Monday, February 20, 2017

Tom Ammiano: Advocate

Tom Ammiano                                                    Photographed Exclusively for A&U by Sean Black

Tom Ammiano first came to my attention about twenty years ago. I was visiting San Francisco and I was at Josie’s Cabaret and Juice Joint. Tom was doing a stand-up comedy act, but he was introduced as one of the city’s Board of Supervisors. As I laughed at one-liners about well-hung juries and the imagined sexual proclivities of Tattoo from Fantasy Island, a thought gnawed at me: How can you do raunchy gay stand-up comedy and be a serious politician? You just…can’t do both, can you?

Young, orthodox Larry didn’t understand then that things work differently in San Francisco and that Tom Ammiano has not given a flying fig about what’s proper since long before Larry was aware of anything.
Ammiano’s activism propelled him to election to the Board of Education in 1990. In 1994, he won a seat on the Board of Supervisors. One of his first actions on the board was to convene AIDS activists and administrators from Kaiser Permanente to explore the HMO’s alleged homophobic treatment of AIDS patients. The issue was personal: his partner, Tim Curbo, had just died of AIDS-related causes just three days before Ammiano was elected to the Board. A few years later he helped to create an ordinance that made San Francisco the first city in the nation to provide universal healthcare access, and he vehemently protested the ousting of renters with HIV/AIDS.

Tom spent most of the past decade in the California Assembly, butting heads with two governors and recalcitrant Democrats and Republicans, to push forward a progressive legislative agenda. He introduced a landmark marijuana regulation bill, the Marijuana Control, Regulation, and Education Act to create a regulatory structure for pot similar to that for alcohol. He passed bills addressing the prevention of drug overdoses, allowing for electronic distribution of EIRs, improving wrap-around services for foster youth, decreasing costs in the criminal justice system, and a landmark law to protect sex workers from prosecution for carrying condoms. In 2013 his K–12 transgender rights bill, letting students choose the restroom that matched their gender identity, became law.

Not only has he fought for progressive policies on HIV/AIDS, LGBTQ rights, affordable housing, immigrants rights, labor, criminal justice reform, he’s insisted that colleagues and the public connect the dots between all of them.

We spoke in mid-November as Tom was preparing for an extended run of his one-man show, days after an election threatened, on the national level at least, many of the issues he’s been fighting for in California.

Larry Buhl: So. That election happened. What now?

Tom Ammiano: It’s hard to wake up and realize what the impact of this could be. In my life we’ve gone through some political setbacks. This one, no pun intended, trumps them all. People say we survived Reagan but some of us didn’t. I don’t think anything has been quite as embarrassing as this. At this stage in my life, and I’m going to be 75 in a couple of weeks, I was hoping for a little more pleasant exit music if you get my drift. Nothing is linear. But this Trump thing is like a roller coaster, dropping a thousand feet before you climb back up.

At least California is an island of progressivism, right?
 
Well, on the coasts, yes. What I’m recognizing as someone older and watching things become movements, like immigration and health care, there’s a lot of queer energy and they’re mostly young.


In Sacramento there were a lot of DINOS, Democrats in Name Only, and I was able to get bills out that would not ordinarily be generated from the vast majority of Democrats, around immigration, transgender, the disabled, social justice issues, legalization of marijuana. The Democratic party has been very shy about going full tilt boogie on these issues.


 In the Assembly you had clashes with Governor Brown. What did it take to bring him around?
 
Jerry Brown respects persistence. So when he vetoed two bills of mine, one on domestic workers which is mostly a Latina issue, and the other on immigration reform, stopping racial profiling through ICE, the second time around he signed them. He’s also a crafty politician. Also I wouldn’t shut up, and I had tremendous support. I don’t want to take too much credit. All of this was a strong team effort. I learned this from my early days, from my activism. You’ve gotta do things in a coalition.

Harvey Milk recognized the suffering of other demographics. He always connected the dots. I thought that was the way to go. I am a subscriber to the gay liberation and one of the ideas coming out of that was connecting with others and not silo-ing yourself. If you look at many social justice issues, environment, healthcare, gay rights, and trans, politicians don’t recognize the issue of poverty in those issues.

Your lover Tim instituted the AIDS education program in the San Francisco school. And you kept it going?
 
He was a revered classroom teacher in the Mission district. We got a grant to spread education about HIV/AIDS. I got condoms in the school when I was on the school board. This was having it in the curriculum, recognizing World AIDS Day, getting involved with the Quilt. And there was a shitstorm around it. Many of the parents were alarmist.


Flash forward to your time as supervisor, protesting loss of housing for people with HIV/AIDS people in the city. Where is that issue now?
 
Today there are activists in housing working on that. It’s the AIDS Housing Alliance. Back then it was, ‘Where do you even report this?’ and the Board of Supervisors was a little clueless. Our housing crisis is phenomenal here. It dwarfs everything. People with HIV bear the brunt of this. It’s far from perfect but I think they’ve made good progress in getting specialized housing. Until we solve our overall housing crisis, people with HIV are vulnerable.


When you talk to people about gay rights, you can move them in terms of them recognizing you shouldn’t be fired, they don’t connect the dots that if you support the affordable housing initiative you also support gay people. If you support affordable health care you also support LGBT people.

What you said about silos and connecting the dots makes sense. HIV/AIDS in society now is long past being a silo issue.
 
Yes and it’s a shrinking world. What’s happening in other places reflects on us if we’re too laid back about it. Here we still have to pay attention to the economically challenged people. I don’t think they’re benefitting in the same way from enlightened HIV/AIDS policy. And then there’s young people who think they’re immortal. I get it. They didn’t see the worst of [the HIV/AIDS] crisis. They didn’t feel it. But I still want to slap them. But we gotta mentor them. When they seroconvert even then they’re a little cavalier. We can’t get smug. It’s definitely not over.


Recreational pot will now be legal in California. You’ve long been in favor of taxing pot. Happy?
 
I’m happy but the proposition is imperfect. I saw pot as a palliative at many deathbeds in terms of appetite and nausea and pain management. But in the legislature nobody wanted to touch it. I came up with regulations to protect patient rights. There were cartels taking over. There were abuses in the system, which made you vulnerable to law enforcement. There are factions, there’s the growers, a lot to contend with. But I was gratified with what we did accomplish. The proposition that just passed is not perfect. It barely passes the smell test. But one good thing is, it talks about sentencing reform, which alleviates some social injustice.


Marijuana is not the third rail anymore. It’s important this passed even with its imperfections. We’ll never get anything until we at least get the legalization part out of the way.




Speaking of third rails, you were never shy about controversy. Like the “condoms as evidence” bill. But what came out of it was a compromise, that law enforcement couldn’t use one condom but could use two condoms to prosecute.
 
I know it sounds ridiculous and I think it was absurd, but considering we started from zero, it’s something. And at least it gets people talking and engaged about the issue. We got what we got and we need to do more. It puts the sex worker in an impossible place. If you don’t have condoms then you’re much more likely to contract HIV and if you do have them they can be used as evidence of prostitution, to jail you and convict.


There’s a high HIV rate among sex workers and there’s the down-low phenomenon where the john contracts an STD and goes back and gives it to his wife. All of that is real and happening. We had some success in San Francisco but on the state level it’s very dicey.

What kills you the most is when you see the flicker of recognition from your colleagues about why something is necessary and the right thing to do but they can’t bring themselves to support you. That’s frustrating. There was one guy who would never vote for anything, and then he would whisper to me, “stay strong!” Well, where were you?

We’re trying to get safe injection sites now. We have had some success with some of the people in the mayor’s administration. We had the same setbacks with needle exchange, but we figured out the board of supervisors could declare an emergency around HIV/AIDS and then you could have two weeks of needle exchange, and then the board would have to pass the resolution again, until finally needle exchange is accepted. It is part of the state law now. Sometimes you have to go through theatrics.


Pulling the levers of politics.
 
[Laughs] Right. Pay no attention to the man behind the curtain.


It’s pseudo-piety, simplistic-morality shit; whenever you go to help someone involved in something highly disapproved by society, they’ll say you’re enabling these people. Even giving out condoms. When I was on the school board, I pushed for condoms in the school and of course teens are sexually active, and the head of the PTA said having condoms in the school is akin to sexual abuse.

Or sex education, that’s just giving them ideas.
 
Right.


Is some of this in your show?
 
The show is about my take with irony and satire and snark about my six years in Sacramento. There are some autobiographical things, but that’s more part of the architecture of the narrative. In the close there is some more personal history but very little personal history. There are many situations where you could laugh or cry but I think it’s better to laugh.


My humor tends to be political. It’s always been topical, social satire. And when I was in Sacramento I would sometimes just make a quip in the moment.

Did that make it hard for other lawmakers to take you seriously?
 
Sometimes. In the beginning it’s hard to be taken seriously because you’re gay or your voice is high or have ideas they’re threatened by. A lot of gay men face this. Some people have thought that if I’m queeny or I’m funny then I must not be serious. But I’m deadly serious.




Larry Buhl is a radio news reporter, screenwriter, and novelist living in Los Angeles. Follow him on Twitter @LarryBuhl.

Read more articles from A&U, here.

Europe Is Seeing Vast Growth in HIV-Positive Migrants

February 20 2017
 
 
_________________________________________________________________________________ 
 
 
[EDITOR'S NOTE: The term migrant as used in this article is in the nomenclature of the European Union's official glossary as it relates to immigrants. That definition being: A broader-term of an immigrant and emigrant that refers to a person who leaves from one country or region to settle in another, often in search of a better life. This differs from the common use in the United States which often colloquially refers to seasonal farm workers.]

While migrants from Sub-Saharan Africa make up most of the migrants in Europe living with HIV, a new study from Sweden discovered a spike in the number of HIV-positive people who’ve migrated to Europe from Central America, the Caribbean, and central/eastern Europe. 

Every year for the last decade, 38 percent of new HIV cases in Europe happened to people not born in the country they were diagnosed in. But lately, the proportion of these populations have shifted. 

Over 250,000 people were newly diagnosed in Europe between 2004 and 2013, reports AIDS Map. Of that number, six percent were from Latin America and the Caribbean, while eight percent were from a European country other than the one they were diagnosed in.

As presented by Julia del Amor, from the National Center for Epidemiology in Spain, at the "HIV in Europe" meeting in Malta, even though sub-Saharan Africans still make up the majority, those numbers are declining, while Latin American and Caribbean numbers are increasing. 

The proportion of migrants living with HIV in Europe reportedly vary from one percent in Romania to 75 percent in Sweden. 

Diagnoses of sub-Saharan Africans living in the United Kingdom fell from 2250 in 2007 to 1600 in 2012, while diagnoses in people from Latin America and the Caribbean rose from 730 in 2007 to 1300 in 2010, then fell again to 900 in 2012. In central Europe, diagnoses rose from 300 in 2007 to 600 in 2012. 

According to Amor, the proportion of late diagnoses among migrants from western Europe also fell, while the proportion among migrants from central and eastern Europe rose. A large reason for this might be a lack of treatment eligibility. 

Treatment policy for immigrants living with HIV in Europe, particularly undocumented ones, has always been unbalanced. For example, while Sweden provides access to antiretroviral therapy to undocumented migrants, other countries do not; in Baltic countries: Lithuania and Estonia do, but Latvia does not; in central Europe: Hungary does, but others do not. 

Because of Sweden’s HIV assistance, it became the first country in the world to reach UNAIDS 90-90-90 goal, with 71.9 percent of HIV-positive people reaching undetectable levels.

On the other hand, Sweden also has one of the highest proportions of late diagnoses — mainly because a high number of people diagnosed in Sweden are migrants.
 
Read more articles from PLUS, here.

New Options Available To Visualize CDC Data

 
February 20, 2017 By Jonathan Mermin 


____________________________________________________________________________________ 



CDC’s surveillance systems track HIV, AIDS, viral hepatitis, STDs, and TB. Getting this information to those who need it most in an accessible, usable, and meaningful format is a primary goal for CDC. The launch of Atlas in 2012 made this a reality with an online resource that gave users tools to create customized tables, maps, and other graphics with the most current CDC surveillance data.

Now, we have launched CDC’s NCHHSTP AtlasPlus. This update has significant enhancements that empower users to explore 2015 HIV, STD, and TB data at the national, state, or county level. They can easily access 2014 data for hepatitis as well. Disease rates can be analyzed by demographic variables, transmission categories, year, and trends over time. In this new version, users can create 2 side-by-side maps or charts, e.g., state-level maps can compare HIV diagnoses among White and African American MSM.

Feedback received from users of Atlas was invaluable in making upgrades, including building tables based on the exact subset of data a person would like to view. New charting capabilities include the following: line graphs by year; pie charts for sex; bar charts by state and country; and bar charts for age, race/ethnicity, transmission category (for HIV), or country of birth (for TB). AtlasPlus is also ready for the mobile user with a new responsive design.

CDC works to give the public health community, policy makers, and the general public regularly updated, reliable data. I encourage you to visit the new AtlasPlus and utilize the data to strengthen your work. Visit the AtlasPlus website for more information on this update and upcoming webinars.

Jonathan Merman is the director of the National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention (NCHHSTP) at the Centers for Disease Control and Prevention (CDC). This article was originally published on the AIDS.gov blog, February 8, 2017.

Read more articles from POZ, here.
 

Trans Teen Wins Wrestling Tournament As Lawsuit Tries To Ban Him From Competing


"These kids don't care who you put in front of them to wrestle. We just want to WRESTLE." 
 
Mack Beggs, a 17-year-old trans male at Trinity High School in Euless, Texas, won his division this weekend at the Class 6A Region II wrestling tournament, and now advances to the state championships.

Beggs, a junior in the 110-pound weight class, identifies as male and has been taking testosterone since 2015. But he must still compete in girls’ wrestling because the sport’s governing body, the University Interscholastic League (UIL), mandates athletes must compete as the gender listed on their birth certificate. 

He won on Saturday after two wrestlers forfeited their matches against him. 

“The thing is, we want to wrestle each other,” Mack wrote on Facebook. “I feel so sick and disgusted by the discrimination—not by the kids, [but by] the PARENTS AND COACHES. These kids don’t care who you put in front of them to wrestle. We just want to WRESTLE. THEY are taking that away from me and from the people I’m competing with.”

Less than two weeks ago, a wrestler’s father sued the UIL, claiming Beggs should be suspended because using testosterone gives him an unfair advantage—and exposes other wrestlers to “imminent threat of bodily harm.”
Mack Rylee Karam
about a month ago
Attorney Jim Baudhuin filed the suit, which names another father, Pratik Khandelwal, as plaintiff—though neither man’s daughter is in the same weight class as Beggs. 

Baudhuin insists his suit has nothing to do with Mack being transgender: “I respect that completely… All we’re saying is she is taking something that gives her an unfair advantage,” he said, misgendering Beggs. “It’s documented. It’s universal that it’s an unfair advantage.” 

Mack says he wants to compete against other boys, but he’s willing to follow the rules. (A proposal to the UIL Legislative Council last year to let transgender athletes compete as the gender they identify with was ignored.) Nancy Beggs, Mack’s grandmother and guardian, says the two have been completely transparent with the IUL since he began transitioning.
Mack Rylee Karam
“Today was not about their students winning,” Nancy told the SportsDay at Friday’s meet. “Today was about bias, hatred and ignorance. These kids have wrestled each other before, they know each other and they were not happy with this.”

While student Madeline Rocha forfeited her match against Beggs, her record means she will also advance to the state championships. Mrs. Beggs claims the two opponents this weekend were the first who have forfeited to Mack.

Currently both UIL guidelines and the Texas Education Code forbid the use of steroids, but make an exception if they are “dispensed, prescribed, delivered and administered by a medical practitioner for a valid medical purpose.”

Baudhuin’s suit is still pending, but he’s hoping to convince lawmakers to remove that exemption. 

Read more articles from NewNowNext, here.

Why Is HIV Spiking Among Young People?

February 19 2017
 
 
____________________________________________________________________________________ 
 
 
Leading up to World AIDS Day, the Centers for Disease Control and Prevention revealed its latest report on newly diagnosed HIV infections in the United States.

The latest data, as shown in the HIV Surveillance Report, shows new diagnoses have decreased through the Black, Latinx, and white communities, but have risen among young gay identified males ages 13 to 14 and among male youth in general aged 24-29. 
 
While HIV-positive live much longer, HIV prevalence has reached an all time high — over 950,000 people.

"Our nation’s HIV surveillance systems have advanced a long way since the early days of the epidemic, both in terms of how data is collected and how it is analyzed and reported,” Eugene McCray, director of CDC’s Division of HIV/AIDS Prevention, said in a statement. “Today, most states report complete information on HIV cases to CDC - including the person’s age, race/ethnicity, risk factors and even their HIV viral load at the time they are diagnosed. Removing duplicate cases takes much less time than it used to, and new technology means we can process large quantities of data much more quickly."

In 2015, men who have sex with men had the highest number of new diagnoses — 26,000 people in comparison to 3,000 people who acquired HIV through heterosexual sex. Additionally, the study found 1,400 new cases who acquired HIV through injected drug use. 

Read more articles from PLUS, here.
 

“Berlin Patient” Timothy Brown Celebrates 10 Years of Being Cured of HIV

POZ profiled Timothy Brown in June 2011.

So why is he taking meds every day?

February 17, 2017


________________________________________________________________________________ 


Timothy Ray Brown—formerly known as the “Berlin Patient”—has marked a decade since he was cured of HIV. Brown, who now lives in San Francisco, celebrated the anniversary with a cake during a community workshop in Seattle, site of the 2017 Conference on Retroviruses and Opportunistic Infections (CROI), reports The Bay Area Reporter.

While living in Berlin in 2006, Brown, who was HIV positive and on antiretrovirals at the time, developed leukemia. To combat the blood disease, Brown underwent chemotherapy that killed off his immune cells. In rebuilding Brown’s immune system, his doctor used cells with a CCR5-delta-32 mutation that made them resistant to HIV. After a decade of various tests, Brown remains free of HIV.

“In a way it seems like yesterday, but in a way it feels like a long time ago that I had to take medications every day,” Brown told The Bay Area Reporter. “That is the best part of my cure—not needing to take daily medication and not needing to depend constantly on my doctors for my survival.”

So why is he now taking daily HIV meds again? To prevent acquiring HIV. Because his immune cells are still susceptible to the less common strains of HIV that use the CXCR4 receptors to infect cells, Brown has started taking Truvada as PrEP, or pre-exposure prophylaxis.

“Recovery has taken too long, but I feel great and I am grateful for everything,” Brown told the newspaper. “I still hang on to the hope that everyone living with HIV will be cured in my lifetime.”

As The Bay Area Reporter notes, Brown’s story continues to give hope to people with HIV and to inspire researchers across the globe.

To read the POZ 2011 cover story about Brown, read “Patient No More.” And to read a collection of our articles on HIV cure efforts, click on #Cure.

Read more articles from POZ, here.


 

Saturday, February 18, 2017

This Week in HIV Research: Kidney Function Improves With Protease Inhibitor Switch; and Viral Load Blips Predict Post-Treatment Control



February 17, 2017


_________________________________________________________________________________ 




This week, a study finds that a switch in protease inhibitor-based regimens helps improve kidney function. Another study finds that viral load blips during early HIV treatment help predict post-treatment control. And a two-drug regimen containing dolutegravir (Tivicay) and rilpivirine (Edurant) worked well as maintenance therapy, according to a study at CROI 2017. To beat HIV, you have to follow the science!

Kidney Function Improves on Switching Protease Inhibitors

Changing a protease inhibitor-based (PI) treatment regimen from lopinavir (Kaletra, LPV) or atazanavir (Reyataz, ATV) to darunavir (Prezista, DRV) improves kidney function, an analysis of data from the UK CHIC study that was published in AIDS showed.

Renal results, as measured by estimated glomerular filtration rates (eGFR), were somewhat better in all study participants who took tenofovir disproxil fumarate (Tenofovir) and switched their PI. Greater improvement in eGFR rates was observed among those whose eGFR slope had declined rapidly or who had suffered renal impairment prior to switching their PI.

Participants whose regimen did not include TDF saw no significant effect on renal function when they replaced lopinavir or atazanavir with darunavir. A small earlier study (47 participants) by the same authors had found no significant difference in renal results when their PI was switched to atazanavir. The current study examined data from 1,430 participants. Study authors theorize that the greater sample size may explain the difference in results.


Early Treatment and Lack of Viral Blips Predict Post-Treatment Control of HIV

Starting antiretroviral therapy soon after seroconversion and avoiding temporary increases in viral load (VL) predicted the likelihood that a person's VL remained undetectable even after stopping therapy, an observational study published in Journal of Acquired Immune Deficiency Syndrome found.

Researchers analyzed data on 778 participants in the CASCADE trial who started antiretroviral therapy within six months of seroconversion. A third stopped treatment at some point thereafter. Ten percent of those who ended treatment continued to show undetectable levels of HIV (post-treatment controllers, or PTC).

Participants whose VL temporarily increased by more than 400 copies/mL while on antiretroviral therapy (viral blip) were more likely to see their VL rebound after stopping treatment. Each such blip increased the likelihood of not controlling the virus without antiretrovirals by 71%. Similarly, the longer the interval between seroconversion and start of treatment, the less likely the person was to become a PTC. Study authors caution, however, that cofounding factors remain, including lower treatment adherence prior to viral blips.

Read our full study summary by Mark Mascolini.



Two-Drug Regimen Shines as HIV Maintenance Therapy

An antiretroviral regimen consisting of only two drugs, the integrase inhibitor dolutegravir and the NNRTI rilpivirine, held up well as a maintenance approach in people with HIV who switched from more complex regimens, according to study findings presented on Feb. 14 at CROI 2017, in Seattle, Washington.

Warren Tong is the senior science editor for TheBody.com and TheBodyPRO.com. Follow Warren on Twitter: @WarrenAtTheBody.

Barbara Jungwirth is a freelance writer and translator based in New York. Follow Barbara on Twitter: @reliabletran.

Read more articles from theBodyPro, here.