32 Years of AIDS Lee E Klosinski PhD UCLA Nathanson Family Resilience Center Semel Institute for Neuroscience amp Human Behavior Gay Communities amp HIV What facilitated the impact of HIV ID: 461931
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Gay Communities & HIV:32 Years of AIDS
Lee E. Klosinski, Ph.D.
UCLA Nathanson Family Resilience Center
Semel Institute for Neuroscience & Human BehaviorSlide2
Gay
Communities & HIV
What facilitated the impact of HIV
infection among gay
communities in the U.S.?
How did gay men shape the US response to the HIV epidemic?How are gay communities currently shaped by HIV?What are the emerging issues?Slide3
About language: GAY
Cheerful, carefree Sexualization of the term=> uninhibited by moral restraints
Moralization of the term=> sinner, sick, criminalSlide4
About language: GAY COMMUNITY
Identity movement
Gay communities not gay communityUnifiers: pride, diversity, individuality, sexuality, minority statusCivil rights movement
GLBT communitySlide5
About language: Gay vs. MSM
Self-identification vs. behavior“Men who have sex with men” (MSM) identifies a behavior, not an identitySlide6
What facilitated the impact of HIV on gay communities?
Post-war concentration of gay men in urban centersSlide7
What facilitated the impact of HIV on gay communities?
Ignition of Gay Civil Rights Movement in 1969 (and before)Slide8
What facilitated the impact of HIV on gay communities?
Post-war mobility
Sexual revolutions of 1960s
Sexual accessSlide9Slide10
RARE CANCER SEEN IN 41 HOMOSEXUALSBy LAWRENCE K. ALTMAN
New York Times
, July 3, 1981Doctors 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. Slide11Slide12Slide13
How did gay communities shape the HIV epidemic in the U.S.?
Community-based care modelsSlide14Slide15Slide16
How did gay communities shape the HIV epidemic in the U.S.?
Community-based care modelsEthos: A patient-led health movementSlide17
PWA EmpowermentThe 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.”
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Denver PrinciplesRECOMMENDATIONS 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.Slide19
Denver PrinciplesRECOMMENDATIONS 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.Slide20
Denver PrinciplesRIGHTS 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.Slide21
How did gay communities shape the HIV epidemic in the U.S.?
Community-based care modelsEthos: A patient-led health movementCommunity-based preventionSlide22Slide23Slide24Slide25Slide26
How did gay communities shape the HIV epidemic in the U.S.?
Community-based care modelsEthos: A patient-led health movementCommunity-based prevention
ActivismSlide27
ACT-UP AIDS Coalition to Unleash Power
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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”Slide32Slide33
What Drove AIDS Activism?Social status of impacted group
Gay identity politics resulted in rapid response to threat to identityLegacy of feminist health movement
Youth of impacted populationGuarded prognosis of HIV/AIDS diagnosisEngagement with medical profession Slide34
What is the legacy of AIDS activism?Infection control
FDA reforms: drug testing, access to investigational new drugs, Phase IV follow-upPatient-provider relationship
Comprehensive social & medical responseResearchResponse to international epidemicSlide35
How did gay communities shape the HIV epidemic in the U.S.?
Community-based care modelsEthos: A patient-led health movementCommunity-based prevention
ActivismMourningSlide36Slide37Slide38
How are gay communities currently shaped by HIV?
Disproportionately impacted, especially men of colorSlide39Slide40Slide41Slide42Slide43
How are gay communities currently shaped by HIV?
Disproportionately impactHigh risk behaviors are increasingSlide44Slide45
What are the emerging issues for gay communities?
Impact of methamphetamineSlide46Slide47Slide48
What are the emerging issues for gay communities?
Impact of methamphetamineOwnership: HIV is not a gay diseaseSlide49Slide50Slide51
What are the emerging issues for gay communities?
Impact of methamphetamineOwnership: HIV is not a gay diseaseInternet & mobile technologySlide52Slide53Slide54
What are the emerging issues for gay communities?
Impact of methamphetamineOwnership: HIV is not a gay diseaseInternet & mobile technology
Prevention – what works?Slide55
Evidence-Based InterventionsEffective for short-term behavior change
Several available
ExpensiveLimited efficacy when used as single agentsVery limited accessSlide56
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.
Fear MessagesSlide57
What are the emerging issues for gay communities?
Impact of methamphetamineOwnership: HIV is not a gay diseaseInternet & mobile technology
Prevention – what works?SerosortingSlide58Slide59
Status sorting is a prevention strategy.Slide60
SerosortingHarm reduction strategy based on beliefs about one’s own & partner’s HIV statusSlide61Slide62Slide63Slide64
Serosorting ConsiderationsIncreasing in recent years, especially among younger men
Atlanta study found used by 1 in 3 men reported serosortingIncreased 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 infectedURAI with a partner believed to be HIV- associated with 22% of attributable risk fro HIV infectionSerosorting 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)Slide65
Outstanding Prevention IssuesAddressing role of racism, stigma,& homophobia
Transition from disease-specific to sexual health framework for MSM disease preventionDevelop male-couple specific prevention initiatives (68% of incident US MSM infections form male were from main sex partners; Sullivan et al, 2009)Slide66
Outstanding Prevention IssuesAddressing a sexual culture of accentuating pleasure & adventurism after seroconversion (L
ébon et al, 2011)Slide67
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!
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...
rawtop@yahoo.comSlide68
Outstanding Prevention IssuesAddressing a sexual culture of accentuating pleasure & adventurism after seroconversion (L
ébon et al, 2011)PrEP (pre-exposure prophylaxis) & PEP (post-exposure prophylaxis)Slide69
Los Angeles CountryHIV/AIDS Epi Materials
http://www.lapublichealth.org/aids/
http://www.lapublichealth.org/hiv/