Study: HIV Math Models
Must Be 'Carefully Examined'

If UCLA math modeler Sally Blower were a responsible researcher, one who respectfully engages the communities affected by her studies, she would be having a public conversation with her critics. She isn't on both accounts.

I'd like to have the opportunity to ask her why she thinks other HIV math modelers should have their work "carefully examined," and why their models must be "transparent enough to permit policy makers to understand them." She's demanding something she herself hasn't delivered.

In a 7-page October 29, 2009, study debunking and criticizing a World Health Organization math model created by Dr. Ruben Granich, proposing widespread HIV testing and treatment could eliminate AIDS in the next decade, Blower and a colleague advance some surprising conclusions and recommendations.

Blower said, on page 6, emphases mine:

We conclude that the model developed by Granich et al., when used with realistic parameter values, does not show that HIV elimination is (theoretically) possible. We recommend that any modeling results that are used as a foundation for health policy decisions should always be carefully examined. [...]

In addition, assumptions that are made to construct health policy models should be made transparent enough to permit policy makers to understand them.

Modeling results should always be interpreted with caution. We recommend that models should never be used as the sole basis for making health policy decisions; many other, often more important factors that are not included in the modeling framework, need to be considered.

Well, since January, with Dr. Grant Colfax of SF DPH's HIV prevention division, we in San Francisco have been carefully examining Blower's dubious math model on alleged mini-epidemics of HIV strains resistant to cocktails.

She has steadfastly turned up her nose when asked for further discussion. Blower has also virulently resisted efforts by public policy makers, to make her convoluted model transparent and understandable.

When will Blower follow the advice she hands out to rival math modelers working on AIDS? Transparency and engagement: Two items missing from Blower's resume.

Strub: UN HIV Stigma Survey
Needs PWA Voices

Lately I've been consumed with addressing the reinforcement of stigma against people with AIDS, brought about by a recent math model created by ivory tower researchers.

UCLA and UCSF scientists generated much controversy with allegations that PWAs in San Francisco, with the assistance of doctors and caregivers, had created mini-epidemics of drug-resistant strains of HIV.

The researchers intimated complacency from PWAs, and that we needed our cages rattled. Projecting the notion that PWAs were unconcerned by the alleged resistant strains, stigmatized us as selfish Typhoid Marys threatening global public health.

One way to fight back against such institutional stigmatization by researchers and others, came my way this week from my friend Sean Strub. He's surviving and thriving as a person living with HIV, with a long track record in AIDS advocacy on many fronts.

Sean's asking people to take some time and answer a few questions, give a few comments and suggestions, and help the United Nations address AIDS stigma and discrimination. I've done as he asked, and hope my answers and suggestions bring some change.

As important, was getting a few complaints off my chest about AIDS stigma that I see in California. It was productive to take some of my anger over UCLA/UCSF and share it with the UN folks working on AIDS. Surely you can find you own reasons, regardless of your HIV status, to take the survey. It will be of benefit to PWAs worldwide.

Here's Sean's message, followed by a note from the UN representative soliciting participation, and links to the survey in six languages:

I am forwarding this survey to you because, as you know, many of us have been working on trying to integrate more people with HIV in HIV/AIDS policy-making and delivery of services.

Over the years, the voices of those who have the diseases have too-often receded to the background, with terrible consequences for the epidemic.

Any person with HIV and anyone working in some capacity with the epidemic is eligible and encouraged to complete this survey. It takes a few minutes, but it is something meaningful you can do to help advance the issues that are important to us.

I know that every survey is read and counted and, ultimately will have an influence on the final report. Their report could have far-reaching consequences, which is why it is so important that you take a few minutes to complete the survey.

This is the note from the UN representative, with all of the links to the survey in various languages:

Each year, the NGO Delegation to the UNAIDS governing body (called the Programme Coordinating Board or PCB) submits a report to the Board. This is an important opportunity for us to present the unique perspectives of civil society on the developments and issues around the AIDS pandemic.

This year, we anticipate that the June 2010 board meeting will include agenda items such as non-discrimination; men who have sex with men (MSM); and a thematic focus on sexual and reproductive health services linked to HIV.

The Survey is currently also available in Chinese, Portuguese, Spanish, Russian and French. It will soon be made available in Thai, Burmese, Swahili and Arabic. The deadline is March 15, 2010.

Link to English Survey
Link to Portuguese Survey
Link to Russian Survey
Link to Spanish Survey
Link to French Survey
Link to Chinese Survey

Feel free to distribute to your networks.

Evan Collins
Email: evanjcollins (at) gmail (dot) com
North American Delegate,
UNAIDS PCB NGO Delegation

Gay Comments Needed
at State Dept Blog

The U.S. State Department needs to hear some pro-gay messages about including gays and men who have sex with men in the Global Health Initiative and PEPFAR campaign, to fight HIV/AIDS globally.

Yesterday I blogged about a recent Dip Note blog post by Dr. Eric Goosby, our top diplomat for AIDS matters, and I also posted a gay-specific comment for all to read. Goosby and the department omitted any mention about gay men. Not a healthy sign for us.Such invisibility bodes ill for addressing gays and HIV issues around the world.

More pro-gay messages are needed today at the State Department blog post. While the official deadline for public comment on the Global Health Initiative, which encompasses PEPFAR, passed yesterday, it is still necessary to use the comment function at Goosby's post to send a gay-specific to him and the department.

Please take a few minutes to visit the Dip Note entry, and leave a good gay comment for our diplomatic corps to read. The fight for gay visibility at the State Department and through PEPFAR is a constant one. Do your part in this fight. Thanks.

Iranian Gay Night of Comedy in SF

Say, did you hear the one about the gay Iranians staging a fun-filled evening of laughter, while their homeland is in the throes of democracy-building and government bullying?

You will on March 12, if you get tickets to this event:

San Francisco's Castro district, the world's best-known gay neighborhood, will be making history again. For the first time ever, Iranian-American comedians will come together in one special night to tackle the subject of homosexuality and Iranians.

Iranian.com is proud to present Mehran Khaghani, Tissa Hami, Amir Malekpour and Max Amini, four of the funniest and accomplished comedians, at Cafe du Nord's Swedish American Hall on Friday, March 12th. Gate opens at 7 pm.

I hope the comics don't do anything dangerous, like out the Iranian president. If they did, Mahmoud Ahmadinejad, being gay and guilty of sodomy, would have to hang himself.

Poor taste, I know, given the activism I've engaged in over the hanging of two gay teenagers in Mashad, Iran, in 2005, but if I can't make a feeble attempt at political humor, who can.

For real gay Iranian political humor, I intend to catch this show next month. See you there.

Gay Town Halls
Omitted from HUD Site?

[UPDATE: HUD has amended the states' pages.]

The Housing and Urban Development agency is soon holding three gay town halls in Chicago, New York and San Francisco. The HUD release about the SF town hit my in-box this morning, and when I went looking for it on the HUD site, I couldn't find it.

I spoke with Brian Sullivan at HUD's press office to explain it's nice to hold the meetings, and send out a release, but it was necessary to also post the release on their own site. After some arguing from him, he agreed to my request to have the state pages of their site updated with the gay town hall info.

Michael, look for our advisory to our forthcoming LGBT town hall meetings to be posted on our California, Illinois, and New York pages. In addition, we plan to promote through Facebook and Twitter. Thanks for pushing us in the right direction!

As I write this at 1 pm PST, HUD's page for California does not have the announcement. Same goes for the Illinois page. Only the New York page had the released, in PDF format, available for public inspection.

Why does it take a blogger to point the Obama administration in the right direction, about basic promotion on the HUD site for gay-related events? How could they even think of excluding the info -- gays, really -- on the town halls?

Seeing the omissions at HUD and over at the State Department blog regarding Obama's global HIV plans today, I detect a pattern. We're going to be casually made invisible in programs and media promotions.

If the Obama administration wants to send a message of keeping the gays invisible unless they get pushy and act up, they're succeeding very well.

All this aside for a moment, I still want to point out that at least HUD is staging three gay town halls. That is three more than the Human Rights Campaign will hold for the community.

State Dept Blog:
Gays Omitted from Obama HIV Plan

Dr. Eric Goosby (above), America's AIDS czar to the world, on Friday made a post to the State Department's blog, the Dip Note, about two crucial components for improving global public health. Goosby, long active with U.S. gay and AIDS service and advocacy orgs, who was last employed by the very gay San Francisco AIDS Foundation's affiliate org, the Pangaea Global AIDS Foundation, omitted men who have sex with men from his post:

Earlier this month, the Obama Administration revealed an important new piece of its foreign policy agenda: a consultation document on the strategy for the Global Health Initiative (GHI). This document outlines the U.S. Government's operation plan for the GHI, emphasizing integration of programming, implementation of sustainable efforts, efficient approaches with positive results and collaboration among partners.

As described in the consultation document, the GHI will support partner countries in their efforts to improve the health of their people, with a particular focus on improving the health of women and children. As a cornerstone of the GHI, U.S. President's Emergency Plan for AIDS Relief (PEPFAR) is a critical piece of this initiative. [...]

If Goosby, the State Department and the Obama administration weren't afraid of addressing the very real needs of gay men at-risk of contracting or living with HIV through PEPFAR, this is the section of the post where we should have been included:

The GHI prioritizes a woman- and girl-centered approach. Over the long term, improving the health of women acts as a positive multiplier, benefiting not only the health but the social and economic development of future generations. PEPFAR also embraces this approach in our strategy, recognizing the disproportionate impact of HIV on women and the centrality of women to the health of their families and communities. [...]

Let us all praise the U.S. emphasis on women and girls in the GHI and PEPFAR principles and programs. Their needs have not been adequately addressed ever, on all health-related matters, not just HIV/AIDS.

But why can't Goosby and the State Department also show some damn concern about gay men and HIV? Given the past year's turmoil and political harassment for gays in Uganda, Kenya and Malawi, where PEPFAR dollars flows, and gay men living with AIDS are doubly-stigmatized, we really need these U.S. officials giving visibility to gays.

Adding insult to injury, the PEPFAR consultation document that Goosby thinks is so wonderful, and will be the guiding force to the program, fails to mention gays or men who have sex with men once.

The outrageous invisibility created by the Dip Note blog post and the PEPFAR document greatly strengthen the stigma already faced by gay men and gays living with AIDS. If Goosby and the State Department are too chicken to say something, _anything_, about gay men and HIV in 2010, we have a clear example of a problem in need of addressing.

NYT Names Gay Man as National Editor

Is the culture war in America regarding gay men over, or just in a lull?

I would expect some skirmishing from right-wing pundits and other cultural warriors about one of the world's most influential newspapers, the New York Times, appointing out gay man and assistant editor Richard L. Berke (above), to become the national editor next month.

In the same vein, so far, gay cultural war orgs -- HRC, GLAAD, NGLTF -- have been as quiet as their conservative counterparts.

So far, Googling news sites, blogs and the web, turns up nothing from either liberals or conservatives about this former reporter, who just happens to be gay, ascending to the national desk's editor's chair. Even the comments at the Times' Media Decoder blog omit anything about his gay identity.

If there's anything out there about this development, send me the link, and I'll amend this post.

The Times made the announcement on Friday, and a story about the personnel changes appeared in the Saturday A-section of the national dead-tree edition, and shared a bio sketch on the new national editor:

Mr. Berke has covered Congress, the White House and four presidential campaigns for The Times. He was the national political correspondent for more than a decade and the Washington editor for three years before moving to New York in 2005.

A graduate of the University of Michigan and Columbia University’s Graduate School of Journalism, Mr. Berke joined The Times in 1986, after working as a reporter at The Baltimore Evening Sun, The Minneapolis Tribune and The Los Angeles Herald Examiner.

No mention was made about him being gay, which is a good thing these days. I wouldn't expect the Times to tell readers about a staffer's race or gender, when such personal characteristics have no bearing on his ability to do the job he's been assigned. But I would expect pundits and advocacy orgs to weigh in with an opinion or two.

Berke begins his new duties on March 22, and I, speaking as both a reader and an NYT shareholder who owns a single share, expect there will no changes in how the paper covers all of the news, including coverage of LGBT people.

On the other hand, you can bet lots of queens will soon be calling the paper the Gay Lady!

UCLA, The Vatican: African PWA
Drug-Resistance From 'Stock-Outs'

A reader tipped me off to a 2008 UCLA study carried out by Sally Blower, that was paid for by the Vatican. UCLA said the "paper was commissioned for the 34th edition of Nuntium by Bishop Rino Fisichella, Rector of the Pontifical Lateran University, Auxiliary of Rome, Pontifical Lateran University, The Vatican." Sounds like the Pope was one of Blower's bosses at one time.

I wasn't the least bit surprised the stigmatizing mathematician was a hired gun for one of the most homophobic, misogynistic institutional menaces to sane and effective global public health.

Some of Blower's findings for the Vatican are widely known and not new:

There are many other problems in allocating a scarce supply of drugs that have ethical and epidemiological consequences. For example, a constant supply of drugs over many years will need to be provided to each HIV-infected individual in order to sustain the benefits of ARV in increasing life expectancy.

But there was one startling conclusion that stood out, especially in light of a solid month of challenges to Blower's math model allegedly showing HIV strains impervious to drugs in San Francisco's gay community and the dire consequences our city's homosexuals are wreaking on Africa's people with AIDS.

What does Blower claim is the root of drug-resistance for PWAs across Africa? Men who have sex with men in Gay Mecca, or political moves to reopen bathhouses, maybe our supposed ways of cavalierly spreading tough-to-fight strains of the virus? No, nothing like that:

Drug stock-outs will result in treatment interruptions that will increase treatment failure rates and the development of drug-resistant strains of HIV.

What are drug stock-outs? When pharmacies and clinics run out of medicines, and none are available for distribution to people living with HIV and other diseases, that is a drug stock-out.

Look again at Blower's conclusion for what will cause the strains. It's not just that she doesn't place blame on the SF gay community, or even the drugs themselves. Blower posits that the bigger factor that will drive resistance is an unsteady, interrupted flow of AIDS cocktails.

Even though Blower's research for the Vatican is two-years old, at the time it was written, she had almost a decade of math models on potential and actual drug-resistance in San Francisco under her belt. Yet, none of that damn modeling was cited in her Vatican study.

If, as Blower has claimed, San Francisco's status as the canary in the world's public health mine, and our gay sexual and HIV-treatment behaviors here have global implications, the Vatican study would have been a good place to make the argument validating such claims. Maybe I should count my blessings that Blower, UCLA and the Vatican omitted San Francisco's gay PWAs.

Study: SF PWA Drug-Resistance =
'Minor Public Health Problem'

We are well aware that a broad array of public health officials, media outlets and bloggers, gays and people with AIDS are raising serious questions about the Sally Blower of UCLA and James Kahn of UCSF math model study, alleging mini-epidemics of drug-resistant HIV strains.

Of particular concern is the last sentence of the study that was published in Science last month:

"Consequently, currently circulating [AIDS drug]-resistant strains in San Francisco pose a great and immediate threat to global public health."

And who exactly are the terrible people responsible for this threat to human life on the planet as we know now it? The same old gay boogeymen usually trotted out by homophobes who use homo-sex to make claims of civilization on the brink of extinction.

Blower and Kahn make clear who the guilty people are behind this immediate threat:

"We calibrated and parameterized the model to represent the HIV epidemic in San Francisco in the community of men who have sex with men (MSM), where levels of [AIDS drug resistance] are already high."

But a 2003 report in AIDScience didn't predict high rates of drug resistance for San Francisco PWAs. Indeed, the researchers predicted the exact opposite, emphases mine:

Both the incidence of resistance (number of cases of transmitted resistance per year) and the prevalence of resistance have been predicted for San Francisco. Surprisingly, it has been predicted that, even with a very high usage of [AIDS drugs] transmitted resistance will initially increase and then fairly quickly stabilize at a relatively low level. These modeling predictions for transmitted resistance have been compared with recently collected empirical data in San Francisco and have been shown to be correct.

Guess who one of the co-authors is. None other than Blower. One of her key citations backing up her 2003 claims, is a study presented in Nature Medicine in 2001, which made the following remarkable statements:

[1] In contrast, we calculate that transmission of resistance is currently low, and predict it will remain low.

[2] We show that the epidemic of resistance is being generated mainly by the conversion of drug-sensitive cases to drug-resistant cases, and not by the transmission of resistant strains.

[3] We also show that transmission of resistant strains has not increased the overall number of new HIV infections.

[4] Our results indicate that transmission of resistant strains is, and will remain, a relatively minor public health problem.

You don't need three guesses to learn who two of the co-authors are. Yep, Blower and Kahn, again. Isn't great how Blower cites her previous work? So much for independent verification. I shouldn't really complain that Blower cites Blower, after all, because of this habit, I've learned that earlier crystal ball predictions from Madame Sally are at serious odds with her 2010 claim roiling San Francisco. But I digress.

Let's go over the statements, one by one. The first recognizes the good news about resistance back in 2001. Second statement about use of AIDS drugs had lead to resistance, not unsafe sexual practices of gay PWAs. This says much about the responsible behaviors of gay men.

Third statement is good news, but confusing. Who exactly was alleging that resistance would potentially equal more transmission in general of HIV?

Finally, the fourth statement and prediction has none of the alarmist and doomsday tone of Blower and Kahn's 2010 apocalyptic dangers facing the world because of gay/PWA drug resistance in San Francisco.

How the hell did we go from "a relatively minor public health problem," to a "great and immediate threat to global public health" in nine years? Sure, it's possible such a grave shift could occur, but the researchers have not addresses their apparent contradictions. Were the 2001 and 2003 allegations by Blower, Kahn, et al., wrong? Hard to say.

These, and a host of other legitimate questions need to be addressed by the UCLA and UCSF researchers. Wish I knew what it will take to force Blower and Kahn to abandon their stonewalling and silence. Communication between AIDS experts and PWAs and gays is required for sane public health policies.

KPIX Vid: UC PWA Expert Won't
Talk Drug-Resistance Study On-Air

If there is one person responsible for properly framing the problems with the UCLA study alleging mini-epidemics of drug-resistant strains of HIV in San Francisco, with dire consequences for Africa, that would be Dr. Grant Colfax, head of SF DPH HIV prevention efforts. I am usually criticizing Colfax, but lately I do nothing but salute him for speaking out about this controversial study. In the KPIX story, you'll hear Colfax again say the findings do not equal the sky falling.

One of the study's co-author is Dr. James Kahn of UCSF, a longtime AIDS doctor and clinician, who should know better than to dump such a study on the local gay and PWA communities and not be prepared for public debate. In a sign of cowardly weakness, that doesn't speak well for him, his colleagues or their research, Kahn refused to go on-camera.

There is a major problem when researchers, faced with mounting gay and PWA criticism, and growing mainstream media attention, hide in their ivory towers. What respectable expect would shriek about drug-resistant HIV "strains in San Francisco pose a great and immediate threat to global public health," then cower in fear at a few queries? Science and public health are ill-served with the shameful, missing-in-action behavior of Sally Blower and Kahn, two of the researchers.

But another real ray of hope, on top of SF DPH and Bay Area Reporter and community criticism, in this dark episode of how not to conduct and present questionable gay/AIDS research in 2010, is the incredible TV news story by Joe Vazquez of KPIX that aired tonight.

Vazquez, in his thoroughness spoke to Colfax and myself, cited the BAR editorial calling for Science magazine to retract the study, made the UCLA/UCSF study understandable to the average viewer, and tried to get co-author Kahn to speak on camera. Kahn refused, and Vazquez used stock footage of him.

The word lame doesn't begin to sum up the awfulness of Blower, Kahn, et al., who threw down their controversial research from the ivory tower, met with serious doubts from a wide spectrum of public health and community leaders in San Francisco, and are too chicken to engage in communication.

Big thanks to Joe Vazquez, for again doing his job well tonight, and committing an act of journalism. Kudos also to KPIX editors for giving the story 4-minutes, an eternity these days in TV news.

Here's the vid of the KPIX story:



(Hat tip for the YouTube vid: NelsonG.)