C.A.R.E. Knowledge Blog

From the Long Beach Post's Brian Addison: PHOTOS: Drag Queens and More Traipse along Broadway for Easter Charity

Vice Mayor Suja Lowenthal kicked off the event with an uplifting message that spirituality is not a judge. "I have my beliefs," she stated to the packed room. "My belief is rooted in everyone. And I truly believe that Mary's is the House of Worship, where everyone is accepted."

Jewels, the host and MC of Hats and Heels, proudly led the way down Broadway, stopping at the World Famous Falcon and eventually ending at Silver Fox with performances at both. Councilmember Robert Garcia ended the evening with a $500 donation to C.A.R.E. while watching the final performance at the Fox.

More at Long Beach Post...

Poz Life Weekend Seminar Coming to Long Beach

Seventeen years ago I attended my first Poz Life Seminar. Back then it was run by LA Shanti, which has now become Life Group LA. Since the mid-nineties, effective medications for HIV have emerged, treatment side effects have diminished, and we now have a better understanding of how our immune system functions. 

Over the years the Poz Life Seminar has evolved as well. About ten years ago I presented at a seminar in West Hollywood on back-to-work options for people who had been on permanent disability. The Life Group LA keeps the information presented up-to-date and relevant. They put on these weekend-long seminars in various locations around Southern California, and once every two or three years they return to Long Beach. 

Now days, with HIV stigma playing a large role in keeping newly diagnosed folks isolated, having a place like this can help us meet others, find support, and learn the latest news about treatment advances, alternative therapies and more. 

The weekend seminar takes place all day April 28 and 29 (Saturday and Sunday) in Long Beach. Registering for the POZ Life Weekend Seminar is easy. Send them a note at info@thelifegroupla.org or call TOLL FREE at (888) 208-8081 and they will contact you.

Silence = Stigma

Stigma has been a big issue in the support groups here at CARE. Or rather, self-stigmatizing has kept people from attending the group. 

For most of the people attending the newly diagnosed group, they've been meeting people in a social arena that uses avoidance of people who are positive who disclose their status. Terms like "clean" and "disease-free" are put out with the hope that by avoiding people who know they are postive, they will avoid the virus. One result of this is that they seldom have any friends who are positive and out about their status--plantonic or otherwise. 

Unfortunately, the main drivers of the epidemic are people who don't know that they're positive. Often someone tests negative, and even after a few more encounters, they're still posting that they tested negative two, four, or six months ago. And as far as they know, they are negative--based on their last test result. 

So when the viral apartheid strategy fails, they're sequestered in an HIV closet of sorts. 

If disclosure is to be the norm, more positive people will need to be open about their status, negative people will need to be more accepting of their positive brothers, sisters, lovers, and friends, and public health messages will need to adress these important issues. 

Long Beach HIV Testing Data

Yesterday I tallied our HIV testing numbers for December and all of 2011. In total we conducted 131 HIV antibody tests with 26 of them coming out positive. That's a positivity rate of almost 20% or one in five (19.85%). When I've talked to coordinators of other testing sites, I hear about 2 to 3 percent of their clients testing positive. 

One of the reasons for the big difference is that we're not out casting a big net to meet numbers. People come to us because of their perceived risk, and many times their assessment is correct. We also get referrals from out positive clients in the CARE Clinic. Often when people are at risk and they know someone who is positive, they'll turn to that person for information on local resources. I also suspect that some of the folks who test positive are coming here because they expect a positive result, and they know their next step will be to sign up for care. 

New Year's Resolutions 2012

For those of you who make new year's resolutions:

Have you noticed how most resolutions are things that are good for you in the long run, but nevertheless are hard to accomplish? You don't hear people make resolutions to eat more chocolate cake or watch more TV. Instead it's something like, "Start going to the gym regularly," "Loose the five pounds I gained over the holidays," or, "Quit smoking."

In public health terminology, these are called health-seeking behaviors, and usually people who do one thing that's good for their body tend to do other healthy things as well. When you successfully accomplish one goal, it motivates you to attempt others. Over time we have better health outcomes and more fulfilled lives. 

When I was working on Project Respect, an HIV risk-reduction study that recruited over 6,000 STD clinic patients, we found that those people who took small steps, like putting a condom in a place where it would be readily available the next time they had sex, were far less likely to return with another STD. Now putting a condom on your night stand (or in your glove compartment) won't protect you from HIV, but it does make you more likely to use it. Putting condoms where you need them is a successful first step, and successful steps encourage further steps, which eventually lead to better health outcomes.

If you're HIV positive and have attended a support group, you've accomplished a difficult step. You've walked into a room full of strangers and acknowledged your HIV status. Asking and giving support is another step. Taking meds, seeing a doctor regularly, and taking control of your health are also positive, health-seeking behaviors. Congratulations on the steps you've taken so far, and best wishes for your future goals!

If you're negative, stoppping by and taking an HIV test is a great positive step. 

The Potential to Reduce HIV Transmission

Science and Nature are the two biggest peer reviewed journals around. For an article to make these magazines, they have to be a significant scientific breaktrhough. So (according to Science Magazine) what was the biggest scientific breakthrough of 2011? It wasn't the discovery of habitable earth-like planets orbiting other suns, or evidence of Higgs boson by the Large Hadron Collider; it was in the field of HIV and public health, or more specifically, using HIV treatment as prevention. From MedPage Today:

In the history of our time, 2011 could be remembered as the year the tide began to turn against the HIV/AIDS pandemic.

Equally, it could be remembered as the year we fumbled the opportunity to end one of our greatest scourges.

The key event was the release in May of data from a single randomized clinical trial — the 052 study by the HIV Prevention Trials Network (HPTN) — that showed that treating people with HIV reduced the risk of transmission by some 96 percent.

The study has been "catalytic," according to principal investigator Myron Cohen, MD, of the University of North Carolina in Chapel Hill, N.C.

Considering that condoms are about 85% effective at preventing HIV trasmission, you would think the government would be all for something that reduces HIV transmission by 96%,  but that might be seen by some as giving tacit approval for folks to have sex. Up in San Francisco, public health has already adopted "Test and Treat" as their policy, promoting testing and offering therapy to everyone no matter what their CD4 count. As a result, the number of new positives has dropped while STD rates have remained steady, a good indication that it's working. 

Other studies coming from places as diverse as Taiwan and Brittish Columbia show that increased testing and earlier treatment is reducing new infections. 

Here in LA, they're looking to combine HIV prevention and treatment planning bodies, so the main object of prevention will eventually be promotion of HIV testing and getting people into care. Unfortunately bureaucracies change slowly, and the sex police will be digging in their heels. I'm reminded of the H. L. Mencken definition of Puritanism: the haunting fear that someone, somewhere is having a good time. 

Here in Long Beach, those undiagnosed with HIV are the main drivers of the epidemic. Consider the hypothetical person who tested six months ago and has had a few partners since then. It's these folks who think they're negative (because that was the indication on their last test) who are recently infected that have the high viral load that makes the virus easier to transmit. Public health estimates that there are 6,000 people living with HIV in Long Beach. If 1,500 of them don't know they're infected, that can mean there are easily over a thousand gay men typing "I'm negative, UB2" in their on-line profile, when in fact they're carrying the virus. 

In the early days of the epidemic--before HIV testing--the gay community rallied together and reduced transmission by assuming all  partners were positive--or they might be positive themselves (and took appropriate precautions). Perhaps we can set aside the viral apartheid contained in terms like "clean" or "disease free" and start thinking about the well being of the community. "Test and Treat" shows you care about yourself and you care about others. Getting tested for HIV every six months if you're sexually active is the first step; if you do test positive, seeking treatment is the best thing you can do for yourself and for the community.

 

HIV Testing in Long Beach, CA

Here at the CARE Program at St. Mary Medical Center in Long Beach we offer free Ora-Quick testing for HIV. The test uses an oral swab--no needles, and if you test confidentially, you'll get your results in twenty minutes. Also, when you test confidentially, you can get a copy of your result if you need to show the courts or your partner.

We're located at 411 East 10th Street in suite 107. We're in the two-story building next to the parking entrance to St. Mary Medical Center campus. There's plenty of free parking in the neighborhood if you don't want to pay. We offer testing Monday through Friday from 8:30 to 4:30, and we're closed for lunch. If you call first, we can probably see you without waiting. You can call our HIV testing line at 562-624-4900. 

The campaign theme for World AIDS Day this year was "Getting to Zero" which comes out of recent studys that have reduced transmission by promoting testing, and making HIV medications available to those who test positive. 

Locally, the biggest driver of the AIDS pandemic are those people who think they are negative, because they had a negative test in the past. But because they tested in the "window peroiod" (now considered to be three months after exposure, before HIV antibodies are produced) or because they were exposed after their previous negative test, they may be exposing others to HIV. Once someone goes on an effective combination of antiviral medication and remains undetectable for more than six months, the chances of them passing on the virus is greatly diminished. So tesing on a regular basis--and seeking medical care if you test positive--is probably the best thing you can do to get Long Beach to zero.

Remembering on World AIDS Day

General Idea: One Year of AZT, One Day of AZT, 1991

Back before I started blogging here at the CARE Program, I wrote mostly on contemporary art at my blog Leap Into the Void. Back in 2008 I bemoaned the fact that World AIDS Day and A Day Without Art had seemed to have fallen by the wayside. My attempt at the time was to remember a specific artist, someone who I had gone to school with, who died of AIDS. Other bloggers followed suit, and their posts can be seen here, here, and here. Part of my thinking was that the era of effective combination therapy came along at the same time as the internet, which means there's little or no record in cyberspace of those who died of AIDS for the most devastating years of the epidemic. Perhaps that's one of the reasons we see so much complacency around HIV prevention and treatment today. 

With that in mind, there's someone I'd like to remember here today. In 2001 I attended the GNP+ conference in Port of Spain, Trinidad. GNP+ is the Global Network of People Living with HIV/AIDS, and they hold an international conference on the off years, in-between the International AIDS Conferences. 

It was in Port of Spain that I met Kenroy Nicholson, a young man in his twenties from Trinidad who was living with the virus. After meeting at the conference we hung out for a few days before I flew back to the United States. At the time he was working at Royal Castle, a local fast food chain. He lived in a township outside the city, an area with dirt roads, and maybe a water pipe that came to each block. His place had no phone or electricity, and was made of tin sheeting and cement blocks. He lived there with his two siblings, their partners and children in a one bedroom home. Of the five adults in the house, he was the only one who was working, and he did it without shoes, and without HIV meds. He never asked me for anything except friendship and understanding. We stayed in touch by mail, and he invited me to return for Carnival the next year. I couldn't return until the following Summer, and by the time I got there he had died.

So I'm dedicating this World AIDS Day post to Kenroy, one of the five thousand people who die each day from AIDS, people who do their best despite the lack of the most basic medical attention.  

If there's someone you'd like to remember, feel free to post in the comments section.

 

World AIDS Day in Long Beach

There are two or three events happening for World AIDS Day in 2011 in Long Beach. World AIDS Day happens every year on December 1, which is this Thursday.

There will be an event at The Center: an art exhibit that starts at 5, a speakers panel at 6:30, and a candlelight walk to the beach at 7:30.

There will also be an event at 5:00pm put on by the Long Beach AIDS Foundation at the band shell at Bixby Park. Bring canned goods or cash donation for hot chocolate or coffee. At 6:00 there will be a procession down Broadway.

(Long Beach) RED is something that happened last year that will probably happen again (though I can't find specifics on line). Downtown Long Beach buildings and fountains will be lit up red, and participating downtown restaurants will donate a portion of their proceeds from 6 to 10 pm to local HIV organizations.

Dirty Pools

Among my duties here at the CARE Program I also do the HIV testing. CARE offers free rapid testing for HIV using an oral swab, with results in twenty minutes. 

As part of the testing process I fill out a risk assessment form with the client. By the time the client leaves my office, they should have a pretty good idea of their own risk of aquiring HIV. The questions fall into two categories--those that address the mechanics of transmission--like sharing needles, or what body part is going in what orafice. The other questions assess risk in terms of risk groups. 

Everyone is a individual, but some groups have higher numbers of people living with HIV. In public health, this is called prevalence. If you have sex with someone in a high-risk group, you're more likely to be having sex with someone who is positive. 

By far the group with the highest prevalence is gay men. In Long Beach, like most urban areas, HIV prevalence among gay men is as high as one in four or one in five. Other high-risk groups include sex workers, people who inject drugs, transgenders, and men who have been incarcerated. 

It's good to protect yourself by using condoms--or clean needles if you inject, and it's also good to be aware of the amount of HIV in the "pool" of people you're swimming with.

If you'd like to get tested for HIV, our office is located at 411 East 10th Street, Suite 107, Long Beach, CA 90813. To schedule an appointment, call (562) 624-4900. Testing hours and information are located here.