HIV Transmission -> What We Know & Why States Are Getting It Wrong

HIV

andrew shaughnessy

By: Andrew Shaughnessy, Manager of Public Policy
PROMO Missouri
@AndrewShag

AIDS.gov states that certain body fluids from an HIV-positive person can transmit HIV.

The body fluids mentioned are: Blood, Semen (cum), Pre-seminal fluid (pre-cum), Recital fluids, Vaginal fluids, & Breast milk.

Nowhere on this list does it mention saliva. Missouri laws, similar to several States, criminalizes behaviors that the CDC regards as posing either no risk or negligible risk for HIV transmission, this includes saliva. The Justice Department goes so far as to detail the best practices States should incorporate to make HIV-related laws align with science.

However, earlier this week, Missouri Legislator Travis Fitzwater (R -49) introduced Missouri House Bill 1181, which would have made it a crime for an individual knowingly infected with HIV to intentionally project saliva at another person.

HB 1181


Missouri is no stranger to strict laws (MO Rev. Sec. 565.085) that criminalize certain behaviors that have been proven by science to not transmit HIV. Several States still reference criminal statutes that fall under this category, which is why States should start modernizing their HIV criminal laws: now. Enacted through the fear of the 80s – early 90s, Missouri, like many States, continues to get it wrong it when it comes to effective HIV/AIDS policy. States enacted these laws with the intention of reducing HIV transmission, however research shows that these fear-based laws have the opposite effect and help HIV proliferate.

Missouri House Bill 1181 was scheduled for a hearing on Tuesday April 7th, but at the last moment was taken off of the docket. This hopefully signals a step in the right direction — but we still have a long journey ahead. Advocates in Missouri and nationwide should continue to monitor any legislation that seeks to further criminalize people who live with HIV.

The Bisexual Community and HIV/AIDS

As part of last fall’s National Black Justice Coalition Conference, “Out on the Hill”, I attended a White House meeting on Gay and Bisexual Men and HIV/AIDS.  I came away from the meeting impressed by the level of concern that the White House and other partners in the fight to eradicate HIV/AID are consistently demonstrating.

At the White House meeting, 09/26/14 Photo Credit. S. Washington

At the White House meeting, 09/26/14 Photo Credit. S. Washington

We’re 30 years into the HIV/AIDS epidemic but according to a report released by the Kaiser Family Foundation (KFF), infections among gay and bisexual men are on the rise in the U.S, especially for men of color.

kaiser hiv-aidsAs a bisexual community expert I think it’s essential to educate folks to the fact that bisexuals have always been at the forefront of the fight to prevent HIV infection. Even if many times history erased us. Since the very beginning of the HIV/AIDS epidemic, the bi community helped shape the messaging, support opportunities and intervention models pertaining to ending HIV/AIDS.

In honor of the 1990 National Bisexual Conference, the City of San Francisco proclaimed the first ever "Bi Pride Day" (check out the dot matrix copy of the proclamation above). As part of the acknowledgement, the San Francisco Board of Supervisors also proclaimed: …Whereas, The contributions of bisexuals in developing AIDS service projects, combating discrimination, and advocating for social justice have long been undervalued or discounted by most of society; and Whereas, The 1990 National Bisexual Conference offers the bisexual community an opportunity to showcase some of its extraordinary work and leadership in establishing model AIDS programs, and working to build a society free of discrimination and injustice; and Whereas, The 1990 National Bisexual Conference gives all people the occasion to finally end the silence about the numbers of bisexual persons who have died of AIDS, and to recognize the tremendous leadership contributions of bisexual activists in the fight against the killer disease...

In honor of the 1990 National Bisexual Conference, the City of San Francisco proclaimed the first ever “Bi Pride Day” (check out the dot matrix copy of the proclamation above). As part of the acknowledgement, the San Francisco Board of Supervisors also proclaimed:
…Whereas, The contributions of bisexuals in developing AIDS service projects, combating discrimination, and advocating for social justice have long been undervalued or discounted by most of society; and
Whereas, The 1990 National Bisexual Conference offers the bisexual community an opportunity to showcase some of its extraordinary work and leadership in establishing model AIDS programs, and working to build a society free of discrimination and injustice; and
Whereas, The 1990 National Bisexual Conference gives all people the occasion to finally end the silence about the numbers of bisexual persons who have died of AIDS, and to recognize the tremendous leadership contributions of bisexual activists in the fight against the killer disease…

Many times bi efforts were slighted, invalidated, forgotten or in some cases erased. And as Dr. Herukhuti, Black bisexual theorist, so eloquently once put it, “bisexual erasure is psychic murder”. Nowhere is this more dangerous than in the arena of public health, where bisexual populations are often erased in favor of a few more convenient fictions:

  1. There are few bisexuals (Not!)
  2. Most bisexuals experience privilege from their heterosexual presenting relationships and do not need (or deserve) care allocated from LGBT resources. (FALSE!)
  3. Even if support providers frequently use bisexual data (‘cause it’s the worst) to strengthen arguments for more support in reaching LGBT populations, there is no legal requirement for them to find and serve bisexual people (SADLY TRUE).
dr_h_sotu

Jan 20th, 2015 tweet from Dr. Herukhuti

Dr. Herukhuti has also directly linked bisexual erasure to the disproportionate rates of HIV bisexual people of color report saying,

“Bisexuals become the disappeared of the movement. Nowhere is the impact of this dynamic felt more viscerally than in black and brown communities. Historically, HIV research and prevention has had a problematic relationship with bisexuality in black communities, fluctuating from demonizing black bisexual men as vectors of HIV transmission to treating us as if we are exactly like black gay men — lumping us into a single box of men who have sex with men along with them. It is, therefore, no wonder that HIV rates are disproportionately higher in black communities.”

It’s no wonder then that gay history runs parallel to the history of biphobia, and its legacy, bisexual erasure. If bisexual historical figures and bisexual figures aren’t “bisexually erased” into being gay men or lesbians, they are removed from the conversation, even if their data isn’t!

For example, in 1985 when Larry Kramer first published his seminal work on the HIV/AIDS epidemic “The Normal Heart”, the only mention of bisexuals is in the stage directions. In the play’s “About the Production” section, Kramer describes the walls of the set being whitewashed and painted in “black, simple lettering” with “facts and figures and names”. One of the items on set walls?

“The number of cases in gays and the number of cases in straights, calculated by subtracting the gay and bi-sexual number from the total CDC figure.”

If gay+bisexual=gay, where does the bisexual go? Contrary to popular belief, we do not disappear in a puff of logic. We just die, and sometimes we die without anyone to remember our name.

To me this feels like vexation without representation, and bisexuals get nothing for their troubles. And troubles they are, with bisexuals facing higher rates of nearly every societal ill such as alcohol, drug abuse, smoking, cancer, sexual violence (including rape, stalking and intimate partner violence), heart disease, suicide and PTSD.

Bisexual oriented AND bisexually behaviorally people simply report more disparities than their gay, lesbian and heterosexual peers. In comparison to some research on transgender individuals, bisexuals report less hate crimes yet nearly the same rates of suicide and sexual assault.

Winning the disparity race has left bisexuals with nothing but shame, often internalized and externalized about our identity. Whether it be damaging oppositional dialogue about bisexual community labels or consistent calls for “visibility” instead of straight up parity, bisexuals have paid the price.

An evolving world is waking up to recognize that binaries are too simple to define love, and that bisexuals need more than just to be named. We need to be served like our lives depend on it and our sanity requires it. Will the world wake in time?

To learn more about the bisexual community and HIV/AIDS, please check out The Bisexual History of HIV/AIDS, in photos.

The Bisexual History of HIV/AIDS, in Photos

“And I just want it known that there is someone out here remembering him with tenderness in my heart and tears in my eyes.”

– Iris De La Cruz, Kool-AIDS On Ice

1981

Dr. David Lourea, a co-director of The Bisexual Center (founded in 1976), was also a pioneer in fight to end HIV/AIDS. In 1981, Dr. Lourea and bisexual/leather icon Cynthia Slater presented safer-sex education workshops in bathhouses and BDSM clubs in San Francisco. Photo Credit: Queerest Library Ever Blog: http://queerestlibraryever.blogspot.com/2013/01/archives-david-Loreau-and-bisexual.html
Dr. David Lourea, a co-director of The Bisexual Center (founded in 1976), was also a pioneer in the fight to end HIV/AIDS. In 1981, Dr. Lourea and bisexual / leather icon Cynthia Slater presented safer-sex education workshops in bathhouses and BDSM clubs in San Francisco. Photo Credit: Queerest Library Ever Blog

 1982

Caption: Former BiNet USA President Alexei Guren is co-founding board member of the Health Crisis Network (now CareResource) in Miami, Fla.; begins outreach and advocacy for Latino married men who have sex with men.
Former BiNet USA President Alexei Guren helps co-found the Health Crisis Network (now CareResource) in Miami, and begins outreach and advocacy for Latino married men who have sex with men.

1983

BiPOL, the first and oldest bisexual political organization, was founded in San Francisco by bisexual activists Autumn Courtney, Lani Ka'ahumanu, Arlene Krantz, Dr. David Lourea, Bill Mack, Alan Rockway, and Maggi Rubenstein.  BiPol launches demonstrations against “anti-gay/bisexual raids in Haiti and U.S.” Photo Credit: Queerest Library Ever Blog: http://queerestlibraryever.blogspot.com/2013/01/archives-david-Loreau-and-bisexual.html

BiPOL, the first and oldest bisexual political organization, was founded in San Francisco by bisexual activists Autumn Courtney, Lani Ka’ahumanu, Arlene Krantz, Dr. David Lourea, Bill Mack, Alan Rockway, and Maggi Rubenstein. BiPol launches demonstrations against “anti-gay/bisexual raids in Haiti and U.S.” Photo Credit: Queerest Library Ever Blog

 1984

Black bisexual LGBT icon ABilly S. Jones (with G. Gerald and Craig Harris) organizes first federally funded national “AIDS in the Black Community Conference” in Washington, D.C. Photo Credit: BiCities TV @ BECAUSE Conference http://blip.tv/bicities/256-abilly-s-jones-hennin-at-because-7021559

Black bisexual LGBT icon ABilly S. Jones (with G. Gerald and Craig Harris) organizes first federally funded national “AIDS in the Black Community Conference” in Washington, D.C. Photo Credit: BiCities TV @ BECAUSE Conference

Caption: After a two year battle, BiPOL activist, AIDS educator, and therapist Dr. David Lourea persuades the San Francisco Department of Public Health to recognize bisexual men in a weekly “New AIDS cases and mortality statistics” report. This model is then used by other department of public health offices around the country.  Dr. Lourea went on to criticize the Department of Public Health for closures of bathhouses and sex clubs in a March 1984 letter.

After a two year battle, BiPOL activist, AIDS educator, and therapist Dr. David Lourea persuades the San Francisco Department of Public Health to recognize bisexual men in a weekly “New AIDS cases and mortality statistics” report. This model is then used by other department of public health offices around the country. Dr. Lourea went on to criticize the Department of Public Health for closures of bathhouses and sex clubs in a March 1984 letter.

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LGBT Wellness Roundup: October 5

As published on Huffington Post’s new LGBT Wellness blog, see original at: http://ow.ly/DhVNO

Each week HuffPost Gay Voices, in a partnership with bloggers Liz Margolies and Scout, brings you a round up of some of the biggest LGBT wellness stories from the past seven days. For more LGBT Wellness, visit our page dedicated to the topic here. The weekly LGBT Wellness Roundup can also now be experienced as a video — check it out above.

New Tips From Former Smokers Ad Features Effects of Tobacco & HIV

BioPic b&w

     Felecia King

    Project Specialist

   The Network for LGBT Health Equity

 
 

This week, the CDC launched the next phase of the Tips From Former Smokers Campaign, and this time they are tackling the issue of tobacco and HIV. The ad features Brian, who smoked for 30 years, and suffered a stroke as a complication of his HIV and tobacco use. (read more about Brian’s story HERE)

Smoking is especially harmful to people who are living with HIV. For example, smokers with HIV:

  • Are at higher risk than non-smokers with HIV of developing lung cancer, head and neck cancers, cervical and anal cancers, and other cancers;
  • Are more likely than non-smokers with HIV to develop bacterial pneumonia, Pneumocystis jiroveci pneumonia (PCP), COPD, and heart disease;
  • Are more likely than non-smokers with HIV to develop two conditions that affect the mouth: oral candidiasis (thrush) and oral hairy leukoplakia; and
  • Have a poorer response to antiretroviral therapy.
  • People with HIV who smoke are also less likely to keep to their HIV treatment plan and have a greater likelihood of developing an AIDS-defining condition and dying earlier than non-smokers with HIV.

(the above examples are from Aids.gov <– Click the link for more info!)

For these reasons, smoking is a significant health issue for all individuals, but it is even more of a concern for people living with HIV, who tend to smoke more than the general population. According to the U.S. Centers for Disease Control and Prevention (CDC), approximately 19% of adults in the United States are smokers. However, the smoking rate is two to three times higher among adults who are HIV-positive.

 

SmokingLGBT    

New Study Looks at Smoking Cessation among People with HIV

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Corey Prachniak is an LGBT rights, HIV policy, and healthcare attorney. He serves on the Steering Committee of the Network for LGBT Health Equity and tweets @LGBTadvocacy.

 

 

 

What makes smoking cessation successful among people living with HIV?  That was the question posed at an event last week at the American Legacy Foundation in Washington, DC.

Dr. Donna Shelley explained that ending smoking among people living with HIV is especially important because “smoking increases the risk of HIV-related infections” and leads to “poorer adherence to HIV meds, higher viral load,” and other health problems.  NAM, an HIV/AIDS organization, notes that HIV-positive “smokers are approximately three times more likely than non-smokers to develop the AIDS-defining pneumonia PCP” and that “oral thrush, a common complaint in people with HIV, is also more common amongst smokers.”  Dr. Shelley’s study focused on testing cessation strategies among people with HIV in New York.

When it comes to quitting smoking, it could be seen as a positive or negative that people living with HIV are already likely to have complicated medical adherence needs.  On the one hand, adding smoking cessation interventions and medications adds to the burden that many people living with HIV already face.  But on the other hand, many people living with HIV have found success at incorporating medication regimens into their lives and are used to managing their care, either on their own or with the support of a medical adherence team.  For people who are doing well adhering to their HIV-related medications and treatments, they may well be able to incorporate tobacco cessation measures with a high level of adherence.

In fact, that is what Dr. Shelley’s preliminary data suggested.  “Adherence at baseline to HIV meds,” meaning how well people remembered to take their HIV medications at the start of the study, “was closely correlated to adherence to cessation medications” by the study’s sixth week, she said.

Dr. Shelley also noted that the people for the study were recruited from healthcare clinics, which often are in more regular contact with their patients than are other types of medical providers.  That’s because these settings tend to offer multiple, highly coordinated services.  So, for example, if a client comes in to see her therapist but has missed an appointment with her primary care doctor, the staff person checking her in can make sure she reschedules with her doctor or gets the prescription refill or referral that she might need.

The research tested three adherence regimens: smoking cessation medication alone; medication and adherence text messages; and medication, text messages, and adherence counseling phone calls.  Interestingly, the research found that the group with the best adherence were those who received the medication and text messages, but not the phone calls, which many people reported as being “too much.”  People also stressed that they liked texts with positive reinforcement – like “stay on track” or “look how much money you’ve saved this month” – versus messages that just reminded them to take their medication.

It’s unclear whether the results are unique to people living with HIV, or would have been the same for others, as well.  But it’s worth noting that people who are already managing HIV-related care preferred quick positive reinforcement on quitting smoking rather than lengthy counseling on taking their meds or daily messages telling them to take their pill.

It’s true that HIV is not just a problem for the LGBT community.  But given that 63% of new HIV infections in 2010 were among men who have sex with men, and that LGBT people smoke at a rate that is 68% higher than the population in general, the intersection of smoking and HIV is a critical topic for LGBT health advocates to keep in mind.

I Did It: Lunch With a Total Stranger

liz margolies

 

 

Liz Margolies, L.C.S.W.

Founder and Executive Director, National LGBT Cancer Network

 

 

woman-dines-alone-in-omotesando-1280x

As published on Huffington Post’s new LGBT Wellness blog, see original at: http://www.huffingtonpost.com/liz-margolies-lcsw/i-did-it-lunch-with-a-total-stranger_b_5090289.html

When a white, atheist psychotherapist has lunch with the founder of Depressed Black Gay Men (DBGM), they each get food for thought.

We met by email when someone forwarded his information to me. The email didn’t even contain a last name, but it was one of the most eloquently written requests for information about LGBT cultural competency trainings I had ever read. Over the course of that day, Antoine Craigwell and I corresponded several times about our respective organizations, but he always avoided answering my direct questions about himself, his profession, or how he came to write so well. Instead he asked to meet for a one-hour lunch the next day at a Cuban restaurant in my neighborhood. I requested a picture so that I would recognize him when he arrived; he sent me a selfie with an intense gaze.

I arrived on time. (Remember, I’m a psychotherapist.) He was 20 minutes late, meaning a full third of our time was already gone, but he vanquished my annoyance with an immediate apology and charm. We took the last two seats at the counter, and I ordered the only vegetarian options available: rice, beans and tostones. He got liver and onions over his rice and beans. I tried to find out more about his personal life, but again, he gently deflected those attempts, keeping our discussion fascinating but academic, until we gradually moved to the focus of his work.

Several years ago, after attending the funeral of a young, black gay man who had taken his own life, Antoine decided to write a book. He is not a mental health professional but noticed three things that can make the experience of depression different for many black gay men: religiously fueled homophobia, stigma, and intraracism. Through interviews and extensive research he discovered that in this population depression is expressed not only in typical ways but often in ways that may include violence, anger, drug use and unsafe sexual practices. We engaged in an intense conversation about racism in diagnoses and untreated depression. When the form of depression is unrecognized and therefore undiagnosed, it is also left untreated. In fact, most studies report far lower rates of depression and mood disorders among blacks and Latinos than among whites. And yet, just as Antoine said, LGB youth who are also members of racial/ethnic minorities have a significantly increased risk of suicide attempts. Clearly, the measurement tools for diagnosing depression are inadequate for recognizing depression in many black gay men. In one report that I found after that lunch, 43 percent of black gay youth reported having thought about or attempted suicide as a result of issues related to their sexual orientation.

Antoine explained to me that the black church is the bedrock of many families and the community, but that in spite of offering invaluable systems for coping with sociocultural stressors, it often espouses a fundamentalist perspective on sexuality, causing some mothers to cast their sons out of families, sometimes for even a hint of homosexuality. The results are often disastrous. As an atheist mother of a queer son, my heart twisted in despair: I don’t think about religion very much, so I was struck by how support and condemnation contradict each other yet are so closely intertwined.

Feeling an urgency to reach more people than books can, Antoine switched directions, producing the documentary You Are Not Alone and founding DBGM, a nonprofit organization with a mission to raise awareness and save lives. “If by what I’m doing, one black gay man could be prevented from killing himself, then my job is done; his healing begins,” he said. Antoine has been showing the documentary around the country. It features powerful interviews with black gay men, religious leaders (Christian and Islamic) and mental health professionals.

According to Antoine, DBGM will soon launch a program entitled “I Am Working on Healing,” with two support groups: “Sons and Mothers” for black gay boys and their mothers, to encourage acceptance of their gay sons, and “My Sons” for black mothers whose sons have committed suicide. Antoine also offers cultural competency trainings wherever possible. “Aha!” I thought. “This may be where our work together begins.”

After lunch I thought about my own social activism, which is primarily focused oncancer, a disease that usually strikes later in life. I then thought about the young black gay men who would never reach adulthood and whose untreated and undiagnosed depression would mean that they would also never likely reach a psychotherapist’s office. I thought about how a good psychotherapist had saved my own son’s life and realized how fortunate we both are that he did. The 40-minute lunch shook me.

When I returned home, I Googled Antoine’s name and learned that my humble lunch-mate is an award-winning journalist. He is also, surely, a powerful agent for change.

To learn more about DBGM, visit their website.

Need help? Visit The Trevor Project or call them at 1-866-488-7386. You can also call 1-800-273-8255 for the National Suicide Prevention Lifeline.

Follow Liz Margolies, L.C.S.W. on Twitter: www.twitter.com/cancerlgbt