Archive for the 6. MY JOURNAL Category

PrEP: PREVENTION & PROFITS

Posted in 6. MY JOURNAL on February 20, 2013 by Richard Berkowitz

Pre-exposure prophylaxis, or PrEP for shorthand, is a new effort to prevent sexually transmitted AIDS by giving HIV medications to those who don’t have the virus but who are considered high risk for getting it.

The first scientific PrEP study, known as iPREX, tested the drug Truvada on gay men. The results were greeted with sensational enthusiasm by several doctors and researchers who said iPREX was a “game changer,” and a “milestone,” that HIV prevention was “forever altered.”

What came next were jubilant claims by some gay men that condoms could now be replaced by a pill that has limited side effects and won’t harm you; in other words, that you can fuck as much as you want without using condoms and still avoid HIV.

However, as time has passed, it seems that the initial enthusiastic reviews of PrEP probably represented the voices of a small minority. As one critic noted, “The volume with which a view is promoted doesn’t necessarily represent the extent to which a view is held. A few people can make a lot of noise that drowns out everyone else.”

After extensive reading and talking to doctors, here’s what I’ve learned:

PrEP should only be an issue for those who can’t or won’t use condoms.  For them the use of PrEP makes very good sense.

We shouldn’t judge those who are unable or unwilling to use condoms. On the contrary, we should understand that there are many different circumstances and reasons that lead some to that point.  We should be supportive in minimizing their risk for acquiring HIV by using PrEP.  It’s a harm reduction measure, like providing clean needles.

But here’s the first problem: Can a drug that has the potential to reap millions of dollars in profits be marketed only to those who can’t or won’t use condoms?  There are already troubling signs that it can’t be.

Unlike the promotion and sale of anti-HIV drugs, safe sex education has no financial returns.  That’s why there must be a role for government and not-for-profits.  Otherwise, it can seem like the only value people at risk for AIDS have, is as consumers of drugs!

The history of AIDS in America has taught us that getting money for properly targeted safe sex education has rarely had the adequate government or other support it deserves. This is absolutely scandalous.  When people say safe sex education doesn’t work, we have to remember that there hasn’t been much of it, and what little there is, has rarely been properly targeted.

We should also be looking critically at where the promotion of PrEP is coming from.

Many doctors and even advocates have financial arrangements with pharmaceutical companies; they have glaring conflicts of interest, which we should at least consider in evaluating what they have to say about PrEP. They may believe in what they’re doing but you can’t avoid the fact that they receive money from the drug companies that stand to profit from their recommendations.

It’s interesting that the promotion of PrEP appears to be greatest in the U.S.  In these economic times when public health education budgets have been slashed, it seems obvious that health departments can put the responsibility for prevention on entities that pay for drugs, like insurers, whether private or government. That makes it easier for budget cuts and safe sex education cuts because paying for prevention falls on the insurers.

We still don’t know how great the demand for PrEP will be, but when figures become available, it’s likely that most men will keep their trust in condoms — the only prevention intervention that has an established track record.  To reiterate, condoms are the only thing that we know, from many years of experience, work.

This is not the time to further weaken safe sex education. The promotion of PrEP means we have to further strengthen it. Unless the promotion of PrEP goes hand in hand with prevention education, it threatens to undermine support for continued condom use even further.  The term being bandied about now – particularly by activists — is “combination prevention,” but I’m having a hard time figuring out what that means. They say we have to reduce the confusion over the term “combination prevention,” but their attempts to clarify it left me just as confused.  Do they mean you have to use a condom and PrEP?  Well, no they don’t seem to be saying that, so what do they mean?  I still can’t tell.

We have many years of experience to be confident that condoms can work, and maybe in time we’ll be able to say the same about PrEP — but not yet. What’s at stake is your life.

AIDS history has taught us that we should always be wary of enthusiastic recommendations that don’t yet have a track record to back it up.  The early use of high-dose AZT is one example.

As we said in How to Have Sex in an Epidemic, safe sex is about more than preventing AIDS.  The promotion of PrEP seems to conveniently overlook or downplay all the other sexually transmitted disease risks, (gonorrhoea, herpes, primary syphilis, nonspecific urethritis, Chlamydia, CMV, etc.) many of which can be prevented with condoms.  This is especially true for the highly sexually active who may be more likely to use PrEP.

While some argue that condoms are a barrier to intimacy, others actually find that they enable intimacy by freeing people from the risk of a life-changing infection.  By removing the threat of transmitting HIV, condoms can actually enhance intimacy.

It’s a tragedy that HIV still infects 41,000 new people a year, but with 300 million Americans, it seems that lots of people are also doing something right.

Safe sex isn’t always easy.  We need to encourage and support each other to keep on doing it.

 

February 20, 2013

I want to thank Mark Adnum of Nightcharm.com for instigating and inspiring me to write about PrEP during our recent interview.

The Man Who Put the First Gay Dick on TV

Posted in 6. MY JOURNAL on February 6, 2013 by Richard Berkowitz

Background notes for the How to Have Sex in an Epidemic video interview clips that follow this post.

In April 1983, as Michael Callen and I were nearing the completion of How to Have Sex in an Epidemic, I got an idea while watching Men and Films, Lou Maletta’s pornographic, all-male, public access cable TV show.  At the time, many sexually active gay men I knew still didn’t want to hear about AIDS, so I was thrilled when Maletta started talking about it on his X-rated show.  I thought, “Why not call him to see if Michael and I could promote our booklet on his program?”  Prime time TV wasn’t ready for safe sex, but Men and Films sure was.

Men and Films began as a gritty, weekly review of the newest releases in hardcore gay male pornography; it featured graphic video clips accompanied by Maletta’s tawdry, sex-soaked, voice-over commentary.

Raised in working class Brooklyn and clearly untouched by higher education, there was something unabashedly “dirty-old-man-ish” about Maletta’s talking style, a lurid tone and twang you might hear at a 1970s sex club, but startling when it was blaring from the TV in your living room — just a click away on your remote control from CNN or Pat Robertson.  In fact, in a 1995 Calvin Klein TV commercial featuring half-naked, post-pubescent teens, Maletta’s X-rated drawl was featured in the ad’s voice-over – a juxtaposition so jarring it led to accusations of “kiddie porn” and enough public outrage to get the ads pulled from the airwaves — mostly because of the way Lou sounded. The ensuing media firestorm, which was better advertising than any TV ad could hope for, was even covered by the G-rated Entertainment Weekly.

Although Maletta later expanded his programming to LGBT news and profiles of underground artists, when Men and Films began, it was interviews with porn stars.  Lou could always be heard off camera, flinging salacious questions or pressuring his guests to pull down their pants and show what they were known for: a bubble butt, a big dick, etc.  It was scandalous TV even for Manhattan cable public access, and many NYC activists were appalled that right when AIDS began, Maletta’s garish, weekly porn revue took off and bloomed at the same time.

MALETTA HX JAN97 1 Crop

Lou was a great self-promoter: He generated juicy, first Amendment press coverage in the Village Voice and other media when some of his segments ran into censorship problems over video clips that included “penetration.”  Lou was being forced by the station to cover the offending shots with a digital black dot, but in his effort to salvage every square inch of naked skin that he could, he made the dot so small that whenever the actors’ fucking moved left or right, the dot had to move and follow along too. It didn’t take long to realize that Lou needed target practice. In clips where the actors were getting close to orgasm and their movements quickened, it got so dizzying to follow the dot back and forth, that some of the penetration could be glimpsed for a second, but by that point I was laughing hysterically with friends who called to make sure I was watching this First amendment insanity.

Whenever Lou had to air a censored segment, he ended it with the station’s phone number along with text urging viewers to call in to protest.  Was he serious?  Call a station manager to complain about not being able to see the entire dick going in and out on the 11pm broadcast?  Many gay men were so uncomfortable with Lou’s depiction of sex that they were more likely to call and ask that the show be taken off the air, in part, because it could be viewed by anyone in Manhattan who had cable TV – even by kids whose parents had yet to figure out the new adult content controls.  Men and Films was so accessible, it inspired a pop-cult satire on the TV show, In Living Color — a series of offensive but hilarious skits called Men on Film.

To conservative, assimilationist gay activists out to prove to America that all gays were just like them, Maletta was a nightmare; but since the new breed of AIDS activists felt the same way about Callen, me and  We Know Who We Are,  I called Maletta with a mounting sense of empathy.

To my surprise, Lou and his apartment-based studio were across the street from where I live.  He agreed to do a segment on “How to Have Sex in an Epidemic,” with one condition:  First, I had to get him an interview with Dr. Joseph Sonnabend who was showing up on the local news: The building co-op board where Joe had his medical practice refused to renew his lease because he was treating people with AIDS.  It became a landmark court case that established the nation’s first anti-discrimination protections for PWA’s, and Lou’s coverage was among the best. (That clip is coming soon.)

It was a cloudy day when Michael Callen and I went to Lou’s 5th floor tenement apartment to be interviewed.  There were S/M accoutrements scattered about, huge shelves of boxed porn tapes and lots of video editing equipment.  After gazing around the apartment and meeting the S/M loving Lou, the S/M loathing Michael wanted to leave. I convinced him to stay, but he managed to extract a moment of humorous revenge:  During the first question in part 2 of the interview, as Lou fires off a list of kinky sexual activities, Mike makes a comical hand gesture toward me, as if to say, that’s Richard’s area of expertise.

Lou and I bonded that day. I began producing weekly reports on safe sex issues and co-anchored a weekly LGBT news segment as the half hour Men and Films expanded into the hour-long Gay Cable Network, which segregated the porn into a separate show, away from the political and cultural news.  By 1991, when Lou retired, he had created the most extensive video archive of LGBT life in the 1980s.  It was purchased by New York University’s Fales Library for preservation before he died.

The two-part interview with me and Callen are in the next two posts.

Part 2: Michael Callen & Richard Berkowitz being interviewed about their booklet, HOW TO HAVE SEX IN AN EPIDEMIC, in May 1983.

Posted in 6. MY JOURNAL with tags , , , , , on January 30, 2013 by Richard Berkowitz

PART 1: Richard Berkowitz & Michael Callen being interviewed about their booklet, HOW TO HAVE SEX IN AN EPIDEMIC, in May 1983.

Posted in 6. MY JOURNAL on January 30, 2013 by Richard Berkowitz

Best CALLEN RB @ Typewriter