Monday, July 31, 2006



Well of course I’m pissed. Yes I’ve had few martinis but I mean that I’m really angry.

Why? Because “they” have lied to us. Talking young people, they tell me that there is no point in worrying about safe sex. There is no such thing anyway --- we are all bound to get HIV in the end so why bother at all. It’s a lot of stress worrying about it so get it over with and all the stress goes away. I put down the trump card --- sickness. Nah, HIV is manageable. It won’t kill you these days. Well, it might but not for a long time! And who wants to live to get old?

These are the people that the kind and dedicated health professionals admit to me are out there. But there is a slight twist. They talk about them (off the record of course) as a willful (even wicked) small group who are fully aware of all the latest information about HIV and the other STDs and yet they knowingly chose destructive behavior. They go on to suggest that a very small minority are so tweaked on crystal (or any substance which happens to be flavor of the month) that they don’t really make choices at all.

Don’t we know that this is just not accurate? Why are so many sensible and together people putting themselves at risk and getting sick? Certainly not because they have all the information. A CDC outlined plan for "information dispersal" may be in place but it don’t mean that the word is getting out there. More significantly, they have inherited a situation founded on lies. So much so that the unspoken ethos is: why should we believe you and why should we even think about it? And heaven forbid we should actually talk about it.

I am not asking you to go back all that far to the time when “they” told us that all sex required the seal (not of approval --- latex). Any contact had to be behind latex or in emergency circumstances maybe saran wrap. If you wanted oral contact, dental dams were advised but instructions were offered on how to safely transform a condom into a sheet, if you were taken short. I wonder how many people followed those instructions or even used condoms for a blow job. We now know that it didn’t matter much (if at all). But the consequences of stigmatizing a range of sexual expression, and demonizing those who continued to express themselves so, was to push them into the category of what the right wing have always wanted --- wicked and perverse indulgers in a “lifestyle” choice which is unhealthy and anti social. The legacy is that there is no need even to talk about it. What hope is there for incorporating the condom (if not eroticizing it) as an expression of loving concern for one’s partner? “They” need to work hard to get back there credibility so that we believe their motives are more than keeping the Federal funds flowing.

Do not think I have gone over to the new age boys. I mean those dears from San Francisco who pulled the shock ads that tell how AIDs actual takes people on. Or, of course, the “self-esteem” brigade (like Seattle’s Gay City) which do not want to confuse people with dire facts (such a downer) but who tell us that coffee chats and games in the park will build souls strong enough to fight off the virus. Remember the Black Death. They thought posies would kill of the plague! The problem with all these guys is that they are quite right there is an issue about human sexuality (gay or straight) that is rarely addressed. Is this why the Needle Exchange Program is so effective --- it’s about mechanics (no shared needles) not about self identity. But does that let us off the hook if we go on infecting each other and the wider world? I had sympathy for Typhoid Mary but no one suggested that her solution was cookery classes followed by a new restaurant job.

I want US to take back the truth and TALK ABOUT IT even if it offends them. Even if they call it pornography. It’s about sexuality, it’s about passion, it’s about life. It is now --- not in the next projection, not in the next grant cycle, not when the research results are published.

Did I say that we are in midst of a Pandemic?.
Had you forgotten?

In respons
e delicious pancake said...

So - let me tell you my vignette. I am a straight man, not in a relationship.
I went to meet with friends in San Francisco, preparing for BURNING MAN. I met a really cool chick attorney. We started to fool around and we got to the point where condom use was pertinent.
"I'm on the Pill - we don't need that .... and I don't have anything."
"I never have sex without a condom."
"Well, I guess we are not going to have sex then"
She gets up, and leaves.
I made the right decision. But, she will be at BURNING MAN at the same camp. Why should I be the one who feels shitty?

Sunday, July 30, 2006

Ooh, Vicar


Nobody heard him, the dead man,
But still he lay moaning:
I was much further out than you thought
And not waving but drowning.

Poor chap, he always loved larking
And now he’s dead
It must have been too cold for him
His heart gave way,
they said.

Oh, no no no, it was too cold always
(Still the dead one lay moaning)
I was much too far out all my life
And not waving but drowning.

Stevie Smith


It's God they ought to crucify
Instead of you and me,
I said to the carpenter
A-hanging on the tree.

Sidney Carter

Thursday, July 27, 2006

Pop Quiz




The expectation that a particular result with follow from an action — that is Outcome Expectancy. A significant consequence is that the expectation influences the result. Embracing the idea "if I try, I will probably fail" is likely to increase the potential for failing.

So, we should not be surprised that in the study Provider Fatalism Reduces the Likelihood of HIV Prevention in Primary Care Settings, there was an impact from "Fatalism" illustrated by some of the statements they reported.

"How much of this can we change if it hasn't changed already" (physician).

"It’s fundamentally very hard to change people's behavior, I have become more and more cynical" (physician).

"I think it's really hard to know how to approach getting people to take responsibility" (physician).

"You talk until you're blue in the face and you think they've heard everything and understand everything and yet they're still out there infecting other people" (nurse practitioner).

"Some people feel if you're gay, it's just a matter of time before you get it. It doesn't matter when." (clinic director).

“We just heard the statistics that something like 9 cities across the United States—something like 10-15% of all new infections are people getting infected with drug resistant virus. So the people that are giving the virus to these people already know they're infected and they're already taking medications. So these are our patients that we teach and instruct on a daily basis who are going out and infecting other patients. In some regards I think it's like almost hopeless to try to change people's sexual behavior, I shouldn't say that but you know, that's basically what my feeling is.” (Nurse Practitioner).

[These extracts are taken from the paper Provider Fatalism Reduces the Likelihood of HIV-Prevention Counseling in Primary Care Settings by Wayne T. Steward; Kimberly A. Koester; Janet J. Myers; Stephen F. Morin. 2006, where you can find a full analysis and References]

This is a real link for anyone wanting more discussion of Burn Out:

Wednesday, July 26, 2006

The Defense of Marriage Act


Rave — No! This is much more of a rant.
You think that I am here celebrating because Washington State Supreme Court has "Defended" Marriage? What the hell does that mean! Talk about a riddle wrapped in an enigma. What we have here is a prejudice shrouded in bigotry. Straight marriages are in the worse shape that they have ever been. Look at the over 50% divorce rate, child protective services interventions, child poverty, and spousal abuse (and I don't even enumerate the numbers of marriages and divorces shared by politicians). Do you fix these problems? Diversion is always easier than confronting problems. No! Let's marginalize non-traditional couples who just might want to seal their commitment.

Not so long ago we used to hear that the problem with gays was that they were "promiscuous" and that they just did not want to settle down. We even heard that this denial of commitment was an off shoot of their "lifestyle choice". Some gay activists did suggest that we confront this by demonstrating just how socially responsible we have become. Sanitize the Parades, Deny Bathhouses and Cruising Spots, No arseless chaps, Hide away the Drag Queens, Buy the White Picket Fence, and the last resort — Join the Log Cabin Republicans. AND YOU STILL NEED TO BE DEFENDED AGAINST.

Myself, I don't give a flying fuck about marriage. But! Like the rest of society. I would like to be able to make my own choice.

What is pissing me off is the aftermath. How do I explain to little Matt that his Daddy is so different that his relationships need to be diminished to "defend" society?

I have yet to bring myself to read the actual judgment but the quotes that I have heard suggest that at least some of the Justices are aware of how paradoxical the decision actually is. Somebody said that they too are worried about the November elections — I won't even go there.

Is they any plus side? Perhaps, it is true that we might now concentrate on some of the other issues confronting us. If indeed we have avoided the subject of Barebacking, as an example, because we don't want to tarnish the image, now is the time to confront it again. Even if we all know that this too is something that is shared by the gay and straight communities.

Nobody is saying give up. What has become real clear is that fitting into a vanilla lifestyle for acceptance is just another closet — and there are many ready and willing to nail it shut. Of course, only in defense of . . . .

I still cannot say it better:

Tuesday, July 25, 2006

Post Test Counseling





Post Test Counseling

The success of antiretroviral drug therapies has prompted calls for expanding and adapting HIV-prevention services. HIV+ individuals are living longer and more sexually active lives, and now face the challenge of maintaining safer sex practices over many years.

In the US, incorporating HIV-infected individuals into prevention activities was initially identified by the government as a key objective when a goal was established to reduce the number of new infections annually by 2005 (CDC, 2001). Unfortunately, recent studies have documented setbacks in prevention efforts, with reports of increased risk behaviors sexually transmitted infections and HIV, particularly among men who have sex with men. In response, the CDC (2003) announced a new initiative to focus attention specifically on reducing HIV transmission by intervening with infected individuals.

A central component of this new initiative is the incorporation of prevention counseling into clinical care settings that serve patients with HIV (CDC, 2003). Such counseling is currently not a standard care practice. In a recent study, 29% of patients said they had never discussed HIV prevention with their providers. Furthermore, the likelihood of this outcome varied by a person's race and ethnicity, with African Americans and Hispanics reporting more counseling than Whites.

In order to be effective, risk assessments and prevention counseling need to become a routine component of ongoing primary care (CDC, 2003).

[These extracts are taken from the paper Provider Fatalism Reduces the Likelihood of HIV-Prevention Counseling in Primary Care Settings by Wayne T. Steward; Kimberly A. Koester; Janet J. Myers; Stephen F. Morin. 2006, where you can find a full analysis and References]

Lady Constance's Culture Corner

Hello Darlings,

I am pleased to see that at least one of you commented on my postings. It is so rewarding when we do get to share a cultural experience. Some dear little anonymous person acknowledged Oscar Wilde but did not share much with us --- Express, Dear, Express.

Perhaps you agree with me that his life is an example of ability and potential cut short. There might have been another 40 years of creativity and wisdom. Instead, he was systematically destroyed by a hypocritical Victorian society which elevated denial and “face” to a level almost beyond belief. I was always told that we would never see the like again. Surprise, surprise, homophobia and moral witch-hunting has returned to the political arena. But remember, as dear Oscar said himself:

And once, or twice, to throw the dice
is a gentlemanly game,
But he does not win who plays with Sin
In the secret House of Shame

Ooh, I have come over all misty. Let us move to something more cheerful. You keep asking about little Malcolm. Somebody thinks it’s Me! I thought the Multiple Personality diagnosis had gone out of vogue? No, darling, little Malcolm was a dear, dear, friend. He did not have the advantage of being American. Indeed unlike me he was not lucky enough to be born in the South of England. No, he came from “Uop North”. I know most people think there is not much culture when you leave London. I am sure that Bolton was a challenging experience for a child. But do remember apart from Orwell’s Road to Wigan Pier, there is an abundance of culture in Lancashire and Yorkshire. What is more appropriate for this venue that dear little David Hockney who hails from Bradford:

Portrait of an Artist (Pool with Two Figures)
1971 Acrylic on canvas (84 x 120 in)
Collection David Geffen

Should you think that is too frivolous a subject matter, we can always turn to L.S. Lowry, who has become so fashionable that I could spit.

Coming out of School,
1927 Oil on wood (34.7cm x 53.9cm)
Tate Gallery.

Well dears, shall I end with one personal memory? I am recalling a weekend stay at the Imperial Hotel in Blackpool. Dear little Malcolm popped over to visit. I think he wanted tea, poor dear. Fortunately (or, perhaps, otherwise) Afternoon Tea was being served in the Ballroom accompanied by a quartet which had encouraged a tea dance! He regarded himself as quite a dancer and how could a lady refuse. I am left with the memory of this incongruous couple flitting around the floor to the delight of the old ladies who adjudicated that we were meant for each other --- we certainly were not!