Freedom under Attack! Bain, freedoms and a complicated way to dialogue

Courtesy of Belizean LGBT Rights

For the first time ever, Belize and Jamaica has almost simultaneous protest regarding professor Bain termination. The debate pitted the issue of religious-base bigotry which has a moral stamp of approval against a collective who is concern about the intersecting issues of rights enforcement and protection as part of an overall health policy concern. Historically, CARICOM member states, have not constructively and responsibly addressed the rights concerns of its L.G.B.T citizens in any substantive way. The Bain case, offers the region an opportunity to teach us all about the limits of free expression and thought and the obligations of individuals in a fiduciary relationships that involves vulnerable groups.

The broader concern for the region, is does religious-base bigotry gets a moral stamp of approval to undermine the rights of L.G.B.T citizens in the region and what happens in the struggle for rights acknowledgment which are already in many states constitutions. The recent debate about Professor Bain termination was argued as an issue of Freedom of Speech in both Belize and Jamaica. Bain, as a result, filed for an injunction on Wednesday to hold on to his job at CHART that he has held since 2001. The article says he is suing on 15 grounds and that Bain is arguing that said disagreement and subsequent termination conflicted with his right to freedom of expression, thought and conscience. He was granted his request for an injunction to prevent his dismissal from Chart on Friday this until his case is heard.

If he is really suing on the basis of "his constitutional rights of freedom of expression and thought," the case has more to do with legal limits on employee behavior than it does on contractual provisions. Interestingly, as I am researching this matter, it does not appear citizens of Commonwealth nations have a protection for "freedom of speech" as contained in the US constitution. Instead, they have laws that protect "freedom of expression and opinion," which may be lawfully restricted to respect the rights and reputation of other persons, national security, public order, public health or public morality. Basically, the distinction limits the actions of people breaching the expression of others to obscenity, defamation and discrimination.

The filing base on "his constitutional rights of freedom of expression and thought," will be interesting as the case moves through the court. In the US, there have been a whole slew of decisions (Garcetti v. Ceballos, Connick v. Myers, Pickering v. Board of Education, Waters v. Churchill, Schumann v. Dianon, Perez-Dickson v. City of Bridgeport, etc.) which uphold that neither employees in the public or private workplace are entitled to First Amendment protection if their speech: is “extraordinarily disruptive” to the workplace or work being done, interfered with the employees job performance, placed strain on his relationships with co-workers, created division within the company, or is insubordinate.

In on case precedent, out of Canada which is extremely interesting and pertinent. "Saskatchewan Human Rights Commission v. Whatcott - The decision rests on a compelling premise: that published statements treating members of vulnerable minority groups as somehow less worthy of dignity or respect – as less human – than the rest of society don’t warrant the same degree of Charter protection as other exercises of expressive freedom." (Please read case link for conclusion)

In another case, Burns v. Dye out of New South Wales is also interesting. Basically a man filed a complaint under the anti-vilification laws (the Australian equivalent to Hate Crimes discrimination laws). The ruling is interesting because it states that just because a homosexual might find the words used offensive, they are not necessarily covered by the law. (I would argue that the absence of such legislation in the Caribbean would equate to the situation where language was not covered by law.) HOWEVER, the court ruled in favor of the complainant because of the public nature of the verbal abuse.

Eweida and Others v. the United Kingdom was a decision that was appealed to the European Court of Human Rights. It ultimately is applicable under 2 provisions. One of the litigants Ms Ladele was employed by the London Borough of Islington, which had a“Dignity for All” equality and diversity policy, from 1992. When in 2004 the Civil Unions law was passed, Ladele, a Christian, refused to conduct civil partnership ceremonies. The court ruled that her view of marriage was not the same as her right to practice her religion and stated that "Islington was not merely entitled, but obliged, to require her to perform civil partnerships" as part of her employment agreement. Another litigant, Mr McFarlane, was a practicing Christian who worked for Relate, a national private, confidential sex therapy and relationship counselling service, as a counsellor from May 2003 until March 2008. He initially had some concerns about providing counselling services to same-sex couples, but following discussions with his supervisor, he accepted that simply counselling a homosexual couple did not involve endorsement of such a relationship and he was therefore prepared to continue. He subsequently provided counselling services to two lesbian couples, which did not consist of sexual therapy, without any problem. However, in 2007 he refused to offer psycho-sexual therapy, on religious grounds, to gay, lesbian and bi-sexual clients. Throughout 2008 employer and employee met many times to resolve the issue. In 2008, McFarlane was dismissed for stating that he would comply with company policy when he had no intention of doing so. McFarlane appealed to the the Employment Tribunal, and the Employment Appeal Tribunal, losing both times as they found he not suffered direct discrimination on the basis of conscience. He had not been dismissed because of his faith, but because it was believed that he would not comply with company policies. With regard to McFarlane's claim of indirect discrimination, the Tribunal found that Relate’s requirement that its counsellors comply with its Equal Opportunities Policy did put McFarlane’s religious beliefs at a disadvantage; however, those were legitimized by the aim to provide of a full range of counselling services to all sections of the community, regardless of sexual orientation. The European Court of Human Rights concurred that the decisions limiting religious freedoms were acceptable for the greater good. This case seem to Mirror the issues around Bain and will be interesting to see how the conservative Jamaica court responds in its final decision.

The case of Bain is going to be interesting in its discourse, as there is an issued about intersection of rights which the Court will be ask to define. What has happened in this bi-national case, is an ensuing discourse about the limits of free speech and its impact on vulnerable groups; the limits of employer/employee relations regarding persons in substantial leadership in carrying out the mission of his employer.

Professor Rose-Marie Belle Antoine wrote on the termination of Professor Bain contextualising the issue best: "At the core, it is about a program leader publicly undermining the very program and principles he was mandated to support. By his words and action, he voluntarily aligned himself with and gave endorsement to, a diametrically opposed, unacceptable message on an issue of grave import for the UWI.

The essence of the harm, therefore, more so than the content of the words that Professor Bain spoke, is the fact that an authoritative leader of the UWI, spoke with one voice with a litigant partywhose purpose and objectives are in direct conflict with the policies of CHART and the UWI. This litigant clearly advocates the retention of a discriminatory regime that excludes persons from enjoying rights of equality on the basis of their sexual orientation. Consequently, the testimony instantly became associated with the UWI in deeply negative and enduring ways, placing deep question marks on the UWI’s integrity and on its public commitment, not only to progressive notions of public health and HIV programming, but more fundamentally, to non-discrimination, equal opportunity, justice and human rights.

It is a fact that the elimination of discrimination on the ground of sexual orientation is a key ingredient of the UWI’s HIV programming which Professor Bain had the honour to lead for many years and about which he testified. Anti-discrimination training is a vital part of CHART’s own program, as conceded in the expert testimony. Significantly, too, the mandate of PEPFAR and the Global Fund for Aids, which funds CHART, is “to develop programs aimed at reducing HIV related stigma.”The mission of UWI’s HIV programming, HARP, as well as CHART, from the very beginning, has co-existed with a human rights agenda, a central plank of which is the need to abolish discriminatory laws on sexual orientation. This is incontestable and no one associated with itcan ever claim to have been unaware of this. I can speak authoritatively to this as one who has been intimately involved with the work of the program from its inception. Further, as an HIV & Law consultant who has been actively engaged for over 20 years in policy development across the region, for governments, international organisations and NGO’s, including on important issues of human rights and justice, I understand why this must be so.

Professor Bain’s longstanding and excellent work on HIV and public health, is without question. Ironically, it is precisely because of his high profile that his remarks and chosen association are so damaging to UWI’s reputation and credibility. The retention of Professor Bain in such circumstances threatened to destroy much of the hard-fought gains and trust that UWI has won in the fight against the scourge of HIV and discrimination in general and seriously undermined its own institutional interests. In this context, such testimony cannot be viewed as a mere personal viewpoint, isolated and insulated from CHART and the UWI’s policy position.Indeed, typically, the very reason authorities like Professor Bain are called upon to speak is because of their professional capacity which is inextricably linked with the institution, the UWI. Thus, Professor Bain cannot separate his personal views from these comments that have come to represent the institution that is the UWI, which is why they are viewed as harmful and irresponsible.

While intellectual freedom is to be protected and encouraged, the UWI has a duty to ensure that on issues where it holds itself up as perpetuating a particular policy for the benefit of the community, the persons who are chosen to take the lead on the matter, are demonstrably in accord with that policy. I cannot think, for example, that UWI could ever appoint an academic known to be a racist, or supporting racist ideology, to head Departments devoted to Race Studies or even History Departments, or a person demonstrating that he or she believes or asserts that women are unequal and their place is in the home, to head the Gender Department! There have been several ‘scientific’ studies that claim that blacks are lazy and intellectually inferior, or women the ‘weaker sex’. Does this mean that in the name of academic freedom, the UWI should compromise its core principles of equality and allow its very integrity to be highjacked? I think not.

Professor Bain, as Head of CHART, was in a fiduciary relationship, where one is placed in a position of great trust, which in turn, induces greater responsibility and duties of care. Professor Bain, and by extension, the UWI, with this testimony, violated these fiduciary duties owed to persons living with HIV, the LGBTI community and to the many who look to it for protection and guiding principle.The bottom line is this: Having given this testimony, it would be impossible for this community, the very constituency that he is supposed to serve, ever to trust Professor Bain again. Thus, the UWI had no choice, after careful review, but to change the leadership of CHART. "

The interesting thing is all this, is what will the Jamaican court decide? We will have to wait, as the drama unfolds. What we do know is that CARICOM member states have failed to uphold the fundamental rights and freedoms of their L.G.B.T citizens in any substantive way. What Bain case may do, is amplify the concerns and needs of L.G..B.T citizens in the region and finally visibilised the fundamentalists movement in the region as well as among CARICOM member state once and for all. Only time will tell.

Source:
Take a Principled Stance http://www.guardian.co.tt/lifestyle/2014-06-04/taking-principle-stand-hiv

R v Keegstra case: http://scc-csc.lexum.com/scc-csc/scc-csc/en/695/1/document.do

Saskatchwan Human Rights Commission v Whatcott: http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web...

Burns v.Dye New South Wales: http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web...

Bain takes UWI to Court
http://rjrnewsonline.com/local/bain-goes-to-court

Bain gets injunction to prevent dismissal
http://jamaica-gleaner.com/latest/article.php?id=53531

Eweida and Others v. the United Kingdom
http://hudoc.echr.coe.int/sites/fra/pages/search.aspx...

ENDS

Meanwhile in Jamaica a new anti gay group AGAIN! has been formed with some wanna-be superstars pastors from unimportant churches called Jamaica CAUSE as they are not members of the Jamaica Council of Churches or other groups and claiming to be fighting homosexuality and gay marriage with a rally at Half Way Tree slated for June 29, 2014

Easier access to public health care for HIV-infected gay men (Observer)

Ingrid Brown

HIV-infected men who have sex with men (MSMs) now experience little or no barrier in accessing services at the island's public health facilities despite Jamaica's stringent buggery laws which criminalises the practice.

This has been made possible by the Ministry of Health which recently facilitated the Jamaica Forum of Lesbians, All-Sexuals and Gays (J-FLAG) training of some 60 health-care professionals, to sensitise them on dealing with this population.

Minister of Health Dr Fenton Ferguson told the Jamaica Observer that J-FLAG has undertaken the training of a number of health professionals across the island to sensitise them on the need to better treat with this vulnerable population.

Ferguson expressed delight that J-FLAG was able to satisfactorily complete the training programme with the health-care professionals.

"That will be very helpful, as a major concern for Jamaica is the MSMs which is now consistently showing a HIV prevalence rate of 32 per cent," Ferguson said, adding that he will be reinforcing this point when he speaks at the upcoming graduation exercise for those who benefited from the training.

Meanwhile, J-FLAG said Jamaica AIDS Support (JAS) has always operated a fully functional clinic to treat its clients, including MSMs, who shy away from the island's clinics and hospitals.

According to Brian Paul, sub-regional co-ordinator of the Caribbean Forum of the Liberation and Acceptance of Genders and Sexualities (CariFLAGS) and advocate for J-FLAG over the last decade, agencies like JAS were empowered to do work with MSMs and transsexuals because the government's health system was not very embracing of diversity

given that there was a lot of hostility against lesbian, gay, bisexual, and transgender (LGBT) people.

"When you get to the gate security guards would turn you away and nurses and other administrative staff within the compound would have been hostile, and so a lot of LGBT people relied on NGOs like JAS to provide that clinical care," he told the Observer. "However, over the years with greater exposure and education, the health-care providers at all levels are now more knowledgeable on sexual diversity and because of that they are now more sensitive to the needs of the population, so we are seeing a lot

more LGBT people accessing health-care in the public sector," Paul said.

He noted that this has been the result of years of advocacy work.

"The national HIV programme has also done a lot to empower its staff and to train persons to be better equipped to deal with the population," he said.

He noted, however, that while the majority of health care providers at all levels are sensitive to the issues of diversity, there are some

who are still interacting with their own personal prejudices and stigma.

"So they may know very well that their jobs depend upon them being tolerant and embracing of diversity, but their own personal stigma and prejudices are still present. But with the advent of the HIV-redress system and with empowerment of NGOs, less and less are we hearing of reports of real discrimination," he said.

Paul said J-FLAG's recent training session with public health-care professionals included persons from deep rural Jamaica as well as the urban centres.

The training, he said, was necessary because some persons were still not sure how to deal with LGBT people.

"Those from the furthest rural parish said they had no idea about these issues and on the rare occasion if they had to deal with a gay or

lesbian client, they were figuring it out as they went along," he said.

Meanwhile, Dr Ferguson told the Observer that he recently had a major consultation with Pan Caribbean Partners Against HIV/AIDS (PANCAP) as well as a Global Fund official and a number of other high-level stakeholders to address the issues faced by the MSM population.

"It was a two-day consultation on justice for all which is focusing on those most-at-risk such as MSMs and sex workers," he said.

Dr Ferguson said Jamaica was able to secure US$19 million from Global Fund for its HIV programme.

Jamaica was initially expecting to receive $5 million for the transitional period 2013-2015, but as the alternate member on the Global Fund Board for Latin America and the Caribbean, Fenton said he engaged the international community about the need for upper-middle income countries to continue to receive support.

"We cannot afford to lose the gain of the last decade with HIV and so we are now in a position where we will be getting US$19 million from The Global Fund which I believe coming from US$5 million is significant," he said.

13,328 Jamaican MSM Reached by HIV Prevention says report on National HIV Program ........ but

A statement has come to hand in recent days that the new round of Global Fund money is now available for the national program to the tune of $506 million and as of March 2014 some 13,000 plus men who have sex with men (while excluding specific programs for same gender loving women) have occurred but what does this outreach means, only condom distribution and testing? when we know especially the least amongst us in the form of homeless LGBT youth in particular (bearing in mind Maslow's theory) how can they make safer sex decisions given the sensitivities involved?

Why for example was the HFLE manual placed as an achievement when the fiasco that played out in the public domain proved that sanitization of sexuality issues is the main reason why we have the homo-negative culture fuelling the problems of displacements?

see more on the HFLE matter:

URGENT NEED TO DISCUSS SEX & SEXUALITY NATIONALLY PART 2

Urgent need for sex & sexuality to be discussed nationally

Children’s Advocacy & LGBT Agencies inconsistent approach to Homeless MSM Youth

Missed Opportunities in HIV-AIDS outreach on the social scenes from 2010 for additional scope 

Here is the statement on the latest round of funding:

As it continues to strengthen the multi-sectoral response to HIV/AIDS infection rates in Jamaica, the Government has budgeted $506 million for the Transitional Funding Mechanism programme.

As contained in the 2014/15 Estimates of Expenditure currently before the House of Representatives, existing gains consolidated, and activities scaled up to reduce transmission of new HIV infections, while mitigating the impact.

The project, which is being jointly financed by the Government of Jamaica and the Global Fund is being spearheaded by the Ministry of Health.

Targets for this fiscal year include: increasing the number of schools targeted from 43 per cent to 74 per cent, with at least one teacher trained in life-skills based Health and Family Life Education, and who has taught in the last year; and reaching 490,000 students through life skills based Health and Family Life Education Interventions in School.

Additionally 3,870 commercial sex workers (CSW); 3,030 Men Having Sex With Men (MSM); and 975 inmates will be reached through prevention activities. Meanwhile, HIV counselling and testing will be carried out for 270,000 persons; and 12,833 adolescents (in the 10 to 14 age group) and 47,800 youth (in 15 to 24 age group) will be reached through prevention interventions in out-of-school setting.

Anti-retroviral combination therapy according to national guidelines, will be provided, and 63,265 CD4 tests done according to national guidelines for 8,182 men, women and children with advanced HIV.

The programme will also provide Polymerase Chain Reaction (PCR) testing according to national guidelines to 2,497 infants born to HIV positive mothers; increase from 60 per cent to 75 per cent Persons Living with HIV/AIDS (PLWHA) on Antiretroviral drug (ARV) reporting at least 90 per cent adherence by pill count; increase from 25 per cent to 60 per cent reported cases of discrimination receiving redress by setting; as well as increase from 162 to 176 the number of institutions adopting policies to address HIV/AIDS.

Some of the achievements up to March 2014 include: increasing the number of schools from five per cent to 43 per cent with at least one teacher trained in life-skills based (Health and Family Life Education) HFLE and who taught in the last year; reaching 289,626 students through life skills based Health and Family Life Education Interventions in School; reaching through prevention activities 20,998 CSW, 13,328 MSM, 1,866 Inmates, 90,000 Sexually Transmitted Infection clinic attendees.

Also 24,241 adolescents (10 to 14 years old) and 75,973 youth (15 to 24 years old) were reached through prevention interventions in out-of-school settings; counselling and testing provided for 200,000 persons; 7,684 men women and children with advanced HIV received antiretroviral combination therapy according to national guidelines; 27 per cent reported cases of discrimination received redress; 162 institutions adopted policies to address HIV/AIDS; and the number of individuals in stakeholder organisations trained in strategic information, were maintained.

ENDS

Owing to the fact that there are no residential responses to homelessness in particular (remembering the Safe House Pilot 2009) that can greatly help with self efficacious work and better results but simply distributing condoms which is overall what the national systems in indeed none state actors such as Jamaica AIDS Support do with very little psycho-social, psycho-sexual work (outside of AIDS 101 workshops) and if the work is so penetrative why do we still have a high rate of infection based on the last survey suggested a rate of over 33% in the MSM cohort.

It seems rather odd to me that since the 1980s we have had hard evidence of the infection and psychological issues with some four major studies in the MSM populations and yet all that has ended as a response is condom distribution and testing, there must be more in terms of personal developmental work and not just meeting targets of testing us a guinea pigs. What is even more egregious about all this is that some of the agencies who do HIV work with MSM are either owned or managed by or linked to anti gay groups albeit that in order to qualify for funding they have to take on such populations though discomforting it is and so they do not put out any extra effort to see the needed changes and life improvements for LGBT people; then to add insult to injuries the LGBT groups or allied agencies too are just doing only enough to provide some sort of track record but no major or extra effort.

See: YOUNG MSM/TRANSGENDER WANT TO BE TREATED AS CITIZENS NOT POTENTIAL HIV/AIDS VICTIMS from March 2014

HIV and MSM community: Should we care? — Pt 2

Layered Stigma among Health Facility and Social Services Staff toward Most-at-Risk Populations in Jamaica

Big AIDS fight boost - Ja gets US$3.8 million from US$7-b fund

Concerns for HIV prevalence rate in MSM in Jamaica & connected matters

2007 MSM Study Reminder 

New HIV infections rising in region, Unprotected straight, anal and bisexual intercourse blamed 2011

Review condom policy for prisoners

Continued oversight of same gender loving women in HIV response

Peace and tolerance

H

Human Rights of Most Marginalised Must Be Protected – Portia Simpson Miller at "Justice for All" conference 2014

also see: Promised (I mean suggested) Conscience vote on Buggery law not a priority right now (yet again)

Prime Minister, the Most Hon. Portia Simpson Miller, says special provisions must be made, where necessary, to protect the welfare of persons who are among the most marginalised and disadvantaged.

She underscored this point in a speech delivered by Justice Minister, Senator the Hon. Mark Golding, during Wednesday’s (April 9) opening ceremony for the three-day Caribbean Consultation on Justice for All and Human Rights Agenda, at the Jamaica Pegasus Hotel, New Kingston.

Mrs. Simpson Miller said Jamaica, like most other Caribbean countries, has signed several international agreements, designed to guarantee the human rights of individuals who “have been treated with disrespect and have to continuously confront discrimination.”

These, she pointed out, include: the United Nations (UN) Declaration on Human Rights; the International Covenant on Civil and Political Rights; and the Inter-American Convention of Human Rights.

The Prime Minister said the Government of Jamaica will also shortly be introducing the Disabilities Bill to Parliament, which will “protect the rights and interests of persons with disabilities, for the first time, in our law”, as also legislation addressing sexual harassment.

Mrs. Simpson Miller contended that integrity and impartiality are “essential features” for sustaining human rights, pointing out that “like all West Indian Constitutions, ours, here in Jamaica, guarantees basic human rights of all citizens.” In this regard, she added, “the state cannot justifiably favour the rights of one part of its citizenry over any other.”

The Prime Minister noted that progress and change, though slow, has been made across the region in relation to countries’ efforts to safeguard human rights.

She, however, suggested the need to develop and advance a public education agenda for promoting the rights of everyone, and assured that Jamaica is committed to justice and equality.

Mrs. Simpson Miller said the consultation is both timely and vital in helping to pave the way for developing a formula that provides the basis for achieving a level of zero discrimination.

“The Justice for All process provides opportunities for rich dialogue of various stakeholders. These include: parliamentarians, faith-based leaders, representatives of the private sector, the youth, and civil society organizations. Through this process, we hope to identify meaningful options on which there is sufficient consensus for our governments to take action,” she added.

The forum is being staged from April 9 to 11 by PANCAP in collaboration with the Government of Jamaica; the University of the West Indies (UWI); and the Global Fund to fight AIDS, Tuberculosis, and Malaria (GFATM), under the theme: ‘Advancing Justice for All and the Human Rights Agenda’.

Over 90 participants from Jamaica and overseas are discussing and deliberating issues pertaining to advancing the human rights agenda, in the Caribbean. Key among these are issues deemed restrictive to the successful implementation of the Caribbean’s response to HIV and AIDS.

The Justice for All Programme, coordinated by PANCAP, is an advocacy platform aimed at increasing awareness around HIV-related stigma and discrimination and their impact on access to prevention or treatment services.

The programme is being coordinated under the patronage of St. Kitts and Nevis Prime Minister, the Rt. Hon. Dr. Denzil Douglas, and United Nations Secretary-General Envoy for HIV and AIDS in the Caribbean, Professor Edward Greene.

The consultations ultimately aim to develop a PANCAP Roadmap for the reduction of HIV-related stigma, eliminate discrimination, and increase national HIV responses by creating a facilitative environment and removing discriminatory laws and practices.

Gay Men Divided Over Use of HIV Prevention Drug Truvada in the US

By DAVID CRARY AP National Writer

It's the Truvada conundrum: A drug hailed as a lifesaver for many people infected by HIV is at the heart of a rancorous debate among gay men, AIDS activists and health professionals over its potential for protecting uninfected men who engage in gay sex without using condoms.

Many doctors and activists see immense promise for such preventive use of Truvada, and are campaigning hard to raise awareness of it as a crucial step toward reducing new HIV infections, which now total about 50,000 a year in the U.S. Recent efforts range from think-tank forums and informational websites to a festive event at a New York City bar featuring popular drag queens.

Yet others — despite mounting evidence of Truvada's effectiveness — say such efforts are reckless, tempting some condom users to abandon that layer of protection and exposing them to an array of other sexually transmitted infections aside from HIV.

"If something comes along that's better than condoms, I'm all for it, but Truvada is not that," said Michael Weinstein, president of the AIDS Healthcare Foundation. "Let's be honest: It's a party drug."

Even as gay-rights organizations celebrate collective progress in the fight to legalize same-sex marriage, the less-publicized Truvada debate has fueled bitter divisions within the gay community. Some who use the drug say they've felt shamed by some who don't, and there's now a lively backlash by users and their allies, including promotion of a "Truvada Whore" T-shirt.

"The discussion can torch emotions like a flame-thrower on a fuel depot," wrote Steve Ramos of the Dallas Voice as the gay-oriented publication reported on the debate in March.

Truvada, produced by California-based Gilead Sciences, has been around for a decade, serving as one of the key drugs used in combination with others as the basic treatment for people who have the AIDS-causing virus HIV. However, the drug took on a more contentious aspect in 2012 when the Food and Drug Administration approved it for pre-exposure prophylaxis, or PrEP — in other words, for use to prevent people from getting sexually transmitted HIV in the first place.

Since then, critics have warned that many gay men won't heed Truvada's once-a-day regimen and complained of its high cost — roughly $13,000 a year. Truvada's proponents say most insurance plans — including Medicaid programs — now cover prescriptions for it, and they cite studies showing that the blue pill, if taken diligently, can reduce the risk of getting HIV by more than 90 percent.

Dr. Demetre Daskalakis, medical director of the ambulatory HIV program at New York's Mount Sinai Hospital, served on the FDA panel that recommended approving Truvada for preventive purposes and is among many doctors who hope that doubts about it fade.

"For folks who are having a significant amount of unprotected sex, it's a slam dunk — not only giving them protective medicine, but engaging them in testing, a whole package of regular health care," he said.

Yet Daskalakis says that out of his large clientele, only about 25 men are taking Truvada for prevention.

"There's some interesting social pushback," he said. "I've spoken to some of my patients who'd totally be candidates but are hesitant to do it. They don't want to be labeled as people on the drug because there's a social stigma."

Daskalakis is dismayed by groups like the Los Angeles-based AIDS Healthcare Foundation — one of the country's leading HIV/AIDS service providers — which suggest that prescribing Truvada for prevention means condoning condomless sex.

"I find some of that opposition irresponsible," Daskalakis said. "If some men don't want to use condoms, they won't. You have to deal with it by acknowledging that sometimes unprotected sex happens, and you can still prevent HIV infections."

To date, preventive use of Truvada appears to be limited, due partly to misgivings among some gay men and partly to lack of awareness.

According to Gilead, 1,774 people starting using Truvada for prevention between January 2011 and March 2013 — nearly half of them women. The company said more recent figures aren't available, but health officials in several cities said they see no signs of a major surge in usage.

"Out of our thousands of patients, we have about 20 on PrEP," said Dr. Robert Winn, medical director at Philadelphia's Mazzoni Center, which serves many gay clients.

"Many ask about it, few take it," Winn said. "The number one reason for that gap is the commitment of having to take it every day."

Weinstein, the AIDS Healthcare Foundation leader, takes heart from the low usage figures, saying they bear out his reservations about Truvada. He says he's undeterred by criticism of his insistence that condomless sex — even in the Truvada era — should be discouraged among gay men with multiple partners.

"There's an element in the gay community that espouses 'anything goes,' that is for sexual freedom and not giving an inch," he said. "But demonizing me or AHF isn't going to shut us up."

Another Truvada skeptic is Richard Weinmeyer, a research associate with the American Medical Association's Ethics Group. In an article in February in Bioethics Forum, Weinmeyer — expressing his personal views — argued that preventive use of Truvada could encourage sexual irresponsibility.

"Personal responsibility for one's actions has simply been thrown out the window in a community in which we are too often concerned about stigma and moral judgment," he wrote. "We dare not speak against the reckless behavior of others because we wring our hands over the omnipresent worry that we will shame one another."

The article drew some harsh online criticism; readers called it "puritanical" and "fear-mongering." But Weinmeyer raised a topic that's a visceral part of the debate — the concept of gay-on-gay "shaming" in which men using Truvada as PrEP are stigmatized.

New York psychotherapist Damon Jacobs, an enthusiastic Truvada user since 2011, has encountered the shaming syndrome as he encourages more gay men to learn about the drug's preventive capabilities. Since co-founding an informational web site called PrEP-o-licious.org, Jacobs says he's heard from men distressed by reactions they faced after broaching the possibility of taking Truvada.

"They'd email me about the names they were called — the 'Truvada whore' syndrome," Jacobs said. "They'd talk with their friends about responsible condomless sex, and they'd get shamed. They'd get seen as a slut."

The U.S. Centers for Disease Control and Prevention offers extensive information about PrEP on its web site.

"Strong research evidence indicates that PrEP, when used consistently, is safe and effective for reducing the risk of acquiring HIV sexually," it says.

However, Jacobs says other wings of the medical establishment should be more active in disseminating that message, both to gay men and to doctors.

"A lot of doctors are still under the belief that if they give their patients PrEP, they'll go out and have condomless sex," Jacobs said. "What they don't understand is that gay men are already doing that."

At the Fenway Institute in Boston — which specializes in gay, lesbian and transgender health — many doctors initially had misgivings about PrEP, but have overcome them, according to Dr. Kenneth Mayer, the institute's medical research director.

"There definitely were apprehensions at the beginning — would it increase risk-taking behavior, would people take it regularly," Mayer said. "More recently, the questions are not whether it's a good idea, but the optimal way to provide it, and which patients are the best candidates."

"I don't have an issue with people voicing concerns about it, but we have proof it works," said Mayer, who hopes high-level federal officials get more involved in the public discussion.

Another challenge is raising awareness of PrEP in black communities with high HIV infection rates.

"We have young minority men becoming infected at disproportionately alarming rates, and now we have something that could avert this," said Lynnette Ford of GMHC, a New York City AIDS service organization. "But there's not a lot of information out there in communities that need it most."

Demetre Daskalakis, the Mount Sinai doctor, said the Truvada debate recalls the way birth control was viewed in some quarters in the 1960s — as an accessory to promiscuity.

"Anyone who takes Truvada, someone is looking at them and saying they're licentious," Daskalakis said. "When this becomes more normalized, we'll be fine."

————

Online: CDC fact sheet: http://www.cdc.gov/hiv/pdf/prevention—PrEP—factsheet.pdf

Higher pill burden is associated with poorer adherence to HIV therapy and reduced chances of achieving an undetectable viral load

AIDSmap

Lower pill burden is associated with higher rates of adherence to HIV treatment and better virological outcomes, according to the results of a meta-analysis published in the online edition ofClinical Infectious Diseases. The research also showed that adherence was better with once-daily regimens compared to twice-daily treatment, but once-daily therapy did not have any advantages in terms of virological suppression.

“Higher pill burden was associated with both lower adherence and worse virologic suppression in both twice-daily and once-daily subgroups,” comment the authors. “Adherence was higher with once-daily ART [antiretroviral therapy] regimens than twice-daily regimens…however, this difference was minimal and did not translate into better treatment outcomes.”

The past decade has witnessed important improvements in antiretroviral treatment. Overall, drugs are now less toxic and better tolerated than in the past. Pill burden has also been reduced and dosing schedules simplified. Two fixed-dose pills (Atripla and Stribild) are now available, providing potent HIV therapy in a single tablet.

A meta-analysis of randomised trials published in 2009 showed that once-daily treatment was associated with higher rates of adherence compared to twice-daily therapy, but that rates of virologic suppression did not differ greatly between the treatment strategies.

More randomised trials have been published since then. An international team of investigators therefore re-visited the questions of whether pill burden and dosing schedule have an impact on adherence and virologic suppression.

Randomised-controlled trials comparing once- and twice-daily therapy published or presented before 31 March 2013 were eligible for inclusion in the analysis. The study populations could include people who had not taken treatment before (treatment naive); treatment-experienced people switching treatment with an undetectable viral load; or treatment-experienced people switching treatment with detectable viraemia.

A total of 19 studies including 6312 people met the inclusion criteria. The studies were conducted between 2004 and 2011. Most (18/19, 95%) were published in peer-reviewed journals. Seven studies (37%) included treatment-naive patients, nine (47%) monitored patients who switched treatment with an undetectable viral load and three (16%) evaluated treatment-experienced individuals who changed treatment when their viral load was detectable.

The median duration of follow-up was 48 weeks, and 17 studies (89%) reported on both adherence and virologic suppression. The majority of studies (eleven, 58%) used MEMS (Medication Event Monitoring System) to assess adherence. The remaining eight studies used pill count.

However, the authors note that none of the studies included fixed-dose single pill therapies.

Higher pill burden was associated with lower rates of adherence (p = 0.004). But when the results were stratified by treatment strategy, the association between adherence and pill burden was only significant for twice-daily combinations (p = 0.001).

There was also a significant association between higher pill burden and reduced chances of achieving virologic suppression (p < 0.0001). This was the case for both once-daily (p = 0.005) and twice-daily (p = 0.0003) regimens.

Turning to dosing schedule, adherence was higher with once-daily regimens compared to twice-daily therapy (weighted mean difference [WMD] = 2.51%; 95% CI, 1.20%-3.83%, p = 0.0002). The adherence advantage of once-daily treatment was apparent in treatment-naive individuals (WMD = 3.94%; 95% CI, 1.42%-6.47%, p = 0.0002), as well as people switching therapy with detectable viraemia (WMD = 5.28%; 95% CI, 0.60%-9.96%, p = 0.03) and also people who changed treatment with an undetectable viral load (WMD = 0.95%; 95% CI, 0.36%-1.54%, p = 0.002). The difference between these sub-groups was significant (p = 0.02).

Virologic outcomes did not differ significantly between once- and twice-daily regimens. The investigators believe there are several possible explanations for this finding. These include the relatively small difference in adherence rates between once-and twice-daily regimens; the short period of follow-up in many studies; and the high levels of adherence support provided in clinical trials. “For all these reasons,” write the investigators, “the difference in virologic suppression that we found between once- and twice-daily ART regimens may be understated.”

They conclude that once-daily treatment is associated with better adherence, and that higher pill burden is associated with poor virologic outcomes.

The authors believe their findings are of significance to health systems which are looking at ways of reducing costs. Single tablet HIV therapy and fixed-dose combinations are marketed at a premium, but the investigators believe “separating out the single-tablet regimens and or/fixed-dose combinations into their constituents is not likely to have a major detrimental impact on virological outcomes (provided that the overall pill burden does not increase dramatically).”

Reference

Nachega JB et al. Lower pill burden and once-daily dosing antiretroviral treatment regimens for HIV infection: a meta-analysis of randomized controlled trials. Clin Infect Dis, published online ahead of print, 22 January 2014.

New HIV Drug Class Shows Promise

Cenicriviroc, an investigational antiretroviral from the new dual CCR5/CCR2 inhibitor class (photo), performed well in a Phase II trial, although with a high drop-out rate because of a complicated dosing. Investigators are currently developing a simplified regimen to mitigate that problem. Presenting their findings at the 14th European AIDS Conference in Brussels, researchers recruited 143 treatment-naive people with HIV for this double-blind/double-dummy study.

The participants were randomly assigned to take Truvada (tenofovir/emtricitabine) plus either 100 milligrams or 200 mg of cenicriviroc or 600 mg of Sustiva (efavirenz). Because cenicriviroc was only available as a 50 mg pill at the time of the study, participants took four pills (which were either cenicriviroc or a placebo) in the morning, one pill (efavirenz or a placebo) at bedtime and one Truvada at a time of their choosing.

This dosing schedule appeared to contribute to the high rate of dropouts: 29 percent in the 100 mg of cenicriviroc group left the study prematurely, compared with 27 percent in the 200 mg cenicriviroc group and 39 percent in the Sustiva group. Twenty-one percent of the Sustiva arm dropped out because of adverse events, compared with none in the 100 mg cenicriviroc arm and 2 percent in the 200 mg arm.

At 24 weeks, 76 percent in the 100 mg arm reached an undetectable viral load, compared with 73 percent in the 200 mg arm and 71 percent in the Sustiva group. By 48 weeks, these numbers had dropped considerably, mostly because of all the dropouts. The respective rates of a fully suppressed viral load considering all those initially assigned to each group was 68, 64 and 50 percent.

The CCR2 receptor latches onto a cytokine called MCP-1, which promotes inflammation. Tests found that those taking cenicriviroc had lower levels of MCP-1, which showed that the drug was successfully blocking the CCR2 receptor.

There was also evidence that levels of soluble CD14, which is an indicator of inflammation, dropped at the 24-week mark among those taking cenicriviroc; meanwhile it rose in those taking Sustiva. By 48 weeks the levels in the cenicriviroc arm rose again and reached a plateau around the level found at the beginning of the study. Meanwhile, the CD14 levels continued on an upward swing among those taking Sustiva.

To read the aidsmap story, click here.

To read the conference abstract, click here.

US Study finds HIV Test Plus Counseling Doesn't Cut Infection Rates

New research finds that prevention counseling with HIV testing didn't cut sexually transmitted infection rates any more than testing with information only.

By Janet Kim, MPH, Everyday Health Staff Writer
TUESDAY, October 22, 2013 – HIV prevention counseling has long been a standard part of the HIV testing process, but a new study finds that it may not be all that useful in keeping certain groups of people from contracting sexually transmitted infections (STIs).

The results of Project AWARE, a study published today in theJAMA, showed no added benefit from risk-reduction counseling offered in conjunction with a rapid HIV test. "I think that right now, to my knowledge, this is probably the best evidence that can really inform the question if there is still a role for risk-reduction counseling," said Lisa R. Metsch, PhD, lead investigator of Project AWARE and chair of the Department of Sociomedical Sciences at Columbia University's Mailman School of Public Health in New York City.
Recommendations to Streamline HIV Screening

When the U.S. Centers for Disease Control and Prevention (CDC) last revised their recommendations for HIV testing, in 2006, one major change was not requiring prevention counseling as part of HIV screening. The idea was that if there were no counseling requirement, more people would get HIV screening, and it would become a routine part of medical practice.

At the time, the American Medical Association supported this change and expected physicians to support the updated recommendations. News of this change in guidance, however, was a cause for concern among HIV/AIDS advocacy groups. They feared that without prevention counseling, people would not be adequately or accurately informed about how to protect themselves and others from HIV.

 

"If we do away with prevention counseling, if we do away with additional intervention based on prevention, we're not going to have an AIDS-free generation," cautioned Lynnette Ford, MSW, managing director of program services and evaluation at the New York City nonprofit GMHC, who strongly believes in the value of prevention counseling.
HIV-Positive, But Unaware

Not knowing one's HIV status remains a significant concern in the United States, where about 20 percent of people with HIV are unaware that they're positive. Because they unknowingly put others at risk for the disease, they are responsible for many new HIV infections. And the later an HIV-positive person is diagnosed, the more advanced their disease and the more challenging it is to improve their health outcomes. One of the main goals of the federal government's National HIV/AIDS Strategy is to reduce the pool of undiagnosed HIV infections.

Earlier this year, in April, the U.S. Preventive Services Task Force (USPSTF) recommended HIV screening for everyone ages 15 to 65 regardless of their HIV risk status. The task force reasoned that HIV screening efforts on such a widespread scale would help to better control the HIV epidemic by identifying more people who are at risk or are already HIV positive. In contrast with the CDC recommendations, USPSTF recommends prevention counseling for all sexually active adolescents and for adults at increased risk for infection.

Even with the CDC and USPSTF HIV screening recommendations in place, prevention counseling continues to be a mainstay of HIV testing efforts. There's some speculation that the long-held perception of prevention counseling's effectiveness likely overshadows research about it. Probably because existing data are not clear, said Dr. Metsch. "The studies done to date did not clearly speak to the issue of whether to provide counseling at the time of HIV testing," she noted.

But, added Metsch, "There was one particular study called Project RESPECT that was published in 1998, and this was the solid scientific base supporting risk-reduction counseling at the time of testing. But it was done before antiretroviral therapy, before the era of rapid testing, when HIV was basically a fatal disease."

As Metsch and her colleagues stated in the JAMA report on the new study, Project AWARE was designed to fill this gap.
No Added Benefit From Risk-Reduction Counseling

The Project AWARE randomized clinical trial ran from April 2010 to December 2010, to evaluate the effectiveness of a rapid HIV test with either risk-reduction counseling or information only in reducing the rates of sexually transmitted infections. Counseling involved a single brief discussion with individuals about their sexual risk behaviors and how to reduce their risks for HIV and other STIs. The information-only session was limited to the basics about HIV and the test itself.

The investigators enrolled 5,012 men and women who sought services at nine STI clinics in the United States. Study participants were categorized in three groups:
Men who have sex with men (MSM), which included men who have sex with men and women
Men who have sex with women (MSW)
Women who have sex with men and/or women

All participants had a rapid HIV test and received either counseling or information only at the time of the test. They were screened for various STIs at both the start of the study and six months later. Medical records were reviewed to assess any diagnoses of STIs between these points in time. All of the participants were tested for gonorrhea, chlamydia, syphilis, herpes simplex virus 2, and HIV; women were tested for trichomoniasis as well. Participants were also asked about their sexual risk behaviors -- including total number of sex acts, number of unprotected sex acts, total number of sexual partners, and number of unprotected sexual partners -- in the six months before the study and the six months after the start of the study.

At the six-month follow-up, overall STI rates did not differ significantly between the counseling (12.3 percent) and the information-only (11.1 percent) groups. The rates of STIs by gender (for the MSW and women-only groups), age group, and race/ethnicity also did not differ significantly between the counseling and information-only groups.

Results were different in the MSM group: 18.7 percent of those who had prevention counseling were found to have had STIs compared to 12.5 percent in the information-only group.

Interestingly, investigators found the overall number of risky sexual behaviors was somewhat lower in the counseling group than in the information-only group. One possible explanation, they surmised, is that "the magnitude or nature of the behavior change was insufficient to reduce STI incidence."
Should the Role of Prevention Counseling Be Reconsidered?

Results of the Project AWARE trial will be welcome or discouraging news, depending on which side you favor in the ongoing debate over the role of prevention counseling at the time of HIV testing.

On one side, as the study authors concluded, "[W]ithout evidence of effectiveness, [risk-reduction] counseling cannot be considered an efficient use of resources."

Nicholas Hellmann, MD, executive vice president of medical and scientific affairs with the Elizabeth Glaser Pediatric AIDS Foundation in Washington, D.C., agrees. "HIV prevention counseling is viewed by many health facilities to be too costly and labor intensive, and by tested individuals to be inconvenient," said Dr. Hellmann, who was not involved with the new research.

"This study shows little or no health benefit from routine HIV prevention counseling for individuals before testing," added Hellman, noting that it "provides a rationale for removal of this key barrier to more routine and widespread HIV testing."

"Prevention counseling is a mainstay in GMHC's toolbox to combat HIV and AIDS," said GMHC's Ford, who was also not involved with the research. "I think the role of prevention counseling should not be reconsidered…there is a need for prevention counseling. Not having prevention counseling, we really miss an opportunity to potentially use teachable moments with clients."

"Prevention counseling is most often successful when utilizing other approaches, such as motivational interviewing or longer-term interventions," Ford said, "Because let's face it, behavior change does not occur overnight."

In lieu of risk-reduction counseling, the authors of the new study proposed "a more focused approach to providing information at the time of testing [that] may allow clinics to use resources more efficiently to conduct universal testing, potentially detecting more HIV cases earlier and linking and engaging HIV-infected people in care."

"I feel that there are lots of other new and exciting developments in the HIV prevention arena that we could be doing," Metsch noted. "I also think…there still could be a place for other types of counseling."

Equality doesn’t mean justice

I didn’t know if I should have entitled this entry as a question, a definitive statement or a mere headline so I left it for the latter but it can be all three given the circumstances that now obtain, I was struck by the above split photo though showing the differences in how equality versus what is just and fair is depicted. The word “Equality” has been banded about so easily by LGBT groups and influentials I guess as a rub off from the North American agitation for such in the business of same sex marriage in a far more tolerant society and a justice system that provides room for seeking redress though itself is not perfect but when the state or another citizen runs afoul of the law remedies come and come sometimes swiftly (the Boston bombings case comes to mind). What is equality though in a rights based sense? Some may say marginalized groups getting the same treatment if not rights as privileged groups, the Collins Gem English Dictionary I have at home defines the word as “State of being equal, uniformity” but is this really real given our local context and the struggle for overall justice.

It struck me as the photo above was posted in the Jamaica for Justice Facebook page some time ago and some comments on it since has had me thinking for real. JFJ has given support to a recently launched online campaign by JFLAG entitled “We are Jamaicans” while it looked sleek and laudable on the face of it the populations that are really affected by the societal challenges and indifference were nowhere present in the close to twenty videos released thus far almost presenting a false sense of who are LGBT people and their allies really when the lower socio-economic groups get overlooked coincidentally with the homeless MSM challenges and the agency themselves becoming office-less via an eviction notice from their landlord related to the behavioural challenges from the same homeless over the years. Just a small percentage of the “community” feeling the impact of JFLAG’s work while the vast majority out there either do not trust, are unsure of their role and or are totally ignorant of the campaigns and objectives. Community engagement is still low save and except for remote sanitized outreach via Facebook the real forumatic activity is nonexistent and may be so for a time to come as they hunt for new office space.

Some questions come to mind:

Is it coincidental or sheer consequence that the agencies are made to become homeless themselves following the failure of nerves to directly address homelessness in key representative populations?

Is the eviction fiasco an attempt to start afresh so as to avoid addressing some key issues, a different location and geographical change connotes isolation and insulation from the problematic homeless populations?

Do you believe equality must also be an ideal to strive for within the LGBT community?

Was Jamaicans for Justice clandestinely sending a message to groups like JFLAG that their agitation is a mere peripheral attempt to seek LGBT rights in Jamaica or the decriminalization of buggery?

Is mere equality just a hairy fairy schism ideal just to play catch up with the heterosexual privilege?

Is it that due to the inability for one to live ones truth one is forced to be pretentious hence this practice to live in stealth has becoming engrained in the population’s psyche?

Why not go for the greater goal that of justice and true fairness?

What about the context of a marginalized group being wholesome within itself before it attempts to reach out to more privileged populations?

Do we have a hypocritical advocacy then in terms of asking for virtues that are not espoused generally by them or leading the populations to such espousing?

Why are we afraid to really be truthful in our scope and ideologies towards truth inclusivity, equality and justice for ALL?

Should persons at leadership of the agencies by held accountable for the recent evictions and failure to properly address the welfare issues?

And if after all the proper agitation devoid of the schisms and buggery is repealed, what is next?

Where is genuine openness and truth in the scheme of things?

Are you expecting any resignations given the recent developments?

When campaign decisions are planned are the general community issues taken into account and a plan B in case of a fallout?

My mind has been changing on this call for equality in Jamaica by the LGBT lobby not even a name change to an old campaign has convinced me thus before seeing this photo and now it has sped up my resolve, the ideal is indeed JUSTICE not just to be mere observers by the fence struggling to see over it on tippy toes as captioned in the little boy or the centre figure. The left partition of the photo suggest mere playing to the needs or hue and cries of aggrieved groups more so than the right partition showing ALL on an equal footing but also espousing the correctness of it where the crates are not mere rights handed out to silence a noisy penny section but rights privileges and freedoms on a truly equal footing to all concerned.

If on the onset the least amongst us are not viewed as equal then it should not be surprising that the corresponding programs, systems, strategies, public relations campaigns and so on will reflect those ideologies which explains why the only time in essence there is serious attention placed on any individual is when their lives are at risk via near death homophobic fallout and even that is troubling as after a while when they recover there is hardly any follow up. Overall then we can deduce that the one of the self made reasons why we seem stuck with very little gains made over the three decades plus is the oversight, dithering and ignoring of some key front-line issues that affect the representative populations chief among them homeless MSM, same gender loving women and transgender persons as the buggery law gets first priority. The fact that the present advocacies are male dominated is an issue as far as SGL women issues are concerned and the leaders in the groups are often way removed from the realities while getting close to them after the fact when the aggrieved makes a report. The threat levels as well for most concerned is minimal so there is a feeling of distance from the on the ground matters in a “that won’t ever happen to me” mindset or a tragic case of individualism. The “followers” as it were and apologists for the agencies also seem occasionally display the contempt and disregard for the lower socio-economic groups sans any reprimand or correction by the leadership or superstar advocates, just check the social media landscape on any given day and you see the indifference spewed whenever the subject matter is raised, the thrust is all about repealing or decriminalizing buggery, who cares about some dirty gay men under our the radar?

The agencies have and seem to be continuing to systematically ignore queer homeless as legal challenges, media presence and how agencies look from a public relations and programmatic standpoint are prioritised as more important much to their peril and to the greater community’s peril.

Our flawed advocacy has repeatedly failed to deliver on several fronts with the lack of principled centred leadership, reinforcing societal deficiencies, lack of proper planning and strategizing in community issues versus the national platform, poor timing and roll out of programs (or lack of relevant programs), warped ideologies both within the structures and outside of them in the LGBT populations itself on the backdrop of a national psyche that evokes separatism, classism and elitism. Anancyism is also a major problem in many respects many of us LGBT people have been forced over time to be circumspect or operating in stealth normalizing ourselves to fit the hetero-normative and hetero-patriarchal constructs and in so doing we adopt a deceptive way of living which seems to have crept into every other facet of our lives. Ideally one would have imagined an advocacy that would be far more open and indeed honest about many of the tiers of issues affecting us yet we tacitly support half truths, deceptive methods of toying with very important international support while advocates ingratiate themselves in spots and play on a gullible LGBT population in the name of speaking on or behalf.

And then we wonder why that after some thirty plus years of agitation between the two major groups that have been at the forefront of this be they Jamaica Forum for Lesbians Allsexuals and Gays, JFLAG and its predecessor GFM, Gay Freedom Movement and we seem stuck in a groove hardly moving from where we were with more social welfare challenges than ever and a roofless JFLAG presently along with its parent Jamaica AIDS Support for Life, JASL? The escapists response is the usual rebuttal for scrutiny inclusive of historical references in abid to dismiss criticisms about the stewardship of the groups/individuals with strong support from the apologetics. Then how are we to ever achieve over freedom with this kind of mindset. NGOs these days in HIV/AIDS and LGBT agitation look and feel more like quasi-political bodies mimicking the political directorate’s indecisions and bereft of new objective thought along with bureaucratic committees, bi-laws and organizational systems that impede more than assist with service delivery, program development and rollout, funding accessibility, fiduciary responsibility, flawed ideological positions, poor and slow decision making and execution of same, non community based consensus, corporatism and elitism.

That could also possibly explain the now disturbing 34% rate of HIV infection in the MSM populations despite a robust and well funded national program of which the NGOs do part take via Global Fund. When the target groups for such programs are not seen as equals to those in the annals of power and influence. Leadership is all off here to me why we cannot build on what has been laid down over the three plus decades and we just merely settle for “Equality” as our main demand. The decriminalization of buggery is the penultimate goal in JFLAG’s mind as I see it having been in the system myself any other activities are obviously distractions or secondary in the scheme of things, case in point the homeless msm in New Kingston and the agency’s dithering on developing meaningful programs to address that massive problem that was allowed to get so.

True equality has to come from within the so called community as it now stands and how we treat with those who are the least amongst us at every level – socially and the NGOs that claim to stand for the representative groups yet barely address the concerns via the needed programs/objectives and if so it is usually for PR to deflect scrutiny on the face of it, inclusivity and true equity not just a piece meal approach for show to impress our foreign allies and funders to get continued assistance. It is interesting for example in the middle of a tolerance campaign in 2011 by JFLAG with help from AIDSFREEWORLD and JASL that JASL was already effecting a ban on homeless MSM from their offices due to the behaviour of a few yet no rehabilitation, engaging and behaviour change responses came from any of the aforementioned agencies and the public spat that played out left the editors of both major newspapers, the opposing religious right and the public the impression that the men were “abandoned” by the NGOs. 

Another disturbing perception on the ground is that persons who do come through the systems do so to their own advantage, a young MSM in his early twenties recently asked (paraphrasing) why are so many older gay activists seem so well off and or reside overseas and don’t seem to care about the other persons locally? It shows that there are some who are watching and wondering hence the mistrust as well and the apparent lack of engagement even refusal to make reports to the NGOs by those persons who have suffered at the hand of abuse. Far too many persons are becoming more aloof and cynical at the whole set up.

Where is the credibility therefore or the moral authority to launch sleek and flowery worded campaigns on such virtues as tolerance and equality (outside of a justice call) and on what ethical strengths can such campaigns seek to make any impact on a cynical society about male homosexuality. That cynicism is fuelled also by the poor crisis communication over the three plus decades as well or half truths on issue by some who seem to be on a narcisstic quest to win awards, pats on the back and praise at the expense of the rest of us while no real change is happening on the ground due to their farcical agitations. The rejected tolerance adverts even after the initial one based on an HIV/AIDS premise was more acceptable for example was the clearest case yet that proved to those within the LGBT populations who were observant and objective and the opposition in the religious right movement as well as secular anti gay voices that we have a serious class problem and related ideologies within. The use of an Italian Jamaican face who hardly resides here or is remotely affected by direct homophobia to try to soften same in Jamaica ended up reinforcing the already hardening positions towards homosexuality from the anti gay voices and that the agitation was foreign/uptown influenced support and that Jamaicans were being forced to accept a foreign lifestyle with the added ingredient of disbelief that homophobic violence is real, most persons on the face of it still believe the sometimes public gay related incidents are gay on gay related violent episodes. Here again the quality of leadership and the decisions at the campaign levels have to be questioned, were they not cognisant of the “not our culture” perception over all these years and why are they still reaching for campaigns devoid of the new realities being taken into considerations.

Despite the fact that our motto says Out of Many, One People

The point is therefore that if we expect to gain such virtuous goals and ideals as tolerance (in the purest sense of the word), inclusivity and justice to include equality then the change MUST begin within the populations, systematically and at the leadership levels. Fiduciary responsibility these days at the leadership and influential levels is much to be desired just the recent evictions of JFLAG and JASL has brought his front and centre or at least it ought to but the code of silence (anancyism) has set in and then we expect laws to be changed to suit us, a society to suddenly accept homosexuality, HIV/AIDS infection rates to go down and the other problems to suddenly disappear? Lofty mid range objective in a restructured JFLAG for that matter as mere equality in not enough as equality is part and parcel of a greater whole that of JUSTICE. I am surely expecting far more sophistication and a total paradigm shift on advocacy overall, the “community”

Think on these things.

Peace and tolerance

H

World’s first condom specifically designed for anal sex

A California company has unveiled prototypes of its new accordion-shaped condoms specifically designed for receptive anal intercourse as well as for men and women, and projects that the condoms will go to market in 2015 pending approvals. [Images and video may not be suitable/safe for work (NSFW).]

A California company, Origami Condoms, is planning to roll out a new condom specially designed for anal sex to the market in 2015 pending regulatory approvals.

The accordion-shaped device is the first to be made with injection-molded engineered silicone instead of conventional latex or animal skin. In addition to the Origami R.A.I. (Receptive Anal Intercourse) condom, the company’s range also includes the Male Condom and Female Condom, both of which share a similar accordion-like design.

The Origami Condoms’ website states the O.R.A.I condom is “intended to facilitate a pleasurable and safe experience for both partners, increase its acceptability, improve sensation and comfort, and influence consistent condom compliance for those who engage in anal intercourse and are at risk for contracting HIV/AIDS, and STI/STD.” And to “provide a receptive partner with the initiative to use a condom without negotiation.”

Last month, the Bill and Melinda Gates Foundation mentioned the new company on its blog saying: “Origami Condoms provides an excellent example of a private enterprise focused on new condom design to promote consistent use by emphasizing the sexual experience.” The foundation is offering a US$100,000 startup grant to innovators to reinvent "the next generation condom that significantly preserves or enhances pleasure" and promotes "regular use."

Before the condom reaches the market in 2015 as the company hopes, it must be approved by the FDA, the WHO and C-Mark (EU) to meet rigorous safety standards. The company also announced on its site that it will launch its crowdfunding campaign on Indiegogo on May 7.

ORIGAMI Receptive Anal Intercourse Instruction from ORIGAMI Condoms

Interview with the Inventor from ORIGAMI Condoms
“In 1993, I had a life changing incident, a broken condom and a HIV diagnosis. 

This drastically changed my view about condoms,” inventor Danny Resnic said.