David Guilbault

LESSONS ON HIV/AIDS & AFRICAN-AMERICANS

I was privileged and proud to have worked on the five-year documentary project, "Why Us: Left Behind and Dying."   The film and research project explored the myriad reasons why the HIV/AIDS epidemic is hitting the African-American community so hard.  Those reasons include poverty, incarceration, homophobia, gender inequality, shame, denial, secrecy, church dogma, drug use, incarceration, racism, and health disparities.

It became a critically-acclaimed documentary that played in film festivals around the world.  We were grateful for those appreciative audiences.

But, for the work to have real impact, it needs to be in the hands of educators and health care workers.  And it needs to be seen by Black youth.  To that end, a curriculum was developed for high schools.  Below are the videos that go with the lesson plan modules for that curriculum.

I invite you to explore this important health crisis through the eyes of disadvantaged high school students from the Homewood neighborhood in Pittsburgh.  They became the film's reporters and interviewers.  And one of them, the courageous and curious Tamira Noble, became the film's narrator, writer and production assistant.

The film was the project of director/writer/producer Claudia Pryor Malis, who sadly passed away recently from cancer.  She was a visionary, compassionate, creative journalist, dearly loved by all she touched.

I was a producer/writer/co-investigator on the project.  Editor for both the film and the curriculum video segments was Howard Malis.  Other major credits on the film were the late Nene Ofuatey-Kodjoe (Producer/Co-investigator), Vivian Siu (Producer), Robert Shepard (Director of Photography), Chris Ivey (Cinematographer) and Jeffrey Edrich (Sound Engineer).

The curriculum was developed by Dr. Kathryn Kailikole.  She is an experienced curriculum developer who holds a doctoral degree in education from the University of California San Diego, a masters degree in mathematics education from the University of California Santa Cruz, and a bachelors degree in applied mathematics from the University of California Berkeley.

 

Lesson One: The Project Begins 

Lesson Two: Genetic Variation 

Lesson Three: Poverty 

Lesson Four: Views of Black Sexuality
 

Lesson Five: Secrecy, Shame and Fear
 

Lesson Six: Gender Inequality
 

Lesson Seven: Masculinity
 

Lesson Eight: Sexual Orientation
 

Lesson Nine: The Church
 

Lesson Ten: Self-Hatred
 

Lesson Eleven: Drugs and Prison
 

Lesson Twelve: Migration
 

Lesson Thirteen: Access to Medicine
 

Lesson Fourteen: Distrust and Conspiracy
 

Lesson Fifteen: HIV and SIV
 

Lesson Sixteen: Subtypes
 

Lesson Seventeen: Natural Transfer Theory
 

Lesson Eighteen: Serial Passage Theory
 

Lesson Nineteen: OPV Theory
 

Lesson Twenty: Student Project Ends
 

AIDS IS A BLACK DISEASE

I had the privilege and pleasure to work on a documentary produced by Diversity Films about HIV/AIDS and African-Americans.

"Why Us? Left Behind and Dying "  is an in-depth examination of the reasons why HIV rates are disproportionately high in black communities. It was made from the point of view of a small group of inner-city African-American teenagers, ages 14-17, from Westinghouse High School in Pittsburgh, PA.

This film is also being made into high-school and college curricula.

African-Americans comprise roughly 13 percent of the U.S population.  But, recent studies suggest that about 50% of new HIV infections are in black communities.  The contributing reasons are plenty - stigma, poverty, forced displacement, disproportionate incarceration, distrust of health systems, gender inequality, homophobia, shame, religious fundamentalism, racism, denial and secrecy.

This documentary needs to be seen.  I urge everyone who reads this blog to do what they can to spread the word about this important work.  You can order the film at www.whyusmovie.com.

AN OPEN WOUND

There should be no doubt that corporate greed and malfeasance are toxic to our world and our lives. British Petroleum needs to be held fully accountable. And corporations around the globe need to be strictly regulated by their governments.

A BRAVE, HISTORIC VOTE

Thank you Democrats for having the conscience, courage and commitment to rise against a political barrage of deceit and greed to do what is right. Shame on you Republicans for marching in obstructive, dishonest lock step against universal health care to protect and enrich your insurance company sponsors.

HEALTHY DEBATE

HOPE FOR HAITI

Music is the heart of humanity.  Tonight's Haiti telethon was filled with heartfelt and honest musical expression.  Each and every artist sang and played with purity and love.  They were extraordinary performances in empathy with the hurt and suffering of our brothers and sisters in Haiti.  Change a life.  Keep the world in your view and a song in your heart.

GOOD REVIEWS

The documentary I worked on for four years for Diversity Films made its Oscar-qualifying public run in LA and NY this past week.  It got good reviews in the Los Angeles Times and This Week in New York websites.  It's called "Why Us? Left Behind and Dying" and looks at why the HIV/AIDS epidemic is hitting the Black community so hard.

PRESIDENTIAL LEADERSHIP

Tonight, President Obama delivered a fearless, truthful speech on health care reform to Congress and the nation.  He once again demostrated his courage, conviction and charisma.  While he passionately outlined what needed to be done to ensure good health for all Americans, his Republican opponents, obstructionist pawns of the insurance industry, sat silent and stone-faced.  They are doing everything they can to obfuscate the debate in the service of their moneyed patrons.  They seek nothing less than to kill any reform in its infancy.  But, Obama was having none of it.  He is determined to pass a bill that provides affordable health care for all citizens.  Seek the truth in this debate.  Expose the lies.  Support this President, as he considers workable options, builds a consensus, respects proper legislative deliberations, leads the moral debate and gets the job done.

Visit msnbc.com for Breaking News, World News, and News about the Economy

 

 

Good Lord.  Does anyone think that Wall Street has learned its lesson about risky, esoteric financial instruments?  Well, they haven't.  The investment industry is about greed, and nothing but greed.  The New York Times reports today that investment banks are looking to buy life insurance policies that the ill and elderly sell for cash.  They will then package thousands together into bonds and resell those to investors, who will receive payouts when the insured people die.  And here's the precious part:  The earlier the policyholder dies, the bigger the return.  So, Wall Street is hoping to make big bucks on early deaths.  Boy, do we need strong government regulation of the financial industry.

HI folks.

As some of you know, I have been working as a producer/writer/videographer on a documentary the past four years for Diversity Films about HIV/AIDS and African-Americans. Well, next month is its world premiere.

It is called, "Why Us? Left Behind and Dying". It looks at why the AIDS epidemic is hitting the Black community so hard, through the eyes of 20 African-American high school students in Pittsburgh. Among the reasons are secrecy, homophobia, religious beliefs, genetics, forced migration, stigma, gender inequality, ideas of masculinity, distrust of medical systems, prison incarceration, poverty and racism.

The students in the film conducted most of the interviews with scientists, researchers, community activists and people living with HIV in their neighborhood The students, themselves, were also subjects of the film. The honesty they were able to bring out of our participants is gripping.

I'm asking you to encourage your friends and colleagues in NY and LA to go see the opening run. It is playing at the theaters listed below.

Claudia Pryor, the Director and Executive Producer, will be attending opening nights in both cities.

I am very proud to have worked on this untold story. Please help us spread the word about this compelling film.

Hope all is well with you and yours. Cheers for now. David.

Los Angeles Opening - Sept. 9-15, Grande 4-Plex, 345 Figueroa
New York Opening - Sept. 11-17, IFC Center, 323 Sixth Ave.

In an editorial, The New York Times looks at who the medically uninsured are in this country, and concludes: "Any nation as rich as ours ought to guarantee health coverage for all of its residents."

"Scores of well-designed studies have shown that uninsured people are more likely than insured people to die prematurely, to have their cancers diagnosed too late, or to die from heart failure, a heart attack, a stroke or a severe injury. The Institute of Medicine estimated in 2004 that perhaps 18,000 deaths a year among adults could be attributed to lack of insurance."

- Editorial, The New York Times

Congressional Republicans and health insurance lobbyists are lying to the American people - knowingly and cynically - to protect their greedy entrenched interests by killing health care reform.  That's the truth, pure and simple.

"The recent attacks by Republican leaders and their ideological fellow-travelers on the effort to reform the health-care system have been so misleading, so disingenuous, that they could only spring from a cynical effort to gain partisan political advantage. By poisoning the political well, they've given up any pretense of being the loyal opposition. They've become political terrorists, willing to say or do anything to prevent the country from reaching a consensus on one of its most serious domestic problems."

- Steven Pearlstein, The Washington Post

I have not had much faith in the political leadership of House leader Nancy Pelosi and Senate leader Harry Reid in the health care reform debate.  Today, Pelosi, finally got some guts and laid the blame for our broken, greedy system at the feet of the real obstructionists of reform - the health insurance industry.  Some of her comments today:

Pelosi: Health Insurance Companies the Real Villains

"They are the villains in this. They have been part of the problem in a major way," Pelosi said of the insurance industry after her weekly press conference. "It's almost immoral, what they are doing," she said, referring to industry lobbying against a public insurance plan option. "Of course, they've been immoral all along. They are doing everything in their power to stop a public option from happening, and the public has to know about it."

The current system works so well for insurers that they don't even want subsidies, Pelosi claimed. "They've had a good thing going for a long time at the expense of the American people and the health of our country," she said, adding that it will be tough to keep them from getting their way. "This is the fight of our lives."

- Nancy Pelosi, Speaker of the House

The chief disinformation operative of the Republican party is leading a propaganda campaign against national health care reform.  He is Frank Luntz. 

He has crafted a 28-page talking points memo for Conservatives, called "The Language of Health Care 2009," to trumpet the dishonest accusation of a "Washington takeover of healthcare."  It is cynical, distorted, fear mongering self-interest at its worst.

Luntz advises opponents of universal health care to make the debate about "politicians," "bureaucrats," and "Washington," and to highlight "horror stories" about "government takeover."  He tells them to play on the fear the public has of "denied treatment."

Luntz writes, "The best approach is to empathize with the fear, anxiety and financial pain people are clearly feeling right now. So instead of dismissing their concerns, acknowledge them – up front – and then pivot to your solution. Some conservatives will undoubtedly find this distasteful. But failure to connect on a personal level at the beginning will lead to communication failure at the end."

Later he writes, "It is essential that “deny” and “denial” enter the conservative lexicon immediately because it is at the core of what scares Americans most about a government takeover of healthcare. Then add to it the source of that denial and you have the perfect anti-government, anti-Washington and anti-Democratic message."

So, you will hear this mantra repeated from Republican after Republican:

“No Washington bureaucrat or healthcare lobbyist should stand between your family and your doctor. The Democrats want to put Washington politicians in charge of YOUR healthcare. We can and must do better. Say no to a Washington takeover of healthcare and say yes to personalized patient-centered care.”

Of course, "personalized patient-centered care" is code for health insurance company control. That is the powerful industry Luntz and his cohorts are trying to protect.

Luntz and his associates are the premier manipulators of language for selfish, partisan ends.

Read one of his mission statements from their web site (emphasis is mine): 

Luntz, Maslansky Strategic Research

"Our focus is on language. We believe that every word you use matters.  Luntz, Maslansky is known across the nation for how we reframe issues.  From changing the “estate tax” to the “death tax,” “tax cuts” to “tax relief,” “global warming” to “climate change” – time after time we have succeeded in changing the course of the debate.  By focusing on how to communicate your message, Luntz, Maslansky helps you reframe the issue using your side’s words and messages.  Our unique research methodology allows us to precisely gauge public opinion and develop the most effective approach and language to take control of the issue.  We know how to change hearts and minds and motivate people to act."

from Luntz, Maslansky Strategic Research website

Their goal is to help "virtually every major industry" to distort their message and mask their true agenda.  Another quote from their web site:

"In the political arena, our CEO, Dr. Frank Luntz, is known for helping change the public vocabulary – he transformed the "estate tax" into the "the death tax," moved the public debate from "school vouchers" to "opportunity scholarships," and re-cast "drilling for oil" as "exploring for energy."  ...  In the corporate arena, Luntz, Maslansky currently works for clients in virtually every major industry: pharmaceuticals, telecommunications, energy, health care, transportation, sports, entertainment, travel and tourism, shopping centers, grocery stores, restaurants, food, and beverages."

If Frank Luntz is involved in a public campaign, you may assume the goal is to "pull the wool over your eyes."

And, so then, is his mission in the health care debate.

Photo Credit:  Frederick M. Brown / Getty Images

Dateline:  MEXICO CITY

THE VIRUS IS WINNING

In the battle against the Human Immunodeficiency Virus, the virus is winning.

33 million people are living with HIV infection according to 2007 figures from UNAIDS.   This increase is a result of new infections and the beneficial effects of more widely available antiretroviral (ARV) therapy.

Three million people are now on ARV drugs.  But, for ever person who starts treatment, two or three more are newly infected.

The call here, at the XXVII International AIDS Conference, is for universal and free access to HIV/AIDS treatment by 2010. 

Offical Conference Press Releases

CLINICAL TRIALS FAILING

At the last conference of the International AIDS Society, the host of this event, in Toronto, there was great talk and hope for the development of vaccines or microbicides to fight the epidemic.  But, nascent clinical trials for both have come up short.  Still, those here insist that we learn something from each failed trial, and that we must continue to devote substantial funds to find a cure.

FUNCTIONAL CURE

However, Tony Fauci, a leader on global AIDS issues, says we may have to accept a ‘functional cure’ where early aggressive drug therapy allows people infected with HIV to live long, relatively healthy lives.  HIV is becoming a widespread, treatable, chronic disease.

COMBINATION STRATEGIES

The talk here is to combine all known prevention and treatment strategies in a coordinated effort to treat existing infections and prevent future ones. Dr. Kevin De Cock, the Director of the World Health Organization, says we have to make that link strong and indivisible.  Best to use whatever works for short-term gains while searching for a long-term solution.

TREAT EVERY INFECTED PERSON

And a dialogue is beginning on starting drug therapy sooner in patients, before their T-cell counts fall below 200, the current benchmark on when to begin therapy.

One idea presented here is creating quite a stir.  A Canadian study suggests that since HIV patients whose viral loads are undetectable are believed to be less infectious, why not treat EVERY infected person, with the goal of eliminating their viral loads and thus preventing future transmissions?  Dr. Julio Montano, of the Canadian group and the President-Elect of the International AIDS Society, says, ‘Basically, the more people you treat and the faster you engage people in treatment, the greater impact you will have on the epidemic.’

LYING IN WAIT

But, the virus may be too smart for even that approach.  It knows how to lie in wait.

According to Dr. Robert Siliciano of Johns Hopkins University School of Medicine, when a person is first infected with the virus, the virus establishes itself in a stable reservoir, from which it begins replicating itself.  When drug therapies start on that patient, the treatment attacks the replicated viruses.  Viral load can drop to undetectable levels.  But, there is still the original virus hiding in the reservoir, undetected.  If the patient were to stop or slow therapy, those latent viruses would start replicating again and return the patient to his/her original level of infection.

PRE-EXPOSURE STUDIES

As early as next year we’ll see the results from trials of antiretroviral drugs being tested for HIV prevention, known as PrEP, or pre-exposure prophylaxis.  Underway in Africa, Asia, Latin American and North America, PrEP is an unproven strategy in which HIV negative people could take an ARV, or combination of ARVs, on a regular basis in the hopes of reducing their risk of acquiring HIV.

HERE, THERE, EVERYWHERE

The goal of all viruses is to adapt and multiply.  And HIV is a master at that.

Peter Poit, the Executive Director of UNAIDS, warned that the virus is always a step or two ahead of us.  As we come to grips with the spread of the virus in one group or one geography, it finds another group in another location – married women in one locale, men who have sex with men in another, intravenous drug users somewhere else.

He also was less optimistic about a cure and said our goal is to keep anyone from dying of AIDS and to give those living with HIV a good life.  To that end, he called for changing the funding model from an insurance scheme to a pension scheme.  He said instead of protecting against unknown events, we should accept the fact that we need to plan for known events, i.e., that millions of people are and will be infected with HIV and are entitled to a full and healthy life.

AIDING HEALTH SYSTEMS

All across the world countries have to deal with this epidemic.  Yet, in so-called resource poor nations, that is an overwhelming struggle.  They are simply not medically equipped enough to meet the challenge.  Speakers here noted that improving AIDS programs around the world will help build and strengthen all health systems.  This disease may become a coalescing factor to bring coordinated, universal health care to millions around the globe.

RICHER, POORER

But, mocking the call for free drugs for everyone by 2010, the rich still fare better with this disease than the poor.  Dr. Anton Pozniak of Advances in ART pointed out, antiretroviral therapy only works if you have access to it and you stay on it.  As he and others said, access to newer therapies by poor people and countries is still a major problem.

SOCIAL CHANGE

And, of course, there are substantial governmental, cultural and organizational barriers to a successful battle against this disease.

Speaker after speaker here decried the fact that in too many countries there are harsh laws against homosexuality and increasing calls for the criminalization of people living with HIV/AIDS.  In too many places, violence against those with HIV is rampant and, sometimes, sanctioned.

Dr. Jorge Saavedra Lopez, the head of the National HIV/AIDS Programme in Mexico reported that, all across the world, the existence and infection rate of men having sex with men is under reported because those MSM are living in the shadows.

For almost every group stigmatized by this epidemic – MSM, intravenous drug users, sex workers, trans-genders, and women in general – there was a loud and consistent call for basic human rights and protections.

SURVIVING EACH OTHER

A successful virus wants to live and thrive in its host.  It does not want to kill it.  More and more humans are now living with HIV.  That’s good for us.  But, it’s also good for the virus.  We're now surviving each other.

Dateline: MEXICO CITY

The theme that struck me today at the plenary session of the International AIDS Conference in Mexico City was 'in with the new'.

Dr. Tadataka Yamada of the Bill and Melinda Gates Foundation addressed the assembly on vaccines and microbicides.  He noted that clinical trials to find safe and effective ones have been so-far unsuccessful.  But, he, and others who spoke, were encouraged by the fact that each trial teaches us a little more about how to go forward.

His headline, to me, though, was that the foundation he represents is looking to challenge scientific dogma.  They are soliciting novel ideas on how to fight HIV/AIDS.  And they are willing to give seed funding to hundreds of such new efforts.  They are willing to finance non-traditional innovation.  More than that, he said, they would provide 'enormous' funds to those that proved promising.

Dr. Yamada lamented that making new medicines is a chancy endeavor, since nine out of ten medicines fail their trials.  He said we were only in the very early stages of clinical trials for vaccines and microbicides to fight HIV and that the later stages would be very costly.  He called on the funding community to continue giving big investments.

 

Dr. Alan Bernstein of the Global HIV Vaccine Enterprise followed that call with an appeal for new minds with new ideas to join the hunt for a cure and a new prevention strategy.  He said it was time to give funding to our best young scientific investigators, calling them engines of discovery.

One young woman, Elisabet Fadul, at a session on the state of the epidemic, was a champion for including youth in the fight.  She talked about how, increasingly, the new face of HIV is young, female and marginalized.  Her call was for evidence-based sexual and health education.  She warned the assembly that they must involve young people when those curricula are designed.

The other 'new' topic I heard as I moved from session to session was advocacy for the passage of anti-homophobia laws.  The host country, Mexico, is leading the way on that issue.

And lastly, in the 'new' theme for today, Phill Wilson of the Black AIDS Institute led a call from community leaders 'for the creation and implementation of a new National AIDS Strategy to bring the same type of commitment to the domestic epidemic that the U.S. shows against the disease overseas'.  That comes as the U.S. Centers for Disease Control and Prevention acknowledged this week that the AIDS epidemic in the United States is 40% larger than previously known.

Dateline: MEXICO CITY

Universal action now.  That's the theme of the XXVII International AIDS Conference in Mexico City.  I'm watching the opening session and it's frustrating viewing.  I’ve heard all of this before.  Speaker after speaker, each also having heard all this before, is repeating the mantra - action now.  Fighting this epidemic is a never-ending now.

The title of Dr. Peter Piot's keynote address is 'Don't Give Up the Fight!".  He's the Executive Director of UNAIDS and knows full well how difficult fighting this epidemic has become, 'Because the end of AIDS is nowhere in sight.  Every day, almost three times as many people become infected with HIV as those who start antiretroviral treatment.  We will set ourselves up for demoralization and failure if we base our strategies on the illusion that the end of AIDS can be achieved any time soon.'

'In most countries, stigma against people living with HIV remains a grave challenge.  On third of countries still do not have laws to protect people living with HIV.  In most countries, discrimination remains legal against women, men who have sex with men, sex workers, drug users, and ethnic minorities.  This must change.'  - Ban Ki-moon, Secretary-General, United Nations

'This means challenging head-on the stigma and discrimination that continue to hamper our progress against this disease.  In this region, men who have sex with men continue to bear the brunt of the epidemic, that means challenging homophobia everywhere in our society: in government circles, in health care settings, in our families, and yes, in our churches as well.' - Dr. Louis-Soto Ramirez, AIDS 2008 Co-Chair

'Combination prevention, just like combination treatment, is the only feasible option.  Anything else is, frankly, irresponsible.  Combination prevention means finding the right mix of activities for each local epidemic.  Combination prevention also invloves mobilizing for social change - no more stigma around HIV, no more homophobia, no more gender based violence, no more ostracism of sex workers." - Dr. Peter Piot, Executive Director, UNAIDS

'It is time to challenge the tyranny of ignorance and denial.  It is time for leaders of all kinds - political, religious, and community - to help move these groups in from the margins of society to the center of the global response to HIV.' - Dr. Pedro Cahn, President, International AIDS Society

Of course, we can't win the battle against HIV without also defeating homophobia, denial, stigma, gender violence, discrimination, economic inequity, racism, intolerance, drug profiteering, scientific dogma, secrecy, ignorance, inequality, poverty, marginalization, insensitivity, infidelity, sexism, promiscuity, shame, fear, guilt, bias, blame, exclusion and religious doctrine. And so, the never-ending now.

Missive Eleven
To Fellow Citizens of the World

We know how to help prevent HIV infections.  Those having sex should always use a condom, drug users should shoot with clean needles, couples should be faithful and everyone should know and disclose their HIV status.  It's that simple.  And yet, the AIDS epidemic continues to grow at an unconscionable rate.  Why?

Because prevention is all mixed up with morality.  There are mistaken beliefs, contradicted by scientific study, that giving out condoms or clean needles encourages sexual promiscuity and drug abuse.

Too often, around the world, and in the United States particularly, you hear arguments against institutional action on prevention because interventions target those considered to be practicing 'sinful behaviors' - the promiscuous, homosexuals, adulterers, prostitutes, criminals, drug abusers.

We think that if 'those people' would just change their behaviors, all would be well.  Well, those behaviors are never going to change.  So, instead of recognizing the facts of life, and doing whatever we can to protect anyone and everyone at risk of getting infected, regardless of our personal opinions about their lifestyles, we condemn 'those people' to death by our inaction.

We counsel abstinence to teenagers we know will have unprotected sex.  We demand fidelity of men and woman we know can and will be unfaithful.  We withhold condoms and clean needles from inmates, while knowing that sexual intercourse and drug use are rampant in prison.  We preach that homosexuality is a sin from our pulpits, knowing many in the congregations are gay and forced to live secret lives.  And we turn a blind eye to sex workers around the world, willfully ignoring the fact that they mostly do what they do to survive.

We stigmatize those that need our help the most, out of misplaced moral arrogance.  We punish those we label as sinners instead of saving them.

When churches won't give out condoms, when prisons won't give out clean needles, when schools won't teach safe sex, when communities won't accept their gay members, people get infected and die.

That, to me, is sinful behavior.

I will be reporting from the Seventeenth International AIDS Conference in Mexico City, the first week of August.  It is my second convention, the first being last year in Toronto.

What struck me last year was that the prevention conversation had moved away from the moral issues I noted above to discussions about programs and procedures to help women protect themselves from the disease.  There was a lot of talk about condom negotiation, the economic and social empowerment of women and the development of germicides.

But, the undertow pulling against progress is always secrecy and stigma.

Like it or not, we have to embrace those at risk, our so-called sinful brothers and sisters.  We all have to attack this plague without undue moral judgment.  It is the right thing to do.  And the only way we can truly bring this epidemic under control.

WHY US? POSTERS

 

 

BIG BUCKS FOR EARLY DEATHS

Good Lord.  Does anyone think that Wall Street has learned its lesson about risky, esoteric financial instruments?  Well, they haven't.  The investment industry is about greed, and nothing but greed.  The New York Times reports today that investment banks are looking to buy life insurance policies that the ill and elderly sell for cash.  They will then package thousands together into bonds and resell those to investors, who will receive payouts when the insured people die.  And here's the precious part:  The earlier the policyholder dies, the bigger the return.  So, Wall Street is hoping to make big bucks on early deaths.  Boy, do we need strong government regulation of the financial industry.

PREMIERE OF HIV/AIDS DOC

HI folks.

As some of you know, I have been working as a producer/writer/videographer on a documentary the past four years for Diversity Films about HIV/AIDS and African-Americans. Well, next month is its world premiere.

It is called, "Why Us? Left Behind and Dying". It looks at why the AIDS epidemic is hitting the Black community so hard, through the eyes of 20 African-American high school students in Pittsburgh. Among the reasons are secrecy, homophobia, religious beliefs, genetics, forced migration, stigma, gender inequality, ideas of masculinity, distrust of medical systems, prison incarceration, poverty and racism.

The students in the film conducted most of the interviews with scientists, researchers, community activists and people living with HIV in their neighborhood The students, themselves, were also subjects of the film. The honesty they were able to bring out of our participants is gripping.

I'm asking you to encourage your friends and colleagues in NY and LA to go see the opening run. It is playing at the theaters listed below.

Claudia Pryor, the Director and Executive Producer, will be attending opening nights in both cities.

I am very proud to have worked on this untold story. Please help us spread the word about this compelling film.

Hope all is well with you and yours. Cheers for now. David.

Los Angeles Opening - Sept. 9-15, Grande 4-Plex, 345 Figueroa
New York Opening - Sept. 11-17, IFC Center, 323 Sixth Ave.

THE UNINSURED

In an editorial, The New York Times looks at who the medically uninsured are in this country, and concludes: "Any nation as rich as ours ought to guarantee health coverage for all of its residents."

"Scores of well-designed studies have shown that uninsured people are more likely than insured people to die prematurely, to have their cancers diagnosed too late, or to die from heart failure, a heart attack, a stroke or a severe injury. The Institute of Medicine estimated in 2004 that perhaps 18,000 deaths a year among adults could be attributed to lack of insurance."

- Editorial, The New York Times

UNHEALTHY LIES

Congressional Republicans and health insurance lobbyists are lying to the American people - knowingly and cynically - to protect their greedy entrenched interests by killing health care reform.  That's the truth, pure and simple.

"The recent attacks by Republican leaders and their ideological fellow-travelers on the effort to reform the health-care system have been so misleading, so disingenuous, that they could only spring from a cynical effort to gain partisan political advantage. By poisoning the political well, they've given up any pretense of being the loyal opposition. They've become political terrorists, willing to say or do anything to prevent the country from reaching a consensus on one of its most serious domestic problems."

- Steven Pearlstein, The Washington Post

HEALTH REFORM VILLAINS

I have not had much faith in the political leadership of House leader Nancy Pelosi and Senate leader Harry Reid in the health care reform debate.  Today, Pelosi, finally got some guts and laid the blame for our broken, greedy system at the feet of the real obstructionists of reform - the health insurance industry.  Some of her comments today:

Pelosi: Health Insurance Companies the Real Villains

"They are the villains in this. They have been part of the problem in a major way," Pelosi said of the insurance industry after her weekly press conference. "It's almost immoral, what they are doing," she said, referring to industry lobbying against a public insurance plan option. "Of course, they've been immoral all along. They are doing everything in their power to stop a public option from happening, and the public has to know about it."

The current system works so well for insurers that they don't even want subsidies, Pelosi claimed. "They've had a good thing going for a long time at the expense of the American people and the health of our country," she said, adding that it will be tough to keep them from getting their way. "This is the fight of our lives."

- Nancy Pelosi, Speaker of the House

SICK TALK ON HEALTH CARE

The chief disinformation operative of the Republican party is leading a propaganda campaign against national health care reform.  He is Frank Luntz. 

He has crafted a 28-page talking points memo for Conservatives, called "The Language of Health Care 2009," to trumpet the dishonest accusation of a "Washington takeover of healthcare."  It is cynical, distorted, fear mongering self-interest at its worst.

Luntz advises opponents of universal health care to make the debate about "politicians," "bureaucrats," and "Washington," and to highlight "horror stories" about "government takeover."  He tells them to play on the fear the public has of "denied treatment."

Luntz writes, "The best approach is to empathize with the fear, anxiety and financial pain people are clearly feeling right now. So instead of dismissing their concerns, acknowledge them – up front – and then pivot to your solution. Some conservatives will undoubtedly find this distasteful. But failure to connect on a personal level at the beginning will lead to communication failure at the end."

Later he writes, "It is essential that “deny” and “denial” enter the conservative lexicon immediately because it is at the core of what scares Americans most about a government takeover of healthcare. Then add to it the source of that denial and you have the perfect anti-government, anti-Washington and anti-Democratic message."

So, you will hear this mantra repeated from Republican after Republican:

“No Washington bureaucrat or healthcare lobbyist should stand between your family and your doctor. The Democrats want to put Washington politicians in charge of YOUR healthcare. We can and must do better. Say no to a Washington takeover of healthcare and say yes to personalized patient-centered care.”

Of course, "personalized patient-centered care" is code for health insurance company control. That is the powerful industry Luntz and his cohorts are trying to protect.

Luntz and his associates are the premier manipulators of language for selfish, partisan ends.

Read one of his mission statements from their web site (emphasis is mine): 

Luntz, Maslansky Strategic Research

"Our focus is on language. We believe that every word you use matters.  Luntz, Maslansky is known across the nation for how we reframe issues.  From changing the “estate tax” to the “death tax,” “tax cuts” to “tax relief,” “global warming” to “climate change” – time after time we have succeeded in changing the course of the debate.  By focusing on how to communicate your message, Luntz, Maslansky helps you reframe the issue using your side’s words and messages.  Our unique research methodology allows us to precisely gauge public opinion and develop the most effective approach and language to take control of the issue.  We know how to change hearts and minds and motivate people to act."

from Luntz, Maslansky Strategic Research website

Their goal is to help "virtually every major industry" to distort their message and mask their true agenda.  Another quote from their web site:

"In the political arena, our CEO, Dr. Frank Luntz, is known for helping change the public vocabulary – he transformed the "estate tax" into the "the death tax," moved the public debate from "school vouchers" to "opportunity scholarships," and re-cast "drilling for oil" as "exploring for energy."  ...  In the corporate arena, Luntz, Maslansky currently works for clients in virtually every major industry: pharmaceuticals, telecommunications, energy, health care, transportation, sports, entertainment, travel and tourism, shopping centers, grocery stores, restaurants, food, and beverages."

If Frank Luntz is involved in a public campaign, you may assume the goal is to "pull the wool over your eyes."

And, so then, is his mission in the health care debate.

Photo Credit:  Frederick M. Brown / Getty Images

VIRAL REBOUND

Dateline:  MEXICO CITY

THE VIRUS IS WINNING

In the battle against the Human Immunodeficiency Virus, the virus is winning.

33 million people are living with HIV infection according to 2007 figures from UNAIDS.   This increase is a result of new infections and the beneficial effects of more widely available antiretroviral (ARV) therapy.

Three million people are now on ARV drugs.  But, for ever person who starts treatment, two or three more are newly infected.

The call here, at the XXVII International AIDS Conference, is for universal and free access to HIV/AIDS treatment by 2010. 

Offical Conference Press Releases

CLINICAL TRIALS FAILING

At the last conference of the International AIDS Society, the host of this event, in Toronto, there was great talk and hope for the development of vaccines or microbicides to fight the epidemic.  But, nascent clinical trials for both have come up short.  Still, those here insist that we learn something from each failed trial, and that we must continue to devote substantial funds to find a cure.

FUNCTIONAL CURE

However, Tony Fauci, a leader on global AIDS issues, says we may have to accept a ‘functional cure’ where early aggressive drug therapy allows people infected with HIV to live long, relatively healthy lives.  HIV is becoming a widespread, treatable, chronic disease.

COMBINATION STRATEGIES

The talk here is to combine all known prevention and treatment strategies in a coordinated effort to treat existing infections and prevent future ones. Dr. Kevin De Cock, the Director of the World Health Organization, says we have to make that link strong and indivisible.  Best to use whatever works for short-term gains while searching for a long-term solution.

TREAT EVERY INFECTED PERSON

And a dialogue is beginning on starting drug therapy sooner in patients, before their T-cell counts fall below 200, the current benchmark on when to begin therapy.

One idea presented here is creating quite a stir.  A Canadian study suggests that since HIV patients whose viral loads are undetectable are believed to be less infectious, why not treat EVERY infected person, with the goal of eliminating their viral loads and thus preventing future transmissions?  Dr. Julio Montano, of the Canadian group and the President-Elect of the International AIDS Society, says, ‘Basically, the more people you treat and the faster you engage people in treatment, the greater impact you will have on the epidemic.’

LYING IN WAIT

But, the virus may be too smart for even that approach.  It knows how to lie in wait.

According to Dr. Robert Siliciano of Johns Hopkins University School of Medicine, when a person is first infected with the virus, the virus establishes itself in a stable reservoir, from which it begins replicating itself.  When drug therapies start on that patient, the treatment attacks the replicated viruses.  Viral load can drop to undetectable levels.  But, there is still the original virus hiding in the reservoir, undetected.  If the patient were to stop or slow therapy, those latent viruses would start replicating again and return the patient to his/her original level of infection.

PRE-EXPOSURE STUDIES

As early as next year we’ll see the results from trials of antiretroviral drugs being tested for HIV prevention, known as PrEP, or pre-exposure prophylaxis.  Underway in Africa, Asia, Latin American and North America, PrEP is an unproven strategy in which HIV negative people could take an ARV, or combination of ARVs, on a regular basis in the hopes of reducing their risk of acquiring HIV.

HERE, THERE, EVERYWHERE

The goal of all viruses is to adapt and multiply.  And HIV is a master at that.

Peter Poit, the Executive Director of UNAIDS, warned that the virus is always a step or two ahead of us.  As we come to grips with the spread of the virus in one group or one geography, it finds another group in another location – married women in one locale, men who have sex with men in another, intravenous drug users somewhere else.

He also was less optimistic about a cure and said our goal is to keep anyone from dying of AIDS and to give those living with HIV a good life.  To that end, he called for changing the funding model from an insurance scheme to a pension scheme.  He said instead of protecting against unknown events, we should accept the fact that we need to plan for known events, i.e., that millions of people are and will be infected with HIV and are entitled to a full and healthy life.

AIDING HEALTH SYSTEMS

All across the world countries have to deal with this epidemic.  Yet, in so-called resource poor nations, that is an overwhelming struggle.  They are simply not medically equipped enough to meet the challenge.  Speakers here noted that improving AIDS programs around the world will help build and strengthen all health systems.  This disease may become a coalescing factor to bring coordinated, universal health care to millions around the globe.

RICHER, POORER

But, mocking the call for free drugs for everyone by 2010, the rich still fare better with this disease than the poor.  Dr. Anton Pozniak of Advances in ART pointed out, antiretroviral therapy only works if you have access to it and you stay on it.  As he and others said, access to newer therapies by poor people and countries is still a major problem.

SOCIAL CHANGE

And, of course, there are substantial governmental, cultural and organizational barriers to a successful battle against this disease.

Speaker after speaker here decried the fact that in too many countries there are harsh laws against homosexuality and increasing calls for the criminalization of people living with HIV/AIDS.  In too many places, violence against those with HIV is rampant and, sometimes, sanctioned.

Dr. Jorge Saavedra Lopez, the head of the National HIV/AIDS Programme in Mexico reported that, all across the world, the existence and infection rate of men having sex with men is under reported because those MSM are living in the shadows.

For almost every group stigmatized by this epidemic – MSM, intravenous drug users, sex workers, trans-genders, and women in general – there was a loud and consistent call for basic human rights and protections.

SURVIVING EACH OTHER

A successful virus wants to live and thrive in its host.  It does not want to kill it.  More and more humans are now living with HIV.  That’s good for us.  But, it’s also good for the virus.  We're now surviving each other.

IN WITH THE NEW

Dateline: MEXICO CITY

The theme that struck me today at the plenary session of the International AIDS Conference in Mexico City was 'in with the new'.

Dr. Tadataka Yamada of the Bill and Melinda Gates Foundation addressed the assembly on vaccines and microbicides.  He noted that clinical trials to find safe and effective ones have been so-far unsuccessful.  But, he, and others who spoke, were encouraged by the fact that each trial teaches us a little more about how to go forward.

His headline, to me, though, was that the foundation he represents is looking to challenge scientific dogma.  They are soliciting novel ideas on how to fight HIV/AIDS.  And they are willing to give seed funding to hundreds of such new efforts.  They are willing to finance non-traditional innovation.  More than that, he said, they would provide 'enormous' funds to those that proved promising.

Dr. Yamada lamented that making new medicines is a chancy endeavor, since nine out of ten medicines fail their trials.  He said we were only in the very early stages of clinical trials for vaccines and microbicides to fight HIV and that the later stages would be very costly.  He called on the funding community to continue giving big investments.

 

Dr. Alan Bernstein of the Global HIV Vaccine Enterprise followed that call with an appeal for new minds with new ideas to join the hunt for a cure and a new prevention strategy.  He said it was time to give funding to our best young scientific investigators, calling them engines of discovery.

One young woman, Elisabet Fadul, at a session on the state of the epidemic, was a champion for including youth in the fight.  She talked about how, increasingly, the new face of HIV is young, female and marginalized.  Her call was for evidence-based sexual and health education.  She warned the assembly that they must involve young people when those curricula are designed.

The other 'new' topic I heard as I moved from session to session was advocacy for the passage of anti-homophobia laws.  The host country, Mexico, is leading the way on that issue.

And lastly, in the 'new' theme for today, Phill Wilson of the Black AIDS Institute led a call from community leaders 'for the creation and implementation of a new National AIDS Strategy to bring the same type of commitment to the domestic epidemic that the U.S. shows against the disease overseas'.  That comes as the U.S. Centers for Disease Control and Prevention acknowledged this week that the AIDS epidemic in the United States is 40% larger than previously known.

THE NEVER-ENDING NOW

Dateline: MEXICO CITY

Universal action now.  That's the theme of the XXVII International AIDS Conference in Mexico City.  I'm watching the opening session and it's frustrating viewing.  I’ve heard all of this before.  Speaker after speaker, each also having heard all this before, is repeating the mantra - action now.  Fighting this epidemic is a never-ending now.

The title of Dr. Peter Piot's keynote address is 'Don't Give Up the Fight!".  He's the Executive Director of UNAIDS and knows full well how difficult fighting this epidemic has become, 'Because the end of AIDS is nowhere in sight.  Every day, almost three times as many people become infected with HIV as those who start antiretroviral treatment.  We will set ourselves up for demoralization and failure if we base our strategies on the illusion that the end of AIDS can be achieved any time soon.'

'In most countries, stigma against people living with HIV remains a grave challenge.  On third of countries still do not have laws to protect people living with HIV.  In most countries, discrimination remains legal against women, men who have sex with men, sex workers, drug users, and ethnic minorities.  This must change.'  - Ban Ki-moon, Secretary-General, United Nations

'This means challenging head-on the stigma and discrimination that continue to hamper our progress against this disease.  In this region, men who have sex with men continue to bear the brunt of the epidemic, that means challenging homophobia everywhere in our society: in government circles, in health care settings, in our families, and yes, in our churches as well.' - Dr. Louis-Soto Ramirez, AIDS 2008 Co-Chair

'Combination prevention, just like combination treatment, is the only feasible option.  Anything else is, frankly, irresponsible.  Combination prevention means finding the right mix of activities for each local epidemic.  Combination prevention also invloves mobilizing for social change - no more stigma around HIV, no more homophobia, no more gender based violence, no more ostracism of sex workers." - Dr. Peter Piot, Executive Director, UNAIDS

'It is time to challenge the tyranny of ignorance and denial.  It is time for leaders of all kinds - political, religious, and community - to help move these groups in from the margins of society to the center of the global response to HIV.' - Dr. Pedro Cahn, President, International AIDS Society

Of course, we can't win the battle against HIV without also defeating homophobia, denial, stigma, gender violence, discrimination, economic inequity, racism, intolerance, drug profiteering, scientific dogma, secrecy, ignorance, inequality, poverty, marginalization, insensitivity, infidelity, sexism, promiscuity, shame, fear, guilt, bias, blame, exclusion and religious doctrine. And so, the never-ending now.

SINFUL BEHAVIOR

Missive Eleven
To Fellow Citizens of the World

We know how to help prevent HIV infections.  Those having sex should always use a condom, drug users should shoot with clean needles, couples should be faithful and everyone should know and disclose their HIV status.  It's that simple.  And yet, the AIDS epidemic continues to grow at an unconscionable rate.  Why?

Because prevention is all mixed up with morality.  There are mistaken beliefs, contradicted by scientific study, that giving out condoms or clean needles encourages sexual promiscuity and drug abuse.

Too often, around the world, and in the United States particularly, you hear arguments against institutional action on prevention because interventions target those considered to be practicing 'sinful behaviors' - the promiscuous, homosexuals, adulterers, prostitutes, criminals, drug abusers.

We think that if 'those people' would just change their behaviors, all would be well.  Well, those behaviors are never going to change.  So, instead of recognizing the facts of life, and doing whatever we can to protect anyone and everyone at risk of getting infected, regardless of our personal opinions about their lifestyles, we condemn 'those people' to death by our inaction.

We counsel abstinence to teenagers we know will have unprotected sex.  We demand fidelity of men and woman we know can and will be unfaithful.  We withhold condoms and clean needles from inmates, while knowing that sexual intercourse and drug use are rampant in prison.  We preach that homosexuality is a sin from our pulpits, knowing many in the congregations are gay and forced to live secret lives.  And we turn a blind eye to sex workers around the world, willfully ignoring the fact that they mostly do what they do to survive.

We stigmatize those that need our help the most, out of misplaced moral arrogance.  We punish those we label as sinners instead of saving them.

When churches won't give out condoms, when prisons won't give out clean needles, when schools won't teach safe sex, when communities won't accept their gay members, people get infected and die.

That, to me, is sinful behavior.

I will be reporting from the Seventeenth International AIDS Conference in Mexico City, the first week of August.  It is my second convention, the first being last year in Toronto.

What struck me last year was that the prevention conversation had moved away from the moral issues I noted above to discussions about programs and procedures to help women protect themselves from the disease.  There was a lot of talk about condom negotiation, the economic and social empowerment of women and the development of germicides.

But, the undertow pulling against progress is always secrecy and stigma.

Like it or not, we have to embrace those at risk, our so-called sinful brothers and sisters.  We all have to attack this plague without undue moral judgment.  It is the right thing to do.  And the only way we can truly bring this epidemic under control.