UPDATE: Michael Johnson (Black, Gay ,HIV+ Man) Released From Prison Early!

Michael Johnson (left) with Dr. Steve Thrasher

There's an exciting update in the ongoing saga of Michael Johnson (also known as "Tiger Mandingo"), a Black gay man with HIV who at the age of 23 in 2015 was sentenced to 30-years in prison for knowingly exposing several gay men to HIV (some of whom subsequently tested positive for HIV later). Johnson's case was a textbook case of HIV stigma combined with racial animus leading to a problematic criminal justice result. Happily, this conviction was overturned in 2016 and last year Johnson agreed to a 10-year Alford plea deal with the last 3 years converted to parole.

One of the key journalists and activists who raised the media profile of the Johnson case was Steve Thrasher (@thrasherxy) (seen pictured with Johnson above the day he was released from prison on July 9, 2019).

A New York Times report on Johnson's release said:

In theory, H.I.V. exposure laws are meant to encourage H.I.V.-positive individuals to disclose their status before having sex, and to practice safer sex, with the ultimate goal of preventing the spread of the virus.
But there is no evidence that these laws have reduced risky behavior or encouraged disclosure, said Catherine Hanssens, the executive director of the Center for H.I.V. Law and Policy, which provided legal support for Mr. Johnson’s case.
In the eyes of the law, an H.I.V. diagnosis is conflated with malice, she added.
“These laws effectively treat an H.I.V. diagnosis itself as evidence that the person acted with bad intentions when sex or other types of physical contact are involved in a crime,” she said.

Congratulations to everyone who worked on this case. Johnson will be moving to and living in Indiana with a friend and says he plans to continue his education and would like to share his story as part of advocacy for HIV prevention and treatment,

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.

SATURDAY POLITICS: Corey Johnson May Become Next NYC Council Speaker

Corey Johnson has been an openly gay city councilperson in New York City representing the 3rd district which includes the gayborhoods of Chelsea, Hell's Kitchen and the West Village along with parts of the Upper West Side since 2013. He replaced former openly lesbian NYC City Council speaker Christine Quinn who lost a Democratic primary for Mayor to Bill De Blasio.

This week comes news that Johnson, who is 35-years-old, openly gay and HIV-positive, may be following in Quinn's shoes to become the Speaker of the New York City council, the 2nd most important and powerful political position in the nation's largest city. Recently re-elected to a second term, Mayor de Blasio tweeted his support for Johnson's bid to become Speaker:

Congratulations to the next speaker of the @NYCCouncil, Corey Johnson. He’s been a force for the people of his district and I know he will bring that same commitment, passion, and energy to the speakership. I look forward to working with him on a progressive agenda for NYC.

The New York Times also reported that Johnson has the votes in the 51-member council to be elected Speaker in January.

Congratulations @CoreyinNYC!

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."

QUEER QUOTE: Draconian 30-Year Sentence Overturned In HIV Criminalization Case

The case of Michael Johnson has been a cause celebre for years, an emblematic of a toxic stew of race, (homo)sexuality, homophobia, AIDSphobia and criminal justice that produces (and is produced by) HIV criminalization statutes. Johnson is a Black gay man who at age 23 was sentenced to 30 years in a Missouri court in summer 2015 because the former college wrestler did not disclose to his male partners that he  knew he was HIV-positive before they engaged in unprotected sexual activity (some of which was recorded on cellphones). This week comes the news that an appellate court has overturned that draconian sentence (conviction for 2nd degree murder would have received less jail time) and ordered a new trial.

The Washington Post reports:

During the trial, Johnson remained adamant that he informed his partners of the positive HIV test. He pleaded not guilty. The prosecution, however, impeached his testimony using three clips of cellphone conversations, recorded while Johnson was jailed. In one snippet of phone conversation, Johnson admitted he was just “pretty sure” he had informed his partners he was HIV positive. 

After slightly more than two hours of deliberation, a jury declared Johnson guilty of three crimes, all felonies under Missouri law: one count of recklessly infecting a sexual partner with HIV, one count of recklessly exposing a partner to HIV and three counts of attempting to recklessly infect a partner with HIV. In July 2015, Judge Jon A. Cunningham of the Circuit Court for St. Charles County sentenced Johnson to 30 years in prison. 

[...] 

Presiding Missouri Court of Appeals’ Eastern District Judge James M. Dowd wrote Tuesday that Johnson’s trial was rendered “fundamentally unfair” by the prosecutors; they tarried too long handing over the cellphone calls recorded while Johnson was in the county jail. “The State’s blatant discovery violation here is inexcusable,” the judges concluded.

Johnson's lawyer Lawrence Lustberg, the ACLU of Missouri and Lambda Legal celebrated this week's result. Lustberg's comment is today's Queer Quote:

"Statutes like the one used to prosecute Mr. Johnson are inherently problematic, as they promote stigma and animus towards people living with HIV in violation of their legal and constitutional rights."

The ACLU notes that the new trial is being ordered due to prosecutorial misconduct and not the underlying constitutional frailty of the criminal statute Johnson was charged and sentenced under.
MadProfessah will continue to follow this case closely and urge readers to contribute to organizations like Lambda Legal, ACLU and the Center for HIV Law and Policy.

Hat/tip to Washington Blade and Washington Post.

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!

New Study Shows Zero Transmission Between Serodiscordant Couples With One Undetectable Partner

Great news! A recently published very large research study of sexual activity (58,000 examples of condomless penetrative sex) between serodiscordant couples (both heterosexual and homosexual, where one couple is HIV-negative and the other is HIV-positive) has demonstrated that undetectable people have a near-zero probability of transmitting the virus to their sexual partners.

Over the course of two years, the study tracked 888 serodiscordant couples — that is, couples in which one partner is HIV-positive and one is HIV-negative. This included 548 different-sex couples and 340 same-sex male couples. The HIV-positive partners maintained undetectable viral levels with antiretroviral therapy (ART), but the HIV-negative partners did not use PrEP. 

There were 11 cases in the study in which partners contracted HIV, but they didn’t get it from their partners. Researchers tested the virus in each case and confirmed that what they had contracted was not phylogenetically linked to their partners’ virus. In other words, it was conclusively proven that they only contracted HIV because they had sex outside the relationship. 

Simon Collins, a member of the PARTNER study steering committee, described the results as “simple to understand.” In a statement, he explained, “This provides the strongest estimate of actual risk of HIV transmission when an HIV positive person has undetectable viral load — and that risk is effectively zero.”

The implications of this result for public policy around HIV stigmatization in the United States are profound. There are numerous HIV-positive Americans who are serving draconian criminal sentences for having sex with other people due to misguided laws (combined with overzealous prosecutions and bigoted juries). Oftentimes, it is people of color who are disproportionately impacted, as exemplified by one of the most (in)famous of these cases, the so-called "Tiger Mandingo" case where a 23-year-old African-American man named Michael Johnson was sentenced to 30 years in jail after being convicted of multiple felonies in Missouri.

Hopefully, this new scientific evidence from the PARTNER study can be used to help organizations like the SERO Project support the repeal of some of these pernicious laws around the country.

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)?

CELEBRITY FRIDAY: Charlie Sheen Reveals He's HIV+

Actor Charlie Sheen revealed in a live interview with NBC's Today this week that he is HIV-positive. Although Sheen was television's top-paid actor when he appeared on CBS' Two and a Half Men his public profile has dropped considerably since he left television after the show Anger Management was cancelled last year. He revealed that he became aware of his status about four years ago and that he has paid out "millions" of dollars in extortion money to people who had threatened to publicly reveal this information. He made a statement:

"I’m here to admit that I am in fact HIV positive. And, I have to put a stop to this onslaught, this barrage of attacks, of sub-truths, and very harmful stories that are about threatening the health of so many others, which couldn’t be farther from the truth." 

It will be interesting to  see how the celebrity gossip culture reacts to this revelation. There were apparently all sorts of rumors about Sheen's health which influenced his decision to come out now. Social media, generally has been relatively kind, so far.

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?

23-Year-Old Black Gay HIV+ Man Faces 60 Years In Prison After Being Found Guilty In Missouri

Michael Johnson is a 23-year-old Black gay man who was known on social media as "Tiger Mandingo" and was a champion college wrestler who allegedly had sex with multiple partners in Missouri without disclosing his HIV-positive status (which he knew about). Atleast one of those partners later tested positive for HIV and Johnson was found guilty of under Missouri's HIV criminalization statue this week of "recklessly infecting" a partner with HIV as well as "recklessly exposing a partner to HIV" and is subject to a punishment that could extend to life in prison.

The case, despite being a case of "he said, he said" was complicated by the fact that Johnson made as many as 30 videos of himself having unprotected oral and anal sex with partners, which since he was diagnosed by the state of Missouri as being HIV-positive on January 8, 2013 are evidence of illegal activity.

Buzzfeed notes:

Johnson was specifically charged on six counts: transmitting HIV to Lemons and to Charles Pfoutz through anal sex (both Class A felonies); one Class B felony for attempting to expose HIV to Montell Moore through anal sex without transmission; and three additional Class B felonies for exposing Christian Green, Filip Cukovic, and Andrew Tryon to HIV. Johnson was convicted on all counts, except the one involving Pfoutz, which was added by the prosecution just last month.  

All six of Johnson’s accusers testified that Johnson did not disclose his HIV status. Multiple medical professionals testified that they had informed Johnson of his status and advised him it was a felony to fail to disclose.

Johnson for his part testified that he had disclosed his HIV status to all six of his sexual partners before they had sex.

The case has become a cause celebre in Black gay circles, with a public letter to Johnson signed by 89 prominent Black gay men being circulated in response to the trial. Here's an excerpt:

HIV should be treated as a public health issue not as a criminal one. Legally requiring disclosure privileges the lives of White people not living with HIV over Black people who are living with HIV.
These laws feed into stereotypes that assume Black gay men are irresponsible and hypersexual. For you, your accusers saw your Black and masculine body as a site of ultimate sexual pleasure, until they had to deal with you as a whole person. At that moment you became a problem and were disposable to them.
HIV criminalization laws burden people living with HIV to take on the sole responsibility of sexual encounters. Regardless of intention or disclosure, there is a shared responsibility among sexual partners. Opening up about your HIV status is a personal decision that should not be mandated or enforced. Disclosing your HIV-status should be about self-reflection and speaking your truth. Disclosure should not be about protecting people who are not living with HIV from transmission. And disclosure should not be about punishing people living with HIV who do not disclose.
We do not care about whether or not you disclosed, or any intention you may or may not have had. We care about you—your life matters. HIV is not a crime and you should not be in prison.

What do you think?

Hat/tip to Fusion

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.

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).

# # #

SATURDAY POLITICS: L.A. County Democrats Endorse Kuehl, Solis, Prang

The Los Angeles County Democratic Party has issued their endorsements in a series of high profile country races.

The LACDP has endorsed two openly LGBT candidates for two important positions: Sheila James Kuehl for County Supervisor (District 3) and Jeffrey Prang (Los Angeles County Assessor). They also endorsed progressive Hilda Solis (and former Secretary of Labor in the Obama administration) for County Supervisor in District 1 (the district I live in).

The County Supervisor positions are incredibly powerful. There are only 5 such positions representing the concerns of more than 10 million Los Angeles County residents, so they have more constituents than all Congresspeople and some United States Senators! Thanks to term limits, two slots are opening up, with the forced retirements of Gloria Molina (District 1) and Zev Yaroslavsky (District 3).

MadProfessah has also endorsed Solis and Kuehl in these races already.

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.

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.