I'm in Toronto this weekend doing a writer's retreat with my lovely co-conspirators for the "Bottom Monologues" project -- Erik, Alex, and Matthew. We're getting a lot of fabulous work done on the project already, with another day of brainstorming ahead of us. Above you'll see the cover sheet for the "Master List" of all the submissions we received from an informal online questionnaire, which 172 lovely bottoms generously responded to! In all, over 300 pages of delicious material to sort through, reflect on, and digest for the stage.

So far, we've concocted seven character sketches for the show. From transmen to escorts to "liberated" poz bottoms, we've got quite a range of experiences to share! What do YOU want to see in the show?

xoxox

T

This video tribute to Ms. White herself is just incredible. The details from JMG:

The St. Olaf Glee Club, better known as Frank DeCaro, Fredrick Ford and Jim Colucci, have created a hysterical Grandmaster Flash-y tribute to Betty White. DeCaro is a midday host on SiriusXM's OutQ, Colucci (his husband) is the author of The Q Guide To The Golden Girls. (They were a hilarious companions on my trip to Key West last October.) You may know Frederick Ford from gay porn, although he's recently pursued a career as a singer and performed at NYC's Folsom East last year.

Watch. Love. Repeat!

A common myth you will hear repeated again and again in media debates over American politics is that we as a society are overly "litigious" -- that is, we are too quick to sue people for trivial matters that used to be handled by friendly neighbors who didn't need to sign contracts with each other because they had trust to fall back on. There is no evidence of this trend historically (in fact, the evidence suggests people are too HESITANT to sue, rather than too quick).

But more importantly, this argument relies on a nostalgia for an American community that never really existed, and that there are reasons to be grateful that we abandoned the vision. Here, sociologist Sally Merry offers what I think is the most brilliant rebuke to this nostalgia that I have ever read, and so I wanted to share it with you today:

In trying to understand what it means when people bring personal problems to court some commentators have blamed it on an American tendency toward litigiousness. They hypothesize, as I discussed in Chapter 1, that Americans are ready to sue at the slightest provocation, their desires unleashed by the breakdown of community and the erosion of authority. By the end of the 1980s, the theory of the litigious American was widely accepted, occupying the status of common sense (see Hayden 1989). Implicit in this theory is the assumption that community has broken down, that the traditional authorities of family, church, and community have weakened so that people go to court rather than rely on these authorities, and that Americans generally regret this change and bemoan the loss of community (e.g., see Lieberman 1981: 186). With the decline in commitment to family and neighborhood life, people pull the government - the police and the courts - into their squabbles. They do so because they no longer feel either the same loyalty to these institutions or the same willingness to defer to the wishes of others. Now it is every man and woman for him- or herself as the modern citizen focuses on his own self-interest rather than on a greater communal good. Since the willingness to compromise and settle differences depends on the existence of social relationships which people wish to preserve, those who fail to settle must be people who put their personal interests above their social relationships.

[...]

I argue, however, that the expansion of formal social control is not caused by the collapse of community but by American individualism and egalitarian values and by the expansive efforts of the state. It is a result of ordinary citizens' desire to escape from community and, at the same time, of the legal system's invitation to them to bring their neighborhood and family problems to the courts. Individuals turn to the law to escape from the bonds of community and to construct a preferred mode of social ordering within families and neighborhoods. They often use the law to challenge the social hierarchies in families and communities which control their lives. Yet, in doing so they also respond to the entitlements and services offered by the state. Thus, the behavior I am describing is not so different from that claimed by proponents of the litigiousness and community-breakdown theory, but my interpretation of this behavior is different.

The theory of litigiousness and of the breakdown of community misunderstands the contemporary American attitude toward community. As long as community is conceived according the romantic American folk vision of a warm, intimate, and supportive social group, it is hard to understand why anyone would give it up. But the very intimacy and totality of such a social world make it miserable for the person who cannot or will not go along. It is not clear that urban Americans truly regret the loss of an intimate, consensual community. Proponents of community portray the alienated urbanite forced to sacrifice the close social world of his ancestral village, but it often seems that he or she wanted to leave. For example, those who lived in the small towns of America during the nineteenth and twentieth centuries left the country for the city, in droves. Obviously, the pull of jobs and the push of rural poverty are critical to rural-to-urban migration, but the attraction of a social life more free of gossip and of the informal surveillance of neighbors, family, and friends also has an appeal. Even eighteenth-century New England communities were constantly changing as discontented people and segments of the community moved away in order to deaJ with their differences (Bender 1978: 73). The United States, unlike Europe and many other parts of the world, lacks a tradition of settled peasant villages in which restrictions on mobility create enormous pressures to compromise interests and to settle. Even American immigrant communities, in which such village-like social structures are recreated, rarely last more than two or three generations, unless they are replenished by new immigrants. For much of American history, the frontier provided, for people enmeshed in conflicts, opportuntiies to move away. Perhaps the original decision to come to the United states was ssimilar strike toward freedom. Indeed, historian Robert Wiebe argues that it is a fundamental cultural logic in America to deal with difference by living apart (1975). "What held American dreams together," he says, " was their ability ot live apart. Society depended on segmentation (1975:46)."

In the postwar period, the suburbs have offered the possibility of a more private.
autonomous life, regulated less by convention, by gossip, and by local leaders. As the working-class adolescent from an inner-city, close-knit neighborhood put it: "I want to get out of here, away frorn the people here. I want to get to a place where you can decide for yourself how you want to live. In Cityville, you have to be what others want (Steinitz and Solomon 19~6: 50)." Other adolescents from this neighborhood want the peace and quiet of the suburbs, their spaciousness, the opportunities that they think the suburbs provide to be oneself and to be free of conventions, although they also fear that life there will be lonely and isolated (Steinitz and Solomon 1986: 17-62). Such suburban neighborhoods provide more freedom of individual expression, self-fulfillment, and individuality in private life-as long as one does not park an unregistered car in the driveway, make noise after 11 P.M., allow a dog to run free, build a structure too close to the property line, or in other ways violate the elaborate set of local regulations and zoning restrictions which are typical of suburbs.

Insofar as contemporary Americans are voting with their feet rather than with their rhetoric, they are continuing to move to suburbs, to choose privacy, separation, and, for social ordering, dependence on the lmv rather than the intimacy of community. In the postwar period, Americans in large numbers left the urban ethnic villages of the inner city to move to the suburbs. Three-quarters of all American housing has been built since 1940, a period in which the single-family detached horne, produced in vast numbers, became the nom1 (Hayden 1984:12). By 1980, two-thirds of the American housing stock consisted of singlefamily, detached homes (Hayden 1984: 12). Increased affluence has been translated into more widely spaced homes, reduced dependence on neighbors, smaller networks of kinsmen in which reciprocity prevails, and fewer people living in the same household, whether through elimination of older relatives, through divorce, or through restriction of the household to the nuclear family. As Americans have moved up, they have moved apart.

References:

Merry, S. (1990). Getting justice and getting even: Legal consciousness among working class Americans. Chicago, IL: University of Chicago Press, pp. 173-175.

This is a truly fascinating public television documentary -- "Take This Hammer" -- from the 1960s featuring James Baldwin touring San Francisco and meeting with African-American leaders. Footage from San Francisco State University's Digital Information Virtual Archive, copyright WNET.org. Here's their description:

KQED's mobile film unit follows author and activist James Baldwin in the spring of 1963, as he's driven around San Francisco to meet with members of the local African-American community. He is escorted by Youth For Service's Executive Director Orville Luster and intent on discovering: "The real situation of Negroes in the city, as opposed to the image San Francisco would like to present." He declares: "There is no moral distance ... between the facts of life in San Francisco and the facts of life in Birmingham. Someone's got to tell it like it is. And that's where it's at." Includes frank exchanges with local people on the street, meetings with community leaders and extended point-of-view sequences shot from a moving vehicle, featuring the Bayview and Western Addition neighborhoods. Baldwin reflects on the racial inequality that African-Americans are forced to confront and at one point tries to lift the morale of a young man by expressing his conviction that: "There will be a Negro president of this country but it will not be the country that we are sitting in now."

Enjoy!

I stumbled across 50Faggots today through their Facebook group. Their website is stunning, as is the footage they've collected from interviews with 10 femme gay boys in NYC, DC, and Chicago over the past two years that you get a taste of in the trailer below:

Can't wait to see more! They're having a launch party May 13th at Hydrate in Chicago, hosted by the *incredible* Cyon Flare (who I saw perform back in 2008) and Acid Betty. Road trip!

Aghhhhhhhhhhhhhhhhh! I've been waiting for MONTHS and MONTHS for new Scissor Sisters! The wait is over! Here's the first track:

The album comes out June 28th!!!!!!!!!!!!!!!

So I was interviewed two summers ago for a documentary on gay masculinity, Christopher Hines' The Butch Factor. It's debuting this Saturday on LOGO at 8 PM! Check out the preview below:

I see champagne and hot dogs in my future!

The data we've all been waiting for! The Kinsey Confidential has up data released from Condomania -- the largest condom store on the web -- that ranks cities based on dick sized based on the orders they get for sized condoms. Condomania explains their "methods":

So just how does Condomania know these intimate details? In 2004, the company launched TheyFit Condoms, the world's first line of tailored-fit prophylactics, in 76 sizes. Since then they have sold custom-fit condoms to over 27,000 men in 70 countries, and now have just begun to analyze this incredible cache of data.

"These fitted condoms range in length from 3 to 10 inches and from super slim to extra roomy." says Chris Filkins, Condomania's Directory of Technology. "After gathering detailed information on over 27,000 penises, we now have the most comprehensive database of penis sizes on the planet! Needless to say, these men's privacy is our utmost concern, and we're interested only in the statistics, and not who's who! But the data itself is pretty interesting."

Previously, the largest formal survey of penis sizes was conducted in 1948 by the famous Kinsey researchers, when 2,500 men recorded their erect penis sizes on pre-stamped cards.

Condomania's ten-times larger database is compiled from the unique "FitKit" measuring system for TheyFit condoms, where the user measures the length and girth of his erect penis to the millimeter and then matches those results to one of 76 possible sizes that comprise different length and girth combinations. In this system, the 76 sizes are comprised of non-sequential letters and numbers, so that the smallest is no more obvious than the largest.

They also include data on the top ranked states based on penis size, and in that formulation, New Hampshire of all places wins the prize:

1. New Hampshire
2. Oregon
3. New York
4. Indiana
5. Arizona
6. Hawaii
7. Louisiana
8. Massachusetts
9. Alabama
10. Washington
11. New Mexico
12. California
13. Arkansas
14. Nevada
15. Virginia
16. Tennessee
17. Illinois
18. Oklahoma
19. South Dakota
20. Georgia
21. Pennsylvania
22. Mississippi
23. Michigan
24. Florida
25. Rhode Island
26. Kansas
27. Maryland
28. Minnesota
29. Vermont
30. Connecticut
31. Wisconsin
32. New Jersey
33. North Dakota
34. Idaho
35. Texas
36. Missouri
37. Montana
38. Ohio
39. Nebraska
40. Colorado
41. Maine
42. North Carolina
43. Delaware
44. South Carolina
45. Kentucky
46. West Virginia
47. Alaska
48. Iowa
49. Utah
50. Wyoming

Moral of the story: I'm not moving to Wyoming anytime soon.

Thanks to Eric for the link

AIDSmap has a story up about a study just published about gay men, with the title "Having older sexual partners increases HIV risk for younger gay men." If you didn't read closely, you might think that the researchers had actually done a study that might buy them the cache to make such a claim. I thought I would take a moment here to dissect what the study actually found, and what we can(not) safely conclude based on those findings.

First, the study wasn't just about "gay men." Though many of the men involved did identify as such (74%), they recruited "men who have sex with men" - which includes a variety of other kinds of guys. Second, and more importantly in my book, they study involved a small sample of 74 men in North Carolina. That's right, 74 people are the basis for that rather startling headline. The meat of their claim is this statement here:

Men with PHI had partners on average 6 years older than themselves, whereas uninfected men's partners were 4 months their junior (P , 0.001). After adjusting for race, sex while intoxicated, and having a serodiscordant/serostatus unknown partner, a participant had twice the odds of PHI if his sex partner was 5 years his senior (odds ratio 2.0, 95% confidence interval: 1.2 to 3.3)

Let me try to translate that into slightly more clear English:

On average, the men that recently HIV-positive participants reported having sex with before they seroconverted were 6 years older than them. By comparison, HIV-negative men's recent partners were 4 months younger than them. When we take into account these guys' race, whether they reported being intoxicated while having sex, and whether they had sex with poz guys or guys whose HIV-status they didn't know, a participant was twice as likely to be in the HIV-positive group if he reported having partners five years older than him.

I hope that was somewhat more readable. In any case, what they're trying to say here is that because there is an association between having sex with older guys and being HIV-positive yourself, there may be causal relationship between those two things. But of course their data doesn't actually show this. Indeed, what there data merely says is that - of the 74 guys they interviewed - the ones who were poz were more likely to report having sex with older men before they were infected. The data they are relying on here is a survey asking men about their three previous partners before infection if poz or their three previous partners before their enrollment if neg.

But of course we can infer other possible theories here, and not just the causal link that they're alleging here. Or at least it could be missing pieces of the story. Now, importantly they did control for race, substance use, and sex with poz and unknown status guys. These are all important factors that should indeed be taken into account, so we don't mistake the difference in age between partenrs for the causal factor when it's actually other factors.

However, in a strange move that they don't explain, they actually don't include in their associative model condom use with their previous serodiscordant or serounknown partners, which actually varies considerably between the two groups (click to embiggen):

Just to clarify: This data isn't about condom use with any last partner, but only the previous partner who was either HIV-positive or for whom you did not know their status. That's a pretty important piece of data, and the different shown above is striking. But there's a bit of a statistical trick going on in their write-up. While the difference above is stark, non-condom use with a previous poz or HIV-unknown partner is not actually what they include in their model. Rather, for their odds ratio calculation, they include whether or not the participant reported having sex with a serodiscordant or serounknown partner at all. But this of course is the less meaningful datapoint -- what actually matters for risk is whether you used a condom with that last positive or unknown partner!

I don't like being duped, and seems to me to be what's going on here. They are using statistical trickery to manipulate our interpretation of their findings. What other conclusion can we reach? They have more meaningful data, and yet they willfully leave it out of the model and never address that exclusion. There is just no way that this was an accident -- they obviously ran the model with the condom use data and it was likely weaker than the one they decided on. Thus, I'm suspicious.

But beyond the statistical manipulation, this is a study of 74 men in North Carolina. Let's not get ahead of ourselves and start making any big claims about "gay men" universally or even across the United States.

Moreover, what is most troubling for me about this data is what they clearly want us to do about it: Prevent younger men from having sex with older guys. This to me is the next logical step in Public Health logic, and it's the one that had a bunch of us gay men's health activist up in arms a year or two ago when Michael Scarce reported on the Ning that STOP AIDS was working on an intervention research project that would attempt to do just that. It's important to know the ways in which HIV gets transmitted, and to be able to implement culturally tailored prevention efforts that come out of that knowledge. But dissociative mixing is not the answer.

Citation:

Hurt CB et al. Sex with older partners is associated with primary HIV infection among men who have sex with men in North Carolina. J Acquir Immune Defic Syndr, online advance publication, 2010.

Oh Tina Fey. You know just what women want:

Thanks to Brent for passing it along on Facebook!

Wisconsin recently passed a law mandating medically-accurate, age-appropriate sex education that includes information about birth control about STI prevention. The Juneau County District Attorney, Scott Southworth, is threatening to arrest teachers who comply with the law:

In his letter, Southworth told school district leaders the new law promotes sexual assault of children, and warns that teachers who follow the law could be charged with misdemeanor or felony delinquency of a minor, with maximum punishments ranging from nine months in jail to six years in prison.

"For example, if a teacher instructs any student aged 16 or younger how to utilize contraceptives under circumstances where the teacher knows the child is engaging in sexual activity with another child -- or even where the 'natural and probable consequences' of the teacher's instruction is to cause that child to engage in sexual intercourse with a child -- that teacher can be charged under this statue," Southworth wrote.

His job is to enforce the law. He is instead enforcing his own law. Fire him. Now.

** Note: Not surprisingly, this is the same asshole who sued the University of Wisconsin for charging him student fees that fund student organizations he disagreed with. The Supreme Court shut him down. **

Under the new policy, those who test positive will begin ARV treatment immediately -- which is a radical shift from the decade-long strategy of waiting until the patient's CD4 count drops before a certain level. The policy is defended in two ways: First, that studies increasingly evidence that there can be significant damage done by the virus to HIV-positive people who do not begin treatment immediately. Second, that reducing viral loads in HIV-positive people will reduce rates of transmission:

A growing body of evidence indicates that HIV causes detrimental effects throughout the body long before the CD4 count falls into the "danger zone" for opportunistic infections (OIs).

The large SMART treatment interruption trial found that patients who stopped therapy when their CD4 count rose above 350 cells/mm3 -- and therefore had periods of unchecked viral replication -- not only had a higher rate of OIs and AIDS-related death, but also of non-AIDS conditions including cardiovascular, liver, and kidney disease.

Early treatment has been linked to decreased risk of morbidity and mortality even at CD4 counts above 500 cells/mm3. Many experts are convinced that chronic inflammation due to ongoing HIV replication contributes to non-AIDS conditions and what appears to be accelerated aging in people with HIV.

Another benefit of early ART is that it lowers the risk of HIV transmission, since treated HIV positive people have lower viral loads than untreated individuals, regardless of CD4 cell count. In 2008, Julio Montaner and colleagues from British Columbia presented a mathematical model showing that treating all people with HIV according to ART guidelines (which then had a CD4 count threshold of 350 cells/mm3) could dramatically reduce the rate of new infections.

At least two things worth mentioning:

1. This policy would put people on meds who may not need them until there are better, less toxic drugs available. For instance, someone diagnosed today may not have gone on them under previous guidelines for another two years. In two years, its possible that there will be ARVs available with fewer side effects.

2. Obviously, if implemented, this would eliminate the possibility of long-term non-progressors (a rare group of positive people who can live healthfully for many years before ARV therapeutic intervention is necessary). A friend of mine in SF who was infected in the mid-80s just went on ARVs for the first time. A very rare situation, indeed. But still worth mentioning.

Thoughts?

It's actually a serious question, and one I found myself pondering last night on the dancefloor at Menjo's in Detroit. I was surrounded by a sea of women - I almost thought perhaps Maxime and I had made the mistake of coming on ladies not. But no, this was not ladies night. It was a run-of-the-mill twinkfest "College Night" at Menjo's, yet at least 1/3 of the attendees were of the female variety.

Let me clarify a bit: These weren't just any version of the straight girl. They're not even classifiable as "fag hags." These women were more like sorority girls than they were fagalicious hipsters. These are the kind of girls who bop up and down on the dance floor enthusiastically with their long hair swishing from side to side, making ridiculous attempts to rub their asses against gay men's crotches while grinning "mischievously" from ear to ear. They're dressed in their finest Forever 21 and Wet Seal garbs, with some generic hoop earrings to boot. You'll find them stocked in gay bars across the country. The come in packs, typically with at least one gay friend in tow -- but on occasion they arrive sans-homo.

So with that specification in mind, I have to ask: Why are they here? And I mean that question quite seriously. The obvious answer is that they came to party with their gay friends, but that seems like a curious answer: We don't generally show up in packs to straight clubs to party with our straight friends. And even when we do, we certainly don't comprise nearly a third of the crowd. No, something more systemic is happening here, something more interesting.

"Straight men are to me what tribal communities along the Amazon must have been to 19th century riverboat Anthropologists. They fascinate me, but I have no interest in getting off this boat to find out more."

I'd imagine being a straight girl has its ups and downs. You get access to dumb straight dick, but then again that dick is attached to a less appealing person. Straight men are to me what tribal communities along the Amazon must have been to 19th century riverboat Anthropologists. They fascinate me, but I have no interest in getting off this boat to find out more. Straight women don't have the luxury of tourism as I do, it seems. They have to find some way to get along with and, god forbid!, cohabitate with these people. If you've ever seen an average straight boy's college dorm room, you'll understand why this could be challenging: Empty Doritos bags strewn across the floor, half-empty PBR cans laying on top of desks, the smell of manscent and stale beer filling the air, a knee-high stack of Playstation 2 games beside the TV.

I'm always amazed when I go to straight clubs on campus here at UM and see how highly sexualized these spaces are. On any given Thursday night, Rick's here on campus will be slammed with 19 year olds with fake IDs, gyrating against each other frantically while sloppily making out against the wall. There is a certain desperation in their efforts, which is likely not unrelated to the fact that they have to get blackout-drunk to be able to explore their sexual desires. Growing up in Michigan doesn't exactly prepare you to feel good about your bodies or your desires, it seems. Getting wasted may be one strategy for managing that shame.

Which leads me back to my initial question: Why are a certain number of these girls MIA from Rick's on Thursday, instead opting to make the trek to College Night at Menjo's? I think the answer has to do with them searching for a place to have fun without the looming gaze of straight men. I know that's a simplistic account, but I think they're faced with a certain amount of pressure at straight bars to smile and flirt and be generally accessible to straight men. I don't mean this to say that straight men are bad people, but rather than straight girls may just want to party without them sometimes. To have fun, without the weight of hetero-sexual tension. So instead of heading to Rick's, they come to Menjo's.

I don't know what to say about their presence. Personally, I find them pretty annoying -- to be perfectly frank. They are not socialized as gay, and thus utterly clueless about gay culture except for what they learned watching Will & Grace. They are the ultimate cockblock, jerking their friends away from potential tricks to scurry to the dance floor -- and keeping those tricks at a distance by pseudo-humping to the music. They are here to party, not get laid, and thus get pissed if their gay friend ditches them for a make-out session. And the worst of them have the temerity to walk into a gay bar and judge its patrons and the establishment itself.

Don't get me wrong: I'm not against letting straight women into gay bars. But the straight women I like to see at gay bars have a sense of what it means to be queer. They may not be gay themselves, but they have their own sense of faggotry within. These women may be referred to as "fag hags" or "fruit flies." They appreciate what makes gay culture gay, and don't just come in from time to time to release some steam. In my book, these women are more than welcome at gay bars. So while I certainly understand what makes the girls I've described in this piece show up at Menjo's -- and I have a lot of compassion for the crap they have to put up with in their homeland -- I'm begging you, ladies, please don't turn your problem of straight men into our problem of putting up with your drunk asses. You may be having a blast, but most of the gay boys around you are secretly wishing you would leave.

Our latest and greatest! In this episode, Maxime and Trevor take over Los Angeles and dish about Los Angeles, fame and fortune, cheating on your boyfriend, bottoms using Viagra, at-home enemas, confidence, the 69 rimjob, and bottoms who dominate their tops! Phew! What an episode!

Join us on Facebook!

Whoa:

Pretty amazing. Although anyone who thinks that straight men will be their primary clientele is a damn fool.

How appropriate: a Good Friday cross-post. I have been posting occasionally to Bad Blood, a blog I created to talk about HIV stigma and campaign strategy. Yesterday I wrote a post gently criticising the announcement of a new NIAID program called TLC-Plus intended to link newly-diagnosed PLHIV into medical care and treatment earlier. Rather than just repost the original entry here, I thought I would contribute some exclusive Trevorade-only content -- about stigma. The NIAID director said something particularly concerning:

"Unfortunately, many people don't make it to their follow-up medical visits for a variety of reasons. Yet these individuals can continue to spread the virus in their communities until we entice them to step through the door, whether it's giving them a pat on the back or offering financial incentives."

NIAID is the program at the National Institutes of Health (NIH) that runs America's HIV research program. Just to be clear, I don't have any particular grudge against NIAID. If I lived and worked in the States, I might. But they auspice the global HIV Prevention Trials Network (HPTN), which as a campaign strategy geek I just adore.

My favourite trial is HPTN #043 Project Accept, which matched 24 pairs of communities in Tanzania, Thailand and Zimbabwe on all sorts of criteria like population density, access to transport, and existing VCT services. In one half of each community pair, they undertook a well-theorised stigma reduction campaign, established peer support networks and provided mobile outreach VCT. In the control community (the other half) they just observed uptake of the pre-existing VCT services and monitored for crossover influence or uptake from the intervention community.

It was a three year, well-funded randomised controlled trial of a community-level, stigma-reducing prevention initiative. Over the past three years I've done a lot of work on HIV stigma and in all the literature that's practically unheard-of. The results were astounding. Uptake of HIV testing was 4x (400%) higher in the anti-stigma communities in Thailand and Tanzania, and 13x higher in Zimbabwe. Here's the takehome point: unless you address stigma, people would rather die, in privacy, untreated, of "cancer", than expose themselves and their families to the shame of a positive diagnosis.

On standard models of health psychology, taking treatment to survive a deadly illness is the most rational thing you could possibly do, which shows how little those models capture of the rationalities people actually use in their everyday lives.

That's why I was so concerned to read the NIAID Director, Carl Dieffenbach PhD, talking about how "these individuals can continue to spread the virus in their communities". I often use Link & Phelan's influential five-component definition of stigma (Ann Rev Sociology, 2001) to explain how different aspects of a public health intervention can unintentionally contribute to the stigmatisation of PLHIV, and I'd like to do that here. (Not quite in their original numerical order.)

• The third and most important component is "us and them thinking", and Dieffenbach's use of these individuals really gives the game away there.

• The first component is labelling, which is an explicit part of the TLC-Plus program under "Enhanced Testing" to identify who in a community is HIV-positive.

• The second is stereotyping, which can be seen in Dieffenbach's assertion that PLHIV "spread the virus in their communities", where the word "spread" implies (perhaps carelessly) those PLHIV intentionally cause onward transmission. (They might instead assume that since nobody cared about their own infection, nobody will care about further new infections -- a possibility I analyse in my Bad Blood post under the rubric of the social contract.)

• The fifth component the presence of social power. Social power is obvious -- there's free medical treatment on offer to poor people.

• Finally, the fourth component is status loss and discrimination. While I think the stereotyping of PLHIV as "spreaders" definitely produces status loss, I'd like to wait and see what actual services the program will provide before saying there's discrimination. If this program ends up providing free or affordable medical care including anti-retroviral therapy for people who otherwise couldn't afford them, then I would be singing its praises regardless of my concerns about the stigmatising language.

But the issue of stigma highlights one big problem with the TLC-Plus methodology, which I discuss in greater depth on the Bad Blood post. In Project Accept, increased uptake of VCT occurred in the context of widespread community diffusion of anti-stigma messages and sentiment. It was a community-level initiative with individual-level outcomes. TLC-Plus remains stubbornly focused on individual psychology and behaviour.

Yes, their project "partners" (which is a nicer way of saying "contractors") are community organisations, but that doesn't automatically make it a community-level intervention. Many of those orgs are community in name only. Part of the danger of working closely with public health departments is that after a while, you learn from the funding process to think and speak in public health language. I feel that the rational individual behavioural focus of that language makes it impossible to conceptualise community-based, culture-level interventions that can engage with social processes like stigma and advocate politically against upstream factors like lack of access to healthcare.

In my post on Bad Blood, I suggest the solutions are (1) social public health, (2) cultures of care, and at the very least, (3) behavioural economics (based on bounded rationality) as a more realistic guide to how people think in reality. I don't know whether the TLC-Plus program includes community consultation, but maybe it's not too late to communicate with its planning body and express a desire for them to get a clue.

I love when people pretend to have something new or powerful to say about HIV/AIDS. 99% of the time, they are more likely to recycle tropes that we've been telling ourselves for the past decade or two. The latest example of this is David Mixner's post at DCAgenda, "What happened to silence = death?", in which he makes the tragically pseudoradical claim that we just need to talk about HIV more to end the epidemic. You know, silence=death, y'all!

Now let's put aside the fact that he seems to misunderstand the silence=death mantra of ACT UP -- it wasn't really just about mentioning HIV or getting tested, but about coming out into the streets and demanding action from homophobic institutions that were helping to fuel the silence and the epidemic, like the Roman Catholic Church and the CDC. But this gross misunderstanding aside, I still have a few words to say in rebuttal:

David,

While I appreciate your commitment to HIV Prevention, your editorial doesn't shed any new light on the issue. You make no mention of the fact that Public Health's stigmatizing and demonizing efforts to smear gay men and their sexual practices may be part of the reason why gay men checked out of prevention and of thinking about HIV/AIDS more generally. You tell people they're a piece of shit for long enough, eventually they stop tuning in to hear more.

My problem with Public Health is that there is no accountability for the racist, sexist, rabidly sex-negative, and often antigay messages that are trumpeted from the mountaintop under the guise of HIV prevention. "Oh, that campaign was racist? Well at least it started dialogue." You hear it time and time again, from the local to state to national level. In their minds, reducing HIV infections is the only end worth measuring - and if it reinforces or reproduces racism or antigay sentiment along the way, so be it.

And don't make the mistake of thinking more funding = better prevention. Most of the CDC dollars allocated to prevention fund tired, useless, and ineffective interventions that have no relation to the complexities of gay men's lives. Just take a look at the available "DEBIs" that ASOs have to put up with. Many people on the ground tell me that they have to pretend to be engaged in these pathetic excuses for interventions while secretly radically changing the curriculum on the ground. The CDC's efforts force ASOs into positions of dishonesty and secrecy. Where's the critique of the CDC's infrastructure in your analysis? Of the damning and devastating impact of abstinence-only education? Of Congress' forcing states to pass HIV disclosure criminalization laws, even though they are harmful to Public Health, if they accept Ryan White dollars?

So forgive me if I'm not sympathetic to your critique. But I think you've missed the point. It's not gay men who need to shape up. It's the CDC, local, state, and federal governments, and the larger institution of Public Health that needs to get its priorities straight.

Trevor

Phew. And that's how Sue sees it.

Watching Towelhead, directed by Allan Ball in 2007, is a disturbing delight. It is the story of a thirteen year old girl who finds out she is a slut, but the process of becoming the slut that she feels she is proves to be rather problematic. First, because as a thirteen year-old most people think she is much too young to love sex as much as she does. She also happens to be a girl and not a boy and people want to protect her from sexuality not let her embrace it. On top of that she lives with her Lebanese father who believes in decency and chastity. But above all, she struggles to be a slut in the face of America, the land of freedom, where embracing sex and being open about it may ruin your life because of gender norms and social models.

While babysitting her neighbor's son, Zack, Jasira finds out some porn magazines and she has her first orgasm masturbating over them. Later, on a date with the father Mr Vuoso, she tells him: when I grow up, I wanna be in your magazines. Although these porn magazines are for men, and even if both Jasira's divorced parents want her to be prude, she cannot help feeling attracted to the joys of debauchery: in various sequences we find her daydreaming about some soft porn photo shootings.

In spite of her angel face and shy attitude, she ends up losing her virginity with her neighbor, who fingers her feverishly when babysitting is over. Along this clandestine, taboo relationship between them, Jasira dates a charming black guy, Thomas, who is careful not to force any sexual intercourse but has to face Jasira's father's hostility, who claims he is not a racist even if he recognizes that he does not want her daughter to hang out with black man. Last, but not least, another neighbor, Melina, prototype of the anti sex feminist, offers Jasira a manual of sexual education for Christmas in which Jasira finds out that she was actually raped by Mr Vuoso.

The movie is disturbing because every adult thinks he knows what is good for Jasira to do, to be, to look for, and in the end her agency is constantly denied because she is perceived as young and innocent. Melina thinks she is a prey for perverts, her father thinks she should not indulge the joys of becoming a woman, her mother sees her as a rival in terms of seduction and a reminder of her own decay, and her neighbor thinks he has her consent when he has sex with her. The power of the movie is to articulate how this teenager, in spite of growing up in a normative, uniform, oppressive context - the American Dream - finds the way to speak for herself and to recognize the legitimacy of her own agency, including in terms of sex as pleasure. Fragile as she is, under the pressure of racism - she is called towelhead because of her Arabic origins - and caught in the conflicts between adults speaking in her name, Jasira gives us a lesson of bravery in her quest for pleasure and rejection of shame. By the end of the movie, the audience is likely to believe she'll become the fierce, proud slut she is meant to be.

The movie is also disturbing because, instead of solving the questions it raises, especially the question of consent in the context of statutory rape, it gives enough food for thought to address this issue without being dogmatic or explicit in its development: Allan Ball loves to trigger that kind of dialectic, suggesting the American way of life is pretty fucked up but asking us to draw the conclusions by ourselves.

Our Canadian friend Shawn Syms asks, "What are the implications?":

What are the implications of exposure-without-disclosure charges expanding from the realm of HIV to other STIs such as herpes? In the case of HIV, the problematic nature of these cases is obvious. HIV is comparatively difficult to transmit, and it's completely possible and in fact commonplace for people with HIV to responsibly engage in protected/negligible-risk sex without having to tell anyone their personal medical information. Sex with a person with HIV is not intrinsically dangerous, but because of the vast amount of misinformation, discrimination and stigma surrounding HIV, people who disclose their status may be exposed to serious personal risk. And there is an increasing medical consensus that many HIV-positive people on successful medical treatment may not even be capable of transmitting HIV even in instances of unprotected sex.

But herpes is different. First, it's far more common than HIV -- which means many more people could potentially face charges. There were roughly 65,000 people with HIV across Canada in 2008, according to the Public Health Agency of Canada (PHAC). There are no official Canadian statistics on the number of people with herpes, because unlike other STIs such as gonorrhea, hepatitis C and syphilis, it isn't even considered a reportable condition by public-health authorities. But the World Health Organization estimates that herpes affects over 500 million people around the world. Some US figures say the numbers there may be as many as 1 in 4 women and 1 in 5 men.

And herpes is much easier to transmit. As the College of Family Physicians of Canada notes on their website, "Genital herpes is spread easily. The virus from an infected person can enter your body by passing through a break in your skin or through the tender skin of your mouth, penis or vagina, urinary tract opening, cervix, or anus. Herpes is most easily spread when blisters or sores can be seen. But it can be spread at anytime, even when there aren't any symptoms."

Outrageous.

Oy vey! What a week I had in California. The Gay Men's Health Summit was incredible (more in other posts), and my friend Justin surprised me by getting us (free) tickets to DisneyLand down in Los Angeles. This video tells it all. Pretty gaytastic!

More soon!

xoxox

T