In two noteworthy nods to the LGBT community, Clinton made the surprise announcement that Ellen Degeneres will serve as US State Department's New Special Envoy for Global AIDS Awareness; and later she mentioned that we will only make effective progress against HIV stigma by "repealing laws" that criminalize and discriminate against people "based on their sexual orientation."

The overarching theme of her vision was that of an "AIDS Free Generation." To achieve this goal, Clinton charged the international community to join the US government in seizing this pivotal opportunity to turn the tide in the global HIV pandemic by redoubling our efforts and funding of HIV treatment and prevention programs, focusing on a combination of evidence-based interventions that will gain the most ground. In particular, Clinton mentioned three top priorities:

1. Reduce mother-to-child-transmission rates to "zero" (not "virtually zero," as Clinton remarked her speech writer suggested she say).
2. Scale up rates of voluntary medical male circumcision.
3. Scale up global provision of HIV anti-retroviral treatment.

Thankfully, she also underscored the importance of continuing support of other (very effective and far less costly) modes of prevention, including use of condoms, microbicides, and regular HIV testing in concert with these larger efforts. I often worry that in the ongoing battle among HIV/AIDS advocates over the supremacy of the HIV prevention versus the HIV treatment strategy, a battle that Clinton claimed should now be settled, we've forgotten that tried and true modes of prevention from decades past are still effective and must remain in our armamentarium. Yes, HIV treatment is effective in lowering viral loads and by extension preventing future infections. And yes, it appears that in the long-term it is cost effective to supply drugs globally to offset tremendous economic costs otherwise shouldered by countries ravaged by HIV/AIDS. However, the promising data we're getting about many new treatment-based interventions still should not trump or overshadow other, equally effective "prevention-as-prevention" modalities (e.g. condoms and good ol' education).

Her comments about using multiple evidence-based approaches highlighted the important concept of finding the optimal mix or combination of HIV interventions to reduce new rates of infection. Already mathematical models of the combination strategy she proposed demonstrate a theoretical reduction of new rates of infection by 40-60% over a relatively rapid timeframe. Moreover, she announced that an additional $60 million of PEPFAR money is to be invested in four African countries to further study the impact of combination HIV intervention strategies to better refine our efforts moving forward. As such, she has called on other nations to now join the US in this effort to further improve our global strategy.

The top three focus strategies are good ones. Modes of reducing mother-to-child-transmission prevented an estimated 114,000 new infections last year from PEPFAR funds alone. And yet, currently 1 in 7 new infections globally continue to occur through this vertical route of infection. So there's certainly a real opportunity for large gains yet to be made on this front.

As for circumcision, since 2007 more than 1 million men have received voluntary circumcisions for prevention of HIV transmission, three quarters of which were funded by PEPFAR. This intervention is known to reduce rates of HIV infection by as high as 44% in circumcised men.

Finally, it is true that treatment is prevention, and that the cost of providing one individual anti-retroviral drugs in Africa has dramatically decreased from an average of $1100/year in 2004 to about $300-400/year today. This is encouraging news, especially for proposed expansion of funds for international anti-retroviral provisions; but I'm certainly for reducing our reliance on medication as much as possible, if we are truly to have a future generation free of AIDS.

Moving forward, Clinton said that there will be increased transparency of multinational organizations, such as the Global Fund, to weed out corruption and fraud. Moreover, countries receiving aid will be expected to ante-up, with more limitations placed on governments using their domestic funds, otherwise appropriated for public health, for other projects, offset by incoming international aid.

Clinton's speech marked an exciting recommitment to the global fight against HIV/AIDS, drawing from the recent move towards more unified strategies to fight this pandemic, as reflected by the National HIV/AIDS Strategy. Above all, these strategies aim to focus our efforts and have us succeed where we have too often failed before: in working together, despite the tendency for HIV/AIDS to divide us.

The study was spearheaded by Dr. Joshua Rosenberger, from the Indiana University's Kinsey Institute, and carried out in collaboration with Manhunt Cares, the research arm of Manhunt™, the well-known social networking site for men who have sex with men.

Researchers analyzed responses from nearly 25,000 users of Manhunt™ and DList™ who responded to a survey that included questions about their sexual practices and asked them to reflect on different types of safer sex educational videos, including more explicit approaches developed by the DC FUK!T Campaign (NSWF). The explicit DC FUK!T videos were compared to more bland, "condom on banana"-type control videos to answer the question of whether sexually explicit messaging is more effective in helping men to learn and retain information about condom use, STDs and other safer sex practices.

But in the meantime, study results have been made available to the public in the form of an engaging, interactive website where visitors can learn more about the study results in a user-friendly and contemporary manner. "As the only online company that has a dedicated Research Institute which promotes an annual sex study with our members, we felt it important to translate conventional academic data into an easily digestible format for our members." says David S. Novak, Managing Director of the OLB Research Institute and Senior Health Strategist, at Online Buddies, Inc. (parent company of Manhunt™ and DList™). The website examines in detail a variety of sexual behavior topics from the larger study.

According to the OLB Research Institute, to date, Manhunt™ and DList™ members have participated in over 100 studies worldwide, with this year's national sex study being the largest in the United States. The study itself, which focused on men's most recent sexual event, found the sexual repertoires of participants to be varied, suggesting the need to rethink some common misconceptions about the sexual behaviors of gay and bisexual men.

"As highlighted in the [website], the sexual experiences that men are having are not all homogenous. For example, less than 40% of men engaged in anal intercourse during their last sexual event, challenging the notion that 'gay sex always = anal sex.' By providing this information to our members, we hope to normalize their sexual behaviors and ultimately reduce existing stereotypes about gay and bisexual men," says Novak.

So I'd encourage you to at least give the website a perusal: http://www.mensnationalsexstudy.com/ It's chock full of interesting tidbits about what your fellow gay/bisexual men do in (and out of) bed. For the more sciency-types, I'd suggest you to access the full report through your academic institution's subscription to the The Journal of Sexual Medicine.

I'm currently working with the Velvet Foundation to develop an exhibition on the History of HIV/AIDS as told from the perspective of the LGBT community. Our aim is to develop this exhibition in advance of the 2012 International AIDS Conference in Washington, DC.

As such, I've put together the following survey to solicit feedback in drafting a proposal and exhibition script. Integral to this process will be the input from a broad cross-section of the LGBT community; so please consider sharing your thoughts.

Here's the link: HIV/AIDS History Survey

For those of you not familiar with the Velvet Foundation, more about this fantastic organization follows after the jump.

OVERARCHING THEME

The declaration, "Here I am" is at the core of the Museum's exhibitions and programs.

"Here I am" is an invitation to all: See me, recognize me, and understand me as a person, regardless of how I define my gender and sexuality. In return, I acknowledge you: Here you are. We are different; each of us is unique. But, let us honor what connects us: the journey each of us has taken in search of self and community, love and respect, expression and fulfillment, equality and freedom, a sense of the past, and hopes for the future. Together, we can learn from each other and rise above the biases and misconceptions that may keep us from truly seeing each other.

"Here I Am," the Museum's core exhibition theme, is about the universal human search for identity.

It tells a story about a process and a journey: How "I" define "me"; how "me" connects to form the "we" of partners, spouses, friends, family, and communities; and what it means to be "me" in American history, culture, and society. All of us live in multiple, interacting worlds: self, family, community, and society. Our realities are shaped by our perspectives, and are often viewed through the lens of our gender expression and sexual orientation. Whether we are conscious of them or not, gender and sexuality are inherent parts of our individual identities.

"Here I Am," rich in personal narratives, spans 400 years of American history. Most of the stories are drawn from the past 150 years and occurred during the time lesbian, gay, bisexual, and transgender (LGBT) people began to forge cultural identities and alliances with others like themselves. The resulting social institutions and communities, however, are not monolithic, but form a mosaic shaped by our difference- the multiple strands that make up our individual identities. Embracing this complexity, the Museum's exhibitions explore how the LGBT experience intersects all parts of American society, historically and culturally.

MISSION STATEMENT

The national museum of American LGBT history and culture will be a forum for the identification, study, and dissemination of the social, historical, and cultural contributions of the lesbian, gay, bisexual, and transgender community--and its relation within the larger society--through collections, exhibitions, research, publications, and other public programs.

VISION STATEMENT

At its core, the Museum will be guided by a set of principles that embodies its mission, informs its vision, and directs its actions:

• Preservation. Be a valued and respected member of the museum community as a collector and steward of a unique part of humanity's history and culture.
• Scholarship. Serve as a resource center for researchers, scholars, and others interested in the study of LGBT history and culture.
• Cultural Unification. Offer a place- and means- for LGBT people to pursue mutual goals and to foster a shared identity.
• Education. Provide the resources and tools needed for teachers and students to explore, learn, and connect with the heritage of LGBT people.
• Social Responsibility. Enhance the well-being of all human communities by providing a secure public forum for individuals and groups to confront, debate, and exchange ideas.
• Inclusiveness. Welcome people of all backgrounds, beliefs, and ages to share in the LGBT experience as a critical park of America's history and culture.
• National Outreach and Collaboration. Reach beyond Washington, D.C., to engage new audiences and to collaborate with museums and collections that are also dedicated to preserving and interpreting LGBT history and culture.
• Innovation. Create experiences that position the Museum on the cutting edge of interpretive philosophy by incorporating novel exhibit design and techniques.

For more information about the Velvet Foundation please visit their website.

As such, addressing health disparities has become increasingly in vogue, and yet the LGBT community somehow continues to fall short on this front. Case in point: the Affordable Care Act, which passed in March 2010, invests in the improvement of health data collection and analysis strategy. Section 4302 contains provisions to improve health disparities by requiring that all federal data collection efforts "gather information on race, ethnicity, sex, primary language, and disability status." Unfortunately, LGBT data requirements were not specifically included, but the law does provide HHS the opportunity to remedy this shortfall through collecting additional demographic data, as needed, to further improve our understanding of healthcare disparities.

HHS now intends to use this foothold to take the necessary steps to collect data on our lives - but that's only if we have the political will to do so and follow through with pressuring HHS to extend its reach on our behalf. I remain skeptical, despite recent encouraging news from the White House and the Secretary of Health & Human Services (HHS), Kathleen Sebelius, that we will soon move forward on collecting LGBT health data to the extent we've been lea to believe. At this moment, when we should be accelerating our efforts on this matter, the pressure from the LGBT community seems to have noticeably waned.

In early June, I had a brief opportunity to speak with the Sec. Sebelius, during which I asked the question burning on the minds of so many in the LGBT community: "When will we be counted? And when will questions about LGBT Americans be included in HHS-sponsored health data collection systems, especially in the National Health Interview Survey?"

The National Health Interview Survey (NHIS), after all, is the grand-daddy survey of our public health data collection system, to which most other national and state-level surveys look for data comparison. Getting questions on the NHIS typically causes a chain-reaction, driving inclusion of those questions on numerous other public health surveys at all levels.

Sec. Sebelius responded by saying that collection of LGBT health data is a priority of HHS and that researchers are currently vetting questions to ensure that information will be gathered most efficiently, minimizing false positives and bias.

When a reporter from The Washington Blade, Chris Johnson, posed a similar question on June 21, Sec. Sebelius echoed publically her previous claims, saying that LGBT health data collection "is definitely a commitment." She continued, "We will be adding data questions to the National Health Surveys. And right now we are looking at developing a slew of questions, market-testing them, coming back and making sure we have the right way to solicit the information that we need." President Obama bolstered her remarks a week later, when he stated, "[HHS] has begun planning for the collection of LGBT health data."

Additionally, HHS also released a fact sheet that outlines clear steps for developing better questions on gender identity along with a timeline, indicating the earliest possible implementation of sexual orientation data collection into the NHIS would happen in 2013. Of course, this implementation is contingent on successful cognitive testing of questions and multiple rounds of field studies - all of which strikes me as peculiar, since a wealth of rigorous studies already exists on how to ask questions accurately about sexual orientation.

In the wake of these announcements, I've heard multiple LGBT advocates suggest our work on this issue is done; that now it's only a matter of time. However, planning and actually implementing are too separate actions; and I'm not so convinced this matter will pan out as well as we hope, especially if we stop the pressure now. It is important for us to remember that this work is being done not because it's required by law; but rather, because it's by the discretion of the current administration at the behest of our community. And that dynamic can easily change the longer we wait, especially if our goals are not met before this upcoming election cycle.

The Question(s)

I'm all about doing what's necessary to strengthen the quality of data we collect; but there comes a point at which the benefit of ensuring that data collection is marginally more accurate is no longer worth the cost of further postponing collection of real data on LGBT people. All surveys are imperfect and can be improved in years following their initial implementation; however, nothing can undo the injustices LGBT people currently face in our healthcare system except starting to document those disparities now.

The current challenge Sec. Sebelius faces is not a new one. On Oct. 24, 1997, then-HHS Secretary, Donna Shalala, faced an analogous situation, when she mandated "the inclusion of information on race and ethnicity in all HHS-sponsored data collections systems." Within a week the HHS-wide policy went into effect, sans the unnecessary field testing that is now required for sexual orientation questions.

So what's different between now and 1997? Nothing really; as Sec. Sebelius could just snap her fingers, make a call over to the head of the National Center for Health Statistics, directing the inclusion of questions to appear in next year's NHIS. At present, one of those questions should be none other than: "Do you identify as heterosexual or straight, lesbian or gay, or bisexual?"

Although less inclusive than many would hope, such an identity-based question would go a long way as a first step in data collection. I believe a yet-to-be-determined gender identity question could also be included in this timeframe, if we push to hasten the process already outlined in the administration's timeline. We must also redouble our efforts to educate the public about gender identity; current data suggest an appalling lack of understanding by the general public about what it means to be transgender.

Consequences of Delays and Roadblocks to Implementation

My fear is that if we wait for the completion of this "market-testing," which will take until beyond winter 2012 at earliest, as per the HHS timeline, the LGBT community will be too preoccupied with upcoming elections to notice any loss in momentum on developing gender identity questions or unnecessarily restrictive preconditions placed on how sexual orientation questions are asked on the NHIS. Such restrictions would likely trickle down to future federal and state-level surveys that look to NHIS as the gold standard, hindering the broader roll-out of our LGBT data collection agenda.

Importantly, inclusion of LGBT questions on the NHIS is not as much an issue of the direct costs of adding new questions, as it is one of the opportunity costs of which existing questions to remove to make room for ours. There are certain limits on how much time federal employees can spend interviewing subjects, resulting in a cap on the number of questions that can be asked for the NHIS. As a result, the likelihood that the LGBT community will receive more than two questions - at least for this first go around - is highly unlikely. So despite what many of us may believe about a "whole slew of questions" being market-tested to include in one fell swoop; that's not likely to happen.

This realization presents another ENDA-like conundrum for our community, whereby the initial question asked will address only sexual orientation, if a separate gender identity is not ready for inclusion. At present, this problem seems unavoidable due to the dearth of data available on how to ask questions that accurately identify transgender people, compounded by the public's ignorance of the concept gender identity and how it's separate from sexual orientation. Moreover, the current transgender questions available are in terrible disarray and in much need of refinement and further testing before they're ready for primetime. Thus, we should now push much harder to hasten the timeline on transgender question development. Otherwise, I fear this situation may pose strife within our own ranks that could hinder initial efforts to collect data.

What to Do Now

In sum, waiting for completion of the "market-testing phase" of LGBT questions in the pipeline risks our effort being side-tracked in the middle of 2012 elections or that questions may be ultimately saddled with unnecessary restrictions. As such, I believe we need to increase pressure on Sec. Sebelius to include at least one identity-based question on sexual orientation this year and to lobby for an accelerated development of a gender identity question. These actions would be small but critical steps to lay the foundation for a future suite of questions to fully address the health needs of the entire LGBTQ community. Otherwise, there's no chance that inclusion of LGBT-related questions into the NHIS will happen this year or next - critical time lost that will negatively impact the lives and well-being of our community.

We have come together many times before to somehow overcome formidable challenges throughout our history wrought with public health crises. Now this final challenge of collecting data on our lives may be one the most important battles we face to improving the health of LGBT people and bring us out of obscurity. And in the process, we will not only promote a society more accepting of LGBT people - we will also become a healthier community.

Choi has reported that he is okay, despite having undergone what appears to be a far more harrowing and aggressive arrest than he has previously experienced during acts of civil disobedience in the US. He has since been released; however, he mentioned that the Russian citizens who were arrested with him would be detained overnight. Choi remains outside the police station in a show of solidarity with his fellow activists.

Pam Spaulding has been actively covering this story, providing regular updates and a live Twitter feed from Dan Choi. Also, for those interested, UK Gay News hosts the Moscow Pride Blog, providing a play-by-play of ongoing developments.

Earlier this spring, LGBT activists were more confident that today would mark the first legally sanctioned Pride parade in Moscow, after multiple attempts over the last several years were thwarted by the homophobic and corrupt former mayor of Moscow, Yury Luzhkov. Luzhkov had been Moscow's mayor since 1992, and was sacked last September by Russian President Dmitry Medvedev. Activists were hopeful the absence of Luzhkov would increase the likelihood of them obtaining their permit. I, along with other friends more familiar with Russian affairs, spoke to Choi shortly before his planned trip, expressing some concern, given rising levels of violence and intimidation by authorities and anti-gay groups. However, Dan seemed optimistic that it would be better this time around.

However, earlier this month, Moscow officials again rejected an application for a Pride parade, in direct violation of the Strasbourg ruling, by indicating it would pose a significant risk to public disorder. It seems Russian authorities are content to play this annual game in order to discriminate against its LGBT citizens.

On Thursday, Alekseyev and Choi joined other activists on a live, nationally televised interview/debate with Russia 1, the nation's premier, state-owned television channel. Activists, including Alekseyev, attempted to make their case, debating with a major anti-LGBT member of the Russian Duma (parliament), Alexander Hinstein, and other heads of Russian hate groups. Exasperated from the overtly biased and outright offensive behavior of the debate moderator, Vladimir Solovyov, and other anti-LGBT groups present, Alekseyev stormed off the set, followed by other LGBT activists.

Although the interview was aired in Russia's eastern provinces thousands of miles from Moscow, it was reportedly replaced by another, less volatile activist's interview in the capital later that evening.

Another major element of concern for activists has been the opposition from neo-Nazis and other anti-LGBT groups usually donned in black vests, reported to have been waiting to violently clash with gay-activists at Moscow's City Hall. Alekseyev indicated, he "would not be surprised [if this were] a provocation from the authorities to justify their illegal ban on the basis that the security cannot be guaranteed." It is reported that Moscow police have also detained counter-demonstrators after they initiated clashes with the gay-activists.

City officials said they had received dozens of petitions from these religious and social groups asking them not to permit the parade on the grounds that it contradicts traditional Russian morality. However, one can't help but wonder how much of this violent opposition was informally sanctioned by the government officials, as opposed to stemming entirely from isolated, independent efforts by these anti-LGBT groups. These hate groups pose as a convenient cover for the local government's homophobic inaction and unwillingness to defend peaceful demonstrators.

Meanwhile, back in the US there are reports that the telephone switchboard at the Russian Embassy in DC has been swamped over the past 24 hours with calls of support for Moscow Pride and the activists.

I feel this volatile situation is certainly escalating and has the potential to send shock waves throughout Russia; but other friends more familiar with Russian politics feel that the Russian state's stranglehold on the media and control of the narrative around LGBT rights will likely suppress these attempts at progress. Alekseyev is reported to have said on Thursday, prior to his televised appearance, "The next 48 hours will shape the future of Moscow Pride and LGBT community in Russia in general - and I am not joking."

We'll have to see how this story unfolds and how the international community responds; lest we risk repeating this now annual event of brutality towards LGBT people by the Russian government and social/religious hate groups, alike.

Choi has written an open letter to Secretary of State, Hillary Clinton, which he has agreed to personally deliver, with all of your signatures, to the State Department upon his return to Washington. Presently, the United States government has said nothing about the events unfolding in Russia. We can make a difference here, with your help.

Sign Dan Choi's open letter to Secretary Clinton urging her to speak out against the violence in Moscow at AmericaBlog.

In the meantime, my thoughts and admiration are with Dan Choi and the other brave Russian citizens standing up for their civil rights in the face of such terrible risk of violence.

As highlighted in the recent National HIV/AIDS Strategy, the plight of gay and bisexual men has taken a turn for the worse over the past decade. Once again, we have reached a tipping point in the course of this epidemic with the imminent rise of another major wave of new HIV infections on the horizon - the likes of which we have not seen since the early nineties.

While many factors are to blame for this new epidemic of HIV among gay men (including a growing complacency around the disease and the threat it still poses to one's health; the advent of the internet, facilitating quick and often anonymous sex; and, until recently, the lack of a coordinated domestic plan to fight HIV); gone from our memories, it seems, is a time when the gay men rallied together to fight for our survival - galvanized by the death and destruction that HIV/AIDS inflicts on our community. Thus, as our communal urgency around the disease has waxed and waned; so has our perceived need to protect each other and ourselves.

In D.C. the picture is especially grim. The recent National HIV Behavioral Surveillance (NHBS) study revealed that at least 14 percent of local gay men surveyed tested positive for HIV, with prevalence as high as 25 percent among African-Americans. That said, only 57.4 percent of those sampled reported using a condom at their last anal intercourse. Considering our community's history with HIV/AIDS, we should know better; yet for whatever reason, HIV/AIDS continues to remain an undeniably "gay disease," begging the question: How have we, a community so impacted by this epidemic over the past three decades, backslid so terribly in preventing its spread?

Perhaps it's because so many of those who would have passed on memories of the devastation have since died from the disease; while others may say it's because we've been so distracted lately by numerous other LGBT civil rights issues - from same-sex marriage to the repeal of DADT. Or maybe it's because those who have survived are so exhausted from practicing and preaching safer sex that their decades of restraint have finally given way to HIV "prevention fatigue."

Regardless of the reason, today we find a new generation of gay men that have experienced their sexual debut after the advent of highly-active antiretroviral therapy and never endured the fear and suffering of those who lived and died only decades before them. They never attended weekly funerals or experienced the pain of having their social circles decimated over night. Today, when just one young gay man dies, it's a tragedy. Sadly, back then it was commonplace. As a result, the new generation remains apathetic toward this disease, partly out of ignorance about what it was like back then. Well, they may soon find out, if something isn't done to stem HIV's alarming resurgence.

Yet despite the bleak situation the gay community currently faces, we now have a much broader arsenal of information and technology to protect ourselves than ever before. Knowledge is power; but this knowledge does us little good if we're unwilling to educate ourselves and our fellow gay men. As such, in recognition of National Gay Men's HIV Awareness Day, following are 6 important, often-overlooked, facts that all gay men should know about this disease and the new epidemic we now face.

1. Newly infected individuals who are still within their "window period" (< 3 months since being infected) are both most infectious (likely to transmit the virus to someone else) and unlikely to test positive for the virus: In a perverse twist of fortune, HIV is most likely to be transmitted by newly infected people, who will likely continue to receive false-negative results from antibody screening tests, until they seroconvert. In the early stages of HIV infection, the virus expands rapidly, seeding throughout one's body, as his/her immune system has yet to mount an appropriate response. Only when this robust response occurs, producing HIV-specific antibodies, will a screening test identify someone as positive. In the meantime, one's viral load becomes astronomically high, dramatically increasing the chance of transmitting the virus, while at the same time being missed by our increasingly sensitive HIV tests. Thus, at times when people may feel most safe, they may be at most risk of infection. So close those windows!
2. The Advent of PEP: Post-exposure prophylaxis (PEP) was initially developed for healthcare workers who were accidentally exposed to HIV, largely through needle sticks. As a result, it was found that if one followed a month-long regimen of anti-retroviral therapy, begun within 72 hours of the exposure, his/her chance of developing an infection was dramatically reduced. Thus, if the condom ever breaks or if you believe you may have been exposed to HIV, get yourself to the nearest clinic or department of health to begin PEP within 72 hours. This gift, however, is not to be abused, as it may breed resistance strains of HIV, if used indiscriminately. It is also quite costly and may have adverse effects on one's body. So be careful; but know PEP is there in case of emergency.
3. The new ins and outs of HIV testing - What routine testing means for us: Stigma around HIV testing will never end, forever remaining a barrier, unless we routinely ask for the test and routinely expect it from our providers. Despite drastic changes in 2006 to the CDC HIV testing guidelines, shifting the recommendation from "opt-in" to "opt-out" testing and ending unnecessary written consent requirements, as well as the need for pre- and post- test counseling, many primary care providers still refuse to offer testing routinely to their patients. In high-risk communities, such as the District of Columbia, the CDC recommends that all individuals, age 13-64, receive a HIV test as a routine part of care - analogous to a blood pressure or cholesterol test. Yet sadly, most physicians still use arcane, risk-based approaches to profile patients and only test those they believe to be at risk. As a result, among those gay men who tested newly positive in the recent NHBS study, who had seen a doctor with in the past year, only slightly more than a third had been offered an HIV test by their healthcare providers. These cases are missed opportunities for early treatment and care. This has to change; so ask your primary care provider to routinely offer the test.
4. You can do everything "right" and still become infected or everything "wrong" and not become infected: It's often difficult for us "non-sciency" types to get our heads around the probabilities that are associated with a particular risk behavior and the transmission of HIV. We tend to have a list in our minds of behaviors to avoid (i.e. unprotected anal sex, using oil-based lube, sharing needles etc.) and behaviors to follow (i.e. using condoms, knowing one's partner's status, etc.) and believe that acting accordingly necessarily means we will never become infected with HIV. And tragically, we'd be very wrong. Often I've heard gay men say that's it's only when one bleeds during anal sex that HIV transmission is likely. But that's just not true. Although, HIV is hard to transmit, one must remember that population level statistics never reduce to individual actions and moments in time. Every sexual encounter presents an opportunity for transmission, as there is no such thing as safe sex, only safer sex.
5. Condoms 101: We have all seen the banana demonstrations and think we know how to use a condom. But bear with me, as there are a few pointers that many gay men often miss or forget. In particular... Always check to see if the condom has expired. Never tear a condom wrapper off with your teeth or sharp object. Never flip a condom over, if you begin to don it the wrong way. Only use condom-safe lube that is water- or silicon-based, never oil-based. Always use lube during anal sex. Know that the verdict is still out on using female condoms for anal sex. Be weary of being over-optimistic and using condoms that are too large. If you're not a "Magnum man," the condom is more likely to slip or break if you use an XL-size. Know that condoms are sexy. Don't believe me? Check out this NSWF educational website: www.DCFukit.org.
6. Take action and have hope: For the younger generation of gay men, it's an accident of history that we are fortunate enough to be living in 2010, instead of 1980. If that were the case, well over half of us would be dead or dying within a few years. We're lucky; and we owe it to ourselves and the future generation of gay men to lower our prevalence of HIV; so we may one be able to live in less fear. If you lived through the eighties and nineties unscathed, share your story with younger gay men. They need to hear it. And finally, take action. One way to help is by volunteering for a HIV vaccine research study at one of many sites throughout the country. Currently, the NIH is recruiting 1350 MSM for a vaccine trial that could one day turn the tide on this epidemic. They need your help. Access the following link to find out how you can become involved: hopetakesaction.org.

Well, he has, with the July 14 release of the final strategy and implementation plan for tackling the domestic HIV/AIDS crisis. Although members of the HIV/AIDS community had much to celebrate on Tuesday, many remained frustrated that the plan took so long to pull together and fell so far short on adequately addressing some of the most urgent HIV/AIDS treatment and prevention needs that America now faces.

At the time he was saddled with this tremendous responsibility, he was still sorely under-staffed at ONAP and already behind schedule according to many community advocates who had waited years for such a plan; so it's a wonder that in just over a year he and his team were able to synthesize such a thorough and comprehensive strategy and implementation plan. And for rising to that challenge, they should be commended.

This undertaking marks the first successful attempt at such a national strategy, after previous failures and false starts. The most recent attempt under the Clinton administration failed to be implemented and went largely unnoticed by much of the community. As a result, this time around, Crowley was able to build on the lessons learned from the past as well as from the President's Emergency Plan For AIDS Relief (PEPFAR). In particular, this time ONAP went into the community to ask the front-line advocates, service providers, and HIV-positive individuals their thoughts on what the strategy should include. Undoubtedly, this open-community process helped to establish the buy-in needed for this strategy to come to fruition and for people to actually pay attention to it.

Thus, having met a key "ask" of HIV/AIDS advocates during the 2008 presidential campaign by successfully raising the profile of HIV/AIDS on the national stage, the foundation to make some significant inroads into the fight against this epidemic has been laid, that is, assuming that we get the implementation right.

The Current State of the HIV/AIDS Crisis

Although tremendous headway was made on the domestic fight against HIV/AIDS in the early 1990s, we have backslid terribly in the past decade. Currently, more than 1.1 million Americans are HIV positive, a prevalence that will continue to grow as long as our incidence holds steady at an estimated 56,000 new infections per year.

On Tuesday, HHS Secretary Kathleen Sebelius noted, "We're merely keeping pace, when we should be gaining ground." For in some US cities, she noted, it is estimated that "nearly half of gay African-American men are HIV positive," a population at the nexus of the racial and LGBT-health disparities that have allowed the epidemic expand, unabated in these communities, for the past three decades.

The Strategy

The NHAS sets three goals that hinge on the key elements of prevention, treatment, and equitable access to quality care:

1. Reduce new HIV infections;
2. Increase access to care for people living with HIV/AIDS and optimize health outcomes; and
3. Reduce HIV-related health disparities.

All of these goals combine in effort to achieve the Vision of the NHAS:

The United States will become a place where new HIV infections are rare
and when they do occur, every person, regardless of age, gender, race/ethnicity,
sexual orientation, gender identity or socio-economic circumstance, will have
unfettered access to high quality, life-extending care, free from stigma and
discrimination.

The NHAS also addresses social factors like stigma and discrimination that lead to poor health outcomes and increased risk of infection. Thus, with concrete goals, timelines, measurable outcomes and a clear vision as a guide, the real work now begins.

The Community's Initial Response

Tuesday's jubilant press conference was tempered by some advocates' frustrations with a strategy that they feel has no financial teeth and does not go far enough to address some of the community's most pressing concerns. Moreover, the Administration's goal of reducing the annual number of new HIV infections by 25 percent within the next five years has been deemed too conservative by critics who also claim the timetables should be far more aggressive.

Crowley countered these claims by saying that in the past, goals were far too unrealistic, and that a 25 percent reduction is a far more obtainable. Regardless, others contend that setting such benchmarks is moot, since at this point we still do not have the reliable metrics, data capacity and an epidemiological infrastructure to accurately gauge and monitor progress in a meaningful way that permits us to adjust our response to this rapidly evolving epidemic.

Aside from these criticisms, the general consensus within the HIV/AIDS community appears to be that the strategy is fine, but that the implementation plan could be much more robust. Although the NHAS calls for a more coordinated, multilateral response from all levels of the private and non-profit sectors and across government agencies, to align resources, streamline processes, and focus attention on populations of greatest need and issues of most importance, none of this can happen if organizations are not funded to begin with.

Although most of the HIV/AIDS community seems to have gotten on board with the NHAS, and feels that its release is certainly a positive sign, many are incensed that we have required so many other countries to have a similar strategy as a prerequisite to apply for PEPFAR funds, when we have not had one until now. Even worse, in order to receive funds, we also required these same countries to demonstrate that at least a third of their prevention programing adhered to Republican-influenced, unscientific abstinence-only interventions.

These same vestiges of the Jesse Helms-era are finally starting to dissipate in this country, largely through recent legislative developments (i.e. the end to the ban on federal funding for syringe exchange programs and increased youth access to condoms) and the NHAS's explicit support of using only evidence-based medical and public health interventions in the future.

Still, translation of this evidence into future policy around HIV/AIDS prevention and treatment will require an unusually frank, especially for the government, assessment of existing policies and programs and how they must be changed to adopt more scientifically rigorous, harm reduction-based approaches - a philosophy not too popular with political conservatives, despite what the science says.

This is particularly important in prevention, if we are ever to provide people with the supplies they need to protect themselves, whether they be condoms or clean needles for injection drug use. As such, the first wave of $30 million in funding announced by Secretary Sebelius, is to be designated for prevention efforts carried out by clinics and other health service and prevention organizations in communities most in need.

What the NHAS Means for the LGBT Community

In addressing the first of the three goals outlined by the NHAS, reducing new HIV infections, gay and bisexual men are identified as the population at highest risk of infection, to which the nation must "re-orient [its] efforts by giving much more attention and resources" to stem the spread of the disease within this community. This past March, the CDC released its first baseline estimates of the size of MSM population, finally giving gay and bisexual (or technically "men who have sex with men") a denominator, by which to compare HIV rates to other populations.

Alarmingly, gay men are believed to comprise approximately 2 percent of the U.S. population, yet account for 53 percent of new HIV infections. In 2006, white gay men still lead the pack, with an estimated incidence of 13,230 new infections per year. Although there were fewer new infections for Black (10,130) and Latino (5,710) gay men, they continue to bear a far more disproportionate risk of infection, with their rates growing most rapidly. To put these figures into perspective, men who have sex with men (MSM) in America are at 44 to 86 times more at risk of becoming infected with HIV than their heterosexual counterparts, and have 40 to 77 times the risk of women. Further sobering statistics reveal:

• Gay and bisexual men of all races are the only group in the United States where the estimated number of new HIV infections is rising annually.
• High rates of HIV among gay men are found not only in large urban areas. More than half of all AIDS cases diagnosed in the United States are among gay and bisexual men irrespective of town or city size.
• Due largely to a total lack of past prevention and treatment efforts targeting transgender individuals, this group is also at terribly high risk for HIV infection, with studies estimating HIV prevalence within the transgender population to be 30 percent.

Of note, has been the administration's refreshingly frank acknowledgment of how the epidemic has disproportionately impacted the "gay and bisexual" community in the past, in part due to governmental inaction. Such statements are a far cry from the Reagan administration's refusal to even mention the word AIDS until 1987, after tens of thousands of largely gay men already had died. In contrast, with this administration the Assistant HHS Secretary, Dr. Howard Koh, responsible for implementing the NHAS, mentioned on Tuesday plans to "initiate consultations with LGBT leaders to continue to advance health promotion" in the area of HIV/AIDS.

Nonetheless, it is also worth considering whether ulterior motives might be playing a role in how the administration has handled the LGBT community through the release of the NHAS. In both a recent New York Times and Washington Post article, the NHAS was curiously billed as a victory for gay rights, amidst pressure from the LGBT community to repeal DADT.

According to these articles, it seems possible that the administration is using the issue of HIV/AIDS to say that the White House is paying greater attention to gay rights issues, when, in reality, the strategy is more a product of HIV/AIDS organizations dating back to 2007 than of any collective LGBT process. In truth, many HIV/AIDS organizations have had to push to keep LGBT groups more engaged on the NHAS, while so many other LGBT rights issues have distracted them from the topic in recent years.

Although the LGBT community will always remain inextricably tied to the destiny of the HIV/AIDS epidemic, the danger in the Administration's characterization of the NHAS as a win for LGBT rights is that it risks reducing the our community's health care "asks" to solely focus on HIV/AIDS, when in fact, a plethora of other health care disparities plague our community far beyond the scope of this crisis.

In particular, our mental health and substance abuse services are tragically insufficient, compounded by dramatically higher risk of tobacco and alcohol use and reduced access to sensitive primary care. Additionally, transgender health issues have been neglected to an embarrassing degree in this country; not to mention that we are not even being appropriately counted in our health care statistics.

Given the level of effort that has been made within the gay community over the years to stem the spread of this disease, the data on MSM incidence for HIV is tragic and depressing. Moreover, it suggests a need not just for a realignment of resources to target efforts with this population, but also a need to rethink our strategies and begin to assess the structural and social changes that will be needed to achieve long-term behavior change in this community. New and creative interventions must be explored for our community, which has been blasted into submission by so many safer sex messages over the years, that "prevention fatigue" has become just as pervasive among gay men as the disease, itself.

Show Me the Money

Finally, it is worth repeating that the chief concern of the HIV/AIDS community is that without new financial resources being identified, many are left quite skeptical about its successful implementation, especially considering the tough fiscal times we now face.

The administration somewhat side-steps this matter by underscoring the need to first refine current policies, making the HIV/AIDS treatment and prevention enterprise far more efficient and cost-effective, with scarce funds made available to populations in which the disease is emerging or spreading most rapidly. Although this approach is necessary for a robust and sustainable plan, it does little to address many of the urgent shortfalls we currently faces in the way of treatment, manifested by numerous wait-lists for ADAP and housing assistance that have recently sprung up throughout the country.

Earlier this year, South Carolina cut all of its ADAP funding, while North Carolina continues to maintain the longest wait-list for HIV drug assistance in the country, boasting more than 800 of the nearly 2,300 people currently waiting. With the economic downturn, states have increasingly been forced to cut their contributions to the program as the number of people seeking government assistance continues to climb. As such, the wait-list figure is expected to balloon in the near future, with an estimated 300 people being added per month, in Florida alone.

Although Secretary Sebelius has promised $25 million in emergency funding to cover these shortfalls, advocates claim that this sum will only provide for one-fifth of the estimated $126 million needed to cover all of those on wait-lists at present. Despite anticipated future Medicaid expansions that will help to cover much of ADAP needs, most of these changes will not take place until 2014, requiring some other source funding to bridge the gap in the meantime.

Charles King, Director of Housing Works, expressed great frustration at the NHAS, calling it a "step backwards" for its failure to sufficiently address the urgent drug assistance and housing shortfalls. Studies have shown that insufficient housing for HIV positive individuals is one of the most significant indicators of poor health outcomes, and the situation must be addressed now, before it gets much worse. Currently in Washington, DC, the wait-list is more than 700 people long.

Learning from PEPFAR

In the late 1990s the United States government was lambasted by the HIV/AIDS community for giving pennies to the international HIV/AIDS crisis, to the tune of several hundred million dollars in international aid, when the need was on a scale of orders of magnitude greater. When I met with a foreign affairs staffer of Senator Jesse Helms in early 2001, he said the Senator staunchly opposed increased funding on the grounds that it would not do any good and would be largely wasted in countries with such poor medical infrastructure and corrupt governments. Then Bono, of U2 fame, met with the him and spoke of the thousands of innocent orphans dying each day in Africa, and suddenly the Senator had a change of heart.

With the Senator's support and blessing, George W. Bush, soon announced the beginning of PEPFAR, which has become a sterling example of how to appropriately scale-up funding for treatment and prevention efforts in resource poor environments. Considering the comparative wealth of resources and infrastructure we already have here, I am confident that similar successes could be realized in no time in the US, if we are only more generous with our funds and wise about how we spend our money.

Although the NHAS directs the State Department to report on best practices from PEPFAR within the next 150 days to inform its efficient and timely implementation, it fails to recognize the most obvious lesson learned from the past decade of ramping up PEPFAR around the world: It was not until the US government really put some skin in the game through an investment of billions of dollars that soon became a commitment of $15 billion over five years, combined with a methodical development of infrastructure in tandem with the growing infusion of aid, that the international community seriously joined in the effort. Similarly, the government could play a similar role in kick-starting the investment into its own NHAS.

The Path Forward

The NHAS is a significant milestone in the history of the epidemic not only for its attempt to marshal our country's collective efforts and resources to finally turn the tide on this damned disease, but also in its symbolism as a plan of common purpose. HIV/AIDS divides and conquers communities. It thrives on the infighting created by pitting us against each other as we vie for limited resources and attention.

Moreover, the history of the epidemic is replete with instances in which the responsibility for the disease was placed on one group or the other. HIV/AIDS is a "gay disease," a "Haitian disease," a "disease of drug users and prostitutes," a "black disease," an "African disease," were the epithets that marked the spread of the epidemic throughout the earth, as the blame was shifted from one group to the next, instilling a sense of complacency in others until it was their turn to bear the blame.

At this pivotal juncture in the history of HIV/AIDS, it would serve us well to remember the words of William Budd, a seventeenth century English physician and contemporary of John Snow, the famed the father of epidemiology, credited with halting London's 1848 cholera epidemic by removing the handle of the Broad Street pump. Budd's work with the poor who suffered most from cholera gave him an appreciation of how inequities in access to health care, wealth and other social disparities impact the health of all of society.

By reason of our common humanity, we are all more nearly related here than we are apt to think. The members of the great human family are, in fact, bound together by a thousand secret ties, of whose existence the world in general little dreams. And he that was never yet connected with his poorer neighbor by deeds of Charity or Love, may one day find, when it is too late, that he is connected with him by a bond which may bring them both, at once, to a common grave.

We a have a plan, and now we must put it into action.

Download the National HIV/AIDS Strategy. Download the NHAS Federal Implementation Plan.

As such, Terry and I have chosen to focus our prevention efforts on gay and bisexual men; particularly younger men, who have no memory of HIV/AIDS as a rapidly fatal and debilitating disease and who are under the false impression that HIV is no longer life threatening.

This is a population that tends to ignore traditional public health messaging, so we've had to "get creative" to attract some attention. The goals of our campaign are:

1. To reduce the spread of HIV and other sexually transmitted infections;


2. To educate MSM about the risks of of sexually transmitted diseases in a straight-forward, no-nonsense fashion; and


3. To promote responsible sexuality in the gay and bisexual community.

But due to proposed drastic cuts in the District of Columbia budget, the program is at-risk, just like those we are trying to help.

Metro Weekly, Washington's gay and lesbian newsmagazine, featured an article about our campaign.

In the past two months, with the help of a small army of volunteers, we have distributed nearly 200,000 condoms. The bulk of these condoms have been distributed in safer sex kits via customized dispensers in two of the major clubs in the city, with many more distributed during Capital Pride in June.

The response to our edgy and sexy social messaging campaign has been tremendous, as the safer sex kits have literally been flying out of the dispensers. We are both pleased with, but also overwhelmed, by the demand for our safe sex kits. And despite the extremely low price per kit (about 5 cents), high demand means we must do some serious fundraising to sustain and grow the project. To that end, we have applied for several local grants and are beginning to solicit donations.

Unfortunately, some of you may have recently learned through the Washington Post that in order to close the District's budget deficit in 2010, the DC Council has proposed to cut completely all $20 million in earmarks to numerous non-profits in the city, including the DC Center, which serves as an umbrella organization for a number of fledging LGBT groups - including the HIV Prevention Working Group, DC for Marriage, and Gays and Lesbians Opposing Violence (GLOV). Because our safer sex program was slated to benefit from funds appropriated to the Center, we're now really on our own with respect to paying for the program!

Even worse, these devastating cuts to the Center's budget make its financial future very uncertain. Earlier this year, the Center was to receive $500,000 to help finance the purchase of a new property; as it has currently outgrown its current location on Fourteenth Street. Then last week, under pressure by Mayor Fenty, that number was slashed to $200,000, when $12 million in earmarks were cut by the Council - eliminating 60 percent of most organizations' funds for the coming year.

Earlier this week, Council Chairman Vincent C. Gray said he wants to remove the remaining $8 million from the budget that was to go towards earmarks - meaning the DC Center will not only receive $0 for the new building, but it will also suffer deep cuts to other grant monies it was counting on to finance a number of its programs, such as the activities of the Crystal Meth Working Group.

David Mariner, current Director of the DC Center, has written an excellent post for The New Gay on the Center's current plight, encouraging DC residents to contact their Council members now to prevent the organization from possibly having to close its doors.

Although the DC government would continue to provide the condoms and lubricant packs to us for free, despite the proposed budget cuts, we would still need to cover the cost of packing them together in our kits, installing the dispensers, distribution, and education - something we cannot sustain without your support.

Of course, that's where you folks come in. We are seeking donations from you to help us continue this cost-effective and vital program.

In this case, you do get quite a bit of "bang for your donated buck" (pun intended). A ten dollar per month fully tax deductible donation through the D.C. Center will allow us to pack 2400 safer sex kits over the next year. If just 100 people sign on as monthly $10 sponsors, we will be able to meet our goal of producing 240,000 safer sex kits in the next 12 months!

Please consider making a monthly or a one time donation to our project through this secure site.

I'm the sort of person who might read a fundraising plea like this, think it's a good idea, and then forget to ever send in the donation.

So, I'm urging you, especially due to the current funding shortfalls of the DC Center, to please click the provided link right now and sign up to help us promote responsible sexuality among gay and bisexual men. Any amount would be great, as with this campaign, a little goes a long way. Not a dime goes anywhere but to pay to make the safer sex kits.

You can read more about our efforts below. Please note that although the posts below are fine, the links to the FUK!T website within those posts will show explicit material not necessarily suited for viewing at work or other locations.

• FUK!T. Use a TOOLK!T: A Safer Sex Kit for Men Who Have Sex with Men
• DC Centre in for a Capital Pride: Safer Sex Campaign Receives Manchester LGF "Homo Heroes Award"
• Dan O'Neill and Dr. Terence Gerace: The New Gay Interview

In light of these drastic budget cuts, please take the time to make a one-time or monthly donation for a program that makes a real difference in people's lives, every day in our nation's capital - and unfortunately the HIV/AIDS capital of America.

Of course, I timed my trek perfectly, meeting a crushing onslaught of Washington Nationals fans (I've heard rumors that their numbers have dwindled... not so much) as they made their way to the stadium for Saturday night's game. Needless to say, I looked rather out of place in my pristine white attire against the dingy backdrop of the Metro Station and the boisterous, motley-colored crowd.

I startled some children who probably mistook me for a ghost, as I pushed my way through the masses, trying unsuccessfully to remain inconspicuous. But I soon arrived at my destination, unmarred and ready for an Experience I wouldn't soon forget.

Soon after my arrival, I had a brief chance to interview Abdur-Rahim Briggs, founder of the Affair and Board Director of the Al Sura Foundation. Over the din of the mingling VIP reception crowd, we discussed the origins of the event, its recent hiatus in 2008 and its future trajectory.

After his twin-brother, Mark, tested positive for HIV in 1997, Briggs felt compelled to bring the African-American community together both to increase awareness of this mounting scourge among black gay and bisexual men and raise funds to support local organizations doing work in this area.

As such, the first White Attire Affair was held in Briggs' backyard in 1999 and designated Us Helping Us as the sole beneficiary. It continued as an annual barbeque event until 2001, at which time Briggs teamed up with producer, Alvin B. King, of KING & I Productions. Under the auspices of the UMMAH Endowment Fund and King's direction, from 2002 until 2007 the White Attire Affair enjoyed a period of exponential growth that elevated it to a level of national recognition. By the summer of its ninth year, the event was attended by thousands of mostly LGBT African Americans.

But by that time, the mission of the White Attire Affair had long strayed from what Briggs had originally intended. Somehow it had morphed into a glitzy, megawatt production that he felt paid lip service to the issues it supported and gave back far too little to the community it sought to strengthen in the face of such a terrible epidemic. He knew something had to change.

Ron Simmons, a friend of Briggs and Executive Director of Us Helping Us, also recognized that something was awry, confiding in him that a change in leadership was long past due. He offered some harsh criticism, in a 2007 Washington Blade article, of what he felt the event had become:

"I don't believe that it really helps us," Simmons [said] about the Affair's work for black men with HIV. "You put on an event that costs close to a quarter million dollars and when the smoke clears, the agency gets $10,000, and the people who are promoting it get the same. It sounds like a business partnership."

Saturday evening, Briggs recounted the fateful conversation he had with Simmons in 2007, in which he was advised that the Affair had lost its way by shifting its focus away from a grass-roots campaign that raised awareness around HIV/AIDS among local gay and bisexual black men towards a large scale social marketing event with a diluted message and purpose.

According to Simmons, the root of the problem among black men who have sex with men (MSM) was not solely their departure from safer sex practices; rather, it was the loss of affirmation that their lives were worth protecting. Otherwise, he argued, if black gay men don't care or have pride in who they are, it doesn't matter whether they know how to protect themselves or not. Taking heed of Simmons' advice and with his blessing, Briggs set out to relaunch the White Attire Affair under a new organization with a new mission, again enlisting the help of producer, Alvin B. King.

After a year hiatus in 2008, during which Briggs "cleaned house" in order to set the organization back on the right track, the White Attire Affair was reborn on Saturday under the aegis of the newly formed entity, Al Sura, literally meaning "new chapter" in Arabic.

Although the first era of the Affair was dedicated to Briggs' brother, Mark; this time it would be in honor of Briggs' close friend, Patrick Kahozi, who had recently passed away. Additionally, Al Sura Foundation's new web-based research forum for HIV/AIDS-urban related studies, the S. Patrick Kahozi Institute, was named in his honor.

Aptly, the phoenix, a symbol that adorns the Al Sura website and is synonymous with new beginnings and rebirth, was visible throughout the evening, as a reminder of the White Attire Affair's new chapter and mission to refocus and recommit its efforts to promote HIV/AIDS awareness within the African-American community. And if Saturday night's success is any indication, its new management team can rest assured that Al Sura will certainly be successful in this mission.

The 2009 Affair was a true celebration of black gay culture, bringing it out of the darkness and shining on it a bright white light of affirmation. It was a firm step in the direction of turning the tide on the skyrocketing incidence of HIV, reflecting Al Sura's four core values of integrity, trust, connection and cultural awareness, most critical to this effort.

Briggs certainly got it right this time around in his charge to "recommit [Al Sura's] journey to the cause of HIV." With great emotion and enthusiasm he quoted Barack Obama, saying that "If there's any doubt that God is with us in this House; well tonight, here's your answer."

And I'd have to agree. Although I haven't attended a recent White Attire Affair for comparison, I would imagine that whatever was lost in years past seemed quite palpable in that moment and set the stage for a fantastic evening ahead and hope for the future of black gay and bisexual men in DC.

The Affair began with a lavish VIP reception from 7-9pm, at which new and old friends, many from the HIV prevention community, were able to socialize before heading up to the main event, on the roof-top of the host building.

The VIP reception was held in an elegantly decorated private courtyard and included live music from two very talented up-and-coming performers - the eclectic and soothing sounds of Nhojj, followed by the vibrant and soulful melodies of Sylver Logan Sharpe.

After his set, I had a quick moment to interview Nhojj to find out his motivation for performing at the Affair.

Having grown up in Guyana, Nhojj moved to New York City to study economics at NYU, and felt drawn to stay there for fifteen years, in part, due to its embrace of cultural and sexual diversity - something he found lacking in his home country. Nhojj lost two close friends to HIV/AIDS, which inspired him to come down from New York to "donate his talents" to the Affair. On the heels of releasing his fourth studio album, Soul Comfort, this Out Music Award nominee, was happy to support this worthwhile cause that promotes acceptance within the gay and bisexual black community - what drew him to stay in this country in the first place.

Rounding off the list of special guests was the author, M.W. Moore, who recently completed a semi-autobiographical trilogy about his life as an NCAA track star, model, and college graduate who turned to a life of crime that landed him in prison for six years. His struggles with his HIV status and sexuality that drove down this path, make his powerful story particularly relevant to the theme of the Affair. He began writing his story in 1997, while incarcerated.

The three novels, For What I Hate I Do, Internal Chaos, and most recently, An About Face, "detail the conflicts, consequences of sexual addictions, drug binges and imprisonment suffered by Moore, who grew up in a respectable middle-class community." He was present to sign books and answer questions about his life, in effort to help young black men avoid the pitfalls he encountered.

Back up on the roof-top, the DJ spun some smooth beats while a warm breeze wafted in from the Potomac. The bright glow of the near-by stadium lights energized the night sky, as models donning the latest in avant-guard fashion from New York, Chicago, Philadelphia, and DC, sexily sauntered through the the crowd.

In the words of Rahim Briggs, the White Attire Affair is far more than a fundraiser; it's a celebration of the past year's growth in the HIV prevention community and progress made in the fight against HIV/AIDS within DC and the African American community, in particular.

As part of this celebration, Al Sura presented four awards to two individuals and two organizations in recognition of their work on HIV/AIDS in the community.

The first award recipient of the night was Christopher Barnhill, a care advocate for MetroTEEN AIDS, which also received one of the organizational awards this year. Barnhill received the volunteer award for his courageous commitment to educating his community about how to live a healthy life with HIV. His mother died of AIDS when he was quite young. At 16 years old, he took a test to find he was also HIV positive, and soon after learned that he had been positive since birth. Raised by his step-mother and grandmother, Barnhill "feels rich" now having lived 22 years with the disease, and fulfilled in his life's work - his "purpose."

Earlier in the evening, I noticed an elderly woman sitting quietly in the corner. When asked why she had come, she replied with a beaming smile, "...because of my grandson. I'm so proud of him."

Not long after, Grandma Boyd presented her grandson, Barnhill, with the Al Sura volunteer award. Standing alongside Christopher's step-mother, she reminded the audience of the importance of including everyone in the fight against AIDS. Her simple but profound statement spoke volumes of the need for us to push each other to be open and honest with ourselves and not discount each other's willingness to show compassion to fight this disease. It was one of the highlights of the evening.

Ron Simmons presented the lifetime achievement award to Bishop Rainey Cheeks, founder of Us Helping Us and Inner Light Ministry Church - a safe haven for LGBT African Americans in DC. Bishop Cheeks, who was diagnosed with AIDS in 1982, spoke eloquently about the effect HIV has had in his community and the state of the crisis today. "HIV isn't asking of the church anything that it shouldn't already be doing," he said. "My mission this year is to get the church to stop just talking about HIV and start doing something." He continued by challenging churches in DC to begin services each Sunday by reading HIV statistics and providing resources and information for people to get tested or seek treatment.

In line with the evening's theme of inclusiveness, Briggs presented the final award of the evening to Transgender Health Empowerment (T.H.E.) along with a $10,000 check of funds raised that evening. Briggs enthusiastically declared the importance of including their transgender brothers and sisters, saying "they are part of our family and will no longer be ignored."

Brian Watson received the award and check on behalf of the organization and spoke of the significance of choosing to include the transgender community, which has for too long been marginalized. He said the generous donation would go to support the Wanda Alston House of T.H.E., serving all LGBT youth in need.

At face value, the White Attire Affair might appear to be just another swanky fundraiser for a disproportionately afflicted niche population, in this case black gay and bisexual men. But after a short time, I realized how wrong that cursory assessment was. Young and old, black and white, positive and negative - a grandmother, a musician from Guyana, a drag queen, an NCAA track star-turned-criminal-turned-author - the rich lives and stories of those infected and affected by HIV in this diverse community was boundless. As one of a handful of white people attending the event, I could have felt awkward or out of place; but that was never the case, as I felt nothing but welcome and part of this community.

As I left the Affair later in the evening, I was struck by the resilience of this community in the face of such a devastating epidemic. The community of gay and bisexual men has already been through so much over the past few decades; but black men, in particular, are swiftly becoming the most disproportionately affected among us.

A recent Washington Post artilce details the devastation the HIV is having on the nation's African-American community, especially among young black MSM.

Although only 12 percent of the US population is comprised of blacks, they account for 46 percent of those living with HIV/AIDS and 45 percent of the 56,300 estimated new infections that occur each year. In 2006, 10,445 or 18.55 percent of the estmated new incidence occurred among black MSM.

In particular, Kevin Fenton, of the National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention at the CDC, said that young black MSM aged 13-29 account for more new HIV infections than any other age or racial group of MSM. With 6.5 of all black men testing HIV positive in the District, MSM make up the lion's share of the black community's cases, accoridng to the DC HIV/AIDS Epidemiology Update Report 2008.

By the end of this year, the National HIV Behavioral Surveillance (NHBS) report should be out, depending on when the mayor's office releases it to the public. The next NHBS report will focus on MSM; and it's my guess, it will be reveal some pretty sobering statistics, especially within the African American community. But I have faith that with Al Sura's rebirth as an organization committed to empowering black men of DC and the HIV/AIDS organizations that serve them to confront this epidemic head-on, black men will come to more fully embrace their lives and sexualities with a new-found fervor of integrity, trust, connectedness, and cultural awareness. And this will mark the beginning of the end for HIV.

Already, Al Sura has set its course to walk the walk. In its first year, it has charged its members to:

• Sponsor Leadership Trainings and Conferences: We seek to train a new generation of HIV/AIDS activists to become public advocates and change agents within their own communities.
• Research and Publish White Papers on HIV/AIDS: We seek to provide deeper insight into the multiple urban issues of health and social justice issues as the relate to Black communities and HIV/AIDS.
• Engage in Coalition Building: We seek to connect ethnic/racial minority groups together along with their yet to be discovered allies in a cohesive strategy to end HIV/AIDS.
• Expand HIV/AIDS Funding: We seek to discover new sources of energy and funds for HIV advocacy, research and direct services to men, women and youth in need.

I look forward to attending next year's White Attire Affair and seeing the positive impact it has on the local community of gay and bisexual black men. The 2009 Affair certainly gives me hope for the future.

In the coming weeks, the health reform debate is sure to hit fever-pitch as decisions are made over the most contentious elements of the vying proposals. And it is in this context, during the committees' attempts to merge and vote on their respective bills, that LGBT Americans must struggle to find a voice to ensure their demands are heard.

Because the stakes are so high, the sense of urgency is so apparent, and the process is so complex, the needs of our community are in danger of being lost in the shuffle; that is, unless we are "fierce advocates" for inclusion in the ongoing health reform debates. Unfortunately, it seems we're so preoccupied these days with everything from DADT to ENDA, that I fear the healthcare policy ship will soon set sail, while we're left flailing our arms on the docks of health disparity.

Social stigma and systematic discrimination based on sexual orientation and gender identity and expression have led to decades of obstructed access to adequate LGBT-affirmative and culturally competent healtcare and have had significant negative impacts on the overall health of LGBT people.

In order to adequately address these disparities and barriers that prevent LGBT individuals from receiving health care, we need to get busy on educating our legislators and pressuring them to support us and our famililes, specifically in the areas of reducing stigma and inequities in healthcare access and increasing the number of providers competent in providing LGBT-sensitive care .

Following is a list of nine of the most salient healthcare reform issues relevant to the LGBT community (supported both by the above National Coalition and the Human Rights Campaign) and a brief summary of why each matters and the progress made of making each of them a reality:

1. Universal access to health coverage for all: In one fell swoop this would level the healthcare access playing field and make obsolete many of the inequities imposed by DOMA and other legislative barriers to access. Passage of a public plan option and expanding Medicaid would provide a windfall of coverage for previously uninsured LGBT Americans; however, it would not help to remedy the problem of a healthcare workforce that is still, for the most part, out of touch with the unique health needs of LGBT people.
2. Extension of employer and federally-provided health benefits to LGBT domestic partners, spouses and families: This issue is at the heart of the recent DOMA conundrum. While some progress has been made in extending meager benefits to same-sex partners through Obama's recent memorandum on June 17th, it will take Congressional action to offer full healthcare benefits by overturning DOMA, which Obama said he fully supports. In the meantime, LGBT Americans in committed same-sex relationships get to pay for their health insurance twice, rather than reap the benefits of a family health plan, a practice that a recent report from the Centers for American Progress shows to contribute to higher poverty rates in the LGBT community than in the general population.
3. Provision of healthcare decision-making authority to domestic partners of LGBT Americans: The President's recent memorandum provides this authority to same-sex couples, but just for Federal employees, comprising less than 1 percent of America's LGBT population. Nonetheless, this action is a step forward. Although numerous large employers and large health plans also extend this right to same-sex couples, it is not yet codified into statutory law.


4. Expansion of and increased access to healthcare providers that are culturally compenent in issues of LGBT health: Aside from community health centers advertised to specialize in this type of care, there ramains a woefully inadequate understanding of the LGBT communty's needs across the healthcare system. Moreover, there is little training, if any, in current medical school curricula to prepare providers to address the health needs of the LGBT individuals.This matter is addressed extensively in Representative Tammy Baldwin's bill (See below).


5. Coverage and increased sensitivity to trangender-related services: Currently, insurance companies regularly refuse to provide health coverage for gender reassignment surgery, hormones, and counseling for transgendered individuals under their "transgender exclusion" clauses. Furthermore, transgendered individuals often encounter barriers to accessing gender-specific services (i.e. gynecological or prostate exams) due to inconsistencies between their registered sex or birth sex and how they identify as an adult. These issues are generally addressed in Representative Tammy Baldwin's bill; however, it lacks the trans-specific language needed (see below).


6. Expansion of federally funded health surveys and research targeting the LGBT community and development of electronic medical records capable of privately capturing data unique to this population: While a dramtic expansion of electronic medical records is currently underway and will be accelerated with passage of proposed health reforms, LGBT-specific language is still left out of research and surveys measuring health disparities - focusing only on disparities in race, ethnicity, disability and gender. For example, many medical records still use heteronormative demographic categorizations, as local regulations currently determine how such data is captured.


7. Development of a National AIDS Strategy and increased funding for HIV prevention: Jeff Crowley, the openly gay Director of the Office of National AIDS Policy, hopes to have a National AIDS Strategy under development by the end of the summer with the goal of reducing HIV infection, increasing access to care, and reducing health disparities. Moreover, a flurry of recent local and national reports showing a spike in new infections among men-who-have-sex-with-men (MSM), especially gay men of color, is forcing Federal health agencies into action. Locally, the National HIV Behavioral Surveillance study focusing on MSM will be released sometime this summer or fall, which will likely draw more attention to the plight of MSM today.


8. Expansion of reproductive healthcare services: All methods of conception, including in vitro fertilization and surrogacy must be covered to offer the full spectrum of options for creating LGBT families.


9. Inclusion of mental health parity: Accessing coverage for mental health care is a challenge for most Americans; however, LGBT individuals are already significantly more at risk for suffering from mental health disorders and substance abuse than the general population, making this issue especially important to our community.

The Senate Committee on Health, Energy, Labor and Pensions (HELP) is now in the lead, as it enters mark-up of the final, and most divisive title of its proposed bill, the Affordable Health Choices Act. This week HELP Committee members will begin debate over whether to include and how to finance the "public plan option," probably the most significant challenge for each of the five committees with purview over health reform. Despite its headstart over the House, so far in the Senate there has been a dearth of discussion on healthcare disparities in general and no mention of LGBT-related healthcare reforms.

However, on the House side, the discussion draft of the Tri-Committee bill (a collaborative effort between the Committees on Energy and Commerce, Ways and Means, and Education and Labor) has been surprisingly inclusive of important HIV/AIDS matters that disproportionately affect our community. In particular, the bill includes the Early Treatment for HIV Act (ETHA), giving states the option to extend Medicaid eligibility to HIV positive people who are not yet classified as disabled because they lack an AIDS diagnosis.

Without ETHA, HIV-positive individuals will continue to be faced with a perverse Catch-22; they will remain ineligible to access HIV treatment through Medicaid that would prevent them from developing AIDS until they'd become disabled from the very AIDS-defining illnesses that such treatment would prevent.

The House discussion draft also includes language that allows AIDS Drug Assistance Program (ADAP) expenditures to count towards Medicare Part D true out-of-pocket costs, helping HIV-positive individuals access catastrophic coverage far sooner, so as to avoid becoming impoverished by astronomically high drug costs.

HIV/AIDS advocates have long requested action on these measures, and their inclusion in the draft House bill represents encouraging momentum that should be applauded and sustained through the rest of the healthcare reform debate. However, still absent from the draft bill is broader language that both addresses the systemic inequities to accessing care that all LGBT Americans face and the terrible lack of healthcare providers that are sensitive to the unique health needs of LGBT patients. The final House bill will be introduced this week and mark-up will begin shortly, with the intention of voting on a final bill around July 27th.

Despite having addressed more of our concerns than any other proposal on the table, Rebecca Fox, Director of the above-mentioned National Coalition for LGBT Health, has identified several areas in which the current discussion draft of the House bill falls short in minimizing LGBT health disparities and makes suggestions for improvement.

• Specifically, she states that the definition of "health disparities" used throughout the proposed legislation is insufficient and should be broadened to state that a population be delineated by race, ethnicity, sex, geographic setting, sexual orientation, gender identity, or other category determined appropriate by the Secretary.
• Furthermore, in some instances, amendments to the proposed legislation sought to limit the use of broader language that would include the LGBT community. For example, one amendment proposes the insertion of "racial and ethnic minority groups" and "racial and ethnic minority individuals" in lieu of "under-represented minority groups" and "under-represented minority individuals." Fox recommends that legislators retain the original language in such instances.
• Frequently, the draft bill mentions the need to collect data on health disparities in many realms of the healthcare system to help ameliorate inequities among different populations. As such, while disparities related to race, ethnicity, disability and geography are often addressed in establishing premiums and payment rates for a public health insurance option, the proposed legislation is silent when it comes to LGBT health disparities.
• Finally, regarding the proposed creation of a Health Benefits Advisory Committee, the current draft states that membership will include those knowledgeable about "disparities relating to race, ethnicity, and disabilities;" however, there is no mention of including those knowledgeable about disparities related to sex, gender or sexual orientation.

The next couple of weeks is our best shot at having these and other LGBT-specific reforms incorporated into the final health reform proposals; however, it will be much more of an up-hill battle in the Senate than in the House.

If there's any hope that LGBT-specific language will be included in the healthcare legislation juggernaut, it will come in the form of amendments inspired by Representative Tammy Baldwin's recently released,Ending Health Disparities for LGBT Americans Act (H.R. 3001).

In the wake of Department of Justice debacle last month and the extension of some benefits to domestic partners of Federal employees through the Presidential memorandum, sans the coveted healthcare ones that such couples seek most, President Obama's touting of Tammy Baldwin's recent bill helped appease many disgruntled LGBT Americans. However, a great deal still needs to happen in order for the key elements of Baldwin's bill to be realized in health reform.

Joining Representative Baldwin in supporting this legislation, which she has been working on for more than a year, are Representatives Henry Waxman (D-CA), Barbara Lee (D-CA), Mike Honda (D-CA), and Nydia Velazquez (D-NY). In its preamble, the Ending Health Disparities for LGBT Americans Act outlines its purpose:

To address the health disparities experienced by lesbian, gay, bisexual, and transgender Americans, to eliminate the barriers they face in accessing quality health care, and to ensure that good health and well-being is accessible to all.

Specifically the bill "would be the first comprehensive approach to establish nondiscrimination policies for all federal health program. It would also fund training for health care providers, extend Medicare benefits to domestic partners, create an office of LGBT Health within the Department of Health and Human Services, and fund local health centers that specialize in LGBT services."

Last I checked, Senator Joseph Lieberman (I-CT) was supposed to be advancing a corresponding bill on the Senate side, the Domestic Partner Benefits and Obligations Act (S.1102). However, not only has there been virtual silence from his office on the issue since I last saw him standing behind Obama's shoulder at the signing of the Memorandum on Federal Benefits and Non-discrimination; but also, his bill, like the President's memorandum, only extends benefits to Federal employees.

It seems this legislation has a long way to go before it's on par with Rep. Baldwin's bill which is far more comprehensive in its coverage of LGBT people. As such, the prospects do not bode well for the inclusion of similar LGBT amendments into either of the Senate bills set to emerge from the Finance or HELP Committees later this summer.

In sum, the current state of LGBT healthcare reform is in total disarray. We have clear goals that we want to accomplish, but no clear plan for how to include them in overarching health reforms within such a limited timeframe. I'm surprised that more LGBT Americans are not up-in-arms at this critical juncture in potentially securing access to LGBT-sensitive health care for generations to come.

Be sure to see Steve Ralls' excellent Bilerico post on lifting the ban, which includes a video on the topic by Immigration Equality.

A Little History on the HIV Entry Ban

In May 1987, the U.S. Department of Health and Human Services (HHS)/CDC added HIV infection to its list of "communicable diseases of public health significance," effectively barring such individuals from entering the United States, except under certain instances in which discretionary waivers were issued. This decision was made in a climate of fear and uncertainty, surrounding a highly stigmatized disease.

While HIV infection is a serious health condition, it does not represent a communicable disease that is a significant threat for introduction, transmission, and spread to the US population through casual contact.

Despite knowing this obvious fact for decades, the United States remained one of only twelve countries to have long-enforced such a strict, unscientific and ineffective policy, undermining its position as a global leader in combating HIV/AIDS. In supporting such a discriminatory and antiquated restriction, the United States has placed itself among the ranks of other bastions of civil liberty - including Sudan, Saudi Arabia, Lybia, Russia, Moldova, Oman and Qatar, among others. Moreover, the ban has forced illegal aliens into hiding, preventing them from seeking necessary care and treatment for HIV, thereby hastening further spread of the disease. Also, as long as the ban has been in place, the International AIDS Society has been unable to have the United States host the biannual International AIDS Conference, losing out on a tremendous opportunity to raise awareness in our country.

The HIV entry ban is an excellent example of why the time is now ripe for us to take full advantage of this window of opportunity to secure our LGBT rights. At the beginning of the Clinton Administration, HHS had already sought to have this HIV entry ban eliminated (in 1991), but failed. When attempts were made a second time in 1993, conservative members of Congress - spearheaded by then Republican Senators Don Nickles of Oklahoma and Jesse Helms of North Carolina - sought not only to defeat these attempts, but also to codify the ban into federal law by including it in the National Institutes of Health Revitalization Act.

As such, for fifteen years this regulation has been enforced both through statutory law and administrative mandate. Then, in July 2008, with the first reauthorization of PEPFAR (known as the Tom Lantos and Henry J. Hyde Global Leadership Against HIV/AIDS, Tuberculosis and Malaria Reauthorization Act), the Congressional ban was legally rescinded - largely due to the efforts of Senator John Kerry (D-MA), Representative Barbara Lee (D-CA) and former Senator Gordon Smith (D-OR). However, despite the monumental achievement of removing this huge barrier, the administrative mandate still remained in place.

On June 2, there was a glimmer of hope when Rep. Barbara Lee posed a question about the HIV entry ban to the new HHS Secretary, Kathleen Sebelius, at her first appearance before the House Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies.

When pressed by Rep. Lee as to when she intended to lift the HIV travel and immigration ban, the Secretary responded, "It is on my radar screen, and will happen soon." Ugh... more waiting, I thought. It seemed so simple; so why the hold up?

Well, turns out it's not so simple. But at least much of the waiting appears to be over and an end to the ban is finally in sight. We just need to make sure that the rule makes it through the home stretch. I can't emphasize this point enough.

Just today, a Washington Post article revealed that President Obama may partially renege on his plan to rescind President Bush's "right to refuse" rule, now claiming he supports the so-called "conscience clause," which broadly allows providers to refrain from any procedure involving a person or situation they find morally reprehensible. This rule could mean that if a physician at a Catholic hospital, not receiving federal funds, doesn't want to treat you because you're gay or transgendered, you're out of luck. The debate has often been framed in terms of abortion; however, the vague language used in Bush's rule leaves it vulnerable to abuse by providers who would deny care because their patient doesn't conform to their moral codes.

In truth, this could just be posturing prior to Obama's meeting with the pope next week, or it might mean actual waffling by the administration on the rule's "conscience clause."

So what happened?

Well, we sat on our haunches and went into autopilot. Meanwhile the revision to the Bush's "right to refuse" rule was published in the Federal Register in February for public comment. We counted on Obama to swing home and knock the rule out of the park; but we didn't tee it up for him as best we could. And now we're kicking ourselves. So let's hope he doesn't back away entirely from rescinding the "right to refuse" rule and make sure this doesn't happen again with the HIV entry ban.

The efforts to finally seal the deal on lifting the HIV entry ban hit a potential snag on Tuesday, June 30, when the CDC inadvertently made available an incomplete version of the rule, that fortunately did not make it into the Federal Register. The incomplete rule was quickly retracted and replaced with the final, corrected version in the Federal Register on July 2.

Although the problem was quickly resolved, the incident gave a glimpse at the inner machinations of the CDC and drew attention to some the more contentious components of the rule that differed between the current and past administrations - namely that the previously proposed cost estimates for lifting the ban were way too high.

Although the public may criticize the Obama Administration for dragging its heels on lifting the ban, there is actually a good reason for this delay, made apparent by Tuesday's snafu in prematurely releasing the incomplete rule. After Congress reauthorized PEPFAR legislation last summer, which both removed the legal barrier to lift the ban and appropriated funds to cover the cost of this action, the CDC, under the Bush administration, allegedly busied themselves with drafting a new rule to finish the job.

However, it is speculated that upon its completion, the rule did not pass initial review by the OMB due to problems with its cost estimates and other issues, such as the precondition for individuals to take a HIV test prior to receiving an American visa.

Requiring people to take a HIV test in their home countries, even if a positive result could no longer obstruct their entry into the United States, may put such individuals at risk for discrimination abroad, as confidentiality around such tests varies greatly throughout the world.

However, all of these issues were addressed in the final version now posted. Phew! Let's be sure it stays that way.

The official publication of the rule on July 2 in the Federal Register will remain for a 45-day mandatory public comment period. After that time, there will be another round of review by OMB and the CDC before the final version is published in the Federal Register. At that point, an effective date for the new rule will be established sometime between 1-2 months after its final publication.

Rachel B. Tiven, Executive Director of Immigration Equality, which helped trail-blaze the effort to lift the ban, has encouraged swift action by the CDC to move this process through its final stages. In an effort to streamline the comment process and garner support of the regulations, Immigration Equality has launched an online petition to allow the public to collectively endorse the new rule and help move repeal forward as quickly as possible.

In sum, Rebecca Haag, the Executive Director of AIDS Action Council says:

Barring entry of people living with HIV/AIDS is a blatant violation of their human rights. The current policy adds to HIV stigmatization and discrimination against people with HIV/AIDS. Ending this policy and practice is overdue. We strongly support the Obama administration's efforts to correct this wrong. AIDS Action Council, along with many community advocates, has fought long and hard to change this policy, and it is a tribute to the determination of the HIV/AIDS community and our Congressional allies that this day finally has arrived.

I couldn't agree more. Now is the time to act to put an end to this ban! Let us not be complacent and silent on this issue.

Public comments may be submitted directly to the Federal Register in the following three ways:

• Written comments may be sent electronically at the following URL: http://regulations.gov;
• you may email them to: Part34HIVcomments@cdc.gov; or
• you may submit written comments, identified by Docket No. CDC-2008-0001 to the following address:

To view public comments and other related topics on this matter, visit the CDC website at: http://www.cdc.gov/ncidod/dq/laws_regs/fed_reg/remove-hiv/index_hiv.htm

The local gay, bisexual and transgender community is still disproportionately impacted by HIV/AIDS. According to the recently updated DC HIV/AIDS 2008 Surveillance Report, men who have sex with men (MSM) accounted for more than 50% of the HIV-positive individuals living in the District of Columbia through 2007. However, because the District is now in the midst of a "severe and generalized epidemic," all groups are experiencing markedly higher risk for HIV infection and transmission.

Since the HIV epidemic has now become a community-wide problem, the local Gay/Bi/Trans HIV Prevention Working Group of the DC Center is seeking a community-wide solution by bringing together organizations that represent the spectrum of risk populations in the District to encourage everyone to get tested for HIV - the first critical step in stemming its spread.

Therefore, a city-wide collaboration coordinated by the HIV Working Group to raise awareness for NHTD will happen this Friday, June 26th from 12 p.m. until 5 p.m. At this media and testing event, five-to-ten local HIV prevention organizations that provide mobile and remote HIV counseling, testing and referral services (CTRS) will come together to announce their cooperative effort to increase HIV testing at locations throughout the city on Saturday, June 27th and beyond.

The Friday event will be located downtown at the old Convention Center site ("City-Center" parking lot) - along the Art Walk, near the intersection of H and 10th streets, NW. It will bring together representatives from numerous HIV prevention groups, including Andromeda Transcultural Health, Carl Vogel Center, La Clinica del Pueblo, Community Education Group, Don't?Guess?Test!, PreventionWorks!, Whitman-Walker Clinic, and others, as well as local political officials to address the mounting HIV crisis among District residents.

Mobile HIV testing units from five-to-ten representative organizations will also be present to provide CTRS. It is anticipated that organizational heads and political officials will address the public and media between 1 p.m. and 2 p.m.; however, this timeframe may change to accommodate individual schedules.

Then on Saturday, there will be at least one mobile unit offering CTRS located in each of the District's eight wards.

Additionally, each of the participating organizations will provide CTRS at their home locations to maximize the geographic coverage of testing sites that day. A final list of testing locations will be advertised later this week and posted on the HIV Prevention Working Group's website.

Other organizations and communities across the country will be observing NHTD and holding local events this week. Please raise awareness of the importance of HIV testing in your community and encourage friends, family and community leaders to get tested on Saturday, June 27th. Find NHTD events and testing sites in your area.

A recent New York Times article demonstrates how closely these issues are linked for LGBT persons seeking health coverage through a domestic partner employed by the federal government. Whether the government must provide health insurance benefits to such individuals has remained a contentious issue since the mid-nineties, when the Defense of Marriage Act (DOMA) was passed by Congress by a vote of 342-67 in the House of Representatives and a vote of 85-14 in the Senate and was signed into law by President Bill Clinton on September 21, 1996. Specifically, the law has two effects:

1. No state (or other political subdivision within the United States) needs to treat a relationship between persons of the same sex as a marriage, even if the relationship is considered a marriage in another state.


2. The federal government may not treat same-sex relationships as marriages for any purpose, even if concluded or recognized by one of the states.

Although two judges (one liberal and one conservative) of the federal appeals court in California recently ordered that employees of their court have the right to receive health benefits for their same-sex partners under the same program that offers health insurance to millions of federal workers, the federal Office of Personnel Management has cited DOMA in countering their decision, mandating that insurers not provide the benefits ordered by the judges.

Stephen Reinhardt, one of the two Californian judges, eloquently concluded that DOMA was unconstitutional because it violated the Fifth Amendment guarantee of "due process of law," saying that "a bare desire to harm a politically unpopular group cannot provide a rational basis for governmental discrimination." Because denying health coverage to same-sex partners would not encourage gay men and lesbians to marry members of the opposite sex, Reinhardt argued that Congress' supposed interest in "defending and nurturing the institution of traditional heterosexual marriage," does not hold water when it comes to extending healthcare coverage.

Despite Reinhardt's sound argument, Lorraine E. Dettman, assistant director of the personnel at the Administrative Office of the United States Courts, said that, "Plans in the Federal Employees Health Benefits Program may not provide coverage for domestic partners, or legally married partners of the same sex, even though recognized by state law."

More than 46 million Americans are currently uninsured, a crisis that is certain to be addressed through imminent healthcare reform legislation. Key components set to emerge from a combined Baucus-Kennedy bill later this month will be the development of a public health insurance plan that will drive a restructuring of the current private insurance market; healthcare cost containment provisions; a revision of how healthcare providers and hospitals are reimbursed for medical care; and a strategy for financing these reforms.

Despite these significant changes to our system, I am concerned that the issue of health disparities among minority populations will not remain central to the healthcare debate. If not, even with drastic expansion of health coverage to all Americans, the playing field for accessing care will remain woefully uneven during the initial reforms and beyond for those LGBT Americans who are still unable to access coverage through their legal same-sex partner's family plan - even with the advent of a public option.

This matter is not insignificant, as countless LGBT Americans will continue to suffer from having a far more limited array of options for accessing health care than their straight counterparts.

CDC's estimates from the 2003 National Health Interview Survey (see Table 7) revealed that marriage is a strong predictor of health insurance coverage in the United States; as those who are married are far less likely to be uninsured (12.6%) than people those who are living with a domestic partner (31.7%) or those who have never been married (26.9%).

According to a 2006 study from the American Journal of Public Health:

It is notable that rates of health insurance coverage were lower among [same-sex relationship] women than [opposite-sex relationship] women; this finding might be at least partially attributed to the inability of same-sex couples to marry or form legal partnerships in most states.

The story of Nancy Gill and Marcelle Letourneau, from Bridgewater, Massachusettes, clearly demonstrates the reason for this disparity. Both lesbians, Gill and Letourneau began dating in 1980 and subsequently had multiple children together. They were married on May 17, 2004, on the first day same-sex couples could obtain marriage licenses from their state. However, some time later, when Nancy applied to put Marcelle on her health insurance plan through her employer, the federal government, she was denied coverage. Those denying health insurance benefits to Marcelle, Nancy's spouse, immediately cited DOMA.

Importantly, among gay men the issue of same-sex marriage is not just about equitable healthcare access, as it has been shown to have a significant impact on crticial determinants of gay men's health - even prior to them attempting to seek care through their more limited set of options. A recent study from Emory University revealed that juristrictions with bans on same sex marriage actually show increased risk for HIV infection among gay men.

The two Emory economists who authored the study measured the impact that social tolerance levels toward gays in the United States had on the HIV transmission rates, and estimated that "a constitutional ban on gay marriage raises the rate by four cases per 100,000 people." Conversely, they calculated that a rise in tolerance and acceptance of gays from the 1970s to the 1990s reduced HIV cases by one per 100,000 people.

The study used data from the General Social Survey, which has tracked the attitudes of Americans during the past four decades; and the economists' conclusions were found to be both "statistically significant and robust," holding up under a range of empirical models. Their rationale for the observed link between such legislation and HIV infection rates among gay men is that "bans on gay marriage codify intolerance, causing more gay people to shift to underground sexual behaviors that carry more risk."

Simply put, "Intolerance is deadly," especially among gay men. As such, banning same-sex marriage saddles the gay community with a double whammy of both being placed at greater risk for contracting HIV and other sexually transmitted diseases and being faced with more limited opportunities for accessing care.

Both Senator Joseph Lieberman (I-CT) and Representative Tammy Baldwin (D-WI) plan to introduce bills that would provide benefits to same-sex partners of federal employees as part of health reform this summer. Although similar bills died in the past, I believe that with President Obama in the White House and current momentum to implement sweeping health reforms addressing the growing health disparities among all minorities that there is a renewed hope that LGBT Americans may finally make headway on this front.

Richard Socarides, a New York lawyer who advised President Bill Clinton on gay issues, said that President Obama should have "broad discretionary authority to find ways to ameliorate some of the more blatant examples of discrimination."

Now the time is ripe (if not long overdue) for him to implement those changes - as fair and equitable access to health care for LGBT Americans is a basic human right that has been legally obstructed by our federal government for far too long.

The Working Group identifies gaps in the local HIV/STD prevention landscape, supports existing public health efforts, and initiates new prevention projects where there is a demonstrated absence and need.

Ultimately, the group aims to develop a coordinated strategy among the District's many and varied organizations doing prevention work for men who have sex with men (MSM). It also serves as a singular voice to the government agencies that determine which prevention programs are funded and how the public health needs of MSM will be met. More after the jump...

The safer sex kits come in two varieties: the TOOLK!T and the FUK!T (differing only in name). Each contains two latex condoms, a lube sachet, and provides an excellent opportunity for safer sex messaging and targeted health alerts for the local MSM community - such as what symptoms to look for in diagnosing a potential syphilis infection, where to access post-exposure prophylaxis in case the condom breaks, where to get an HIV test, or how one can volunteer to become involved in a local HIV/AIDS research study focusing on gay men.

Since the early 1980s, gay men have been encouraged to use condoms as one of the most effective ways to protect themselves from contracting HIV. Despite risk-reduction education campaigns directed at MSM in the wake of the HIV/AIDS crisis, the evidence indicates that there remains a deficit in condom-use skills among this high-risk population. Because most condom failures are attributed to errors in use, increasing knowledge and skills of their use presents an important opportunity to reinvigorate the practice of this prevention tactic and once again improve condom efficacy among a new generation of gay men.

On May 29 and 30th, the FUK!T/TOOLK!T campaign officially launched in the District, at Town Danceboutique, a gay club that is visted by thousands of patrons each weekend. Since the campaign is finally making condoms and lube more readily available, we felt the time was ripe to start educating the community again about the "do's" and "dont's" of condom use - especially when it comes to gay sex.

The event happened just in time, as the HIV Working Group is now planning a massive, blitz distribution of more than 20,000 FUK!Ts and TOOLK!Ts during DC's Capital PRIDE week (June 6-14th) to raise awareness for the campaign. Numerous organizations will be distributing the kits along the parade route and at booths during the street festival.

We decided that a two-pronged approach was necessary to effectively market the safer-sex kits to vastly different audiences. Understanding that in order to catch people's attention, a more edgy and sexy tactic was needed than the traditional, government-funded campaigns, the "FUK!T" moniker and concept was developed for adult venues after a series of informal focus groups considered variations on this theme.

However, considering that this explicit logo wouldn't work in restaurants and other establishments frequented by the general public, the group also devised the "TOOLK!T" logo as a more palatable alternative.

The two logos are branded in a parallel (Coke/Diet Coke-type) fashion so that the public views them as synonymous campaigns, while still remaining venue-appropriate. Sister websites accompany each version of the kits, providing sexy and, at times, explicit imagery, that is complemented with extensive, evidence-based information on sexual health and sexually transmitted diseases. The explicit nature of the websites is meant to eroticize safer sex and condom use again through a frank, no-holds-barred fashion; an approach that we hope resonates better with our target audience than more traditional campaigns.

Check both of the websites out:

• The X-rated FUK!T site: www.dcfukit.org (careful, explicit images)
• The TOOLK!T site: www.dctoolkit.org (appropriate for a broader audience)

The FUK!T/TOOLK!T campaign is an improvement over the one-off condom distribution efforts of the past for several reasons:

• The kits facilitate co-distribution of condoms and water-based lubricant; rather than just distributing condoms alone. Studies show that rates of condom failure - slippage and breakage during anal sex - are due to using them with oil-based lube (which chemically weakens the integrity of latex) or even worse, using no lubrication at all.
• The kits are located in wall-mounted dispensers by exits and in discrete locations in social establishments where gay men meet, often with the intention of eventually hooking up. Thus, the condoms and lube are strategically placed at the final point of potential public health intervention before men engage in sexual activity, significantly reducing the likelihood that they will find themselves without access to protection in their moment of need.
• Rather than forcing patrons to engage in an often awkward conversation about safer sex in front of their peers (a practice that also annoys business owners) and shoving fistfuls of condoms into their hands, this approach empowers individuals to make the decision to use the condoms themselves, at their convenience - a far more effective way to elicit real behavior change.
• Most importantly, through a network of regularly stocked dispensers, an infrastructure is developed in which gay men know at all times where they can count on finding condoms and lube freely accessible. They can even locate the nearest FUK!T/TOOLK!T dispenser through the website: http://www.fc-kits.org/findfuktcondomkits.html

Although the DC Department of Health provides up to 3 million condoms and packets of lube for free each year (all you have to do is ask and they'll ship 'em to you) and actively seeks out venues through which to spread them to the masses, there is still no real mechanism in place for establishments to easily distribute the dump-truck loads of condoms offered to them.

As a result, businesses are burdened with having to find creative ways to 'get rid of' these condoms and lube, often at their own expense. This scenario usually means that the best venues to distribute the condoms will likely refuse to participate or will stockpile them away to collect dust and eventually expire. And if they do decide to actively participate, it will likely be for a limited period of time or for a one-off promotional event.

The FUK!T/TOOLK!T campaign addresses this problem by facilitating the distribution process from start to finish on behalf of the businesses. We freely provide customized dispensers to fit the aesthetic of the establishment (color, size, quantity, location, and design), procure the condoms and lube from the Department of Health, assemble the safer sex kits, and stock and maintain the dispensers at the venues on a continual basis.

Based on a safer sex kit distribution scheme from Manchester, England that has been touted as one of the most successful British prevention projects to date; the Working Group is hoping to do something similar with the FUK!T/TOOLK!T campaign, but in a way that is specific to DC's modern HIV/STD epidemic.

Condom dispensers are pretty ubiquitous in bars throughout Europe and the UK, but sadly not in the US, which may help to explain why we have higher STD rates than these similar cultures.

While living in Manchester in 2005, I was amazed how in the same moment gay men would ask bartenders for both a drink and a safer sex kit, which were often mounted on displays behind the bar-tops. If only, I thought, DC's gay culture could somehow do the same to reduce stigma around condom use by making them as equally easy to access, perhaps we could make some headway against our skyrocketing rates of HIV and other STDs.

Realizing that in order for such a campaign to be a success in our community we would first need to secure buy-in from local establishments. Dr. Terry Gerace (a medical doctor, who developed the FUK!T/TOOLK!T websites and has funded and directed much of the campaign so far) and I began to set up meetings with local business owners, armed with the most recent HIV/AIDS surveillance reports from the CDC and DC Department of Health, as well as a tape measure to determine the exact dimensions of the dispensers business owners might want... if we were lucky.

Although we impressed upon them both the severity of the local HIV epidemic among MSM and the important role they could play in stemming its further spread, surprisingly we received push-back from several prominent gay establishments saying that condoms or safer sex kits in their businesses "weren't a good fit" or were "too political."

Personally, I feel it's a matter of social responsibility that business owners help those young gay patrons who may leave their establishments even slightly intoxicated and more prone to engage in risky sexual activity, especially in the context of DC's severe, modern HIV epidemic.

Since it's a community-wide problem, the TOOLK!T/FUK!T campaign seeks a community-wide solution that will require sustained engagement from our network of partners to effect real, lasting behavior change that will ultimately improve the health of our community. Unfortunately, not everyone appears convinced of the campaign's value.

Sadly, this puritanical view of condom use, buttressed by the misinformed notion (a la Pope Pope Benedict XVI) that condom distribution will only worsen the HIV/AIDS crisis by encouraging people to have more sex, remains a prevailing theme in cultures throughout the world, to the consternation of many public health officials.

Despite overwhelming evidence that abstinence-only and ABC-programs actually put people at greater risk for transmission of HIV and other STDs and unwanted pregnancy, both the Catholic Church and the American Religious Right refuse to listen to the science. But this should be of no surprise, as both groups have a long history of total and utter disregard for scientific evidence when taking a stance on some of the most contentious issues of our time - from evolutionary theory to embryonic stem cell research.

Yet despite these early challenges from within our own community and anticipated opposition to the campaign in the future from outside groups, the FUK!Ts and TOOLK!Ts have already been very well received by local gay men and many local businesses that have agreed to mount dispensers in their establishments in time for Capital PRIDE - and the requests for dispensers keep rolling in!

More than anything, the campaign seems to resonate with gay men, who really seem to respond to this innovative, refreshing message of making condom use fun and sexy again.

Paradoxically, provocative and innovative campaigns, that break the traditional tired models of the past, often fizzle and die before they are able to have sustained traction or demonstrate their effectiveness because government funding won't step in to keep such controversial efforts afloat. The FUK!T/TOOLK!T campaign will soon meet a similar fate unless our community recognizes its importance and is willing to help keep it afloat until alternative, long-term funding sources are secured. As such, I'd encourage you to please consider donating to this important campaign.

The FUK!T/TOOLK!T campaign is funded in part by support from The DC Center, a tax deductible non-profit. As such, donations to the DC Center are fully tax deductible. To donate to the FUK!T/TOOLK!T Campaign through the DC Center, access the link below to be taken to the DC Center's Secure PayPal Page. In the "Purpose" field, please type "FUK!T" or "TOOLK!T," so the funds will go to support this campaign.

If you are interested in participating in the ongoing efforts of this exciting new campaign, the HIV Prevention Working Group is always seeking new members and perspectives to advance progress in the fight against HIV. Additionally, volunteers meet every one-to-two months to assemble the FUK!Ts and TOOLK!Ts by hand. Until we can contract this labor-intensive step to an outside organization, we need all the help we can get. You are welcome join us!

EDITORS NOTE:

The Gay/Bi/Trans HIV Prevention Working Group meets the fourth Wednesday of every month at the DC Center (1111 14th Street, NW). It's online presence can be found at: www.fighthivindc.org.

Please contact Dan O'Neill at danielfoneill@gmail.com if you would like to participate or join the Working Group listserv.

But that's all it took for him to become hooked and send his life into a tailspin. Before his addiction, Garza was living an ideal life, by most gay men's standards; he owned a three-bedroom house, two cars, and had a $60,000-a-year job with America Online. But that rapidly changed as his new addiction began to take hold, consuming everything important to him and ultimately leaving Garza with a hollow shell of the life he once had.

Over the two years following the first time he used crystal meth, Garza's three-bedroom home shrunk to a one-bedroom apartment that he cohabited with a roommate and several other, young homeless meth-addicts. His life became smaller and increasingly insular, as his personal wealth, health, motivation, and relationships were all sacrificed, in order to feed his addiction. By December of 2004, he was homeless, his Jeep had been repossessed, and he had been fired from his job. And then, when it seemed there was nothing left to lose, he lost his freedom, when two Fairfax County police officers entered his apartment to find him and is roommates in the throes of getting high.

As the police handcuffed Garza, he realized he had hit rock bottom. And it was only then that he began the steady climb to recovery and the slow path to rebuilding his life. Just imagine if someone had intervened or if Garza had been able to get help before he began his precipitous decline. That might have made all the difference. But sadly, Garza's story isn't unique, as it continues to unfold in the lives of countless young men around the country. In the gay communities of San Diego, Los Angeles, Chicago and New York the crystal meth epidemic still runs rampant in the shadows of meth-awareness billboards and highly visible media campaigns in gay bars and clubs.

Garza and other local gay men recovering from crystal meth addiction contend that despite recent efforts to shed light on this issue, the silence surrounding this closeted epidemic in Washington, DC is what sets it apart from other cities. That said, 'silence' seems to be a prevailing theme for crystal meth use, regardless of where you live. Once thought to be immune to the crystal meth crisis as it raged out west and throughout much of Middle America, DC is swiftly becoming a very hard-hit region of the country. In 2006, the Whitman-Walker Clinic reported that crystal meth had become the primary drug of choice for those entering its addictions service programs, topping even alcohol use. In 2000, zero meth labs were identified in this region (Maryland, Virginia and DC); a number that grew to more than 80 in 2006, as the crisis continues to expand.

It's easy for us to dismiss this issue as a problem only for those who've made the wrong decision to use the drug. But truthfully, we all struggle with addictions in one form or another, and fortunate are those of us who've never encountered that first, casual experience with crystal meth. Health experts estimate that 22 percent of all gay men have tried crystal meth at least once - just as Garza had (See: Osborne, D. 2005. Suicide Tuesday: Gay Men and the Crystal Meth Scare. Carroll & Graf: New York). Furthermore, a recent San Francisco study found that 15 percent of gay/bi men has used crystal during their most recent sexual encounter. Those using the drug put themselves at two to three times the risk of contracting HIV and other STDs. We owe it to ourselves, our community and the next generation of gay men to warn of the devastation that crystal meth can cause in their lives.

As such, the members of the Gay Men's Chorus of Washington (GMCW) will make a bold move this summer to break the silence surrounding this problem - through song. GMCW will feature Through a Glass, Darkly, as part of its June show about friendship and recognition that our lives and relationships are worth both celebrating and saving. On this latter count, Through a Glass, Darkly, an award-winning and Emmy-nominated production created by Michael Shaieb for the Twin Cities Gay Men's Chorus, explores the life of a meth-addict, Sebastian, and how his addiction affects both himself and lives of those around him.

Event: Through a Glass, Darkly
Venue: Lisner Auditorium at George Washington University (730 21st Street, NW, Washington, DC 20052)
Dates: Saturday, June 6, 2009 at 8 pm and Sunday, June 7, 2009 at 3 pm (ASL Interpreted)
Tickets: http://www.gmcw.org/season/throughaglassdarkly.php

The production's three characters represent archetypes of the crystal meth epidemic: the struggling addict that sees meth rapidly destroy his life; the individual who tries the drug for the first time; and importantly, the loved one of someone suffering from addiction. Our hope is that everyone can relate to someone in this tableau of addiction in our community. Through this production, the Chorus aims to help prevent GLBT individuals, especially youth, from ever using crystal meth and to provide resources and support to those seeking to recover or to those whose loved ones are struggling from addiction.

Through a Glass, Darkly has presented some obvious marketing challenges for the Chorus, like how to sell the idea that a musical production about crystal meth addiction can be entertaining. In truth, the show has a driving rock-opera, Rent-like feel that is balanced with more poignant ballads. It's sure to appeal to most anyone, and will take you on quite the emotional roller coaster. What's more, for the first act of the show, prior to Trough a Glass Darkly, the Chorus will perform a selection of songs about friendship, celebrating those who support the GLBT community through thick and thin.

So even though this production might not sound like your cup o' tea at face value, I can assure you that's it's something you don't want to miss. GMCW has taken on this monumental challenge because its mission goes much further than simply entertaining our community; it seeks to effect positive change in the lives of GLBT people and beyond. While the task of presenting a work about crystal meth is complex, GMCW is intent on telling this relevant story that cannot be ignored. Longtime fans and newcomers to GMCW shows can expect the same high quality production values that have built the Chorus' reputation in the past through sets, costumes, dancing and top-notch musical performances. With Through a Glass, Darkly, these elements combine to dramatize several gay lives with artistry, passion, sharp-wit, and heart. But this production needs your support to amplify its important message.

Several local organizations are already helping in this effort. In particular, the Crystal Meth Working Group (CMWG) of the DC Center is sponsoring this production to help bring meth addiction out of the darkness to the bright lights of the stage. In supporting this effort, the CMWG will also raise awareness of the resources it provides to combat this scourge of of our community and help those in recovery. The combined efforts of GMCW and the CMWG could not be more timely, considering the severity of the current crystal meth problem in DC and its strong ties to the raging HIV, Syphilis and other STD epidemics now assailing the local gay community.

Once again, GMCW appears to be at the forefront of producing edgy, innovative, and relevant material, as in the near future, both the New York City Gay Men's Chorus and the Orange County Gay Men's Chorus also plan to produce Through a Glass, Darkly. And hopefully, with the lessons learned from GMCW and the Twin Cities Gay Men's Chorus before us, these choruses will be equally successful in bringing this important issue to light.

By serving as a sounding board to break the silence of crystal meth addiction in the District, GMCW stays true to its mission "to educate about the Gay experience." For sadly, today crystal meth use has become an ever-increasing part of our local Gay experience, and the onus is on us to turn the tide on the this trend. We can start by joining in this conversation and brining a friend. For who knows, Through a Glass, Darkly and the dialogue that ensues might make all the difference to someone in need.

Event: Through a Glass, Darkly
Venue: Lisner Auditorium at George Washington University (730 21st Street, NW, Washington, DC 20052)
Dates: Saturday, June 6, 2009 at 8 pm and Sunday, June 7, 2009 at 3 pm (ASL Interpreted)
Tickets: http://www.gmcw.org/season/throughaglassdarkly.php

I love the WWC and have served there for nearly three years as a volunteer STD screener, HIV tester and results counselor at the Gay Men's Health and Wellness Clinic (GMHWC). As such, I have been given an inside and informed perspective on many of the issues at stake and feel compelled now, more than ever, to voice my opinion. My objective is not to point fingers and lay blame, but to weigh in on the findings of the recent roundtable and to offer some hope on how we might move beyond this potentially destructive impasse.

The WWC, a trusted provider of health care to the local GLBT community for the past few decades, has been gay from the get-go. Appropriately, it was named for two, famed 19th century Washingtonians, the gay poet, Walt Whitman - a nurse during the Civil War - and Dr. Mary Edwards Walker - a Union Army physician, who was both awarded the Medal of Honor for her valiant service and defamed for assuming traditionally male roles in her time. Borne out of the Gay Men's VD Clinic that operated out of the basement of the Georgetown Lutheran Church in the early seventies, the WWC was officially chartered in 1978, to serve, first and foremost, the health needs of the GLBT community, when no one else would.

But sadly, this early gesture of solidarity to help those beyond the GLBT community has now diluted the Clinic's mission and purpose under its current CEO, Don Blanchon, and Board of Directors. In the process much of the GLBT community has been left by the wayside. The Clinic's gay identity has been rapidly stripped away in recent years at a time when GLBT-specific services are needed more than ever.

In my role as a STD screener at the Clinic, countless times patients have told me "Thank God the Clinic is here; as otherwise I would have had no where to go." Or worse, they'd say that their healthcare provider discriminated against them or was insensitive to their unique sexual health needs as a GLBT person. Although Whitman-Walker's administration still maintains that the Clinic will forever continue to provide GLBT-specific services, the perception of the community is that these days are certainly numbered. A couple weeks ago, if you hopped onto the Whitman-Walker website, it's mission statement still read:

Whitman-Walker Clinic is a non-profit community-based health organization serving the Washington, DC metropolitan region. Established by and for the gay and lesbian community, our Clinic is comprised of diverse volunteers and staff who provide or facilitate the delivery of high quality, comprehensive, accessible health care and community services. Whitman-Walker Clinic is especially committed to ending the suffering of all those infected and affected by HIV/AIDS.

I am very familiar with the Clinic's simple, yet powerful mission statement, as I and many other gay, lesbian and trans individuals were driven to volunteer or to seek care there knowing we were giving directly back to our community or would receive medical care geared specifically to our needs. Yet sadly only weeks ago, in the midst of the mounting controversy surrounding the Clinic's alleged mismanagement, the WWC Board officially voted to change its mission to the following:

Our mission is to be the highest quality, culturally competent community health center serving greater Washington's diverse urban community, including individuals who face barriers to accessing care, and with a special expertise in LGBT and HIV care.

So I'd ask you to be the judge by comparing the above two mission statements and deciding for yourself whether this change reflects a movement away from the Clinic's historical roots.

The new statement clearly says to me that the WWC's goal is now to provide health services to everyone - all under-served populations - even to those who happen to be GLBT; which is far different from saying that providing GLBT services is central to its purpose. I would never have a problem with the Clinic expanding its services to other populations in need, as it has done for decades; however, in recent years it has become a primary care clinic for all under-served groups at the expense of its core GLBT mission. The very community that founded the Clinic has been moved from its center to the periphery, a change that has profound ramifications for those seeking GLBT-specific health services and has angered many who feel a vital health resource has been hijacked from them.

This action by the Board, which left me and Council Member Catania equally mystified, poses two questions in my mind:

1. Why did the Clinic's Board feel the need to make this change in the first place if, as Don Blanchon and its Board have been saying all along, WWC has remained true to its core mission and its commitment to GLBT services?
2. Why remove "established by and for the gay and lesbian community," except to de-emphasize the WWC's role in providing these services?

Having limped along financially for the past several years, in which annual revenue has decreased by 44%, the Clinic has now been crippled and has morphed into something entirely different from what its founders had envisioned. Blanchon and the Board have argued that shifting to a primary-care model that focuses just on the delivery of medical care, from its original comprehensive health services model, which offered a spectrum of both social and medical services, was necessary to keep the Clinic's doors open.

However, Catania showed that the options of providing social and medical services are not mutually exclusive in devising a financially viable business model for the Clinic; as six other current major GLBT health centers throughout the country have provided comprehensive social and medical services, all the while experiencing boosts in revenue. During this same time period, WWC has suffered a financial free-fall in its move towards a primary care, HMO-type model, which also counters Blanchon's claim that its financial downturn is due largely to the economy. If that's the case, why have these other clinics not suffered in a similar fashion?

As a result of this deliberate restructuring, the WWC has been steadily stripped of its gay identity right before our community's eyes. On the watch of the current CEO and medical director there has been an utter neglect of the Gay Men's Health and Wellness Clinic, which has been left to wither and die on the vine while other GLBT services, like the Lesbian Services Program, comprised of more than 18 support groups, a buddy program for chronically ill and homebound women, and a lesbian health clinic, have all been uprooted and disposed of entirely.

The Bridgeback Program, the popular Man 2 Man Prevention Program, Volunteer Services, and the Food Pantry have all been dropped, along with Women Over Fifty and Women in their Twenties, both of which have moved to a new home at The DC Center. Moreover, its recent relinquishment of sponsorship of the DC Capital Pride Festival, a role the Clinic assumed as sole presenter in 2003 after a six-year partnership with One-in-Ten; its decision to end its relationship with the AIDS Marathon Program; and a precipitous decline in the donations it has recouped from DC's annual AIDS Walk, are all further indication of its steady detachment from the GLBT community. Most recently on the chopping block was the Crisis Intervention Line, which was disconnected last month.

In 2008, Blanchon eliminated the Prevention and Education Team and curbed the mobile testing vans, which remained idle until just months ago. These decisions were made at the same time the Clinic was experiencing a 232% increase in new incidence of HIV infection, an alarming trend that continues to expand, resulting in the worst rates we've seen in decades. But what I find most troubling about these decisions is that the Clinic's stakeholders, the GLBT community, and in some cases, even the Board, were not made aware of Blanchon's intentions to dispose of any of the above-listed programs until after they were already discontinued, stifling any possible objection to their removal.

In a recent interview with The Washington Blade, an executive committee member of the Clinic's Board, said that when the need for another round of cutbacks became apparent in early December 2008, a special effort was made to preserve programs "most critical to the Clinic's core mission." He must have been speaking about the Clinic's new mission, as I struggle to understand how these actions stay true to the Clinic's original charge of being "established by and for the gay and lesbian community."

And as GLBT programs continued to be eliminated, one respected past volunteer of the Whitman-Walker Addiction Services (WWAS) Program, Dr. David Schwartz, was struggling to prevent the hiring of a prospective counselor who expressed the belief that "gay sex is a sin." Despite his fervent efforts, the WWAS Program Director that had initially asked him to help with the interview process, dismissed his concerns and subsequently hired the individual as an addictions counselor, citing that at least one other current employee presumably held the same belief about gay sex. Dr. Schwartz's startling testimony follows.

Sadly, Dr. Schwartz's experience of being a dedicated WWC volunteer, only to be callously ignored and discarded upon expressing grave concerns about the Clinic's policies and procedures is nothing new, suggesting that a pervasive dysfunction in personnel management has troubled the Clinic for quite some time.

When I first arrived at the Clinic in 2006, despite occasional setbacks, the vibrant volunteer program was still thriving under Gray Border, then Director of the GMHWC. However, since that time the 'esprit de corps' of the volunteers in the GMHWC and related programs has undergone a noticeable decline, causing volunteers to leave in droves. As one employee of the Clinic put it, in his 20+ years working there, he had never seen the morale so low. Suddenly, its volunteers, the life-blood of WWC, were being treated as though they didn't matter and were expendable. Their suggestions on how to improve the Clinic fell on deaf ears and their concerns were continually ignored. This is not to say that there are not countless employees and volunteers who have persevered and continue make all the difference in the Clinic's ongoing successes. And they should be commended.

However, the compelling testimony of both Mary Murray, past WWC Volunteer Program Manager, and Dr. Terry Gerace, past GMHWC volunteer doctor, speaks volumes of the prevailing 'WWC culture' in recent times. As Murray indicates, there are far fewer volunteers at WWC now than Blanchon previously lead the DC City Council to believe, partly because he has continued to get rid of the many GLBT-focused programs. According to Murray, the true number is now closer to 150, rather than the 800 that Blanchon claimed during his testimony at the January 28th roundtable. There was a time when the Clinic boasted 800+ volunteers, but that was several years ago; most have since left out of frustration or have been forced out.

For more than three decades, members of the DC GLBT community have volunteered their time and opened their hearts and their checkbooks on behalf of the Clinic, with the understanding that their efforts and their donations were going right back to their community, at times when it seemed their government and society had abandoned them. However, private sector giving has fallen more than 57% since Blanchon assumed WWC's helm in 2006. I would contend that members of the GLBT community, perhaps historically the largest source of private sector donations, have finally wisened up to the fact that WWC is no longer sufficiently addressing their health needs and would rather give their GLBT-charity dollar to someone else. The Clinic's own 2008 data has revealed a demographic reversal in its client base since Blachon's arrival, showing that only 33% of its clients now self-identify as GLBT, the rest being heterosexual.

Considering the GMHWC (then the Gay Men's VD Clinic) is the very entity from which the present-day Whitman-Walker Clinic owes its existence, I find it difficult to believe that the current Board and administration feel it is no longer part of its core mission. However, recent changes under the current CEO and medical director would suggest just that.

In January, the GMHWC was unceremoniously renamed, the "STD Clinic." You shouldn't be surprised if you weren't aware of this change, as the current administration didn't even bother to notify the many gay men (screeners, HIV testers and counselors, and doctors) that currently make up far more than half of the evening Clinic's volunteers. Although Blanchon and other gay Board members profess that the Clinic is still committed to the GMHWC, the following testimony submitted by a past dedicated volunteer doctor, Terry Gerace, suggests that is not the case.

In Dr. Gerace's own words:

One only has to walk into the Gay Men's Health and Wellness Clinic, to find the waiting room populated with women (and until very recently, young children) sitting side by side with gay and transgendered clients waiting for confidential HIV and STD testing. What used to be a safe and anonymous space for gay men to seek medical treatment, no longer exists.

What's more, beyond this shift in focus, the GMHWC has suffered serious shortcomings in its ability to deliver quality medical care, which Dr. Gerace enumerates in his testimony.

Unfortunately, as was the case with Dr. Schwartz, Dr. Gerace's volunteer service was also terminated after he raised concerns about Clinic practices.

Many of the Board's medical missteps mentioned by Dr. Gerace may have been avoided, if not at least been better informed, if Board Members were more versed in GLBT-health related issues; which brings me to another matter that the Clinic needs to address. Of the 22 WWC Board Members (now 21, after Jim Sandman's recent departure as Board Chair on April 24th), only one is a physician - meaning that the overwhelming majority of the Board may not have sufficient understanding of medical issues, particularly those facing the GLBT community.

Not only would it be helpful to have more gay physicians on the Board of Directors of an organization that is supposed to be a GLBT-focused medical facility, especially one that has decided to move towards focusing on a medical delivery model, but also, members of the Board should make regular visits to observe how the Clinic is functioning. In my nearly three years volunteering at the Clinic, I (like Dr. Gerace) never saw a Board Member at the GMHWC, which is still running every Tuesday and Thursday evening, as it has been for years.

Compounding the accusations that the Clinic has moved away from its GLBT focus and grossly mishandled its finances, damning evidence was presented by Catania (a series of emails between employees, Blanchon and senior HR personnel) and testimony was given by the Clinic's current Director of Annual Giving, Robert Benish, showing that the Clinic violated federal law by withholding employees' 403b pension contributions for an unauthorized time period without investing them.

Catania then suggested that the Clinic likely implemented this practice to pay its outstanding financial obligations instead of rightfully placing those amounts into employee pensions, where they could reap the benefit of the market's recent rebound - an opportunity now lost to Clinic employees. Catania said it was not his intention to pursue this matter beyond ensuring that it would be rectified moving forward.

For a detailed account of this matter, see the following testimony by Benish.

Ironically, the issue regarding the laying-off of several long-standing Clinic employees (the "Christmas Massacre") this past December, which Blanchon and the Board have claimed to be the sole motivation for Catania's investigations, was addressed far more aggressively and persistently at the roundtable by Council Member Jim Graham (one of the most instrumental figures in founding the WWC; as well as a past Board Member and President). Council Member Graham found it inconceivable that Blanchon could have fired individuals such as Dr. Patricia Hawkins and Barbara Chinn, both senior staff members at the Clinic for more than 20 years, just days before Christmas without severance. The Board was not even informed of this specific decision until January 2009. Graham, clearly angered, asked of Blanchon, "Whatever possessed you to take this action?" He also questioned how not providing appropriate notice and severance benefits to such long-standing, devoted employees could be justified considering the disastrous state of the Clinic's financial system, incapable of accounting for the many wasteful financial decisions brought to light during the roundtable. Mistreatment of such valuable individuals is a testament to the Clinic's recent level of managerial dysfunction.

But perhaps the most egregious action the Clinic has unintentionally committed in my mind, as a gay man living in the middle of the District's modern HIV epidemic, has been its creation of a vacuum in the area of GLBT sexual health and HIV/AIDS prevention, in which other organizations and available funds have not moved in to address these public health issues, because our community was left to believe that WWC had those bases covered. Thus, for all the good WWC has done over the years promoting the health of and advocating for GLBT people, in recent time, it has propped itself up as the prevailing voice of the this community's health needs while simultaneously moving away from its provision of GLBT-specific services. And though its efforts to remain at the forefront of combating HIV in our community have helped so many, not being transparent about its recent mission change until pressed by Council Member Catania has set us back in our fight against the many epidemics now plaguing our community. As such, we must now work extra hard to recover lost ground in our battle against HIV/AIDS.

Finally, I would be remiss if I didn't mention the role Arnold & Porter LLC (A&P) played in this whole conundrum. In response to Catania's pointed allegations, the WWC Board retained A&P in February 2009 to conduct an audit and independent investigation of the accusations. The firm found overwhelmingly in favor of the Clinic, refuting most of Catania's claims. However, Catania expressed that the firm's "so called" independent investigation of the Clinic was a "total white wash," as its flawed sampling methods and conflicts of interest ran so deep that the credibility of its rushed report, which appeared to be more an advocation of Blanchon than an audit, may have been severely compromised. The Board stood by the veracity of the report's conclusions; however, Catania listed the following evidence supporting his concerns:

• Jim Sandman, Chair of the Board when A&P was selected, previously had a 30 year career with the firm, 10 years of which he was a managing partner.
• A&P had a previous history of doing pro bono work for WWC.
• 2 of the 3 report authors had performed this previous pro bono work for WWC.
• These same authors were alleged friends and colleagues of Sandman.
• A current WWC Board Member is the wife of a current member of the firm.
• Although the Board voted to hire A&P to perform the audit on February 3rd, there is a report that the authors had discussed the matter with Board members prior to the January 28th roundtable.
• A&P interviewed 27 individuals, of which 8 were Board Members and 12 were currently employed senior WWC staff, indicating that 74% those interviewed had a current vested interest in the Clinic.
• Only 2 of the interviewed individuals were even slightly critical of the Clinic.

Although many in the gay community may disagree with this post, my comments are not meant to divide us; rather, their purpose is to address some of the grave concerns I have with how recent actions by those currently leading the Clinic will affect the future health of the District's GLBT community - all of which Council Member Catania addressed at the recent roundtable. Having volunteered there for quite some time and spoken with so many people affiliated with the Clinic - Board members, clients, volunteers, and health providers - I can say with informed confidence, that something needs to change and that David Catania's decision to probe into the Clinic's management is appropriate and timely. Moreover, if I am misinformed on some of the points I've raised, it still stands that the perception of the DC GLBT community is that the Clinic is no longer sufficiently addressing its healthcare needs, a charge that Council Member Graham reminded us, is specifically mentioned in Article 3 of the WWC Articles of Incorporation.

I have held my tongue for too long on this subject for fear that my comments would only present barriers to future organizational collaboration. I also feel that many others who could shed light on this matter feel it would only distract us from important public health work that needs to be done, for these same barriers have historically plagued progress in the fight against HIV/AIDS. However, only by contributing to this discussion and addressing the dysfunction that has lead the WWC to its current state can we ever bring about the substantive change needed to tackle this modern epidemic in our community. This begins by acknowledging mistakes that have been made and then moving beyond them.

Regardless of where one's opinions fall, we must realize that in the end, all parties involved want the Clinic to succeed, especially at a time when HIV/AIDS is hitting our community so hard. We need to get through this most trying time in the life of the Clinic.

Before leaving the roundtable, Councilmember Graham asked Blanchon, "Do you acknowledge that you have made some serious mistakes?" He responded, saying, "Yes, in hindsight I would have done things differently." Graham then said, "so there is an opportunity to make amends...as many of these issues can be made right even today."

In truth, we've all made mistakes. In bailing out the Clinic in 2005, Catania perhaps could have put in place greater oversight in how those funds were spent; and the GLBT community could have pressed the Board to be more aggressive in preserving the programs most vital to our health. That said, the heavy-handedness, dishonesty, and utter disregard for WWC personnel demonstrated by Blanchon and the Clinic's management team are inexcusable. Moreover, the Board's abdication of so much of its responsibilities to the CEO and disengagement from the issues most critical to the Clinic's viability are equally indefensible.

However, many of these mistakes were acknowledged at the roundtable, and I am confident that the DC Council, the new Board Director, June Crenshaw (bless her for stepping into this role at such a tumultuous time), and Blanchon, whatever his ultimate fate with the Clinic may be, can now begin to rebuild WWC together. If the Board moves forward with Blanchon, his sincere dedication to the Clinic and his acknowledgement of past mistakes that he is willing to rectify will go a long way to set the Clinic back on the right course. However, if the Board decides to go forward with a new CEO, I am confident they will make the right choice. Regardless, the foundation for future progress and cooperation has been been laid, and it's now time for the Clinic to relax its defensive posture, take heed of the concerns raised at the recent roundtables, and return its reputation to its rightful place.

Otherwise, as Catania said, the Clinic will continue to "disappear before [our] eyes," just at the time our community needs it most. And this simply cannot happen; as the GLBT community desperately needs this Clinic now and for generations to come.

The gay community is now experiencing a rather devastating case of déjà vu; as recently it's become quite apparent that we are in the midst of a second major wave of the HIV/AIDS epidemic, at a magnitude that we have not seen for a couple of decades. A constellation of new data and recent national and local HIV/AIDS surveillance reports paints a very grim picture for current HIV incidence among men who have sex with men (MSM).

Many of us have seen the startling headlines, the District's 3% HIV prevalence figure that was emblazoned across TV screens and newspapers nationwide late last month; but we may not have considered what this means for us, as gay men - still the most disproportionally affected risk group for acquiring HIV.

Since 2000, the gay community has observed a steady increase in new annual incidence of HIV, after a brief decline in the late nineties due to the appearance of HAART and being saturated into submission with safer sex messages. However, the recent reports from the CDC and the DC Department of Health suggest that over the past couple of years, rates have once again skyrocketed within this risk group, a trend that is only now being noticed due to the inherent delays of reporting HIV/AIDS data.

Compounding the problem, the District's rate of new HIV/AIDS infections for 2007 (277 cases/100,000 individuals) is more than 13 times the national average (21 cases/100,000 individuals), according to recent data from the Kaiser Family Foundation. It is also important to note that the 3% HIV prevalence figure recently reported by the DC Department of Health is three times what is required for a "generalized" and severe epidemic. Jointly, these statistics indicate that whatever the risk currently is for MSM to acquire HIV, that risk becomes astronomically higher in the context of the District's modern epidemic.

Confirming this frightening supposition, the Whitman-Walker Clinic reported a 232% increase in actual (not estimated) new diagnoses last year, observing a dramatic upsurge from 80 clients testing HIV-positive for the first half of 2007 to 266 testing positive for the first half of 2008 - out of roughly the same number of total tests administered. Although the Clinic provides primary care and sexual health services to all underserved populations, its main client base is still largely comprised of gay men. Thus, one may conclude that this spike in new diagnoses was observed predominantly among MSM in the DC metropolitan area.

Altogether, these numbers suggest that the HIV epidemic, especially in DC, seems to have hit a 'tipping point' in the past couple of years, causing it to break free of its previously steady upward trajectory to now expand exponentially. And because many of these startling, new findings are already one-to-two years behind due to reporting delays, the reality of the current situation is likely far worse than what's been revealed.

Although many factors are to blame for this new epidemic of HIV, including the advent of the internet facilitating quick, anonymous sex; the gay community's raging crystal meth and bare-backing problem; and the lack of a coordinated domestic plan to fight HIV; gone from our memories, it seems, is a time when the gay community, like never before, rallied together to fight for survival, galvanized by the AIDS crisis. Perhaps it's because so many of those who would have passed on these memories of the devastation that AIDS caused died from the disease in the eighties and nineties. Or maybe it's because those who survived are so exhausted from practicing and preaching safer sex, that even they have succumbed to the recent phenomenon of HIV "prevention fatigue."

Regardless, today we find a new generation of gay men that have experienced their sexual debut in the late nineties or beyond and never endured the fear and suffering of those who lived and died only decades before them. They never attended weekly funerals or experienced the pain of having their social circles decimated over night. At the peak of the AIDS crisis, for example, the San Francisco Gay Men's Chorus saw its numbers decline by more than half within a year's time, in which only 210 singers survived to read the 257 obituaries of those who did not. Today, when just one, young gay man dies (whether AIDS-related or not), it's a tragedy. Sadly, back then it was commonplace.

I believe this second wave of new HIV infections may be upon us because we, as gay men, never really addressed the fundamental questions of how gay culture fueled this epidemic the first time around:

• How were the behaviors that favored the spread of HIV among gay men initially created and how could they be curbed beyond the technological quick fix of donning a condom or downing a handful of PEP after that condom breaks?
• Is it possible to modify these behaviors in a way that would not compromise the gains we have made through gay liberation over the past decades?
• How might we move towards the creation of a sustainable gay culture, in which our homosexuality is celebrated in a way that does not destroy us in the process?

It's not that surprising that we never acknowledged the need to answer these questions and fundamentally change our behavior the first time around, since engaging in such a public discourse would seem to play into the hands of anti-gay forces, only confirming their misconception that HIV was an exclusively "Gay Disease," resulting from our "degenerate" behavior. We were put so much on the defensive during the eighties and nineties that we never fully acknowledged that, in a lot of ways, HIV actually is a "Gay Disease."

We ramped up the use of condoms in order to prevent HIV transmission while also maintaining the "gay sex positivity" that defined much of who we had become in the latter half of the twentieth century. But getting gay men to finally use condoms and practice safer sex was a monumental task that seemed to gain traction only when our lives appeared to be in imminent danger. Unfortunately, that perception seems to have gone to the wayside, as we are now seeing rates of new infection similar to those observed in the early-to-mid nineties. And that begs the question: why have gay men back-slid so terribly in our practice of safer sex?

Although condoms and other modes of 'playing it safe(r)' are an essential part of combating the epidemic, they remain insufficient strategies for tackling the problem, if not reinforced by an underlining cultural sea change in our value system. For as long as I can remember, gay sex (under any circumstance) has been de facto tainted or diseased, always requiring a condom. Framed in this way, condom use is not an altruistic act of empowerment that one does out love for himself and, at a higher level, for his fellow gay men; rather, it's something one does because he'd be an idiot not to in the face of such terrible risk. Thus, it only follows that as the perceived risk of infection waxes and wanes, so will the use of condoms.

Yes, disease is transmitted at the individual level; however, it is amplified to epidemic proportions at the cultural or societal level, especially within groups that:

1. engage in very infective modes of transmission,


2. have already high prevalence of the disease, and


3. have highly fluid rates of partner change.

It is now clear that the sense of community among gay men forged by the HIV/AIDS crisis in decades past desperately needs to be revived, if we are once again to turn the tide on this epidemic. But this time around, we need to raise the bar with respect to the value we place on our relationships and how we interact with each other, especially in bed. We need to probe deeper (pun intended) when it comes to the questions we ask each other about sex.

"You been tested?" said in the breathless throes of getting it on, will no longer suffice. We need to follow up with: "When were you last tested?" and "How many people have you had sex with since?"... "What types of sex have you had?"... "Did you use a condom?"..."Did you know the serostatus of those sexual partners?".. etc. And we need to answer those questions honestly.

Above all, we must acknowledge (although it is still said otherwise, in courtrooms and in bedrooms across America) that damn it, we're worth it; our gay lives and our gay relationships are worth protecting. This is a critical first step in stopping the spread of HIV within our community, and puts the onus squarely on us, both individually and collectively, to make that change. We have done it before; and now we need to do it again - for each other!