Justin,
I don’t know if this is okay to ask you but I want to ask you anyway. We are friends on Facebook but we’ve never talked. I know you add people who you don’t necessarily know but at least know of your work, and that is all good with me. I’m even friends with your fan page and the Justin’s HIV Journal page, so I feel like I know you already.
Anyways, okay, have you heard of the new HIV prevention method that is a shot and shows a 100-percent efficacy rate? With all the things you’ve accomplished do you think you would prefer to be HIV-negative knowing that you may not have been so successful if you were negative? Also would you take an HIV cure?
—Poz Swimfan
Umm, WOW, these are all great questions and all are very loaded. But let’s take one question at a time.
If any of my readers don’t know, earlier this year a new HIV vaccination method now in clinical trials with macaques has thus far proven to be 100-percent effective in preventing transmission of a hybrid of simian and human immunodeficiency viruses. This proof-of-concept study is being led by researchers at the Aaron Diamond AIDS Research Center at Rockefeller University in New York. If this prevention method is approved it would only have to be taken about three times a year vs. the currently approved pre-exposure prophylaxis (PrEP) pill, which has to be taken almost every day; is ninety-two-percent effective (in preventing the transmission of HIV), though some say ninety-nine percent; and is recommended with the use of condoms. With this new method, the shot lasted about five to ten weeks on average in the monkeys who were given the prevention candidate. My opinion: It’s one step closer to a cure, at least hopefully. The more and more we come up with vaccines for disease, the more and more there is a chance for a cure. I truly believe that one day there will be a cure; and yes, sometimes preventative vaccines come before a therapeutic cure.
Now, onto your second question. A really good friend said to me that I had never looked better in my life before I was diagnosed with HIV. HIV made me change my mentality on how to live my life as it’s very hard to face one’s self in the mirror when one only sees pain, well I have to do that so that I can strive to live for a better life. I do have to attribute HIV with helping me refocus on what was and is important to me, which is my family, education, and health.
HIV has, I will admit, given me a degree of success, but that only came after tapping the strength I had in myself to overcome HIV and other personal demons. I used to do some things that I would normally not do to get away from the pain I would feel. I then met someone who helped me through and had me believe in myself again and what I could do to help people. My children’s book helps children deal with their own disclosure, my column in a Baltimore newspaper helps the local community, and this advice column helps others around the world with questions about HIV/AIDS. If it weren’t for HIV, I wouldn’t be able to help others as much as I have. But who knows—if it hadn’t been HIV it might have been something else.
Most of us believe in some sort of higher power, and some of us are atheist. I personally believe in a higher power and all I know is that my higher power will get me through, whether the end is near or far. I take comfort in leaving my mark here on earth, being a husband, father, and trying to be the best person I can be. So, as you can see, it’s really not about my success but contributing to the success and empowerment of others that I take joy in.
Would I take the cure?
I don’t know.
◊
Justin B. Terry-Smith has been fighting the good fight since 1999. He’s garnered recognition and awards for his work, but he’s more concerned about looking for new ways to transform society for the better than resting on his laurels. He started up in gay rights and HIV activism in 2005, published an HIV-themed children’s book, I Have A Secret (Creative House Press) in 2011, and created his own award-winning video blog called, “Justin’s HIV Journal”: justinshivjournal.blogspot.com. Now, with this column, Justin has found a way to give voice to the issues that people write to him about. Visit his main Web site at www.justinbsmith.com. He welcomes your questions at jsmithco98@hotmail.com.
People Who Heal People
With a Nontraditional Approach to Wellness, Health People Uses Proven HIV/AIDS Prevention Principles to Empower a Community by Chip Alfred Chris Norwood, founder and executive director
Photographed Exclusively for A&U by Alina Oswald
It all started more than twenty years ago when some courageous women did something to help their neighbors that nobody had ever done before—risking their own lives in the process. In the midst of a violent drug war erupting on their streets, a small group of HIV-positive women set out on a mission to teach people in their community about AIDS. “Thirty people were shot to death within a few months two blocks from our office,” Health People founding executive director Chris Norwood remembers. “I really had to look at the absolute determination of the peer educators. They didn’t stop—even with gunfire all around them. It was really extraordinary for women in 1990 to go out in their own neighborhood and try to get other people into care and support groups because the stigma was huge.”
The organization that began with an office in a single room at Bronx Community College has become a multifaceted, internationally recognized model for training and empowering people in areas overwhelmed by chronic disease. “I’m really proud of not only starting the program,” Norwood says, “but also that I personally have been able to learn from the program and from the peer educators.” Health People: Community Preventive Health Institute addresses health issues in the South Bronx, an area heavily impacted by poverty, with some of the worst health statistics in the state, and sizable immigrant and ex-offender populations. Predominantly Hispanic and African-American, many of the local residents are living with chronic illnesses including HIV/AIDS, hepatitis C, diabetes, heart disease, and asthma.
Over the years, Health People has expanded and evolved to improve the overall health of the community it serves. With about twenty full-time staffers and thirty part-time peer educators, the community-based organization offers outreach, prevention, self-care classes, mentoring and support. “People are very enthusiastic here about saying, ‘Okay, nobody’s helping us. We’ll do it ourselves.’ You have a level of community awareness that is very good for peer programs,” Norwood declares. Along with the physical health issues there are often mental health challenges that compound the problems. This is one of the reasons most of the programs offered by Health People don’t take place in their facility. “If you want to enroll people who are isolated and depressed, you have to go out to where they are.” She believes Health People’s methods are working “for practical and very human reasons. We’re training people to do evidence-based education. The courses are facilitated by people in the community who either themselves have HIV/AIDS or chronic diseases or have family members who do.”
The success stories from HIV/AIDS education are being applied here to prevent and treat other chronic ailments. “What has become the standard education strategy in AIDS, which combines peer education with multi-session prevention or self-care courses, is extraordinarily effective for chronic disease,” Norwood contends. “AIDS organizations as a group—especially community-based organizations—have more experience on a community level than anyone in the country in being able to engage low-income discouraged people in self-care.” At Health People peer educators offer more than just facts and figures. “Classes are very interactive. People don’t just get information; they are supporting each other. People feel comfortable doing this.”
One of those peer educators is Ryziel Wylie, a Bronx native whose focus is mainly HIV and hepatitis C. A mentor for young men on parole, Wylie teaches people about medication and better living, helps citizens returning from prison or jail integrate back into society, and links them to medical services. He also works with HIV-negative populations, teaching them about the importance of safe sex and harm reduction. Wylie has spent time behind bars, abused marijuana and alcohol, and has engaged in risky sexual behavior in the past. Now three years clean and sober, he describes himself as “gracefully recovering” and feels fortunate he’s remained HIV and hepatitis-free. This, he says “allows me to help those who weren’t so lucky. If we’ve experienced what some of these individuals have gone through, we have a better understanding and connection with them.”
Wanda Williams, Health People Assistant Coordinator AIDS Education; Peer Educator and Young Men’s Mentor Kevin Holmes; Rosa Martinez, Prevention Coordinator; and Norwood
“Peers provide the best ‘patient-centered’ information in language that is not only understandable but also most culturally and socially relevant,” states Hal Strelnik, Professor of Family & Social Medicine and Assistant Dean for Community Engagement at Albert Einstein College of Medicine, and chair of Health People’s board of directors. He is a strong advocate for the peer education model because “peer educators have ‘walked in the shoes’ of those they seek to help, bestowing on them a different kind of credibility than health professionals have.” When an effective peer educator speaks, people want to hear what he or she has to say. “They listen because everyone has a story. They may be surprised that the story I have to share is similar to theirs,” says Wylie, adding that educating others has its share of inherent rewards for him as well. “It makes me feel great to know that I have been able to help someone make a better decision or move forward with their life at an integral point in their life. When I was younger I didn’t have this. I see a smile on their face and it puts a smile on mine knowing that I’m doing the right thing.” Strelnik says peer educators serve as role models. “Their very presence and expertise together convey a message that, ‘If I can live and manage this condition, so can you!’ And now there are more and more studies proving that Health People’s pioneering approach was right on target.”
One Health People program that gives Norwood great pride is Kids-Helping-Kids. In its ten years, this peer mentoring program has proven to be one of the most innovative and unique youth programs in the nation. It is specifically designed to help children and teens whose parents have HIV/AIDS or other chronic illnesses. Older teens are trained to become leaders and mentors for younger kids. According to an evaluation by the National Disease Research Interchange funded by the National Institute of Child Health and Human Development, kids in this program are significantly less likely to abuse drugs than similar kids who aren’t in the program. More than that, these teens have shown themselves to be real leaders and inspiring, dedicated mentors for the younger children.
Despite the success of this and other Health People initiatives, Norwood points out that sustaining financial support for her organization and similar programs in underserved communities has been challenging. She claims some funding decision-makers are essentially saying that real people doing community education is offensive. The message, according to Norwood, is that “these people shouldn’t be doing that. It should be done by someone with a master’s degree. Poor communities can’t do this for themselves. It always has to be done from the outside.”
In a research project presented at the 2010 International AIDS Conference in Vienna, Norwood shows that AIDS funding in New York City is being disproportionately distributed by borough. According to data from the New York City Department of Health, a major shift in AIDS funding occurred from 2005 to 2012. The Bloomberg Administration steadily closed community AIDS programs supported with Ryan White funding in the Bronx and Brooklyn and moved some of this funding to Manhattan-based programs. “I think it reflected utter contempt for poor communities,” she tells A&U. In particular, she says peer-educator models and self-care education took a hit. If you follow Norwood’s premise, this reallocation of funding might be having deadly results. In 2005, before the funding shift that favored Manhattan, deaths of people with AIDS in the Bronx, Brooklyn and Manhattan were all virtually equal to each borough’s percentage of HIV/AIDS cases. By 2012, the last year for which city statistics are available, deaths of people with AIDS in both the Bronx and Brooklyn were thirty percent higher than their percentage of city HIV/AIDS cases, while Manhattan’s percentage of HIV/AIDS deaths had decreased to the point that its share of city deaths was twenty-three-percent less than its share of city HIV/AIDS cases. “We can’t show cause and effect,” she acknowledges, “but death shifts like this are unusual and certainly should be examined.”
Senior Peer Educator Ryziel Wylie and Norwood
Due to health reform, however, there may be a light at the end of the tunnel when it comes to financial resources for CBOs. Ultimately, Norwood understands that flexibility and collaboration are two crucial factors affecting the survival of organizations like Health People. “Now community groups can form real alliances with medical centers. You just have to work really hard to get reimbursed for the services you offer. As a nonprofit leader, you have to be a salesperson and an entrepreneur.” The bottom line for Norwood is results, such as witnessing a young man like Wylie turn his own life around and going on to do the same for others. “Health People is a great place to come and learn,” he attests. “I never thought that I would gain from it what I have.”
Tricks of the Trade
WehoLife Videos Take a Edgy, Frank Approach to HIV Prevention by Stevie St. John
These aren’t your mother’s HIV-prevention messages…unless, of course, your mother is a sassy, redheaded drag star.
That drag star would be Miss Coco Peru (Girls Will Be Girls, Trick), who is featured in one of the most popular short videos produced by the recently re-launched WehoLife.org. The video’s “Mother Knows Best” opening credits beckon to 1950s-era family sitcoms—but when the teenage son seeks her advice, the video’s edgy side is quickly revealed. (That’s assuming you weren’t tipped off by the video’s YouTube description, “Five rules for a joyful, good …” well, the last word can’t be printed here, but suffice it to say, it isn’t “relationship.”)
In the video, the son is smitten with a guy he’s thinking could be “the one”—not for marriage but for his first foray into anal sex. Ignoring her son’s squeamishness, Peru relishes doling out frank advice along with a gallon-sized bottle of lube.
“I love talking anal,” she says. “Brings back memories.”
WehoLife, a Los Angeles LGBT Center-managed program funded largely by the city of West Hollywood (aka WeHo), has been talking sex on the Web for years in the name of HIV prevention. Initially an online resource page (where to get tested, where to get condoms), the WehoLife.org website took “a leap in a whole different direction,” as David Giugni, social services manager for the city of West Hollywood said, with the 2008 debut of In the Moment.
In the Moment, which wrapped up its fifth and final season in June 2013, was an ongoing on-line soap opera about several young gay men in West Hollywood, a famous enclave for people who are LGBT (mostly G—lesbians and bisexual women comprise just five percent of the population, while gay and bisexual men represent forty-one percent).
The Center touted In the Moment (still viewable at WehoLife.org) as “steamy.” With storylines about dating, unprotected sex and infidelity, the series didn’t shy away from racy content.
And yet the latest WehoLife videos—the ones released since the re-launch this June—have a sensibility that seems to take it a step further yet. Not only is the language explicit, but the tone is overtly sexy and often, considering the seriousness of the root subject matter, surprisingly playful.
Two “porn studs” (Diego Sans and Travis James) strip one clothing item at a time as visitors to WehoLife.org answer survey questions. (They don’t go full Monty, but they don’t have a lot covered up at the end of the survey video either.)
A cast of animated characters sings about post-exposure prophylaxes. P-E-P, it prevents H-I-V. We’ve got 72 hours for this emergency…
The “Fabulous Fruits,” a shape-shifting team of superheroes, hit the streets of WeHo to fight the evil of syphilis in another “gaymation” video.
“No one wants to see a sore penis,” said Brett Holland, who manages the WehoLife program. “If you make a cute cartoon and make a story that’s entertaining…you’re not only entertaining, you’re spreading a message.”
The edginess of the videos was cultivated deliberately. Explicitly sexual content has been shown effective at getting more people involved in discussions about HIV prevention, said Holland, who cited Australia’s “Protection” campaign.
And the subtlety of the messaging is strategic, too. You’re not likely to see someone in a WehoLife video come right out and say, “You should always use condoms” or “Don’t have unprotected sex.”
“No one likes to be told what to do,” Holland said. He wants to bring more people into the discussion to have fun and, at the same time, send prevention messages “without banging people over the head.”
“And I think it’s working,” he said. “The community is listening.”
Drag queens, porn stars, stripteases, animated fruit, profanity, sexual slang…a city government is paying for this?
It can be tricky, Giugni acknowledged, to walk the line of just what a city-funded initiative can get away with. But he said the tactics have support from the City Council. Notably, WeHo’s five-member council includes two of the nation’s few openly HIV-positive elected officials, John Duran and Mayor John D’Amico.
“Council is willing to take the risk,” Giugni said. “They understand what the message is and the importance of the messaging….[It’s] a priority for this community that we are going to be cutting-edge and doing everything we can…to get that message out.”
West Hollywood is “a very open city in trying new things,” Holland said. It’s also a city that’s deeply affected by HIV, with about seven percent of residents being HIV-positive (per a community study released in 2013). The city incorporated in 1984, not long after the HIV/AIDS epidemic began, and it banned discrimination based on HIV status (as well as sexual orientation) the following year. Also, in 1984, it partnered with AIDS Project Los Angeles (APLA) and the Center on a campaign promoting the use of condoms.
“The city was engaged from the beginning with prevention and education,” said Corey Roskin, a social services specialist with the city of WeHo. “It always has been a priority.”
Roskin noted that WeHo funds direct HIV services via service agencies (such as Being Alive, the Sabon Community Clinic, Aid for AIDS, APLA and the LGBT Center) in addition to its prevention efforts.
“There’s really a full spectrum,” he said.
Holland, who has experience with theater/TV acting as well as playwriting, serves as creator or co-creator for WehoLife videos and as writer or co-writer for at least the majority of them. He lines up a “genius team” of contractors for filming and production, and he includes in the script process subject matter experts.
That subject matter isn’t narrowly focused on HIV/AIDS and STDs. HIV prevention is a complicated topic, Holland said. It’s about why people make choices. Drugs and alcohol can affect those choices. So can isolation, depression and a host of other factors.
WehoLife videos touch on some of those factors. One recent video, for example, imagines a television shopping channel dealing in meth, a drug that’s prevalent among gay and bisexual men and that’s highly correlated with unsafe sex and HIV transmission. Continuing to cast people with established followings, that video features Drew Droege (known for his YouTube videos in which he impersonates actress Chloe Sevigny) and Jeffery Self (whose credits include the LOGO sketch show Jeffery & Cole Casserole).
Holland is also planning an ongoing web series that focuses on alcohol and its possible effects—both funny and serious.
WeHo is a mostly white city as far as residents go—but it’s a go-to nightlife destination for men from all over the L.A. area, and they’re not all the young, muscled gay types that embody what Holland calls the “WeHo aesthetic.” Holland said he’s out to reflect diverse viewpoints in WehoLife videos, two of which have highlighted the lives of transgender women.
“We’re here for everyone,” Holland said. “Everyone has a place, and everyone’s part of our community.”
◊
Stevie St. John previously worked for five years in the Los Angeles LGBT Center’s marketing and communications department and has done freelance work for the Center since leaving at the end of 2012.
◊
Stevie St. John is a freelance writer in Los Angeles, where she serves on the board of the local chapter of the National Lesbian & Gay Journalists Association (NLGJA-LA).
Can We Talk About HIV? Si, Se Puede
The CDC looks for new strategies to reach Latinos by Larry Buhl
Harm reduction professionals understand the importance of getting people to talk about a disease in order to significantly reduce infections. But what if social norms dictate that the target group doesn’t want to talk about it?
HIV outreach coordinators around the country have been grappling with this conundrum for decades. But now they have a ton of government dollars to help in their efforts.
In September, the Centers for Disease Control and Prevention (CDC) launched the We Can Stop HIV One Conversation at a Time campaign. It’s a national, bilingual communication campaign that encourages Latinos to talk openly about HIV with their families and friends.
It’s not the CDC’s first foray into cultural-specific outreach. In fact, the campaign falls under a larger umbrella at the agency called Act Against AIDS, a portfolio of ten campaigns that have the goal of risk reduction for men and women of color.
We Can Stop HIV One Conversation at a Time is the first CDC campaign by and for U.S. Latinos. The campaign is reaching out to Latinos through online, print media, transit, and billboard advertising, as well as social media outreach, and will present its messages in English and Spanish. Partnerships with leading Latino-serving media outlets and organizations will help amplify bilingual campaign messages.
The campaign was launched in September at the People en Español Festival in San Antonio, Texas, and will continue to be promoted at a variety of community events over the next year. Event cities include Los Angeles, Houston, Miami, Chicago, and San Juan. The campaign’s New York City event on September 4 was hosted in conjunction with MTV Tr3s, the network’s Latino-focused channel.
Just as one HIV/AIDS message won’t work for all Americans, one message won’t work for all Latinos, either. Latinos in the U.S. are a diverse group, segmented by age, geography, acculturation, language preference, and country of origin. It is hard to get agreement among the populations about which designation is better: Hispanic or Latino (for purposes of this article, it’s Latino).
What is common to many Latino groups is a higher barrier to openly discussing HIV/AIDS, according to Nick De Luca, prevention communication branch chief at HIV/AIDS prevention at CDC.
“To develop the campaign, we did extensive research with over 300 Hispanic/Latinos across the U.S. as well as twenty agencies that work with Hispanic/Latinos,” he tells A&U. They reached out to all age groups and represent all parts of Latino communities in the U.S. The goal, De Luca says, was to find out exactly why many were reticent about talking about HIV/AIDS, and sometimes about sexuality in general.
“There was a strong effort to address some of the cultural issues that we identified through our research. We found that Hispanic/Latinos in the U.S. generally don’t talk enough with family and with friends about HIV, even though they discuss many other topics. We heard that some cultural norms in the community, as well as sexual stigma, could lead to what we call ‘sexual silence.’ And that prevents them from having lifesaving conversations.”
One way to more effectively encourage Latinos to talk about sex and sexual roles is to appreciate how many Latinos, generally older ones, see distinct gender roles, machismo and marianismo, where men make decisions and women defer. Deftly reframing these roles so that women can, for example, feel free to ask men to use condoms, can be a key way to reduce risk of HIV and other STDs, experts agree.
And De Luca says that We Can Stop HIV One Conversation at a Time doesn’t pull any punches about what’s at stake. “We talk about how anyone can get it regardless of gender or age or marital status and how it affects more Latinos than you think. If current trends continue, one in fifty Latinos will be infected with HIV. Right now more than 220,000 Latinos are estimated to be living with the virus. Latinos make up sixteen percent of the U.S. population and account for just over twenty percent of new HIV infections each year.”
De Luca points to another statistic: A recent study by the CDC found that only about half of Latinos have talked with friends and family about HIV in the past year, and another found that even when Latinos are ready to talk about HIV, many do not have the information they need to have these life-saving conversations with loved ones.
Culturally Appropriate Intervention
Programs in the CDC’s Act Against AIDS initiative are only part of U.S. governmental efforts to reach out to Latinos/Latinas and other groups in the
fight against HIV/AIDS.
HRSA has been funding a variety of initiatives, including Culturally Appropriate Interventions of Outreach, Access and Retention Among Hispanic/Latino Populations, as part of its Special Programs of National Significance (SPNS).
The initiative’s ten demonstration sites are now in the beginning stages of designing, implementing, and evaluating new methods to identify Latinos who are at high risk or living with HIV, and improve their access to and retention in quality HIV primary care. The ten grantee organizations will develop pilot programs that can be used around the country.
Two of the ten grantees are in Los Angeles, AIDS Project Los Angeles (APLA) and Bienestar. Jeff Bailey, director of client services at APLA, tells A&U that they are in the first phase: identifying HIV-positive men of Mexican origin (the five-year grant APLA received specified “Mexico”) who are not engaged in primary medical care.
“We’re using social media, community partners, the Mexican consulate and some non-traditional sources, like freestanding community clinics in Mexican-American neighborhoods to find [these men],” Bailey says.
Once the men are identified, the program will be launched as part of the Los Angeles AIDS Walk on October 12, with 100 Latino men leading the walk. There will also be an event in L.A. as part of Dia de los Muertos, at Hollywood Forever Cemetery on November 1.
Finding the men is one roadblock, getting them to be out and proud about their status is another. And all of these roadblocks are erected, at first, by silence. As with getting Latinos—especially Latino men—to talk openly about sexuality and HIV, there are cultural barriers to bringing them in to be treated—or even tested—for HIV, Bailey says.
“First there is the stigma with HIV and men who have sex with men,” Bailey says. “For some, there are beliefs that there are treatment options other than Western medicine that are preferable. There’s the comfort level of going into a clinic. In other words, they don’t want to be seen by neighbors going into a clinic that handles HIV cases. And some undocumented men believe that they’re ineligible for care in the U.S.”
Bailey adds that isolation is one of the biggest problems. “Men often will not want to talk with family, and they can’t or won’t build a support system around this (HIV) issue.” But Bailey and his teams are finding the men, and he fully expects to get them talking about the issue one conversation at a time.
Larry Buhl is a radio news reporter, screenwriter, and novelist living in Los Angeles. His podcast on employment issues, “Labor Pains,” can be found at www.laborpainspodcast.com.
Knockout
Trailblazing Filmmaker Patrik-Ian Polk Takes Jabs at the Barriers to Sexual Health by Sean Black
Photos by Duane Cramer
Patrik-Ian Polk can take a great deal of the credit for fast-forwarding queer black cinema into present-day; in fact, some even tout him as the “Father of Black Gay Cinema.” After bursting onto the scene in 2001 with his directorial debut Punks (a gay black romantic comedy produced by Babyface and Tracey Edmonds), Polk, a longtime friend of the Black AIDS Institute and a member of the Black Hollywood Task Force on AIDS, garnered further serious attention for his dramatic comedy series Noah’s Arc. Created for Logo TV, the 2005 instant hit shined an unapologetic spotlight on the lives and loves of a group of gay African-American men. Since then he’s been responsible for bringing us feature titles like The Skinny and the movie-spinoff of his TV series, Noah’s Arc: Jumping The Broom.
His latest entertainment offering is another poignant leap towards mainstreaming gay black America in a more serious yet still-subtly-provocative way. Blackbird is a coming-of-age tale about a gifted high school senior, played by impressive newcomer Julian Walker, a choirboy grappling with his sexuality in a conservative Southern Baptist locale. The film is set in the creator’s hometown of Hattiesburg, Mississippi, and is based on the novel by Larry Duplechan. It stars Isaiah Washington and Academy Award-winner Mo’Nique [A&U, February 2004]. Washington also serves as a producer of the film while Mo’Nique and her husband Sidney Hicks serve as executive producers.
Apart from traveling to promote his latest film, reading scripts, and crafting his next original screenplay, Polk takes time to talk to A&U about combating the spread of HIV in the community he loves and knows the best.
“Sexual health is a huge issue for gay black men in the twenty-first century. With HIV rates continuing to be among the worst in the world our community needs to be taught the simple information that can keep us healthy and alive,” Polk insists.
He echoes concern published earlier this year in the Washington Post. Black Americans are between eight to nine times more likely than white Americans to test positive for HIV. The findings predict that the disparity will only get worse and the gap will widen because black Americans also have the highest rates of new HIV diagnoses. Nearly half of all new cases of HIV are among black Americans.
“As gay black men, we don’t often grow up with normal socialization of our sexuality. Our gayness is often something that we feel the need to hide and not share with our families openly. So where are we to learn about issues of sexual health? How to clean out your booty if you’re engaging in receptive anal sex; how a pill can prevent you from contracting HIV; etc. With my films, I’m not trying to make PSAs about this stuff, but I do try to present practical information that is rooted in the characters and the stories I’m telling.”
Aiming to bring awareness to his audience Polk believes that, by staying connected to the emotional lives of the characters he’s creating, the viewers will stay engaged and absorb some of the self-love messaging. “Emotion is universal, regardless of race, sexuality, or gender.”
Discussing filmmaking, youth, family, relationships, his influences, and HIV, A&U brings you closer to this month’s major contender—Mr. Patrik-Ian Polk.
Sean Black: Thank you for taking the time to speak with us. Your latest movie, Blackbird reminded me of beginnings, how we start. What sparked your interests in becoming a filmmaker?
Patrik-Ian Polk: By the time I was in junior high school, I already had a healthy interest in television, movies, and storytelling. I had no clue what a filmmaker was, but I knew I was interested in telling stories. I used to watch soap operas with my grandmother after school and in the summers. At one point, I started writing my own soap opera using the names of my school friends. We even filmed an episode once. I wish I still had that videotape. It was hilarious! But when Spike Lee emerged with his first film She’s Gotta Have It, and he wrote a companion book that detailed his journey to becoming a filmmaker and directing his first feature film, that was when I was first introduced to the concept of what a director was and that you went to film school to become one. So I have Spike Lee to thank for inspiring me and helping me focus my dreams and aspirations. Later, I ended up attending the top film school in the country, the University of Southern California.
Let’s go back to your childhood.
I grew up in the late seventies/eighties in Mississippi in a time before we had the Internet, smartphones, and laptop computers. A time when you could leave your house and not come home until the streetlights turned on, and no one worried about you being murdered or kidnapped. I was an excellent student, always did really well in school with minimal effort, and thankfully had a mother who wouldn’t hesitate to indulge my creative and educational whims. She would support any idea that I came home excited about. When my little white best friend Alicia Jackson started playing cello in second grade, I came home proclaiming I wanted to play the cello. So my mother took me down to the music store and we got my first cello. When I was about thirteen years-old, I started a major lobbying campaign with my mother for a video camera. This was back when video cameras used a full-sized VHS tape. That camera was huge! But my mother got it for me. Her encouragement instilled in me a sense that I could do anything; accomplish anything—that nothing was outside my reach. If I could dream it, I could do it. Period!
I was also allowed the freedom to explore various religious faiths as a child—Baptist, Methodist, Catholic, etc.—so I developed a strong sense of religious and racial tolerance. I was keenly aware that my sexuality was not something I could or should be open about as a young man, but I never felt the threat of being ostracized because of my homosexuality. In fact, I rarely if ever felt anything other than acceptance and encouragement as a child.
What relationships do you nurture today?
I keep a small, close circle of friends and try to maintain regular contact with my immediate family. I feel it is important to have people in your life that you can inspire or mentor, but it’s also important to have mentors or people who you look up to, who have accomplished things that you hope to accomplish. If you surround yourself with losers, then that can’t help but have an effect on your own success.
Do you embrace a broader notion of family?
There are two types of family. Your “true family,” or the family you’re born into. And your “real family,” or the family you choose. Your real family takes on an even greater significance because you choose them—especially for many gay people, who often end up being distant from their true families because of tension surrounding the sexuality issue. If you choose wisely it becomes harder and harder to tell the difference between your “true” and “real” families because they feel like one and the same.
We’ve seen many coming-of-age stories about gay characters. What sets Blackbird apart from the rest?
I think by this point we’ve seen many coming-of-age stories about white gay characters. But we have very rarely seen these stories from black perspectives. Pariah told the story of a young black female coming to terms with her lesbianism—a first of its kind. And now Blackbird tells the story of a black teenaged boy trying to reconcile his religion and his burgeoning homosexuality. As young people, we often derive our first and most significant ideas about life and lifestyles from popular culture. So it is of course important for these stories to be told so that gay youth of color have more concrete examples of their lives.
Larry Duplechan’s novel Blackbird is set in rural California during the 1970s. Why did you set your film adaptation in the present day?
I always felt the film needed to be set in the present. The book tells a lovely story set in the 1970s complete with all the cultural references of that era. But as a film and as one of the only black gay coming-of-age films, Blackbird needed to be set in the present day, especially since I set the movie in Mississippi. Besides, period pieces are hard to film [grin].
What do you think of Tyler Perry’s work?
Tyler Perry is most definitely one of my professional heroes. When I think of all that man has accomplished—the four television series on the air at once, the many films produced, the wealth accumulated, the movie studio he owns—I cannot help but be inspired to climb to new heights. One of my mantras I return to in tough times [is] “Tyler Perry lived in his car after his first production failed; he now owns an island and is friends with Oprah.”
I recently attended a dinner thrown by Essence magazine honoring black men in film; the dinner was hosted by Tyler Perry in his Beverly Hills mansion. To be in the room with Tyler Perry, Spike Lee (another personal hero), Sidney Poitier—it was incredibly surreal. I got to meet and chat with Mr. Perry, but we were asked not to take photos. There is a large group photo that appeared in Essence that I hope to get a copy of. I must admit, on my way out of the dinner party, I did make a stop in the powder room, which was as big as my entire kitchen and living room combined and I did secretly snap one cell phone photo. I have no intention of sharing it or posting it anywhere- it’s not even that great of a photo—but I do look at it from time to time. Not in a creepy, I’m-stalking-Tyler-Perry kind-of-way, but as inspiration when my life is low. When Tyler addressed the dinner party, he spoke about his first time going to Oprah’s house and how that inspired him. He said he hoped that some of us were similarly inspired that night at his house. I most definitely was. I know a lot of people hate on Tyler Perry, but to me he is nothing but a hero.
What are some of your favorite gay-themed films?
My favorite film of all time is Mahogany [starring Diana Ross (A&U, August 1999)]: Some would call that a gay film. I was lucky when I was in college at Brandeis University in Boston to be the Entertainment & Arts Editor of the paper, so I got to see all kinds of great independent and foreign films. Some of my favorite gay ones include: Lilies, Edward I, Nowhere, Y Tu Mamá También, Tongues Untied, and The Incredibly True Adventures of Two Girls in Love.
Are the characters in your films doppelgangers taken from your off-screen social scene?
People always assume that because I’m a gay filmmaker making films about gay people I must be borrowing from my personal life in the creation of characters. This could not be further from the truth. Aside from the occasional line of dialogue, I rarely take from real life. So my point of connection with my characters is simply the human connection.”
In The Skinny your actors take pause in tribute to the important legacy of Langston Hughes. Has his artistry informed yours?
I admittedly don’t know a lot of about the life of Langston Hughes, but his writings have been incredibly inspirational. He captured the consciousness of the African-American experience in America and is considered one of our greatest and most mainstream writers. The fact that he was also gay adds many other layers to his works—which on the surface seemed to be solely about race, but clearly had sexuality implications as well. To live in and walk around Harlem, in some of the same places that people like Langston Hughes actually lived and visited feels very special. I often wonder what Langston Hughes, James Baldwin, Lorraine Hansberry and the like would think about the society we live in today and—more specifically—what they would think of the work of an openly gay black artist such as myself.
Julian Walker and Mo’Nique in Patrik-Ian Polk’s BLACKBIRD
The publisher of The Langston Hughes Reader in 1958, called Hughes “the unchallenged spokesman of the American Negro.” Whom do you turn to for civil rights leadership today?
When I seek insight about civil rights issues today, I turn to the work of people like James Baldwin, Langston Hughes, Martin Luther King, Jr., Bayard Rustin, Nina Simone, Maya Angelou [A&U, January 2001]. In terms of contemporaries, I look to journalists, reporters, writers such as Melissa Harris-Perry, Rachel Maddow, Eugene Robinson, Jonathan Capehart. I don’t think it’s fair to credit me as a spokesperson for anyone [laughs]. I am an artist. I am a storyteller. I happen to tell stories about gay African-American experiences. It is unfortunate that I am basically the only one telling these stories on a consistent basis, and I look forward to there being more. But I don’t want to be credited as being the spokesperson for anyone. I am more than happy to be known as a gay black filmmaker, and if I never do any work outside the black gay genre (if there is such a thing) I will die a happy man. I love my community and it makes me happy to tell our stories. That’s not to say that I will never do a film that tells some other story that’s not specifically gay and black—but I do love what I do and feel it is my mission as an artist. To tell the stories of my people, my black gay people. We’ve existed in the shadows for far too long.
Can you describe the nexus of your work?
The best films and television not only entertain us but expose us to new ideas, new cultures, new ways of thinking about life. Certainly with my work, I recognized early on the need for gay-themed films that explored the black gay experience. Within that framework, I have tried to educate my audience on what it means to be black and gay in this country. I’ve tried to educate about important issues such as the HIV epidemic and fun issues such as the proper way to prepare for anal sex in my last film The Skinny [available on Netflix]. It’s important to me that my work not only entertain but also educate and expose the viewer to new things.
You have been a longtime supporter of Phill Wilson [A&U, February 2014] and the Black AIDS Institute and have been honored with their Heroes in the Struggle award. Whom do you consider to be the heroes today when it comes to the fight against AIDS?
The heroes in the struggle against HIV really are the researchers, doctors, clinicians, treatment advocates, the people working on the front lines of this fight. The ones working in small towns, in rural areas. Bringing sexual health messages to clubs and places in the community where black gay men gather. It’s not often work that is glamorized, but it is among the most important being done today.
A&U’s Alina Oswald interviewed you for the February 2005 issue. In it you mention the ineffectiveness of abstinence only programs in schools. Since Congresswoman Lee [A&U, October 2012], a founding member and co-chair of the Congressional HIV/AIDS Caucus, has introduced The Repealing Ineffective and Incomplete Abstinence-Only Program Funding Act of 2013, HR 3774. It aims at halting federal support of abstinence-only-until marriage programs and instead allocates funding towards a broader and more comprehensive sex education program. How do you feel about this finally taking root nearly a decade later?
Abstinence-only sexual education programs are the biggest waste of government resources to come out of conservative politics. We should do away with this archaic and ineffective messaging.
Where would you direct the course of conversation around HIV?
We need to be talking about this issue much more than we are. HIV has faded into the background of our consciousness, but we as gay black men [GBM] must continue to address this issue. I’m producing a groundbreaking PSA campaign for the CDC that addresses this problem in the gay black male community. The messaging is direct, informative, practical and sure to be somewhat controversial. But we need to know the facts in order to protect ourselves. For example, the fact that we are not talking about PrEP [pre-exposure prophylaxis] as a viable way for GBM to stay HIV-negative is absurd to me. With the infection rates as high as they are in our community, the fact that taking one pill a day with little to no side effects can prevent someone from contracting HIV should be national news. But we can’t wait on the mainstream media to pick up our cause. We need to demand that this be made available en masse!
A bacterium with a live biotherapeutic grows into a microbicide candidate
by Chael Needle
LifeGuide [Treatment Horizons]
The development of female-initiated HIV prevention methods—female condoms, antiretroviral treatment as prevention, vaginal and rectal microbicide candidates—has been guided by the idea that the empowerment of women and girls is key to improving their health. Effective safer sex methods may be useless if the context surrounding the individual still puts her at risk. For example, an individual may want to use a particular product but may not be able to afford the expense or have ready access to it. Or an individual’s sexual partner(s) may not support her decision to use prophylaxis, or demand sex without her consent. Social stigma surrounding AIDS may convince an individual to set aside prevention strategies for fear of being associated with the virus.
A new topical microbicide candidate seems to hold the potential to not only be effective but to address many of the barriers that thwart prevention. Developed at Osel Inc., a biopharmaceutical company, and the National Cancer Institute, MucoCept is a novel, first-in-class candidate that genetically enhances the ability of naturally occurring vaginal bacteria to inhibit HIV and block transmission.
The bacterium used is a common strain of lactobacilli called Lactobacillus jensenii, which is a member of the normal vaginal flora. The live recombinant lactobacilli are engineered to express an HIV entry inhibitor called cyanovirin-N on the cervical/vaginal mucosa. Cyanovirin-N binds to HIV’s entry-seeking protein gp120 and inhibits HIV transmission.
It’s the product of ten years of work, says Dr. Laurel Lagenaur, MucoCept’s principal investigator at Osel. One of the most recent steps was to test the therapeutic in a macaque challenge model. Explains Dr. Lagenaur: “In these models you repeatedly challenge the animals and you look for infection. You look for the drawn-out survival curve. If you had a couple who was disparate—for instance, the man had HIV and the woman did not and they’re in a [sexual] relationship—what you want your product to do is increase the time that it takes for the person to get infected, to the point where you increase it infinitely. In an animal model you give a much higher dose of virus so that they get infected at a more advanced rate and then you look at whether your product slows down the rate of infection. In this case it slowed it down sixty-three percent and that’s good.” A reduction in the viral load of infected macaques receiving the product was also noted.
A class apart
In the context of antiretroviral-based and non-antiretroviral based microbicides, MucoCept is set to distinguish itself. Like antiretroviral-based candidates, MucoCept inhibits the virus in a specific way. Yet, the potential for an individual to develop drug resistance with an antiretroviral-based microbicide is present. If drug resistance develops, the user would have to change therapies, says Dr. Lagenaur. Antiretroviral-based microbicides might be effective, in other words, but also might be date-stamped.
“Other microbicides that have been out in the field have been non-specific inhibitors, like all of the early-tested microbicides: N-9, cellulose sulfate, PRO 2000, Carraguard. Many of those were polyanions or detergents, so either they kind of worked against the membrane of the virus or they bound to the virus. But—none of those worked,” Dr. Lagenaur explains, adding that one positive result of these studies is that researchers have learned that combining contraception and HIV prevention, which some of the candidates tried to do, may not be harder than we thought.
“Our product is a really novel class of microbicides because it’s a biologic. First of all, this product will only work in women because this product is meant to colonize the female reproductive tract. [Yet], there could be future products that could colonize both the vagina and the rectum. This product [so far] only colonizes the vagina well,” says Dr. Lagenaur.
Novel and natural
As a biologic, a therapy derived from living organisms, the cyanovirin-N-expressing lactobacilli naturally colonize the female reproductive tract and could potentially offer protection for weeks at a time. “This particular protein, cyanovirin, was found in a drug screen at the National Cancer Institute many years ago and kind of languished because there wasn’t a good way to make this antiviral protein cheaply and efficiently,” says Dr. Lagenaur, adding that if it were developed as a conventional microbicide it would be limited by its coital dependence, the need to apply it every time you engaged in vaginal sex. “By linking this protein to a bacterium…the bacterium is the factory for you. You put the bacterium into the vagina and it will continue to make this antiviral protein….”
The capacity of bacteria to grow and multiply makes it unnecessary to apply a microbicide like this around the time of sexual activity, as well as makes it efficient and affordable to produce. Gone would be much of the costs associated with traditional therapeutic manufacturing, purifying, formulating, and so on, says Dr. Lagenaur. A big batch of bacteria may be grown in multi-liter fermenters, freeze-dried, and then delivered in a dried capsule.
We can think of MucoCept as a “second-generation probiotic,” says Dr. Lagenaur, different from some of the other probiotics in that the lactobacilli is “capable of coming back alive and then it grows and it produces your antiretroviral so you don’t have to worry about fresh drug. Once you have the bacteria, it’s making fresh drug….You use the bacteria to do your bidding!”
Overproduction is not a concern. “MucoCept tends to replace the [resident] Lactobacillus that is already [in the vagina] but if there’s no Lactobacillus it will become the normal flora there….It doesn’t really overgrow because it’s not a pathogenic organism. It’s what’s called a commensal organism, kind of the native species of what’s supposed to be there. So, it grows to a certain level that the body tolerates…,” notes Dr. Lagenaur. “And in this case it produces the antiviral at a low level and we know that the level we produce is at a level that can inhibit the virus but it’s not so great that it would be toxic. It’s the self-limitation of the system—the bacteria can produce only so much protein.” The settled-on level of antiviral has been tested in an animal model.
A double benefit
Improving vaginal health lowers the risk of HIV transmission and MucoCept’s Lactobacillus is protective, controlling various vaginal infections and safeguarding against inflammation.
Referring to the CAPRISA 004 trial, which found that a one-percent tenofovir gel provided moderate protection against the sexual transmission of HIV for women, she says, “For the group of women who had tenofovir and had no vaginal inflammation, no infections occurred. Women who had tenofovir and had vaginal inflammation is where they saw infections, and of course women who got placebo also had infections.
“Vaginal inflammation was a big cofactor for infection. And this can be caused by a number of things—a viral infection, or another bacterial infection, or something called bacterial vaginosis, which is an overgrowth of bacteria, other than lactobacillus, in the vagina. By actually putting in the Lactobacillus as part of the product, we are giving women what they need to have there anyway. There’s a high level of bacterial vaginosis in women in developing countries. It’s actually as high as twenty-five to thirty percent of women worldwide who may have bacterial vaginosis, but not recognize it. So they have a low level of inflammation and levels of inflammation bring in white cells [of which] one component is the CD4 T cell and that’s what HIV infects.”
Real-life contexts
Usability of any product in a real-life situation is a factor of its viability as a prevention method and MucoCept addresses the concerns many women have about more conspicuous products.
“What I like about MucoCept is that a woman could use this very covertly. What’s more covert and natural than what already lives in the vaginal tract? You could deliver this in a form that would be invisible to the user. It’s not gelatinous; it’s not sticky; it has no odor…,” she notes. “Another aspect is that it could always be female-initiated and not coital dependent so it could be applied well in advance or any time she wants…[T]hat makes it very much more in a person’s control. So it gives a woman more options….
“Secondly, there’s a stigma associated with using anti-HIV products,” says Dr. Lagenaur, noting that often the presence of a prevention method sometimes translates to partners as evidence of infection. “However, MucoCept is [not only an HIV inhibitor but] also a women’s health product because it’s a Lactobacillus and women could use it to prevent bacterial vaginosis or ‘to enhance vaginal health,’ if you want to say it that way. So, a woman in a developing country could seek a product like this and tell a partner that it’s for vaginal health…and yet it’s protecting her in two ways—it’s improving vaginal health and there’s the anti-HIV component to it.”
Future potential, next steps
The next step in Dr. Lagenaur’s research is animal-based preclinical safety testing, a process necessary to make sure it has no toxic effects on the reproductive tract or liver, and so on, in order to be able to give it to humans as part of a trial. Later, the team will work on formulating the biologic and finding the right dosage. “Then there will be acceptability studies,” says Dr. Lagenaur. “Do women prefer to have the product as a capsule? Do they prefer it in an applicator? Do they want it as a film? Do they want it as a gel? How do they want it delivered? And that’s a little bit on the advocacy and consumer side:You have people ask, what do you think about a product like this, and if you were using a product like this how would you take it? It’s very important because you’d want a product that women would feel comfortable using. Or men, for that matter, if you develop a similar product for them.”
Notes Dr. Lagenaur: “Our product is sort of a first in class. It’s not a me-too product. If you look at some of the antiretrovirals out there, it’s like, try this one, try that one, but they’re all basically similar. MucoCept is a very different kind of product. In that way, we have a little bit of a higher hurdle because it’s a very novel approach and people might not be as comfortable using a modified bacterium. But if you think about it, it’s a natural bacterium with one little change—and that’s a lot more natural than a drug. It’s a bacterium with one additional protein, so, if you think about it in that way, it may end up being safer than other things out there.”
Chael Needle wrote about a statin in the context of drug-drug interaction for the August issue.
Power of Evidence
A movement to decriminalize sex work gets a boost from a multi-nation study by Larry Buhl At the XX International AIDS Conference, Richard Horton from The Lancet holds up the journal’s special-theme issue on HIV and sex work. Photo by IAS/Steve Forrest
Presentations at a session on HIV prevention strategies for sex workers, which took place at the XX International AIDS Conference two months ago in Melbourne, Australia, showed that decriminalization of sex work could significantly decrease global HIV infections among female sex workers.
The study was part of a series of papers by The Lancet that underscores the need to address one of the highest risk groups of HIV—sex workers—to impact the HIV epidemic.
Researchers who studied HIV among female sex workers in Canada, India, and Kenya concluded that structural changes, like decriminalizing sex work, give sex workers greater control over their environment. That control makes it safer for them and their clients.
Anna-Louise Crago, a doctoral candidate at the University of Toronto, was an editor of the Lancet series. As a former sex worker, Crago has a firsthand understanding of the challenges faced by this population.
Crago says that sex workers reported that perpetrators knew that they could not access police protection. “The antagonistic relationship with police that criminalization creates and the abuse by police that criminalization fuels across many contexts creates a climate of impunity for violence against sex workers, by police and by their clients.”
Because sex work is a crime almost everywhere in the world, men and transgender people who trade sex are driven underground and face unsafe situations, according to Steffanie Strathdee, Associate Dean of Global Health Sciences at the University of California San Diego School of Medicine and one of the leaders of the Lancet series. In talking with A&U, she pointed out how laws against sex work and the environments sex workers face enhance an already perilous situation.
“They fall prey to abusive johns and police. They face an increasing risk of violence, and due to fear of arrest they are less likely to insist on limits and safeguards, including condom use. Imagine if you are a sex worker on the streets trying to escape the police, you’re going to work in more remote environments where you can’t be found, and that leaves you prey to abuse by clients.”
The controversial policy of condoms as evidence—police “proving” that suspects are engaging in sex work by finding condoms on their persons—is just one example of the system working against the health and safety of sex workers.
“Police may think they are doing a good thing by taking condoms away, and may not realize in fact they are not going to prevent this person from having sex,” Strathdee continues. “They are just going to have unprotected sex or reuse condoms and that isn’t going to help anyone.”
The Lancet series on sex work and HIV comes on the heels of a World Health Organization (WHO) report that urges governments to decriminalize behaviors to better address the spread of HIV:
In the report summary, the WHO said; “Countries should work toward decriminalization of behaviours such as drug use/injecting, sex work, same-sexCourtesy: The Lancet
activity and nonconforming gender identities, and toward elimination of the unjust application of civil law and regulations against people who use/inject drugs, sex workers, men who have sex with men and transgender people.”
The WHO says that sex workers are fourteen times as likely to have HIV as other women, and transgender women fare the worst: they’re almost fifty times as likely to have HIV as other adults.
Megan McLemore, a senior researcher in the Health and Human Rights Division of Human Rights Watch, points out that some individuals belong to more than one of these high-risk groups and that transgender sex workers face dire conditions.
“Transgender people are highly susceptible to HIV because the environment of risk disproportionately affects trans people,” McLemore says. “When you combine employment discrimination, getting kicked out of houses, you have a lot of people who have to engage in sex work for survival.”
McLemore says what unites these groups is that their activities are either illegal or heavily stigmatized in many parts of the world. That means that they are unlikely to seek out medical help or advice simply because they don’t want to be arrested for being gay or having sex for money.
McLemore and other decriminalization advocates say the proclamations from the WHO and the Lancet series have significant implications for HIV prevention because they take the onus of protection off the individual and castigate legal systems that make it difficult, if not impossible, to prevent the spread of HIV among the sex work population.
A few parts of the world have attempted to address the dangers to sex workers by changing their laws. New South Wales, Australia, decriminalized sex work in 2009. So far New Zealand has not experienced any repercussions from decriminalization, although sex worker advocates agree that not a lot of research has been done since 2009 and that the rate of HIV and other STDS in that country were low to begin with.
In December, Canada’s nine Supreme Court justices unanimously struck down laws targeting sex work. The Court proclaimed that Canada’s laws caused unreasonable harm to sex workers’ safety and health. But the battle isn’t over yet. The Court gave the government twelve months to respond and the legislature has introduced legislation to re-criminalize sex work. Because conservatives have a majority in the parliament there is a good chance they will succeed in reversing the Court’s ruling.
“We have a very right-wing government here and the Prime Minister is close to his evangelical base and is an evangelical,” Crago said. “Sex workers may have to go back to court if it is re-criminalized, and show that the laws are unconstitutional.”
Short of complete decriminalization, or even legalization, it is possible that changing some police policies could have a positive impact on the health and safety of sex workers. One of these policies is condoms as evidence. Not surprisingly, this policy often keeps sex workers from carrying protection.
Human Rights Watch released a 2012 report on the condoms-as-evidence policy in four cities, Washington, D.C., New York, San Francisco, and Los Angeles, and since then has had success in changing policies, McLemore tells A&U.
“In San Francisco the prosecutor has agreed not to use condoms as evidence in misdemeanor [investigations] and police have agreed not to confiscate condoms. In New York City, a bill has not yet passed, but prosecutors in four of five boroughs have agreed to not use condoms as evidence. In D.C., while not admitting they had done it in the first place, the police reassured the community by issuing cards saying they would not confiscate [condoms] and a number with a complaint line for any abuse by metro police.”
In part of Nevada, sex work is tolerated, and some areas around the world have permissive attitudes like red light districts where police turn a blind eye.
But McLemore and Strathadee agree that complete decriminalization will have the biggest impact on the health of sex workers and that it needs to happen on a multi-country level.”
With the WHO declaration and the Lancet study, the movement to de-criminalize sex work has gotten a boost. But Crago admits there is still a lot of work to do.
“The discussions around sex work often happen in very sensationalistic and moralistic terms that devalue or silence sex workers’ voices. Hopefully we are moving to the point where their voices are heard and respected. I think many people regardless of how they feel about sex work understand the value of evidence, and I think the evidence is clear and convincing that criminalizing sex work has a devastating effect on sex workers’ health.”
◊
Larry Buhl is a radio news reporter, screen- writer, and novelist living in Los Angeles. His podcast on employment issues, “Labor Pains,” can be found at www.laborpainspodcast.com.
A Man for All Reasons
Outspoken, Eclectic Entrepreneur Michael Lucas Sounds Off Fervently About HIV Prevention by Dann Dulin
Photos by Christopher Logan
Raised in Russia and a U.S. citizen since 2004, Michael has quite a résumé: lawyer, adult film actor, male escort, writer, documentary filmmaker, political activist, and public speaker. His film company, Lucas Entertainment, produced the first adult film in Israel, Men of Israel.
Michael’s constant course and challenge in life is to reinvent himself. Compassionate and committed to social issues, he’s against drug abuse, child exploitation, anti-Semitism, and unsafe sex. He’s done print PSAs promoting safer sex and the importance of getting tested and he supports AIDS causes, including New York’s GMHC. This past May he participated in the city’s AIDS Walk and raised enough money to be a Star Walker (those who make over $1,000. Michael brought in $3,200.)
Recently divorced after an thirteen-year relationship, Michael, who is negative, is currently dating an HIV-positive guy. Always an open book, last year Michael announced that he was taking Truvada as PrEP (pre-exposure prophylaxis), a therapy of one pill taken daily that can reduce the risk of HIV infection by as much as ninety percent. A hot-button issue, the use of PrEP has attracted many health professionals who are avidly against it but also many who are seeing the benefits. Michael says it changed his sex life, but he’s quick to admit that it can be risky, with potentially serious side effects. Although he once opposed barebacking, Michael now stands up for condom-free adult films in light of PrEP.
After contacting Dr. Robert Grant of the University of California, San Francisco, who conducted a major PrEP study, Michael was committed to trying the drug regimen. At an AIDS conference last year, Dr. Grant announced that, “No one in iPrEX [the study] acquired HIV infection with a drug level that would have been expected with daily dosing….We have not seen anyone become infected that indicated daily use.” The study included high-risk participants such as men who had unprotected sex and negative men who had sex with positive men.
Explaining about his serodiscordant relationship, Michael says: “We have made a joint decision not to use condoms because he is on medication (and undetectable) and I am on PrEP.”
Because of Russia’s increasing homophobia and anti-Semitism, Michael renounced his Russian citizenship several years ago and decided, five years after his American naturalization, to also become an Israeli citizen. Since then, he has resettled his parents and other family members in the U.S. His passion for Israel is evidenced in his first documentary, Undressing Israel, an entertaining and illuminating film. His latest documentary, The Campaign of Hate: Russia and Gay Propaganda, is deeply disturbing and available on DVD and on iTunes, as well.
Michael’s weapon is his voice—and he urges others to speak up, as well. He lays a heavy burden on public forums of discussion and debate to resolve burning topics.
Having resided in Munich and Paris, Michael now calls Manhattan’s Hell’s Kitchen home. He also has a house on Fire Island and spends one month each year in Tel Aviv. At forty-two, Michael does have one regret though: his decision to legally change his birth name.
Dann Dulin: So what made you choose the name “Michael Lucas”?
Michael Lucas: I didn’t choose that name, it was chosen for me by [an adult film] studio that I was working for in 1997. I would like to have kept my real name, Andrey Treyvas.
Name one myth about being a porn actor.
There are no fluffers and it’s a business. Also, the majority of porn stars are not doing drugs.
When did you begin taking Truvada as PrEP?
I began taking Truvada in June 2013 when very few people were talking about using the drug as a course of prevention. It wasn’t gaining traction as a new form of prevention and people needed to start talking about it. I think it is the most effective form of protection.
For years you advocated condoms, now you’ve changed your position…
I am still advocating safe sex. I would never advocate anything else. But there are a few points to be made here. First of all, the CDC changed their language regarding safe sex. Now, when they refer to sex without condoms, they refer to it as “condomless sex.” Why? Because there are new ways to have safe sex.
Safe sex, in my opinion, starts with a conversation with one’s partner, understanding their status and knowing if they are on a medical regimen. Someone being treated for HIV who complies with their medical regimen [and suppresses the virus to undetectable levels] is far less likely to transmit the virus. There is also, of course, PrEP, which I am on, and it has been approved by the FDA as an effective form of prevention. And, yes, there will always be condoms, but the truth is that people do not use condoms as often as they should. I feel strongly that we should explore every form of protection, including Treatment as Prevention and PrEP.
How did you first hear about the epidemic?
I remember hearing about it on Russian TV when I was fourteen years old.
Was it discussed in school?
They, of course, told us about it, but it was referred to as something that was happening in the West. You have to remember that when the epidemic began, everyone was just learning about it. No one really knew what was going on. Prevention wasn’t discussed until the early nineties.
This disease has killed over thirty million people worldwide. It used to scare me. The thought of getting it worried me for half of my life. I remember witnessing the devastation it caused in the eighties.
How often do you get tested?
Before I was on PrEP, I would get tested about three times a year. But now that I am on PrEP, I am required to get tested every three months. That’s another advantage of PrEP. People are encouraged to get tested regularly and to continue a healthy level of care. I think anyone who enters a relationship should know his and their partner’s status. Of course, if the relationship becomes committed, then I would hope that they get tested and discuss what level of care is appropriate for them.
Has anyone close to you died from this disease?
Yes, a friend of mine died, a brilliant ballet dancer from Russia. We traveled together. I remember on a trip to Turkey he got very sick. He passed away two months later. It was so very sad. I remember being shocked because it was the first time this disease hit close to home.
What do you consider the most pressing issue for the HIV/AIDS community?
The most disturbing thing to me is the stigma that surrounds HIV/AIDS. For so long, heterosexuals discriminated against those with HIV. In recent years, the gay community has begun to shame those who are HIV-positive. Fighting the stigma is key to fighting the disease.
You frequent universities, educating students about HIV. What drives your activism?
I think we have a responsibility to help our community be a better place. We are all passionate about something, so I have attempted to use my public platform to help bring awareness to issues I care about.
Which individual has inspired you the most?
The Italian journalist Oriana Fallaci [a passionate war and political correspondent who interviewed many world leaders] for being brave, honest, and forward thinking.
What’s your take on the current affairs in Russia and of Putin?
It’s the same as any decent person would have. I condemn violence against the LGBT community and the military aggression against Ukraine.
Your film, Undressing Israel, is a love letter to the country. Can you expound on your affinity toward this place?
Israel is my country; my birthright! Growing up in Russia, I was forced to repress my Jewish identity. I was given my mother’s maiden name at birth, specifically because Treyvas sounded less Jewish than my father’s surname, Bregman. The core of my worldview is my Jewish identity.
What’s your take on the current conflict in Israel today?
The situation is tragic, but on a basic level the Israelis are defending their right to exist against a radical group who want them to cease to exist. Israel is a liberal democracy pitted against violent religious fundamentalists. I am disappointed that so many people on the left are quick to criticize Israel but accept their enemies’ repression of women, gays, and religious minorities.
To borrow a Proust question: What’s your current state of mind?
I am very content with what I have going on right now. My company is doing extremely well, I have an amazing new boyfriend and I’m looking forward to an exciting fall.
One last question: Whom do you consider a hero in the epidemic?
I would be remiss if I didn’t mention my boyfriend, Tyler Helms. He took his diagnosis and used it to create change—publicly disclosing his status in 2009 and raising thousands of dollars for AIDS related causes. Tyler’s also on the board of directors for GMHC.
But there are so many people who have passionately joined the fight to end the AIDS epidemic over the last thirty plus years. They are all heroes in my opinion.
Starting All Over? Really?
We must continue to transform prevention know-how into prevention action
I’m pretty sure that I can assume most of us infected with HIV—better known as GRID or “the Gay Cancer” back when this virus began its ruthless appetite for an entire generation of gay men in the early eighties—watched Larry Kramer’s masterpiece, The Normal Heart, despite how difficult it may have been to relive.
I’m sure those of us in that “First Generation,” the first wave of terrified, ignored, and truly hated “victims,” probably experienced more emotions in one sitting than we have in a long time. I know I cried for the countless friends I’ve lost, not to mention my own fear and agony when no one really knew what was happening, what to do about it, or if we would even survive a few weeks or months. Eventually—and it took some time—we realized we had to fight for ourselves. And once we galvanized a movement together from scratch, OUR loud voices demanded care, medication, and assistance. We continued the fight for more research and medication, and, after years of absolute HELL, HIV/AIDS became a somewhat manageable illness. With the development of protease inhibitors and all of us taking some sort of cocktail, we no longer felt the need to update our Last Will and Testaments every other month.
A lot has changed in the fight against HIV/AIDS since the first buried headlines about a “gay cancer” began appearing in gay newspapers, then becoming headline news as the virus claimed the lives of famous celebrities, which helped to put a real and more urgent face on the disease. Cries for a vaccine and a cure grew louder. Now there are research facilities around the world solely working on finding a vaccine and/or a cure for the virus that has taken millions of lives around the world—both homo- and heterosexual—in thirty years. Many of us in the “First Generation” are still alive, despite what the disease stole from us in the beginning. And as new medications hit the market, everyone with access to these medications lived longer, productive lives.
Those newly infected (and there are approximately 6,000 NEW infections every day—still!), have the luxury of combinations of these new drugs in one pill, and have been spared the horrible side effects we dealt with. In the “old” days, we were kept chained to a toilet, and, unfortunately, while happy to be alive, our bodies were re-shaped, giving us a hump on our back or making us look like pot-bellied stickmen!
SO WHY WOULD ANYONE WANT TO TAKE THE RISK JUST TO GET LAID?!
There has been a shift toward condomless sex in the face of new prevention strategies: men who have sex with men are serosorting (having sex with men of the same serostatus) and/or seroadapting (adopting practices based on serostatus); using PrEP in isolation; knowing that PEP is available if they feel that they have been infected; and taking the Swiss Statement—which has been interpreted as saying that a positive person whose viral load has been suppressed due to antiretrovirals is not infectious—to heart.
It’s important to note that the Swiss scientists made it clear that they did not mean that transmission wasn’t possible. And recently French scientists have discovered something that might—might—present a problem for those who are thinking about going condomless, whether it’s due to the promise of PrEP (as of right now, that means Truvada) or Treatment as Prevention (TasP).
Due to my limited space here, I cannot give you all of the clinical details and findings of countless tests, most of them from Europe. But I can wrap them up into a few sentences that are very important.
French researchers analyzed 306 semen samples in men who were all taking antiretrovirals (ARVs) and had an undetectable viral load for at least the previous six months. A series of tests were performed and the researchers detected HIV in at least one sample from seventeen of the men, comprising nineteen percent of the study group. It was not clear if the detectable virus in the semen posed a significant risk for transmission. Research would suggest that this is unlikely.
NO TRANSMISSIONS IS NOT THE SAME AS ZERO CHANCE OF TRANSMISSION. That’s an important sentence. The researchers calculated the ninety-five percent confidence intervals for the results seen. What this means is that they calculated the odds of zero transmissions being the “true” figure and what the maximum possible risk of transmission was, given the results seen.
As I said, there’s much more detail to these studies, including the prevalence of sexually transmitted infections (STIs) among gay men.
So, what is my point?
We have been down this road before! Just when the gay community thought we were finally getting some control over the number of HIV/AIDS infections/cases, we are thrust smack dab in the middle of it all over again! The rate of infection is once again reaching staggering numbers, which means gay youth and women of color (who are usually infected from a male partner/husband) are not paying attention—AGAIN!!—to the life-saving warnings of SELF-PROTECTION. They are not listening to those of us who had NO warnings in the late seventies and early eighties, when HIV/AIDS first began swallowing an entire generation of gay men at an alarming rate.
Had we listened to doctors, the healthcare community, and activists back then, maybe many of our buried friends would still be walking this earth with us. But we have a chance to listen to them NOW! While something like Truvada as PrEP may be an effective tool to help fight HIV/AIDS, we must look at our own BEHAVIOR, TOO; we must not rely on ANY pill (used with or without a condom) to throw caution to the wind.
With the new research that proves “undetectable viral load” doesn’t necessarily mean what we thought it did. TAKE A MOMENT AND THINK!!
Is the risk worth your or your partner’s life?
◊
Along with being a contributing writer for A&U, Chuck’s had other work published in journals, magazines, anthologies, and e-books.
Necessity: Mother of Prevention
Born Free Africa Counts Down to Zero Mother-to-Child Transmission by Stevie St. John
At its heart, it’s a simple problem with an elegantly simple solution.
An HIV-positive pregnant woman with access to care and medication can greatly diminish the chance that she will pass HIV on to her child during pregnancy, during childbirth or while breastfeeding. All she has to do is take one pill a day.
For that to happen, though, several pieces must fall into place. First, the expectant woman must have access to medical care, including HIV testing. Only if she knows that she is HIV-positive can she get the care she needs. Her healthcare providers must be trained in providing HIV testing and offering care for those who are positive. They must have access to testing equipment and, of course, to the antiretroviral meds themselves.
Without treatment, the risk of mother-to-child (or perinatal) transmission is some thirty-five to forty-five percent—compared to just less than one percent for those who get the needed care. And those children who are born HIV-positive face a fifty-percent chance of death before the age of two if they do not receive treatment.
Just one pill a day, taken by the expectant mother, would prevent the vast majority of these tragedies.
A mother in Khayelitsha Township shares her story with John Megrue, Chairman of Born Free Africa. Photo courtesy Born Free Africa
“HIV is a huge issue globally,” says John Megrue, founder and chair of Born Free Africa. “Having newborn babies born HIV-positive is really a huge challenge.” And the objective of a new generation being born HIV-free, he says, was “something that I thought was central to success” in the fight against HIV/AIDS.
Born Free Africa is a private sector-led initiative that partners with governments, donors, and nonprofits to provide funding, training and policy analysis in order to eliminate mother-to-child HIV transmissions in some of the most affected African countries such as Kenya, Uganda, South Africa, and Nigeria.
Megrue called Born Free Africa “a quite broad constituency thinking about it and trying to make a difference.”
The Problem of Perinatal Transmissions
In affluent countries, mother-to-child HIV transmissions have become quite rare. The Centers for Disease Control and Prevention says that perinatal transmissions in the U.S. have dropped by more than ninety percent since the mid-1990s, even though the number of HIV-positive women giving birth has increased dramatically.
But there are still many countries, the vast majority of which are located in Africa, where such transmissions remain a serious issue.
According to Born Free Africa:
• Worldwide, mother-to-child transmissions peaked in 2003 and have declined more than fifty percent in subsequent years
• 260,000 children were infected in 2012—an average of more than 700 per day
• In children, more than ninety percent of new HIV infections are the result of transmission via pregnancy, childbirth, or breastfeeding
• Nigeria accounts for more than one-quarter of newly infected children each year
• Twenty-two countries account for more than eighty percent of cases.
“It’s a systems problem,” Megrue says, referring to the barriers that must be overcome in order to halt mother-to-child transmissions. “We’re all working together to solve these challenges.”
Countdown to Zero Transmissions A health worker in Khayelitsha Township, South Africa, is interviewed as part of a documentary film project to explain mother-to-child HIV transmission. Photo courtesy Born Free Africa
The Born Free Africa Web site features a prominent countdown clock: the “countdown to zero transmission.” As of May 29, it stood at 581 days, with the green and white hours, minutes and seconds all marking progress toward December 31, 2015.
The specificity of the clock reflects an ambitious goal: halting mother-to-child HIV transmissions by the end of next year.
Why 2015? The deadline came out of Millennium Development Goals set by UNAIDS. Among ten “targets and elimination commitments” set by UNAIDS is the goal to “eliminate new HIV infections among children by 2015 and substantially reduce AIDS-related maternal deaths,” according to the 2011 United Nations General Assembly Political Declaration on HIV/AIDS.
The Millennium Development Goals were set in 2000, Megrue notes, with enormous strides made in subsequent years. In fact, Born Free Africa says that new HIV infections in children have declined by fifty percent between 2003 and 2012.
But there are still more than 200,000 annual transmissions worldwide, says Born Free Africa, with ninety-eight percent of those being completely preventable. But there are persistent challenges—funding issues, for one thing—that must be met before a generation born free can be achieved.
Navigating those challenges, Megrue shares, called for high-speed, fast-paced decision making—“and that plays to the private sector’s strengths.”
That’s where Megrue, chief executive officer of the private equity advisory firm Apax Partners, came in.
In 2011, the U.N. tapped Megrue, a longtime philanthropist with experience working in Africa (largely on issues related to poverty), to get involved. As a result, Born Free Africa was formed. In addition to Megrue, the organization’s advisory board includes CEOs and other power players from companies such as Chevron, NBCUniversal, J.P. Morgan, Johnson & Johnson, and GE Healthcare.
“Being part of something that the private sector can have such an influence in has been incredibly joyful,” Megrue says.
Making Prevention Fashionable Model Sasha Pivovarova and her daughter pose for a Born Free fashion campaign wearing Alberta Ferretti, who incorporated into the design an exclusive pattern print by Kenyan artist Wangechi Mutu. Photo by Robert Massman/robert@robertmassman.com
In Africa, Born Free Africa does work such as hiring talent and providing training for healthcare professionals. The organization also hosts visits from governmental and other leaders who come to see how mother-to-child transmissions are being combated.
In addition to its on-the-ground work, Born Free Africa puts its resources to work to raise awareness. For example, Megrue partnered with Vogue, Diane von Fürstenberg, Claire Danes, Liya Kebede and Wangechi Mutu to host a Mother’s Day Carnival in support of Born Free Africa; he called the event “a real crescendo of consumer awareness.”
Held in New York, the event featured performances by Ariana Grande and Idina Menzel. It also included family-oriented activities such as family portraits, cookie decorating, yoga, arts and crafts, face painting with M•A•C makeup artists, soccer with the New York Red Bulls, and basketball with the New York Giants.
There were many high-profile guests in the crowd, including actor Matt Bomer and designers Ivanka Trump, Vera Wang and Donna Karan.
Trump, Wang and Karan were also all part of a Born Free Africa initiative to raise awareness through a partnership with the fashion industry. Earlier this year, they and nineteen other prominent designers—all of them mothers—designed items for a limited edition Born Free Collection, sold via ShopBop.com. The collection’s array of tees, scarves, bags, pants, blouses, skirts and other items are based on the work of New York-based visual artist Wangechi Mutu, who was born in Kenya. Proceeds from sales of the Born Free Collection items benefit Born Free Africa, with a M•A•C AIDS Fund matching grant for up to $500,000.
“As a mother and as a fashion designer, Born Free is everything I believe in—taking care of mothers so they can take care of their children, which takes care of the world. That I could do all this through creativity was perfection,” Karan tells A&U via e-mail. “When you think about the vulnerability of new mothers and their babies, you’ll do anything to eradicate the transfer of HIV from one to the other.”
Karan says she was “completely inspired” by the Born Free campaign.
“Whenever you have a creative avenue to fight a real threat, it brings out the best in everyone,” she says.
By bringing out the best in everyone—from fashion designers to government leaders and private sector CEOs—perhaps Born Free Africa can build the awareness and support needed to reach its ambitious goal of wiping out perinatal transmissions of HIV.
Stevie St. John is a freelance writer in Los Angeles, where she serves on the board of the local chapter of the National Lesbian & Gay Journalists Association (NLGJA-LA).
Prev
