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Gay Communities & HIV: 32 Years of AIDS

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Gay Communities & HIV: 32 Years of AIDS Gay Communities & HIV: 32 Years of AIDS Lee E. Klosinski, Ph.D. UCLA Nathanson Family Resilience Center Semel Institute for Neuroscience & Human Behavior GayGay CommunitiesCommunities && HIVHIV •• WhatWhat facilitatedfacilitated thethe impactimpact ofof HIVHIV infectioninfection amongamong gaygay communitiescommunities inin thethe U.S.?U.S.? •• HowHow diddid gaygay menmen shapeshape thethe USUS responseresponse toto thethe HIVHIV epidemic?epidemic? •• HowHow areare gaygay communitiescommunities currentlycurrently shapedshaped byby HIV?HIV? •• WhatWhat areare thethe emergingemerging issues?issues? About language: GAY • Cheerful, carefree • Sexualization of the term=> uninhibited by moral restraints • Moralization of the term=> sinner, sick, criminal About language: GAY COMMUNITY • Identity movement • Gay communities not gay community • Unifiers: pride, diversity, individuality, sexuality, minority status • Civil rights movement • GLBT community About language: Gay vs. MSM • Self-identification vs. behavior • “Men who have sex with men” (MSM) identifies a behavior, not an identity What facilitated the impact of HIV on gay communities? •Post-war concentration of gay men in urban centers What facilitated the impact of HIV on gay communities? • Ignition of Gay Civil Rights Movement in 1969 (and before) What facilitated the impact of HIV on gay communities? • Post-war mobility • Sexual revolutions of 1960s • Sexual access RARE CANCER SEEN IN 41 HOMOSEXUALS By LAWRENCE K. ALTMAN New York Times, July 3, 1981 Doctors in New York and California have diagnosed among homosexual men 41 cases of a rare and often rapidly fatal form of cancer. Eight of the victims died less than 24 months after the diagnosis was made. The cause of the outbreak is unknown, and there is as yet no evidence of contagion. But the doctors who have made the diagnoses, mostly in New York City and the San Francisco Bay area, are alerting other physicians who treat large numbers of homosexual men to the problem in an effort to help identify more cases and to reduce the delay in offering chemotherapy treatment. The sudden appearance of the cancer, called Kaposi's Sarcoma, has prompted a medical investigation that experts say could have as much scientific as public health importance because of what it may teach about determining the causes of more common types of cancer. How did gay communities shape the HIV epidemic in the U.S.? • Community-based care models How did gay communities shape the HIV epidemic in the U.S.? • Community-based care models • Ethos: A patient-led health movement PWA Empowerment The Denver Principles-1983 • We condemn attempts to label us “victims,” a term which implies defeat, and we are only occasionally “patients,” a term which implies passivity, helplessness, and dependence upon the care of others. We are “People With AIDS.” Denver Principles RECOMMENDATIONS FOR ALL PEOPLE: • Support us in our struggle against those who would fire us from our jobs, evict us from our homes, refuse to touch us or separate us from our loved ones, our community or our peers, since available evidence does not support the view that AIDS can be spread by casual, social contact. • Not scapegoat people with AIDS, blame us for the epidemic or generalize about our lifestyles. Denver Principles RECOMMENDATIONS FOR PEOPLE WITH AIDS: • Form caucuses to choose their own representatives, to deal with the media, to choose their own agenda and to plan their own strategies. • Be involved at every level of decision-making and specifically serve on the boards of directors of provider organizations. • Be included in all AIDS forums with equal credibility as other participants, to share their own experiences and knowledge. • Substitute low-risk sexual behaviors for those that could endanger themselves or their partners; we feel people with AIDS have an ethical responsibility to inform their potential sexual partners of their health status. Denver Principles RIGHTS OF PEOPLE WITH AIDS: • To as full and satisfying sexual and emotional lives as anyone else. • To quality medical treatment and quality social service provision without discrimination of any form including sexual orientation, gender, diagnosis, economic status or race. • To full explanations of all medical procedures and risks, to choose or refuse their treatment modalities, to refuse to participate in research without jeopardizing their treatment and to make informed decisions about their lives. • To privacy, to confidentiality of medical records, to human respect and to choose who their significant others are. • To die – and to LIVE – in dignity. How did gay communities shape the HIV epidemic in the U.S.? • Community-based care models • Ethos: A patient-led health movement • Community-based prevention How did gay communities shape the HIV epidemic in the U.S.? • Community-based care models • Ethos: A patient-led health movement • Community-based prevention • Activism ACT-UP AIDS Coalition to Unleash Power Activism’s Legacy “We had the brainpower, and we had the street power. We, ACT-UP, got those drugs out there. It is the proudest achievement that the gay population of this world can ever claim.” Larry Kramer “How to Survive a Plague” What Drove AIDS Activism? • Social status of impacted group • Gay identity politics resulted in rapid response to threat to identity • Legacy of feminist health movement • Youth of impacted population • Guarded prognosis of HIV/AIDS diagnosis • Engagement with medical profession What is the legacy of AIDS activism? • Infection control • FDA reforms: drug testing, access to investigational new drugs, Phase IV follow-up • Patient-provider relationship • Comprehensive social & medical response • Research • Response to international epidemic How did gay communities shape the HIV epidemic in the U.S.? • Community-based care models • Ethos: A patient-led health movement • Community-based prevention • Activism • Mourning How are gay communities currently shaped by HIV? • Disproportionately impacted, especially men of color How are gay communities currently shaped by HIV? • Disproportionately impact • High risk behaviors are increasing What are the emerging issues for gay communities? • Impact of methamphetamine What are the emerging issues for gay communities? • Impact of methamphetamine • Ownership: HIV is not a gay disease What are the emerging issues for gay communities? • Impact of methamphetamine • Ownership: HIV is not a gay disease • Internet & mobile technology What are the emerging issues for gay communities? • Impact of methamphetamine • Ownership: HIV is not a gay disease • Internet & mobile technology • Prevention – what works? Evidence-Based Interventions • Effective for short- • Expensive term behavior change • Limited efficacy when • Several available used as single agents • Very limited access Fear Messages I used to like the way I looked, Now I look pregnant. I don’t care how good the sex is or how hot the guy is, nothing is worth what I’m going through now. What are the emerging issues for gay communities? • Impact of methamphetamine • Ownership: HIV is not a gay disease • Internet & mobile technology • Prevention – what works? • Serosorting Status sorting is a prevention strategy. Serosorting • Harm reduction strategy based on beliefs about one’s own & partner’s HIV status Serosorting Considerations • Increasing in recent years, especially among younger men – Atlanta study found used by 1 in 3 men reported serosorting • Increased risk if knowledge of HIV status is incorrect or inaccurately disclosed – 48% of HIV+ MSM in Nat HIV Behavioral Surveillance study didn’t know they were infected – URAI with a partner believed to be HIV- associated with 22% of attributable risk fro HIV infection • Serosorting was independently associated with a small decrease in risk of HIV seroconversion (OR = 0.88; 95%CI, 0.81-0.95), even among participants reporting ≥10 partners (Philip et al, 2010) Outstanding Prevention Issues • Addressing role of racism, stigma,& homophobia • Transition from disease-specific to sexual health framework for MSM disease prevention • Develop male-couple specific prevention initiatives (68% of incident US MSM infections form male were from main sex partners; Sullivan et al, 2009) Outstanding Prevention Issues • Addressing a sexual culture of accentuating pleasure & adventurism after seroconversion (Lébon et al, 2011) Wanna Take My Load? I'm always looking for hot bottoms to seed... If you're in NYC and interested, send me your pics and stats... [email protected] BiohazardMen Party Rules These parties are for like-minded men to get together to cruise, dance, have fun and uninhibited sex. That’s what we want! Outstanding Prevention Issues • Addressing a sexual culture of accentuating pleasure & adventurism after seroconversion (Lébon et al, 2011) • PrEP (pre-exposure prophylaxis) & PEP (post-exposure prophylaxis) Los Angeles Country HIV/AIDS Epi Materials • http://www.lapublichealth.org/aids/ • http://www.lapublichealth.org/hiv/.
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