Tag Archives: HIV

Doin’ It On the Regular

     If you’re HIV-poz, what’s essential to achieving viral suppression?

     The answer:  adherence to antiretroviral (ARV) therapy.  This faithfulness and fidelity about taking your HIV meds on the regular put you on the righteous road toward becoming undetectable.  And that, my friends, is the ultimate destination—to NOT transmit the virus to your sexual partners.

     Unfortunately, however, social factors are undermining adherence to ARV therapy among persons living with HIV in the United States.  This results in drug resistance that compromises future treatment options. 

     Some of these significant and sometimes insurmountable societal challenges include unemployment, loss/lack of medical insurance, mental instability (anxiety, depression, destructive behavior, suicide), as well as the “gift that keeps on giving:” racism and racial inequity.   And to make matters even worse, the COVID-19 pandemic–that’s spreading like uncontained wildfires ravaging the world, particularly the U.S.—is a potent accelerant.

     Overall, the proportion of the HIV population on ARVs who adhere to its daily regimen at an optimal rate remains quite low, according to MPR, Monthly Prescribing Reference.  A multispecialty drug information resource for healthcare professionals, MPR offers concise prescribing information, as well as news and features on cutting-edge topics in harmacotherapy.

     According to Poz.com, “Looking to estimate the rates of adherence to ARVs as well as the prevalence of drug resistance among people with HIV, investigators analyzed data from the Integrated Dataverse from the Symphony Health database and the Monogram/Lab Corp Database.  The period they analyzed ran from January 1, 2015, to September 30, 2017.  Published in AIDS and Behavior, this study measured adherence based on the percentage of days within a 12-month period that was covered by prescriptions filled by each individual.

     “On average, 72% of the days in that period were covered by ARVs among the nearly 170,000 people included in the analysis.  Forty-five percent of the study cohort members were considered to have poor adherence because less than 80% of the days in the year were covered by ARVs, while 30% had suboptimal adherence (80% to just under 95% of days were covered) and just 25% had optimal adherence (95% or more days were covered).” 

     The study examined nearly 96,000 samples provided for drug resistance testing and discovered that 31% showed evidence of resistance to ARVs.  “From state to state, the prevalence of drug resistance ranged from 20% to 54%,” according to Poz.com.  “ Out of the five states that had the highest prevalence of drug resistance, three of them had a rate of poor adherence to ARVs greater than 40%.  In Southern states, 50% of the individuals had poor adherence to ARVs.”

     The authors of the study emphasized that social determinants of health should be taken into consideration when selecting an ARV regimen.  They added that efforts must be made to improve adherence–thereby preventing the development of resistance.

     They concluded, “’This study is one of the first in the U.S. to provide a comprehensive understanding of the current status of adherence to ART (antiretroviral therapy), the prevalence of resistance to HIV drugs, social determinants of health that could be associated with poor or suboptimal adherence and ART resistance’.”

     So, adhere to the bottom line:  If you’re HIV-poz, keep poppin’ your ARV meds—and “make sho’ to do it to it on the regular.”  Safeguard your health!  And that of your intimate partners. 




The HIV/Syphilis Connection

     Conclusive data now bear out that among men who have sex with men (MSM), those infected with HIV have a much higher syphilis diagnosis rate than those who are HIV-negative.  This disparity varies widely between states, which could be as a result in part by more frequent testing among MSM living with the virus.  Or, the disparity could be minimized by more sexual contacts between the two groups.

     Recently, Centers for Disease Control and Prevention (CDC) researchers unveiled their findings of the analysis of MSM syphilis diagnosis rates at the 2018 Conference on Retroviruses and Opportunistic Infections (CROI) in Boston.

     According to Poz.com, “Before conducting this analysis, which provided the first estimate of the ratio of syphilis diagnoses among MSM with HIV versus those without, the CDC researchers already knew that the majority of syphilis diagnoses between 2012 and 2016 were among MSM.  During that period, between 48 percent and 57 percent of annual diagnoses among MSM were seen in those who had HIV.”


The “Skinny” on Syphilis

     Syphilis is a bacterial infection (Treponema pallidum) that is most often spread through sexual contact.  Usually, this infection causes the disease over several years.  In its early stages, syphilis causes disease of the genitals, mucous membranes, and skin.

     And if not treated, the infection can lead to serious problems including heart ailments, neurological issues (neurosyphilis), blindness, dementia—and even death. 

     Since 1996, syphilis rates have been increasing in the U.S.—notably among MSM. 

     Red alert:  if you’re infected with HIV, syphilis can hit you harder.  And faster. 


Delving into The Findings

     The researchers reviewed national case report data on syphilis diagnoses from 2014. For their purposes, that included information on the sex of the individual diagnosed, the sex of that individual’s sex partner, and the men’s HIV status.  They limited their analysis to the 34 states that provided data that classified at least 70 percent of the syphilis cases as women, MSM or men who have sex with women only.

     Among all MSM, the diagnosis rate per 100,000 persons across all 34 states was 237.7, ranging between 35.1 in Montana and 618.3 in Mississippi.

     Overall, those HIV-diagnosed MSM had a syphilis diagnosis rate nearly eight times that of their HIV-negative counterparts.  The statewide diagnosis rate per 100,000 persons among HIV-poz MSM ranged between zero in South Dakota and 2,035 in Arizona.  And among HIV-negative MSM, the statewide diagnosis rate per 100,000 persons in this group ranged between 27 in Montana and 496 in Mississippi.      Therefore, in each state, the ratio of HIV-positive versus HIV-negative syphilis diagnoses varied extensively (excluding South Dakota, the one state with no diagnoses). 

     In conclusion: “The CDC researchers speculate that the disparity in syphilis diagnosis rates may be driven in part by a greater rate of testing for the sexually transmitted infection among those MSM living with HIV compared with HIV-negative MSM,” according to Poz.com.  “Additionally, they conjectured that in states with lower syphilis diagnosis ratios between MSM with and without the virus, more sexual interactions between these two groups might have spread the STI more evenly between them.”



The “Undetectability” Of It All, Part Two

     This past March, I penned “The Undetectability Of It All,” for Wyattevans.com.  The article stated that the AIDS United Public Policy Committee declared that it has “strongly affirmed the conclusive evidence proving that people living with HIV who have achieved a sustained, undetectable viral load cannot transmit HIV to sexual partners.  This evidence-based declaration reinforces AIDS United’s programmatic, policy and advocacy work to expand access to antiretroviral medications to all people living with HIV.”  AIDS United is the largest and longest-running national coalition of community-based HIV/AIDS organizations.

     And now, there’s additional evidence that supports the AIDS United declaration.  But before we examine those findings, let’s answer the question:  what does it truly mean to be undetectable?   

     Well, it doesn’t mean that the HIV-positive individual is cured.  However, it does mean that antiretroviral treatment is being effective, and that the amount of HIV in the blood is so low that even the best available tests don’t detect it.

     To have an undetectable viral load means that there are fewer than 20 copies of the virus in one milliliter of blood.  Typically, the tests of those who have just been diagnosed and not having undergone treatment show millions of copies in the exact same sample size.

     Now, let’s examine the new study that supports the AIDS United proclamation.  The findings demonstrate that there were no transmissions of the virus within mixed-HIV-status couples when the partner living with the virus was on antiretroviral (ARV) treatment and had a fully suppressed viral load.

     This study, entitled Opposites Attract, was comprised of gay/SGL (same gender loving) couples that had nearly 600 cumulative years of follow-up data and about 12,000 reported acts of condomless penetration.  These acts excluded any for which the HIV-neg partner was taking PrEP (pre-exposure prophylaxis).

     Based on the Opposites Attract data, the investigators were able to estimate that the annual risk of HIV transmission in which only one infected partner with an undetectable viral load is between zero and 1.56 percent.


     According to Poz.com, Andrew Grulich, PhD, an HIV epidemiologist at the Kirby Institute at the University of New South Wales in Sydney, Australia, and chief investigator of the study, stated, “’We think this is a really exciting result and adds to a body of research that HIV is not passed on in the context of undetectable viral load, even with high rates of sexually transmitted infections’.”

     Opposites Attract did not restrict potential participants according to whether they used condoms or had undetectable viral loads.  By the end of last year, the study had enrolled 358 gay/SGL male couples in which one partner was poz (158 from Australia, 105 from Thailand, 96 from Brazil).

     So, just how was the study conducted?  “Researchers collected information about sexual behaviors from the HIV-negative partner at each study visit,” stated Poz.com.  “These partners received HIV testing along with sexually transmitted infection (STI) testing upon entering the study and at all subsequent study visits.  The HIV-positive partners received viral load and STI testing at each study visit.

     “The investigators defined an undetectable viral load as less than 200.  For all new HIV infections in the initially HIV-negative partners, generic testing was conducted to determine whether these men likely contracted the virus from their partner in the study.

     “A total of 343 couples made at least one follow-up visit, contributing 591 cumulative years of follow-up data.  (Each year of data on a couple counted as one year of follow-up.)  The men reported anal sex with any man beside their study partner at 57.4 percent of these visits.”

     The online publication continued.  “Upon their entry into the study, 79.9 percent of HIV-positive men were on ARVs and 77.9 percent had an undetectable viral load.  A total of 75.2 percent of the men on HIV treatment maintained a fully suppressed virus throughout their participation in the study.

      “Overall, 14.3 percent and 11.7 percent of the HIV-positive and -negative men, respectively, were diagnosed with an STI during the study.

     “A total of 73.8 percent of the couples reported engaging in condomless sex during the study.  These men provided 318 cumulative years of follow-up data on periods when they reported engaging in condomless intercourse within their study partnership, including a total of 16,889 reported such acts.”

     Grulich concluded the following about the Opposites Attract findings.  “’This is life-changing news for couples of differing HIV status’.” 

     However, the chief investigator of the study cautioned, “’But it is important that the HIV-positive partner is under regular medical care and does not miss any of their antiretroviral medication in order to ensure they maintain an undetectable viral load.  Our data add to previous studies that show that there has never been a recorded case of HIV transmission from an HIV-positive person to their HIV-negative sexual partner when the HIV-positive partner had an undetectable viral load’.”

The “Undetectability” Of It All

     For years, I’ve been reporting and writing about HIV/AIDS.  When I’ve asked individuals the question, “Would you be sexually intimate with someone who’s undetectable?,”  I’ve gotten some rather blunt and curt responses.   Here are three:


    “But doesn’t pre-cum contain the virus?”

    “Nah…I’ll think I’ll pass!” 

    However, the 44-member AIDS United Public Policy Committee—the largest and longest-running national coalition of community-based HIV/AIDS organizations–strenuously begs to differ.  According to AIDS United, its Public Policy Committee very recently has “strongly affirmed the conclusive evidence proving that people living with HIV who have achieved a sustained, undetectable viral load cannot transmit HIV to sexual partners.  This evidence-based declaration reinforces AIDS United’s programmatic, policy and advocacy work to expand access to antiretroviral medications to all people living with HIV.”

     Before we go any further, let’s clearly and completely understand what it really means to be “undetectable.”   First, it doesn’t mean that the HIV-positive person is cured.  However, it does mean that antiretroviral treatment is being effective, and that the amount of HIV in the blood is so low that even the best available tests don’t detect it.

     To have an undetectable viral load means there are fewer than 20 copies of the virus in one milliliter of blood.  Typically, the tests of those who have just been diagnosed and not having undergone treatment show millions of copies in the exact same sample size.

     Therefore, on March 6, the AIDS United Public Policy Committee released the following statement:  “Substantial evidence strongly demonstrates that a person living with HIV who has a sustained, undetectable viral load cannot sexually transmit HIV to another person.  Continued analysis of large-scale clinical trials has shown zero cases of HIV sexual transmission.  This expands on prior data that the risk of HIV transmission from a person living with HIV who is on antiretroviral therapy and has achieved an undetectable viral load (viral suppression) in their blood for at least 6 months is negligible to non-existent.”

     AIDS United concurs with the stance of the Prevention Access Campaign (PAC), which is “People living with HIV on ART (antiretroviral therapy) with an undetectable viral load in their blood have a negligible risk of sexual transmission of HIV.”  PAC “is a multi-agency health equity initiative to end the dual epidemics of HIV and HIV-related stigma by expanding access to HIV prevention, and empowering people with and vulnerable to HIV with accurate and meaningful information.”

     The AIDS United Public Policy Committee added, “Too many people living with HIV are not getting the message of this benefit of treatment and sustained viral suppression from their clinical providers or the HIV education and advocacy community.  Understanding that maintaining viral suppression through successful antiretroviral therapy not only maintains health but also prevents transmission can encourage people living with HIV to initiate and adhere to treatment regimens and may help reduce HIV-related stigma.  We acknowledge, however, that social and structural barriers exist that prevent some people living with HIV from achieving viral suppression.”

     Sadly, antiquated U.S. HIV laws and policies simply do not reflect the up-to-date science regarding HIV transmission risks.  “Scientific evidence about the reality of transmission risk based in this data about viral suppression and transmission risk has already had an impact on HIV criminalization statutes and prosecutions in Europe,” according to AIDS United.

     The organization, therefore, makes two critical recommendations:

  • That providers and educators consistently share the message that new evidence demonstrates that a person living with HIV who has a sustained, undetectable viral load cannot sexually transmit HIV to another person.
  • That HIV criminal laws and policies in the United States be modernized to reflect the science related to viral suppression and HIV transmission risk.

    Jesse Milan, Jr., AIDS United president and CEO, termed the transmission evidence “a landmark development” that too few of us are hearing about.  “This development puts each one of us living with HIV at the forefront of stopping new infections,” stated Milan, Jr.  “It gives everyone strong, clear and direct language to stop the stigma and move all communities faster towards ending the epidemic.”

Structural Inequality Fuels HIV in Black MSM

   A brand new—and perhaps controversial—study has uncovered that economic insecurity, housing instability and stigma largely shape the sexual relationships of many African-American men who have sex with men (MSM).  According to this study, these structural inequalities influence the kinds of relationships and sexual behaviors that men have.

     It’s a fact that the bulk of HIV prevention interventions and studies focus on the individual. However, according to Columbia University’s Caroline Parker in an article published in Culture, Health and Sexuality, “Our research underlines the continued need to attend to the structural drivers of HIV among Black gay, bisexual and other men who have sex with men.”

     Before we drill deeper into the study, let’s define the term structural inequality. It’s the condition where one category of individuals are ascribed an unequal status in relation to other categories of persons.  This relationship is perpetuated and reinforced by a confluence of unequal relations in roles, functions, decisions, rights and opportunities.

     Between 2013 and 2014, Parker and her colleagues conducted a qualitative, ethnographic study in New York City.  Roger Pebody states in his Aidsmap.com article, “Structural Inequalities Create Vulnerability to HIV for Black Gay Men in New York,” “In-depth interviews were conducted with 31 black MSM and participant observation was conducted in locations frequented by black MSM (such as parks, community organizations and house parties).  In addition, 17 community advocates and healthcare professionals were interviewed.

     “Amongst the men interviewed, whose average age was 29, social problems were common.  Ten had spent time in prison, 15 were unemployed, 16 had housing problems, and nine had no health insurance.  Five men told the researchers that they were living with HIV.  Whereas half identified as ‘gay,’ the others described themselves in a variety of ways, including bisexual, straight, discrete and having no sexual identity.”

      According to the study, men who struggle with housing instability and unemployment sometimes used sex to meet their material needs.  They described exchanging sex for shelter, food, clothing, the payment of phone bills and taxis, alcohol and drugs.  Some used dating app profiles to sell sex.

     And, the men’s precarious circumstances constrained their ability to negotiate condoms.  One man explained:  “’Okay.  If you are eating and you have clothing, you have shelter, you’re probably going to resist it and a very blatant resistance.  But if you are hungry, that’s a different ballgame.  I can sit here and tell you I’m a very proud person but you let my stomach rumble for more than three days, okay, you can call me’.”

     Pebody wrote, “While sex without a condom put men at risk of HIV, a lack of food or shelter might have a more immediate impact.  Men made choices which made sense to them in their current circumstances (for example, having multiple partners to access temporary housing and other resources).  Interviewees with fewer economic problems had different approaches to sexual relationships which did not reflect these pressing economic considerations.”

     The researchers took note of the way in which different places and environments formed men’s sexual relationships.  Some of the interviewees stated that they had experienced disapproval or homophobia in their family homes.  As a direct result, four of the men were made homeless. 


     As well, many men did not introduce male sexual partners to family members; consequently, sex was more likely to occur at a partner’s home or in a public space.  Recalled one interviewee: “’I couldn’t bring any company over or they couldn’t stay overnight or whatever, (but my brother) could bring girls over and there was discrimination towards me with my mom’.”

     According to Pebody, “Some men who lived independently also avoided bringing male partners home because of homophobic reactions from landlords or neighbors.  Men sometimes felt unsafe in their own homes.

     “Many respondents met partners and had sex with them in parks, streets, sports clubs, trains, supermarkets and restaurants.  This was particularly the case for men with unstable or no housing, and for men who identified as straight or discreet.  These meetings might be arranged on apps like Jack’d and Grindr. 

     “These interactions were usually rushed—men were afraid of being observed by other people, being assaulted or being arrested. The rush meant that condoms were less likely to be used.”

     Respondents of the study stated that they went to gay bars and nightclubs, particularly those frequented by Black and Latino men.  According to the respondents, they felt that these settings were safer places to socialize and meet other MSM (men who have sex with men).

     “For men who sold sex, bars provided some protection against the police,” wrote Pebody.  “Men with housing difficulties sometimes went to clubs to find ‘a generous friend’ with a place to stay. However, commercial venues did not always feel welcoming to men who did not have money for drinks or the right clothes to wear.”

     The researchers concluded:  “’Among most of the men in this sample, the pursuit of same-sex relationships took place in a social context characterized by economic insecurity, housing instability, and widespread stigma and discrimination.  We draw attention to how men’s position in a social structure configures their opportunities, restrictions and priorities in sexual relationships and how these shape their choices and behaviors in health-relevant ways’.”

One Step Closer To The Cure

     Outstanding news! Just recently, the International AIDS Vaccine Initiative (IAVI) was awarded a contract from the National Institutes of Health (NIH) to help advance the development of potential AIDS vaccines.

     IAVI is a global, non-profit, public-private partnership that works to accelerate the development of vaccines to prevent HIV and AIDS. The Initiative researches and develops vaccine candidates, conducts policy analyses, serves as an advocate for the HIV prevention field, and engages communities in the trial process and AIDS vaccine education.

     While emphasizing the need for new AIDS prevention tools, IAVI takes a comprehensive approach to HIV and AIDS that supports existing prevention and treatment programs of the virus. And, the initiative works to ensure that future vaccines will be accessible to all who need them.

     The contract earmarks $98 million over seven years. And specifically, IAVI will provide various services to the National Institute of Allergy and Infectious Diseases (NIAID)—part of NIH—in its mission to manufacture HIV envelope protein immunogens that can prevent infection. These immunogens are being developed to induce a protective immune response that wards off HIV. The hope is to manufacture immunogens and then test them in human clinical trials.

     Mark Feinberg, IAVI president and CEO stated, “’IAVI is dedicated to expediting the development and global availability of an effective vaccine, and is committed to supporting the success of the overall efforts of the HIV vaccine field. Building on IAVI’s experience in the characterization and production of HIV envelope vaccine candidates, our efforts to advance the work of NIAID-supported investigators will also provide additional opportunities to develop and share insights and innovations into how to make the HIV vaccine production process as reliable, robust and timely as possible’.”

     Continued Feinberg, “’Given the imperative to accelerate HIV vaccine development efforts, this new partnership with NIAID promises to facilitate meaningful progress and impact towards this goal’.”

     2016 is a banner year for IAVI: it marks two decades that The Initiative has been searching for an end to the HIV/AIDS epidemic.

One Million Dollars in Prevention

     Last year, I wrote an article for Wyattevans.com entitled, “The Quiet Invader within Native Americans.”  In it, I reported the unfortunate and harsh reality that HIV testing, treatment and care are not reaching Native Americans the same way as they are other U. S. citizens. 

     Fortunately though, much-needed assistance is on the way.  According to The Associated Press, The Indian Health Service (IHS)–the federal Native-American health care organization—and the U.S. Centers for Disease Control and Prevention (CDC) are awarding up to $1 million to Native-American tribes and organizations for HIV care and prevention.  The funding may also be allocated to organizations like Two-Spirit, a Native-American LGBTQ group.

     The grant comes at a time when HIV-positive Native Americans have poorer survival rates compared with other races and ethnicities.  The mission of IHS is three-pronged:  to decrease transmission of the virus, reduce the number of new infections, and increase education and discussion about HIV in the Native-American community.

     Rear admiral Sarah Linde, MD, the IHS acting chief medical officer, stated, “IHS data shows that as many as 26 percent of the American Indian (AI) and Alaska Native (AN) people living with HIV infection do not know it.” 

    And according to Lisa Neel–a program analyst at the HIV Program for IHS, there are an assortment of reasons why.  “Poverty, which limits access to doctors and can put health concerns on the back burner for those struggling to feed themselves, is an all too common problem for Native Americans.”

     Neel also states, “That compared with other racial and ethnic groups, American Indians and Alaska Natives have higher poverty rates, have completed fewer years of education, are younger, are less likely to be employed, and have lower rates of health insurance coverage.”

     Often, this results into individuals not getting tested; therefore, scores are oblivious that they are in fact HIV-positive.  Tragically, this results in some of those infected not getting needed treatment until their HIV advances to the point that they experience symptoms.

     Neel is concerned that “cultural stigma faced by some gay and bisexual Native American men could also be discouraging testing and treatment,” and cites the higher rates of alcohol and drug use among all American Indians and Alaska Natives.

     She concludes, “Although alcohol and substance abuse does not cause HIV infection, it is an associated risk factor because of its ability to reduce inhibitions and impair judgment.  Compared with other racial/ethnic groups, AI/AN tend to use alcohol and drugs at a younger age, use them more often, and in higher quantities, and experience more negative consequences from them.”

     The funding will be distributed over the course of five years, with up to $200,000 being granted per year.  To receive funding, tribes and nonprofits must apply by August 28

Conversations With The Duchess 2

“I Am a Survivor!” 

Guest Writer:  Carlton R. Smith 

     For my second column, I was trying to think of a theme that would be of compelling interest to my new readership.  

     Then, I had an epiphany:  how about sharing my story, my journey of being a longtime HIV survivor.

     As of March of this year, I quietly celebrate 30 years of living with HIV.   God and His amazing grace has made this milestone possible. 

     And simply put, I’ve always wanted to be an instrument of change.  It’s been my strongest desire that my testimony would be as a shining light to help others who are living with the disease. 

     My personal journey began during the mid-80’s, as part of the disco scene of Studio 54, Better Days and the Garage. These were the glamorous New York City nightclubs during the height of the disco era where many people endeavored to escape the reality of the real world.   

     Like scores of other folk, I wanted to a part of the nightlife and the sexual freedom of that decade.  I’d arrive around close to midnight and hear my favorite DJ beat those melodic sounds that linger in your memories as though it was yesterday.  I’d groove to Grace Jones, Donna Summer, First Choice and Gloria Gaynor, among others. 

     Remember the songs “Slave to the Rhythm,” “Hot Stuff” and “I Will Survive?”   I certainly do!  And, I can vividly recall sweating up a storm, sucking on my favorite cocktails–and meeting hot dates that gave you “service” in the bathroom stalls!   It all reminds me of that “Basic Instinct”movie scene, the one in which Sharon Stone and her girlfriend Roxy ushers the Michael Douglas character into the men’s room stall to “carry on” inside the club.

      Yes, those are some of my memories of the mid and late 80’s.  And, who would’ve thought that a little four-letter word (AIDS) would be an epidemic that would take the lives of millions of people across the globe?

     Therefore, my life’s journey starts the day I found out my HIV status.  I was a twenty-three-year-old Same-gender-loving (SGL) man with the expectation of entering the Air Force. I’d visited the local recruiting station, and signed up for what I’d hoped was going to be a great opportunity to expand my educational background after finishing college.

      However, I received a letter from the military recruiting station’s medical office requiring me to immediately come in for a follow up.  It never dawned on me that my test results would be at issue.

      I remember that chilly morning in March.  At the medical office, I learned that I had acquired AIDS, and had that my life expectancy was only between five months to five years.   And, I was truly devastated by the comments from the doctor who said that my “promiscuous lifestyle” and prior sexually-transmitted diseases were responsible for the infection.

     Like many other men during that time, I didn’t have any information about HIV/AIDS.  Feeling angry, confused and suicidal, I asked myself, “What kind of future will I have?”  I felt as if I’d fallen into a deep abyss, without a parachute.  I didn’t know what would become of my life. 

     Fortunately, because of my strong spiritual background, I realized that suicide just wasn’t an option.  The only thing for certain was that the Universe (God) had my back.  My unshakeable faith in God and prayer got me through this dilemma, along with the positive support I received from many people who themselves were infected/affected by the epidemic.

     Moreover, I just couldn’t get over the hypocrisy the so-called Black churches were spouting to tithe-offering individuals who love God as much as other fellow Christians.  This judgmental attack is why churches are behind the curve on HIV/AIDS prevention.  This promotes ignorance and stigma.  Once again, I had to bounce back and know for myself that God is Love. 

     Even though I saw death all around me, I didn’t succumb to the illnesses that plagued many of my associates and friends. I had the will and the power to survive!!   This was the result of many years of process and sharing my stories about living with HIV to many groups. 

     And, having a HERO (Health Education Resource Organization) buddy give me support enabled me to soldier on.  The information and resources I obtained through the support of others empowered me to become an advocate and a leader.   I found strength in discussing my status as “Heaven In View” (HIV)–and encouraging others to do the same.  Meeting esteemed individuals including A. Cornelius Baker (National Association of People with AIDS, NAPWA), Bishop Cheeks (Inner Life Ministries) and Marlon Riggs (director of the film “Tongues Untied”) also was empowering.  

     All of this assisted me in bolstering my self-identity and self-esteem to later establish a purpose of survival in a culture where Black men and women were being accosted by media outlets for the high incidences of HIV/AIDS. This “scarlet letter” of affliction had penetrated the inner circle of the Black community.

     Through advocacy groups, Black SGL men and some Black women made a declaration to fight against HIV/AIDS in their communities.  As a result, these minority leader activists created a purpose for community-based organizations whose main purpose was to disseminate information about prevention and treatment during the third wave of the epidemic. These national and local organizations (National Minority AIDS Council, NAPWA, etc.) created the groundwork for many to raise their voices.

     Not being called a victim of the epidemic became the cornerstone of empowering many individuals living with HIV/AIDS.  The death of Ryan White  was the impetus for Ryan White HIV/AIDS Program Legislation, the largest Federal program focused exclusively on providing HIV care and treatment services to people living with HIV.  White was diagnosed with AIDS following a blood transfusion in December 1984.  He later died from the disease.

     Today, I have become that advocate, policy maker and community leader/ stakeholder for many individuals across the country.  As an activist, a champion, and a fighter, I’m one who dared to care for the community and give himself to that community. 

     Being stigmatized gradually guided me to my passion to keep myself healthy. It is the love of God that has sustained me and allows me to serve humanity with divine purpose.                                                

His Royal Highness,


     Carlton R. Smith has advocated on LGBTQ and HIV/AIDS issues for many years, placing emphasis on the African American LGBTQ community– specifically men who have sex with men (MSM).  Mr. Smith has served on various committees providing leadership and outreach, and continues to represent the needs of LGBTQ individuals at the local, state and federal levels.

     Carlton’s resume is both substantive and stellar:  currently, he is the Executive Director and one of the founding members of The Center for Black Equity-Baltimore (formerly Baltimore Black Pride, Inc.), now in its 14th year of operation.  Also, he is a member of the JHU CFAR community participatory advisory board at the John Hopkins University Center for AIDS Research. 

     As well, Carlton serves as community co-chair of the GBISGLRT Response Team (convened by the Maryland Department of Health and Mental Hygiene), and is one of the co-founders of “Sankofa” Community Conversations on Black Same-Gender Loving Men, established in 2014.

     Carlton also is a former member of Maryland Moving Forward Network,  National Minority AIDS Council, National Black Gay Men’s Advocacy Coalition (membership chair/member of its executive committee), and was Vice-Chairman of the Greater Baltimore HIV Health Planning Council

     And, Mr. Smith is an ordained deacon with Unity Fellowship Church of Baltimore.  You can connect with and follow Carlton on Facebook at Carltonraysmith; on Twitter: @BmoreBlackpride, @Duchess_WitTea; on Instagram and Vine, Baltimore Black Pride.

Sex In Prison, Part One

     It’s an unfortunate fact that Black men—vastly over represented within our prison system—make up a high percentage of HIV-positive inmates. And according to the study, “Incarcerated Black Men Report Sex in Prison, Posing Challenges for HIV Prevention and Treatment,” these males pose an infection risk not only to other inmates—but to members of their communities once they are released.  The study was conducted by the Columbia University School of Nursing.

     “While sex is prohibited in U.S. prisons, sexual encounters are commonplace and few inmates express concern about getting or spreading HIV,” stated one of the authors, Tawandra Rowell-Cunsolo, PhD, Assistant Professor of Social Welfare Science at the Columbia University School of Nursing. 

     “The study asked open-ended questions about sexual behavior.  Many of the respondents said that deprivations of prison life promote same-sex encounters and that, although they have been exposed to prison rape, most of the sexual behavior within the institution is consensual.  Some also expressed negative attitudes toward men having sex with men.”

     Rowell-Cunsolo continued, “To prevent HIV in prisons and curb its spread once inmates are sent home, we need a better understanding of how Black men perceive sexuality while they’re imprisoned.”


     According to the study, the latest advances in HIV prevention and treatment haven’t penetrated the U.S. prison system, where inmates already at high risk for developing HIV frequently lack access to basic prevention—and don’t get tested for the virus.  “Previous research into the spread of HIV within the prison system has shown that inmates have much higher infection rates than the general population, but hasn’t provided a clear picture of what interventions might be most effective in this environment.”

     Rowell-Cunsolo added, “These are people who can benefit from education and outreach while they’re in prison, but there’s also a much larger public health issue at stake here.  These are people who are going to come out of prison, and preventing the spread of HIV in prison becomes a large community issue once these men return home.”

     Currently, nearly 1.7 million persons are in the federal prison system.  And at current incarceration rates, one in three Black men will be in prison at some point in their lives.  Rowell-Cunsolo surveyed 63 Black inmates at one of the largest maximum-security male prisons in the U.S., inquiring about their sexual behavior within that institution.  Two-thirds of that facility’s prisoners were Black; most of the study’s participants were married with at least one child.

     Over the past ten years, prison-based HIV research has found that only about half of American facilities offer HIV testing.  “There are some prison systems that distribute condoms or have a needle exchange program to prevent the spread of HIV, but for the most part this isn’t done because its seen as supporting behavior that’s explicitly against the rules in prison,” Rowell-Cunsolo stated. 

    The author continued, “That makes basic sex and HIV education really important.  Some of these men have been incarcerated since before the AIDS epidemic hit the scene and they literally don’t know how it spreads or how to protect themselves.”

     Each year, according to the U.S. Centers for Disease Control and Prevention, an estimated one in seven people with HIV passes through the prison system.  More than 1.1 million Americans are now living with HIV, and almost one in five don’t know they’re infected.

     COMING NEXT:  Former Prisoners Discuss Their Sexual Experiences In Prison.

HIV Crim: A Dangerous Global Phenom

     What does the word phenom mean?  Well, as the shortened form of phenomenon, it refers to “a person or thing of outstanding abilities or qualities.”

     However, when applied to HIV criminalization, it takes on an entirely different understanding or subtext, which is ominous…and dangerous.  You see, a new report by the HIV Justice Network and the Global Network of People Living with HIV (GNP+) has just concluded, “HIV criminalization is a growing, global phenomenon that is seldom given the attention it deserves considering its impact on both public health and human rights, undermining the HIV response.”

     Entitled “Advancing HIV Justice 2: Building Momentum in Global Advocacy Against HIV Criminalization,” the report covers the period between April 2013 and September 2015.

     But first:  just what is HIV criminalization? The Global Network of People Living with HIV (GNP+) states that it is “the application of the criminal law to people living with HIV based solely on their HIV status.  This happens through HIV-specific criminal statutes, or by applying general criminal laws that allow for prosecution of unintentional HIV transmission, potential or perceived exposure to HIV without transmission, and/or non-disclosure of known HIV-positive status.”

HIV CRIM 2016 3     According to the organization, criminal laws used against HIV-positive individuals impact entire communities. Additionally, these statutes perpetuate discrimination and stigma—not to mention fear, shame and anger directed at those living with the virus.

     “These laws and prosecutions do not only impact the people investigated, prosecuted, or incarcerated.  These laws undermine core sexual rights and public health principles,” states Julian Hows of GNP+.  “Their existence and application exacerbate racial and gender inequalities and jeopardize critical HIV prevention and service delivery efforts.” 

     The following are highlights of the report:

  • Seventy-two countries have adopted laws that specifically allow for HIV criminalization, either because the law is HIV-specific, or because it names the virus as one—or more—of the diseases covered by the law. When the HIV criminalization laws in 30 of the United States are counted individually, this total rises to 101 jurisdictions. 
  • Sixty-one countries now report prosecutions for HIV nondisclosure, potential or perceived exposure, and/or unintentional transmission.This number increases to 105 when individual states (in America) and Australian territories are counted separately.  And of the 61 countries, 26 applied HIV criminalization statutes, 32 applied general criminal or public health laws, and three—Australia, Denmark and U.S.—applied both HIV criminalization and general laws.
  • From April 2013 to October 2015, the highest number of prosecutions were reported in the following countries:Russia (at least 115); U.S. (at least 104); Belarus (at least 20); Canada (at least 17); France (at least 7); Italy, United Kingdom (at least 6 each); Australia, Germany (at least 5 each).   

     GNP+ adds, “Of particular concern is the fact that 30 sub-Saharan African countries have now enacted overly broad and/or vague HIV specific statues enabling legal repercussions against people living with HIV.” 

     And, the organization emphasizes, “The trend is in contrast with the latest science which shows that people with HIV who adhere to HIV treatment and have an undetectable viral load are not infectious.  In addition, this approach of the criminal law violates key legal and human rights principles.”

     However—and fortunately—there is a bright side, according to the report. “Important and promising developments in case law, law reform and policy have taken place in many jurisdictions, most of which came about as a direct result of advocacy from individuals and organizations working to end the inappropriate use of the criminal law to regulate and punish people living with HIV.”

Just How Many “Undetectables” Are There?

     Get a load of this encouraging new development:  recent research has indicated that the Centers for Disease Control and Prevention (CDC) may have overstated the size of the U.S. HIV population, while significantly underestimating the share that has a fully suppressed viral load (undetectable).  Researchers utilized HIV lab reporting to estimate prevalence of the disease in New York City and 19 other jurisdictions. 

     Next, they used previously published data to construct a revised HIV treatment cascade, or the HIV Care Continuum.  This cascade refers to the descending proportion of individuals living with HIV who have been diagnosed, are retained in medical care, have been prescribed antiretrovirals (ARVs), and are virally suppressed.

     Before going further, let’s fully understand what being undetectable is–and means.  First and most importantly, it does NOT signify that you are cured of the virus.  What it does mean, according to Melissa Dahl’s article entitled, “What Does It Mean to Have ‘Undetectable’ HIV,” is that “the anti-retroviral treatment is working, and that the amount of HIV in the blood is so low that even the best available tests don’t pick it up.  As it is usually defined now, to have an undetectable viral load means that there are fewer than 20 copies of the virus in one milliliter of blood.  Compare that to those who have just been diagnosed and not yet treated, whose tests show millions of copies in the same sample size.”

     Dahl adds, “The very latest research is showing that it is highly unlikely for people with an undetectable viral load to transmit the virus to a sexual partner—even without the use of a condom.”

     Now, back to the care continuum.  In 2011, the CDC estimated that 1.2 million Americans were living with HIV.  Poz.com states, “The U.S. care continuum estimate, which also refers to 2011, has long stated that 86 percent of the American HIV population has been diagnosed, 40 percent is engaged in care, 37 percent has been prescribed ARVs and 30 percent is virally suppressed.  These figures are frequently cited as troublesome barometers of the dismal job the U.S. health care system is doing taking care of HIV-positive individuals.”


     But as stated in the first paragraph, recent research has indicated that in fact, viral suppression rates have been steadily rising among HIV-infected Americans.  Poz.com continues, “Researchers used 2009-2013 data from the Medical Monitoring Project, covering 23,125 HIV-positive people, to estimate the proportion of those receiving HIV medical care who had a fully suppressed virus.”

     From 2009 to 2013, the portion of individuals who had a fully suppressed virus at their last viral load exam rose, from 72 to 80 percent.  The largest increases were seen among 18-to-29-year-olds, whose viral suppression rate rose from 56 to 68 percent; 30-to-39-year olds (62 to 75 percent); and blacks (64 to 76 percent).

     Poz.com adds, “The researchers in this new study estimated that, in fact, the CDC’s HIV prevalence estimate for 2011 was 25.6 percent too high, that the true number of Americans living with the virus was 819,200—or somewhere between 809,800 and 828,800.”

     Now, thanks to the improving surveillance of CD4 and viral load test results throughout the nation, the CDC can better make more accurate estimates of the number of those who are undetectable.  And, an official revision of the national HIV viral suppression rate should come later this year.


Jamal Hailey:  Being a Frontline Soldier in the War on HIV is Personal, Part Three

     HIV expert and activist JAMAL HAILEY has his own personal stake in the war on HIV he’s helping to wage: he’s had family die from the disease.

     In Part Three of my exclusive Huffington Post Queer Voices interview with Jamal, he provides us with exceptional insight into exactly why he’s so dedicated and committed to the struggle against HIV.  It’s a poignant and compelling conversation!

     For Part Three, visit:  http://www.huffingtonpost.com/wyatt-obrian-evans/jamal-hailey-being-a-fron_2_b_9488288.html

Jamal Hailey Stigma AIDS

Jamal Hailey:  Being a Frontline Soldier in the War on HIV is Personal, Part Two

     HIV expert JAMAL HAILEY has his own personal stake in the war on HIV he’s helping to wage: he’s had family die from the disease.

     In Part Two of my exclusive Huffington Post Queer Voices interview with Mr. Hailey, he discusses stigma, the intersection of HIV and IPV/A, HIV prevention and care from a radical social justice perspective, and the practice of counseling psychology.   It’s a rather substantive and telling conversation.


    For Part Two, click on the following link:   http://www.huffingtonpost.com/wyatt-obrian-evans/jamal-hailey-being-a-fron_1_b_9404788.html

HIV Crim Rates: Riddled with Disparities

     HIV criminalization rates in California and across the nation might be much higher than originally believed, concluded a new study by the Williams Institute. Additionally, Black men and women—as well as white women—were much more likely than white men to be charged under HIV-related laws.

     Entitled “HIV Criminalization in California: Penal Implications for People Living with HIV/AIDS,” this seminal and eye-opening report was produced by UCLA’s (the University of California, Los Angeles) the Williams Institute. According to its mission statement, the Institute “is dedicated to conducting rigorous, independent research on sexual orientation and gender identity law and public policy.  A think tank at UCLA Law, the Williams Institute produces high-quality research with real-world relevance and disseminates it to judges, legislators, policymakers, media and the public.”

      The report analyzed data from the California Department of Justice concerning any individual who’d been in contact with HIV-related criminal laws (the criminal justice system) between 1988 to June 2014.  During that time, findings demonstrated that the state’s four HIV laws affected 800 individuals.  And get a load of this:  95 percent of the cases did not require proof of exposure or transmission in order to prosecute. 

     Here are some of the report’s key findings:

  • Almost every incident in which charges were brought resulted in a conviction (389 out of 390 incidents). Among those with known sentences at the time of conviction, 91 percent were sent to jail or prison for an average of 27 months.
  • Based on charges of these crimes, African-Americans and Latinos/as comprised 67 percent (or two thirds) of those who ran afoul of the criminal justice system.
  • Based on their HIV-positive status, women comprised 43 percent of those who ran afoul of the criminal justice system.
  • The vast majority of these incidents (95 percent) involved sex work.The law that criminalizes sex workers living with HIV does not require intent to transmit HIV or exposure to HIV.
  • Across all HIV-related crimes, white men were significantly more likely to be released and not charged (in 60 percent of their HIV-specific criminal incidents) than expected. Black men (36 percent), black women (43 percent) and white women (39 percent) were significantly less likely to be released and not charged.

HIV CRIM 7    

     Congresswoman Barbara Lee, co-chair and co-founder of the bipartisan Congressional HIV/AIDS Caucus stated, “’For too long, federal and state laws have discriminated against people living with HIV.  These laws serve only to breed fear, distrust and misunderstanding.  I applaud the Williams Institute for their hard work in drafting this report that shows the real impact of these discriminatory laws on Californians’.”

     In a recent The Pride (a Los Angeles LGBT publication), Amira Hasenbush and Ayako Miyashita(co-authors of the study) penned an article entitled “How Criminal Laws Target People Living with HIV.”  In it, they stated the following:  “’Criminalization in any form can change the course of a person’s life.  But the application of HIV criminal laws is yet another difficult burden placed upon individuals living with HIV.’  

     “’To the degree that these data suggest an unequal application of justice, we must ask ourselves—are these laws fair or are they merely steeped in fear?  Do they protect and serve, help or harm our communities?  Is justice being delivered here?  Our research does not provide us with all the answers to these questions.”

     Hasenbush and Miyashita concluded, “But we can say that just like the rest of the criminal justice system, under HIV criminalization laws, certain communities bear more weight of the penal code than others.”

Homophobia:  HIV’s Dependable Partner In Crime

     HIV has many allies, collaborators and accomplices, which include denial, poverty, stigma, and the “it can’t happen to me” syndrome.  And,homophobia is a member of that club—and a dominant one at that.

    According to Poz.com, the leading and renowned news site dedicated to HIV news and prevention, “Homophobic attitudes and laws in European nations keep men who have sex with men (MSM) from accessing HIV-prevention services and from discussing their sexuality with health care providers.”

     The media outlet continued, “Publishing their findings in the journal AIDS, researchers examined data from the European MSM Internet Survey,which includes HIV-related information about 174,000 gay and bisexual men in 35 European countries.  They compared this data with various countrywide laws, policies and attitudes toward homosexuality.”

     So, what did the investigators uncover?  “The researchers found that higher levels of homophobia in a nation was linked with lower HIV knowledge among gay and bi men, and that the men in these countries were also less likely to use condoms.”

     Let’s examine HIV risk.  This recent study concluded that personal responsibility actually was trumped and overshadowed by another factor—which is insidious and deeply ingrained.  John Pachankis, PhD, an associate professor of epidemiology at Yale University, stated the following: “’Our findings suggest that rather than primarily being the result of personal failure, HIV risk is largely determined by national laws, policies, and attitudes toward homosexuality.  This study shows that gay and bisexual men in homophobic countries are denied the resources, including psychological resources like open self-expression, that are necessary to stay healthy’.” 

     Sobering news, indeed. 

     Another significant finding of the study was that MSM living in nations with marked homophobia have fewer sexual partners—and therefore are less likely to have HIV.  “The investigators concluded that this was a consequence of the men being more likely to stay in the closet due to an inhospitable environment.”

     Oh, yes.  HIV can definitely depend upon homophobia for a huge assist in getting its job done.


Breaking:  HIV Is Killing Fewer Blacks

     HIV is losing a critical bout in the long and grueling boxing match called AIDS.  And this victory for persons of color certainly is a cause for celebration. 

     According to Michael Smith, writer for the health media outlet MedPage Today, the Centers for Disease Control (CDC) has reported that that the mortality rates of blacks in the U.S. fell substantially between 2009 and 2012.  During that time, the number of deaths fel1 by 18 percent. 

     However, the number of deaths remained higher among HIV-infected blacks  than among HIV-positive individuals of other racial and ethnic groups–although the gaps seem to be narrowing. 

     Consistent features of the U.S. HIV/AIDS epidemic have been ethnic and racial disparities:  each year, blacks have been making up almost half of all new diagnoses despite being only 14 percent of the population.  And cases have been soaring amongst some subgroups, including black MSM (men who have sex with men). 

    According to Smith, the CDC stated that this new data illustrate that decreases in mortality between 2009 and 2012 were seen in all groups but were “greater and more consistent among blacks than among other races/ethnicities.” 

     The CDC calculated two rates—the rate per 1,000 individuals living with HIV and the rate per 100,000 population.  In 2012, the CDC reported, “an estimated 8,165 deaths occurred among black persons living with HIV, which was 48% of the total mortality among people with HIV.  That was 1.5 times the 5,426 deaths among whites and 3.2 times the 2,586 deaths among Hispanics or Latinos. 

     “But overall, the number represented an 18% decline in the number of deaths among blacks from 2008 through 2012. 

     “The death rate per 1,000 blacks living with diagnosed HIV fell from 28.4 in 2008 to 20.5 in 2012—a 28% decline—but the rate remained 13% higher than for  whites and 47% higher than Hispanics or Latinos, the agency said. 

     “The 28% decline among blacks was greater than the 22% drop seen among all people living with HIV.” 

     Though this is encouraging and heartening news, we cannot afford “to rest on our laurels,” so to speak.  And let me put it another way:  before you “get horizontal to ‘Git Busy’,” strap on your favorite “latex raincoat!”

Gay couple dressed in suit and hat. caption talks about the importance of aids testing

HIV Infection Soaring Among Brooklyn MSMs

      There’s both good and bad news coming out of HIV stats from New York’s Department of Health and Mental Hygiene (DOHMH).

     First, the good news:  in the past 10 years, HIV infection rates have been cut in half.

     Now, the bad news.  More than half of new HIV infections occurred among MSMs (men who have sex with men)—specifically those under 30.

     Susan Scutti, writer for Medical Daily, quoted C. Virginia Fields, president and CEO of the National Black Leadership Commission on AIDS, who stated that  “’Complacency among the young that HIV/AIDS is just a matter of taking one pill a day’ can make them less likely to practice safe sex.”

     Scutti continued, “Close to 112,000 people were living with HIV/AIDS in New York City as of June 2011, but the true number, doctors with DOHMH believe, is possibly 20 percent higher since many people do not get tested and do not know their status.

     “New infections also disproportionately affect the black and Hispanic communities, which accounted for nearly 80 percent of the newly diagnosed cases.  The majority live in central Brooklyn neighborhoods—Bedford-Stuyvesant, Crown Heights, Williamsburg, Bushwick and East Flatbush—areas that are already home to the city’s largest group of those living with the disease.

     “Although infection among young MSMs is rising, they are not alone in contracting the disease.  Many MSMs do not identify as gay, preferring to hide their sexual preferences for other men, and some doctors believe they are infecting their black female partners, who made up 79 percent of all new HIV cases among Brooklyn women in 2011.” 

     And according to Dr. Kevin Fenton, director of the National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention at the Centers for Disease Control and Prevention, Black women are “bearing a disproportionate burden of disease compared with their white or Hispanic counterparts.” 

     Fortunately however, there are avenues of hope.  For nearly 25 years, an infrastructure of health care services specifically targeting HIV/AIDS have been in place within Brooklyn:  HEAT/FACES, a network of HIV/AIDS clinics; and the Brooklyn AIDS Task Force, which serves minority communities in particular.


Sir Elton John

Sir Elton John Continues to Step Up to the Plate, Batting Home Runs

     While conducting my usual round of research, I uncovered a rather timely article by Darryl Hannah for Inside Philanthropy entitled, “With HIV Infections Rising among Gay Men, This Funder Aims to Sound the Alarm.”  Hannah stated, “Here in the U.S., AIDS can feel like yesterday’s news, and many funders long ago moved on to other issues, including many LGBT funders who’ve been focused on rights issues.”

     The writer continued, “In fact, though, the rate of new HIV infections remains very high, and is rising.  But you’d never know that judging by the complacency of the media or, unfortunately, of many gay men.  Which is why the Elton John AIDS Foundation’s (EJAF) latest grant making includes funding to raise awareness of the persistent threat of HIV.”

     According to the Kaiser Family Foundation, the following dire and gloomy realities are concrete, undeniable evidence that we continue to need EJAF support, clout…and dollars more than ever:

  • In 2010, over 15,000 individuals died of AIDS.
  • Although gay/SGL (same gender loving) men make up just two percent of the U.S. population, they account for 55 percent of all AIDS deaths.
  • This two percent comprise the majority, 56 percent, of people living with HIV.
  • Gay/SGL men account for 66 percent of new HIV infections.
  • 12 to 13 percent of gay/SGL and bisexual men in the U.S. are HIV-positive—including one in five in many major American cities.
  • When you examine HIV/AIDS infections among African-American gay/SGL and bisexual men, the numbers are nearly doubled.

     Hannah wrote, “In short, AIDS is hardly a plague of the past in the gay community.  But it’s seen as such, and the Kaiser study found that few gay men said they discuss HIV with friends and sexual partners and 30 percent had never been tested for HIV.  Only a third knew that HIV infections are rising.  A majority said they were ‘not concerned’ about HIV.

     “It’s frightening findings like these that has the Elton John AIDS Foundation, one of the nation’s largest funders fighting HIV/AIDS, sounding the alarm more loudly and looking for ways to challenge rising complacency about AIDS in the LGBT community.”

     Recently, EJAF formed a partnership with the Human Rights Campaign.  The Foundation awarded this national LGBT organization a $300,000 grant to increase awareness of HIV prevention, treatment, and care among LGBT persons—with a specific focus on young gay/SGL and bisexual men, and transgender women.  The Foundation also hopes to increase awareness and access to care for low-income individuals.

     Additionally, EJAF has just announced $1.5 million in grants, which includes funding to combat stigma confronting those who are poz.

     According to Hannah, “Sir Elton John himself remains as dedicated to this issue as ever.  And deeply worried, too, about issues that he wants more widely shared.  In a recent op-ed for the New York Times, he wrote:

     “’…as engaged as the gay community and civil rights activists have been in the fight for marriage equality, we have lost ground on the fight that so intensely galvanized the gay community to begin with:  HIV and AIDS…we are failing to maintain the kind of basic awareness and education that is needed to save lives’.”    

Drinking and HIV

Kickin’ One Back May Be One Too Many

      Some time ago, I wrote a Huffington Post Gay Voices column entitled, “Kickin’ One Back May Be One Too Many.”  The piece deals with such an important and timely issue, that I’ve decided to re-introduce it. 

     So, here it is:  in a group of U.S. men who have sex with men (MSM), heavy drinking plus having more than one unprotected receptive anal intercourse partner in the past two years doubled the risk of acquiring the HIV virus.  And check this out: heavy drinking alone raised the risk of HIV infection by a whopping 60 percent. 

     The impact of heavy drinking on HIV infection –with or without unprotected receptive anal intercourse—is not well understood.  Therefore, to address these issues, Multicenter AIDS Cohort Study (MACS) investigators studied 3,725 HIV-negative men enrolled in the cohort from 1984-2008.  

     MACS is the first and largest study specifically created to examine the natural history of AIDS.  Now in its third decade, this study involves nearly 7,000 MSM nationwide.  MACS is ongoing at four institutions:  UCLA, Northwestern University in Chicago, the University of Pittsburgh, and Johns Hopkins University in Baltimore.  With 2,000 participants, the UCLA site is the largest.  And amazingly, after more than 25 years, the cumulative dropout rate is less than 15 percent.  This reflects the participants’ high level of commitment and interest. 

     These men self-reported their drinking habits and the number of unprotected receptive anal intercourse partners.  They reported drinking a median of eight drinks weekly, and 30 percent reported having multiple unprotected receptive anal intercourse partners in the past two years.  During 35, 870 person-years of follow-up, 529 men became infected with HIV. 

     Statistical analysis determined that heavy drinking—in excess of 14 drinks weekly—raised the risk of HIV infection 61 percent.  Among men with zero or one unprotected receptive anal intercourse partner in the past two years, heavy drinking did not significantly affect risk of HIV acquisition.  However, among men with two or more partners, heavy drinking doubled the risk of infection. 

     According to the researchers, their findings “suggest that alcohol interventions to reduce heavy drinking among men who have sex with men should be integrated into existing HIV prevention activities.” 

     This study resonates so strongly with me because my ex-partner Alonzo, whom I wrote about in a Huffington Post Gay Voices column entitled “It’s (Just) The Way That I Love You,” was, on occasion, a heavy drinker.  And nearing the end of our monogamous relationship, his drinking became even more excessive.  Alonzo suffered from chronic depression, which certainly contributed to overindulging. 

     After we parted, Alonzo’s drinking worsened.  It’s my understanding that that excess caused him to engage in unsafe sex.  Subsequently, he contracted HIV, which developed into full-blown AIDS. 

     And with breakneck speed, the disease ravaged this robust, muscular man.  And sadly, as a result of AIDS-related complication, Alonzo passed away in 1996. 

     In the coming months, I’ll be exploring and writing about LGBTQ depression, particularly in African-American men.

Drinking and HIV

Drinking and HIV

I’ve just posted my revealing and thought-provoking article regarding the correlation between drinking and HIV. This is such a critical issue! Visit my BLOG for “Kickin’ One Back May Be One Too Many.”

10 Things about HIV Infected men

Let’s Have Some “Poz(itive)” Talk

     Dating and/or having sex can be a daunting challenge for MSM (men who have sex with men), particularly those who are HIV-negative.  But only if you let it.  And, I’ll explain exactly what I mean about that a little later.

     But first, stats on HIV.  Recent data from the Centers for Disease Control and Prevention (CDC) show that 1 in 5 sexually active MSM in America are HIV-positive, but that 44% of them don’t know it.

     Regarding estimated new HIV infections among all MSM in the U. S. in 2010 (year of most recent stats) Blacks/Africans accounted for 10,600 (36%); Hispanics/Latinos accounted for 6,700 (22%); whites accounted for 11,200 (38%).

     Of particular note:  Overall, Blacks account for more new HIV infections, people estimated to be living with HIV, and HIV-related deaths than any other racial/ethnic group in the U.S.

     Many MSM consider dating/having sex a tricky, unnerving and perilous journey, full of potential health minefields. 

     Well, it doesn’t necessarily have to be.

     My assistant thought that a recent Queerty piece, “Ten Things HIV-Positive Guys Want Negative Guys to Know,” would make a thought-provoking article for www.wyattevans.comHe’s correct, and maybe it will help give “neg guys” a totally different perspective.

    So, without further ado, I present to you, the “Ten Things HIV-Positive Guys Want Negative Guys to Know.”

  1. All positive guys are not barebacking drug addicts.  It’s probably human nature to try and find fault in the actions of those becoming infected.  If we see them as extremists it helps the rest of us feel more secure in our own choices.  And yet, the truth is that the majority of new infections occur within “primary relationships,” such as a lover or boyfriend, and usually because one partner did not know he was infected and then transmitted HIV to his partner.  That’s why there’s such intense focus on getting tested and doing it regularly.  New infections are typically not the result of some insane night at a meth-fueled sex party or a boozy night at the baths.
  2. Living with HIV is not a toxic horror show of medications.  Yes, HIV usually requires medications and doctor visits.  So does every chronic condition.  With so many option for HIV drug therapies, side effects have been reduced drastically and ones in development will reduce them even further.  Poz guys are not weeping every morning as they chug down pills with their morning coffee.
  3. HIV infection does not automatically turn guys into dangerous liars.  One of the most unfortunate misconceptions about positive guys is that they outright lie about their status just to get laid, or worse, are on a mission to infect others.  Can we dial down the rhetoric about intentional transmission, please?  What is true is that positive men often have trouble disclosing because of the very stigma that results from sensational rumors like this one.  It is unfair to blame all positive men due to the reckless behavior of a relative few.
  4. “Drug and Disease Free, UB2” is every bit as stupid and non-productive as it sounds.  If you are using this dangerous phrase as a filter for potential sex partners, you could be doing yourself more harm than good.  We know positive guys who are undetectable are not infecting their partners, so rejecting people based on their status can be more discriminatory than practical.  “UB2” also sets you up for a false sense of security, because as one British study suggests, the risk of sex with someone who thinks they are HIV negative is higher than sex with an undetectable positive person.  This is because the viral activity in a newly positive person can be incredibly high, and he may not even know it.  Of course, either way you have to know who you’re dealing with.
  5. Our health and risk behaviors are up to us and no one else.  After decades of scientific and treatment research focused on those with HIV, new options are now available to sexually active negative men, such as Pre-exposure Prophylaxis (PrEP).  This advance puts negative guys in control of their own infection risks.  Your own health is always in your hands through the choices you make—and they have nothing to do with the status of your partner, whether known or unknown. 
  6. Guys with HIV are not promiscuous…or have a rotten sex life…or no sex life.  All of these are usually false, if you’re using the typical sex life of a single gay man as a barometer.  We all have our moments.  Sometimes our dance card is filled, sometimes there’s a drought, and sometimes the sex we have sucks, and not in a good way.  And just like the rest of us, positive guys are getting their share and having satisfying, balls-to-the-wall sex when they’re lucky.
  7. How they got it and who gave it to them is none of your business.  The details of someone else’s infection isn’t your personal soap opera or cautionary tale, no matter your good intentions.  If poz guys feel like sharing it with you sometime, they will.  Chances are they came to terms with it long ago and it’s probably not very interesting, anyway.
  8. If you need an HIV educator, go find one.  Having HIV doesn’t come with a master class in epidemiology and HIV transmission.  Every person with HIV is not an expert or a prevention specialist—or an activist.  They are simply living with the virus.  And if they do find themselves having to educate you about the simplest facts of HIV prevention, don’t be surprised if they are the ones that decline to have sex.  Nothing kills the mood like HIV 101.
  9. Positive guys aren’t going anywhere soon.  Recent studies suggest that someone being infected with HIV today in the United States has the same odds of living a normal life span as anyone else.  People with HIV see a physician more often, and other health concerns can be identified and addressed sooner.  They are also more likely to avoid drugs and alcohol, eat well and exercise regularly, the keys to health and longevity.
  10. Even more breakthroughs are coming.  There is research underway that will continue to change the landscape and make life easier and less risky for both positive and negative.  Treatments for HIV infections will become even less toxic and even more effective.

     The reality is that poz guys are out there.  And probably, there are too many MSM who believe they are neg, but actually are poz. 

     Also:  what if that poz guy is a great match for you on so many levels?  What if he’s the one you’ve been searching for?  Do you summarily dismiss him because he’s poz? 

    Meaty food for thought, eh?

Socio-Economics as a Driver of HIV in Black MSM

     Fenway Health, a Boston LGBT group, has just reported that although Black men who have sex with men (MSM) is a very small part of the population, they make up more than 20 percent of new HIV infections in the United States.

Additionally, an analysis of data from a recent six-city study of African-American gay, bisexual and MSM reveals a link between HIV and socioeconomic factors.  To read more, visit:  www.baltimoreoutloud.com/thinking-outloud/mood-swings/item/2485-socio-economics-as-a-driver-of-hiv-in-black-msm

American Indians With HIV/AIDS

The Quiet Invader within Native Americans

     A rather disturbing report just hit my desk that really gave me pause.  Therefore, I decided to make it a Wyattevans.com exclusive. 

     According to Neal Broverman’s article, “Are the Odds Stacked Against Native Americans with HIV,” recently published at Hivplusmag.com, “The most recent studies of HIV among Native Americans living on the Navajo reservation in New Mexico found alarming numbers, with infections up 20 percent from 2011 to 2012.”

That article went on to state, “The results, reported in the New York Times, included another disturbing but little-discussed statistic:  Native Americans with HIV and AIDS have lower survival rates than any other racial group.  This affects me deeply because my maternal grandmother was Native American.

Statistics from 1998 to 2005 demonstrate that HIV rates among Native Americans “were slightly higher than but comparable to those of Caucasians, but lower than those of African-Americans and Latinos.  The problem is that testing, treatment, and care are not reaching Native Americans the same way they’re reaching other Americans.”

According to Lisa Neel–a program analyst at the HIV Program for the Indian Health Service, the federal government health program for American Indians and Alaska Natives–there are an assortment of reasons why.  “Poverty, which limits access to doctors and can put health concerns on the back burner for those struggling to feed themselves, is an all too common problem for Native Americans.”

Neel also says, “That compared with other racial and ethnic groups, American Indians and Alaska Natives have higher poverty rates, have completed fewer years of education, are younger, are less likely to be employed, and have lower rates of health insurance coverage.”

Often, this results into individuals not getting tested; as a result, scores being oblivious that they are in fact HIV-positive.  Stats show that at the end of 2009, 18 percent of all Americans infected with HIV weren’t aware of their status, while 25 percent of Native Americans and Alaska Natives living with HIV did not know they had the disease.  And of course, this means that some of those infected in these groups not getting needed treatment until their HIV advances to the point that they experience symptoms.

Neel is concerned that “cultural stigma faced by some gay and bisexual Native American men could also be discouraging testing and treatment,” and cites the higher rates of alcohol and drug use among all American Indians and Alaska Natives.

She concludes, “’Although alcohol and substance abuse does not cause HIV infection, it is an associated risk factor because of its ability to reduce inhibitions and impair judgment.  Compared with other racial/ethnic groups, AI/AN tend to use alcohol and drugs at a younger age, use them more often, and in higher quantities, and experience more negative consequences from them’.”