CELEBRITY FRIDAY: Black AIDS Institute Names New Executive Director (Raniyah Copeland)

The new executive director of the Black AIDS Institute has been named as Raniyah Copeland. The president and chief executive officer of BAI has been Phil Wilson since its founding in 1999. The BAI is the nation's first  and only "national HIV/AIDS think tank focused on Black communities." Copeland, 34, has worked at The Institute for the last ten years. Wilson announced his retirement last year and the board conducted an extensive 10-month process to find a new leader for the organization.

The announcement was made at BAI's signature event "Heroes in the Struggle" last Saturday December 1.

CELEBRITY FRIDAY: Openly Gay MacArthur "Genius" Fellow Gregg Gonsalves

The 2018 MacArthur Fellows were announced yesterday and at least one of the "genius grant" winners is openly gay: Gregg Gonsalves, a well-known HIV/AIDS activist who was instrumental in the AIDS Coalition to Unleash Power (ACT-UP) in the 1990s. More recently he has become a global health advocate and received  a Ph.D. in epidemiology from Yale University in 2017.

The official summary of Dr. Gonsalves' work from the MacArthur Foundation is:

Gregg Gonsalves is an epidemiologist and global health advocate integrating his experiences as a community activist with quantitative analysis and operations research to improve responses to global public health challenges. For nearly three decades, Gonsalves was an HIV/AIDS activist, working with domestic and international organizations such as AIDS Coalition to Unleash Power (ACT UP) and the AIDS and Rights Alliance for Southern Africa. His efforts to connect the HIV/AIDS community with top-tier researchers and scientists were a critical catalyst to fundamental advances in scientific knowledge of the disease. These experiences deeply informed his later training in epidemiology and current efforts to optimize the effectiveness of health programs for epidemic diseases, particularly within poor and marginalized communities. 

Using a variety of quantitative approaches and operations research modeling, Gonsalves has determined how to identify hot spots for HIV testing in real time in order to maximize identification of undiagnosed HIV-positive persons; shed light on ways to minimize dropout of HIV-positive patients at key points in the care continuum; and assessed the epidemiological costs of emerging epidemics of HIV in the United States due to intravenous drug use and lack of needle exchange programs. In another line of research, Gonsalves examined the link between high rates of sexual violence against women living in informal settlements in Cape Town, South Africa, and the lack of indoor sanitation—the remote location of facilities left women vulnerable to attacks. He developed a mathematical model that determined the optimal number of new facilities and demonstrated that sanitation investments by the city would significantly reduce instances of sexual violence as well as their associated costs. 

Gonsalves co-founded the Global Health Justice Partnership (GHJP), an interdisciplinary initiative between the schools of law and public health at Yale University, to further advance human rights and social justice perspectives in public health and legal research, practice, and teaching. Working in cooperation with local nongovernmental organizations, GHJP mobilizes research and evidence around pressing health issues and translates that evidence into action. For example, GHJP and colleagues in South Africa documented the failure of mining companies and the South African government to compensate families for tuberculosis (TB) and silicosis acquired in the mines, and they continue to advocate for policy reform based on their comparative research. Currently, GHJP is working with organizations in Brazil to investigate the role of the war on drugs and high incarceration rates on the community burden of TB as well as advocacy for wider availability of hepatitis C treatment in U.S. prisons. Through these initiatives, Gonsalves is training a new generation of researchers who, like himself, work across public health and human rights sectors, scholarly research, and activism to correct disparities in global public health.

Congratulations!

2017 World AIDS Day

Today is World AIDS Day. It is the 29th annual recognition of the impact on HIV and AIDS organized by the United Nations.  This year's theme is "Increasing Impact through Transparency, Accountability, and Partnerships."

UPDATE: Michael Johnson Accepts 10-Year Plea Deal In HIV Transmission Case

There is an update in the infamous Michael Johnson case: where a 23-year-old Black gay man was sentenced to 30 years in prison under Missouri's discriminatory HIV criminalization statute after a trial influenced by homophobia and racism. Happily, the 30-year sentence was overturned last year.
The news comes that Johnson has agreed to a plea deal where he gets a 10-year prison sentence (including the 4 years he has already served). He is entering an "Alford plea" which says that he agrees that the state has enough evidence to convict him of a crime.

The Center for HIV Law and Public Policy issued a press release on the Johnson case:

New York, NY, September 21, 2017 – Today, in conclusion to a prosecution short on fairness and riddled with questions about racism and homophobia, Michael Johnson entered a plea in the St. Charles County Circuit Court in Missouri. Earlier this year, a state appeals court vacated his original conviction due to prosecutorial misconduct that, according to the court, made Johnson’s first trial “fundamentally unfair.” 

However, because Missouri’s HIV criminal law hinges liability on whether or not the defendant can prove he disclosed his HIV status prior to sex – a virtual impossibility in most instances – Johnson decided to accept a plea deal that credits him with time served. Under Missouri’s law, one of the harshest in the country, Johnson could have faced up to 96 years in prison if found guilty. 

“It is disturbing that Michael is not yet a free man and was not exonerated after his years-long struggle for justice, but we respect and support his decision not to risk a life behind bars,” said Mayo Schreiber, Deputy Director of the Center for HIV Law and Policy (CHLP). “It likely is the end of his case, but our work to bring an end to HIV criminal laws like Missouri’s continues.” 

Johnson, who was 21-years-old at the beginning of this case, entered a no-contest plea to charges that he had sex with partners without first advising them of his HIV status. In exchange, he has accepted a sentence of 10 years in state prison, which will include time already served since his arrest nearly four years ago.  He previously had been sentenced to 30 years in prison before the appeals court threw out the original conviction. 

Prior to his arrest in 2013, Johnson was a promising young college student and star athlete. His prosecution has drawn condemnation from state and national organizations and individuals uniformly outraged by his conviction and opposed to these fundamentally unfair laws being used to prosecute people living with HIV and, disproportionately, like all other criminal laws in the United States, people of color.

In related news, this week the California state legislature passed SB 239, which modernizes the state's laws around HIV transmission so that HIV is treated like other communicable diseases.

Hat tip to TowleRoad

REPORT: Racial Disparities Exist In HIV Criminalization

This will not be a surprise to anyone who has been following the story of HIV criminalization in the United States over the last few years. The Black AIDS Institute has issued a report on a new academic finding that exposes the racial disparities that exist in HIV criminalization.

Two studies—one commissioned by the Williams Institute, a think tank at the UCLA School of Law that conducts independent research on sexual-orientation and gender-identity law and public policy, and the other presented at the International AIDS Conference in Durban, South Africa, in July 2016—link the criminalization of HIV to higher rates of incarceration for PLWHA of color, and community activists confirm it.

[...]

Researchers found that while White men made up 40 percent of the people diagnosed with HIV in California, only 16 percent of them had had contact with the criminal-justice system related to their HIV status. Black men made up 16 percent of PLWHA but 19 percent of those who had contact with the criminal-justice system. They were also more likely than White men to come into contact with the system repeatedly based on their HIV status: 25 percent vs. 10 percent. Overall, White men were more likely to be released and not charged. Black women made up only 4 percent of the population of PLWHA, yet an astounding 21 percent of them had come into contact with the criminal-justice system. Researchers say that more work needs to be done to identify what is driving the racial and gender disparities. 

In July, Trevor Hoppe, Ph.D., assistant professor of sociology at the State University of New York at Albany, presented his paper "HIV: Does Race Impact Sentencing Under Criminal HIV Exposure and Disclosure Laws in the United States?" at AIDS 2016. Hoppe looked at five states—Arkansas, Florida, Michigan, Missouri and Tennessee—and found that Black men were given an average sentence of 110 months after being convicted on an HIV-specific criminal law, while White men averaged 74 months for violating the same statute. He found the greatest racial disparity in Arkansas, where Black men's sentences were double those of white men—279 vs. 140 months. "In Arkansas, Black men were sentenced to a dozen more years," says Hoppe.

There are too many examples of public policy not keeping up with the advancement of scientific knowledge about HIV transmission and, unsurprisingly, it is people of color who appear to be disproportionately impacted by this. Just ask Michael Johnson!

WORLD AIDS DAY 2015 Is Today

Today is World AIDS Day. Interestingly, the term "AIDS" is increasingly becoming disfavored among clinicians and doctors who work in this are, who are gravitating towards the term "HIV Stage 3."

Check out this helpful fact sheet:

1. Acute HIV Infection
   Acute HIV infection is the earliest stage of HIV. Acute HIV infection generally develops within 2 to 4 weeks 
2. after a person is infected with HIV. During acute HIV infection, many people have flu-like symptoms, such as fever, headache, and rash. In this acute stage of infection, HIV multiplies rapidly and spreads throughout the body. The virus attacks and destroys the infection-fighting CD4 cells of the immune system. HIV can be transmitted during any stage of infection, but the risk is greatest during acute HIV infection.


3. Chronic HIV Infection
   The second stage of HIV infection is chronic HIV infection (also called asymptomatic HIV infection or clinical latency). During this stage of the disease, HIV continues to multiply in the body but at very low levels. People with chronic HIV infection may not have any HIV-related symptoms, but they can still spread HIV to others. Without treatment with HIV medicines, chronic HIV infection usually advances to AIDS in 10 to 12 years.


4. AIDS 
   AIDS is the final stage of HIV infection. Because HIV has destroyed the immune system, the body can’t fight off opportunistic infections and cancer. (Examples of opportunistic infections include pneumonia and tuberculosis.) AIDS is diagnosed when a person with HIV has a CD4 count of less than 200 cells/mm3 and/or one or more opportunistic infections. Without treatment, people with AIDS typically survive about 3 years.

I wonder how Charlie Sheen is marking todays date (in light of recent revelations)?

QUEER QUOTE: CHLP Responds To Black Gay Man's 30-Year Jail Sentence

I previously blogged about the case of the HIV+, Black, gay college wrestling champion named  Michael Johnson who was arrested, tried and convicted using Missouri's draconian HIV criminalization statute for sexual activity he engaged in with consenting adults. Yesterday I blogged this week that Johnson has now been sentenced to multiple, concurrent 30-year terms. Michael Johnson is 23-years-old and apparently had diagnosed learning disabilities while he was in college.

The Center for HIV Law and Public Policy has released a statement condemning Missouri's prosecution (and persecution) of Johnson which is today's Queer Quote:

“The criminal statute that Michael Johnson was convicted of violating was originally passed in 1988, at a time when HIV was considered a ‘death sentence.’  Today, with proper treatment, HIV is a chronic, manageable disease and those with HIV can expect to live a full, healthy life. Yet violation of the Missouri law is a class A felony, with a sentencing range of 10-30 years or life imprisonment. Other class A felonies include murder or child abandonment resulting in death.  Punishing Michael Johnson as if he is a murderer because state officials have failed to address a severely outdated, irrational criminal law is not only fundamentally unfair, it is barbaric.”

Here at MadProfessah.com we will be following this case closely!

UPDATE: Black Gay Man, 23, Sentenced To 30 YEARS Under Missouri's HIV Criminalization Law

The sentence for Michael Johnson, the former college wrestler who had unprotected sex with numerous guys that he met on the Internet and mobile hook-up apps, and was subsequently charged with (and found guility of) violating Missouri's draconian HIV criminalization statute has been released: 30 years in prison. Johnson actually received multiple sentences of 30 years but the judge said he could serve them concurrently (at the same time).

St. Charles County Circuit Judge Jon Cunningham, who issued the sentence, told Johnson he had committed "very severe" crimes. Prosecutors said he didn't tell the partners he had HIV."The main thing is the profound effect your actions have had on the victims and their families," the judge said.Johnson was given 30 years on the most serious allegation and a total of 30.5 years on the four lesser charges.  Those were the amounts of prison time recommended by the jury. Cunningham decided to have the terms on the lesser charges run concurrently with the 30-year sentence.

It should be noted that if Michael Johnson had been found guilty of second-degree murder the sentence would be between 10 and 30 years!

Had Michael Johnson been convicted of second-degree murder in Missouri, the sentence would have been between 10 and 30 years.  Forcible rape: no less than 5 years; Forcible rape if a weapon is used or serious physical injury results, it could be as little as 15 years.  Forcible rape of a child under the age of 12 has a mandatory 30 years, the same sentence Michael Johnson got today.  First degree statutory rape of a child under the age of 12 could get as little as 10 years.

The primary organization I know that is doing something about such unfair actions is the Center for HIV Law and Policy.

QUEER QUOTE: Openly LGBT Los Angeles Supervisor Proposes PrEP Program

Sheila Kuehl is  widely known as one of the smartest politicians in California so it was great news when she was elected to be one of the five most powerful people in Los Angeles County last November. She is using her position to enact public policy that will positively impact her constiuents. Karen Ocamb of Frontiers Magazine reports that Supervisor Kuehl is going to propose that Los Angeles County find a way to implement Pre-Exposure Prophylaxis (commonly known as PrEP) to low-income and at-risk individuals.

At next Tuesday's Board of Supervisors' meeting Kuehl is going to introduce this motion which is today's Queer Quote:

Recommendation as submitted by Supervisor Kuehl: Authorize the Interim Director of Public Health, in partnership with the Director of Health Services, to develop and implement a plan for a robust, comprehensive program to deliver Pre‑Exposure Prophylaxis (PrEP) throughout the County, considering a broad range of medical providers, including the Departments of Public Health and Health Services’ operated clinics as well as community‑based organizations and clinics, that can effectively provide PrEP to those at high risk for contracting HIV; instruct the Interim Director of Public Health to report back to the Board in writing within 30 days on the PrEP program implementation plan, including details on program target population, program elements such as robust public education and awareness campaign, the provision of technical assistance to local providers and service delivery elements, specific timeline and milestones for program implementation, program monitoring and evaluation of the plan, and the Departments of Public Health and Health Services’ financed investment strategy; and instruct the Interim Director of Public Health to develop and release a solicitation within 45 days to fully support private‑sector delivery of PrEP services to benefit uninsured and underinsured residents of the County at high risk for HIV infection.  (15‑2677)

The motion itself goes into far more detail about the necessity of the move and discusses the potential positive impacts it could have on the transmission of HIV in Los Angeles County. For example:

Since the FDA approved PrEP in 2012, Los Angeles County has become home to more PrEP demonstration projects than any other area of the U.S. These projects, including projects at multiple DHS sites, are designed to assess the feasibility, acceptability, and cost-effectiveness of PrEP as an HIV prevention intervention. These demonstration projects show that the delivery of this intervention is, in fact, feasible and that demand is high and growing, particularly among those groups of Los Angeles County residents most at risk for HIV. Outside of these demonstration projects, numerous Los Angeles County residents have been able to access PrEP through their private health insurance plans and Medi-Cal. Despite increasing local access to this intervention, however, many Los Angeles County residents at high risk for contracting HIV, who could benefit from PrEP, are still unable to access this service.  

Among the factors contributing to limiting access to PrEP are a lack of knowledge and awareness by consumers and providers, cost, and limited PrEP service delivery sites. The delivery of PrEP as part of a comprehensive public health HIV prevention strategy must include access for high risk uninsured and underinsured individuals in Los Angeles County, especially young African-American and Latino gay men, transgender persons and African-American and Latina women. For these reasons, the Los Angeles County Commission on HIV recommended, in an October 2014 resolution, that this Board authorize and expedite expanded access and comprehensive implementation of PrEP. 

I'm happy to see this moving forward. I wonder how this will spur other large urban jurisdictions with large HIV-impacted populations like New York City, Atlanta and Chicago to act similarly sooner rather than later?

CDC Announces $185M To Combat HIV In Gay Men and MSM

The CDC announced a substantial investment of $185 million in HIV prevention among gay and bisexual men and men who have sex with men. This is a huge endorsement in the efficacy of PrEP (Pre-Exposure Prophylaxis) in combating the HIV/AIDS epidemic.

Up to $125 million of the funding will be provided over three years to state and local health departments to scale up two new, powerful HIV prevention strategies:

• Increasing PrEP uptake: Numerous studies have shown that people who take PrEP daily can reduce their risk of contracting HIV by more than 90 percent.

• Health departments will be funded to provide PrEP information and referrals and to conduct outreach and training to increase the number of health care providers who are knowledgeable about PrEP and offer it to their patients.

• The primary objective is to increase the knowledge about and uptake of PrEP among MSM and transgender people at greatest risk of infection.

• Twenty-four health departments in areas where MSM are severely impacted are eligible to apply for these funds.

• Using routinely collected data to increase engagement in HIV care: A recent CDC study showed that more than 90 percent of new HIV infections in the U.S. could be averted by diagnosing people living with HIV and ensuring they receive prompt, ongoing care and treatment. Only about half of MSM diagnosed with HIV in the U.S. are engaged in regular care.

• Health departments will be funded to expand the use of HIV surveillance data to help connect and reengage people diagnosed with HIV but not in care with needed services, prioritizing MSM and transgender people.

• Twelve health departments in areas where MSM are severely impacted and that have sufficient clinical data are eligible to apply for these funds.

“Science tells us that increasing PrEP access and engaging more HIV-positive people in care and treatment could prevent tens of thousands of new HIV infections, but these strategies remain underused,” said Eugene McCray, M.D., director of CDC’s Division of HIV/AIDS Prevention. “This new funding will drive wider adoption where it’s urgently needed and provide lessons on how to improve uptake nationwide.”

Finally some good news about the HIV/AIDS epidemic in the United States.

Today is National Black HIV/AIDS Awareness Day

Today, February 7th,  is National Black HIV/AIDS Awareness Day.

FDA Proposes Reducing Lifetime Ban On Gay Blood Donors To One Year

The Food and Drug Administration (FDA) released a statement today which indicates that it will propose changing the current lifetime ban on blood donations from any man who has had sex with another man since 1977. The proposed policy will be that gay men who declare that they have not had sex with another man in over a year shall be allowed to donate blood.

The reaction to the proposed policy change was decidedly mixed:

Slate’s Mark Joseph Stern wrote: “…the FDA remains trapped in the 1980s—terrified of gay men and their diseased, untrustworthy ways. Perhaps in another 31 years, we’ll see the FDA move to a sensible, nondiscriminatory rule. For now, we’re stuck with this embarrassing, unscientific half-measure. 

U.S. Senator Patty Murray (D-WA) told her constituents, “Today’s announcement is a welcome step in the right direction. However, I am disappointed that low-risk gay men are still being discriminated against with this outdated policy. Healthy Americans who don’t engage in risky behavior, regardless of their sexual orientation, should have the opportunity to donate blood and help in the effort to save lives. I look forward to working with Secretary Burwell to build on the step taken today by removing this discriminatory ban while keeping our blood supply safe.”

I think my position is somewhere closer to Senator Murray's than Mark Joseph Stern's although I would agree that this is a half-measure. That being said, you can still acknowledge that a change has been made, and the change is in the right direction even if it is not as much change as one would prefer. I also agree that the proposed policy change would STILL be discriminatory and is unacceptable public policy, but it is still better than the current policy which was completely irrational and rooted in homophobia.

REPORT: Lifting Ban On MSM Blood Donation Would Increase Supply By 2-4%

The Williams Institute at UCLA Law School has released a report that analyzes the impact of changing the current lifetime ban on blood donation by any man who has had sex with another man (MSM) since 1977.

In "UPDATE: Effects of Lifting Blood Donation Bans on Men who Have Sex with Men" authors Ayako Miyashita and Dr. Gary Gates estimate the number of men who would donate blood if the "gay blood ban" was relaxed at over 300,000 leading to an increase in the blood supply of 2-4%  (600,000 pints) per year which could potentially save the lives of 1.8 million people.

The way the estimate is done is that Miyashita and Gates look at three different scenarios in which the current lifetime ban is changed in three ways: removed entirely, changed to a "deferral" lasting 12-months after sexual contact with another man and changed to a 5-year deferral.

In the US, 8.5% of men (10 million) say that they have had at least one male sexual partner since age 18. GSS data show that 4.1% of men (4.8 million) have had a male sex partner in the last five years, and 3.8% of men (4.5 million men) reported having a male sex partner in the last twelve months.

[...] 

If the current MSM ban were completely lifted, we estimate that an additional 360,600 men would likely donate 615,300 additional pints of blood each year. If MSM who have not had sexual contact with another man in the past twelve months were permitted to donate, we estimate that 185,800 additional men are likely to donate 317,000 additional pints of blood each year. If MSM who have not had sexual contact with another man in the past five years were permitted to donate, we estimate that 172,000 additional men would make an additional 293,400 blood donations.

To me it appears as if the report buries the lead! 8.5% of American men say they have had sex with another man since age 18 (i.e. as an adult). Does that mean that this percentage of the population is "gay"? Not really, since being gay is a complicated combination of identity, self-realization and  resistance to social stigma. However, in my mind the significance of this figure is the demonstration that same-sex sexual attraction among men is more common than is usually reported to the general public.

QUEER QUOTE: Science Publishes Response To Image Of Transgender Sex Workers

A few weeks ago the most prestigious science journal in the world, Science, published a special issue with numerous articles about HIV/AIDS in conjunction with the 20th International AIDS Conference being held in Melbourne, Australia. The July 11th issue used a cover of "transgender sex workers in Jakarta, Indonesia" although none of the articles in the issue had anything to do with this community.

The National Organization of Gay and Lesbian Scientists and Technical Professionals NOGLSTP) wrote a letter to the editor ebuking Science for the ill-advised cover, which they published in the August 15 issue and Dr. Marcia McNutt (Science's first female editor in its 200-plus year history) responded.

Here is the text of Shelley Diamond's letter to the editor, which is today's Queer Quote:

I am Chair of the Board of Directors of the National Organization of Gay and Lesbian Scientists and Technical Professionals (NOGLSTP) that encompasses lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ) people in science, technology, engineering, and mathematics. On behalf of NOGLSTP, an AAAS affiliate since 1994, I wish to register our indignation with the 11 July cover of Science showing transgender sex workers from Jakarta. The cover, a misguided attempt to pique interest in reading the special section on HIV/AIDS, has provoked many readers, including many members of our organization, to express their dismay at Science's lack of decorum and lack of sensitivity to a much maligned and misunderstood community. The scant attention the magazine paid to the transgender sex worker community makes these omissions all the more important. With one inappropriate picture, you have managed to stereotype all transgender women as sex workers and vectors of disease, as well as hyper-sexualize women of color in general. NOGLSTP applauds the articles presented in this issue, but we question why the cover explicitly shows transgender sex workers when there is no actual content in the articles about HIV prevention, care, or treatment efforts in these transgender communities. 

To avoid the kind of hurtful misunderstanding and atmosphere of disrespect that has been generated by this dehumanizing and insensitive decision, NOGLSTP leadership would have been happy to facilitate discussion between science and engineering leaders in the trans community and the editorial staff of Science regarding appropriate content as it relates to transgender sex workers and the struggles they face, of which HIV infection is but one. 

This incident should be used as a teachable moment to correct the prejudices of those who are insufficiently familiar with LGBTQ communities and their concerns. We exist in all cultures, ethnicities, and walks of life. We are proud scientists, engineers, mathematicians, doctors, and technologists who are part of the Science readership. The cover photo is unworthy of Science and AAAS. The LGBTQ communities, including in particular the trans community in this instance, deserve more respect than you have offered. The ethic of science demands that we regard all minds and people equally. 

Prejudice has no place in our endeavors. 

Rochelle DiamondChair, NOGLSTP Board of Directors, Pasadena, CA 91109, USA.E-mail: rd-chair@noglstp.org

And the response from the editor of Science, apologizing for using the image:

We deeply regret the harm done by the ill-considered choice of cover. Dr. Diamond, in her letter, has made constructive suggestions to help our organization prevent further misunderstandings with the LGBTQ communities, become more sensitive to their issues, and repair damaged relations. We are already in discussions on how to follow up on those recommendations. Many thanks to other leaders in the LGBTQ and other communities who have also graciously stepped forward with offers of help. 

Marcia McNuttEditor-in-Chief

I am a big fan of NOGLSTP (full disclosure: they gave me an award in 2011) and am glad to see that discussion about the image used in Science and an ackowledgement i print that LGBTQ people are part of the readership of Science. I personally was not offended by Science magazine's use of the photo to promote its special issue on AIDS but I can see how many people could have been offended and do agree that it was an "ill-considered choice."

It will be interesting to see how Dr. McNutt follows up with her letter. Perhaps some coverage of NOGLSTP's Out to Innovate summit in November 2014 or at the very least some discussion of the role of LGBTQ people in science would seem like reasonable actions.

Science Magazine Has Special Issue On HIV/AIDS This Week

The most prestigious scientific journal in the world has a special issue on HIV/AIDS this week, with a cover devoted to an article about transgender sex workers in Jakarta (pictured above). Next week, the 20th International AIDS Conference is being held in Melbourne, Australia.

Hopefully the news on progress in the fights against AIDS/HIV will be good in the next few weeks!

CDC Endorses Truvada For HIV Prevention Purposes

There was important news in the fight against HIV/AIDS this week. The federal government announced they were issuing guidelines that recommend that sexually active HIV-negative gay men take doses of Truvada for "pre-exposure prophylaxis" (PrEP) purposes.

The guidelines say PrEP should be considered for HIV-uninfected patients with any of the following indications:

• Anyone who is in an ongoing sexual relationship with an HIV-infected partner.

• A gay or bisexual man who has had sex without a condom or has been diagnosed with a sexually transmitted infection within the past six months, and is not in a mutually monogamous relationship with a partner who recently tested HIV-negative.

• A heterosexual man or woman who does not always use condoms when having sex with partners known to be at risk for HIV (for example, injecting drug users or bisexual male partners of unknown HIV status), and is not in a mutually-monogamous relationship with a partner who recently tested HIV-negative.

• Anyone who has, within the past six months, injected illicit drugs and shared equipment or been in a treatment program for injection drug use.

“While a vaccine or cure may one day end the HIV epidemic, PrEP is a powerful tool that has the potential to alter the course of the U.S. HIV epidemic today,” said Jonathan Mermin, M.D., M.P.H., director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. “These guidelines represent an important step toward fully realizing the promise of PrEP. We should add to this momentum, working to ensure that PrEP is used by the right people, in the right way, in the right circumstances.”

This is a very important step. California's largest AIDS service providers had endorsed this position a few weeks ago, so it is good that this policy position will adopted nationwide.

CA AIDS Service Organizations Applaud Easier Access To Truvada For HIV Prevention With HIV-Negative Gay Men

For Immediate Release
Friday, April 18, 2014

Phil Curtis
213.201.1623
pcurtis@apla.org

Gil Diaz
323-993-7604
gdiaz@lagaycenter.org

Anne Donnelly
415.558.8669x208
adonnelly@projectinform.org

California Improves Access to HIV Prevention Pill
Important new tool in fighting AIDS, Pre-exposure prophylaxis (PrEP)
may be up to 99% effective in preventing new infections

Three leading California AIDS organizations -- AIDS Project Los Angeles, the L.A. Gay & Lesbian Center and Project Inform in San Francisco -- today applauded California’s Medi-Cal program for easing access to a well-established AIDS medication that has been proven to prevent HIV infection in at risk individuals.

The action lifts a requirement that doctors complete an authorization request when prescribing PrEP for HIV negative individuals.  PrEP is the brand drug Truvada, an AIDS drug manufactured by Gilead Sciences in Foster City, CA.  The action is effective immediately and will be published in Medi-Cal’s June Provider Bulletin.

Many in the HIV/AIDS community consider PrEP a groundbreaking HIV prevention tool.  The authorization request is considered an obstacle for both doctors and patients. With Medi-Cal’s action, doctors will now be able to prescribe the drug for men and women who test HIV negative and indicate that they are “at risk” of infection through HIV exposure.

“The Medi-Cal ruling is a game changer in HIV prevention,” said AIDS Project Los Angeles Executive Director Craig E. Thompson. “Appropriate access to PrEP through Medi-Cal provides us with another intervention – along with safer sex and condom use – to reduce the number of new HIV infections.”

“Medi-Cal’s action also brings an element of health equity to the program’s low-income beneficiaries,” Thompson said. “Private insurance plans have been covering PrEP for some time, often without prior authorization.”

"Project Inform and other organizations working directly with people at risk of acquiring HIV have conjectured that the slow uptake of PrEP may be more attributable to clinicians' reluctance to provide sexual health services of this type than to patients' lack of knowledge of PrEP or willingness to take it,” said Project Inform’s Executive Director Dana Van Gorder. “Lifting the TAR removes a potential obstacle that may have contributed to providers’ reluctance to prescribe PrEP."

Research modeling shows Truvada may be up to 99 percent effective in preventing new infections, depending on adherence and whether the drug is used in conjunction with safer sex counseling, provision of condoms and other prevention services.

“By making it easier for people at-risk of HIV infection to get access to medicine that has been proven to prevent HIV infection, California has set an important precedent for the rest of the nation,” said L.A. Gay & Lesbian Center Chief of Staff Darrel Cummings. “This collaboration between Medi-Cal and community advocates will move California closer to the comprehensive response that is needed to help end the HIV epidemic.”

The policy change resulted from discussions with Medi-Cal’s Pharmacy Policy Branch Chief, Mike Wofford, his staff and representatives from APLA, the L.A. Gay & Lesbian Center and Project Inform. The discussions focused on provider knowledge of PrEP, possible side effects associated with long-term use of Truvada, and community acceptance of the intervention.

Previously, Medi-Cal patients asking for Truvada could have been asked to meet several conditions outlined in the TAR for “high risk” individuals. Some of these conditions could have required the provision of condoms and monthly HIV testing – not necessarily real world conditions.

“There is a reason the AIDS community is talking about ending the epidemic,” Thompson said.  “We have three successful medical interventions to reduce new infections, including PrEP. What we need now is broad community and provider education on these interventions to increase acceptance and utilization.”

The three interventions include: PrEP for at risk HIV negative individuals, post-exposure prophylaxis or PEP for people who know or suspect they have been exposed to HIV, and HIV anti-retroviral treatment as prevention (TasP) for those living with HIV (HIV/AIDS drugs can bring viral load -- the amount of virus in the body -- down to undetectable levels in people who are HIV positive, reducing the likelihood that they will be able to transmit the virus to sexual partners).

# # #

Obama Signs Defense Bill Repealing Military Sodomy Prohibition

Good news! Even though "Don't Ask Don't Tell" (the federal law banning open homosexuality in the U.S. armed forces) was repealed more than three years ago, the military still prohibited sodomy between servicemembers in the Uniform Code of Military Justice (UCMJ). President Obama signed the National Defense Authorization Act (NDAA) into law earlier this week and it contained multiple gay-related provisions, the most prominent being a repeal of the military's sodomy law.

In 2011, Democratic legislators tried to repeal Article 125 of the Uniform Code of Military Justice, but the effort was defeated after conservative groups accused them of trying to legalize sexual abuse of animals. This time around, Senate Democrats, including Colorado Senator Mark Udall, Kirsten Gillibrand of New York, and Jeanne Shaheen of New Hampshire offered a proposal that would alter the language so as to keep bans on “forcible sodomy” and “bestiality” while decriminalizing consensual sexual activity between gays and lesbians. 

The new proposal met little resistance, even in the Republican-controlled House, and even among legislators who just three years ago opposed allowing gays and lesbians to serve openly in the military.

This is excellent news for LGBT people in the military and another victory in the kulturkampf for the champions of equality. Now there is nowhere in society where gay sex is criminalized, although it is still stigmatized socially.

Interestingly, the other gay-related provisions address another stigma: the criminalization of HIV-positive people.

The Washington Blade's Chris Johnson reports:

Additionally, under Section 572, the legislation directs the Pentagon to submit a report to Congress no later than 180 days after the bill is signed into law on personnel policies regarding service members with HIV or Hepatitis B.  The bill directs the Pentagon to include a description of the policies as well as related retention, deployment and disciplinary actions as well as an assessment of whether these policies are evidence-based and medically accurate.

According to the LGBT military group SPART*A, service members become non-deployable once they’re discovered to have HIV; can’t commission as an officer or warrant officer; can’t fly aircraft or work in any jobs requiring a flight physical; are restricted to stateside duty assignments (with the exception of the Navy); and are not eligible for special schools such as Ranger, Special Forces or other special ops jobs.

Thompson said the provision is welcome because it will examine whether the military’s current HIV policy is appropriate or outdated.

“This review is welcome and overdue because many of our laws, policies, and regulations regarding HIV were written at a time when we knew far less about the routes and risks of HIV transmission, and prior to the development of effective HIV treatment,” [ACLU Legislative Representative Ian] Thompson said.

Legislative action dealing with the stigmatization of HIV and HIV-positive people is something that I think will be more common in the near future. Since the "AIDS panic" days of the 1980s and early 1990s there are some horrendous and draconian laws on the books around the country.

I'm glad to see there is some positive movement towards decriminalizing HIV, since it has a disparate impact on gay men.

REPORT: LGBT Philanthropy Has Increased 400% Between 2003-2012

A new report from Funders for LGBTQ Issues indicates that the funding for organizations that advocate for LGBT equality has increased dramatically in the last decade. From 2003 the total granted by philanthropic sources was about $30 million while in 2012 it had increased to over $120 million.

From the overview:

In 2012, U.S. foundations awarded 4,068 grants totaling $121.4 million to support organizations and programs addressing lesbian, gay, bisexual, transgender, and queer (lGBTQ) issues. This is roughly a one percent decrease from 2011, when we identified $123 million in grants for lGBTQ issues. 

Foundations also granted an additional $12.7 million to public foundations and other intermediaries for the purposes of re-granting to lGBTQ communities — more than double the $5.5 million awarded for re-granting in 2011. with re-granting dollars included, lGBTQ grantmaking totaled $134 million, a record high. we generally exclude these dollars from our analysis to avoid double-counting. However, dollars awarded through intermediaries are not necessarily re-granted in the same calendar year. Given the high dollar amount awarded for re-granting in 2012, some of the modest decrease in total lGBTQ grants may be more due to the cyclical nature of re-granting initiatives than to any substantive decline. 

In addition, the Arcus Foundation, one of the top lGBTQ funders, conducted a strategic review in 2012 that led to the launch of a new lGBTQ strategy in early 2013. Although Arcus’s lGBTQ grantmaking has since returned to its previous run rate, transition to the new strategy resulted in an $8-million decrease in that foundation’s lGBT grantmaking in 2012, significantly reducing the overall total in comparison to 2011. Arcus’s 2013 lGBTQ grantmaking is currently on track to achieve its previous level of about $16 million. This further indicates that this year’s slight decrease in total dollars is an aberration. However, it also demonstrates the vulnerable position of lGBTQ funding, which remains highly sensitive to any fluctuations in the handful of top funders that provide the lion’s share of foundation support for LGBTQ communities. 

Generally, the level of lGBTQ funding was stable in 2012, a likely temporary pause in its broader trajectory of growth.

The report goes on to note that just 0.24% of all philanthropic dollars, i.e. twenty-four cents out of 100 dollars, goes to support LGBT issues nationwide.

The top ten private funders for LGBT advocacy are:

Read the entire report, there is very interesting information there.

NYT Spotlights HIV Crisis Among Young Black and Latino Men Under 25

Well, this is a surprise! Today the New York Times has a front page, above the fold (most prominent placement), story entitled "Poor Black and Hispanic Men Are the Face of H.I.V." by Donald G. McNeil Jr. The key point is that 25 percent of new infections are in men who are either Black or Latino.

Here's an excerpt:

Nationally, 25 percent of new infections are in black and Hispanic men, and in New York City it is 45 percent, according to the Centers for Disease Control and Prevention and the city’s health department. 

Nationally, when only men under 25 infected through gay sex are counted, 80 percent are black or Hispanic — even though they engage in less high-risk behavior than their white peers. 

The prospects for change look grim. Critics say little is being done to save this group, and none of it with any great urgency. 

“There wasn’t even an ad campaign aimed at young black men until last year — what’s that about?” said Krishna Stone, a spokeswoman for GMHC, which was founded in the 1980s as the Gay Men’s Health Crisis. 

Phill Wilson, president of the Black AIDS Institute in Los Angeles, said there were “no models out there right now for reaching these men.” 

[...] 

According to a major C.D.C.-led study, a male-male sex act for a young black American is eight times as likely to end in H.I.V. infection as it is for his white peers. 

That is true even though, on average, black youths in the study took fewer risks than their white peers: they had fewer partners, engaged in fewer acts of sex while drunk or high, and used condoms more often. 

They had other risk factors. Lacking health insurance, they were less likely to have seen doctors regularly and more likely to have syphilis, which creates a path for H.I.V. 

But the crucial factor was that more of their partners were older black men, who are much more likely to have untreated H.I.V. than older white men.

The fact that the HIV epidemic is becoming browner and younger has been known by HIV activists for quite awhile but it is useful that the mainstream media is starting to pay attention and send the message to the wider population.

I'm somewhat surprised that my friend Phill Wilson is quoted saying there are "no models" for reaching young Black and Latino men who have sex with men (MSM), when he runs the Black AIDS Institute which is a national organization focused on creating, studying and promulgating such models.

In Los Angeles, In The Meantime Men is an organization which focuses on HIV prevention in young Black men and Bienestar focuses on HIV prevention and treatment in the Latino community.

I think what Phill meant to say was that there are no widely adopted or generally accepted models for reaching the communities the article is focused on.