Category Archives: US policy

Dear Secretary Clinton…,

I thought I would post a letter that I would write to Hillary Clinton about her recent remarks at NIH this week, the video of which can be found below. I love the woman, but I am sad about her lack of any reference to MSM.  The speech was discussing how the US can lead the world in establishing an “AIDS Free generation”.   Sorry Secretary Clinton, but in most areas, even in areas with generalized epidemics like subSaharan Africa, MSM transmission and infection  rates are on the rise, and an AIDS free generation won’t magically appear without targeted aid and prevention efforts directed towards these groups.

Dear Secretary Clinton,

While I applaud the United States’ efforts in leading the world to fight AIDS, and its strong commitment to ensuring an AIDS free generation through programs such as PEPFAR, I am extremely  disappointed by your complete lack of any mention of men who have sex with men in your global prevention strategies.

You mention microbicides which “give women the power to protect themselves.”  Yes this is true, but there is also a robust (and largely underfunded and underpublicized) movement to develop a rectal microbicide to give MSM (and heterosexuals) the opportunity to protect themselves.    You talk about “combination prevention” that the US will lead including: ending mother to child transmission, expanding voluntary medical male circumcision and scaling up medical treatment for people living with HIV/AIDS.  There is no mention in this three pronged “AIDS Free generation plan” of addressing the prevention needs among vulnerable communities such as men who have sex with men, intravenous drug users and transgendered populations.   While I applaud the State Department’s efforts, targeting male circumcision and mother to child transmission, while not addressing prevention among men who have sex with men will not lead to an AIDS Free Generation.

Dr. Frits van Griesvan of the CDC, in his article , along with numerous other studies, detail the balooning rates of HIV among men who have sex with men with India, China,  and several areas of Latin America and subSaharan Africa.  PEPFAR II, has a specific directive targeting HIV prevention at MSM, and it is time for our government and your department to take action and put this plan into action – studies show that current prevention efforts only reach 10% of MSM around the world who would benefit from prevention education and programs.   You discuss a story about the Tanzanian mother infected with HIV concerned about passing it to her child.  What about the man in Botswana who has anal intercourse with another man without condoms because homosexuality is illegal in his country, and he has no education on how to maintain his health since the subject is never spoken about?  You briefly mention the presence of such laws making homosexuality illegal, but never further discuss this topic in the 30 minute speech.

You do mention “embracing treatment as prevention.”  While this prong is not directed toward MSM specifically, it obviously can help MSM currently living with HIV and prevent the spread of the virus among their communities.  For this I applaud you.  However, be aware that many MSM who present at clinic for such treatment will be stigmatized due to their sexual orientation  if it is disclosed, and may not feel comfortable obtaining treatment at traditional treatment clinics due to barriers to care that exist for MSM populations including providers who are homophobic, stigma against MSM and laws criminalizing homosexuality.

I have worked closely with the State Department in my past work before attending medical school, as I was employed by several USAID contractors.  In my capacity working towards improving the life of women and children around the world, I have seen the impact the the US, the State Department and its subsidiary USAID can have on the lives of individuals through improving health.  Why not give men who have sex with men the same fighting chance to protect themselves against HIV that you state you are giving to heterosexual men and women through promotion of male circumcision?

Thank you,

SR

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Silence = Death = Huh??

So today, I decided to put on my ACT UP t-shirt I obtained from the ACT UP Paris booth at the International AIDS Conference two years ago.  The link provided here, is for the New York chapter, initially formed by a group of gay and lesbian activists in New York in the late 1980’s – the New York website appears to not have been updated in quite some time.  As Wikipdeia tells me, membership has recently dwindled. However, as the group has become international,  my shirt is from ACT UP Paris which seems active and has reported news from  Vienna.  ACT UP Paris was responsible for placing a giant pink condom around the Paris obelisk in 1993 to draw attention to their cause (see photo)

I was surprised to see people were not familiar with the mantra on my shirt. Upon walking into Starbucks the barrista said “Oh I thought your shirt had something to do with Smurfs.” I really didn’t get that one.  To be fair, it was in Spanish and said “Silencio = Muerte.”  While ACT UP’s main era of signature protests was in full bloom while I was still a young kid, I would have imagined that certain individuals would be familiar with the mantra, Silence=Death.  Some how or other I heard about the group and their signature protests growing up gay on the heels of the era of AIDS, when many still feared for their lives. ACT UP was responsible for staging protests designed to bring attention to various aspects of the AIDS crisis from housing to funding levels to treatment.  Yes, there were some individuals who talked to me about my shirt and their involvement back in the day with ACT UP, but the shirt overall just received resounding stares. There is currently no ACT UP chapter in DC.

However, as a public health practitioner, clinician in training and activist, I must certainly agree that almost 25 years later  SILENCE  still = DEATH.  I have discussed in past posts how Vienna has paid little attention to MSM and the rising HIV epidemic in this population.  If we do not speak up people will continue to die.  And although we are not  engaging in large-scale protests as in the days of ol (although apparently ACT UP Philadelphia just participated in a housing protest), silence will equal death.  If we do not fight for governments stop criminalizing homosexuality,  homosexuality will continue to remain taboo and stigmatized in Africa, Asia and the Middle East, MSM will have nowhere to seek GLBT affirming health services and HIV protection and treatment, and the epidemic will thrive.  If we do not carry the message of our ACT UP brothers, and remain silent, then yes, needless deaths of men who have sex with men will continue to occur in the US and the rest of the world.    In the words of the RENT cast (one of my favorite show’s) cast: “Actual Reality – ACT UP Fight AIDS”.  Educate.  Wear a condom.  Read my blog.  Distribute condoms at the club.  Do whatever you can to ensure that silence does NOT equal death among men who have sex with men. Anyone have any ideas on other things we can do in the spirit of our ACT up brothers? Comment! Here is a clip I found with coverage from the late 80’s (1989) about ACT Up’s housing protest in NY which was the top story (As a former New Yorker I also love how Jack Cafferty is the anchor – he’s a NY staple). If you look 0:58 in, you’ll see the SILENCE =DEATH sign.

The White House’s new HIV Policy: “In the begining it was known as the gay disease”

So although this blog will have a “global” focus, some of the issues will just be whatever is on my mind relating to HIV and how it influences us men who have sex with men.  Some of the issues will not be relevant to all readers, but that being said I hope that all posts provide enlightening information.  

Recently, Obama has announced the White House’s new policy to help curb HIV infection in the US.   The strategy is three-pronged: reducing new HIV infections, ensuring care for HIV positive individuals and narrowing health disparities.   

His announcement comes with a commitment of $30 million in funding to help decrease HIV infections.  Currently, I work on a $600 million USAID funded international maternal and child health program, and having supported PEPFAR international HIV programs, this is absolutely a drop in the bucket. The new Global Health Initiative, also initiated by Obama calls for $63 billion USG investments in global health over 6 years.   However, that’s not my man concern about what all this means.  

If one watches the 12 minute announcement below, you will note how little is said about the largest face of the epidemic in the US: gay men and other men who have sex with men.   Most of us gay men know that we form the largest group of new HIV infections: According to the CDC incidence statistics we are responsible for over half of all new cases (and this is on the rise. We know there are racial disparities to this too if you look at the second chart).  And according to a nifty June 2010 CDC fact sheet, MSM are the only group in the US in which new infections are increasing. Yet, in the announcement all I heard were the terms “gay, homophobia and partner”  mentioned briefly in passing.  While Obama mentions that “in the beginning HIV was known as a gay disease” he fails to mention that it still is.  

So, if this is such a problem, why was HIV and gay men not significantly mentioned during Obama’s introductory speech regarding his new HIV/AIDS policy (which mind you developing countries receiving aid under PEPFAR have had for years)?  Only at the end (9 minutes in) does Obama state that the policy will affect “communities  where the need is greatest” and mentions gay and bisexual men.  However, there is no elaboration of this, and no discussion about how exactly this plan will increase access to testing, counseling and treatment for gay men (and all African-Americans).   

Credit: CDC, http://www.cdc.gov/hiv/topics/surveillance/incidence.htm

Men who have sex with men are the group with the most new HIV infections

 Yes, a comprehensive approach to reduce the number of infection is great.  But I wish Obama would have signaled specifically what we would do to curb the (only) GROWING epidemic among MSM.     When was the last time we have seen a PSA targeted toward young gay men, gay men of color, etc? Actually, when was the last time we have seen a PSA about HIV in general? Obama does mention the need to use media and Internet to promote HIV and AIDS awareness.  This is great in theory but need to be put into action through social marketing campaigns.  

Obama mentions that this new strategy must parallel the international AIDS strategy.  However, having worked for various international organizations that receive tons of PEPFAR money, I can tell you preventing HIV in “most at risk populations” (refered to MARPs in the international community) is probably the lowest priority of US government funders and rarely, if ever hits the radar screen of donors and policy makers.  While millions get poured into preventing  heterosexual transmission of HIV through male circumcision in sub-Saharan Africa, no attention (or funding) is paid to the rising MSM epidemic in Malawi, South Africa, etc.  Apparently the International Women’s Health Coalition agrees with me that PEPFAR needs to address MSM (see Goal 7).  

Yes, there are good points of this HIV strategy which seems like it should have been announced 20 years ago.  All HIV positive individuals, gay, straight, black and white do need access to drugs and treatment and HIV positive individuals absolutely need access to health insurance. Let’s hope that the mantra of the Vienna AIDS Conference, “Right Here, Right Now”comes to fruition.