American Prospect: Best HIV/AIDS Reporting This Year!

It is hard to find good reporting on the domestic AIDS epidemic in the US that isn’t sensational, or focuses nearly entirely on individuals who contract HIV–as if it’s only their fault and that there are no policy decisions that are also complicit in driving the US epidemic. When was the last time you read a feature story that focused on the Centers for Disease Control & Prevention (CDC), National Institutes of Health (NIH), Congress, Health & Human Services or any of the other federal agencies responsible for AIDS treatment, care, prevention, and research?

Well, The American Prospect, the liberal monthly policy magazine published not one, but TWO stories on domestic HIV policy, and both do a really great job of reporting what’s going on in terms of national HIV policy.

Kai Wright, the best AIDS reporter in the biz, has a story on AIDS in the South that shows his strength as a writer, and his enormous ease with a very complex subject as he deals with virtually every angle of the issue from history to prisons, to homophobia to government funding. He writes:

What was once considered an urban, coastal epidemic — centered in gay havens like New York City, San Francisco, and Los Angeles — is now a surprisingly rural, Southern one. More than half of all new infections logged between 2001 and 2004 were found in the South. Those infections are far more likely to be found among Southerners who are black, low-income, and diagnosed with advanced conditions they do not have the resources to control.

What’s being done? Adam Green’s story focuses on the work by AIDS activists in the US to push the government to have for a coordinated National AIDS Strategy. In case you didn’t know, part of Bush’s much celebrated (and highly problematic) PEPFAR prorgam is that any country applying for PEPFAR dollars must have a national strategy for AIDS prevention, treatment & care. THE UNITED STATES HAS NO SUCH PLAN. In addition, the nation’s capital has an HIV prevalence rate worse than many countries in sub-Saharan Africa. Green writes:

Instead, the domestic response is built on a loosely connected network of local, state, and federal programs. Authors and activists often describe this existing HIV/AIDS programming as a safety net. But the metaphor is not quite apt. There’s only a tenuous connection between the organizations. There’s little strategic coordination and no clear goals. The result is that people who are at risk or infected don’t know where or how to access care. In 2002, an estimated half of people with HIV/AIDS were not receiving care.

For more information on the National AIDS Strategy visit their website. Also, in early August I will be in Mexico City with CHAMP at the International AIDS Conference blogging on issues pertinent to the domestic AIDS epidemic at the conference, so be sure to check us out at www.AIDS2008.com

Saliva HIV Tests Showing False-Positives in NYC

If you’ve taken an HIV test, and have taken the 20 minute tests, you know there are two kinds: The finger prick test, and then the cheek-swab test. Well, NYC Department of Health has recently suspended use of the latter test because of a 3 year history of false-positives, according to the Centers for Disease Control and Prevention’s latest MMWR (Morbidity & Mortality Weekly Report). They write:

The cause for the episodic increases in false-positive oral fluid tests has not yet been determined. NYC DOHMH has again suspended the use of oral fluid testing in STD clinics, and finger-stick whole-blood testing is the only rapid HIV test being used in this setting. These findings underscore the importance of confirming all reactive HIV tests, both from oral fluid and whole-blood specimens. In addition, the results suggest that the NYC DOHMH strategy of following up reactive oral fluid test results with an immediate finger-stick whole-blood test reduced the number of apparent false-positive oral fluid test results and might be a useful strategy in other settings and locations.

Testing with blood is simply more reliable, but the CDC goes on to explain why they still recommend the use of the saliva based HIV test:

CDC continues to encourage the use of rapid HIV tests because they increase the number of persons who are tested and who receive their test results. Six rapid HIV tests have been approved by FDA since 2002 (10). The New York City data indicate that repeating a rapid test on finger-stick whole blood after receiving a reactive oral fluid test result allows clinic counselors to provide more accurate test-result information to patients while minimizing the number of finger-stick tests that must be performed. Regardless, confirmatory testing is required to confirm both oral fluid and whole-blood reactive rapid HIV tests. Before testing, all patients should be informed that reactive rapid HIV test results are preliminary and require confirmation. In general, testing with blood or serum specimens is more accurate than testing with oral fluid and is preferred when feasible, especially in settings where blood specimens already are obtained routinely.

Overall, oral fluid rapid tests have performed well and make HIV testing possible in many venues where performing phlebotomy or finger sticks is impractical for screening. However, users should be aware of the unexplained variability in the rate of false-positive test results. CDC will continue to work with FDA and the manufacturer to investigate the causes and extent of increases in false-positive oral fluid tests, monitor the performance of oral fluid and other rapid tests to ensure that they continue to perform as expected in testing programs, and investigate other combination test strategies to minimize false-positive test results.

I hate giving blood, but if you can help it, get the finger-prick test. It’s really not painful and seems to be more reliable. Getting blood drawn is probably still the best way, but waiting for days on end for lab results is nerve wrecking, so I only do those when I get an annual physical and blood work done with my doctor. Even if you get a positive result any of the rapid tests, they will always do a blood draw to confirm the results, which is why they know the saliva test was giving a higher rate of false positives.

Teen Sex

I love it when people do clever anti-propaganda. Take a look at the original government PSA to get parents to talk to their kids about sex:

Pretty stale and stupid, right? Now take a look at this ad, which is a spoof of the prior one. If more PSA’s were done like this, people–especially teens–might actually pay attention.

Non-Shock of the Week: Housing Improves Health for HIV+ & Other News

This was a big news week for people interested in HIV/AIDS domestically, which is usually rarely covered (and certainly not well) in the press. (For those of you new to this blog, I do a lot of work in HIV/AIDS prevention and policy as an activist/community organizer and writer.)

  1. The biggest, and most non-shocking of them all was the release of results from two major demonstration projects that showed if you give people with HIV access to affordable housing, they are much more likely to have fewer emergency room visits, fewer opportunisitic infections, adhere to treatment, and a host of other benefits. READ MORE.
  2. Also since this was the Black Church Week of Prayer on HIV/AIDS, a few editorials came out in newspapers. And I guess some people prayed about it. Columbia, SC’s The State produces an opinion piece that is high on blame-filled righteousness, and low on structural issues, which we KNOW for a fact are driving the epidemic in Black communities: “While there’s a dire need for more government funding for treatment and education, all citizens, black people particularly, must take responsibility for themselves and help battle this public health crisis, which affects all races, socio-economic groups and genders…People must change their risky behaviors. HIV/AIDS can be prevented. Anyone ever heard of abstinence, for example?”

Really? Ugh. My mom wants me to move to Columbia to be closer to family. I love you Ma, but when I read shit like this, I just can’t.

3. A better op-ed was written for the Marysville Appeal-Democrat, by two doctors with the DC based National Medical Association (which represents Black physicians). The offered some concrete advice for Pres. Bush to deal with the domestic AIDS crisis in Black communities: “• Develop a national plan. Despite the fact that this scourge is decimating minority communities in this country, the U.S. has no national plan to deal with the AIDS epidemic. • Appoint a leader. Not only does the U.S. not have a plan, but no one is in charge of the problem. Once a leader is named, community groups, churches, medical groups and others should work together to resolve the most pressing issues. • Focus on resources. While funds are scattered around the country to fight HIV/AIDS in many little pockets across the U.S., the bulk of the money should instead be devoted to African American communities with the highest rates of HIV/AIDS. “

4. The best editorial was written by Minnesota Congressman Keith Ellison for the Louisiana Weekly: “We must take time to get involved in our local communities, urging our friends and families to get tested and get educated about transmission modes of HIV/AIDS. We must continue our efforts to ensure that treatment is accessible to all those who are currently living with HIV. It is essential that we see this crisis in its broader context if we hope to slow the spread of this epidemic in our communities. I also believe we must take a hard look at other factors that the experts tell us contribute to these high rates of infection among African Americans: economics, education, homophobia, incarceration, and faith in government.”

5: Lastly there was a major breakthrough in HIV science, as reported by Science Daily: “By outfitting immune-system killer cells with a new pair of genes, scientists at the Albert Einstein College of Medicine of Yeshiva University transformed them into potent weapons that destroy cells infected with HIV, the virus that causes AIDS. Their novel strategy of genetically engineering immune cells to redirect their infection-fighting ability toward killing HIV-infected cells could lead to an entirely new approach for combating AIDS and other viral diseases.”

Letter to the New York Times on HIV and Gay Youth Editorial

(originally published on www.preventionjustice.org

Today the New York Times published a batch of letters responding to their editorial on rising HIV rates in young gay men. Since they didn’t publish my letter written as CHAMP staff, I thought I’d do it here (This is why we love the Internet!):

The January 14th editorial, “HIV Rises in Young Gay Men,” spent a lot of energy blaming 19-year olds, and ignored core issues that hamper effective prevention efforts.

A recent Journal of Adolescent Health study counted youth homelessness as a major factor in HIV risk. The New York City Council commissioned a 2007 report showing that one-third of all homeless youth in NYC were gay.

Congress continues to bankroll abstinence-only education programs in spite of the proven increase risk behavior they cause. Though the HIV epidemic grows worse in black and Latino communities, the Centers for Disease Control & Prevention (CDC) budget has remained stagnant for a decade.

We still have no national HIV prevention plan, 27 years into the epidemic.

Young gay men are not to blame for the profound failure of government to provide comprehensive HIV prevention—nor for the media’s continued ignorance of the root causes of HIV.

NYT Article on Gay Youth and HIV Draws Mostly Misinformed Analysis

(originally written for Prevention Justice.org: The blog of Community HIV/AIDS Mobilization Project)

Want the good news or bad news first?

I’ll give you the bad news.

Sex columnist Dan Savage whose syndicated column Savage Love is read weekly by millions in alternative weeklies around the country, wrote a blog entry for the Seattle news site The Stranger about the NYT story on rising HIV infections among young MSMs. His blog post was his usual snarky self, but horribly misinformed. He writes:

” so long as gay health educators refuse to level with gay men–there’s no “moderating” your meth use; you can suck too much cock; anal sex isn’t a first-date activity and having anal sex with hordes of anonymous partners, even with condoms, is sure-fire way of contracting HIV–these new campaigns won’t have much of an impact. And so we’ll be reading this story again in a couple of years, yet another story about HIV infection that makes tragic heroes of guys like Javier Arriola and goes on to suggest that straight talk about HIV infection is part of the problem, not part of the solution.”

Though Savage is very clever in his use of 4-letter words, he actually contributes to a problem of stigmatizing gay men who are HIV+ and/or in higher risk categories, but he also doesn’t understand the role race plays in all of this. CDC Behavioral Scientist Greg Millett recently published a meta-analysis of studies of Black MSMs and found that “…the assumption of higher risk behavior among black MSM-as measured by unprotected anal intercourse, total number of sex partners, and commercial sex work-was not found to explain the differential in infection rates relative to non-black gay and bi men. This conclusion was based on a review of more than 25 separate studies (Gay City News).”

The Washington Blade’s News Editor Joey DiGuglielmo tries to respond to Savage in their blog, but actually perpetuates a lot of the misinformation Savage spreads in the first place. DiGulielmo writes:

“…what HIV experts have often told me is that gay men who contract HIV in the ’00s almost always have done so by taking needless sexual risks. My friend Dane, who’s also well read on the topic, has even said that any gay man who contracts HIV these days is pretty much always making irresponsible sexual decisions.”

What? “My friend Dane who is well read on the topic?” I know he was writing for the blog and not the paper, but how does that pass as substantive expertise? Is the blog not held to similar standards as the paper? Doesn’t the news editor have access to sources (in DC, land of the policy wonks, to boot!) who could answered some quick questions on this? Even dropping by the CDC’s website would have given more useful information and data.

So that’s the bad news. Literally, and figuratively.

The good news, you ask? Thank GOD for GMHC Executive Director Dr. Marjorie Hill’s letter to the NYT’s story, which sheds some real light on a few contributing factors to the rising numbers.

Young gay men need real support and education before they have been infected and when they are at greatest risk. Research shows that key resiliency factors for gay youth are family acceptance and school-based interventions, such as gay-straight alliances and anti-bullying initiatives.

Sadly, when the New York City Council passed the Dignity for All Students Act ensuring these protections, Mayor Michael R. Bloomberg vetoed it. When the Council overrode his veto, Mr. Bloomberg chose not to carry out the law.

Our political leaders bemoan the continued spread of H.I.V. Yet when faced with real opportunities to address homophobia and other root causes of the epidemic, these same leaders fail us. It’s time that we recognize antigay bias for the public health threat that it is and seek its eradication.

All this could have been avoided if the original news story had gone one step further in explaining the structural interventions that would be useful for young Black and Latino gay men, and less stigma and blame.

Open Letter to the Left and the AIDS Movement

[NOTE from Kenyon: I got this letter over a list belong to, and know Suzy’s work in the HIV/AIDS world pretty well. I thought this might be an interesting addition to conversation many folks doing work on HIV/AIDS and the rest of the Left.]

Open Letter to the Left and the AIDS Movement:
Two ships passing on our winding way to a new dawn
Wednesday, July 4, 2007

[Note: I am a queer, white, HIV-negative person who uses female pronouns and has non-transgender privilege. These ideas are the result of conversations with many people, but I wrote this as an independent AIDS community journalist and a leftist, and I don’t speak for any group. Many thanks to my mentors who gave me feedback yesterday! It has changed a lot.]

The US Social Forum blew my mind, it grew my mind like a wild weed, it heard my voice and it rendered me inaudible—I talked and cheered and chanted so much that I couldn’t speak above a whisper from Saturday morning until today. It gave me a feeling like, the Left is finally getting its shit together. I got a sense that people of color—especially immigrants, indigenous people, women of color and queer people of color—were like, “the Left is ours,” and were bringing the most innovative strategies and concepts to be seen in years, rocketing the whole thing into another dimension.

The speech by Andrea Smith of INCITE! Women of Color Against Violence at the plenary on Liberating Gender and Sexuality: Integrating Gender and Sexual Justice Across Our Movements—and the audience of hundreds’ overwhelming response to it—was one of the most inspiring moments of my life. Not only did Smith question the domestic violence movement’s reliance on the state to protect us, her organization’s work offers all our movements the building blocks of an alternative.

I’ve been an activist for 17 years (mostly on access to higher education and queer and AIDS issues), and I feel like this is what many of us have been hoping for, yet not daring to imagine. Could the Left really be shedding its massive layers of racism, sexism, and homophobia? But the most inspiring moments always leave room for us to grow. This is a moment of great possibility for the AIDS movement and the Left. I won’t make a list of reasons why the AIDS movement had moments of feeling marginalized at the USSF, but to illustrate this, I will say that HIV/AIDS was not mentioned once at the plenary on gender and sexuality.

For those of us in the AIDS movement, this kind of silence tugs at old wounds, because Reagan did not say “AIDS” out loud until 1987, by which time an average of nine Americans had died of AIDS for every day that he had been in office. Now, we have lifesaving medicines in the US and other rich countries, but about 8,500 people around the world die of AIDS every day, and according to the NAACP, every day 72 African Americans contract HIV.

My goal with this letter is to point toward the light the Left offers the AIDS movement now, and ways the Left can learn from the AIDS movement now. The Social Forum illuminates both, because without women of color at the center, neither will ever find its way—and without the innovative new strategies emerging now, we would all just be talking.

Life after nonprofits

INCITE’s second book, The Revolution Will Not Be Funded: Beyond the Non-Profit Industrial Complex, sold out all copies at the Forum, and its panel by the same name filled up so quickly that organizers had to post a sign on the door saying, “Please do not open – Fire Hazard!”—and still people squeezed in. Southerners on New Ground (SONG, a multiracial LGBT/queer group) held a workshop where participants also discussed the limits of the 501c3 model (for example, competition for funding between community groups; letting funders set your agenda; allowing college graduates to serve as front lines in communities they know nothing about or are themselves gentrifying; big nonprofits setting movement goals; grassroots groups not being taken seriously; self-perpetuation being valued over service and honesty, etc.) and exciting new ways to do what SONG called “free organizing.” There were also “hybrid models,” with some aspects of both the 501c3 and the free, such as a working board of directors with no staff, or having members vote on organizational decisions and pay dues. (For questions to ask yourself and help stimulate more ideas, see http://www.southernersonnewground.org/?p=53)

One attendee talked about her childcare collective, which charges only $75 every five months (for groceries). An activist from Louisville said that her community trusts her group more now that they’re not backed by a white funder from outside the community. An activist from LA told how the Garment Worker Center is moving from a paid-staff model to all volunteers, with mentoring from Brooklyn’s Sista II Sista.

In the AIDS movement, we know how the move from street action to institution-building meant that we had built the capacity to provide lifesaving services to our communities. Plus, AIDS organizations are the biggest employer of LGBT people in the US—and in some places, a provider of jobs to many people in our community who have a hard time finding work in a discriminatory environment due to their experience with prison, homelessness, drug use, or sex work, or because they’re trans or gender non-conforming or living with HIV.

But our institutions are now turning on their creators—people living with HIV—and turning them into passive “consumers” of services, as if your local AIDS service organization were the local mall and HIV is no longer political. And “AIDS, Inc.” took us off the streets, cooled off our activism. Who among us hasn’t feared losing our jobs if we speak at that demo, or been told protests are a relic from the past? At the Campaign to End AIDS, a major national mobilization in 2005, Sean Strub, the PWA founder of POZ magazine, listed the major AIDS advocacy organizations that had failed to endorse or support the campaign, and railed against the lack of HIV positive inclusion on nonprofit boards.

SONG members pointed out that whether or not we choose to find new ways of serving and organizing our communities, we’ll be forced to anyway, because our community-based nonprofits are dying. This especially speaks to the AIDS movement. Small HIV prevention and support organizations that Black, Latino, gay and other communities started 20 years ago are closing their doors all over the country because the federal money is being cut back to just cover medical care and HIV testing, not vital programs like condom distribution, street outreach, counseling, buddy programs, language interpretation, and housing. (For more info see http://www.poz.com/articles/401_11463.shtml)

The most inspiring and transformative HIV/AIDS program I’ve ever witnessed, Philadelphia’s TEACH Outside, has been on the chopping block several times this year. Run by John Bell, who was a leader in ACT UP for years and is an HIV positive, African American Vietnam vet in recovery who spent years in prison, TEACH Outside is a class for people living with HIV who are newly released from incarceration. John Bell teaches how to live healthy with HIV and strategies for dealing with life on the outside, mentors students in activism, and tells them to call him anytime—but the biggest challenge for students is dealing with the double stigma of prison and HIV. I asked him once if the program is more than just a class, and he said, “It has to be. Because people aren’t just unfeeling beings. Even though people have been incarcerated they’re still human beings. To allow that person to become a working member of society, we’re going to have to actually address the totality of their being. The emotional side, the spiritual side, the intellectual side.”

Philadelphia’s Project TEACH classes keep facing the axe because they are “psychosocial programs,” not medical programs. So what are we going to do about the totality of the human being when the government will no longer fund it? Let’s figure it out. The AIDS community should aim to be among those at the forefront of this effort, because our communities may have the most to lose, with lives depending on our services.

Protecting each other

We can also learn new ways to protect our communities from violence. At another Social Forum panel, the Young Women’s Empowerment Project (a youth leadership organization grounded in harm reduction and social justice organizing by and for girls and young women ages 12-23 impacted by the sex trade and street economies) from Chicago talked about defending each other from street violence without relying on the police, who offer their own forms of violence. Some of the ways they suggest creating conditions in which violence against women is unacceptable include solidarity among women (sisterhood in the hood), safe housing, allies who can deal with pimps, and self-defense training. However we do it, finding new ways to protect each other from violence is an urgent need for the AIDS community, because the police do not protect people who are most at risk for HIV, like trans and gender non-conforming people, sex workers, and drug users. And the link between HIV and violence—which messes with people’s ability to protect themselves from HIV—means that protecting our communities from violence is HIV prevention work. Continue reading