Monday, February 29, 2016

Risk-Managed: A Biopolitical Diary Entry

Medicine in Canada changed this weekend. Proprietary Truvada has been approved for Pre-exposure Prophylaxis purposes for preventing HIV-1 infections (but not HIV-2, FTR). Very soon, if not already, private insurance plans will be covering PrEP prescriptions for Canadians at high risk of contracting HIV. I do think the decision is a benefit to HIV prevention efforts, but I had a visceral/existential reaction to the news for few reasons.

A) My personal effort paid off. I co-wrote a letter to the federal and provincial Health Ministries on behalf of the Carleton University Graduate Students' Association to ensure Health Canada didn't include the homophobic policy addendum that queer men could receive a PrEP prescription on demand, which some US states have on the books.

B) PrEP's administration made me actually feel biopolitics stripping a layer of ignorance and privilege off of me. Public policy decisions were made that will have an impact on the physical security of my body. Had I not been a personally effective advocate, my opinion would never have been asked.

Imma break it down. I'm a slutty condom enthusiast; the guys I fuck are a Truvada's ideal customers. I was never super worried about HIV; the bacterial infections are usually what I'm trying not to catch. Now that PrEP is approved, I'm nervous that the group of guys who I sleep with are going to ill-advisedly swap condoms for PrEP, putting me at increased risk for bacterial sexually transmitted infections. Oh and someone who diligently took his meds has now contracted HIV despite, so there's that too.

Thank fucking god queer dudes can't just ask for PrEP in Canada. My anxiety is bad enough as is. The doctor between the patient and the prescription is my only peace of mind. My sex life gets theoretically less safe with each injudicious PrEP prescription. I hope that Canadian doctors can rise above racism and homophobia in their clinical practice and impart and asses HIV risk prudently. I have no choice but to believe in the system chosen for me.

It's obviously completely different, but throughout my activism around PrEP, I felt exasperation that women must feel when their reproductive autonomy is challenged. A small group of people got to make decisions for "a problem group". These decisions have bodily implications for me, but likely not for those making the decisions. Disconnected authorities make policies about or for the body, but disregard the person. Through all of this thinking, I came to the distillation of privilege as never being in the "problem groups" that need to be regulated.

The sexual context of PrEP certainly articulates it as more privileged than the biopolitical contexts of (dis)ability, incarceration, immigration, and reproduction. However, I will not waste the experience. I raged as I parsed through tropes of nuanced homophobia, racism, and neoliberalism from organizations and friends I stand in solidarity with most times. I was/am proud that I spoke up for my biological security without being asked, and I am nervous about what this public policy will mean for me. I have realized that I am passionate about social change that prioritizes condom culture, scientific literacy, and self-love, and I am excited to integrate these themes into creative work.

I think I feel a costume coming on...

PS: Fuck yeah, Germany. These rockstars effectively cured HIV!!!

Thursday, February 25, 2016

Capitalism & HIV: A Love Story

Once upon a time capitalism met a lovely disease named HIV/AIDS. Capitalism and HIV hit it off right away. And why wouldn't they? Together, the pair of fiery lovers ravage the corners of Earth.

HIV is not the monster is used to be, but capitalism still is. HIV has once been cured via bone marrow transplant; we have drugs can stave off accidental exposure if you get them quickly (PEP), and the treatment that HIV patients* receive (ART) can dramatically reduce or stop the chance of transmission from sex with HIV patients. Most exciting, there's an HIV vaccine undergoing human trials right now!

The quality of life of an HIV patient is usually very high if they're medicated properly. The line "undetectable is the new negative" is a soundbite HIV activists have been pushing for a couple years now. While I support the initiative to break down stigma, it's not really accurate. I defer to the expertise of Dr. Joel Gallant to make the scientific distinction:
from the standpoint of prognosis and life expectancy, people with undetectable viral loads and normal CD4 counts have more in common with HIV-negative people than they have with people with untreated HIV infection. But there are still important differences between someone with well controlled HIV and someone without HIV -- if there weren't, we wouldn't still be looking for a cure. Even with well controlled HIV, you have a chronic medical condition that is expensive to treat and that causes an increase in chronic inflammation and immune activation. You still have viral DNA integrated into your own genome. I'm not willing to go so far as to say that "undetectable is the new negative," though I understand the sentiment.
Despite scientific advancement, the fight against HIV is constrained by the socio-economic context of breakthroughs in treatment and prevention. There's simply no point to inaccessible care options.

The deployment of PrEP (pre-exposure prophylaxis) drugs is where the capitalism-HIV relationship goes sour. Thanks to capitalism, the socio-economic context of PrEP is pretty awful, which sucks because there's pocket of people who sell sex, inject drugs, and regularly engage in high-risk unprotected sex who should 100% be on PrEP for personal and public health. The problem is that the maker of PrEP wants MORE.

Culturally, PrEP enthusiasts harness the most powerful and problematic gay stereotype there ever was to pad big pharma's bottom line. Gay men have HIV; be afraid enough of your sex life to take these pills everyday. Even though no medical professional or pharmaceutical company rep would ever say PrEP was a substitute for condoms, so how did the ideas of "If you're on PrEP, you can stop using condoms" become a common thought?

HIV activists did regrettable things.

Thanks US CDC!
AIDS service organizations (ASOs) have been overwhelmingly in favor of PrEP prescriptions for gay men on demand (AHF being the notable exception). Gayness is not illness that needs to be medicated for, dicks. Behavioral assessment is the only legitimate way to determine HIV risk. ASOs are undoing all the work they've done to counter the ill-conceived notion that men's queer identities, and now also black women's identities, rather than behaviors, put them at risk for HIV.

The push for PrEP has meant ASOs have to speak about HIV from both sides of their mouths. They're saying in one breath "undetectable is the new negative" and in the next using fear of HIV among queer men and black women to advertise PrEP. Effectively, big pharma outsourced their corporate outreach to ASOs.

The part of the context that reflects poorly on ASOs isn't the double speak, though. It's the accidental re-stigmatization of HIV patients and racist/homophobic logic. No one needs to take PrEP to be accepting of potential partners who have HIV when condoms have saved magnet couples (one HIV+, one HIV-) from risk and celibacy for decades.

Stigma against HIV makes no practical sense. HIV should medically be treated like any other chronic disease. Anyone can have HIV. People are born with the virus, or they can contract it by complete fluke getting a tattoo or taking out a garbage bag with a used needle jutting out. Stigma prevents disclosure and testing and ultimately results in more transmissions.

02/08/2016 in Calgary
Stigma in general, however, is a long-standing public health tool. "Don't do X; you will get Y, and suffer Z consequences while costing the government money." For stigma to advance public health goals, it has to identify behavior that can be changed. Relative to HIV, those behaviors are poor testing practices, unsafe needle use, and unprotected sex.

A PrEP prescription says "Hi, I'm Abcde, and I engage in high risk behavior". Fair enough. Your body, your choice! But we don't get to lie about what it means. PrEP isn't a thing gay dudes (or black women) are all doing. You can't (ethically) leverage your prescription against the wishes of your sexual partners to use protection (that's totally rape culture). The people PrEP was designed to help are inherently at risk for a long list of STBBIs and health complications other than HIV.

Unfortunately, there's no way around PrEP stigma in a dating context. If you discriminate against HIV status for the purposes of finding a life partner, you really need to do some research. However, the people who advertise their PrEP prescriptions on dating apps and sites are giving away substantive clues about their personal lives.

I couldn't date a PrEP user because of what it says about their relationship with their body. If another human was presented with the same scientific facts as I've seen and chooses regularly against condoms or injects drugs, then we don't have enough in common to form a relationship. My condom use is self-love, and I demand basic scientific literacy and a healthy mind-body relationship from prospective partners. I am not compatible with people who accept that level of risk for their bodies.

We must make sure that the practices advanced for public health are minimally oppressive. Unabashedly, I'm choosing risk-management over homophobia and racism, and science is on my side. While the use of PrEP is totally responsible for those at high HIV risk; in a dating context, it marks them. I accept that PrEP-stigma isn't ideal, but I'd rather a scientifically justified intra-community dating malaise, than concede in public policy the stereotype that gay men and black women have HIV.

All of these problems are capitalist problems. If there was no profit motive behind PrEP, there would have been no concerted effort to brand PrEP as a gay guy's/black women's drug. It would have been made available to appropriate patients free of cost without the oppressive fanfare it's gotten.

ASOs need to fight capitalism as hard as they fight HIV stigma. It really grinds my gears how lobbying and outreach resources that ASOs have funneled in to PrEP projects could have been spent pushing basic income programs to eliminate poverty.

My frustration is distilled in the analogy of smoking, vaping, and lung cancer prevention. Smokers aren't bad people, but smoking is bad. The Canadian Cancer Society wants you to stop smoking, not switch to e-cigarettes. They're probably happy that many people did substitute vaping for smoking, but they aren't wasting their resources lobbying Health Canada to mandate that insurance providers cover the costs of e-cigarettes.

Capitalism and HIV are the kind of couple you can't wait to see drive off a cliff together. Someday...Someday.

*Language note: I've decided against person-first language for political reasons. No one says "person living with diabetes" or "person who is queer", because "diabetic" and "queer" aren't offensive. If we're going to break the stigma of HIV, we need to talk about universal health care too. Capitalism uses money to trick people into forgetting our interdependence. I refuse to believe demanding healthcare for any (dis)ability or chronic illness is shameful, so I write/say "HIV patients" in solidarity with their medical demands on the state.

If you're interested in further reading check out Why Person-First Language Doesn’t Always Put the Person First.

Friday, February 12, 2016

Non-Drivers Should (Formally) Have Rights

If ethical veganism is a human right, so too is the right not to drive.

The clarification of creed in Ontario's Human Rights Code offers a unique opportunity to correct job discrimination against non-drivers, and set Ontario apart as a policy leader in human rights and poverty reduction. The rights claim of ethical vegans and non-drivers is the same; reasonable personal decisions shouldn't be grounds for discrimination.

As an environmentalist and minimalist, I am ethically opposed to personal vehicle ownership. Further, vehicle ownership isn't financially feasible for me and millions of other Ontarians.

Ontarians don't drive for any combination of three reasons: economic constraint, structural ableism, and reasonable personal choice.

Being poor, (dis)abled, and/or principled are not legitimate grounds for discrimination. Yet, many job postings list vehicle access or ownership as a condition of employment. This editorial was actually inspired by a particularly agitating tutoring job application that stated bluntly: "Only candidates with regular access to a car will be considered for an interview" on the third section of the application, after open-ended written responses.

Why is that legal? If a company can't be profitable without exploiting it's employees, then it should fail. If the job requires a vehicle, a vehicle should be provided. Car-sharing services are widely available; the burden of vehicle access is an employer's responsibility.

Driving is a privilege, not a right; let's enforce that.

Thursday, February 4, 2016

#Thisisme: 31 Confessions Later

We did it!! Hayleigh and I made it through a month of confessions! I learned so much about myself and the people in my life during #Thisisme. Over the month, I came out as (in reverse chronological order):

#Thisisme ended up being one of my favorite things I've done as an adult. I feel pretty badass about the whole thing. It's so freeing to be able to talk and tweet honestly about funny sex and drug stories now. I've purged myself of shame.

I was so happily surprised that Hayleigh blogged along. Hayleigh is one of those friends who I've gone huge gaps of time without seeing, but it's always easy to pick back up with. I definitely think we're closer friends for having done #Thisisme together.

#Thisisme made me miss the traditional issue-driven writing I do, but it was a really great experience writing for a broader audience. I'm not sure to what level I'll continue with writing that's as causal as the most part of #Thisisme. (I did my best to put Post-Modern in simple language)

I only received one piece of negative feedback. It came in the form of a text from my estranged older brother. It read "You should have some respect for your mother and father and keep that off Facebook" after I published Kinky. Hoooookay! So my brother is 2 years older than me, dropped out of high school, and has a criminal record detailing a couple years in prison. Our father is retired RCMP, so his concern for our parents is pretty fucking rich.

Despite there being a glorious irreverent edge to candor, I didn't foresee the emotional toll of project. I just looked at it as a writing schedule. I had made list of things to write about and reordered them a number of times. It ended up helping for sure, but if I came to the day and I just didn't have it me to write about whatever I was supposed to, I didn't. The Body Image Issues (3rd most read, after the sexy posts) was an off-book write, and so was Picky EaterAnti-hero was my retainer post that I wrote when I was brooding over something around the end of the first week.

A few days stand out to me as struggles. Having a shitty day, obviously, but Olympic Killjoy & Fashion Forward are the posts I look back on with the most angst because of something I didn't say.

At the turn of 2016, I publicly stated that I was just not dating. I'm focusing on my my career and legacy in 2016, and I'm not one to choose love over empire. The Universe and I like to play jokes on each other, so at the most inconvenient of times I met an awesome human. Who starts dating someone a radical confessional blogging challenge?? I guess me.

The circumstances forced a lot of compatibility conversations to the fore, which was actually kind of awesome. I don't really date a lot. Other than the guy I'm now seeing, I've only 'officially' dated two people and casually one other. I have a long list of deal-breakers, and second dates are rare events in my life. When that someone gets past that long list of deal-breakers, I catch feelings pretty fast, and I did.

My conundrum was two little voices in my head arguing over how/if this relationship development would be reflected in #Thisisme. Ultimately, it was not. I chose self-censorship over authenticity because I was in a new relationship I didn't want to risk. I desperately wanted to tell the world that there was a crack in my heart of ice, but I didn't. I could tell the world about my anxiety and promiscuity, but not about my happiness. What the fuck, right?

I knew the authentic alternative but chose complacency. I hate that disclosing an affinity for someone is presumed to mean such a narrow array of outcomes, as if feelings were simple products of permission. I didn't have crazy expectations; I didn't want to chase or ensnare anyone; I just wanted say that I hope for his self-defined success, and I want to share his company as much as he'll give it freely.

Even though our life trajectories may fuck it up really soon, I got the guy. January 1st, I couldn't have possibly foreseen writing this summation. No regrets, just a final confession.

#Thisisme 31 confessions later, much less jaded.

Irreverent love isn't just political; it's indocile.