Thursday, August 21, 2008

GQ: Gay Life, HIV, Serosorting, Money,
PEP & Swiss Recommendations

A publicist from Conde Nast publications sent me an email this afternoon alerting me to the pending web-posting on Friday morning of David France's extensive GQ article on AIDS and gay men, "We All Forgot the Condom." I think France has done folks like myself, critics of AIDS Inc and the HIV prevention mafia, a great favor in simply painting a landscape portrait of where America is right now in terms of stopping new HIV infections.

He broaches sensitive topics such as anal sex, poppers, serosorting, failures of AIDS nonprofits, rising national HIV stats, and lots of other important issues. I share some lengthy excerpts below, of keen interest to my agenda.

And there are two things I want to pull out from France's story and go out of my way to say, thanks for mentioning these items. One, he twice references a fact getting ignored by the SF media and Mayor Gavin Newsom -- falling HIV rates. Discussing serosorting, pozzies sleeping only with pozzies, France writes:
Some researchers think so, citing data from San Francisco showing that syphilis rates have soared while HIV rates have decreased ... But there is another possible explanation for the lower rates in San Francisco despite a return to unsafe sexual practices.
Second, France gets a tip o' my hat for reporting on the recommendations of Swiss researchers earlier this year, and the shameful non-debate conducted by AIDS Inc institutions across America:
Last January no less an authority than the Swiss National AIDS Commission actually advocated unprotected sex for some patients with repeated undetectable results and no other sexually transmitted diseases, saying they posed zero risk of infection. This is a startling finding, one that certainly would change life for couples in which one is positive and the other negative. But it could also have a far-reaching impact on the epidemic’s march ...

Did this good news touch off celebrations here in the United States? Hardly. The Swiss study went largely ignored in the media. What’s more, powerful AIDS groups rushed to condemn it.
The sobering truth on failed vaccine efforts and forms of HIV prevention science:
The search for an AIDS vaccine has been a colossal global undertaking, with spending topping a billion dollars a year and clinical trials involving nearly 25,000 subjects. And yet scientists have little, if anything, to show for their efforts and have recently resigned themselves to failure ...

The same goes for the so-called “liquid condom,” a tantalizing theory that an effective microbicide might be added to a lubricating jelly to neutralize HIV on contact. In all of the large-scale microbicide trials to date, most medicated ointments showed no efficacy whatsoever, and two increased transmissions.
But what about the penile condom messages promoted by the Centers for Disease Control and Prevention and every HIV group in the country?
And the reason for these increases? Gay men are no longer abiding by the one commandment that dominated gay life for decades: “Use a condom every time.” In survey after survey, gay men say they have stopped using condoms. “I think the last rubber gay guys used in this town was in 1985,” Michael Petrelis, an AIDS blogger in San Francisco, joked when I asked him about this trend.
How to best sum up some of the complexities of gay men's attitudes and resistance to penile condoms?
Gay men say they feel cheated out of the full pleasure and intimacy of sex, and many have come to perceive condoms as emblems of a still hostile world, imposed on them by a culture that continues to stigmatize gay sex. “To use a condom every time you have sex, for the rest of your life?” says Daniel Siconolfi, of New York University’s HIV-prevention think tank, the Center for Health, Identity, Behavior, and Prevention Studies. “That’s a very, very big burden. That’s a lot to ask of somebody. And it’s not being asked of anybody other than gay men.”
GQ magazine provides a valuable history lesson, for old timers like me who remember Michael Callen and honor the heroism of Dr. Sonnabend, but also for young gay men who probably have never heard of the life-saving pamphlet they published in the early 1980s. Reading this passage reminds that much of the real prevention work was, and still is, done by those outside of AIDS Inc:
The suggestion was contained in a stark pamphlet, forty pages folded and stapled and wrapped in a white, tombstone-like cover with the title “How to Have Sex in an Epidemic: One Approach.” The pamphlet was written by Richard Berkowitz and Michael Callen. They weren’t doctors or epidemiologists ...

It’s difficult now to fathom how hard it was to disseminate information or raise an alarm before the Internet. Callen and Berkowitz could find no newspaper willing to report their theory, nor any community group able to publish it. So they paid for the publishing costs with donations from patients of their mutual doctor, Joseph Sonnabend — Callen threw in his own tax refund — and then delivered stacks of the booklet to gay venues in the city, including my local bar, where I watched them drop off a stack and then read through it in one sitting.
David France also segues into the matter of PEP, which the sexually active fag community in San Francisco should have been educated about, through a continuous social marketing campaign, not just a pilot ad effort, from our multi-million dollar prevention groups and the local DPH. How many fags in Frisco must contract HIV before we see a PEP campaign here?
The data confirm that this morning-after approach—called post-exposure prophylaxis, or PEP—is extremely effective: It reduces infections by 81 percent. If administered within hours of exposure, PEP appears to block all but a few transmissions. What’s more, the drugs are regularly prescribed to rape victims in emergency rooms.

But PEP is not routinely available to the most common targets of HIV in America today: gay men exposed through either a broken condom or a night spent carelessly. Without ad campaigns and other promotional pushes, most don’t even know it is available. Why the silence?
Well, one person with a big mouth who hasn't been silent about PEP is my pal Sean Strub. He's not only been vocal on this issue, but also on the need to further debate in the USA the recommendations of the Swiss experts. His quotes here are why we still need honest and provocative activists:
AIDS activists find this indefensible. Sean Strub, who founded Poz, calls this “practically criminal negligence. We on the front line know what works. It’s incredibly irresponsible that we’re not making it much more widely available.” ...

But HIV is a weekend peril; most transmissions likely happen late Friday night, as far from a doctor’s appointment as possible. So some gay men keep a starter set of morning-after pills on hand, just in case. Strub, who is HIV-positive, doles his own pills out to HIV-negative friends. “It’s probably illegal, but that’s what I do,” he says.

GQ and David France deserve big pats on the back for pushing this kind of AIDS story in the corporate media. May the article engender pointed and honest debates about failing HIV prevention strategies being pushed by AIDS Inc.


Anonymous said...

There is a saying that says that you aren't allowed to complain about something unless you are DOING something about it. I applaud Sean Strub and Michael Petrelis for forcefully confronting "AIDS Inc" for AIDS Inc's development of stupid and ineffective "HIV prevention" campaigns, all the while ignoring proven effective strategies like PEP. We (the community of gay men) need to stand up, scream loud, and DEMAND that PEP be available on demand. If Les Pappas and Better World Advertising can be paid millions of dollars for ineffective so-called "social marketing campaigns" for HIV "prevention" that consist of insipid slogans on billboards like "HIV Stops with Me", "I am the Cure", and "HIV: Not Fabulous", then those same millions could be spent on advertising and implementing PEP programs that might actually do something to prevent real HIV transmissions. Shame on AIDS Inc for their silence. We need to ACT UP and speak up in favor of demanding PEP now!

Thomas Strong said...

Hi Michael,

Thanks for publishing these quotes from what sounds like a very interesting article. It will be interesting to see how the discussion of this piece unfolds across the web...