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Bill Clinton's Real AIDS Legacy

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SOS with Bill Clinton 1992-small.jpg

Last week, Salon.com published an excerpt from my book, Body Counts: A Memoir of Politics, Sex, AIDS, and Survival that documents how poorly Bill Clinton's administration responded to the HIV/AIDS epidemic, particularly their failure to lift the ban on federal funding for needle exchange programs.

The piece has provoked more than 60 comments, but not a single one is substantively supportive of what I wrote.  The vast majority of the comments are generic Clinton defenders or haters. The defenders cite his support for LGBT rights -- and dismiss, ignore or defend his egregious support of the Defense of Marriage Act and Don't Ask, Don't Tell. And the haters just hate everything about him, as they always have.

What I wrote in Body Counts and what Salon.com excerpted was the truth -- but are there so few who remember it?  And why is it that in 2014 the question of a President's record on AIDS is immediately conflated with his record on LGBT issues?

It seems like the truth about the epidemic's history is getting glossed over everywhere, rewritten or ignored. Maybe it is true that there aren't so many people who really know the Clinton administration's record on AIDS. But that makes it all the more incumbent upon them to share what they witnessed.  Silence still = Death.

To read and comment on the piece published on Salon.com, please click here

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Please visit Body Counts at www.SeanStrub.com, on Facebook.com/BodyCounts and on Twitter @BodyCountsBook.

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Thank you to the Des Moines Register for its editorial leadership in advocating for modernization of Iowa's HIV criminalization statute. In 2012, the Register was the first major mainstream media in the U.S. to recognize how criminalization imposes a horrific injustice on people with HIV and is terrible public health policy. 

The Iowa State Senate's Judiciary Committee passed a criminalization reform measure last year, 11 to 2 (with three of the five Republican votes on the committee).  Tomorrow (February 11) is the "Day on the Hill" for HIV advocates in Iowa and they will be swarming the Capitol, buttonholing legislators to educate them about the issue and why it is so urgent to modernize the statute.  I was present for the "Day on the Hill" in Des Moines last year and am looking forward to meeting with advocates, legislators and people with HIV who are working for change next week when I am in Des Moines, Cedar Rapids and Iowa City. 

Great job, Iowans!

Please click here to read the Des Moines Register's editorial "Lawmakers should correct Iowa's HIV mistake."


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Please visit Body Counts at www.SeanStrub.com, on Facebook.com/BodyCounts and on Twitter @BodyCountsBook.

David Mixner reports today on Towleroad, that next week (Tuesday, January 21) the NFL's A Football Life Cable TV program will remember former Washington Redskins player Jerry Smith, who was gay, closeted and died of AIDS in 1986. In the early 80s, rumors about Jerry Smith's sexual orientation were rife in Washington, D.C., where he was an enormous star and widely recognized anywhere he went. In Body Counts, I recall a very memorable meeting with Smith one evening at a party.

I was 19, very slight, and hadn't reached my full height.  I looked at least three or four years younger than I was.  The party was packed with Washington's A-list gays.  All the "better boys" wore pastel-colored sweaters; mine was an embarrassing dark brown.  When I was introduced to Smith, he immediately treated me like a kid brother, picking me up and carrying me around on his powerfully muscled shoulders.  It felt like I was wrapping my legs around a tree stump as we waded through the crowded party."

A Football Life  airs this coming Tuesday, January 21, on the NFL Network. (I'll admit, I didn't know the NFL had their own network). The program will be followed by a panel discussion with several of Smith's former teammates and David Mixner.

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You can watch the trailer by clicking here.

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Please visit Body Counts at www.SeanStrub.com, on Facebook.com/BodyCounts and on Twitter @BodyCountsBook.

If you haven't heard of TV talk show host Alicia Menendez or seen Alicia Menendez Tonight on the cable network Fusion, this is a good time to do so; in a short period of time, she has become a star with her own rabid fan base.

Her program, Alicia Menendez Tonight airs Monday -- Friday at 7:00 PM EST and is focused on the intersections of politics, sex and money.  It is terrific, consistently addressing issues that are ignored or under-covered elsewhere. She does it with wit, sophistication and the refreshing perspective of a post-partisan millennial realist. 


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Alicia enjoyed the movie Dallas Buyers Club, as so many of us have. But also like many of us, she was disappointed that Matthew McConaughey and Jared Leto failed to use their platform at the Golden Globes -- where they each won awards -- to bring attention to the epidemic or convey any sense of concern about the realm in which the characters they played existed.


Alicia calls out McConaughey and Leto with eloquence, in the form of an open letter to the two brilliant actors. I highly recommend watching the clip from the show or reading the transcript.



And, Alicia, in case you actually read this yourself, take a look at the short film, HIV is Not a Crime, at the Sero Project; it is a perfect topic for your program.  Thanks.

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Please visit Body Counts at www.SeanStrub.com, on Facebook.com/BodyCounts and on Twitter @BodyCountsBook.

Body Counts: A Promise Kept

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sbc1min-sos-glasses-small.pngFor me, writing Body Counts was not simply an exploration of my own life. It was a promise kept, a responsibility as a survivor of the Plague Years to pay tribute to the friends, lovers and comrades who fought -- and died -- to make a change in the epidemic. I discuss this impetus for writing Body Counts in this video below, shot by my friend, videographer Christopher King of Endless Echo



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Please visit Body Counts at www.SeanStrub.com, on Facebook.com/BodyCounts and on Twitter @BodyCountsBook.

Writing a memoir is, necessarily, about revisiting the past. In Body Counts, I've covered quite a lot of the past, from my 1976 arrival in Washington, as a fresh-faced 17-year-old from Iowa, to running an elevator in the U.S. Senate, up through the decades to my current HIV advocacy.

My work today, with the Sero Project, fighting HIV-related stigma, discrimination and criminalization, is about the future, but is necessarily informed by the past.  I wish the Centers for Disease Control and Prevention could learn a bit more from the past and let it properly inform their plans for the future. 

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Instead, they sometimes seem mired in the past, addressing the epidemic that was, rather than the epidemic as it currently is. Sero recently joined with several other groups to send an open letter to the CDC to challenge their misleading depictions of gay/bi/MSM sexuality and HIV prevention practices.


It is deeply troubling that in 2014 community groups still need to point out the issues raised in this letter. It is indicative of how far off the mark the federal response has so often been.  The letter is wonky, but when it comes to changing policy, the part that isn't about leadership is all about the wonk. 


Open Letter to the Centers for Disease Control and Prevention (CDC) on 2013 MMWR Report on HIV Testing and Risk of US Gay, Bisexual and other MSM[1]:

A call to re-evaluate language, methods and recommendations 
in order to support men's health and HIV resiliency:[2]

 CDC urged to reduce its own risk of misleading depictions of 
Gay/Bi/MSM sexuality, HIV prevention practices

Seeking the spotlight of World AIDS Day, CDC released a report in their Morbidity and Mortality Weekly Report (MMWR) focused on gay, bisexual and other MSM (men who have sex with men) in the United States -- the population that remains both disproportionately affected by HIV and drastically underserved by federal HIV/AIDS prevention resources.

The press release for the report, headlined "Sexual risk lower among U.S. gay and bisexual men who accurately know their HIV status,"[3] provides a constructive and accurate emphasis on the success of gay and bisexual men who know their HIV status. Thus, it delivers an encouraging message about the importance of HIV testing.

However, the full MMWR article is quite different in its messaging and emphasis, skewing sharply to language that could encourage sexual stigma and blaming.

Both documents use increasingly antiquated language on risk, miss the opportunity to take a bold and scientifically-validated stance on systems change to facilitate more frequent HIV testing for bisexual and gay men, and does not clarify if transgender women are included in the historically-confusing category of MSM.

We urge CDC to take this opportunity to re-evaluate language, methods and recommendations regarding the sexuality and HIV prevention practices of gay, and bisexual men and other MSM.  

We look forward to further dialogue with you on these and other issues:

1) "Unprotected anal sex" and "unprotected discordant anal sex" are the key terms for looking at sexual behavior across the three years of the NHBS cohort.

However, these terms have grown increasingly non-specific, or even inaccurate, in the current landscape of HIV prevention and the parameters of sexual decision-making by gay men, other MSM and their partners.

Insertive anal sex and receptive anal sex are distinct acts with very different levels of risk -- a spectrum of risk that is further broadened through widespread sero-adaptive practices. In addition, the use of virally-suppressive HIV treatment is a relevant factor in accurate risk assessment and sexual decision-making.

In the report, unprotected is used to refer to the non-use of condoms. However it does not mean that sex occurred in an environment of heightened HIV risk. Although much of this data was collected before PrEP licensure, reports emerging today should use clearer language -- such as "sex without condoms," rather than "unprotected."

These distinctions are neither political nor semantic. They are integral to reaching the goals of the National HIV/AIDS Strategy and curtailing the epidemic.

Gay, bisexual and other men who have sex with men and their partners need accurate information for sexual risk reduction. There are noted methodological models for data collection that effectively clarify and refine descriptions of sexual behavior that should be adopted across research conducted or supported by CDC.

2) We agree that increased HIV testing is a priority, and that "the data suggest that some men may benefit from more frequent testing."

However, we believe that "at least annual HIV testing" that is only to happen more frequently at provider discretion is insufficient in the current environment.

Once again, CDC has missed the opportunity to take a bold and data-supported stand in favor of more frequent HIV testing for all gay and bisexual men and other MSM. Sticking to the once-a-year standard, leaving it at providers' discretion to advocate for more frequent testing (which many do), is not warranted given the strong -- and historically consistent -- findings of behavior change by those who test positive as well as the recognized role of treatment as a prevention modality.

By formally recommending testing on a quarterly basis, CDC will encourage systemic changes that will result in more men learning earlier if they are infected and allowing them to make informed decisions about their health care and sexual practices. Individuals who tend to lag behind in testing with the recommended interval will be prompted to test more frequently.

A system that is set up to facilitate more frequent HIV testing is a resource not only for case-finding and entry into care, but also to support the use of PrEP, which requires testing every 3 months.

In addition, we support efforts at the time of testing that would help identify HIV negative men who would benefit from access to PrEP and other prevention interventions, and increased vigilance in opposing the stigma, discrimination and criminalization of those who test positive.

3) We urge a reconsideration of the reliability of venue-based sampling for the gay, bisexual and MSM cohort of the NHBS. CDC's own research, as well as that of others, has pointed to the significant shift of sexual networking and social structures to finding partners online, and to greater integration of young LGBT people in networks that are less segregated in terms of sexual orientation. Venues, if used, must be interpreted broadly to include a wide range of non-commercial and commercial spaces, and even digital space. Further, the highly urban-based sample continues to under-power for potential differences in rural and Southern populations of gay, bisexual and MSM, despite rising incidence and prevalence in the South and potentially significant differences in social and sexual structures in non-urban areas.  

4) We continue to recommend that CDC clarify the inclusion or exclusion of transgender people in the NHBS, including the MSM cohort, and all other population research and HIV/AIDS cohorts and studies. While we anticipate and commend significant improvements in the collection and reporting of data on transgender people[4] -- including transgender women who evidence high rates of HIV where data is available -- the press, policy-makers and the HIV/AIDS community must have clear information on how to interpret the conclusions of all data vis a vis transgender populations.

5) While we recognize that CDC does not control how the press communicates its policies and findings, we are concerned (though not surprised) that major news stories on the MMWR did not reflect the messaging of the press release. We encourage a coordinated and clear press strategy, including op-eds by top CDC officials and HIV/AIDS leaders, press briefings and other modalities, to eschew the biases that can come up in these stories. However, it is most important that CDC avail itself of all opportunities to ensure that the source documents, such as the MMWR itself, are free from overt or covert stigmatizing language in its descriptions, findings and areas of emphasis.

6) In an era of expanding prevention options, it is nonetheless imperative to continue to make condoms (and safe, condom-compatible lube) accessible and invest in prevention education for gay and bisexual men and other MSM to increase their capacity to meet their own goals for sexual health and safety.

While many gay men continue to use condoms frequently and consistently, we may be seeing gay men feeling more comfortable being honest about the challenges of condom use (which are reflected in effectiveness rates cited by CDC) -- and must do whatever is possible to encourage this honesty and rejecting the stigma that may come towards those who speak up.

CDC must supply and encourage respectful, unbiased, and accurate data and messaging not only on male condoms but all HIV prevention technologies and practices, including sero-sorting and sero-positioning, that people are using to mitigate risk.

Increased knowledge and uptake of PrEP and PEP, sero-adaptation, and the development of integrated systems of care to facilitate their use will take significant resources and coordination, including education and training of primary care physicians.

7) The MMWR releases was a missed opportunity for CDC, along with federal partners, to reinforce the importance of essential services to support individuals who test positive across the HIV care continuum, and to articulate a cogent HHS-wide strategic approach to ensure that gay, bisexual and other MSM achieve viral suppression. 

As you know, the HIV Care Continuum is a planning model that identifies issues and opportunities for improving the service delivery of services and health outcomes for people living with HIV. As such, it is increasingly used by both government and non-governmental stakeholders. Helping individuals across the continuum of care achieve requires attention to psychosocial issues; identification, prevention and treatment of mental health and substance use disorder; provision of housing; efforts to mitigate HIV stigma, discrimination and criminalization; and employment opportunities and work force re-entry support for of HIV+ persons.

8) Finally, we stress that continued rigor is needed on the part of CDC, and its federal partners, to assure greater concordance between resource allocations and the populations most affected by HIV, including robust and up-to-date and affirming HIV prevention efforts by and for gay and bisexual men.

We come to you as partners for constructive dialogue and change.  We look forward to engaging with you on these and other issues in order to ensure significant, necessary shifts in language, funding, research and communication practices in the year ahead.

Sincerely, the undersigned (list in formation)*

ACT UP
Philadelphia
AIDS Foundation of Chicago

Gay Men's Health Crisis (GMHC)

Global Network of People Living with HIV, North America (GNP+NA)

HIV Prevention Justice Alliance (HIV PJA)

Housing Works

International Rectal Microbicide Advocates (IRMA) 

National Center for Transgender Equality (NCTE)

Positive Women's Network - USA (PWN-USA)

Sero Project

Transgender Law Center 

Treatment Action Group 

US People Living with HIV Caucus

Visual AIDS

* To join the list of endorsers, go to http://bit.ly/1kmeVPg

[1] Centers for Disease Control and Prevention. HIV Testing and Risk Behaviors Among Gay, Bisexual, and Other Men Who Have Sex with Men -- United States. MMWR 2013;62(47); 958-962

[2] Please direct correspondence to Julie Davids of the HIV Prevention Justice Alliance (HIV PJA) and AIDS Foundation of Chicago: jdavids@aidschicago.org

[3] www.cdc.gov/media/releases/2013/p1127-World-HIV-AIDS-day.html, accessed 12/10/13

[4] http://www.cdc.gov/hiv/risk/transgender/ accessed December 17, 2013


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Please visit Body Counts at www.SeanStrub.com, on Facebook.com/BodyCounts and on Twitter @BodyCountsBook.

Sean In Bookstores Soon



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