Kenyon Farrow

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

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.

This is the way to do social marketing for HIV prevention for Black and Latino Gay men.

My friends at the Institute for Gay Men’s Health at GMHC continue to break the mold in terms of how to do effective, interesting, and NON-STIGMATIZING HIV prevention. For Black gay men in particular, we know that number of sex partners, higher rates of drug use or higher rates of unprotected anal sex isn’t what is driving the epidemic among Black gay men (who have the highest HIV rates in the US). One of the things that may be a contributing factor among Black gay youth is “serial monogamy”—Black gay men tend to only date one person at a time, but not having safe sex in those monogamous relationships, which are often (as is generally true with youth) short lived.

Also, when polled about their rates of getting tested, Black gays are generally getting tested regularly, so testing does not equal prevention. So all those “get tested” campaigns are not the issue, and they can actually be more stigmatizing, because the only time Black gays get talked about in public purview is to “protect the public” from disease. I guess we’re not considered part of the public—HIV+ or not.

If we recognize that folks need to have safe sex in their monogamous relationships, this social marketing campaign makes perfect sense as an intervention. I also love the fact that the ads are also all over Black and Latino neighborhoods in NYC.

Kudos, GMHC!

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.

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.”

(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.

(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.

Showing the “missing pieces” of HIIV prevention puzzle in the United States, more about three hundred people poured into the downtown Atlanta streets for the PJM Unity Rally and March in Atlanta, GA, on Tuesday, December 4th, where the National HIV Prevention Conference (NHPC) ended on Wednesday. People from across different communities marched to demonstrate unity for a comprehensive HIV prevention in the US, not to be divided by community or issue.

In order to draw conference attendees from the hotel to the opening rally two blocks away at Hardy Ivy Park, a group of carolers sang an HIV prevention song to the tune of “The 12 Days of Christmas.”

“In the AIDS epidemic, the gov’ment gave to me-NO NATIONAL PLAN, anti-gay bias, a decade of flat funding, a fast track to prison, no decent housing, roadblocks to treatment, silver virginity rings, censorship of science, discrimination, misinformation and a country full of H.I.V.”

Other PJM folks were in the lobby, decorating marchers with the PJM sash—a white satin cloth with the red PJM Unity logo.

The spirited marchers burst from the Hyatt onto Peachtree Street, blowing whistles and chanting, and made their way to Hardy Ivy Park to meet the crowd already assembled. The march MC Waheedah Shabbazz-el took the bullhorn and hyped the crowd to a frenzy, reminding the crowd, “HIV is more than a disease, It’s positive proof of injustice!” The marchers grabbed signs and fliashlights from organizaers and marshals, and the rally was in full swing. READ MORE!!

World AIDS Day is usually marked by solemn events marking another year into the HIV/AIDS epidemic. We count how many deaths, and how many people living wit HIV, and sometimes we remember famous people who have died from the disease.

And there is where it usually ends.

But this year, YOU can do something different! I AM!

I am heading off to Atlanta on Friday to begin to work spend the next few days writing, blogging, pr-ing and capturing the Prevention Justice Mobilization. The PJM is working with several other organizations to across the nation to re-ignite a social justice movement around the HIV epidemic in the US, because “HIV is NOT just a disease. It’s proof positive of injustice!” We will be hosting a series of activities beginning World AIDS Day in Atlanta, and running in conjunction with the CDC and NIH’s National HIV Prevention Conference in Atlanta December 2-5th.

The truth is that we STILL have an HIV epidemic in this country, and it does not appear to be getting better. Many of us have lulled ourselves into thinking about HIV as solely an issue of individual risk-and have abandoned any kind of radical analysis on the left. The Left, by and large, simply does not deal with HIV as a social justice issue at all.

But hopefully we, with your help, can change that. We can both remember and honor people who have died from HIV but also continue to think through, and include in our analysis in a real way (not just add to the lefty laundry list) the way in which risk of HIV infection is a symptom of socio-economic status in a racist/misogynist/homo and transphobic society.

Here are some tools to help speak to this issue, and I hope you’ll pass this along to your friends and comrades, and your lists.

So I hope you listen to this radio show that speaks very much to the issue.

• The internationally broadcast radio show Making Contact just began airing a show about Black and Latina women and HIV called The Color of AIDS: Bringing Risk Up to Date. You can listen to it on the site. They write: In the United States, HIV/AIDS is no longer just a disease affecting white, gay men. The percentage of cases of women living with HIV has tripled in the past 20 years, and women of color are most affected. Yet outdated perceptions about the epidemic drive government prevention work, from the way data is collected to who gets tested. On this edition, those on the frontlines of the grassroots HIV/AIDS movement bring the discussion about HIV risk up to date. They say generating more relevant prevention models is literally a matter of life and death, especially for women of color.”

• The AIDS TASK Force of Great Cleveland TODAY released The Financial Health of AIDS Service Organizations in the United States, 2001-2007

• Keep up with the latest in Prevention Justice on the site and blog, www.preventionjustice.org.
  You can also endorse the mobilization there, if you haven’t already.

The Southern Voice, Atlanta’s gay newspaper, just finished a two-part series on condom use and gay men. The articles expose the different relationships that gay men have to condom wearing in the new millenium. The first story in the series from last week focuses on young gay men, who came of age after the heightened awareness of HIV in the 1980s/1990s.

There was once a time, in the not too distant past, when there wasn’t a gay social function — whether held at a club, community center or festival — that didn’t stock condoms seemingly by the truckload.
There was once a time, in the not too distant past, when many gay men — older men, teens, even gay porn stars — wouldn’t think about having unprotected sex, particularly with casual sex.

Times have changed.
Jay Dempsey runs the P.O.O.L. program for gay men at AID Atlanta, and begins each new group by asking attendees whether condom use is still the sexual norm among local gay men.

“The answer’s always no,” Dempsey said.

The change in gay men’s views toward condoms is often associated with the onset of highly effective anti-AIDS drugs in the mid-’90s, when the perception of the disease transformed from an automatic death sentence to an almost invisible, manageable illness. Experts agree that no longer seeing friends suffer or die from AIDS has affected how gay men approach safer sex, but other factors have changed as well.

The second story focuses on so-called condom fatigue-the idea that older gay men have grown weary of wearing condoms. The practice has increased with the proliferation of barebacking happening due to sex parties, online sex-seeking sites, and raw porn.

For many years, Tierney said, gay men faced a simple decision when it came to using a condom: Do it, or die. With contracting HIV no longer meaning sudden death, Tierney said gay men are now engaging in “higher level reasoning” that includes considering which sexual position they assume, the type of sex they’re engaging in, their partner’s viral load and a host of other factors.

At the same time this week, a story broke in the UK about two porn actors contracting HIV after a third actor first tested HIV negative before their shoot, but later tested positive.

I have noticed in the last year since being single again that several men I have had sex with have stated to me when I pull out my rubbers that “It’s OK. I get tested every 3 months, 6 months, or yesterday, or whatever.” It’s amazing to me that we’ve come to assume that getting tested is the same as HIV prevention, which is hardly the case. The HIV antibody test is only checking for the antibodies your body produces to fight HIV, which takes about 3 months to show up. It is not testing for the virus itself. That’s why the porn actor actually had HIV, but must have recently seroconverted, which is why his first test was negative: Negative for the HIV antibodies.

Some people will say that “wearing condoms is not natural, which is why gay men want to have sex without them.” That’s true, which is why I am hoping we eventually get both a vaginal and anal microbicide. But at the same time, there are many things we do to prepare for sex that aren’t necessarily natural. Lube isn’t natural, for instance.

But more importantly, we need to begin to debunk the myth that HIV is solely about individual behavior. It’s not-otherwise HIV rates would be equally distributed amonst populations. But we know that black gay men have fewer sless unportected anal sex, and in some studies fewer sexual partners than white gay men, yet black gay men have much higher rates of HIV. We know that poverty, structural racism, violence, housing instability, mass imprisonment and homophobia are all reasons black gay men have more disease burden (called “social determinants” of health).

I am part of a new movement called “prevention justice.” And the Prevention Justice Mobilization (PJM) is a series of HIV-prevention events and actions around the United States from November 1 to December 15, 2007. We are uniting to demand leadership in the fight against HIV/AIDS and justice in prevention policies.

The events and actions will include:

• Local events around the country across the range of prevention justice issues, including on World AIDS Day (December 1)
• Events at the National HIV Prevention Conference, Atlanta, December 2-5, including Unity Rally on December 4!
• A statement of Prevention Justice principles and accompanying materials like a Prevention Justice Briefing Book and a World AIDS Day Action Kit

Why Prevention Justice?
It’s no accident that the groups at the lowest rungs of the social and economic ladder also have the highest rates of HIV, including African-Americans, (especially black women and black gay men); Latina women; gay men and other men who have sex with men; transgender people; undocumented immigrants and people residing in the Deep South. And good prevention policies are vital for the health, rights and dignity of all people, including people living with HIV.
Prevention Justice believes that the best way to prevent HIV/AIDS is to ensure that all people have the economic, social, and political power and resources to make healthy decisions about our bodies, sexuality, and reproduction for ourselves, our families, and our communities.

The Prevention Justice framework changes not only the way we look at HIV prevention, but how we go about advocating for HIV prevention. Prevention Justice means the people and communities most affected by the epidemic are at the forefront of policy efforts, and that HIV prevention cannot be separated from human rights.

What are the Prevention Justice Mobilization goals?

• Unity and Leadership in the Struggle against HIV!

• Promoting unified actions and cooperation among AIDS groups and prevention advocates.

• Demanding the resources we need to fight HIV and win progressive policies, rather than competing with one another for crumbs.

• Mobilizing progressive organizations across the country that work on intersecting issues (like racism, criminal justice, immigration, gender-based violence, welfare, housing and economic and environmental justice) to explicitly incorporate HIV/AIDS in their efforts and to engage the AIDS community to support a progressive agenda for all communities.

Mobilized for Prevention Justice!!!

• Endorse the Mobilization as an organization or individual

• Affiliate your local events from November 1 – December 15 with the Mobilization

• Organize a local event for World AIDS Day and list on our site as part of the Prevention Justice Mobilization – we have a World AIDS Day Toolkit to help your efforts

• Mobilize people from your community to attend PJM events in Atlanta, Dec. 1-5

The PJM was initiated by Community HIV/AIDS Mobilization Project (CHAMP) in collaboration with SisterLove, the Georgia Prevention Justice Alliance, the Harm Reduction Coalition, the National Women and AIDS Collective, the New York State Black Gay Network, ACT UP Philadelphia, the Center for HIV Law and Policy, and AIDS Foundation of Chicago.