Show me AIDS programs that are fully funded. Show me AIDS programs that have no trouble acquiring meds. For everyone who needs them. Show me AIDS programs or public health programs that don’t treat young boys with the patriarchal attitude of: this is what you have to do.
Show me anything that has failed as badly as public health.
Show me the money.
AIDS DOT GOV is a US government website that posts on AIDS issues. It’s a good thing. I am not sure who reads it.
I know for a fact who doesn’t read it. Hard to reach populations are called that because they are hard to reach, difficult to get to, and when we do reach them, then what.
You’ll find video, audio, and anything that can touch upon awareness.
“We’d love to hear more from you,” we are told. It might be true. It might not.
There is usually a price to pay if you deviate from mainstream perceptions.
I do believe they are reaching some in the transgendered community. They had to put out to do that. It didn’t just happen. It was not an accident. They had to embrace inclusion. They are reaching some transgendered people.
In the sex work community — not so much. Survival sex is almost impervious to listening.
Boys who do sex work are not being reached.
Boys of color who do sex work are not being reached.
I know counselors in AIDS ORGS who will tell you that adolescents of color do not do sex work. They don’t believe it. Stereotypes are hard to shake.
So is stigma.
We use the word whore a lot. To draw attention to the fact that gender is not always relevant to what we think is real. Be a whore and wear it proud. Whatever.
I do not really care what you do. It’s up to you. I am of the firm conviction that following the lead of mainstream culture can end up boiling you in oil. Be very careful. In the old days, it was cops, pimps, dealers, and tricks who were dangerous.
Today, there’s public health.
In Africa, they’re telling boys that if they become circumcised, they can’t get AIDS. African boys believe this and they comply.
Often, to discover it was not true.
Discovering you have AIDS is a bit more dramatic than discovering the book you’re reading is stretched some, or essentially disguised. Books are nothing.
Most of new media as well, is nothing. Until you make it something.
A safe house for boys who are doing or have done sex work is a new idea in the world of AIDS. The grand poobahs in AIDS would be shocked to really come to terms with not so much how little such boys understand, but how little they trust. Some will never trust anything ever again.
They don’t just automatically “lose distrust” if they need treatment for HIV, getting it is easier said than done. Such boys do not like giving away their freedom, their names, their ages, or the families they fled. Or disclosing how they make a living today. Prostitution is against the law. Prostitutes carrying around condoms is against the law. Trust issues.
The THEY are, after all, government.
Sometimes the boys bet on the paradigm that one hand wipes and the other hand is oblivious. They tell me government is incompetent. The physical a year requirement in primary care is ephemeral, as is fasting for cholesterol tests and why are we testing young boys for cholesterol anyway. Because it’s in the funding rulebook.
The message they really get from public health is more You Better Follow the Regulations Manual or else. Or else what. We will drop you from the rolls. You will have to begin again. At the beginning.
It’s one thing to get fucked for a living.
It’s another thing to be objectified when you are not making a living. Many boys balk, and yet the attitude of public health is: we are only trying to help.
Actually, they are just keeping their funding. You are reduced to a checklist. Antenna that can focus on objectification is an attribute we have historically coveted.
The boys know that there are no slogans about getting (not just tested) treatment. They know that a YouTube video is ubiquitous. They are uneducated. Not stupid.
We put our videos on http://le-too.tumblr. com and http://realstoriesgallery.org and http://smashstreetboys.com and http://showmeyourlife.tumblr.com.
We use Tumblr not FB. FB kicked us off. Because as sex workers, it was more than FB could stomach.
The lowest of the low on a good day.
We get around through Tumblr’s “ask” feature. We can go anon. WE can use our names. We decide. Not FB. It is a grapevine of boy sex workers all around the planet.
The boys have asked me to refrain from explaining how the “ask” feature works. Okay.
AIDS DOT GOV is shooting for the mainstream They have a voice that does exactly that.
They do not speak the boys language, Miss Thing.
They do not speak the languages of the people who are the most intransigently marginalized of the off the grid populations of people at risk for acquiring HIV. Simple.
I don’t know if they have a presence on Tumblr or not. That is the point whether they do or they don’t. I don’t know about it.
Why. Because they are suits. Like the boys themselves, I avoid the government.
We have to be our own ORGS. We have to form our own liaisons. We have to speak our own language. We have to have our own codes. We have to make what we can of it our own culture.
Because if we do not, they will eventually kill us. We understand that we are not the mainstream gay community. We are the misfits who don’t fit in. I did sex work to not starve. I share that history with where the boys are at today. We are lucky to survive and we know it.
When we were being beaten up by our friends and families, where was the government. It was not there for us.
Why has public health failed.
You have failed because you have failed. If only a minority of people with HIV can stay in primary care, you have failed. It is not our failure. It is your failure.
“But the patient is not being cooperative.”
Are you looking for the hard to reach or for cooperation. Decide. You can’t have both. It isn’t possible. Get over it.
We could never afford the drugs. Where has public health been advocating for us. We are poor. We have no money. What has public health done at the doors of Big Pharma. In a word, nothing.
When public health tells us everyone can be treated we do not believe you. We KNOW people who are on waiting lists. We think you want to use us and abuse us simply because everyone does and that is our experience.
So you have a LONG way to go to reach young boys doing sex work and the statistics bear that out. The video we have posted here will make you uncomfortable even if it is only two seconds long.
It portrays a kind of bondage that can be inherent to sex work, and it portrays the kind of relationship we understand we would have with public health. One is the other and the other is the other.
Personally, I have no faith in you whatsoever. Show me the money.
Tim Barrus: The term AIDS-FREE GENERATION is the most offensive dog piddle I have ever heard. And I am not going to shut the fuck up about it. When we reduce what is an extraordinarily complex paradigm down to the level of a slogan or a jingle, what we are really doing is discounting the hard work it is going to take to actually achieve something that is as it stands today, a feat IMPOSSIBLE to pull off unless CULTURE makes some pretty serious changes. We discount the struggles that are going on right here, right now. We reduce HOPE to a mantra as stupid as Just Get Tested. Sure, get tested, but get treated, too. Where is the mantra that says Get Treated If You Can. It is a fantasy. It cannot be done until we begin to face the reality of what those changes will be that we have to pull off. Today, only a small fraction of people in the US with HIV can even stay in primary care. Because there are OBSTACLES we make CHOICES not to remove. Like the COST, the outrageous rip offs, that stand in the way of people getting treated. So instead of confronting what is real, we wrap it up in an illusion that makes hope another Disney Channel with singsong consequences pretending to be no consequence at all. It is truly pathetic. It’s the equivalent of hoping Bambi can find its mother. It is something sixth graders can endorse but in the final analysis it doesn’t matter what sixth graders do. It doesn’t matter how many bake sale they have. It doesn’t matter how many miles they walk. WE are the adults. It matters what we do.
April 18, 2013
If We Want an AIDS-Free Generation, Why Are We Cutting PEPFAR?
by Chris Collins
The vice president and director of public policy at amfAR explores why PEPFAR cuts continue.
Chris Collins
The persistent shortchanging of PEPFAR, the President’s Emergency Plan for AIDS Relief, is one of the more significant and perplexing trends in America’s global health policy. Funding for PEPFAR (America’s bilateral global AIDS program) has been falling consistently from its peak in fiscal year 2010. In fiscal year 2012, $250 million was transferred out of the program to the Global Fund to Fight AIDS, Tuberculosis and Malaria. For fiscal year 2013, the White House proposed cutting PEPFAR by $550 million (11 percent) and in March of this year Congress went part way, taking $176 million from the program in the Continuing Resolution.
Funding for PEPFAR has fallen 12 percent since 2010 in the State Department HIV bilateral budget line. Last week, the White House proposed an additional $50 million cut for 2014. When the mandated sequestration cut is taken into account, the program is now at its lowest funding level since 2007.
This downward funding spiral might make sense if there was a consensus that tackling AIDS has become less important, or if PEPFAR was not producing results. But the opposite is true. In November 2011, Secretary of State Hillary Clinton announced that achieving an AIDS-free generation was a “policy priority” for the U.S. government. President Obama went on to set bold new targets for AIDS treatment and other services through PEPFAR. In November 2012, the Administration released a PEPFAR Blueprint lauding the program’s accomplishments and affirming the need to “rapidly scale-up core … interventions.” Doing so, the Blueprint argued, would accelerate declines in HIV incidence globally.
In February of this year, President Obama inspired all those engaged in the response to AIDS when, in his State of the Union address, he reaffirmed his commitment to the goal of an AIDS-free generation. The same month, the Institute of Medicine (IOM) weighed in with their assessment of PEPFAR, four years in the making. It concluded that the program has been “globally transformative” and has “had major positive effects on the health and well-being of individual beneficiaries, on institutions and systems in partner countries, and the overall global response to AIDS.”
Why the mismatch between results, rhetoric, and financing? Budget deficit pressures do not explain it: total U.S. global health spending is just a quarter of one percent of the federal budget. Politics doesn’t explain it either, with PEPFAR maintaining a unique level of bipartisan Congressional support.
The more likely reason for steady reductions in PEPFAR funding is an Administration decision to gradually de-emphasize bilateral AIDS investments in favor of multilateral institutions and multiyear commitments to these institutions. Increased investments in the Global Fund and other multilateral health organizations are a badge of honor for President Obama. These institutions have demonstrated clear results in countries around the world, and U.S. funding leverages investments from others.
The question is not whether increased funding for the Global Fund is good, because clearly it is. The question is whether those increases justify year-on-year reductions in our bilateral AIDS program. It is not a matter of choosing between multilateral and bilateral approaches, but of marshaling sufficient resources to end AIDS.
One concern is that as Global Fund and PEPFAR funding trends head in opposite directions, net U.S. resources dedicated to tackling AIDS are in decline. Since on average approximately 57 percent of Global Fund resources are allocated to combating HIV/AIDS, the $600 million increase in support for the Global Fund since 2010 and the $543 million decrease in funding for PEPFAR during that time adds up to an overall decline in U.S. government funding to tackle the global AIDS epidemic.
Another problem is the lost opportunities to strengthen health systems when PEPFAR is cut. According to the distinguished IOM panel, the program is helping build health systems through improved laboratory capacity, supply chains, and staff training. The IOM observed that PEPFAR is “uniquely situated as a platform for research to spur innovation and to address knowledge gaps” in the global AIDS response.
And then there is the move toward to greater “country ownership” of healthcare financing and decision making. Clearly country ownership is an important goal and should be pursued at a rate that is appropriate for each individual country setting. But a reduced commitment to PEPFAR could lead to an accelerated and premature hand-off of AIDS programs with potentially disastrous consequences. Already there are concerns. A Center for Strategic and International Studies (CSIS) report released in March noted the “legitimate fears” that a rushed transition in South Africa could disrupt the delivery of AIDS treatment to people there.
In many countries where PEPFAR operates, those groups most severely affected by the epidemic, including gay men, people who inject drugs, and sex workers, are socially and legally marginalized. Last year UNAIDS reported that more than 90 percent of funding to address HIV among these populations in low- and middle-income countries came from external sources, not the countries themselves. Though PEPFAR still needs to pay greater attention to these most-at-risk groups, the program has been a leader in tending to their HIV-related needs. If PEPFAR is scaled back, real progress to address the epidemic among the most vulnerable could be in serious jeopardy.
Congress has been broadly supportive of domestic and global AIDS funding for many years. And the President deserves praise for his leadership on AIDS, which includes game changers like the Affordable Care Act, the National HIV/AIDS Strategy, and funding increases for domestic AIDS and the Global Fund. The President is to be commended for being outspoken against HIV-related stigma and for equality for gay people, including young Black gay men, who are perhaps the most vulnerable in America’s epidemic.
With the end of AIDS within reach, it is time to think about legacy—the President’s and our own. The most damaging consequence of continual reductions in funding for PEPFAR is slower than necessary progress in pursuing the end of the AIDS pandemic. The PEPFAR Blueprint shows how expanded delivery of proven interventions will yield falling HIV incidence and mortality rates within a few years. The Global Fund has an essential role to play in this effort, and other donors and affected countries need to invest more.
But the honest truth is that the world won’t end AIDS without PEPFAR. Some will say, judge PEPFAR on its outcomes, not its funding. But when PEPFAR’s own Blueprint calls for rapid scale-up of effective services in order to show tangible gains, it’s hard to understand why now is the time to cut back. The urgency of delivering lifesaving services remains acute, with the IOM observing that there is a “substantial remaining unmet need for all services … that are part of an effective response to HIV.”
Congress and the President should not set the AIDS budget based on short-term expediency. Instead they should recognize the longer game: defeating a major infectious disease, and securing this generation’s legacy as beginning the end of AIDS. To achieve that goal, both the Global Fund and PEPFAR need appropriate funding.
The IOM panel assessing PEPFAR’s work concluded that the program “has the opportunity and the potential to once again transform the way global assistance for health is envisioned and implemented.” The question is, will we allow it to seize the opportunity and fulfill its potential?