Sexuality and Society

World AIDS Day & the First U.S. National HIV/AIDS Strategy

Shari Dworkin on December 1, 2010

On World AIDS Day (December 1), it is crucial to recognize the progress that has been made concerning prevention, treatment, and care efforts and all of the urgent work that still needs to be done. Worldwide, 33 million people are living with HIV. In the United States alone, 1.1 million people are living with HIV (CDC, 2010). Within the US, 20% of people are not aware that they are living with the virus. In the richest nation in the world, 3 decades into the epidemic, 56,000 people per year are infected, HIV is the leading cause of death for African-American women age 25-34, the epidemic has an alarming impact on communities of color, particularly young MSM of color, and there are vast disparities in access to prevention, treatment, and care (El-Sadr, Mayer, & Adimora, 2010).

Despite the fact that I normally discuss the state of the HIV pandemic globally, I am going to focus my comments on the epidemic in the United States. This is because in July of 2010, President Obama put into place the FIRST National HIV/AIDS Strategy in history of the United States. The goals of the policy (White House, 2010, p. vii) are to:

Reduce the number of people who become infected with HIV,
Increase access to care and health outcomes for people living with HIV; and,
Reduce HIV-related health disparities.

In order to meet goal #1, the policy proposes that the US:

“intensifies HIV prevention efforts in communities where HIV is most heavily concentrated, expand targeted efforts to prevent HIV infection using a combination of effective, evidence-based approaches, and educate all Americans about the threat of HIV and how to prevent it” (p. vii).

In order to meet goal #2 (increasing access to care and improving health outcomes for people living with HIV), the policy calls for:

“establishing a seamless system to immediately link people to continuous and coordinated quality care when they are diagnosed with HIV, take deliberate steps to increase the number and diversity of available providers of clinical care and related services for people living with HIV, and to support people living with HIV with co-occurring health conditions and those who have challenges meeting their basic needs, such as housing” (p. ix).

Finally, in order to reduce HIV related health disparities, the public and private sector are called upon to:

“reduce HIV-related mortality in communities at high risk for HIV infection, adopt community-level approaches to reduce HIV infection in high-risk communities, and reduce stigma and discrimination against people living with HIV” (p. ix).

The US National HIV/AIDS Strategy can be found here.

Meeting these goals is an enormous task and will require efforts well beyond the federal government, academia, media, health care institutions and practitioners, policy-makers, community mobilization and community based groups to include each and every sector of society. In December of 2010, a special issue of JAIDS was released that assessed the state of the epidemic in the US and made suggestions to ensure that the goals of the National Policy are realized. In it, Chris Collins and Dazon Dixon Diallo praised the National Policy and argue that for prevention efforts to truly succeed, it will be important to advance prevention funding alignment (ensure funding matches epidemic conditions and priorities) and accountability (improve transparency of prevention funding), go to scale with effective prevention efforts in communities at elevated risk, foster synergies between evidence-based prevention and community-based efforts for home-grown and locally developed interventions, and to go “beyond individual behavior change programming by putting a greater emphasis on structural, network, and policy interventions” (Collins & Diallo, 2010, p. S. 148).

Colleagues Ada Adimora and Judith Auerbach agree with this last point in particular, underscoring that “social determinants — the conditions in which people are born, live, work, and age — are critical influences on health and that these determinants, which are shaped by the distribution of money, power, and resources can be influenced in positive ways” (Adimora & Auerbach, 2010, p. S. 132). They detail how social determinants both influence HIV risk and the course of the epidemic and reveal how several structural interventions (such as comprehensive sex education with access to male and female condoms, syringe exchange programs, health care availability, and housing) help to reduce risk behaviors and increase access to care.

Indeed, the National HIV/AIDS policy and its implementers hope to reduce the number of people who become infected with HIV, increase access to care and health outcomes for people living with HIV and reduce HIV-related health disparities. To do so, it will be necessary to support work that intervenes on social and structural determinants of HIV, including poverty reduction, incarceration, homelessness, and food insecurity, along with the numerous other strategies that are discussed and planned as a result of the National policy.

———————————————-

Related links:

References:

Adimora, A.A. & Auerbach, J. (2010). Structural interventions for HIV prevention. JAIDS, 55 (S2), S132-135.
Collins, C. & Diallo, D.D. (2010). A prevention response that fits America’s epidemic: Community Perspectives on the status of HIV prevention in the United States. JAIDS, 55 (S2), S148-S150.
El-Sadr, W., Mayer, K., Adimora, A.A. (2010). The HIV Epidemic in the United States: A time for action. JAIDS, 55 (S2), S63.

Top Ten Sexual Stories of 2009

Kari Lerum and Shari L. Dworkin on December 31, 2009

In his book, Telling Sexual Stories: Power, Change, and Social Worlds (1995, Routledge), Ken Plummer explains that when individuals narrate seemingly internal and personal stories about their sexuality, these aren’t very individual or internal at all. Rather, such narratives emerge in themes that are made possible due to specific cultural and political conditions; sexual stories are thus part of larger sexual storytelling culture, and can be understood and made meaningful and visible only via existing cultural frames.

In 1995 Plummer documented three kinds of emerging sexual stories: rape stories, coming out stories, and recovery stories. The year of 2009 brought several unique opportunities of its own to tell sexual stories. Some of these stories reaffirmed and revisited familiar plots to “old” sexual stories, while some forged new territory. We have decided to group this year’s stories (which we have selected with a highly subjective and US based lens) into themes; each theme is a compilation of several individual stories, forming what we see as a larger set of cultural stories being told about the pleasures and dangers of sexuality, and the roles of social institutions in regulating and redefining normative sexual boundaries. Thanks to Phil Cohen, Holly Lewandowski, and Amanda Hess for story leads. Also, thanks to RhReality Check’s Amy Newman for her list of top stories from 2009 (from which we borrowed a few).

#10. “Squeaky-clean”-men-who-cheat stories, starring Tiger Woods! Tiger Woods and Elin Nordegren

In her recent article on Tiger Woods, Shari Dworkin debunks widespread psychological and “sex addiction” explanations for Tiger Woods’ affairs:

“Recent media coverage of Tiger Woods’ marital “transgressions” is overflowing. Some argue that Tiger is sex obsessed and has a “sex addiction” given his high sex drive and desire for sex with many women over time. Others argue that any sports star who is on the road and away from home so much has a huge chance of being unfaithful to their wife. (Some media reports argue that it is “rare” to find a faithful male sports star). Still others argue that Tiger Woods’ late father pressed him down under his thumb too much as a youngster and upon his death, Tiger unleashed his “wild side.” Finally, some news reporters offer that Tiger was “traumatized” as a child when his father cheated on his mother, and that he must just be paradoxically following in dad’s footsteps. But very little media coverage attempts to press beyond an individual level and not many articles offered a much needed broader analysis of masculinity, race, sport, sexuality, and media.”

Similar structural and cultural analyses incorporating masculinity and institutional/political power could and should also be applied to the other stars of this story, including: Mark Sanford, John Ensign, & John Edwards.
Additionally, a cross-cultural perspective is needed here as well (e.g. why are these stories so powerful and shaming in the US, but not in European countries?)

#9. Gay-marriage-success stories, starring: Argentina!

Argentina Gay Marriage -- first in Latin America — Latin America's first gay marriage, in Argentina

According to The Guardian: “In Latin America policies and attitudes have mellowed over the past two decades and in most countries it is now illegal to discriminate on the basis of sexual orientation. Buenos Aires, Bogota and Mexico City boast gay pride parades and gay-friendly districts where same-sex couples can kiss and hold hands in public. Yesterday Di Bello, 41, and Freyre, 39, became the continent’s first gay married couple. The pair sidestepped a court ruling blocking their wedding in Buenos Aires by holding the ceremony in Ushuaia, capital of Tierra del Fuego province and the world’s southernmost city. They exchanged rings at a civil ceremony witnessed by state and federal officials, prompting jubilation by gay rights activists and consternation from the Catholic church. “My knees didn’t stop shaking,” said Di Bello. “We are the first gay couple in Latin America to marry” (Guardian.co.uk — Dec. 29, 2009).

Gay-marriage- success stories from 2009 also starred: Mexico City, Washington DC, New Hampshire, Sweden, Iowa, Vermont, and Norway. These are just the states, countries, and cities adopting gay marriage in 2009 and doesn’t include the longer list of locales which legalized domestic partnership in 2009. [The appendix to this is the Gay-Marriage-doom-&-gloom story: starring the Catholic Church (Maine) & the Mormon Church (California, from 2008)]

#8. Multiple-birth stories, starring: Angela Suleman (aka Octo-mom!)

While more women are having multiple-baby births (thanks to IVF technology), not all multiple-birth mothers are viewed the same. Kathryn Joyce from RhReality Check offers an insightful comparison between the highly demonized Angela Suleman (“octo-mom”) and a “Reality TV” family with 18 children:

“Suleman’s newborns were delivered, as it were, into a pop cultural moment of preoccupation with large families. Reality TV shows about families with many children abound on TV’s TLC channel, most notably with the chronicles of the 18-child Duggar family. That the Duggars are grounded in and motivated by the pro-patriarchy Quiverfull movement, with its emphasis on female submission and male headship, is breezily dispensed with in favor of dwelling on the sentimental and zany experiences of life in a 20-person family. “Jon and Kate Plus Eight,” another reality TV show about a large family – this one the result of sextuplets born to a mother who, like Suleman, chose not to selectively reduce the number of embryos that “took” during an IVF treatment – is less burdened by the extremist ideology that undergirds the Duggars’ convictions, but still presents a traditional picture of large family life, with married heterosexual parents and a stay-at-home mother. …. While many observers are concerned with her apparent inability to support such a large family, the fact that she is unmarried has alone been cause enough for others to declare her family a situation of de facto child abuse” (for Joyce’s full article click here).

#7. Homo-hater stories, starring: conservative religious anti-gay activists in Uganda and the US!

Doug Coe, leader of the arch conservative U.S. group, "The Family" — Doug Coe (center), leader of "The Family"

In a recent post on Uganda’s “Kill the Gays” bill, Kari Lerum wrote that:

“…there is an increasing amount of scrutiny and disgust from many regarding the direct connection between the Ugandan anti-homosexual campaign and a conservative U.S. religious group called “The Family” — which some, including The Observer have called a ” cult” due to the requirement for core members to remain secret about their activities. Regardless of what the group is labeled, it is clear that it has been successful in recruiting high level political leaders including some US congressmen and Uganda’s president Museveni to its core values: “fighting homosexuality and abortion, promoting free-market economics and dictatorship, an idea they once termed ‘totalitarianism for Christ’ ”

#6. Catholic-priest-cover-up stories, starring: the Irish Catholic Church!

Irish Justice Minister Dermot Ahern — Irish Justice Minister Ahern at press conference about decades of Priest abuse

As quoted in the LA Times: “Leaders of the Roman Catholic Church in Dublin engaged in a widespread cover-up of abuses by clergy members for decades, a “scandal on an astonishing scale” that even saw officials taking out insurance policies to protect dioceses against future claims by the victims, a commission reported Thursday after a three-year investigation” (see full article here)

Ross Douthat, a conservative writer for the New York Times and the National Review, describes how a culture of fear around sexuality is precisely the kind of culture that produces sexual abuse — and especially cover-ups of sexual abuse. Douthat concludes that:

“…you can see how it could all go bad — how a culture so intensely clerical, so politically high-handed, and so embarrassed (beyond the requirements of Christian doctrine) by human sexuality could magnify the horror of priestly pedophilia, and expand the pool of victims, by producing bishops inclined to strong-arm the problem out of public sight instead of dealing with it as Christian leaders should. (In The Faithful Departed, his account of the scandal, Philip Lawler claims that while less than five percent of priests were involved in actual abuse, over two-thirds of bishops were involved in covering it up.) I suspect it isn’t a coincidence that the worst of the priest-abuse scandals have been concentrated in Ireland and America — and indeed, in Boston, the most Irish of American cities — rather than, say, in Italy or Poland or Latin America or Asia” (see Douthat’s article here).

# 5. Panic-over-sex/gender/sexuality-fluidity stories, starring: Caster Semenya!

Castor Semenya — 18 year old Caster Semenya got a makeover

Mississippi girl fighting for her right to wear a tux for her Senior Class photo — Ceara Sturgis, fighting for her right to wear a tux for her Senior Class photo

articleLarge-150x150 — Click here for Adina Nack's post on "cross-dress" codes

In her post in Sexuality & Society, Shari Dworkin writes, “While Caster Semenya’s recent “news” seems to have shocked the world, the concern about “gender verification” in sport has taken place for quite some time. The tests have changed over time…but the point has not (e.g. when women are “too good,” they must not be women). …” (see also sociologist Philip Cohen’s story about Semenya, and an update on Caster’s status in the NYT). Note that in these stories there are never any calls for parallel sex verification tests to see if men they are “too much of a man,”—a man that no other “normal” man can hope to “fairly” compete with. This is because of the specific role that sport has historically played in terms of making boys into men (when women compete, there have been numerous fears that they are masculinized and are not “normal” women).

This year’s sex/gender/sexuality-panic stories also starred: Morehouse College‘s dress code, a high school girl wearing a tux, & a 4 yr. old boy kicked out of preschool for having “long” hair.

# 4. Harsher punishments for-sex-with-minors stories, starring: Roman Polanski!

Roman Polanski

Filmmaker Roman Polanski was arrested in 1977 for the sexual assault of a 13 year old girl. He spent 42 days in a California prison and was released. Upon hearing of a judge’s plan to have him serve more time and possibly deport him, Polanski fled to France. In 1988 Polanski was sued by the girl he assaulted and in 1993 settled with a payment reported at around $500,000. In the years that have passed Polanski also married (in 1989), had two children, and continued on as a prolific and well regarded film maker. For reasons that are still murky in terms of timing, Polanski was arrested on Sept. 26, 2009 (32 years after the crime) at the Zurich, Switzerland airport at the request of US authorities. Polanski’s case, spanning decades and continents, offers an insight into how laws and attitudes about sex with minors has changed in the US:

The LA Times reports that “(s)tatutory rape convictions similar to Roman Polanski’s typically result in sentences at least four times longer today than the 90-day punishment a judge favored before the director fled the United States in 1978, a Times analysis of Los Angeles County court records shows. Polanski’s arrest in Switzerland on an international fugitive warrant — and his pending extradition proceedings — have sparked transatlantic debate about whether the 76-year-old Academy Award winner should serve additional time behind bars for having sex with a 13-year-old girl….The Times analyzed sentencing data to determine how L.A. County courts today handle cases in which men admit to statutory rape — also known as unlawful sex with a minor — in exchange for the dismissal of more serious rape charges, as Polanski did. The findings show that those defendants get more time than Polanski has served — even factoring in his 70-day stint in Swiss detention — but less than his critics may expect. … “Thirty years ago, sexual assault — rape and sex crimes — were treated differently,” said Robin Sax, a former sex crimes prosecutor for the L.A. County district attorney’s office. “Time and education haven’t worked for Polanski’s benefit.”

Sociologist Barry Dank, founding editor of the Journal Sexuality & Culture, has blogged extensively about the Polanski case. Dank writes:

“There is no question that what Roman Polanski did to a 13 year old girl in the 1977 was wrong, and illegal. But it is also wrong to drag Polanski back to the US 31 years after the crime and have him spend an unspecified amount of time in prison. What possible good would come about by Polanski doing time for the crime? Obviously, it would not function to rehabilitate him or change him in some way. The fact that Polanski has had a stellar film career and apparently lived a law abiding life for 32 years after the crime is indicative that the case for changing Polanski is simply irrelevant.”

The details of Roman Polanski’s case lies in stark contrast to the case of Phillip Garrido, a registered repeat sex offender who was arrested earlier this year for kidnapping 11 yr old Jacee Dugard, and holding her captive and sexually abusing her for 18 years (from 1991-2009). The young Dugard bore two children out of Garrido’s abuse (now ages 11 and 15).

Despite today’s more stringent punishments for statutory rape, we hope that US jurors and judges will be able to distinguish the vast differences between the sexual crimes of Polanski and Garrido.

# 3. No-condoms-for-those-who-need-it-most stories, starring: Pope Benedict XVI!

While HIV/AIDS rates in sub-saharan Africa continue to soar, and condoms are very effective in fighting HIV/AIDS (when used correctly and consistently) Pope Benedict told Africans that it was wrong to use condoms.

The Pope’s message was also heard in the US, at least among some US Catholic college students. Amanda Hess, writer for the Washington City Paper highlights how all 3,000 students at Catholic University are now prohibited from having sex that is “disruptive” (defined as “ANY” sexual expression inconsistent with the Catholic Church including premarital sex and same sex sexuality). These rules are written into the code of student conduct. Hess states that:

“Deference to the catechism spares Catholic administrators from the awkward enterprise of referring to masturbation, condoms, or any other specific of a typical undergraduate’s sex life” … “violations to the student code can’t be absolved in typically Catholic fashion, with forgiveness administered privately after confession to a priest. At the Catholic University of America, your sins are subject to judicial review” (click here for full article).

Clearly, if the Catholic church cannot discuss sex outside of sex within marriage, they cannot discuss condoms very effectively.

#2. Backlash-against-sexual-&-reproductive-justice stories, starring: the murderer of Dr. George Tiller!

Gosh, this story is soooo last century (the 80s and 90s were full of anti-abortion terrorism stories), but unfortunately it’s still a story in 2009.

George Tiller

Dr. George Tiller, a doctor who provided late term abortions in Wichita, Kansas, was shot dead while attending Sunday Church services. Jodi Jacobson, Editor of Rh Reality Check explains the importance of Dr. Tiller’s work, as well as the cultural context for how perceptions of his work are widely inaccurate:

“In all the extensive coverage of the assassination in his church of Dr. George Tiller by a murderer affiliated with extremist right-wing groups, little has been said to shed light on what late-term abortions are, who has them and why. Instead, much of the media and talking heads pontificating on this subject have constantly focused on Tiller’s being “one of the very few doctors who perform late-term abortions,” without providing any context as to why he did so and under what circumstances. As a result, the dominant narrative is one which perpetuates an assumption that people are electing to have late-term abortions for the sake of convenience.” (To read Jacobson’s entire analysis, click here).

And finally, we’d like to end on a positive note, with a list of sexual and reproductive justice stories from 2009:

1. Sexual-&-reproductive-justice stories, starring Barack Obama!

Obama signed and/or was involved in the following sexual health and justice developments:

images-7

Repeal of the Global Gag Rule
Ending the HIV Travel Ban
Affordable Birth Control Act
Emergency contraception available to 17 year olds without a prescription
Critical funding for sexual and reproductive health programming
Supported starting a large prevention campaign to end HIV/AIDS in the African-American community. He formed a campaign called “Act against AIDS” and also formed an Act Against Aids Leadership Initiative AAALI) that partners with 14 of the nation’s leading African-American civic organizations in order to “integrate HIV prevention into each organization’s outreach programs.” The program refocuses national attention on the AIDS epidemic and features a media campaign called “9 1/2 minutes,” to draw attention and visibility to the fact that every 9.5 minutes, someone in the USA is infected with HIV.

And although this last bill still needs to be signed, we are expecting Obama to:

fulfill his promise to fund evidence-based, scientifically based sex education.

As Kari Lerum noted in a recent post, “the movement toward more abstinence-only approaches is driven almost entirely by conservative religious ideology, not scientifically reliable evidence.” Because of the lack of scientific credibility for Abstinence-only sex education, we are hopeful that all funding for abstinence-only sex education will finally be eliminated from the US Federal budget.

We are intrigued by many of this year’s sexual stories, saddened by some, and encouraged by others. May 2010 be filled with opportunities to reframe old (sexist, racist, homophobic, and sex-negative) stories into sexual stories that involve measured discussion of sexual health, sexual justice, and sexual rights.

Kari Lerum & Shari L. Dworkin, Eds. Sexuality & Society.

Growing global opposition to Ugandan “kill the gays bill”

Kari Lerum on December 14, 2009

In the past several days there has been growing global dismay and disapproval over Uganda’s “kill the gays bill” (to use Rachel Maddow’s term). As well there is an increasing amount of scrutiny and disgust from many regarding the direct connection between the Ugandan anti-homosexual campaign and a conservative U.S. religious group called “The Family” — which some, including The Observer have called a ” cult” due to the requirement for core members to remain secret about their activities. Regardless of what the group is labeled, it is clear that it has been successful in recruiting high level political leaders including some US congressmen and Uganda’s president Museveni to its core values: “fighting homosexuality and abortion, promoting free-market economics and dictatorship, an idea they once termed “totalitarianism for Christ’ ” (as quoted by Jeff Sharlet, author of The Family: The Secret Fundamentalism at the Heart of American Power, 2008). This post is a follow up on my last post on this issue and a compilation of several news stories for the purpose of updating concerned readers on the Uganda situation. I start with snippets of a Nov. 25, 2009 article from The Observer which describes the history and ideology of “The Family” (I have put some words in bold for emphasis; also note that the article below mispells Sharlet as “Sharlett”). I end with a very preliminary list of groups lining up in opposition to this bill.

Museveni, Bahati, named in US ‘cult’ (click here for the full article in The Observer)

Wednesday, 25 November 2009 20:45

NEW YORK: “President Museveni, Ethics Minister Nsaba Buturo and MP David Bahati have been linked to a shadowy religious fundamentalist group in the United States known as the ‘The Family’. …According to journalist, academic and author Jeff Sharlett, who has spent years researching on The Family, its core agenda includes fighting homosexuality and abortion, promoting free-market economics and dictatorship, an idea they once termed ‘totalitarianism for Christ’. “

“It recruits people in positions of power and influence to promote its agenda and, according to Sharlett, the group has had its sights on Uganda for over 20 years. He also says the group is behind the anti-gay legislation recently tabled in Parliament by Ndorwa West MP, David Bahati, which proposes the death penalty for men who have gay sex with disabled people, under-18s, or when the accused is HIV-positive.”

“In an extensive interview with National Public Radio (NPR), a privately and publicly funded non-profit radio network in the United States, Jeff Sharlett said that The Family identified President Museveni as their “key man in Africa” in 1986. …”

“Describing Museveni as a “core” member of the group, Jeff Sharlett alleged that President Museveni visits, spends time and “sits down for counsel” with Doug Coe, the leader of The Family, at the group’s headquarters at a place called The Cedars in Arlington, Virginia.“

The Observer reporter continues:

“One of The Family’s central ideas, according to Jeff Sharlett, is that Jesus Christ’s message was not about love, mercy, justice or forgiveness. Rather, it was about power. The group says that Jesus didn’t come to take sides, he came to take over. “Doug Coe, the leader of the group, tries to illustrate this, for instance, by saying, sort of posing a puzzle: name three men in the 20th Century who best understood that message of The New Testament. And most people are going to say someone like Martin Luther King, or Bonhoeffer; or maybe the more conservative, they can say, [evangelist] Billy Graham. And Coe likes to give an answer – Hitler, Stalin and Mao, which just makes your jaw drop. And he will say – he’s quick to say these are evil men, but they understood power. And that message recurs again, and again, and again in The Family,’ Sharlett said.”

“Sharlett, who spent time within The Family as an undercover researcher, given access to its leaders and archives, said that the group actively promotes dictators in pursuit of its economic and other interests. Because of its influence in Washington, the seat of the American government, foreign leaders find it in their interest to associate with the group.”

“Senator Tom Coburn, who also sits on the Senate Arms Forces Committee, is quoted to have said he has been on a mission to Uganda to “promote the political philosophy of Jesus as taught to him by Doug Coe.” … Jeff Sharlett says he has established in recent investigations that the group has been channeling money to Uganda to promote its activities, including the anti-gay Bill. … “The Family has poured millions of dollars working through a very convoluted chain of linkages passing the money over to Uganda,” he said. According to Jeff Sharlett, in Uganda, Museveni, Buturo and Bahati are not merely under the influence of The Family but they are, in effect, The Family.”

“The Family, also known as The Fellowship, was founded in the United States in 1935. According to its founder, Abraham Verene, God came to him one night in April, 1935, and told him that Christianity has been focusing on the wrong people, the poor and the suffering, “the down and out”. He commanded him to be a missionary to and for the powerful, the “up and out”, who could then pass off the blessings to everybody else.”

Doug Coe the head (or perhaps more aptly titled, “the godfather”) of The Family does not have the name or face recognition of other conservative evangelical Christian leaders such Billy Graham, Jerry Falwell, Pat Robertson, James Dobson, or Rick Warren (in fact, it is very difficult to find ANY good or current photos of the man online). Nevertheless he is well known in Washington DC amongst politicians and has considerable political influence domestically and globally. In 2005, Time Magazine named him one of the 25 most influential evangelicals in America. As reported by Time:

Several members of Congress live in rooms rented in a town house owned by a foundation affiliated with the group. Coe and his associates sometimes travel (on their own dime) with congressional members abroad and—according to investigations by the Los Angeles Times and Harper’s—have played backstage roles in such diplomatic coups as the 1976 Camp David accords…

While Time Magazine named Coe and described his organization over four years ago, only in the past several months has The Family began receiving serious, and critical, media attention. This attention began after Jeff Sharlet published his book on the Family in 2008, and escalated after the summer of 2009 political sex scandals of Senator John Ensign and S. Carolina Governor Mark Sanford, both of whom are connected to the group. With the introduction of the Uganda anti-homosexual bill in October 2009, The Family and other US based evangelical Christians such as Rick Warren became subjects of widespread academic and human rights critique.

In the past few days scores of politicians, global public health workers, human rights groups, and religious leaders have denounced this bill as a fascist, even genocidal, act. Below is a sample of those making public oppositional statements:

Politicians: Senator Russ Feingold “has warned that relations between Uganda and the United States would suffer because of a proposed Bill against homosexuality. Mr Russ Feingold, who chairs the Senate’s Committee on Africa, said he was outraged by the Anti-homosexuality Bill proposed by Ndorwa West MP David Bahati.” (US Senator joins critics of Anti-homosexuality Bill (Dec 14) Daily Monitor)

Public health officials: According to Stephen Lewis, the former United Nations envoy on AIDS in Africa, “This intended anti-homosexual statute has the taste of fascism.”.. “The proposed law would “demonize homosexuality” and “intensify stigma,” driving gays underground and making it much more difficult to prevent the spread of AIDS…”. (http://www.stephenlewisfoundation.org/)

Human rights groups: Amnesty International and Human Rights Watch have both released statements in absolute opposition to this bill.

Religious leaders: Several moderate US Christian leaders have expressed opposition to this bill. Some Conservative evangelical Christian religious leaders in the US are also now coming out against it. After several calls by human rights activists and reporters, US evangelical pastor Rick Warren released a video statement to Ugandan Christian leaders asking them to not support the bill (while maintaining that God does not support homosexuality). Warren has been identified as closely tied to Ugandan anti-gay activist Martin Ssempa. Click here to view Warren’s video address and read Amie Newman’s analysis.

The growing multi-sector, and increasingly multi-national, opposition to Uganda’s anti-homosexual bill is heartening. The bill itself has been temporarily “tabled.” However the hatred and fear stirred up by US-based anti-gay activists in Uganda and surrounding African countries is enormous, and will take much work to reverse. Building coalitions between Ugandan and African-based human rights activists, moderate religious leaders, and HIV/AIDS workers is an obvious step. But another, perhaps more crucial step in the US is for the politicians to finally uphold their commitment to a separation of Church and State. It may be time for the White House and Congress to officially sever its ties with The Family.

See also:

December 1st is World AIDS Day–theme is “Universal Access and Human Rights”

Shari L. Dworkin on December 1, 2009

On December 1, 1988, the World Health Organization declared its first observance of World AIDS Day. Since that day 21 years ago, every December 1st has been used to raise awareness about the global HIV/AIDS pandemic. In 2006, the Political Declaration on AIDS set a goal to have “universal access to comprehensive prevention programmes, treatment, care and support by 2010.” While progress has been made, we are very far away from being able to trumpet that successes have been fully reached. For the year 2009, the theme of World AIDS Day is Universal Access and Human Rights.

Currently, approximately 33 million people are living with HIV/AIDS (for a full set of global epidemiology slides, click here). Women constitute one half of the people living with HIV/AIDS, and this percentage has risen rapidly from 35% in 1985 (for a slide on the percentage of women in the epidemic around the world, see the UNAIDS epidemiology slides above). Shockingly, young people constitute one half of the new infections each year. While there is no cure for HIV/AIDS, anti-retrovirals have offered hope, newfound possibilities for health and well-being, and added years of life to millions of individuals, households, and communities around the globe. In the case of treatment, while many (but certainly not all) in the United States have access to life saving anti retroviral therapies, the availability of treatment is widely variable around the world. Unfortunately, only a small proportion of those with HIV/AIDS have access to anti-retro viral therapy. (For more details on the prevention, treatment, and care dynamics of the epidemic around the globe, see the UNAIDS 2008 Report on the Epidemic.)

Universal access as a theme is pointing to the need to ensure that populations have access to HIV/AIDS prevention, treatment, and care. This is easier said than done—in 2007 only 31% of people who needed treatment received it—and the rate of infection is far outpacing the increases in the number of people who are receiving treatment. Economic retractions around the globe threaten the progress that has been made and there are some reports that treatment programs are being halted or scaled back substantially given economic constraints (UNAIDS 2008 Report).

Because of the way that the number of infections is far outpacing those who have access to treatment, and because the epidemic is largely spread through drug use and sexual contact, the importance of prevention cannot be overstated. Prevention is well recognized as a key factor in slowing the pace of the epidemic—and this is not simply a matter of getting people much needed information and skills about condoms. Prevention is also about tending to the root causes of the epidemic, which involves issues related to social inequalities, homophobia, poverty, gender inequality, the criminalization of drug use and sex work, violations of human rights, and lack of health care access and infrastructure. And, then of course there are the complexities of culture and human behavior, and the fact that many prevention programs work for a short time, even up to a year, but these behavior changes are not often maintained in the long run. There is a great deal of promise in structural, interpersonal, cultural, and group level behavioral prevention interventions. However, the promise of these prevention interventions will not be fully realized without attention to social inequalities and human rights issues.

This brings us to the second aspect of the theme of World AIDS Day 2009: human rights. While it may not be obvious to many, violations of human rights shape HIV/AIDS risks and access to prevention, treatment, and care around the world. Men who have sex with men, sex workers, and drug users experience stigma and discrimination throughout the world. Many countries attempt to make HIV/AIDS a public health issue, but far too often, it is treated as a moral issue where populations are blamed for their fate (particularly sex workers, drug users, and men who have sex with men). Some countries do not even count “men who have sex with men” as a category in their surveillance systems and men who have sex with men have the lowest coverage of HIV prevention services of any category (UNAIDS, 2008). In numerous countries, women who are known to be HIV positive are thrown out of their homes when they test positive for HIV/AIDS and do not have adequate access to education, property rights, or income generation to help them to survive (and these factors shape their risks to begin with)—this is the case even when their partners may have infected them. In my own travels and research in South Africa and Kenya, it is clear that many women will not bring their children back to health care centers or clinics to be treated with ARVs for fear of being thrown out of their households and families by their male partners, relatives, or community members. Many men do not come to clinics to be tested because of HIV/AIDS stigma and because of perceptions that clinics are women’s spaces. Men also do not test because of ideals of masculinity which teach men to avoid signs of “weakness” or need. In many countries HIV positive women and men are subject to forced sterilization. Sex workers and drug users are often arrested and viewed as criminals, and prisons do not have adequate access to drug rehabilitation, condoms, or ARV’s, exacerbating the epidemic among “high risk” populations. And the U.S. has been known to stop funding prevention programs that take comprehensive sex education and condom use into account, arguing (against a very strong evidence-base) that abstinence and be faithful approaches work best (for studies that show that comprehensive sexual education and condoms work better than abstinence only programming, there are too many to list, but see this for one). The list of the links between social inequalities, rights, and HIV/AIDS risks goes on and on.

There have been gains, and there have been many of them. The number of people on anti-retroviral therapy has increased 10 fold in the past 6 years alone (UNAIDS, 2009). Recognition of the role of gender inequality and homophobia in shaping HIV/AIDS risks is increasing, as has prevention programming which is increasingly gender-specific and transformative for both women and men. Defining ‘human rights’ and implementing changes in rights has newfound momentum and if this continues, may provide marginalized populations with increased protections, resources, legal recourse, and access to prevention, treatment, and care. The US has a centralized dissemination program to diffuse evidence based successes to community based organizations. There is global mobilization to eradicate mother-to-child transmission. The economic contributions to prevention and a global scale ups in treatment have been a stunning testament to the fact that the global community can rally much needed support.

Still, there is much work to be done both domestically (U.S.) and globally. The incidence rate of HIV/AIDS in Washington DC is similar to that found in Western Kenya. The age distribution in some countries on the African continent has shifted life expectancy downward by several decades in several countries due to the epidemic. AIDS is the leading cause of death right now among African American women aged 25-34 in the United States and African-American women are 21 times more likely to die of HIV/AIDS than Caucasian women. There are millions of orphans due to HIV/AIDS. Sub-saharan Africa constitutes 10 percent of the world’s population and over 65% of the cases of HIV/AIDS. Anti-poverty efforts and food security efforts have been slow to link up with HIV/AIDS prevention, treatment, and care and are much needed. National policies have been hampered in their implementation by a lack of coordination, technical skill, and competing economic and health needs. Young people need prevention efforts more than ever before and prevention efforts reach adults the most. To achieve universal access and human rights within the HIV/AIDS epidemic is a goal that all social sectors and countries must all strive for. At the same time, all must be mindful that recalcitrant issues such as social inequalities and social justice shape the epidemic profoundly and must be dealt with head on in action and not in rhetoric.

__________________

For more information on the AIDS pandemic and how you can get involved in advocacy, research, or activism see the following links:

India officially recognizes third sex/gender

Kari Lerum on November 13, 2009

India is a vital location for sexuality scholars and activists, further confirmed by yesterday’s news that “India’s third gender gets own identity in voter rolls.” Partial text of this news story is quoted below:

By Harmeet Shah Singh, CNN

NEW DELHI, India (CNN) — Indian election authorities Thursday granted what they called an independent identity to intersex and transsexuals in the country’s voter lists.

Before, members of these groups — loosely called eunuchs in Indian English — were referred to as male or female in the voter rolls.

But now, they will have the choice to tick “O” — for others — when indicating their gender in voter forms, the Indian election commission said in a statement.

“Enumerators and booth-level officers (BLOs) shall be instructed to indicate the sex of eunuchs/transsexuals etc as ‘O’ if they so desire, while undertaking any house-to-house enumeration/verification of any application,” a statement from election authorities said.

India, home to more than 1 billion people, has 714 million registered voters.

Intersexual people are seen as a marginalized community in India. Many end up begging on the streets, becoming prostitutes or earning their livelihood by dancing at celebrations.

This news comes on the heels of a July ruling in India that decriminalized homosexual sex (discussed in a previous post comparing sexual rights movements in India and the U.S.). The comparable U.S. ruling to this came just six years ago with Lawrence V. Texas.

The story above uses the terms “intersexual,” eunuch,” and “transsexual” as interchangable identities. Perhaps in some contexts they may all be considered members of the same “third gender” category, but it is also useful and important to clarify some basic differences between these terms and others. Below are some very short, shorthand definitions:

Eunuch: an historic English term for a man who has been castrated to perform special social functions.
Intersexual: a term referring to people who are born with a mixture of both “male” and “female” hormonal, chromosomal, and/or genital characteristics (historically referred to as “hermaphrodite.”) (See the work of biologist Anne Fausto Sterling.)
Hijra: A term originating in South India referring to a person usually born male or intersex, but who uses female pronouns as dresses in feminine/”women’s” attire.
Transsexual: a term referring to someone who changes their sex through medical (surgical and/or hormonal) procedures.
Transgendered: a term referring to someone whose gender identity is different from the one traditionally assigned to their sex category. (People are born into sex categories of male and female; many but not all then become gendered masculine or feminine and into “men” and “women.”) Thus a transgendered person born in the female sex category may identify with the gender category “man” or “boi.” This may or may not involve surgical or hormonal alteration (in other words, it can simply be a social agreement).
Drag: a term that comes out of gay culture, involving someone temporarily “performing” a gender not usually associated with their sex (through dress, gestures, and so on). Ironic humor and extravagant campiness often involved.
Transvestite/cross-dresser: These are older terms with many meanings and histories — and often the term has been used in a derogatory fashion. In terms of practice though, “cross dressers” are often not gay, but “straight” men who simply enjoy dressing up as “women.”

These definitions are not meant to be comprehensive, but simply an entry point for those unfamiliar with these terms. There are also dozens of other terms associated with specific cultures and histories. (Readers, feel free to share other definitions, links, or references!)

Ok, now on to the topic at hand. Whenever I discuss the idea of recognizing more than two sexes/genders with my students, they inevitably claim that “society” will never let more than two sexes exist. Where would “they” go to the bathroom?!” they cry. Well, now we finally have a case where a “society” did allow more than two sexes to exist. Officially exist. Like in the Census Bureau. Then again, the concept of a third sex/gender has a long history in India (Reddy 2005).

Three things fascinate me about this new development in India:

1) the social/activist process by which a third sex/gender became legally recognized (if readers have information on this I’d love to hear about how this worked in India),
2) the acceptance of a third gender category based on either Social identity (people who simply feel and dress as a different sex/gender) and/or Biological identity (people who possess hormonal, chromosomal, and/or genital characteristics of more than one sex). As a result, this category applies to people who are intersexual, people who undergo surgical or hormonal treatment, and/or people who simply identify with a gender category not typically associated with their sex. This recognition of a third sex/gender free from the limitations of a dichotomous sex category system, opens up all sorts of interesting questions. (E.g., in the U.S., the underlying premise of the gay marriage debate is that there are only two sexes: Male and Female, and two basic types of sexuality: Gay and Straight. If a third sex/gender person wanted to get married in the US system, what kind of marriage would it be?)
3) Finally, I am intrigued by the implications of politically enfranchising this socially/politically marginalized group. (I am thinking here of how in the U.S., millions of marginalized Americans are barred from voting by simply denying felons the right to vote). Keep in mind here that a large proportion of Hijra are sex workers, and that sex workers in India are already quite well organized. Like the gay rights activism of ACT UP a significant amount sex worker activism in India is linked to the HIV/AIDS epidemic (e.g., SANGRAM and the Sonagachi Project). How will the newly enfranchised Hijra will impact the movement for sex workers rights, gay rights, intersexual/third gender rights, and HIV/AIDS interventions? What will they say about ongoing controversies around intersexual athletes (such as the Indian runner, Santhi Soundarajan)? I will be watching with great interest!

(Thanks to Melissa Embser-Herbert for the story tip).

Some recommended books on “third gender” related issues:

Jacobs, Sue-Ellen, Wesley Thomas, and Sabine Lang (Eds). 1997. Two-Spirit People: Native American Gender Identity, Sexuality, and Spirituality. University of Illinois Press.
Manalansan, Martin. 2003. Global Divas: Filipino Gay Men in the Diaspora. Durham, NC: Duke University Press.
Namaste, Viviane. 2000. Invisible Lives: The erasure of transsexual and transgendered people. Chicago: University of Chicago Press.
Preves, Sharon. 2003. Intersex and Identity: The Contested Self. Rutgers University Press.
Reddy, Gayatri. 2005. With Respect to Sex: Negotiating Hijra Identity in South India. Chicago: University of Chicago Press.
Stryker, Susan and Stephen Whittle, (Eds). 2006. The Transgender Studies Reader. New York: Routledge.

As one HIV ban ends, another morphs (guest post)

Kari Lerum on November 4, 2009

This story comes from British-based Elizabeth Pisani. Pisani has a Ph.D. in Epidemology, is author of The Wisdom of Whores: Bureaucrats, Brothels, and the Business of AIDS, and has a blog by the same title dedicated to “sex and science.”

__________________________________

Yesterday the US finally dropped its absolutely senseless law forbidding people with HIV from visiting the Land of the Free. (While Saint Obama is getting patted on the back for ending the ban, he was actually signing off on something that George Bush put in motion last year). That’s unmitigated good news for people with HIV, their lovers, friends and families, as well as for a lot of US employers who can’t import some of the best and the brightest simply because they have a not-very infectious virus that can only be transmitted in a tiny number of well-known ways which we can protect against with safe, cheap technologies.

Does this signal a new wave of common sense in HIV prevention in the United States? That’s certainly what we expected when Obama was elected. During his campaign, for example, he recognised that sterile needle programmes cut HIV infection among injectors, saving lives and money, and pledged to end a ban on funding those programmes from federal coffers. So cities such as his home town of Chicago, pictured in the map below, will now be able to use central money to provide clean needles to the inner city injectors that need them most. As long as they set up in one of the grey spaces. In the cemetary, in other words.

(Click to enlarge)

On this fantastic map, which comes from Yale University’s Dr. Russell Barbour by way of Stop the Drug War, the red areas are the parts of town where it would be illegal to operate a federally funded needle exchange under new rules proposed by Congress. The Drug War Chronicle provides an interesting history of the needle exchange shenannigans. Essentially, Obama did not remove the ban from a budget bill because he thinks policy shouldn’t be made through sub-clauses in budget bills. Democrats on the committee discussing the bill disagreed, and dropped the ban. Then Republicans, not willing to give up the idea that the availability of clean needles would have us all racing to start shooting up smack, decided to protect the innocent by forbidding needle programmes within 1,000 feet of “a public or private day care centre, elementary school, vocational school, secondary school, college, junior college, or university, or any public swimming pool, park, playground, video arcade, or youth centre, or an event sponsored by any such entity”. That’s the red bits on the map of Chicago above. Here’s Dr, Barbour’s map of needle exchange exclusion zones in San Francisco:

This is clearly just a way of pulling the rug from under any effort to increase access to clean needles. We’ve come to expect this kind of implaccable opposition from conservative Drug Warriors in the United States. We used to expect the Brits to be more rational about their drug policy, and the UK has, thank God, held on to its policy of providing clean fits for anyone that needs them. But with the sacking of the government’s independent advisor on drugs David Nutt for repeating his independent advice after the government chose to ignore it, I’m not so sure.

I’m not even going to wade in here about whether or not idependent scientific advisers to government should shut up after their advice is ignored, but I will commend to you a wonderful paper by Dr Nutt on the dangers of Equasy, (pdf) an irrational addiction to horse riding. This has been seized on by many who have not read it as an example of his inappropriate analyses. Irony, where art thou?

The US Drug Warriors also joyously seized on the latest round of anonymous surveillance of HIV among drug injectors in Britain, sending out an e-mail crowing about rising rates of HIV and drawing a link between that and the fact that the UK was the first country in the world to have national injection safety programmes. My next post will put those rather one-eyed claims into perspective.

—————————-

Click here for the original story .

Signs of change for the Obama/Clinton State Dept (third in a series on trafficking)

Kari Lerum on November 1, 2009

In this third post on the contemporary anti-trafficking movement, I evaluate the degree to which the Obama administration has taken a turn away from the sexual politics of the Bush administration in its approach to trafficking, as well as global health funding (click here for the first and second posts).

It is no secret that the Bush administration was vastly at odds with the scientific community on many issues, including global warming, stem cell research, and sexual health matters such as HIV/AIDS research and sex education. Obama’s campaign and election has brought widespread support from the scientific community; prior to his election 61 Nobel laureates publicly endorsed Obama’s science policy.

While many changes have occurred since Obama’s inauguration in January 2009, I focus here on four indicators of change around global sexual health and anti-trafficking efforts:

the appointment of Dr. Eric Goosby as US Global AIDS Coordinator,
the appointment of Luis de Baca as the director of the Trafficking in Persons office,
the content and tone of the 2009 Trafficking in Persons report (in comparison to previous TIP reports), and
the status of the anti-prostitution pledge requirement for USAID funding

1) On the appointment of Dr. Eric Goosby, PlusNews Global HIV/AIDS news and analysis reports:

“Just three weeks into his new appointment, United States Global AIDS Coordinator Dr. Eric Goosby outlined …some of the changes that President Barack Obama’s administration will make to the country’s global AIDS policy …

“Goosby … made it clear the scientific evidence rather than moral concerns would drive intensified eforts to reach high-risk groups — men who have sex with men, injecting drug users and sex workers — with HIV prevention and care” (emphasis mine).

2) On the appointment of Luis de Baca to head the Trafficking in Persons Office, according to Kathleen Franke, Professor and director of the Center for Gender & Sexuality Law at Columbia University:

“de Baca’s appointment is very good news. Mr. de Baca, a lawyer who has worked as legislative counsel for the House Judiciary Committee and in the Justice Department as chief counsel of Civil Rights Division’s Human Trafficking Prosecution Unit is a smart, experienced and effective choice for the job. He has worked for years on this issue and is very-well respected in criminal justice and advocates’ circles alike for his approach to this difficult problem. He was one of the lead DOJ attorneys who successfully prosecuted Kil Soo Lee, the former owner of an American Samoa garment factory, who was sentenced to 40 years in prison for his role in illegally confining and using as forced labor over 200 Vietnamese and Chinese garment workers.” (“Good news on U.S. Anti-Trafficking Policy.” Gender and Sexuality Law Blog, March 25, 2009.)

3) On the 2009 Trafficking in Persons report. Melissa Ditmore , who has a Ph.D. in sociology and has worked for many years as a sex work scholar and activist, is one of several hopeful readers of the 2009 TIP report:

“I’m encouraged by the greater recognition of trafficking into a wide variety of workplaces, the concern for people who have been unjustly imprisoned, and the lack of sensationalism when discussing sex work. …

“Enforcing existing labor laws such as wage and hour provisions is one way to address abuses in many workplaces, particularly in factories and agriculture. Expanding these provisions to address domestic workers (they are not offered such protections now) would benefit maids and nannies and other live-in employees. Obama emphasized evidence and efficacy in his inauguration speech – these are a few examples of opportunities to act” (“Trafficking Report: Less Sensationalism, more Reality.” Rh Reality Check, June 23. 2009).

4) On the status of the anti-prostitution pledge requirement for USAID funding. As reported in my second post in this series, in 2006 this was found to violate first amendment rights of U.S. organizations attempting to provide public health services (see: Pepfar watch). The Bush Administration filed an appeal on this decision one week before Bush left office. In July of 2009, the U.S. Department of Justice under Obama dropped its appeal. Jodi Jacobsen, founder and former director of the Center for Health and Gender Equity (CHANGE) reports that this move by the Obama DOJ is being heralded by the public health community:

“in withdrawing the appeal “without predjudice,” the Obama DOJ retains the right to resubmit an appeal by January 8, 2010. Many advocates are hopeful that the Administration will use the intervening time to closely review the negative i plications of this policy for HIV prevention work in the field.” (Read more at: http://www.huffingtonpost.com/jodi-jacobson/doj-drops-appeal-of-injun_b_242676.html)

So now, with these revisions and appointments in place, all that most of us can do is watch to see how they are implemented. Rest assured I will be watching and posting an update on any DOJ movement on the anti-prostitution pledge around January 8, 2010. And for right now, as Secretary of State Hillary Clinton visits Pakistan, the U.S. State Department has an opportunity to show its commitment to ending “modern day slavery” in Pakistan. In a story published by Time magazine earlier this week, we learn of three landlords holding their debt-bonded workers as hostages:

“As Hillary Clinton pays her first visit to Pakistan as Secretary of State, an unfolding hostage crisis will test the Obama Administration’s rhetoric on human rights in the region. Officials at the U.S. embassy in Islamabad say at least three landlords have held as many as 170 bonded farmworkers at gunpoint on their estates in the country’s southeast Sindh province since late September. With U.S. attention focused on getting Pakistan to deal with huge security issues to Washington’s satisfaction, will Clinton be able to press Islamabad’s rulers to address a controversy involving rural poverty and modern-day slavery?

The crisis began after the workers’ advocates successfully petitioned three district courts to declare as illegal the debts that the landlords were using to compel the workers into indentured servitude. Those debts average around 1,000 Pakistani rupees — roughly $12. The hostages, a third of whom are children, some as young as 4 months old, are landless peasants, known as haari in Urdu. According to Ghulam Hyder, a spokesman for Pakistan’s Green Rural Development Organization, the landlords have killed one hostage already and are threatening to kill the others unless they drop the cases and return to work. The landlords also abducted Amarchand Bheel, an advocate for the laborers, as he traveled to court to plead their cause.

A 2004 study by the International Labour Office (ILO) estimated that there are up to a million haari families in Sindh alone, the majority living in conditions of debt bondage, which the U.N. defines as modern-day slavery. Last fall, Pakistan’s Daily Times newspaper quoted the labor minister of neighboring Punjab province as saying that landlords hold millions of forced laborers in “private prisons” across the country (emphasis mine).

Thanks to Obama, de Baca, and others on the TIP team, the U.S. State Department can finally begin to recognize the full range and magnitude of highly oppressive working conditions (most of which entail stories such as the one above). Let’s hope that U.S. responses to the situation in Pakistan and elsewhere are measured, non-sensationalist, and extend far beyond simple demand-side strategies (i.e. “shaming and naming” the consumers of goods and services produced in oppressive conditions).

See also:

Alarming new HIV rates among MSM in the US reported: Now what?

Shari L. Dworkin on September 30, 2009

On August 24th, 2009, CDC representatives at the National HIV Conference in Atlanta, Georgia reported that gay men and other MSM (men who have sex with men) are 50 times more likely to have HIV than heterosexual women or straight men. The report is not yet available at the CDC website and interestingly, only the “gay” newspapers have picked it up as a worthy news story (thus far).

This statistic is reported as confirming, in emphatic terms, the disproportionate impact of HIV/AIDS on gay and bisexual men of all races and ethnicities. It also recognizes that the highest impact is on African-American men. This announcement is crucial in a few key ways:

First, while there is no cure for HIV or AIDS (and a partially effective vaccine–soon to be another post), many in the US have had access to anti retroviral medications (ARVs) for decades. Many people therefore assume that HIV prevalence has leveled off and that there are very few NEW HIV cases in the US. This is simply not the case. We have a truly problematic epidemic here in the US, and the numbers clearly show us that certain populations are even more at risk than we knew.

This leads me to my second point: Our resources should be aligned to reflect where the risk is. It is not clear that this is happening, particularly in communities of color.

This new announcement tells us, in a convincing and unrelenting way that there is a disproportionate impact on MSM.

So, it’s clear that there’s a huge problem here. Still, I have some critical questions about this report.

1) First, is there a differential risk between gay men, bi men, and MSM who may not identify as “gay” or “bi” ? Why not report the difference in risk between gay men, bi men, and MSM?

2) Second, what is the difference between:

a) the risk among gay men, bi men, and MSM (as a category and separately, since they lumped them all together) compared to risk among heterosexual women and b) the risk among gay men, bi men, and MSM (as a category and separately) compared to risk among heterosexual men?

If there is a difference there, shouldn’t we also report that? If we don’t separate out analyses (a) and (b), don’t we unnecessarily set up a “heterosexual” and “minority sexuality” binary?

3) Further, given that (a) and (b) were not analyzed and presented and given that heterosexual women are experiencing rapid increases in risk in some populations, how can we assure that resources aren’t needlessly pulled from them due to the way the data is being presented?

I have more thoughts, but I’ll stop there for now. There are many interesting framings of data that we can offer that rely on categories of gender or sexuality. We should do both at once. I am proud of my Centers for Disease Control for coming out, so to speak, with these newest figures, and as usual, I look forward to even more figures if these are also bravely revealed. Nuance, not simplicity helps—just as we find in media sound bites.

HIV/AIDS

Top 10 Sexual Stories of 2010