Ideology Trumps Science

In 2003 President George W. Bush signed legislation that created the President's Emergency Plan for AIDS Relief (PEPFAR), a program that has funneled $25 billion to combat the AIDS epidemic primarily in Africa. The cynics among us might lament that calling AIDS an "emergency" more than two decades after its appearance shows just how long our government willfully neglected the global pandemic. Still, more than 2 million people have received anti-retroviral medications through PEPFAR.

But PEPFAR's politics, with its insistence on abstinence-heavy HIV prevention messages, have always been troubling to the majority of AIDS activists. A report just released by the Council for Global Equality shows in saddening, infuriating detail just how PEPFAR's moralistic presumptuousness hinders, complicates and confuses HIV prevention efforts. For example, PEPFAR requires any organization receiving funds to adopt a policy explicitly stating their opposition to sex work, thus making it all but impossible for any group trying to prevent infections among sex workers -- one of the world's most vulnerable populations -- to receive any PEPFAR support. PEPFAR funds also routinely go to organizations that, at best, do no outreach to men who have sex with men, or, at worst, to governments like Uganda's that make homosexuality (or "carnal knowledge of any person against the order of nature," as the Ugandan penal code describes it) a criminal act.

The report is a fascinating, if dispiriting document. As tempting as it is to place blame on the Christian right wing for its pervasive influence on PEPFAR's particulars, those of us who work as AIDS advocates should be asking ourselves how we have allowed this travesty to go on for so many years.

You can read the entire report here.

A Bit of Video Wisdom

Here are 18 seconds of wisdom from YouTube.

Fighting HIV Stigma Protects Public Health

Too often we've heard that legal services for people with HIV are "secondary" to health care services. What people with HIV need more than anything, the argument goes, is medicine, as though pharmaceuticals alone will render HIV "chronic and manageable" no matter what non-medical crises a person with HIV might face. The insistence on viewing AIDS as primarily a medical issue (as opposed to, say, a civil rights issue or a social justice issue) has even resulted in major funders requiring legal agencies like ours to evaluate the effectiveness of our services by demonstrating improved health outcomes in our clients. And "health" is always defined as personal health, rather than social health. Imagine trying to justify fighting a discriminatory job termination by showing how much a lawsuit increases your client's CD4 count.

Now comes a study that shows what we in legal services have known all along: social health and personal health are inextricably linked for people with HIV. The study, published in the August, 2009 issue of the Journal of General Internal Medicine, examined the relationship between social stigma and access to health care. In essence, the study showed that the more people with HIV experience stigma, the less likely they are to access health care regularly or take their medications as prescribed. Here's one of the study's more sobering conclusions: "We found that respondents experiencing high levels of stigma had over four times the odds of reporting poor access to care."

Perhaps even more sobering, the report showed that one third of the participants reported experiencing "high levels of internalized HIV stigma."

Clearly, then, fighting against HIV stigma -- something we, like our colleagues at other legal agencies around the city and country, do every day -- is fighting for better health care, for the health of individuals, communities, and the nation as a whole.

Why You're Glad You're Not a Teenager Anymore

We got a call this morning that really got us thinking about the difficulties of facing HIV as an adolescent.

Theresa called with concerns about her godson, Gerard. Gerard is 16 and has been HIV-positive since birth. Theresa has known about his status for his entire life, and when Gerard's mother died she took him in for several years. Theresa knew that Gerard has had a steady boyfriend for the past year, and yesterday while she and Gerard were hanging out in her kitchen she asked him if he had told his boyfriend about his HIV status. Gerard said he had not, and added that they always had protected sex. Theresa asked Gerard if he was afraid to tell his boyfriend about his HIV status, and he said he wasn't; he just hadn't gotten around to it.

So Theresa called us, wanting to know how her godson's actions squared with Illinois law. We told her that the law requires a person with HIV to disclose that information before engaging in "intimate contact" with another person, and that the law defines "intimate contact" as anything which might transmit HIV, whether it does or not. So under a strict reading of the law, Gerard had committed a felony every time he and his boyfriend had sex.

Next came the really difficult question. What would we advise her to do?

One thing was clear: under the Illinois AIDS Confidentiality Act, Theresa could not legally inform Gerard's boyfriend (or anyone else, for that matter) of Gerard's HIV status without Gerard's written permission. She said she had no intention of betraying Gerard's trust that way. But what could she advise Gerard to do? Here are the suggestions we made:

He could tell his boyfriend that the two of them should go get tested for all STDs, including HIV. After all, public health departments routinely put out the message that sexually active gay men should get STD tests done every six months (yes, that's a ridiculous message to put out, as it suggests that gay men can do nothing short of celibacy to eliminate their risk of contracting STDs, unlike straight people). Hopefully the boyfriend's tests would all come back negative. Then Gerard could disclose his HIV status to his boyfriend, emphasizing that safe sex works. Perhaps Gerard would want to include his boyfriend's parents in that discussion.

He could self-report to the local department of health, and have them inform his boyfriend that he may have been exposed to HIV. They would do so without disclosing Gerard's name. Of course, if the boyfriend hasn't been with anyone but Gerard in the last year, he would know who the department of health was talking about. And getting the information from health authorities, rather than from Gerard personally, might create a lot of bad feelings.

He could end the relationship and keep quiet. But as Theresa pointed out, this option prevents Gerard's boyfriend from learning important information for his own sexual health. Theresa felt strongly that the boyfriend should get an HIV test.

Lastly, Theresa asked what repercussions Gerard might face. Would he be arrested? Put in jail? We told her that the likelihood of a criminal prosecution in a case like this is very low, at least here in Cook County, Illinois. A bigger concern might be the boyfriend's parents threatening some sort of civil legal action against Gerard for putting their son in jeopardy without informing him first. But it seemed to us that the real risk Gerard faces is that his HIV status becomes widely known at his school; it's hard to imagine that any 16-year-old boy who learns he's been dating someone with HIV for a year will tell none of his friends at school. And if Gerard's status became common knowledge at school, it's hard to know how difficult his life there might become.

We sure hope things work out for Gerard and his boyfriend.

More CORBA Help

Perhaps you recall that last spring President Obama signed the American Recovery and Reinvestment Act, which among other things provides a 65% subsidy for COBRA premiums for those who become COBRA eligible between September 1, 2008 and December 31, 2009. If you don't recall this momentous event, then clearly you have not been reading our blog regularly, like all good people should, since we blogged about it back then. We even included a link to the IRS regulations that govern the program. Gosh, we are marvelous, not to mention thorough.

Well, now there's news that the program will be extended to February 28, 2010. The extension is included as part of the Department of Defense Appropriations Act, which the President signed into law on December 19.

Here's an important thing to know about this extension: your COBRA coverage doesn't have to begin by February 28, 2010. Rather, your COBRA eligibility has to begin by February 28, 2010. For example, if you lose your job on February 28, you would be eligible for the extension, even though you probably won't have your COBRA coverage in place until a month or two later.

If you really want to make your brain overheat, read through the Act here. You'll have to wade through 63 pages of blah-blah-blah until you get to the COBRA stuff in Section 1010. Here's our favorite tidbit:

(c) RULES RELATED TO 2009 EXTENSION.—Subsection (a) of such section is further amended by adding at the end the following: ‘‘(16) RULES RELATED TO 2009 EXTENSION.—
(A) ELECTION TO PAY PREMIUMS RETROACTIVELY AND MAINTAIN COBRA COVERAGE.—In the case of any premium for a period of coverage during an assistance eligible
individual’s transition period, such individual shall be treated for purposes of any COBRA continuation provision as having timely paid the amount of such premium if—
(i) such individual was covered under the COBRA continuation coverage to which such premium relates for the period of coverage immediately preceding such transition period, and
(ii) such individual pays, not later than 60 days after the date of the enactment of this paragraph (or,if later, 30 days after the date of provision of the notification required under subparagraph (D)(ii)), the amount of such premium, after the application of paragraph
(1)(A).

That sure clears things up.