious leaders in their fight to hang gay people. But the LGBT population isn’t the only one suffering from the ignorance and superstitions that pass as Christianity:

Rebecca Nakityo, 17, spends every free moment watching gospel TV, reading the Bible or praying in church. The soft-spoken teen — who has lived with her aunt and uncle since her parents’ death several years ago — told IRIN/PlusNews she believed she was cured by God six months ago.

According to Nakityo, as the pastor’s voice reverberated through the church hall, she felt filled with the healing power of God. Nakityo now regularly gives testimonies about her “healing” and has stopped taking her ARVs (anti-retroviral medications).

By the time many young people find their way back to the health system, it is too late. “We had a client who was in church; they brought her and dumped her at Baylor (Baylor College of Medicine Children’s Foundation Uganda) — we tried to treat her but it was too late,” Ssuna said.

The so-called “prosperity gospel,” sometimes known as “name it and claim it” theology, has become a major force in Uganda. Much as elsewhere, there are entire satellite and terrestrial television stations whose entire programming is devoted to making all sorts of miraculous promises in exchange for prayer — and donation. Well-known American pastors like Benny Hinn, Creflo Dollar, T.D. Jakes and others have inspired legions of home-grown Ugandan prosperity preachers who are known as much by their immense houses and expensive S.U.V’s as they are by their highly-charged emotional services.

If pastors have no shame about living in extreme wealth and extravagance  while 52% of Ugandans get by on less than US$1.25 a day, then it should come as no surprise that they would also have no shame about urging their followers to also abandon life-saving medications.

According to Mary Kiwanuka, who has an adolescent daughter living with HIV, the influence of television evangelists should not be underestimated. “These children are exposed to too much television which shows people being healed,” she said. “In their circumstances, with too much peer pressure and the pill load, if there is an alternative they take it.”

Anti-gay McHugh notes the same misreporting that I saw

Timothy Kincaid

October 5th, 2010

Dr. Paul McHugh is not a friend of our community. Long an anti-trans activist, he wrote an amicus brief in support of the Proponents of Proposition 8 in which he claimed that homosexuality cannot be defined.

But McHugh wrote a letter to the editor of the Baltimore Sun in which he noted the same misreporting of a study on HIV prevalence that I discussed here last month.

Sexually transmitted diseases proliferate among men and women who have multiple sexual partners. If the recent measure of HIV infection among Baltimore’s gay men was restricted to those who frequent “gay” bars and clubs, then it will overestimate the prevalence of HIV in Baltimore because it will not include those gay men who are not seeking extra partners (“Baltimore leads in HIV infection in gay men,” Oct. 2). The prime public health message to the people in any community seeking to reduce STDs, including HIV, is and has ever been, “If you are sexually active, have few and preferably only one sexual partner.”

McHugh is correct both in his analysis of the numbers and in his recommendation for the best way to avoid contracting sexually transmitted infections. It’s a pity that his anti-marriage efforts are in direct contradiction to his observation.

Malawi VP: Addressing Gays Crucial In Fight Against HIV/AIDS

Jim Burroway

September 29th, 2010

Malawi’s Vice President Joyce Banda urged a gathering of religious leaders in the commercial capital of Blantyre to address the needs of LGBT people in the fight against HIV/AIDS. Banda’s remarks were delivered to a meeting of the Malawi Interfaith Association, which is meeting to discuss the increasing HIV infection rate among the clergy:

Banda said same-sex liaisons are a reality in Malawi saying there were Men Having Sex with fellow Men (MSMs) and that there were also lesbians, – Women Having Sex With Women.

“I am of the opinion that MIA is strategically positioned to bring faith leaders together to debate on how faith response to HIV and AIDS should reposition itself to tackle the issue of homosexuality without necessarily compromising moral integrity of faith institutions,” Banda a devout Christian said.

She said gays and lesbians are vulnerable groups and that they need to be paid attention by the clergy in the national response to fight HIV/Aids.

Is unclear how clergy might “pay attention” to LGBT people, given the fact that homosexuality is illegal in Malawi (punishable with up to fourteen years’ imprisonment) and widely condemned in society. Malawi gained worldwide attention with the arrest and conviction of Stephen Monjeza and Tiwonge Chimbalanga following a traditional marriage ceremony earlier this year. The couple were finally pardoned by President Bingu wa Mutharika. He later described their attempted wedding as “satanic.” LGBT advocates and ordinary citizens have experienced official repression and witch hunts, according to local news media.

Washington Post gets the HIV prevalence story wrong

Timothy Kincaid

September 24th, 2010

Darryl Fears of the Washington Post starts off with

Study puts HIV rate among gay men at 1 in 5

One in five gay men in the United States has HIV, and almost half of those who carry the virus are unaware that they are infected, according to a new Centers for Disease Control and Prevention study.

The problem? That’s just flat false.

As we reported, the CDC study was of men in urban settings and not reflective of gay men on the whole. It was not even representative of gay urban men, just those who are living it up at the bars.

And there is a material difference.

As we have stated in the past, only about 12% of gay men are infected with HIV. But Fears doesn’t have to take our word for it, it’s right there in the study which he was reporting. And the CDC made a point of warning against reporting their study in a sensational way:

Finally, these findings are limited to men who frequented MSM-identified venues (most of which were bars [45%] and dance clubs [22%]) during the survey period in 21 [metropolitan statistical areas] with high AIDS prevalence; the results are not representative of all MSM. A lower HIV prevalence (11.8%) has been reported among MSM in the general U.S. population. [emphasis mine]

While it may take an extra few minutes to read the whole report, it can make the difference between providing news and spouting nonsense.

Of course the Post was not alone is their sloppy reporting. The AP was actually worse

One in five sexually active gay and bisexual men has the AIDS virus, and nearly half of those don’t know they are infected, a federal study of 21 U.S. cities shows.

“We don’t have a generalized epidemic in the United States. We have a concentrated epidemic among certain populations.”

Even gay magazine, Bay Windows, got in on the act with the headline, “CDC: One in five gay, bi men is HIV-positive”.

More sensationalistic HIV headlines

Timothy Kincaid

September 8th, 2010

Here’s a Reuters headline from France:

HIV spread “out of control” among French gay men

And here’s the meat of the story:

Thursday’s study, published in The Lancet Infectious Diseases journal, found that HIV in France fell significantly from 8,930 new infections in 2003 to 6,940 in 2008.

But the number of new infections among gay men was stable despite a decline in other groups, and accounted for 48 percent of new cases in France in 2008.

To Reuters “stable” = “out of control”

Yes, France has unacceptably high HIV infection rates – nearly 10% of gay men. Yes, we need to address the increase in young gay men who seem to be receiving ineffective messaging. Absolutely.

But, really!

More talk about cancer drugs to cure HIV

Timothy Kincaid

September 3rd, 2010

The pharmaceutical world has become quite skilled at treating HIV. For most HIV infected patients, a daily drug can reduce the virus in the body to the point where it has virtually no impact; the immune system is not effected by the virus and it is even theorized that such persons are no longer infectious.

But “virtually” is the important word. While the virus may seem gone, it is not. Rather it is lurking in cells that the drug regimen cannot reach and should the patience cease their treatment the virus will return even fiercer than before.

And it is this lurking that has proven to be the attribute that has stopped researchers from finding a cure.

But, as we discussed last month, some are starting to think outside the box and are utilizing existing cancer drugs to break through this last threshold and actually prepare a cure for those infected with HIV. Now a similar effort is being reported for a Merck cancer drug, but using a different theory. (Bloomberg)

Researchers at the University of North Carolina in Chapel Hill plan to test Merck’s drug, Zolinza, next year in about 20 people infected with HIV, the AIDS virus. The goal is to determine if Zolinza, or a medicine like it, can force HIV out of cells where it can reside, concealed from attack by potent antiviral treatments, said David Margolis, a professor of medicine who’s leading the research.

While AIDS drug cocktails can eliminate more than 99 percent of virus from an infected person, the treatment isn’t a cure because a remnant of the virus remains hidden in certain cells. For years, scientists have sought a simple way to drive the remaining virus into the bloodstream where the drugs can clear them from the body. Zolinza, approved in 2006 for use against a rare type of blood cancer, may work by blocking an enzyme that helps the virus avoid detection.

This is not a certainty, of course, but previous testing has shown promise.

In a laboratory test published last year, Margolis used the medicine to coax HIV out of hiding in cells taken from infected patients.

It may prove that the optimism for a cure is as hasty as was the optimism for a vaccine which was in the air a few years ago. But, nevertheless, I do think that for many HIV infected persons, there is a reasonable hope that within their lifetime they will again be free of this virus.

Aid For AIDS Nevada FINALLY dumps Canyon Ridge Christian Church

Timothy Kincaid

August 25th, 2010

Top: Canyon Ridge Community Church in Las Vegas Bottom: Canyon Ridge's "dearly beloved family and friend" wants to kill you for being HIV-positive.

Although no one at Aid For AIDS Nevada has responded to (or even acknowledged receiving) my letter, they have finally responded to Dr. Warren Throckmorton in regards to their chumminess with Canyon Ridge Christian Church:

After evaluating Canyon Ridge Christian Church’s backing of Pastor Ssempa of Uganda and his support of the Anti-Homosexuality Bill, we feel that it is in the best interest of our clients, supporters and staff to dissolve our relationship with the church immediately. Unfortunately, we will be unable to continue to work with the church, as long as they are associated with Pastor Ssempa. Since what he and the Anti-Homosexuality Bill represent violates the basic human rights that should be afforded to all Ugandans. Our mission is to provide client service programs that assist in enhancing the physical health and psychosocial wellness of the individuals living with and affected by HIV/AIDS in southern Nevada, while promoting dignity and improving the quality of their lives. We will further this mission without the support of Canyon Ridge Christian Church.

AFAN arrogantly dismisses concerns about CRCC

Timothy Kincaid

August 24th, 2010

There is nothing like public criticism to encourage a response. And after and the Red Ribbon Army and a number of others began to increase a call for explanation, Aid For AIDS Nevada has finally given the weakest of responses to Dr. Throckmorton for why they have not severed ties with Canyon Ridge Christian Church.

We do not partner with Canyon Ridge. In fact, we are simply a recipient of their donations in support of our lifesaving, essential programming for individuals surviving HIV/AIDS…we are not able to cease a partnership that does not exist.

Which still does not answer my questions: “please let me know whether you will continue to allow CRCC to participate in your organization and to display their organization’s name” and just why have you not responded to expressed concerns. And, especially, why have you deleted comments on your Facebook page from now half a dozen or so different activists who simply want answers.

The Red Ribbon Army is wondering something even more basic: “why Aid for AIDS of Nevada is unwilling to condemn Uganda’s Anti-Homosexuality Bill.” You’d think that would be a no-brainer.

But maybe AFAN doesn’t really care what you think; they don’t really need to. Two-thirds of their funding is from governmental sources and only about 17% of their annual budget comes from the AIDS Walk – and the majority of that is from corporate sponsors.

Ottawa Police disclosed that gay man transmitted “infectious disease”

This commentary is the opinion of the author and may not necessarily reflect that of other authors at Box Turtle Bulletin.

Timothy Kincaid

August 24th, 2010

Gay groups in Ottawa are furious with the police for releasing information about a gay man’s sexual health, so furious in fact that they are refusing funds from a police fundraiser. (Citizen)

Several groups in Ottawa’s gay community will refuse funds to be raised by police at a pancake breakfast Monday, in protest over how officers publicly identified an HIV-positive man.

In an unusual move that infuriated the gay community, police publicly released a photo of Steven Paul Boone, 29, charged in May with aggravated sexual assault. Police say he failed to disclose his HIV status to another Ottawa man who contracted the disease after the two had unprotected sex several times.

The story began in May when Boone was arrested. (CBC)

Steven Paul Boone, 29, remained in custody Friday after being charged with nine counts of aggravated sexual assault, said an Ottawa police news release.

The charges were laid after another man alleged in April that he contracted an infectious disease after sexual contact with Boone in late January and early February. Police said they could not disclose the nature of the disease, including whether it was HIV, the virus that causes AIDS.

Although the police did not specifically state that the infectious disease was HIV, advocates felt that releasing the man’s photo was inappropriate.

By releasing the photo, [Brent Bauer, of the Ottawa Gay Men’s Wellness Initiative] said, police invaded Boone’s privacy, and spread fear among gays, who might now hesitate to get tested for AIDS.

Okay, to see if I have Bauer’s logic correct, he thinks that because a man who failed to disclose his HIV-positive to sexual partners was exposed by the police, therefore people will not want to get tested.

Oddly enough, that theory was put to the practical test. And failed spectacularly. What Bauer is not acknowledging is that between the photo being released and the pancake breakfast something else happened: five additional victims came forward. (Citizen)

A 29-year-old man accused of failing to disclose his HIV-positive to sexual partners has had his charges upgraded to include attempted murder.

The four counts of attempted murder were laid against Steven Paul Boone in relation to four of his alleged victims. Boone has also been charged with four counts of administering a noxious substance — HIV — to the four men.

Here we have a guy with at least six victims, four of which seroconverted. And Boone did not disclose his status to any of them even though, as it turns out, he had known of his HIV status for at least a year. And it is at least a reasonable assumption that three of them would not have known to get tested if the police had not released this guy’s picture.

Studies regularly confirm that – because most people are not despicable vermin like Boone – the biggest contributor to the continued spread of HIV is ignorance of one’s status. Not only are most HIV+ people responsible, but medications can reduce viral loads to the point where it might not be possible to pass on the virus.

But if these men had not seen Boone’s picture, they may not have gotten tested before endangering others.

I can appreciate that the community in Ottawa is offended in that they believe the police are not considering their complaint about the privacy rights of those who are HIV positive. And I appreciate the value of clear guidelines that protect the privacy of the innocent. But I find the defense of Boone to be difficult to fathom.

I have long been an advocate for those impacted by HIV/AIDS. I was privy to the early debates over confidential v. anonymous testing and I am still not convinced that names-based reporting is the most effective policy (or at least not as it is currently administered).

But I believe we should be doing everything in our power to stop the continued spread of HIV within our community. That should drive our policies and our sympathies and if that means that we put the interests of the uninfected – even the irresponsible uninfected – ahead of those who are deliberately endangering others, I have no problem with that.

I don’t wish to threaten the privacy of the vast majority of responsible HIV positive people who would never dream of doing anything that would pass on this virus. But people like Boone are a danger and a threat to the members of our community and we are fools if we put their interests before our own.

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