Box Turtle Bulletin

World Vision’s concern about Uganda’s “Kill Gays” bill

World Vision is a Christian relief and development organization focusing on care for children and communities. Although there are many organizations showing a child standing in a puddle with flies buzzing about their heads, World Vision is the largest with a budget in excess of $2.5 billion, with over 97 cents of each dollar going directly to programs.

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

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

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

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

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

Major Medical Journal Warns “Ugandan Bill Could Hinder Progress on HIV/AIDS”

The British medical journal The Lancet has just published an article warning about the detrimental effect Uganda’s proposed Anti-Homosexuality Bill would have on that nation’s fight against HIV/AIDS.

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

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

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

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

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

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

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

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

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

Obama administration scales back on AIDS response

The New York Times is reporting the Obama administration is scaling back the US’ response to the AIDS pandemic in favor of a new emphasis on pneumonia, diarrhea, malaria and fatal birth complications.

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

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

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

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

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

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

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

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

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

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

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

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

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

My Concerns about the Public Option

On Saturday, the US House of Representatives voted for the Affordable Health Care for America Act, a healthcare reform bill which has been the highest priority of the Democratic Party leadership since the party took control of the presidency and both houses of the legislature. There are a number of very positive inclusions in that bill, including some that deal specifically with the GLBT community.

Probably the most specifically significant to our community is the incorporation of the McDermott/Ros-Lehtinen bill to remove the special ‘gay couples tax\’ on spousal benefits provided by an employer. Currently, heterosexual spousal benefits are provided tax free and employers may claim them as an operating expense, but same-sex spousal benefits are considered to be part of the employee’s taxable income. This can result in thousands of dollars of tax demanded from our government solely because the spouse of the taxpayer is the same sex. Removing this tax is a tremendous relief on gay taxpayers.

Also included are changes in treatment for HIV patients, heath data collection related to the LGBT community, new sex education rules, and non-discrimination language.

However, the bill, as passed by the House, also provides for a “public option”, or insurance provision by the federal government. This government run health care mechanism is by far the most controversial aspect of the bill. And, depending on where you fall on the right/left scale, you may well have strong arguments either for or against such a move.

But while I have opinions in general about the decision on the part of the government to compete in the world of service provision, that is not the point of this commentary. Rather, I wish to express specific concerns about how this effort may impact our community negatively.

Continue reading after the jump.

CDC: “Down Low” Men Not Responsible For HIV Among Black Women

African-American women make up 61% of all new HIV cases among women in the U.S., and they are 18 times more likely to become infected than White women. Until now, it was believed that this exceptionally high infection rate was due to bisexual African-American men. But a new statement from the Centers for Disease Control and Prevention throws cold water on that theory:

Heterosexual black men with multiple sex partners — not bisexual men who secretly have sex with men — are responsible for high rates of HIV among black women, according to a senior CDC official.

“We have looked to see what proportion of infections is coming from male partners who are bisexual and found there are actually relatively few,” said Dr. Kevin Fenton, director of the National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention. “More are male partners who are having female partners and are injecting drugs or using drugs or have some other risks that may put those female partners at risk of acquiring HIV.”

…”What we\’re seeing is a concentration of the epidemic among the poor, among ethnic minorities and racial minorities in the United States,” Fenton said.

Among gay men, African-Americans are bearing a disproportionate brunt of HIV infections. In the most tragic example, Black teens make up only 13% of the nation’s teen population but they account for 69% of new HIV/AIDS cases for those among the 13-19 age group.

HIV Vaccine Results Called Into Question

Remember that HIV vaccine story we were so excited about? It turns out that it may not be so promising after all. A Wall Street Journal article over the weekend determined that unreleased analysis of the data suggested the trial might have been a statistical fluke:

The second analysis, which is considered a vital component of any vaccine study, shows the results weren’t statistically significant, these scientists said. In other words, it indicates that the results could have been due to chance and that the vaccine may not be effective.

The additional data were available to the researchers on Sept. 24 when they announced the trial results, but they chose not to disclose them, said Jerome Kim, a scientist with the U.S. Army who was involved in the study. News of the second analysis was first reported on the Web site of Science magazine, but the story didn’t provide specific data. Full details of the trial are to be aired at an AIDS meeting in Paris that starts Oct. 19.

A group of 22 scientists who were critical of the study when it began in 2004 wrote that they feared that “one price for repetitive failure could be crucial erosion by the public and politicians in our capability of developing an effective AIDS vaccine collectively.” The WSJ article suggests the Army, the Thai government and the U.S. National Institutes of Health rushed to put a positive spin on the study. The AIDS Healthcare Foundation is calling for an independent review.

Who Are We Without the Wall?

Yesterday, major media outlets reported that for the first time an AIDS vaccine has had partial success in humans. In trials, it was about 31 percent effective. This is a far cry from the 70- to 90-percent effectiveness typically required for a vaccine to be licensed, but it shows that a vaccine is possible and represents the first-ever major breakthrough.

Since the announcement, I’ve allowed myself to consider seriously what a world without AIDS would look like. I was born in 1983 and remember the late ’80s, early ’90s television reports on the devastation wrought by AIDS in the U.S. The reports were terrifying, and it is odd to look at them in retrospect, knowing what they foreshadowed:

Since then, even as medical advances have made AIDS a chronic illness instead of a death sentence, contracting HIV has been one of my biggest fears, which goes to show that the stigma associated with it remains. I fear hearing, “you’re HIV positive” more than being told I have an inoperable brain tumor, which I know is irrational. I’ve had probably five HIV tests, and for all except the first one, the anxiety of waiting a week for lab results has made me run to the nearest rapid HIV testing site and get an answer in 20 minutes, which is also excruciating.

I grew up understanding that gay = AIDS, an equation that I realize is outdated and perhaps prejudiced. But part of me fears that being infected with HIV would confirm all the dire predictions made for me by reorientation therapists and concerned family members. I’ve often felt the pressure to defy these predictions by leading an exemplary life — which I of course haven’t, and won’t. But the point is that AIDS has been framed as the natural “consequence” of homosexuality.

Perhaps the best-known piece of writing on the social meaning of AIDS was written by Susan Sontag, “AIDS and Its Metaphors,” in which the author talks about the ways in which we imbued a virus — which is inherently indifferent to human feelings, morals, and motivations — with exactly those attributes. AIDS was cited by people like Pat Robertson as divine retribution for sinful sex, an understanding that reversed the natural inclination to view the afflicted person as a victim. People with AIDS were “guilty,” or earned it, or something like that. You “get” AIDS; you don’t “get” a brain tumor. HIV in the blood is a “poison,” AIDS a “plague.” As dehumanizing as terminal disease is, even more dehumanizing — and disempowering — is how moral, religious, and political leaders talk about AIDS and its victims.

On the other hand, the AIDS crisis galvanized the gay rights movement, and many of the advances in equality were made during the late ’80s and early ’90s. The AIDS crisis was the tipping point for social acceptance of homosexuality, a change that is reflected in the language. It’s no longer politic to call gay people “homosexuals” or refer to the homosexual “lifestyle,” but in the ’80s these were standard phrases used by newscasters:

A lot of the momentum of Act-Up has waned, but AIDS consciousness still permeates gay culture. Gay people will tag “be safe” (code for “use condoms”) to a goodbye at the end of an evening. I’ve been accosted more than once at a New York gay bar by an awkward grad student wanting me to fill out a survey about my sex life, which includes transparent questions about condoms, meth use, and depression (I can save you the work: gays who are reckless with drugs are probably more likely to have sex without condoms, and are probably more likely to be depressed). Public health officials obsess over how to “reach” us and set up condom stands at every LGBT event imaginable. And we’ve been Riding For The Cure forever. What happens when the finish line appears beneath us?

We thought the wall would stand forever,
And now that it’s gone we don’t know who we are anymore.

The Hedwig quote probably implies a nostalgia for AIDS that I do not intend, so let me be clear: the day the AIDS crisis ends — whether it’s a gradual process or an all-at-once medical achievement — will be a great day, the end of suffering for millions around the world. But it will mark the beginning of a shift in the culture. Will condom use plummet? Will the rate of other STDs rise? Will it change the forms our relationships take?

Probably.

The brief window of worry-free (or at least more worry-free) sex ushered in by the discovery of antibiotics, the pill, and abortion would open again — to the chagrin of social conservatives who have made the regulation of  sex, reproduction, and sexuality an essential component of their agendas. It would deflate many of the biological justifications for religious arguments (or maybe we’d just be cheating God?).

Whereas earlier gay rights activists wanted nothing to do with heterosexual marriage, the shift has been toward assimilating and adopting marriage, which some people think is good and other people think is bad (I’m on the fence). Part of this has come from increasing social acceptance and support of gay couples, but it would be silly to deny that the re-medicalization of sex had anything to do with the rise of monogamy in the gay community. Will the end of AIDS reverse this trend? I am not saying that bathhouses will reopen their doors and meth-fueled orgies will mark the scene until the next pandemic comes around, but de-coupling sex and relationships from the fear of death, disease, and social stigma will change the dynamics. In a sense, though, sex will always be fraught with anxieties: the virgin won’t stop wondering whether he or she will be good for their partner, and people will still feel the sting of betrayal when they find out they are being cheated on.

I’ve hesitated to use the word “freedom” or “liberation” in discussing the de-medicalization of sex. There is something mundane about equating this with human freedom. It seems a rather nihilistic, ’60s-’70s understanding of it. I have no idea what it really entails, but I doubt that freedom just means you have nothing left to lose.

This commentary is the sole opinion of the author and does not reflect the opinion of Box Turtle Bulletin’s other contributors.

HIV Vaccine Results Encouraging

Eventually it had to happen. Eventually one of the promising vaccines trials for HIV had to provide at least some protection.

And it has. Partly. The trial showed that a vaccine was about 31.2% effective. (NY Times)

“I don\’t want to use a word like ‘breakthrough,\’ but I don\’t think there\’s any doubt that this is a very important result,” said Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, which is one of the trial\’s backers.

“For more than 20 years now, vaccine trials have essentially been failures,” he went on. “Now it\’s like we were groping down an unlit path, and a door has been opened. We can start asking some very important questions.”

This is not the vaccine that will announce the end of the era of AIDS. But it is the first vaccine that has shown any effectivity at all and it allows researchers an opportunity to build upon this start to find something that will really work.

Researchers Discover Antibodies Which Block HIV From Developing AIDS

According to the journal Science via the Los Angeles Times:

After nearly two decades of futile searching for a vaccine against the AIDS virus, researchers are reporting the tantalizing discovery of antibodies that can prevent the virus from multiplying in the body and producing severe disease. They do not have a vaccine yet, but they may well have a road map toward the production of one.

A team based at the Scripps Research Institute in La Jolla reports today in the journal Science that they have isolated two so-called broadly neutralizing antibodies that can block the action of many strains of HIV, the virus responsible for AIDS.

Crucial to the discovery is the fact that the antibodies target a portion of HIV that researchers had not considered in their search for a vaccine. Moreover, the target is a relatively stable portion of the virus that does not participate in the extensive mutations that have made HIV able to escape from antiviral drugs and previous experimental vaccines.

Infection rates in gay/bi men

Those leading the fight against AIDS and anti-gay activists sometimes have a common goal: portray the incidence of HIV in gay and bisexual men in the most frightening terms. This appears to me to be what is happening as the result of a presentation at the National HIV Prevention Conference (Southern Voice)

Gay and bisexual men account for half of the new HIV infections in the U.S. and have AIDS at a rate more than 50 times greater than other groups, according to Centers for Disease Control & Prevention data presented at the National HIV Prevention Conference this week in Atlanta.

That’s a pretty frightening statistic. But perhaps the raw numbers give it some perspective.

Dr. Amy Lansky of the CDC presented research at the Aug. 24 plenary in which the CDC estimated in the U.S. there were 692.2 new HIV cases in 2007 per 100,000 men who have sex with men (MSM).

In other words, the rate of new infections in the population of gay and bisexual men in 2007 was 0.69%. Or in 2007 one out of every 144 gay/bi men seroconverted.

That still is very high. And it is consistent with our calculations that about 12% of gay/bi men (or about 6% of all gay/bi people) are infected with HIV. (So play safe kids… or better yet, find someone to have and hold from this day forward.)

But, in those terms, perhaps it isn’t quite as scary as the somewhat meaningless announcement that “MSM are 50 times more likely to have AIDS than women and non-gay or bisexual men.” I think most of us already know that sexually active gay men, especially those unpartnered, are at a much higher risk of HIV than Grandpa Joe and Grandma Sally.

And I wonder at the wisdom of making announcements of such comparisons. Provided without context, this quote can seem counter-intuitive. A gay man with both gay and straight friends might think that such ratios do not reflect their observations. And using language that feels out of sync with the realities of the experiences of gay men will not encourage better behavior; rather it will cause the target audience to dismiss the information.

Further it may distract from the fact that HIV transmission is not homogeneous within the gay community; some age, ethnic, and geographic subgroups need and deserve much more attention and focus in our battle against HIV/AIDS. Making statement that sound as though “HIV is a gay disease” misses the picture and downplays the tragic way in which this virus has devastated some gay communities – especially minority and economically challenged subsets – far worse than the “Will and Grace” gay man.

Such declarations also run the risk of providing a false sense of security to others in the non-gay-male category who live in communities which are disproportionately impacted by this disease. And it may encourage those responsible for shepherding resources to overlook, for example, sexually-active single black women in specific urban settings.

So while I strongly support that accurate information be presented and disseminated as widely as possible, I’d caution those who make statements about this disease to consider that their words not only be factually correct but also convey messages that are not confusing or counter-productive.

Lack of Clarity in Reporting on HIV and Circumcision of Gay Males

Several studies have shown that in African and Asian nations heavily impacted by HIV, circumcision can reduce infection rates in males by 50 – 60%. Now a CDC doctor has announced that while circumcision is effective in reducing female to male transmission during vaginal sex, it does not assist in resisting infection between gay males during anal sex. (U.S. News & World Report)

Circumcision “is not considered beneficial” for gay men concerned about lowering their risk of becoming infected with HIV, Dr. Peter Kilmarx of the CDC told the Associated Press. He released the study findings at a conference on Tuesday.

The finding are at odds with some studies conducted in Africa, which have suggested that circumcised males may be less prone to HIV infection during heterosexual sex. But circumcision may not offer the same protection when it comes to anal sex, Kilmarx said.

In the study, the CDC team tracked the HIV infection rate of nearly 4,900 men who had anal sex with an HIV-infected partner. The researchers found an HIV infection rate of 3.5 percent — whether the men were circumcised or not.

While this may appear informative to a heterosexual, this reporting leaves more questions than it answers.

• Were these 4,900 tops who engage in insertive sex only? Because if not, how could the circumcision of a bottom (passive partner) possibly impact HIV transmission?
• Does the 3.5% infection rate reflect a bottom to top transmission? Was this 3.5% in a year, a decade, when?
• Were these “partners” in relationships or just sex-partners?
• Or did they just say, “Here are some cut men and here are some uncut men. Let’s see to what extent they seroconvert”?

This story is but another illustration of why it is important that gay men and women are included in reporting stories that effect our lives. It would be interesting to know the extent to which bottom to top HIV transmissions occur and whether circumcision of the top could impact this transmission. But reporting like this tells us nothing of much use at all.

A Sanctuary for LGBT African-Americans In DC

Bishop Rainey Cheeks (in blue) prays with youth during a service at Inner Light Ministries (Nikki Kahn/Washington Post)

This Sunday’s Washington Post highlighted Inner Light Ministries, a Black church in Northeast Washington, D.C., in which some two-thirds of the congregation are gay:

In the middle of a sermon, Bishop Rainey Cheeks felt his medicine bottle bulging in his pocket and realized he hadn’t taken his pills. He paused in the pulpit and faced the congregation in his tiny storefront church.

“Excuse me,” Cheeks remembers telling his parishioners last year as he poured three pills into his hand. “This is my HIV medicine. I’m going to take it now.”

As he washed down the pills with water, Cheeks saw some members staring with wide eyes. Everybody knew that their pastor, an imposing man with flowing dreadlocks who once competed in taekwondo championships, is gay. But not everyone knew that he is HIV-positive.

Inner Light Ministries is providing an important sanctuary for Black gay people, who often feel rejected by both the African-American community as well as the LGBT community. The ministry also provides a vital link for those who are dealing with the additional prejudice and stigma associated with being HIV-positive. Bishop Cheeks is worried about the complacency the younger generation has about HIV/AIDS, which he sees as a dangerous mix of believing it to be “manageable” disease and believing that it’s what they deserve:

“Most messages . . . to young folk is if you’re gay or lesbian, you’re going to hell,” [Bishop Cheeks] said. “So why take responsibility if you’re already condemned?

“They need to understand God loves them. But they also need to be accountable for their sexual behavior. Not everything goes.”

Black Gay Men, AIDS, and No Community Support

Alvin McEwen found an article about Black gay men and AIDS hitting really close to the gut. He posted his reaction on his blog. It’s a perspective we never talk about. I’m re-posting it with his permission. — Jim Burroway

AIDS is killing off black gay men and lack of LGBT community support may an unfortunate factor:

Black gay men have less choice when it comes to sexual partners than other groups and, as a result, their sexual networks are closely knit. These tightly interconnected networks make the rapid spread of HIV more likely. In a study looking at social and sexual mixing between ethnic groups in men who have sex with men, H. Fisher Raymond and Willi McFarland, from the San Francisco Department of Public Health in the US, show that social barriers faced by Black gay men may have a serious impact on their health and well-being.

. . . Black gay men are the least preferred of sexual partners by other races. Black men are perceived to be riskier to have sex with, which can lead to men of other races avoiding Black men as sexual partners. They are also perceived as less welcome in the common social venues of gay men in San Francisco. As a result, Black men are three times more likely to have sexual partners that are also Black, than would be expected by chance alone.

In the authors\’ view, the combination of attitudes on the part of non-Black gay men, friendships and social networks that are less likely to include Blacks, and the environments found in gay venues serve to separate Black gay men from other groups.

So the personal ad phrase “no fats, no olds, no fems, no blacks” is now taking on sinister proportions. It’s not that I’m passing judgment on people’s personal dating choices. But it does go farther than that. The LGBT community can sometimes be consumed with the gay ghetto clique mentality. And as you can see, it’s killing those who are generally not allowed to be in the “clique.”

But hey, at least the black community supports us . . . when we seem to be at death’s door. That’s when folks make these lovely speeches about “it’s not just a gay disease,” and “let’s not stop until we find a cure.”

I got an idea – how about giving us a little support while we are healthy. How about not isolating us or making our lives seem dirty by using the word “lifestyle” like it’s a pooper scooper.

So both the LGBT and black community have work to do. I can only hope the work gets done before too many LGBTs of color suffer.

California HIV Emergency: Schwarzenegger, Legislature may slash HIV funding

[The following is a guest post by journalist Rex Wockner, cross-posted at his web site. This very important story is reprinted here with permission and at his request.]

Gay and HIV advocates rallied at the state Capitol in Sacramento, Calif., on June 10 against draconian cuts in HIV funding proposed by Gov. Arnold Schwarzenegger and under consideration by the Legislature. Wockner News photo by Charlie Peer/Outword Magazine

California Gov. Arnold Schwarzenegger has proposed, and the California Legislature is considering, draconian cuts to all types of HIV-related funding in the near-bankrupt state.

In the worst-case scenario, which is still not off the table, slashes to the AIDS Drug Assistance Program could result in thousands of Californians who make less than $41,600 per year losing access to the state-provided drugs that suppress HIV and keep them alive.

In the apparent best-case scenario, not all HIV drugs would be available via ADAP and patients would have to pay part of the cost of the ones they could get. That is problematic because some HIV-positive people have developed resistance to some HIV drugs, and need access to the full arsenal of therapies to stay alive.

Further, the current plan apparently completely eliminates state funding for the tests that determine if a patient is responding to treatment — such tests as CD4 counts, viral-load measurement and drug-resistance monitoring.

These tests are essentially mandatory in HIV treatment. Doctors use them so they can change a nonresponsive patient’s drug combination to another combo that works in that patient — before the patient’s immune system breaks down further and the patient develops a life-threatening opportunistic infection.

The current plan apparently also dramatically slashes funding for education, prevention, counseling and testing programs.

Some 35,000 working- and middle-class Californians who don’t make enough money to pay for their own treatment could be adversely or dangerously affected by the possible cuts to ADAP and elimination of monitoring testing.

Gay and HIV advocates have strongly denounced the budget proposals, and a large rally was held at the state Capitol in Sacramento on June 10.

Rethinking HIV Testing

There is no good reason for any American becoming HIV positive today.

Which is not to say that there are not a lot of very understandable explanations why an individual might become infected. Social pressures, education, self perception, culture, diminished self worth, drugs and alcohol, and even trusting the word of a careless liar all play their part in the instances and circumstances that lead to poor choices and HIV infection.

And so infection rates stay consistently high in the gay community, and astronomical in some sub-populations. A study of HIV infection rates in Chicago found infection rates of over 17%* of gay men in that city. When looking at subgroups, the statistics become even more troubling:

Thirty percent of gay black men in Chicago tested positive, the study showed, while Hispanics and white men had rates of 12 percent and 11.3 percent, respectively.

A quarter of blacks aged 18-24 tested positive. More than 37 percent of blacks aged 25-34 – the highest of any age group – tested positive. The numbers are similar to national figures.

These are rates of infection that are simply unacceptable. And there\’s no reason, no justification, for 37% of any ethnic or age group to be infected with a virus that is detectable and preventable. Considering the weath in this nation and the billions spent on bailing out bankers and car makers, that black gay men have rates this high raises hints of racism, homophobia, and elitism.

But there is an explanation, one that makes sense to me; these men didn\’t know they were infected. Half of the infected gay men – and two-thirds of infected black men – were unaware of their HIV status.

Why?

Because they didn\’t get tested. They were “worried about the result.”

I understand that worry about what it means to be HIV positive can be a strong disincentive to get tested. As long as you don\’t know, you don\’t have to deal with it.

But I think this report, like all those I\’ve seen from the AIDS establishment, misses a component that is present with every HIV test that I or anyone I know has taken.

It isn\’t just finding out whether one is HIV positive. It\’s also going to some clinic (when they are open), filling out questionnaires, being grilled about the intimate details of your sex life, and then sitting in a waiting room where you are sure everyone is staring at you before being called into an office and being told by a total stranger whether you have a life-changing disease and, if so, reporting your name to the government.

It\’s an unpleasant process. And frightening.

And I think it might be time to begin considering a change. I think it\’s time to consider allowing people to test themselves in the privacy of their own home.

I know there are strong objections to this notion.

There is fear that inexperienced users will make mistakes and get false conclusions from improperly handled tests. There\’s also fear that at-home tests would not be sensitive enough to assure accurate results or may be too expensive.

But the current oral swab tests are pretty darned easy. If some scared teenage girl who missed her period can pee on a swizzle, surely a gay guy can run a swab over his gums.

Also, the oral tests are over 99% accurate. And there\’s little reason to think that they would be significantly less accurate in one\’s home than in the clinic. And if we as a city, state or nation, can afford to pay the clinic administators to provide free testing, I’m sure we can come up with some scheme to get the prices on tests affordable by those who need them; it just makes economic sense.

I will concede that some guys will ignore the fact that these tests only tell you whether you were infected before a three month (or so) window. Some will assume that a negative test means “100% negative today”. But this is also a misconception that can occur in a clinic and can be mitigated by careful packaging.

But the biggie reason given for opposition to the public availability to HIV tests that one can take and home and get immediate results is that in a clinic setting those who test positive can get counseling.

I appreciate the need for counseling. I\’ve even argued the merits of this approach.

But it\’s not working, folks. There are still thousands of guys out there that have been infected and do not know it. And they are not going to come into your clinic to find out. And maybe, just maybe, it\’s because they don\’t want to be subjected to your counseling.

I have come to believe that many of these “I don\’t know” guys might know their HIV status if they were able to anonymously purchase a little kit at the drugstore, take it home, and know the results in 20 minutes.

Yeah, some will freak out. And panic. And there won\’t be a counselor in front of them.

But they will at least know their HIV status.

And if they were provided with the option to immediately call a hotline for information and counseling, they might do so. Or they could go to a clinic. Or go online.

But they would know. And there\’s a very good chance that they would not then go out and infect someone else.

And this approach would be useful not only to unknown virus carriers, but to those they come in contact.

I think that many a gay guy – or black woman – would say, “Yes, I know you say you\’re ‘clean\’. But put this in on your gums and get comfortable because nothing is in going in anything for the next twenty minutes.”

It’s is bound to reduce infections better than the “baby, just trust me” method.

I don\’t doubt the sincerity of those who wish to keep HIV testing in carefully controlled environments. And I am sure that some readers will object to this proposal, fearing that it would be a catastrophe.

And I\’ll even grant that I may be wrong. Perhaps allowing people control over their own HIV testing would result in more problems than it solves. Maybe I’ve understated some concern or forgot some consideration.

But with infection rates – especially unknown infection rates – as high as they are, it\’s time to look for new solutions. It\’s time to ask the question. And it\’s time to start the conversation over whether personal access to HIV tests could help bring down the incidences of unknown infections and help stop the spread of this disease.

– – –

* Though higher than our estimates of about 12% of gay men, this is consistent with our estimates. HIV infection rates in black gay men is far higher than other ethnic subgroups and with a population that is 37% African American, this skews the local average higher than the national average.

Addendum: This commentary does not attempt to address the specifics of the African-American community. I’m not qualified or adequately knowledgeable to address the exact circumstances leading to disparity in infection rates between ethic subgroups or to advance targeted solutions. Rather, this commentary seeks to start a discussion and new thinking about the lack of testing in infected populations of all races. For more information directed at HIV/AIDS in the African American community, see the Black AIDS Institute or the Minority AIDS Project.