Friday, August 29, 2014

Homophobia is Hijacking PrEP

The ACO (Aids Committee of Ottawa) is slated to release a statement on the inclusion of PrEP HIV medications (Pre-Exposure Prophylaxis - brand name Truvada) as part of an HIV prevention strategy, and I'm a bit nervous. The organization is reported to support making PrEP prescriptions available to all sexually active "gay men" (super unrepresentative language). If the ACO does support this policy, they will have been duped by big pharma. Even worse, they will have advocated a homophobic agenda in which privileged (mostly white, cis, American, and gay) men re-articulate risk as per their liking.


The advocates of PrEP are largely affluent cis gay men (they can afford an extraneous prescription), who openly partake in risky sex. I'm of the civil libertarian tradition and begrudge no one their pleasure with other consenting adults. Where I draw the line is the audacity these bedfellows have in attempting to redefine their activities as less risky through a flawed and profit-driven prevention treatment.


Let's warm up with some PrEP facts. 
  • PrEP only prevents 1 strain of HIV. There are 2. (Admittedly, 1 is more prevalent and virulent, still)
  • PrEP's has 2 levels of side effects 
    • Common side effects include: headache, stomach-area (abdomen) pain, and decreased weight.
    • Serious side effects include liver problems and a buildup of lactic acid in the blood (lactic acidosis). New or worsening kidney problems, including kidney failure. Bone problems. Changes in body fat. Changes in your immune system.
  • PrEP the medication schedule requires CONSTANT VIGILANCE. The Aids Health Care Foundation reports that due to issues with adherence among people taking the drug in clinical trials, PrEP efficacy is about 50%. Non-adherence will lead to drug resistance and HIV transmissions. 
  • The good numbers on PrEP are what we call a "beat up" in the social sciences (facts that are worded to illicit a specific response--in this case political support for PrEP). Also a quote from the CDC webpage: "Among gay and bisexual men, those who were given PrEP were 44% less likely overall to get HIV than those who were given a placebo." The 92% you see everywhere is best case scenario, not reality. Reality is that swaths of babies are born because of little pills that didn't get taken correctly. (#justsayin)
  • The President of the Aids Healthcare Foundation said verbatim: "a government-sanctioned widespread scale up of PrEP appears to be a public health disaster in the making".


There is no such thing as a zero risk sexual encounter. Risk can only be mitigated. 

Remember:
Risk=(probability)(impact)

Using this equation we see how dumb PrEP actually is as a preventative means. Condoms are ~97% effective at preventing HIV transmission when used properly. The combination of an undetectable viral load and a condoms is ALWAYS safer than the the combined protection of PrEP and an undetectable viral load (and if you're thinking "what if the condom breaks?", there's PEP for that).

The real magic of condoms is how they protect your from all sorts of nasty things you don't want on your fun bits. If you're an MSM (male who has sex with males) who can't live without fluid exchange, find a monogamous partner and wait 3 months or accept the risks involved. Don't pretend like the science is good enough to redefine unprotected sex as without risk.  

Only two groups of people should be prescribed PrEP as a preventative measure: sex workers and the recurring partners of HIV+ patients. 

To articulate all "gay men" as having the same likelihood as these two groups to be exposed to HIV is homophobic. This approach conflates the identity of "gay man" with promiscuity, a stereotype that has haunted the community for decades. No one, "gay man" or other, should have the option to go on PrEP because they resist condoms. 

By failing to use a condom you place yourself at a heightened risk for every other STI. I'm going to use the super crass term PrEP-slut** to differentiate those who have legitimate reasons for the prescription (the two groups listed) and those who take it to facilitate their promiscuity.

(**Author's note: I'm not slut-shaming; I'm idiot-shaming)

As soon as mainstream queer culture realizes that PrEP-sluts are at an inordinate incidence of every STI other than HIV (well, maybe HIV if they didn't take the meds correctly), they will join the stigmatized ranks. Grindr profiles will start saying "no poz guys/PrEP-sluts", and we're back where we started with a fragmented community dictated largely by wealth and privilege.

Every step along the way, big pharma makes money, from the PrEP, to the antibiotics, to herpes suppression treatments. True Blood nailed it. Why make a vaccine when you can have a treatment? New Blood was a blatant metaphor for ARVs, but why only sell your drugs to the people who are infected when fear and bad stats can make you rich?

I close pointing to palpable disrespect within the PrEP dialogue, a disrespect of both the self and for partners. The purpose of PrEP is to stay sero-negative, not to stay healthy. We are seeing a narrative battle for the what gets to count as safe(r) sex, and I am unwilling to accept that promiscuous sex without a condom, regardless of PrEP, meets that definition.

I hope that the ACO recognizes the ineffectiveness and oppression that would stem from offering PrEP prescriptions to all "gay men" who ask for them as a preventative measure. I reiterate PrEP has a preventative function for sex workers and the recurring partners of HIV+ patients, but to offer prescriptions beyond these groups would be remiss.

Wednesday, August 27, 2014

Spending Smarter on Wellness

New Brunswick’s political parties are busy promising costly short-sighted promises, but I’m still waiting a realistic plan to move from the problems of today to the prosperity of tomorrow. The economy needs to be designed into a productive and equitable relationship between investors and average citizens. By the same wisdom, we deserve services that characterize a compassionate government. With a small population and the full powers of provincial jurisdiction, New Brunswick is not poorly suited to re-negotiate public policies along progressive ideals.

 
New Brunswickers have to decide what we want our economy to emphasize, and my suggestion is wellness. As income inequality narrows, demand for wellness services inevitably rises, as will the workforces of healthcare and para-medical services.

This blog is my call on party leaders to produce a balanced plan to becoming Canada’s kindest province. European models of development have shown decades of economic competitiveness internationally by providing their citizens with generous social services. 

While European social democracy is a reasonable model to strive for, the province must manage the transition in a way that does not detract from our attractiveness as a place to live or invest. In fact, the entanglement of these two factors cannot be underestimated. 

Richard Florida flipped the planning world on its head proving that the creative class’ inherent transience and economic value puts life place-making on equal importance with primary job creation. Anecdotally, planners used to assume people followed jobs, and now the data shows that, in many very important sectors, jobs follow concentrations of talented people.

It is the responsibility of our public managers to make this province a good place to live, so why not try to make us Canada’s best? By focusing on a wellness economy and the quality of life in the province, we reap the benefits of being a superlative place to live and do business.

So let’s start making life cheaper for citizens. Many wellness services are poorly housed in the corporate sphere. I’m not about to make the “make it all free” argument (I’d love to); we’re just at step 1. We need to de-corporatize dentistry, optometry, speech and physical therapies, and pet care services in New Brunswick.

Ask yourself this: if you need glasses to be a healthy Canadian, who has a right to be healthy, why are they so expensive? Profit motive shouldn’t have any place in health services. The provinces’ finances at this point in no way could support socializing these services, but legislators can structurally articulate these services as not-for-profit.

The Province should provide one-time seed money to set up (a) non-profit wellness corporation(s) that serve New Brunswickers at cost, with emphasis on serving low-income citizens. Democratically selected boards of directors would be sought to oversee these services and ensure their long-term sustainability. In addition to services, the Province should make the tactical decision to invest in Crown pharmaceutical manufacturing that would produce generic drugs sold to hospitals and residents at cost.

For a one time investment, New Brunswick could have Canada’s cheapest generic prescriptions, fillings, glasses, and vet bills. Sounds a lot better than what the dudes in the suits are talking about. #Justsayin


**PS: abortion should, be safe, legal, and free. Not your uterus? Not your problem!**

***PPS: piece on creative revenue forthcoming***

Monday, August 18, 2014

@CapPride is Just an Expensive Party.

Happy Pride, Ottawans!

If it suits, I hope you get a chance to attend some of the events planned for Capital Pride's 2014 edition, Free to Love. This blog post is mostly in response to some coverage Capital Pride got in the Ottawa Citizen; therein, it is concluded that Ottawa's pride is both part and protest; except, no one can find this protest.

To characterize Capital Pride as activist would require at minimum an explicit mandate to make the conditions of queer people in Ottawa better. The stated mandate on the website is:

The mission of the Capital Pride Festival is to perpetuate the spirit of pride in the gay, lesbian, bisexual, trans, two-spirited and questioning (GLBTTQ) community in Canada’s National Capital Region of Ottawa–Gatineau.

I'm not 100% sure how perpetuating the spirit of pride is going to quell queer suicides and poverty, but let's pretend that this "spirit" is in fact double mandate to celebrate and protest. So where's the protest this year? What issue(s) is(are) being focused on?

*crickets*

"Creating a visible presence and space" for the more privileged of queer identities isn't activism in 2014; it's good business (just ask Toronto). The double-income-no-kids pair are the ideal tourists, and as pride festivals around the world are increasingly profit-motivated, event planning has followed suit.

You may notice perusing the Capital Pride events page that most evening events have a cover charge; some of them are quite prohibitive. Let's pretend you're partying hard this Pride festival:

Nature Nocturne Pride Edition: 25$
Jer's Vision Boat Cruise: 25-60$
Capital Pride Comedy Boat Cruise: 25$ 
Rainbow Party: 22$
Proud Chicks Dance Party: 20-25$
Laugh Out Proud: 25$

These prices were not set with struggling queers in mind... I'm not sure if any of you readers would have made it to GlowFair in Ottawa this Summer, but the mostly free event put DJs on Bank Street and serves as a much better blueprint for financially accessible event planning. (There's an ironic amount of people who organized both of these festivals)

Protest and prohibitive costs are not compatible ideas. This tension is exemplary of how far away from activism modern pride festivals have shifted.

In the same ideological vein, it's contradictory that pride festivals are used as fundraising opportunities. Pride festivals started out demanding equality and ended up bankrolling the non-profit industrial complex.

Capital Pride lacks an emphasis on critical awareness. The festival, if it is to have any legitimate claim to activism, must articulate itself as an inclusive queer pride. Organizers must centrally integrate educational and activist initiatives from queer politics into the core of planning.

I'm not saying don't go frolic this week (by all means!), but don't think think you're being a part of some benevolent social movement. We can always hope that next year, everyone's heads are a little less up their (cl)asses!


Cheers,



D$$