I interviewed José for this article when he visited L.A. with his partner and fellow activist Anselmo Fonseca -- co-founder with him of Pacientes de SIDA pro Politica Sana -- on the occasion of José's receiving a "Community Hero" award from Alianza and Bienestar.

This dear friend and personal hero of mine will be greatly missed, but the memory of his fiery spirit and courage will go on inspiring many.

As Americans argue over healthcare reform and whether poor people should receive government-funded health care, one of the first and bloodiest battles ever fought over this issue took place ten years ago in Puerto Rico -- and got little coverage in the mainland media.

The central figures were two pioneering AIDS activists, José Fernando Colón and his partner Anselmo Fonseca. They fought -- and continue to fight -- the corruption and outright inhumanity so entrenched in our healthcare system, that have the United States in such a clamor today. The two men's activism, though largely unrecognized in the mainland LGBT community, has had a major effect on mainland AIDS policy.

"We went against the whole system and threw them down," José told me in a recent interview for A & U Magazine.

While the United States wanted Puerto Rico for reasons of Caribbean military strategy, our government evidently found it inconvenient to deal with Puerto Rican social problems -- even though many Puerto Ricans live well below the official poverty line set by mainland standards. As a result of federal inattention, the Commonwealth's health system has decayed even more disastrously than healthcare on the mainland. Most American politicians act like they don't know or care what happens in Puerto Rico.

Says Guillermo Chacon, vice president of New York's Latino Commission on AIDS, "One of the most difficult things is getting the mainland to recognize Puerto Rico as being part of the country."

So it's questionable whether Puerto Ricans will benefit at all from the Obama administrations's efforts to reform healthcare.

Enter José Fernando Colón. He was born in San Juan in 1952. By the time he graduated from the University of Puerto Rico, José was quietly out to family and closest friends. In 1982 he went to Spain with his partner Eduardo Aramis for graduate studies in literature. While there, he published his first book of poetry, and it looked like he would spend his life quietly in Hispanic literature.

But life turned things in a different direction. Aramis became ill with what turned out to be AIDS. José had learned that he, too, was HIV+. He abandoned the studies, and took his partner home to Puerto Rico.

This was when the two men had their first shocking encounter with the greed and criminality that had rapidly collected around federal AIDS funding.

No Room at the Hospital

The Ryan White CARE Act had just been created in 1990, making $220 million available through growing hundreds of organizations and agencies. The Act was intended to benefit PWAS and their families who were uninsured, under-insured or low-income. Puerto Rico's rate of HIV infection was already on record, so the new legislation applied there as well. Unfortunately, as the feds often do with aid to foreign governments, they started disgorging multimillions of dollars in AIDS aid into 50 states and U.S. territories without demanding any accountability or oversight on how the funds were spent.

What Congress had done was write a blank check for fraud...and for crimes against poor people with HIV/AIDS.

When Eduardo developed a lung infection and Kaposi's sarcoma, and went to the San Juan AIDS Institute for help, he was denied treatment. Yet AIDS drugs were available in Puerto Rico and he qualified as "low income." Later, at the Hospital Auxilio Mutuo, Aramis was assigned to a doctor, Jorge Garib. But the doctor saw Eduardo only once, and bluntly told him that he had a fatal pneumonia. No other doctor would see Aramis.

In 1991, José's partner finally died.

For the next two years, José went into a deep depression. Then one day in 1995, he met Anselmo Fonseca. Anselmo too was HIV+ and had lost a partner to AIDS. Shortly they became a devoted couple. When José developed pneumocystis pneumonia and the cocktail treatments were first made available, the two men battled the uncaring system and managed to get treatment together.

José was now 43, and Anselmo 37. The two built a good business teaching private English classes -- they had clients all over the city. But by 1999 their outrage was growing as they learned of other Puerto Rican PWAs dying because treatment was "unavailable." A few officials with a conscience joined them, and a complaint reached the San Juan office of the FBI. Since the FBI is charged by Congress with investigating crimes of fraud in the federal healthcare system, the bureau had to respond.

Offshore Banking With AIDS Money

In March 1999, José and Anselmo learned the first shocking details that FBI investigation had turned up.

At that time, Ryan White funding for Puerto Rico totalled $75 million a year. The FBI learned that some of these monies had been embezzled for personal use by assorted politicians, lawyers and administrative medical personnel. At the San Juan AIDS Institute, $2.2 million dollars had been siphoned away into offshore bank accounts, where they paid for all kinds of personal luxuries -- from jet skis to a maid for Dr. Garib.

The question had to be asked: How many Puerto Ricans were dying because their treatment money had been embezzled?

José and Anselmo were so outraged that they immediately founded a community-based organization called Pacientes de SIDA Pro Política Sana -- AIDS Patients for Sane Policies. Its mission: fight for justice, and for equal access to care by Puerto Rican PWAs. But in sharp contrast to so many giant AIDS orgs that float on massive funding streams, this little NGO would take no federal money, no pharmaceutical grants, no large gifts from donors. According to the two men, PSPS was funded by their personal savings and business earnings. Since nobody pulled their strings, they were free to call a spade a spade.

Organizing done, José and Anselmo faxed the first PSPS announcement to the Associated Press. The phone started ringing, and José was asked if he would identify himself openly as HIV positive -- still a risky thing to do in Puerto Rico, where Catholic-Church-dominated society was largely homophobic towards gays and tended to view AIDS as the result of "immorality and sin."

After a wave of FBI arrests, three groups of suspects, including San Juan AIDS Institute directors and administrators, went on trial. José had the satisfaction of seeing Garib slumped in the dock as a prisoner. He testified about what the doctor had done to his partner. Sad to say, the FBI's courtroom position was that the federal government was the sole victim of these frauds.

In 2000, with Anselmo, José traveled to Washington D.C. to testify before the House of Representatives. Only around a dozen Congresspersons bothered to show up and listen to these woes of far-off Puerto Rico. As they sat scattered in a sea of empty seats, the once-quiet literature professor boldly barked at them that the U.S. government ought to amend the Ryan White Act to demand full accountability on spending.

"You have to help us with these thieves!" he told them.

Back in San Juan, 14 individuals, including Dr. Garib, were finally convicted of felonies and sent to prison. Additionally, a handful of leading Puerto Rican politicians were tainted by links to the scandal, including a former Senator and the governor of Puerto Rico himself, Dr. Pedro Rosselló, whose office had allegedly received a shoebox full of cash.

The mainland's major media barely mentioned this landmark courtroom drama. But the San Juan AIDS Institute case was only the first of many battles to come.

Housing Vouchers for Sale

By 2005, with the economy sliding, federal budget cuts were reducing Puerto Rico's Ryan White share to $58 million. José and Anselmo found that local AIDS programs still tended to drag their feet on getting care to Puerto Ricans with HIV/AIDS.

A major issue was the $15 million a year that the city of San Juan received through Ryan White. By now, the local media had learned to interview PSPS. The little NGO's position was this: "It seems that the municipality lacks the in-house expertise to carry out important and time-sensitive tasks in order to provide highest quality of services and treatment to guarantee adherence to life-saving medications... The current millions of life-saving dollars destined for this segment of our population are not adequately being administrated."

PSPS established itself as a watchdog, denouncing the misuse of funding, including patients not receiving their prescribed medications, and doctors not getting paid for as long as five months, as well as problems with housing vouchers.

José told reporters: "These housing vouchers were being sold to people who were not sick."

The head of San Juan's Section 8 Program was indicted for soliciting bribes from people who wanted to be moved up on the waiting list for services.

But by late 2006, as problems worsened, 21 AIDS clinics in San Juan -- all of them administered by the city government -- insisted that they had stopped receiving Ryan White reimbursements. This created a deadly domino effect -- San Juan, in its turn, was not forwarding funds that were supposed to go to 29 other cities and towns in Puerto Rico.

Return of the Feds

One evening in December 2006, 84 agents swooped down on four San Juan AIDS Program offices. Far into the night, they seized computers and thousands of documents, and interviewed office workers about possible misuse of Ryan White funds in the San Juan municipality. This operation was bigger than the first one. The San Juan Star reported, "Agents from the Federal Bureau of Investigations, the U.S. Internal Revenue Service, the Puerto Rico Police and the U.S. Health and Human Services Office of the Inspector General participated in the raids."

Unfortunately, with so much AIDS paperwork now in FBI custody, services to many sick people were disrupted. By March 2007, GMA News TV was reporting:

"The U.S. has halted payments to clinics that treat AIDS patients in Puerto Rico, forcing hundreds of poor people to go without free medicine in a U.S. territory with an AIDS rate nearly double that of the mainland. Puerto Rican officials blame the FBI, saying agents investigating fraud seized documents clinics need to get reimbursement for drugs and services. The FBI denies it is responsible. Patient advocates blame the San Juan city government."

In the capital, some 2000 PWAs were receiving only enough meds to last 5-7 days per month. "People's lives are in danger," Anselmo Fonseca told the press.

Meanwhile, on another front, Jose and Anselmo were battling officials over the dwindling ability of unable-to-work or about-to-be-homeless PWAS to get housing through HOPWA (Housing Opportunities for People With AIDS). The local situation mirrored similar problems that were developing with HOPWA on the mainland -- ongoing budget cutbacks meant that more and more sick people on the HOPWA waiting lists went without a roof over their heads.

In response to a complaint from PSPS, the PR Secretary of Health Lorenzo Gonzalez Feliciano retreated into lofty sarcasm when he replied to José: "We are very sorry to hear that our efforts to facilitate housing to our HOPWA Program participants do not meet your expectancies."

Incredibly -- as I write this in 2009, three years later -- the 2006 FBI investigation is still grinding forward, as the agency continues to scrutinize piles of documents.

Catholic Church Leverage

All this is happening in a commonwealth where there is essentially no separation of church and state. The Catholic Church is allowed to do the kind of open lobbying that it wouldn't dare to do on the mainland. Despite inroads made by Protestant evangelizing, around 80 percent of Puerto Ricans still identify as Roman Catholic. On the AIDS front, the Church continues to propagandize Puerto Ricans on avoiding condoms and embracing abstinence-only instead.

On a parallel track, PR's growing community of out LGBT people has been working to legalize same-sex marriage or civil unions in the commonwealth, but the Church blocks them at every turn. In 2007, the Church did propose a compromise concept called "shared residence." This was the brainchild of San Juan archbishop Roberto González, who worked with legislators to introduce the bill himself. The Church was willing to allow the extension of hospital visitation rights, inheritance rights and medical-insurance rights to any two persons living together under the same roof, whether they were straight or gay. But the Church made sure that "shared residence" language did not recognize same-sex couples as a family unit or offer them the same protections and rights that marriage does.

Said Puerto Rican senator Jorge de Castro Font, who backed the bill: "Puerto Rico is a Christian town." (The shared-residence bill didn't pass.)

Given this dominance of the Church, it's all the more extraordinary that openly gay José and Anselmo have managed to make themselves so visible in Puerto Rican politics. In 2008, for the first time ever, Governor Acevedo Vilá invited three LGBT Puerto Rican leaders to take part in a traditional annual ceremony, the saludo protocolar, at the governor's official residence. Representing PSPS, José was one of the three distinguished invitees, along with Bilerico's own Pedro Julio Serrano, president of Puerto Rico Para Todos, and Rev. Margarita Sánchez, president of PR's chapter of Amnesty International.

Most amazing of all, the San Juan archdiocese allows PSPS to help organize the massive candlelight AIDS vigil every year. The sanctuary of the stately baroque cathedral, built in 1521 and second-oldest in the western hemisphere, is always packed with people for the event, as thousands more stand outside with their flickering candles. José has actually stood at the pulpit, where a priest ordinarily stands, and made a public pledge to keep on fighting for PWAs for the rest of his life. The scene is emblematic of LGBT Catholics who continue to fight valiantly for acceptance within the Church.

Indeed, despite so much ecclesiastical opposition to what PSPS is doing, Colón credits his deep Catholic faith for giving him strength to go on fighting.

Scandals on the Mainland

Today Pacientes de SIDA Pro Política Sana is still almost unique among AIDS organizations -- PWA-founded, community-based and volunteer-operated. It counsels thousands of clients about their civil rights where treatment and service referrals are concerned.

Thanks to the efforts of PSPS and its allies, some Democratic and Republican Congressmembers -- along with a few officials like Attorney General Janet Reno -- finally sniffed the wind and realized that AIDS spending didn't always pass the smell test. In 1999, legislators asked the General Accounting Office for an audit of federal AIDS programs and services, including those in the U.S. In 2000, the Ryan White CARE Act was reauthorized by Congress. And the testimonies of José and other whistleblowers were finally sinking in. That same year, Congress added amendments to the CARE Act to increase accountability, and to enhance service in urban and rural communities.

These changes proved what two people can do, even when confronting a government colossus.

But getting compliance may be hard with so many Americans denying that there's a problem.

Some in the U.S. media like to pontificate that Puerto Rico's problems are just an "isolated instance," that the commonwealth has "traditional" problems with political corruption. But the undeniable fact is -- these Puerto Rican scandals are actually a reflection of the larger scandals and criminality that have encrusted itself around healthcare on the mainland. In the area of fraud alone, states abound with examples of federal AIDS funds being embezzled, misspent, not spent at all -- or funds simply soaked up by outrageously high overhead and directors with outrageously high salaries.

Two glaring mainland cases got only modest news notice here. In the early 2000s, right in Los Angeles County where I live, local activists learned that $17 million earmarked for HOPWA housing had sat in a bank account unspent. Yet this inaction affected two thirds of L.A.'s PWAs. Meanwhile, in New York, a state Supreme Court Judge found the Giuliani administration in contempt of court for failing to place homeless PWAs in housing, even though funds were available.

We have to ask ourselves what impact these sordid and unfeeling practices continue to have on the actual AIDS death rates -- as when a sick person who can't get decent housing finally dies on the street somewhere because of combined illness, stress and exposure.

Some LGBT members of the AIDS establishment were not happy about news attention to these crimes. ACT UP DC's Wayne Turner published a number of investigative pieces. In a Washington Monthly piece, Turner commented drily, "AIDS groups who have taken great pains to stake out a benevolent image still refuse to acknowledge that the number of 'isolated incidents' of fraud, mismanagement, and abuse of AIDS funds are increasing nationwide."

When I detailed some of these crimes in a 2002 column for A & U, a few readers wrote the magazine to protest. One San Francisco gentleman who had made large donations to AIDS nonprofits emailed me angrily to insist that I was making it all up. Responding in my next column "Dollars and Deaths," I pointed out that the cases I cited -- far from being fictitious -- had already gone through the courts.

How could this be happening, when AIDS is supposedly such a humanitarian issue? When "winning the war on AIDS" is supposedly such a national goal? And why so little outcry from PWAs on the mainland? Sad to say, I learned that many U.S. PWAs see the abuses very clearly, but they keep quiet because poz whistleblowers are often targeted for what one of them calls "consumer disenfranchisement." This particular man, who lives in a Southern state, told me that he was punished for his allegations of local funding fraud by being denied services at his local ASO. Similar cases of punitive service denial, or of barring whistleblowers from conferences and meetings, are on record across the country.

José Colón told me: "I was openly threatened because of my activism. If I hadn't been vindicated by the trials, I might have had to leave the island."

The Troubled Present

This year, as the Ryan White Act once again faces reauthorization by Congress, and the Obama administration flounders around trying to reform healthcare, it's clear that the United States of America still has a long way to go if it is really going to clean up its act in this important area.

Some mainland recognition has come to PSPS -- but mainly from Latinos. In September 2009, the two men traveled to Los Angeles, where José was named a "Community Hero" in an annual ceremony co-organized by Alianza and Bienestar, two organizations that serve the Latino community in Los Angeles County. More recently the Puerto Rican Chapter of the National Association of Social Workers designated José as "Citizen of 2009."

Meanwhile, José is returning to writing -- sitting down to write a book about the PSPS story. And he has an incredible story to tell. He and Anselmo Fonseca played a major part in the history of the AIDS epidemic, by jarring the U.S. federal government into its first efforts to stop the illegal diversion of AIDS funds -- to ensure that taxpayer money actually gets to the PWAs and their families for whom that funding was intended.

Indeed, the two men's battle was one of the first shots fired in that greater war to reform all healthcare -- one that is likely to last as long, and mire the country as deeply, and divide it as sharply, as the war in Afghanistan.
_________________________

Photos by Sean Black, courtesy of A & U Magazine.

Further reading:

About Pacientes de SIDA Pro Politica Sana

Warren's A & U column on Puerto Rico's healthcare problems

Wayne Turner on the AIDS Institute scandal

Wayne Turner on Colon's testimony before the House in 2000

Text of José Colon's testimony before House of Representatives in 2000

Warren's 2002 article on AIDS corruption "Dollars and Deaths"

Blabbeando on "shared residence"

About Alianza

About Bienestar

Indeed, what I see is dogged drum-beating for more testing, more treatment. In short, more of a problematical thirty-year-old AIDS tech that is working less and less well, because of buildup of drug-resistant strains.

I've been writing this column for fourteen years, and now and then I have to scratch my head at things that don't make sense. Sense often vanishes with AIDS because of the colossal push-me, pull-you impact it has on politics. There is the colossal political chasm it has opened, between those who see AIDS as a humanitarian cause and those who see it as the devil's work. There is the colossal money involved - the colossal amounts needed for domestic and global treatment and - let's face it - colossal profits for the pharmaceutical industry.

When AIDS first exploded in the early 1980s, the treatment choice was something new called antiretroviral drugs (ARVs). LGBT people marched and clamored for access to new drugs because gay and bi men were hit so hard. They got their wish. Today, three decades later, there are half a hundred patented drugs, a few of them still experimental, that group into half a dozen categories, and are used in different combinations.

The drugs do buy time, so the industry has rushed to re-label AIDS as "chronic" rather than "fatal." In the case of my friend theater director Michael Ward, they bought him almost twenty years. But those years were hardly "chronic"--along the way Michael battled Kaposi's and other serious additional issues. It was sheer will to live that kept him going. In the case of another friend, TV commercial producer Philip Labhart, he got just a few years of grace, before galloping lymphoma swept him away.

Defenders of antiretroviral treatment (ART) argue that U.S. death rates have plummeted, people live way longer, hospitalization is down, etc. But truth must be told -- ARVs are still problematical. There is the individual body's intolerance of some drugs. There is growing resistance of HIV strains, and the well-documented side effects of many drugs, some of which are severe and possibly fatal. Sooner or later, time usually runs out on "chronic."

Most of all, there is the staggering lifetime cost of treatment for Americans. An updated figure comes from a 2008 study reported in Medical Care. It puts the total at over $600,000 for twenty-four years, said to be an average extended survival time. But that figure doesn't always include managing and treating side effects, treating opportunistic infections, etc. In Michael Ward's case, according to his surviving partner, the total ran into millions. One AIDS doctor I've interviewed tells me, "One of the big costs comes in the last weeks of life, keeping a person alive in intensive care."

I'm baffled that, all this time, the LGBT community has stuck so politically with the drugs. Sure, we got what we asked for. Sure, our well-to-do can afford their own treatment. Plus some of us landed invitations to the White House, and six-figure jobs with nonprofits and government agencies. But at the end of the day, some of us still die of AIDS. And there are still community members who are poor or unemployed or homeless...who can't qualify for programs or get into ADAP.

So I'm scratching my head at why LGBT people aren't marching and clamoring for something better... and cheaper.

The Life-and-Death Cost Gap

In a time of economic meltdown, a safe, effective, inexpensive vaccine is the logical answer to ending the AIDS epidemic. Instead of costing those millions of dollars to keep a single person alive with drugs, a vaccination might cost as little as--say, 23 cents. Bill Gates likes to talk about the 23-cent vaccine. But given the profit motive running the U.S., an AIDS vaccination might be marked up to, say, $500. That's roughly what the HPV series costs. The HPV vaccine is one of the most expensive--$390, according to the CDC, plus extra for office visits. Say, $500 as a round total.

But hey... $500 for a lifetime of full protection from HIV infection sure beats $600,000 (maybe even millions) for twenty-four years of after-the-fact AIDS treatment.

In the case of HIV-negative gay and bi men who want to have unlimited sex--if they were vaccinated, they could go out and have it, and not worry one minute about getting infected. The faithful HIV-negative gay partner wouldn't have to worry about being unknowingly infected by an errant spouse, if both were vaccinated.

Yet I've noticed that the LGBT community is not marching and clamoring for a vaccine the way they did for the ARVs. Instead, many in the community still buy into this thirty-year-old treatment model that is not only expensive and problematical--but causes them a lot of anxiety.

With developing countries, a similar gap looms between treatment and vaccination costs. It's true that drugs must be heavily discounted out there, because cash-strapped governments must buy them for free distribution to their poorest citizens. So lifetime cost is not as awesome, compared to cost of existing vaccines used in developing countries. But there is still a significant spread. In 2012, according to PEPFAR, annual cost of one person's treatment with generic ARVs was $335. If that HIV-positive person lives for 10 years, the lifetime total is $33,500.

For rough comparison to an existing vaccine, we can go to WHO's anti-polio effort. The oral polio vaccine (OPV) distributed by UNICEF costs between 11 and 14 U.S. cents for one dose. But that one dose confers lifetime immunity. If an AIDS vaccine could be marketed at a comparable price, doesn't it make sense to get a person's whole lifetime for 11-14 cents, instead of just ten years for $33,500?

Questions About Why

Why is the United States stuck in this nonsensical policy?

We are the country that came from behind in the space race, to put men on the Moon in seven years. President Kennedy said, "We choose to go to the Moon in this decade...because that goal will serve to organize and measure the best of our energies and skills, because that challenge is one that we are willing to accept, one we are unwilling to postpone, and one which we intend to win." Yet when it comes to AIDS, the United States is apparently "willing to postpone" this new challenge.

To make a comparison -- if this were polio, we would still be toiling to keep already-paralyzed people alive in iron lungs instead of preventing polio with a vaccine that we fought to create. Indeed, it took having a President with polio--Franklin D. Roosevelt, running World War II from a wheelchair--to show Americans that a vaccine was vital. It was FDR who personally launched polio-vaccine research with a project at the National Foundation for Infantile Paralysis. The project hired Jonas Salk, who discovered the vaccine in 1955. In short, the polio vaccine was achieved in just 10 years.

Why are we not putting the same kind of race-to-the-Moon polio-vaccine energy into marketing an AIDS vaccine?

Is it because (as some conspiracy writers assert) certain powers-that-be want to see a global-population reduction of several billion people, so they aim to let lots of people die of disease? Is it because religious conservatives don't want a vaccine that lets people feel they can safely engage in "immoral sex" outside of marriage? Is it because most of the biotech industry is now mired so deep in conflict of interest and corporate profit from the drugs that it can't find its way out of a wet paper bag? Is it because organized nonviolent protest has finally been effectively crushed in the U.S., making it impossible to repeat the fierce AIDS demonstrations of the 1980s?

Is it maybe all of the above?

To date, Bill and Melinda Gates have forked out $2.5 billion in grants for HIV/AIDS research. But apparently they still haven't committed to a likely vaccine candidate and its clinical trials. Last summer, Gates stated to the press, "There is a very good chance it will be a decade plus before we'll have the thing."

So here I am -- hearing the 2013 drum rolls for more of the same MO that leaves humanity without a truly effective and affordable way of stopping AIDS. More testing, more people treated, and of course more drug sales for corporations. A minimum $600,000 spent per person instead of, say, $500. It doesn't make sense at all.

(A version of this commentary appeared originally in the January 2012 issue of A & U Magazine.)

A few years ago, I posted at Bilerico about my own journey to paganism. Classical paganism encourages people to question everything (which is how our ancients made so many key scientific discoveries). So my definition of paganism may differ from others. But I'm reposting it again, because I'd like to join the discussion that has exploded around the Fox misstep. Here it is, after the jump:

Yet paganism is at the core of American history. Many of our American founders -- men like Jefferson and Franklin, women like Mercy Otis Warren -- had political ideas that were rooted in classical (i.e. Greek and Roman pagan) institutions of government. The very idea of an "American republic" was based on a pagan idea, created by ancient Roman tribes who threw off a cruel monarchy and took back the political power over their own lives. The word "re-public" traces to Latin words that mean "back to the people."

Many Americans are pathetically misinformed about what "paganism" is. They swallow everything that the religious right tells them -- that all pagans practiced human sacrifice, ate babies for breakfast, practiced devil worship and sex orgies, etc. etc.

Americans have also devoured PBS and History Channel shows alleging that Adolf Hitler was a "pagan." If PBS says this, it must be true, right? (The producers of these shows never explain why, if Hitler was a pagan, his rise to power was supported by so many Catholics and Protestants, not to mention the Vatican.)

The fact is -- the early Church warred against "pagans" because these people were the enduring masses who still followed the old pre-Christian ways. Latin pagensis means a person who lives in the country, not the city. By the closing days of the Roman Empire, Christianity had captured the empire's old urban centers and government bureaucracy, but country people were still largely untouched by this change. Every village still had its little temples and shrines and festivals to the old Gods and Goddesses. It took the Church nearly a thousand years of war and public executions to stamp out the lingering pockets of paganism across Europe.

I identify with these historical "pagans" because of the way that militant American Christianity is trying to stamp out everything non-Christian in this country.

Some Americans even believe that pagans are atheists. An old friend of mine, whom I've known since grade school, told me recently that she wished I would find the Lord someday. She's a devout Catholic and feels distressed by what she sees as my lack of belief in anything. I told her that I had found the Lord...and the Lordess.

How I Got There

A biography byte: I started out at age 6 in Presbyterian Sunday school, and went to Catholic convert at the age of 17. But I left the Catholic Church at age 20. From there I touched bases with agnosticism, existentialism, Hinduism, Buddhism, Islam, but those didn't work for me. Around 1979, I reconnected with some of my First Nations relatives while working on my historical novel "One Is the Sun."

That time in the 1980s got my feet back on the ground and prompted me to re-examine everything I thought I knew. I constructed a new MO for myself that started with God and Goddess, and went on to constantly learn new things and question old things. I like the word "pagan" as a job title of where I'm at, because ancient pagan philosophy and science was based on asking courageous questions and following wherever the questions led. That included questions about sexual orientation and gender. The ancient Greeks and Romans lived the whole gamut of gay, lesbian, bisexual, transgendered and straight, and they addressed those questions with more courage than establishment Christianity ever did.

So as an American pagan, I find it amusing to see the religious right fuming about how "America was founded on the Bible."

One look at Liberty, chief symbol of the United States from our beginning, and you know that the righters are lying in their teeth. The Goddess of Liberty appeared on our earliest coins. She stands on top of the Capitol dome in Washington D.C. She holds a torch at the entrance to New York Harbor. She can be seen in ten thousand other places across our nation, in public buildings and in our arts. Under the name Libertas, She was beloved by the pagan Romans, and a symbol of freedom for slaves.

But you won't find Her anywhere in the Bible.

____________________________

Copyright 2007 by Patricia Nell Warren. All rights reserved. First published in Echo Magazine.

Till now, Mali had a relatively low rate of HIV transmission. But with civil-war rape now exploding, those figures may rise.

Most Americans think of HIV transmission as taking place in peacetime situations. Examples: among sex workers, or mutually consenting heterosexuals or MSMs, or even porn stars who didn't wear a condom. U.S. prevention programs are definitely tailored to peacetime. Yet as far back as the 1990s, civil wars around the world have been identified as a major factor in the spread of AIDS.

According to GlobalSecurity.org, the last hundred years have seen a huge shift in the percentage of civilian deaths during warfare. "During World War I," says this military-oriented NGO, "civilians made up fewer than 5 percent of all casualties. Today, 75 percent or more of those killed or wounded in wars are non-combatants."

Africa -- Afflicted by War

Global Security goes on to comment, "Africa, to a greater extent than any other continent, is afflicted by war. Africa has been marred by more than 20 major civil wars since 1960. Rwanda, Somalia, Angola, Sudan, Liberia, and Burundi are among those countries that have recently suffered serious armed conflict....Billions of dollars of development assistance have been virtually wasted in [these] war-ravaged countries." Indeed, any map of Africa showing the war zones is literally pockmarked with them.

Today the U.S. AIDS establishment has a big focus on getting testing and treatment into every African country where AIDS exists. These tasks are difficult enough in regions lacking in the most minimal public-health delivery systems. But the tasks can be more difficult, sometimes impossible, in regions where fierce civil fighting is going on, or where tens of thousands of refugees are living piled up in huge camps.

Says UNICEF: "We are very much aware of the hostilities and human suffering that are deeply connected with conflicts across the African continent. Yet the situation is far worse than what we see, read and feel sitting thousands of miles away from the conflict zones. UNICEF has warned that rape and sexual violence in some of the conflicts of Africa have taken the form of an epidemic....While sexual violence is common in war-zones, women and children are now being raped in displacement camps, during aid distribution and even after conflicts have ended."

Worse yet--according to Amnesty International, war rape has evolved beyond the historic pattern of victorious soldiers gratifying themselves sexually while looting. Today it often is a key element of military strategy. In countries where traditional societies still reign, victims of war rape can find themselves shunned by spouses, families, and society generally. So a sheer mass of these crimes, directed at civilian "enemies," can swiftly contribute to the collapse of morale and social order on that other side.

Just a year ago, Doctors Without Borders reported on widespread rapes during fighting between government troops and rebel bands in the Democratic Republic of the Congo. According to agency representative Annemarie Loof, who was speaking with CNN World, "Women had been restrained with ropes or beaten unconscious with the butt of a gun before being attacked, some in front of their children." In 2012, the Journal of the American Medical Association did a study in Eastern Congo, revealing that an estimated thirty percent of the region's women and twenty-two percent of its men had been subjected to rape by soldiers.

In 2004, the UN News Center reported on a similar epidemic of rapes in the Darfur region of Sudan. The news service stated: "Armed militias in Sudan's strife-torn Darfur region are continuing to rape women and girls with impunity, an expert from the United Nations children's agency said today on her return from a mission to the region. Pamela Shifman, the UN Children's Fund (UNICEF) adviser on violence and sexual exploitation, said she heard dozens of harrowing accounts of sexual assaults."

Uganda's Example

Uganda is a case in point, since it has been ballyhooed as the first African country to introduce the faith-based ABC prevention program teaching "Abstinence before marriage; Be faithful; Condoms." Ironically this program could only have succeeded in a peacetime setting. Yet from 1981 on, Uganda's northern reaches have been consumed with chronic civil war against a rebel army, and reports of sexual atrocities against civilians have been rife. Not surprisingly, later surveys showed that the ABC program was not very successful.

The spread of AIDS in Uganda was analyzed through the lens of civil war by the British science journal Epidemiology and Infection in its August 1991 issue. Authors Smallman-Raynor and Cliff commented, "The classic association of war and disease substantially accounts for the presently observed geographical distribution of reported clinical AIDS cases in Uganda. Both the spread of HIV 1 infection in the 1980s, and the subsequent development of AIDS to its 1990 spatial pattern, are shown to be significantly and positively correlated with ethnic patterns of recruitment into the Ugandan National Liberation Army (UNLA)....This correlation reflects the estimated mean incubation period of 8-10 years for HIV 1 and underlines the need for cognizance of historical factors which may have influenced current patterns of AIDS seen in Central Africa. The findings may have important implications for AIDS forecasting and control in African countries which have recently experienced war."

As further irony, Uganda makes news with its ongoing determination to pass the notorious "anti-gay" law. One clause applies to people with HIV, stating, "A person commits the offense of aggravated homosexuality where the offender is a person living with HIV." In the most recent version of the bill I've seen, the punishment for an HIV-positive offender is life imprisonment. But some observers continue to insist that the bill, in its final form, will contain the death penalty. Either way...what injustice might befall an HIV-positive Ugandan man caught in the toils of such a prosecution, whose status is the result of war rape? Who might not have known he was positive till he was forcibly tested? How does he defend himself?

With Muslim/Christian civil conflict continuing in Uganda, it's no wonder that many observers say enforcement of this law will greatly complicate the war on AIDS in Uganda.

Americans Often Oblivious

Here in the U.S., the AIDS establishment is gearing up to pump new ARVs into Africa, in the wake of all those recent pronouncements that "treatment must be made available to more millions." AIDS Healthcare Foundation just announced: "Dr. Salami Olawale, the Nigerian Country Director for the AIDS Healthcare Foundation (AHF), has announced that about 300,000 Nigerians have been infected with HIV since the start of 2012. Olawale announced this sobering fact during a call to action encouraging members of Nigerian communities to get tested for HIV--something only about 20% of the country's population has done."

Yet Nigeria has just experienced a new flare-up of civil war. In northern Nigeria this past summer, heavy fighting broke out between Christians and Muslims, who are retaliating on each other with widespread killings and burnings of property. Government troops raced in to restore peace. But according to Amnesty International, reports of atrocities against civilians by both sides have reached Western media. Given the fierce hatreds between the two religious factions, sexual violence was a given. Yet little is said that some of these 300,000 new Nigerian cases of HIV may be the tragic result of war rape.

Americans are often oblivious to the way in which war-time sexual violence will cut across their ARV efforts in Africa.

Shortly after I published this commentary in A & U Magazine, civil war broke out in the West African nation of Mali. And a new name was added to the list of countries where this problem may now become endemic.

How to ensure that these casualties of war are treated with respect, once their HIV status becomes known to their families and their local societies? Once it is known that their infection resulted from war rape? How can governments take AIDS aid without making efforts to change old attitudes that shun and stigmatize these victims of war crimes? Without a change in attitudes, any adult victim might understandably do everything possible to avoid being tested or treated, for fear of the social consequences.

Today, in the U.S. media, the air is full of grand statements about how "global AIDS can be ended in our lifetime" if only enough test kits and doses of drugs are pumped out there.

But the fact is--war everywhere on our planet will have to end before we can even talk about "ending AIDS."

A shorter version of this commentary originally appeared in the December 2012 issue of A & U Magazine. This new version is updated with mention of the Mali conflict. New version is copyright 2013 by Patricia Nell Warren. All rights reserved. War graphic via Bigstock.

So often, I have to report bad news about the greed, corruption and malfeasance that infests much of the biomedical world today. So for once I'm glad to report some good news -- namely a cure that is said to work for 80 percent of those treated. A few months ago, a friend of mine, Karen Connell, sent an email headed "Whoopi" to her personal e-list. Her doctor had just told her she was finally cured of an old Hepatitis C infection, thanks to this new drug.

Long-Time and Invisible

For many decades, Hepatitis C has been a major identifiable cause of liver disease among Americans. The RNA virus causing it was first discovered in 1989. The infection is often asymptomatic, staying undetected for years. Chronic infection can lead to cirrhosis or cancer of the liver. In the U.S., HCV is spread primarily by sharing of dirty needles among intravenous drug users, by unsterilized medical equipment and -- until the U.S. started screening the blood supply for HCV in 1992 -- by blood transfusions. HCV is not known to be spread by direct sexual contact.

Till now, standard treatment has been a combination of Interferons and ribavirin, a protease inhibitor. (Interferons are proteins released by the body that stimulate the immune system against invaders like viruses.) Often the persons being treated were virus-free for a while, only to have HCV re-emerge in their bodies again.

But last year the FDA approved a new protease inhibitor -- boceprevir, manufactured by Merck (trade name Victrelis). It's the first new hepatitis drug in 20 years. With this and similar new drugs, complete cures are now possible for as many as 80 percent of HIV-negative persons who have HCV -- even those with long-entrenched infections. Among these, Karen Connell is now an example, and she consented to be interviewed.

PNW: When did you first discover that you had contracted Hepatitis C?

KC: In August of 2009. I had just had my annual physical and happened to mention to my doctor that my chiropractor, who also did kiniseology, told me something was going on with my liver and ran a liver-function panel. It came back indicating that my enzymes were high. So my doctor had a liver panel done in conjunction with the normal labs he did every year. He called me and asked if I had had any contact with Hepatitis C. He told me to go have the labs done again, just to be sure, along with a viral count.

PNW: Do you know how you first contracted the virus? So often, today, Hep C is contracted by injection-drug users. But back in the era you're talking about, Hep C was more commonly transmitted through transfusions of infected blood.

KC: Yes, that's exactly how I got it. Thirty years before, after my husband assaulted me and slashed my throat, the hospital gave me 8 pints of blood transfusions before they started surgery. They didn't know how to screen for that particular virus until ten years after I was infected. It was like he had taken another shot at killing me, and I was really furious.

PNW: How did learning you had Hep C infection affect your life?

KC: I'm a serious "if life gives you lemons, make lemonade" kinda gal, and I believe that things happen for a reason. But before I could get back to my philosophy of life I got really scared. It seemed there was no cure for this "dragon" that could continue on into cirrohsis or even liver cancer. I was furious that my body had let me down and allowed this to happen. I had no clue what it was and started to research it. The more I read, the more scared I became. I found out that I had been carrying this virus around for 30 years and had no symptoms, except that I tired easily.

PNW: Did your caregivers try other treatments first? And what was the protocol?

KC: First I was referred to the G.I Department and got a doctor who specialized in colon cancer. He went over my options and told me that he recommended the current treatment at that time, a combination of Interferon (which is chemotherapy but a lower dose than for cancer patients) and Ribavirin. I asked for a referral to a hepatologist and got one. That doctor ran all kinds of tests, liver biopsy, upper endoscopy, treadmill test and a CT Scan just to be sure I was strong enough physically to go through the treatment. I was almost 65 and that made them a bit wary. For most of the treatment, I was virus free. But three weeks after stopping the drugs, the virus was back.

PNW: So what was your doctor's next move?

KC: For my second round of treatment, they had this new drug that had only been FDA approved for 6 months. Boceprevir was added to the previous two drugs and I was off down the drug path again starting July 2011.

PNW: The new drug is very expensive, right? Did your insurance cover it?

KC:Yes, this drug costs $10,000 a month. But it was covered by Medicare through Kaiser Senior Advantage. So things went okay until I entered the "donut hole" everyone talks about on the commercials, about Medicare supplemental insurance. That was when I had a $4,500 out-of-pocket expense in one month. Then catastrophic coverage kicked in, so it wasn't bad after that. But with weekly labs it did add up quickly. I was fortunate that I could handle it financially.

PNW: The medical literature talks about side effects of Hep C treatment. Did you experience any?

KC: The side effects of all three drugs were mild nausea (they gave me more drugs to control that), and dizziness. And extreme fatigue. Some days I felt like it was all I could do to keep puting one foot in front of the other. I also developed such severe anemia that they added Procrit to my weekly shot routine. And the new drug played havoc with my taste buds. Nothing tasted good, not even chocolate! And I had sores in my mouth, so it was really hard to eat.

PNW: How did you feel on hearing from your doctor that you're finally virus-free for good?

KC: I did a little Snoopy happy dance. I had finally killed the dragon!

PNW: It's interesting that the news stories describe this new drug as one that makes Hep C "manageable" -- yet you're among the percentage who actually get cured. How lucky does that make you feel?

KC: Yes, I definitely was one of the fortunate ones. In spite of my age I was able to work the entire time I was in treatment. I just refused to give in to this affliction, and my side effects were manageable most of the time. I ate well and slept a lot. I also had a retired nurse as my caregiver so she gave me the weekly and later bi-weekly shots. I also stayed in touch with friends and they sent me prayers and healing energy. I am grateful for all the support I had through this long 2 1/2 years.

More Challenges Ahead

Today as many as 300,000 Americans living with HIV may also be HCV-infected, with increased chances that they will die from liver disease caused by HCV. Indeed, the incidence of co-infections is increasing, according to the CDC.

Treatment of people who are co-infected with HIV and HCV is still an ongoing battle. HCV viral loads are higher in co-infected people than they are in people who are HIV negative. Interactions between the HCV drugs and the HIV drugs can be a problem. The effect of HCV on the history of HIV in a person's body is still not well understood. At the 19th Conference on Retroviruses and Opportunistic Infections last spring in Seattle, co-infected treatment was a hot topic.

However, the current advances in what my friend Karen calls "killing the dragon" are cause for hope.

Further Reading:

Basic Information on boceprevir

This article was previously published in Warren's "Left Field" column in the September 2012 issue of A & U Magazine.

I'm talking about the 12 times in 90 minutes (count 'em) that Romney interrupted moderator Jim Lehrer. Sometimes, in the course of a lengthy interruption, he also interrupted President Obama. Several times, when Lehrer tried to assert himself, Romney continued to bulldoze and bully and push the interruption till Lehrer gave up and let him take an extra turn.

Lehrer has stated that a debate moderator should be like a baseball umpire - get out of the way and let the debators play. But on Wednesday night Lehrer forgot that real-life umpires are there to enforce the rules of the game. And sometimes the umpire has to kick a player's butt.

But it was in Los Angeles Unified School District in the late 1990s, serving as a commissioner of education, that I got crystal clear about the life-and-death importance of parliamentary procedure. I was appointed one of the parliamentarians for the Human Relations Education Commission when it was started - a body that brought together a volatile mix of racial, ethnic and other groups with histories of being oppressed, that were battling for equality in the district. Respect for every viewpoint on that commission - whether you personally agreed with it or not - was a given if the HREC was to get through its monthly meeting without a blow-up. We lived and breathed by Roberts Rules of Order. It was the parliamentarians' job to advise the chair and the members on the rules.

In America's supposedly democratic society, Robert's Rules of Order is the traditionally accepted procedure for every public discussion and debate and decision-making - whether in Congress, or a local chamber of commerce, or a board of directors, or a town meeting. In every such event, the chairperson is there to see that the meeting is orderly and the rules are observed. Everybody who wants to speak should be able to do so without being interrupted. If a situation gets out of hand, the chair can call on the sergeant-at-arms to escort a troublemaker out of the room.

So What Really Happened?

On Wednesday night, Jim Lehrer was supposed to be the chair. That's what a debate moderator is supposed to do - not just decide on the questions and watch the time. I was waiting and wishing for Lehrer to assert his authority as chair and say, "Governor Romney, you're out of order. Don't interrupt." Indeed, at the start of the event, when Lehrer laid out the ground rules, he should have added, "And no interruptions, please."

Instead, Lehrer let Romney make tire tracks all over him. Either he was being partial to the Republican candidate, or he lacks the stuff to handle this kind of situation.

Obama, at least, showed a minimal respect for democratic procedure. He refrained from interrupting Romney. The only time he interrupted Lehrer was over his time being shorted by five seconds. What Obama could have done - and should have done - was call Romney on the interruptions right then and there. Instead, unfortunately, the President held back and let the moment pass.

Why does Romney interrupt? He represents a segment of American society who say openly that they don't believe in democracy. They believe that their God is above human rules, and that God makes their political opinions "right." So they see themselves as being above society, and not answerable to it. They don't feel that they have to show respect for the opinions of others. Hence (for example) the heckling and raucous interrupting that Tea Partiers do at countless town halls across the country for the last couple of years.

But this religious-right disrespect for "order" is happening in a larger American context. As a deeply stressed society, we're losing our grip on the ability to have "civil discourse." You can see it any day on TV talk shows and news shows, where the typical round-table discussion often disintegrates as people get steamed up. They start by interrupting each other. Next, everybody is talking over the top of everybody else. And the moderator (if there is one) is either helpless to stop it, or is actually participating in the angry babel.

But Wednesday night in Colorado was not your routine ruckus on a news show. What we saw that night was a moment in U.S. history when a Presidential candidate was allowed to get away with procedural murder in front of a global audience of millions. Romney showed blatant disrespect for the chair and the other speaker from beginning to end of the event. To me, the spectacle was appalling. It shows me how far down the slippery slope of social and political decay our country has slid, with less and less possibility of an orderly procedure to analyze and solve our problems.

Just as appalling is the way most news media are oblivious to what really happened on Wednesday night. CNN praised Romney for "shaking up the race." The Detroit Free Press burbled about Romney's "confident debate performance." Others lauded Romney as "game-changing," "aggressive." They condemned Obama for not being just as "aggressive." Some suggested that Obama should have interrupted Romney himself, immediately, to point out his lies. I don't think so. If Obama had interrupted too, he would have sunk down in the dirt to Romney's level. The debate might have decayed into the typical TV shouting match. That would even more heartbreaking for us all to watch than the spectacle we saw on Wednesday.

Romney is seen by many as "winning" on "style" and "performance." But what was that performance? It was not just telling a pack of lies about his platform. It was the bullying, the cutting across another person's time to speak, the riding roughshod over Obama and the moderator. "Style" was trampling on the dignity and order that the debate deserved to have as a public political event. Which is exactly the kind of Presidency that Romney will deliver if he wins. He, and his party, and his religious supporters, will see to it that the rest of us have less and less chance to speak as well.

Indeed, Romney must have done a lot of bullying and interrupting while governor of Massachusetts, in order to make himself so patently unpopular there. In Boston Magazine, Jason Schwartz wrote the other day, "Romney made such a mess of things in Massachusetts that he's not even trying to campaign in the state where he was chief executive just six years ago."

In the remaining debates, I hope the next moderators have some courage and preside like a real chair.

But if the moderators go on enabling Romney's power-play disruptions, Obama will once again have the challenge of calling for order himself. When his next turn comes, he ought to say, "Governor, with all due respect, you're out of order. Don't interrupt me again. And don't interrupt the moderator." That action would not only put Romney in his place in front of millions of people around the world - it would also demonstrate Obama's greater fitness for the White House, more than a dozen rebuttals of Republican lies could ever hope to do.

(Umpire whistle graphic via Bigstock)

Nowhere is this problematical trend more visible than in public education. There it crimps efforts at prevention of HIV infection among U.S. youth.

A Little Historical Background

While the American sex-education movement started way back in the early 1900s, on the heels of throwing off Victorian constraints, it didn't hit many states till after World War II. People kept on reacting to the war's explosive loosening of sexual constraints and the consequent explosion of sexually transmitted disease, especially syphilis (for which there had been little treatment till penicillin was discovered).

I vividly remember that day, in the early 1950s, when sex education came to the high-school classrooms in my Montana home town. There had been some fiery sermons against it throughout the dozen churches in town, but no organized resistance. The majority of townspeople appeared to recognize that sex ed was the common-sense thing to do, given the fact that students were apparently not getting adequate information at home. Hence the new textbooks with their prim little drawings (not photographs!) of sex organs, that made the girls blush and the boys titter.

Today that conviction of common sense is fast disappearing from American life, as state after state is now passing laws that put severe faith-based constraints on any discussion of sex and sexually transmitted disease in the classroom. That includes HIV and AIDS.

Surprisingly enough, the "abstinence till marriage" movement made its first appearance on the American scene before the AIDS epidemic did. According to research done by SIECUS, it got going in 1981, during the administration of Ronald Reagan, as a reaction to the intensely sexy Sixties and Seventies and a soaring rate of teen pregnancy. With the Democrats out of office for the first time in decades, Republicans obediently bent the knee to church influence for the first time, as they moved to convince state legislators and boards of education that young people should avoid having sex till they married.

After the Epidemic Started

Just a few years later, the abstinence movement got a huge boost from the revelation that a new viral disease called AIDS was out there and picking up speed.

Today, because of the gay and bi men who were first in the headlines for having developed AIDS, some states have used this as one of their excuses that any discussion of sexual orientation should be outlawed in their schools. Indeed, there is a widespread right-wing urban myth that only gays get AIDS - ignoring the fact that most of the world's people living with HIV/AIDS are heterosexuals. Thus, for example, Tennessee state Senator Stacy Campfield (R) astounded the media recently with his statement that it is "virtually impossible to spread HIV/AIDS through heterosexual sex."

Another area of puritan explosion is where established federal policy recommending condom use runs into a growing ultraconservative grassroots imperative that aims to outlaw access to contraceptives as much as possible. In such an atmosphere, it's impossible to teach students how to use condoms for HIV protection.

While the federal government doesn't require states to mandate sex education, it does require states to offer HIV education. However, the red states are finding ways of getting around that requirement. According to the Guttmacher Institute, 33 states do mandate HIV education, but - incredibly - only two states require that HIV education be medically accurate! This explains why some programs have no problem putting out appalling misinformation about HIV - that it can be transmitted by sweat and tears, for instance. Thirty-five states and the District of Columbia allow parents to withdraw their children from HIV instruction at school.

On the side, the U.S. has ever been willing to push its culture into developing countries. Along with basketball and burgers, we've leveraged "abstinence till marriage" and anti-contraception ideology into foreign governments' programs across the globe. This was done during the Bush presidency, through the faith-based machinery within PEPFAR. Bush's administration had strict puritanical requirements, including a mandate that 33% of prevention funds be spent on abstinence-till-marriage programs.

Ignoring Science

After Barack Obama became President, a glimmer of waking up to reality hit government policymakers - at least for a little while. In 2009, Obama's administration axed more than $170 million in funding for abstinence-only programs that had been proven worthless. In their place was a new pregnancy-prevention and sex-education effort - one that would be based on scientific evidence.

While the new President was opting for science, however, his political opponents in the red states have been opting for repression on sex at the state level, both in and out of school. Virginia, always a bellwether, now considers sex between unwed individuals to be fornication and illegal - a Class 4 misdemeanor. Bryan Fischer of the American Family Association is demanding the nationwide criminalization of both homosexuality and fornication. In Alaska, Governor Sean Parnell needed an appointee for a panel that appoints state judges - and he selected a man, Don Haase, who believes that extra-marital sex should be a crime - possibly even a felony, if voters support it.

Not to be outdone, the state of Tennessee is considering a bill that outlaws "gateway sexual behaviours" on school campuses - meaning possibly hugs and hand-holding. New Jersey has actually outlawed hugging at school.

The Bottom Line

So we have to ask the $64 question. Religion or no religion, does "abstinence till marriage" work?

Two years ago, the National Organization of Women commented on two studies showing that the policy affects different groups of students differently. NOW said:

"A 2003 evaluation by the Pennsylvania Department of Health... and a 2003 evaluation of Arizona's abstinence-only program found that abstinence-only education works on young people who have never had sex. Obviously, not all young people fit the same mold. We see that once adolescents become sexually active, abstinence-only education considerably diminishes in its ability to adequately address their health needs. Furthermore, withholding comprehensive sexual education puts sexually active youth, sexually abused youth, and LGBT youth at higher risk of unwanted pregnancies."

Sad to say, in spite of evidence that abstinence programs seldom work, President Obama's arm has apparently been twisted severely by the church lobby; he is supporting this dubious policy once again. In April the HHS Office of Adolescent Health added Heritage Keepers Abstinence Education to the list of 31 programs that are viewed as "evidence-based" and "effective" - even though reports on performance of the Heritage program show that it had little effect on students.

To sum up, after 30 years of "abstinence till marriage," the CDC finds that the United States still has the highest teen pregnancy rate among developed countries. A significant percentage of girls still get pregnant. Why? Because of simple, stark lack of education about how sex works.

Disastrous Effect on Infection Rates

As for HIV/AIDS, CDC's recent research shows that young people 13-29 were still accounting for 39 percent of all new U.S. infections, with a disproportionate number being gay and bi males as well as African Americans and other minority youth.

In addition, one out of every 4 U.S. teen girls has at least one STD, such as gonorrhea or chlamydia. Indeed, the teen STD rates soared during the Bush years.
Tennessee state Sen. Stacey Campfield (R), the man who sponsored Tennessee's "don't say gay" bill and once compared homosexuality to bestiality, now has a theory about the spread of HIV/AIDS. Campfield told the Huffington Post's Michelangelo Signorile that it's virtually impossible to spread HIV/AIDS through heterosexual sex and that AIDS came from the gay community:

According to the CDC's 2009 National Youth Risk Behavior Survey (YRBS), "Many adolescents begin having sexual intercourse at early ages: 46.0% of high school students have had sexual intercourse, and 5.9% reported first sexual intercourse before the age of 13. Of the 34.2% of students reporting sexual intercourse during the 3 months before the survey, 38.9% did not use a condom. .... HIV education needs to take place before young people engage in sexual behaviors that put them at risk." Yet amazingly, in the same breath, the CDC also calls for programs that teach abstinence.

As the new puritanism continues to sweep the country ever harder, and the 2012 Republican campaign speeches focus more on Jesus than on jobs, I'm reminded of the 14th-century Europeans who kept on believing - till the bitter end - that more prayers and more sermons would deliver them from the Black Death.

This is an updated version of a commentary first published in the July issue of A & U Magazine.

Further reading:

Guttmacher Institute's state-by-state breakdown on abstinence policy

Good Siecus article on abstinence-only history in federal funding

(God vs Science graphic via Bigstock)

The book cover says it all. It portrays the author standing on a granite boulder, against a background of alpine meadow and Montana timber, with her hair blowing in the wind and her arms raised in victory.

No better way to sum up the story of a Montanan who started life as a rugged man. He loved the law and politics and became a county attorney, with a love of hunting and hiking the Rockies on the side.

In his heart, though, this man knew he was really a woman. And she became a woman in 2007 - the first and so far the only transgender lawyer in Montana history.

Zenker writes: "I realized that gender transition, even under the best of circumstances, is unequivocal and unforgiving. It required of me everything I had, and then some. I was still paying for it. Yet, there was no compromise, no half measure. I had to make my way in the world as a woman, or not at all."

Bobbie and I first met in July 2011, when I visited my home state to do an "Out West" program with author/filmmaker Gregory Hinton at the Bozeman Public Library.

Montanans like to call their state the "last best place," and Bobbie's story is one of the best to come out of that place. Indeed, I think that TransMontana is one of the best ever in its genre.

Yet the story couldn't have happened in any other part of the U.S., I think. As a native Montanan, whose family have been rooted there for many generations, I'm well acquainted with the state's traditional, conservative and embedded attitudes about gender. So is Bobbie - she spent most of her life in Montana, and battled with every one of those attitudes, and won. Victory included finding employment after the transition.

She writes: "I was finally able to get a job as a woman, signifying the completion of my transition into mainstream American womanhood."

TransMontana is available at Amazon.com in both e-book and paperback editions. More information on Bobbie and her civil-rights work in Montana at her website.

Here's my Outsports/SBNation commentary that focuses on Sundhage's contribution.

(Photo credit: CNN)

Here's some eyewitness history by me, as a former marathoner, on why the symbols in sports are so vital.

Here is my first - focusing on the potential showdown in dressage between Ann Romney's horse Rafalca and a horse ridden by Netherlands rider Edward Gal - one of the greats in that sport.

I think it's very ironical and piquant that an entry connected to a presidential candidate who opposes gay relationships and same-sex marriage should be competing against Gal, who is openly gay and has a committed partner.

The first dressage grand prix is scheduled for August 2. We'll see who prevails. My money is on Gal, of course.

Those who want to read all the Outsports Olympic blogs can find them at the top of the front page at Outsports.com.

(Edward Gal img src)

America's suicide rate has spiked in the last decade. Suicide is now 10th on the cause of death list. For many, bankruptcy, unemployment and homelessness are right up there as motives. For vulnerable teens, bullying at school is often the motivator. In our armed forces, suicide among emotionally distressed soldiers now claims as many lives as combat does.

Against this somber background, it's not surprising that AIDS suicide rates are up as well.

But suicide's ubiquity, and its persistence as a "moral" (read "religious") issue, haven't made it any easier for Americans to deal with.

Indeed, our government seems to think that its National Strategy for Suicide Prevention (NSSP) - a program on which the CDC and NIH cooperate with several other agencies - will work merely because it might do better interventions and surveillance of people's behavior. Unbelievably, some points in its program are devoted to keeping people from accessing potential tools of suicide - like redesigning cars so people can't use them for carbon-monoxide poisoning. Government people who waste taxpayer dollars on such efforts evidently don't get it that people bent on ending their own lives will find a way to do it, no matter how many road blocks are thrown in front of them.

Slated to Disappear

My friend's phone call moved me to review some of the literature on AIDS suicide.

A routine web search dredges up a whole raft of studies, editorials, and pronouncements from the 1980s and early '90s. They mirror the fact that suicide is still deeply taboo with many people in our country - viewed as a "sin against God." Where AIDS is concerned, suicide is still viewed by some as the most deeply taboo expression of a disease that is taboo to many. During that early period of the epidemic when AIDS was still universally defined as a "death sentence," AIDS and suicide often went hand in hand in the news. In one study of 207 New York City women, 42 percent of them attempted suicide within the first month of being diagnosed with HIV.

In another study of that era, noted psychiatrist William Breitbart, writing from Sloan-Kettering Memorial Center, commented, "A study of men with AIDS in New York City (40) demonstrated a relative risk of suicide 36 times greater than that of males in the general population. ... the relative suicide rate of men with AIDS aged 20 to 39 years was 21 times the rate of men without AIDS. At the time of these studies, AIDS was primarily seen in the male homosexual population, so it is not surprising that all the suicides reported occurred in males. AIDS patients who commit suicide generally do so within 9 months of diagnosis."

Breitbart mentioned another study, done on HIV-positive military personnel, which highlighted a rate of suicide attempts that was 16 to 24 times higher than that same rate among non-infected personnel.

But an unsettling fact emerged from my review. After the introduction of treatment by AIDS drugs in the mid-1980s, the dark shadow of that "death sentence" was supposed to be lifted for good - not only physically, but emotionally, spiritually and mentally. Replacing it was the pharmaceutical industry's rainbow promise of many years of "living with AIDS" and "managing AIDS as a chronic disease." Today, treatment by some of the 125 ARV drugs on the market is assumed by many to mean indefinite and relative good health, ability to work and have loving sexual relationships, to enjoy life and find happiness.

So thanks to the drugs, AIDS suicide was supposed to disappear. But it didn't.

Judging by a 2010 article in American Journal of Psychiatry, titled "Elevated Suicide Rate Among HIV-Positive Persons Despite Benefits of Antiretroviral Therapy," the experts appear to be somewhat surprised that the suicide rate among people living with HIV/AIDS is still a towering three times higher than that among the general population.

We have to ask why that is happening.

"Treatable Psychiatric Disorders"

Some experts are convinced that AIDS suicide is almost never a rational action. They believe that a person has to be driven by what the article calls "comorbid psychiatric conditions" in order to even seriously consider "suicidal ideation," i.e., thoughts of ending one's own life. Indeed, the American Institute for Suicide Prevention puts out the statement that 90 percent of suicides involve what they describe as a "diagnosable and treatable psychiatric disorder." (AIDS experts do make an exception for depression and dementia that result directly from physical and chemical changes in the AIDS-afflicted body.)

Of course, the diagnosis of a psychiatric disorder creates a reason for the medical industry to throw even more drugs at the PWA - in the form of antidepressant meds. Ironically, some antidepressants are themselves the possible cause of suicide, especially among young people. In 2004, the FDA issued a warning about this, following many years of outraged complaints over the mounting suicide statistics among children being treated with certain drugs.

In 2006, the Washington Post finally reported on this emerging awareness, saying, "Widely used antidepressants double the risk of suicidal behavior in young adults, from around three cases per thousand to seven cases per thousand, according to a huge federal analysis of hundreds of clinical trials. It marks the first time regulators have acknowledged that the drugs can trigger suicidal behavior among patients older than 18."

But we have to look still deeper, at other factors that may be driving this new suicide trend. It's likely that some AIDS suicides are not the result of "psychiatric disorders" or negative antidepressant chemistry at all. Instead, they may be the understandable human reaction to finding oneself in a seemingly intolerable situation, with no discernible way out.

To paraphrase a question from the film Titanic, which the young hero asks after he saves the girl from jumping off the ship: "What could have happened to these people with AIDS to make them think they had no way out?"

Reasons to Stop Living

According to the statisticians, more men than women commit AIDS suicide. But regardless of gender, the PWA is subjected to AIDS-industry rhetoric - that if only he or she is patient enough enough, and adheres to the prescribed ARV treatment obediently enough, he or she will somehow reach that golden shore - those sunny years of improved quality of life that the drugs supposedly confer. In short, successful treatment alone is supposed to be a reason to live.

But in most cases, there is the bald scientific fact that ART drugs aren't effective forever.

Sooner or later, there is growing resistance of different HIV strains to the different drugs. Sooner or later, the tipping point is reached where treatment begins to fail, and that PWA's health may finally begin to fade. The golden years of reprieve are finally over, and the individual must now face the inevitable. This can be a shattering moment for that person's psyche - hearing the report from his or her caregiver that the most recent resistance-test results are not good. Or hearing that other tests are showing the first signs of opportunistic infections (Kaposi's sarcoma is on the upswing again) or lethal side effects to liver or kidneys.

On the heels of this bad news, a person may plunge into deep depression and despondency about what's ahead. This is the moment when the psychiatrists want to rush in with their screening and their own array of drugs, to keep the PWAs with waning morale from harming themselves. But antidepressant meds aren't a watertight solution either, as we've already seen.

This is what may have happened to my friend's gay male buddy.

Pain as a Major Factor

Unremitting pain is also important to look at, as a reason for a PWA to exit life. As far back as the early '90s, William Breitbart, while serving as chief of psychiatry at Sloan-Kettering Memorial Hospital in New York, became concerned at seeing pain as a growing suicide issue among his AIDS patients. In a 1993 study, Breitbart made this flat-out statement:

According to several preliminary clinical studies, pain is a significant problem for patients with HIV infection and is associated with psychological and functional morbidity. Clinicians have neglected pain management in AIDS patients, focusing instead on treating life-threatening opportunistic infections, cancers, and neuropsychiatric syndromes such as AIDS dementia complex. There are few systematic studies that examine the prevalence of pain, describe specific pain syndromes, or examine the relationship of pain experience and psychological factors in the AIDS population. One recent retrospective chart review of hospitalized patients with AIDS revealed that more than 50% of patients required treatment for pain, with pain being the presenting complaint in 30% (second only to fever).... At MSKCC, we examined the prevalence and characteristics of pain in a population of HIV-infected persons receiving medical care in an ambulatory setting. Thirty-eight percent of ambulatory HIV-infected patients reported significant pain.

Yet, in the years since Breitbart reported these ominous observations, American society has become so obsessed with the moralistic notion of preventing drug addiction that we are increasingly reluctant to deal with the stark need for pain relief in chronically ill and dying people. Already in the early 2000's, all across the country, the DEA was pushing state medical boards to investigate pain-management prescribing. With the 2011 trial of Michael Jackson's doctor, the pain-med crackdown went into even higher gear.

No sane person would deny that it's important to stop "doctor shopping" by people who are really addicted. Yet where is the balance that is needed here? Today a doctor who prescribes legitimate and legal pain relief might be slammed with bogus "pill mill" charges by a state medical board that aims to look good on paper by racking up prosecutions. Understandably, many physicians are now refusing to do pain management - with the obvious negative results for pain-ridden patients.

In a recent Journal of the American Medical Association, an article by author Joan Stephenson is headlined, "Experts say AIDS pain 'dramatically' undertreated." It is inhumane to withhold pain relief from people who are moving from chronically to terminally ill, if the growing pain destroys any quality of life that they might still be able to enjoy.

Worse still, palliative and hospice care is now expensive enough that it is falling victim to budget cuts. Example: a 20-year program in Marin County, California, that was axed in 2009, leaving hundreds of seriously ill PWAs adrift.

The bottom line: Anyone with a low pain threshold and fierce untreated AIDS pain can find reason enough to look for a way out.

Religious Judgmentalism

Another reason for a PWA to sink into depression and hopelessness: the worsening mean-spirited religious judgmentalism sweeping the country.

Some conservatives feel that AIDS treatment should be reserved only for the "innocent victims," namely for children who are infected through "no fault of their own," or for adults who might have been unknowingly infected by a blood transfusion or a philandering spouse. But, in the opinion of these conservatives, the individual who was infected through drug addiction, or through what is viewed by some as "immoral or perverted" sexual activity, does not deserve any consideration or any taxpayer funding for care. North Carolina minister Charles Worley made headlines recently for announcing that the way to cure AIDS is to kill all gays.

Some surveys try to prove that AIDS-phobia has actually decreased in the U.S., thanks to a growth in public understanding of AIDS. According to Pew Research, "Just 23% of the public now agree with the statement that AIDS might be God's punishment for immoral sexual behavior, while 72% disagree. When this question was first asked in 1987, public opinion was divided on the question, with 43% agreeing and 47% disagreeing."

But these statistics don't reveal the real problem. That disapproving 23% of the public now has many more elected officials and paid lobbyists in government than it did in the 1980s. Example: North Carolina State Representative Larry Brown, who stated that the government should not pay for treatment for people who get AIDS through "perverted lifestyles." It's little comfort to PWAs that some of these elected extremists would also deny taxpayer monies to care for smokers, alcoholics and the obese, because these people are also ill "through their own fault."

Congress is now packed with church-owned Republican politicians who have come up with the astonishing notion that "the Bible prohibits government healthcare because it's socialist, and Jesus opposed socialism." These are the same pols who vote to balance the federal budget by axing any publicly funded health services that they don't support on "Biblical grounds" - and that includes HIV/AIDS services. Speaker of the House John Boehner, a staunch Catholic, led the way in slashing over $32 million in AIDS services, even as the House upped the funding for DOMA defense.

Among the cuts would be research funding for the NIH, and state AIDS Drug Assistance Programs. As of June 14th, the wait list to receive ARV drug treatment through the nation's AIDS Drug Assistance Programs had hit 1,963 people across 9 states. The number of people waiting to receive medication through state-run drug programs has increased more than 5000% since August 2009, according to the National Alliance of State and Territorial AIDS Directors. Result: in any state where ADAP is now virtually unavailable, an individual's reaction to finding that he or she is being denied treatment could well extend to suicide.

Ironically, some state and federal budget cuts are even targeting suicide-prevention programs. In a recent study, the top 10 states with the biggest cuts in mental healthcare, including suicide prevention, were mostly red states, with Alaska leading the way with a 35% reduction in this area of funding.

Likely we will see most of these AIDS suicides among middle and low-income people of all ages, as well as the homeless and indigent - people that the bible-based One Percenters don't care about anyway.

In my unhumble opinion, the hard-hearted politicians and church leaders who create this climate will bear significant blame for these deaths - the very deaths that they have the nerve to label "sins against God."

How Can Suicide Prevention Be Effective?

Once upon a time, America had many progressive and socially conscientious American church people who were ready to leap into the breach, with private-sector relief for everyone who needed it. Compassionate folks like these created everything from Depression Era soup kitchens to international disaster relief to big hospital systems. Today I'm wondering where this private-sector religious progressivism has gone, as a potential national force. In its place is a vast growing void in lost services created by ultraconservative religious callousness.

Will the socially conscientious church people finally organize and help fill that deadly void? Will they join hands with equally compassionate and conscientious Americans who are not religious believers of any kind - reaching across the lines of creed, color, gender, sexual orientation, and political positioning - in order to build a private-sector support network that will replace the slashed government programs affecting human health and welfare? One that will deal with potential AIDS suicides in a realistic and truly helpful manner? I wonder.

Last but not least - we have to ask what happens when an individual's life is overrun by many of these pressures all at once? By religious judgment coming on top of treatment failure, social stigma, unbearable physical pain, denial of access to treatment, and/or the combined devastation of AIDS and AIDS-related infections? How in the world is this person's morale going to be strengthened, so that he or she can fight off the thought of suicide as a way of escaping that vortex of hopelessness looming ahead?

We have to answer this ultimate question if we're going to stop the ongoing uptick in U.S. AIDS suicide.

Truly effective "AIDS suicide prevention" won't be achieved by relentless screening and psychiatric medicating. It will have to be reality-based. It can only be achieved when our society has the courage to eliminates social and medical circumstances that would cause a man or woman with AIDS to consider suicide in the first place.

Further reading:

"Elevated Suicide Rate Among HIV-Positive Persons Despite Benefits of Antiretroviral Therapy"

"Suicide Risk and Pain in Cancer and AIDS Patients," by Wm. Breitbart

Palliative Care for Patients With HIV

(A shorter version of this commentary was originally published in the April 2012 issue of A & U Magazine. Suicide clipart via Bigstock.)