The doctor on a mission met the homeless heroin addict who lived under a tree last year at Jackson Health System’s special immunology clinic when both men were struggling to overcome the odds. Jose De Lemos, infected with HIV and hepatitis C from a shared needle, had gone without treatment for almost a year.
He’d dropped 80 pounds, suffered from night sweats and a rash on his leg and chest. Even walking hurt.
He was in no mood for conversation with a well-meaning doc.
But Hansel Tookes, a University of Miami doctor with a degree in public health and a calling to public service, isn’t the kind of doctor who is easily put off. He talked to De Lemos anyway. Sent him to dermatology, started him on meds for HIV and hepatitis C, worked to find him a bed in rehab, and talked — about his own uphill battle to create a syringe exchange program in South Florida, the kind of program that might have prevented De Lemos’ infection.
A public health advocate in Miami, where new HIV infection rates consistently top the state and national charts, Tookes had been struggling for years to get a bill passed in the Florida Legislature to create a program in Miami-Dade County to help end that terrible distinction.
In that time, he had gone from medical student to doctor. Testified before legislative committees over and over. And learned just how hard he would have to fight to get what he considered a very modest proposal to save lives and improve public health through a conservative, Republican-dominated Legislature.
For De Lemos, his doctor’s commitment to the cause — an unpopular one, at that — was a revelation: “I’m hard-headed. And he’s persistent. He’s like, ‘If you get clean, you can talk about this. You’ll be great . You can help me.’ I admire him because he went through a lot but he kept going.”
Tookes recalled a different moment with his patient: “He started crying because he said he didn’t know people cared.”
For the next eight months, as De Lemos kicked heroin, endured a skin condition that caused blisters across his entire torso and finally saw his sky-high viral count drop, Tookes started seeing hope, too. His proposal, which had been stalled for years, started gaining traction. The nationwide heroin epidemic had changed the dialogue about blood-borne diseases. De Lemos’ appointments with Tookes now usually included an update on the needle exchange bill in Tallahassee. Sometimes, when there was a big vote, Tookes played video recordings of the committee meetings on his phone for De Lemos to see.
“The reception in the ER isn’t great. I had to prop the door open,” Tookes said, with a laugh. “But we watched.”
In March, a full five years after Tookes published a study in a medical journal when he was still a student that documented the harsh reality of illicit needle use in Miami, Gov. Rick Scott signed the Miami-Dade Infectious Disease Elimination Act, making Miami-Dade’s program the first legal needle exchange in the American South.
The victory didn’t mean his fight was over. Legislators weren’t unanimous when they approved the bill, and the IDEA act reflects that: It creates a five-year test program, only in Miami-Dade and without any public financing. Tookes and UM, which will run the program, must raise all the money for the program privately, through grants and donations. Tookes — doctor, public health advocate and needle exchange crusader — must now also become a fundraiser.
He’s undaunted. His determination has carried him this far, and he is already envisioning the rest.
“When I flew back to Miami after the bill had passed, I looked at the city as we were landing at MIA and I thought, what we just did is going to change the health of tens of thousands of people,” Tookes said. “And that was an amazing feeling. And that’s an amazing truth. And that’s where we are.”
Advanced HIV cases
Tookes, a 35-year-old internist, took on the against-the-odds fight for a needle exchange because he felt he had to. Too many people were coming through the doors of Miami-Dade’s public health system like De Lemos, with advanced cases of HIV in an era when the virus that causes AIDS is generally treated as a disease you live with, not one that kills you. Injection drug overdoses were rising, too.
The doctor knew getting people into treatment earlier could make a huge difference in their lives and reduce infections of others. (“I’m trained to look for public health solutions,” he said.) A needle exchange was a step toward that goal. Florida had never allowed a needle exchange program before. But why couldn’t that change?
His grandmother, Gracie Wyche, had set the bar high in his family. She was a pioneering black nurse in Miami who started out in the then-segregated wards of Jackson Memorial and eventually became a head nurse, concentrating on a mysterious illness in the 1980s that later became known as AIDS. Tookes became even more interested in public service during his undergraduate work at Yale University and a stint as an investigator for Project Aware, an HIV testing/counseling clinical trial at UM. He got a public health degree at UM, and then his medical degree.
Now a third-year resident who does his research through UM’s division of infectious diseases at the Miller School of Medicine, Tookes said his grandmother’s work set him on this path. “She inspired me,” he said. “There’s just a long history of service on both sides of the family.”
The HIV numbers drove him, too. In 2014, the Miami-Fort Lauderdale region ranked No. 1 in the nation by the U.S. Centers for Disease Control and Prevention for the rate of new HIV infections in areas with more than 1 million people. That year, Miami-Dade County had 1,324 new HIV cases, the CDC said, while Broward had 836 cases. Statewide, in 2014, the Florida Department of Health said 110,000 people were diagnosed and living with HIV. People are still dying of the virus: In the United States, 6,955 people died from HIV and AIDS in 2013, according to the CDC.
Tookes saw the toll up close, in the examining room. A man in his 40s who had sex with men, no body fat and pneumocystis pneumonia, a disease often associated with AIDS _ who didn’t know he’d probably had HIV for years. An impoverished woman from Liberty City with a debilitating bacterial infection from a severely compromised immune system, who had never before been tested for HIV. Or a young man diagnosed with HIV a few months ago who revealed to Tookes during a clinic visit that he uses intravenous methamphetamine.
“Everything with this issue _ all of the advocacy that we did for this policy _ was to fix an issue that we were seeing in everyday clinical practice . I think as physicians, we had a duty to intervene,” Tookes said. “We knew there was something we could do for these people to help them from getting so sick, and so we decided to fight for it.”
He faced deep suspicion about the idea going back to the just-say-no 1980s. Although needle exchange programs have become increasingly common even in GOP-controlled states _ Indiana’s governor and now Republican vice presidential candidate Mike Pence changed his position last year after an outbreak of HIV and hepatitis C _ Florida remained a holdout. Some lawmakers continued to believe that giving addicts clean needles amounted to government-endorsed drug use.
Starting in 2012, Tookes — backed by a coalition including the Florida Medical Association, the Florida Hospital Association and the Miami-Dade State Attorney’s Office — tried to make headway with lawmakers. When he hit the wall of opposition, he didn’t give up. He didn’t get disillusioned or cynical. He tried again. And again. In the legislative sessions of 2013, ‘14, ‘15.
Then 2016 came along. The heroin epidemic created a whole new conversation around the issue of injection-drug use.
State Sen. Oscar Braynon, a Miami Gardens Democrat, sponsored the syringe exchange bill — over and over — because of the high rates of HIV and hepatitis C in his district. He said he saw opposition flag after Florida shut down its “pill mills” starting in 2011, sending opioid users to the needle.
“The first thing people hear is that you’re trying to empower drug users to use drugs,” Braynon said. “But the narrative changed over time … What started to happen is that drug use picked up. First it was people in the ‘hood. But now it’s some of the wealthier people.”
And so the Legislature’s attitude changed. Injection drug use — and the blood-borne diseases that can go with it — were no longer just “a Miami problem,” Tookes said.
“In the context of a nationwide heroin epidemic and in the context of what I believe were many more constituents across the state going to see their senators and representatives and telling them that this was something that was ravaging their communities, we had a lot more of a sympathetic ear from the Legislature this year,” he said.
A needle exchange program won’t fix Miami-Dade’s problem with HIV and hepatitis C. But Tookes says it will help. And though a small percentage of HIV infections can be traced directly to needle use and the biggest risk factor is still sex, reducing the number of shared needles reduces the community’s risk overall. People who share needles don’t always tell their sexual partners that they are at risk.
A needle exchange also brings the hard-core, drug-injecting population into the public health system to be tested and treated. That reduces the risk to everyone else and cuts costs of treating their illnesses.
This is not just theory. In Washington, D.C., the number of new HIV infections dropped from an average of 19 a month to six a month after a needle exchange program was introduced in 2008, according to a study released last year by George Washington University’s public health school. The reduction in cases saved taxpayers an estimated $45.6 million, using CDC estimates that the average lifetime of care for AIDS patients costs about $380,000.
Miami-Dade stands to save money, too, if addicts stop reusing needles. A study co-authored last year by Tookes showed that the cost of treating patients who had bacterial infections as a result of dirty needles ran about $11.4 million a year at taxpayer-funded Jackson Memorial Hospital.
For Tookes, all of these public health arguments start with what he learned on the streets of Miami interviewing intravenous drug users when he was still a medical student at UM. The study he published in 2011 showed that drug users in Miami were 34 times more likely to dispose of their needles in public than drug users in San Francisco, which has had a needle exchange program since 1988.
Tookes still sees the bits and pieces of drug equipment in bushes and along streets, even in upscale places like Brickell Avenue, lined with highrise condos and financial companies from all over the world.
“I still have syringe radar,” he said. “I spot them everywhere.”
A few miles away from the Jackson clinics where Tookes works, in the shadow of the Metrorail station in Miami’s Overtown neighborhood, Carlos Franco is handing out his precious stash of clean needles to addicts once again.
Franco, 67, says he began his underground one-man operation more than two decades ago after he was horrified to see his girlfriend share needles with other drug users. He buys the sterile syringes, 100 to a box, at his own expense when he has the money, from the North American Syringe Exchange Network.
Franco is instantly recognizable to many in the neighborhood, where orange caps from syringes are sprinkled in vacant, overgrown lots and along sidewalks and under bushes.
“φOye!” yells one man, hailing Franco from a block away.
The operation is quick, Franco reaching into his backpack and handing over several packs of needles. The man, identified only as Flaco _ “Skinny,” in Spanish _ nods his thanks, looks both ways and disappears behind a metal gate next to a house across the street.
Around the corner, near the Interstate 95 overpass, Franco points out the improvised “cookers” that litter the shrubbery, bottoms of soda cans fashioned to heat up drugs. As he’s talking, a blond, thin guy in a T-shirt and jeans walks up poking a toe into the shrubbery.
Franco pulls the box from his backpack. “You need this?”
The man nods, his face now eager. Franco hands him a packet of syringes. Sean says he is 41, from New Jersey, a construction worker when he can find work. He is a heroin addict.
Sean has hepatitis C, something he shrugs off. “If you’re on the streets, it’s sort of required,” he says, with a short laugh that reveals a few missing teeth.
He walks away. A moment later, only half-hidden by a metal fence, he hunches over his arm.
“What really bothers me,” Franco says, “is when the numbers on the side of the syringe are worn off because it’s been used so much. That, and when they use a needle so dull it looks like a nail going into the skin _ it can’t get through.”
Franco knows his needle distribution is both illegal and dangerous, but he’s not sure if he’ll give it up when the official needle exchange program is running. He supports the idea of a legal program but worries about the people who might be too afraid to try it.
“I’ll wait and see,” he says. “A lot of people on the streets know me. I’m not sure if they will go to an official program. The cops might harass the program.”
‘People are still dying’
No one knows exactly why Miami-Dade’s HIV infection rate remains higher than other metropolitan areas, even as medicines are better than ever, statewide rates have declined and mother-to-child transmissions _ AIDS babies _ are rare.
Public health officials rattle off a variety of contributing factors: Thirty-five years into this epidemic, younger people think of HIV as a treatable, chronic disease. Drugs like Truvada, which can prevent HIV infection if taken as a precaution, have added to that perception. HIV is largely an urban disease. Immigration brings people to Florida from places without much access to healthcare or health education. Miami is an international party town, and the highest risk for HIV is unprotected sex, especially for men having sex with men. Testing and medication in South Florida can be difficult to find.
Also, HIV has fallen out of the headlines for the most part, added AIDS Healthcare Foundation’s advocacy and legislative affairs manager Jason King.
“People are still dying. But you don’t get the press coverage … So it’s not at the forefront of people’s minds.”
Stigma is part of the problem, too. If you can’t admit you have HIV, your sexual partners are probably at higher risk.
“It’s not a death sentence like before but the stigma still exists,” said King, who is HIV positive. “And then they have to be conscientious about disclosing it to their next partner and they fear rejection.”
That’s definitely true in Miami-Dade, said Dr. Cheryl Holder, a general internist who works at Jessie Trice Community Health Center and is an associate professor at Florida International University.
Holder says stigma, especially in the African-American community, is one of the toughest issues she combats when she sees patients with HIV.
“We’re seeing changes in communities, but it’s still labeled as wrong and there’s something wrong with you … I still have patients who hide their medicine.”
Walking out of the health center at the end of a day not long ago, she saw one of her patients, a young man in a hoodie, waiting for a ride from a family member. “If it weren’t for his diagnosis, I would have waited with him for his family. But as I walked by, he didn’t look at me and I didn’t look at him. And that’s when I know it’s stigma. He couldn’t just pull me over and say, this is my doctor. We need to normalize healthcare so I don’t have to walk past my patient and not meet his mom.”
In some ways, Tookes’ work starts again now. Though Congress lifted a ban on federal funding for needle exchanges late last year, no federal money can be used on needles themselves. And Florida’s bill specifies that no public money can be used for the program.
That leaves Tookes, working with UM, raising it all — about $500,000 a year. And the pressure is on: Other counties in Florida are watching to see how well the program works.
“This pilot program is going to make a big dent in the infection rate in Miami. All eyes are on us. We have to make this a success.”
He has raised $100,000 from private donors locally — including Joy Fishman, the widow of the inventor of Narcan, the “save shot” for people who are overdosing — and another $100,000 from the MAC AIDS Fund.
Nancy Mahon, global executive director of the fund, said that syringe exchanges are key to fighting HIV/AIDS. “Needle exchange programs like this halt new infections, period. There is still work to do, but providing sterile syringes and supportive services to IV drug users is a solid step in order to begin saving lives.”
Miami-Dade’s health department is joining the effort.
“Definitely, we will be helping in any way we can,” administrator Lillian Rivera said. “We can’t buy the syringes, but we definitely will be providing wrap-around services. As the patients come in, we will be ensuring that they will be tested for HIV and hepatitis … All of the services that we have will be available to the patients that come through the door.”
The IDEA Exchange, which will be run through UM, comes too late to prevent De Lemos’ infections. But it’ll help others as the 35-year war on the epidemic continues _ as many as 2,000 in the first year, Tookes said. A project manager will start work in August, and other staff members are next. The AIDS Healthcare Foundation is donating the HIV and hepatitis C test kits with the agreement that those identified with one of the diseases will be linked with medical care. Tookes is hoping that other groups will follow.
And De Lemos — at 53, homeless no longer — will do his part, inspired by the fight of his doctor to pass the law. His viral load is so low it’s considered undetectable, and he is looking at life with new eyes. Service is part of his personal plan now. “I really want to be a part of this needle exchange program. If he can do that, I can do anything.”
Tookes says he will measure success with each HIV test, each syringe handed out.
“This has been a long journey … It’s a very exciting time for Miami. We’re going to save a lot of lives. We’re going to save a lot of money. We’re going to give people a lot of clean needles. We’re going to provide HIV tests. We’re going to get people into treatment … We’re going to change the world.”
Published via the AP member exchange.
Survivors from the HIV/AIDS epidemic of the 1980s and 1990s are accustomed to being told they dodged a bullet. They know they are fortunate to be alive, all these decades later.
But on the 35th anniversary of the first public scientific notice of a rare and mysterious pneumonia afflicting five young gay men in Los Angeles, those who made it through the early years of panic, confusion and grief say it’s not as if they can ever feel the disease is all in the past.
It’s more like they are veterans of a war, they say, living with that bullet still inside them.
Today, more than half of the 1.25 million Americans infected by the human immune deficiency virus are 50 and older; in just four years, that share should reach 70 percent. As the longevity boom collides with a resurgence of HIV diagnoses nationwide, scientists are just now learning how this persistent, incurable virus — along with the powerful drugs that keep it at bay — takes a toll on the body that makes natural aging look like a gift.
“A 60-year-old with HIV,” says Scott George, director of advancement for the Community AIDS Network in Sarasota, “really has the body of a 75-year-old. And it’s devastating.”
If caught in time and treated appropriately, the retrovirus that could develop into a fatal case of acquired immune deficiency syndrome rarely gets that far anymore. But like other chronic illnesses and the pharmaceutical regimens they entail, HIV accelerates the aging process.
“Treating HIV disease does not necessarily restore health,” says Steven Deeks of the AIDS Research Institute at the University of California San Francisco.
Physicians and public health workers worry that, because an HIV diagnosis is no longer a virtual death sentence, people in at-risk populations don’t fully consider the downsides of unsafe sex and drug use.
Jack Cox has lived with the virus for 31 years. At 76, the Sarasota resident is part of the first generational cohort to grow old with HIV, and he would not recommend it to anyone.
“You still have the flu all the time,” he says with a wry smile. “I have to work really hard to stay positive, because that part of me that was life-affirming became life-threatening.”
After his partner fell ill, Cox tested positive for the virus. But he was one of the fortunate few who remained symptom-free.
He embarked on his own therapeutic regimen: Chinese medicine and a network of loving friends. It took 11 years for his T-cell count to fall below the diagnostic threshold of 200. By this time, 1996, he had avoided the toxic doses of early experimental medications.
Cox, who has endured bouts of depression and heart disease, adds that emotional and spiritual support are also important. Every day, before swallowing the many pills he needs to stay alive, he arranges them in a circle, as a sort of ceremonial ritual.
At a 1998 Project Inform meeting in San Francisco where he learned that “a bunch of us would live a long time,” Cox got his first real inkling that old age would be a possibility for him. Participants were among the first to learn that the latest mixture of drug therapies actually worked, and people with the disease no longer had to die.
“I cried when I heard that, because that was what I had been thinking,” he says simply.
The financial burden of fighting the virus is enormous, especially for survivors who abandoned or switched careers because of their diagnosis. According to the latest research, it costs more than $23,000 per year to keep the average HIV-positive American’s immune system in working order.
This is one reason why the Community AIDS Network’s George is so frustrated when he meets prospective donors who say, “But I thought the disease has been cured.”
It is also the reason behind CAN’s phenomenal growth spurt. The nonprofit education and treatment center, founded in 1991, has gone from 23 to 73 employees in the last 18 months and is expanding its headquarters.
It started, George says, when the organization’s financial officer — who has since retired — discovered a fairly obscure federal program that allows a nonprofit clinic to buy drugs from the manufacturers at cost. This saved CAN from going under, and when the word spread, other Florida clinics with fragile finances asked the Sarasota group to take them over. The result is an HIV support network that now stretches from Miami to Jacksonville.
George recently formed a support group for HIV-positive men, to complement the network’s long-standing group for women. Most of the 20 or so men who attend are over 50, he says, but even those who are openly gay prefer to keep their health status private.
“You can’t have a normal life; you live with this thing in the back of your head, no matter what happens,” he says. “It’s a horrible secret to hide. People will judge you. Stigma is one of the biggest things.”
Cox, who came out as gay in 1970 along with two other men at Montana State University, feels no need for secrecy about his years of experience with HIV.
“I’m different,” he says with a shrug. “I’m gay, so I grew up different.
“But I have been lethal, and I haven’t recovered from that,” he adds reflectively. “Not that I killed anybody with it. But I stopped being a creator and became a killer, in some way, during that era.”
This is an Associated Press member exchange story.
Three out of every 10 gay or bisexual men in several Southern cities have been diagnosed with HIV, three times the national rate, according to a study about how common HIV infections are in metro areas.
The study echoes other research that reported higher rates of HIV diagnoses in the South but it is the first to look at how common HIV diagnoses are in these men by city.
“For the first time, we can see not only the numbers, but the proportions,” said Dr. Jonathan Mermin of the U.S. Centers for Disease Control and Prevention.
The report found 21 of the 25 metro areas with the highest levels of HIV diagnosis in gay and bisexual men were in the South.
HIV was diagnosed in about three in 10 gay and bisexual men in El Paso, Texas; Augusta, Georgia; and Baton Rouge, Louisiana.
In Jackson, Mississippi, the rate was four in 10, the highest in the nation.
According to the report, about 11 percent of gay and bisexual men had been diagnosed living with an HIV infection nationwide during the time covered by the study.
Emory University researchers produced the new numbers using national counts of HIV diagnoses in different communities. Lacking good census counts of sexually active gay and bisexual men, they used data from previous studies to calculate how many men had sex with other men.
In its look at metro areas, the study counts only those who have tested positive for HIV.
Because many HIV cases are not diagnosed, those numbers don’t reflect how common HIV infections really are in each area. It’s also not clear what factors may vary from city to city that might explain differing rates.
Still, while the largest total numbers of gay and bisexual cases are in large cities like New York and Los Angeles, this research gives a better understanding that the chance of encountering partner living with HIV is far greater in some smaller communities, some experts said.
The research was released through an obscure publication, the Journal of Medical Internet Research. CDC officials described the work as important and useful in deciding how to target HIV prevention funds.
On the Web
One of the greatest challenges to ending the epidemic and finding a cure is the lack of significant, substantive conversations happening around HIV/AIDS. Activists have been providing vital feedback to our leaders since the beginning of the epidemic.
A conversation this week with Secretary Hillary Clinton signified that candid dialogue offers the potential to generate new ideas and better inform how we create aggressive policies to treat the nearly 37 million people living with HIV globally and to prevent the 50,000 new infections across the United States every year.
Our elected officials must play a critical role in ending the epidemic and need to be willing to commit to achieving our collective goal of finding a cure. GMHC sent a presidential survey before the Iowa Caucus to all 16 candidates in the race at the time, and it boggles my mind that only three replied.
In 2016, you do not get to run for president of the United States and not be willing to answer questions about how you plan to address one of the worst epidemics of our time. GMHC is challenging the remaining candidates running to sit down with HIV and AIDS activists and engage in the kind of dialogue that we did today.
We all agree that if you are running for president of the United States, you should answer our questions, hear our concerns, and listen to our proposals.
We are very grateful that Hillary kept her word and met with us today. I was especially pleased that she addressed stigma as one of the main drivers of the epidemic in this country and her commitment to addressing this stigma if elected president is the kind of leadership needed to end HIV and AIDS.
The conversation also reflected her in-depth knowledge of policy, as well as the sense of urgency that is critical to finding a cure.
That same sense of urgency will be reflected this Sunday when GMHC hosts the 31st annual AIDS Walk New York in Central Park.
AIDS Walk NY started when our president would not even say the word AIDS.
Today, it remains an annual event that reminds us of how far we have come, and of the reality that we must work together to finally celebrate the end of HIV and AIDS.
Gay Men’s Health Crisis the nation’s leading provider of HIV and AIDS care, prevention services and advocacy, serving nearly 9,000 people living with and affected by HIV and AIDS in New York City, the epidemic’s largest U.S. epicenter. As the world’s first HIV and AIDS service organization, GMHC is an expert in providing services that every person affected by the epidemic deserves.
Last year, 225 new cases of HIV infection were diagnosed in Wisconsin, according to the Wisconsin HIV/AIDS Surveillance Annual Review for 2015.
That number is lower than the average of 247 new cases reported per year in Wisconsin over the past decade. But it’s slightly higher than the 221 cases recorded in 2014, when Wisconsin recorded the ninth lowest HIV-infection rate in the nation.
The 2015 review also showed ongoing disparities in new infections among men who have sex with men and people of color. Men in the state acquired the infection at 7 times the rate of women last year, with 196 new cases reported among males, compared to 29 among females.
Sixty-two percent of the new cases were among racial and ethnic minorities, even though they make up only 17 percent of the state’s population. From 2011 to 2015, the HIV infection rate among black males has been 16 times the rate among white males. Hispanic males have acquired the disease at 6 times the rate of white males during the same period.
Among women, the infection-rate disparity was even higher: African-American females were infected at 25 times the rate of white women, and Hispanic women were infected at 8 times the rate.
The infection rate for men who have sex with other men was the highest of all groups, accounting for 80 percent of all new diagnoses last year. Half of the men who were infected through gay sex were under 30 years old.
“This report demonstrates the importance of continuing to focus on the still-fatal AIDS epidemic, and especially its disproportionate impact on some of the most vulnerable members of our communities, said Michael Gifford, CEO and president of AIDS Resource Center of Wisconsin, in a prepared statement.
“We’ve got the tools to turn the tide,” said Bill Keeton, ARCW vice president of government and public relations. “We’re already seeing it.”
One of ARCW’s most promising tools is its PrEP clinic. PrEP is an acronym for “pre-exposure prophylaxis.” People using PrEP simply take an anti-retroviral pill once daily to protect them from acquiring HIV infection.
The strategy reduces the infection rate among at-risk people who don’t use condoms or don’t know the HIV status of their partners.
If every HIV-negative person in an at-risk community was on PrEP, and every HIV-infected person in an at-risk community was on medications that suppress the amount of virus in their blood to undetectable levels, then the community could become free of the virus.
“It’s going to take a while for people to understand it and get comfortable with it,” Keeton said.
Currently ARCW has about 60 individuals enrolled in PrEP, although there are probably more who are receiving the treatment through private physicians.
On gay online hook-up sites in many cities across the country, men are listing their HIV status either as “on PrEP” or “undetectable.” Still, epidemiologists warn that using condoms and adhering to safer-sexual behavior is the only way to ensure that you will not become infected or infect others.
“With PrEP and unfettered access to health care, (we’re) definitely moving in the right direction,” Keeton said. “The trend is good.”
“We’ll start to see the impact of the PrEP programs in the surveillance report that comes out a year from now,” he predicted.
In the meanwhile, ARCW has its work cut out for it. More than 7,900 people in the state are living with the virus, and the overwhelming burden of HIV disease is among young men and people of color, according to Gifford.
ARCW is working to provide comprehensive wrap-around services, which includes everything from finding a job and a place.
A new app has the potential of broadening the use of a prescription drug that can prevent HIV infection among those at high risk.
But some HIV/AIDS activists are raising concerns because the app allows people to order prescriptions online for pre-exposure prophylaxis, commonly known as PrEP, without direct contact with a doctor.
PrEP can reduce the risk of HIV infection by 90 percent. It’s recommended by the U.S. Centers for Disease Control and Prevention for people at high risk, including sexually active gay men and people with infected sex partners.
Earlier this year, Nurx, a company headquartered in the San Francisco area, announced it would add PrEP to the prescriptions available to users of its innovative app.
The service currently has limited reach, delivering prescribed oral contraceptives to customers in California and New York. On its website, Nurx promotes its services: “If you have health insurance, Nurx is free. If you pay cash, you can get birth control from $15 per month.
“Whether you are currently on the pill or new to birth control, Nurx is for you. We always ship you three months of birth control, for your convenience.”
Most recently, Nurx announced the availability of PrEP “right from the app with our clinical team. No need to go into the doctor’s office, or to the pharmacy.”
Customers would apply online with Nurx and receive a prescription after completing a health survey and undergoing lab tests that show normal kidney function and no HIV infection.
Some public health officials see services like Nurx as a new way to help lower new HIV infection rates, especially in areas that lack HIV/AIDS services or where such services are overburdened.
However, others, such as activists with the California-based AIDS Healthcare Foundation, are concerned.
“While the goal to improve access to effective HIV prevention tools is admirable, removing any or all direct contact with a physician or medical provider is not,” said Michael Weinstein, president of AHF. The organization has taken a position against widespread deployment of PrEP as a communitywide public health strategy. In 2014, Weinstein referred to Truvada, the anti-viral medication used for PrEP as a “party drug.”
AHF does support the use of PrEP on a case-by-case basis that’s decided between a medical provider and patient.
Weinstein said STD rates are skyrocketing, particularly among young people using hookup apps like Grindr and Tinder.
“We challenge the wisdom and ethics of an app that allows people to order a drug to prevent HIV as readily as ordering pizza,” he said. “PrEP is not simply a pill taken in isolation: It is a four-part HIV prevention strategy that can be highly effective, but one that offers no protection against any other STDs. Eliminating primary contact with the physician or medical provider from this equation is really a disservice to the patient.”
PrEP as a prevention strategy includes the use of Gilead Sciences’ medication Truvada to prevent HIV infection in non-infected individuals.
Truvada was first approved for treatment of HIV/AIDS patients in August 2004. The FDA approved use of Truvada as PrEP in July 2012.
Guidelines issued by the FDA for PrEP include:
• An initial baseline negative HIV test.
• Daily adherence to the Truvada medication.
• Ongoing periodic HIV testing to ensure the individual on PrEP remains HIV-negative.
• Continued use of other prevention methods, such as condoms.
In Wisconsin, a key resource for information and access to PrEP is the AIDS Resource Center of Wisconsin, which announced expanded access to health care services across the state on World AIDS Day in December 2015. ARCW is online at arcw.org. — L.N.
Learn more about Nurx.
Wisconsin Gazette’s roundup of community bulletins, nonprofit announcements and other local news.
Wright in Wisconsin: Gov. Scott Walker in March recently signed Assembly Bill 512 to designate and mark a highway route as the Frank Lloyd Wright Trail.
Walker said, “It’s great to be here at Taliesin to see first-hand some of Frank Lloyd Wright’s work in Spring Green. The bill we’re signing into law will help visitors to our state easily identify and find Frank Lloyd Wright landmarks, like the one we’re at today. Wright’s architecture is world-renowned, and these signs will boost tourism even further throughout Wisconsin.”
The route will run through Kenosha, Racine, Milwaukee, Waukesha, Jefferson, Dane, Iowa, Sauk and Richland counties and direct travelers the right way to Wright attractions.
The bill, authored by Rep. Todd Novak, R–Dodgeville, and Sen. Howard Marklein, R-Spring Green, passed the Assembly with a vote of 96-2 and was concurred by the Senate on a voice vote.
Reggae for public rides
A reggae concert at Riverwest Public House on Locust in Milwaukee April 8 will raise money for the Milwaukee Transit Riders Union, an organization of bus riders fighting for better transit in the city. For more, go to transitridersunion.org.
GSAFE is seeking an executive director to begin work in July. For more about opportunities with the nonprofit, which advocates for LGBT youth and on education issues, go to gsafewi.org.
Historic Milwaukee Incorporated also is hiring. The nonprofit dedicated to increasing “awareness of and commitment to Milwaukee’s history, architecture and the preservation of the built environment” is seeking a part-time accountant. For more, go to historicmilwaukee.org.
High costs, higher ed
U.S. Sen. Tammy Baldwin, D-Wis., met with students at the University of Wisconsin-Milwaukee in late March to talk about student loan debt and her reform bill, the In The Red Act. The measure would allow student borrowers to refinance debt at lower rates, increase Pell Grants to keep pace with rising costs and also would make a new investment in community college. For more, go to, baldwin.senate.gov.
Milwaukee County Supervisor Marina Dimitrijevic announced the state approved an $838,000 Knowles-Nelson stewardship grant at South Shore Park to enhance the beach and boat launch and improve water quality. South Shore Park also is receiving a $100,000 grant from the Milwaukee Metropolitan Sewerage District to reconstruct the parking lot, another water quality project.
Sifting the Future educational events are planned on April 20 in Madison and April 21 in Eau Claire. The hills of western Wisconsin supply 75 percent of the country’s frac sand market. Organizers invite people to learn about frac sand mining impacts on Wisconsin’s ecological and agricultural landscapes. The Madison event is at 7 p.m. at UW-Madison’s Union South. The Eau Claire event is at 6 p.m. at The Plaza. For more, go to midwestadvocates.org.
Honored by ARCW
The Aids Resource Center of Wisconsin’s annual Make A Promise Dinner and Gala takes place on April 9 at the Wisconsin Center in Milwaukee. ARCW is honoring state Rep. John Nygren for “his courageous leadership addressing the heroin epidemic, opiate overdose and his long-term commitment to supporting care and treatment for people with HIV.” ARCW also will recognize BMO Harris Bank for its philanthropy and UW Health for its work specializing in providing health care to people living with HIV.
Meanwhile, ARCW also is receiving honors. The Human Rights Campaign, the nation’s largest LGBT civil rights group, recognized the nonprofit as a “Leader in LGBT Healthcare Equality.” For more, go to arcw.org.
The Natural Resources Foundation of Wisconsin is offering 188 expert-led field trips around the state in 2016, a 25 percent increase from 2015. The program offers opportunities for all ages and abilities to explore public lands, waters and wildlife by foot, bike, boat and even train. Since 1994, nearly 40,500 people have joined the foundation on field trips. Trips take place in 46 out of 72 Wisconsin counties. For more, go to wisconservation.org.
Cream City crew
The Cream City Foundation welcomed a new board member, Pat Galgan, and announced its slate of officers for 2016: Paul Milakovich, chair; Angelique Harris, vice chair; Erika Baurecht, vice president; Jose A. Milan, treasurer; Stewart M. Morrisey, assistant treasurer; Bridget Paskey, secretary; Renee Krinberger, chair of the fund development committee; and board members Galgan, Rob Doerfler-Eckstein and Eric M. Peterson. CCF is Southeastern Wisconsin’s LGBT community foundation. For more, go to creamcityfoundation.org.
Send community announcements to Lisa Neff at email@example.com.
Fair Wisconsin PAC today announced its endorsement of Hillary Clinton in next week’s Wisconsin Democratic presidential primary.
In a press statement announcing the endorsement, the group’s political action committee called Clinton “a champion for LGBT equality.”
Fair Wisconsin is the state’s largest organization dedicated to advancing and achieving equality for LGBT Wisconsinites.
The press statement said in part:
“In the U.S. Senate, Clinton championed hate crime legislation, fought for federal non-discrimination legislation to protect LGBT Americans in the workplace, and advocated for an end to restrictions that blocked LGBT Americans from adopting children. As Secretary of State, she advanced LGBT rights abroad and enforced stronger anti-discrimination regulations within the State Department, declaring on the global stage that “gay rights are human rights, and human rights are gay rights.”
Clinton’s LGBT agenda
FW went on to praise Clinton for having “the most comprehensive and far-reaching LGBT policy agenda ever produced by a presidential candidate.” The group detailed her LGBT agenda, which includes:
Fighting for full federal equality for LGBT Americans. Clinton has said that she would work with Congress to pass the Equality Act, continue President Obama’s LGBT equality executive actions, and support efforts to clarify that sex discrimination includes discrimination on the basis of “gender identity.”
Supporting LGBT youth, parents, and elders. Clinton has vowed to pass the Safe Schools Improvement Act and the Student Non-Discrimination Act to combat bullying.
Honoring the military service of LGBT people. Clinton said that as commander-in-chief she would upgrade the service records of LGBT veterans dismissed due to their sexual orientation and support efforts to allow transgender personnel to serve openly.
Securing affordable treatment for people living with HIV and AIDS. Clinton would work with governors to extend Medicaid coverage to people living with HIV, cap out-of pocket expenses for people with HIV/AIDS, and expand the utilization of HIV prevention medications, including pre-exposure prophylaxis (PrEP).
Protecting and advancing transgender rights. Clinton would direct the federal government to improve its reporting of hate crimes and streamline identity documents that impose barriers on transgender Americans seeking official identification documents.
Promoting human rights of LGBT people around the world. Clinton would continue to ensure America’s foreign policy is inclusive of LGBT people around the world. She would increase the U.S. investment in the Global Equality Fund to advance the human rights of LGBT people around the world.
For a full list of Clinton’s endorsements, click here.
Information in this report was provided by Fair Wisconsin.
Wisconsin Justice Rebecca Bradley, writing in her college newspaper 24 years ago, called gay people “queers” and said “homosexual sex … kills.”
“But the homosexuals and drug addicts who do essentially kill themselves and others through their own behavior deservedly receive none of my sympathy” wrote Bradley, who was appointed to the state’s highest court last October by Gov. Scott Walker.
Walker’s appointment to fill a vacancy on the court put Bradley in the position of running this year as an incumbent.
On March 7, Bradley issued a statement that said, “Recently an article I wrote while a college student at Marquette 24 years ago has surfaced on left leaning blogs and now the mainstream press. I was writing as a very young student, upset about the outcome of that presidential election and I am frankly embarrassed at the content and tone of what I wrote those many years ago.
“To those offended by comments I made as a young college student, I apologize, and assure you that those comments are not reflective of my worldview. These comments have nothing to do with who I am as a person or a jurist, and they have nothing to do with the issues facing the voters of this state.”
On April 5, voters in Wisconsin will decide whether to elect Appeals Judge JoAnne Kloppenburg or Bradley to a full 10-year term on the court.
Bradley’s 1992 writings, which appeared in the Marquette Tribune, were circulated on March 7 by One Wisconsin Now, which held a news conference at the Capitol.
“Rebecca Bradley has revealed such a depth of hatred and contempt for people that she cannot be trusted to uphold the most basic tenet of our judicial system, that all are equal before the law,” said One Wisconsin Now executive director Scot Ross. “She denies people their dignity because they are different than her and condemns people that hold political beliefs other than hers.”
One Wisconsin Now provided these excerpts from Bradley’s writings at Marquette:
• “This brings me to my next point — why is a student government on a Catholic campus attempting to bring legitimacy to an abnormal sexual preference?” Rebecca Bradley, Feb. 11, 1992.
• “Either you condone drug use, homosexuality, AIDS-producing sex, adultery and murder and are therefore a bad person or you didn’t know that he supports abortion on demand and socialism, which means you are dumb.” Rebecca Bradley, Nov. 11, 1992.
• “Perhaps AIDS Awareness should seek to educate us with their misdirected compassion for the degenerates who basically commit suicide through their behavior.” Rebecca Bradley, Feb. 11, 1992.
• “Heterosexual sex is very healthy in a loving marital relationship. Homosexual sex, however, kills.” Rebecca Bradley, Feb. 28, 1992.
• “One will be better off contracting AIDS than developing cancer, because those afflicted with the politically-correct disease will be getting all of the funding. How sad that the lives of degenerate drug addicts and queers are valued more than the innocent victims of prevalent diseases.” Rebecca Bradley, Nov. 11, 1992.
• “But the homosexuals and drug addicts who do essentially kill themselves and others through their own behavior deservedly receive none of my sympathy.” Rebecca Bradley, Feb. 28, 1992.
Scott Foval, the regional political coordinator for People for the American Way, called Bradley’s statements “demeaning.”
“As a gay man and long-term survivor living with HIV, Rebecca Bradley’s hateful diatribes against people like me while at Marquette are shocking and deeply disturbing,” Foval said in a statement. “I question how anyone in the LGBTQ community or anyone living with HIV/AIDS feels they could get a fair decision from her. The demeaning statements she authored gravely undermines her ability to continue to serve on the state Supreme Court.”
At the Human Rights Campaign, legal director Sarah Warbelow said, “The writings that have surfaced today would be deeply troubling from anyone, much less a sitting Supreme Court justice. Everyone, regardless of their sexual orientation or gender identity, should be able to expect a fair and impartial decision from the Wisconsin Supreme Court. Unfortunately, this disturbing and hateful language raises serious questions about Justice Bradley’s commitment to full equality under the law for LGBT residents and people living with HIV/AIDS.”
U.S. Sen. Tammy Baldwin also issued a statement: “It is extremely troubling that Gov. Walker would ignore this low-road record of hate speech and appoint Rebecca Bradley to Wisconsin’s highest court.”
Baldwin, who is gay, continued, “These hateful and divisive writings raise serious questions about Rebecca Bradley’s fitness to serve on the Wisconsin Supreme Court as a fair, impartial and independent justice.”
Bradley, 44, has never married. Walker has appointed her to every judicial position she’s held.
In her Supreme Court bid, Bradley is heavily backed by the big right-wing, dark-money groups that also support Walker and the state’s Republican leadership.