HIV Is Coming to An Unprepared Rural America

Williamson, West Virginia.

Rural America has many problems facing it ranging from economic decline to scarce access to medical facilities to a mindset that in some that embraces ignorance and bigotry.  Now, as a column in the New York Times makes clear, some parts of rural America, including much of neighboring West Virginia is about to face an HIV crisis that it is ill prepared to deal with largely due to closed mindedness, the stigma attached to being gay and/or HIV positive and lack of access to progressive testing and medical treatment. Much of the increase in HIV positive residents come from drug use and shared needles yet, rather adopting policies that might reverse the trend, many localities are shuttering programs that might stem increased infections. Here are highlights from a very troubling column:

While there are still about a million people living with H.I.V. in the United States, in some of America’s largest cities, the news about H.I.V. and AIDS is surprisingly positive.

“New H.I.V. Diagnoses Fall to Historic Lows,” the New York City Department of Health announced on Nov. 22, reporting that the largest city in the United States had fewer new diagnoses of H.I.V. in 2018 than during any year since statistics were first kept in 2001. This was just a few weeks after Philadelphia’s Department of Public Health reported a 14 percent drop in the number of newly diagnosed H.I.V. infections overall, and a drop of more than one-third among black men who have sex with men — an especially vulnerable population.

San Francisco and Chicago have also seen their rates of new H.I.V. infections falling.

[I]n much of rural America, an opposite trend is emerging. There have of course always been cases of H.I.V. in sparsely populated parts of the country, but in these places far from cities, the conditions that lead to H.I.V. transmission are now intensifying — and rural America is not ready for the coming crisis.

Indeed, in Appalachian West Virginia, the crisis has already arrived. A cluster of 80 new H.I.V. infections has been diagnosed since early last year in Cabell County.

Unlike large urban areas that have dealt with similar health and substance crises in the past, and that have networks of service providers and consumers in place, small rural health jurisdictions often lack the infrastructure to confront the crisis and have little history of dealing with comparable health issues, she explained.

[W]hen prescription highs can’t be sustained, people often turn to using — and sharing — needles to inject heroin and then fentanyl, leading to hepatitis C and H.I.V. This avoidable crisis has been exacerbated by unemployment, declining coal mining production and economic pressures on regional press to act as effectively as a watchdog.

At the same time, health care is relatively inaccessible. “It’s not so easy to get to the nearest town to see a doctor,” Dr. Judith Feinberg, professor of medicine at West Virginia University, explained, pointing to a lack of transportation and stigma as the biggest barriers to testing and care. People living with H.I.V. are stigmatized everywhere, but those who live in large cities can get tested while feeling relatively anonymous in a clinic in ways rural dwellers cannot.

[T]he C.D.C. released a list of 220 counties similarly vulnerable to such outbreaks among people who use intravenous drugs. The densest concentration of those counties is along the Appalachian Trail, with 28 of them in West Virginia — more than half of the state’s 55 counties.

“There is no way that doesn’t wind up as an H.I.V. outbreak in the state,” Ms. Young says. Yet unlike in places like New York — with its comprehensive sex education; efforts at queer- and trans-specific public health; embrace of public syringe exchanges; and what its health commissioner, Oxiris Barbot, describes as a “sex positive approach” — when it comes to confronting its H.I.V. epidemic, rural America is ill-prepared at best and antagonistic at worst.

[D]espite research showing that syringe programs are effective at limiting transmission of H.I.V. and encouraging people to enter drug treatment, two cities in West Virginia — Clarksburg and Charleston — have recently moved to close or limit their needle-exchange programs. Negative press, business worries and conservative approaches are among the reasons the programs have been reduced when they urgently need to be expanded (along with statewide testing and education about preventive H.I.V. medication).

While it’s true that people who are black, queer, transgender, homeless, incarcerated or poor, or who use injection drugs, are disproportionately affected by H.I.V. and AIDS, the misguided impression that members of these groups are the only ones affected has unfortunately contributed to the media’s choice to deprioritize coverage of H.I.V. and AIDS in recent years.

Meanwhile, the rural, heterosexual white Americans who have been the subject of countless national profiles because they’re imagined —  incorrectly — to represent all of President Trump’s supporters, are more at risk all the time. But while we’re bombarded by analyses of many aspects of their plight, we don’t hear about this crisis facing them.

[T]he new major terrain of the crisis right now is in rural America, and it can’t be ignored any longer.

The Link Between Bullying, Social Rejection and LGBT Suicide

The sad reality is that suicides among the LGBT community are higher than in the general population.  This is not due to anything inherently wrong with being LGBT or a higher level of mental illness among those who are LGBT.  Instead, the problem stems from how society treats people in sexual minority groups.  Bullying, of course springs to mind, but also involved is family and societal rejection, all typically fanned by the constant anti-LGBT drumbeat of right wing Christian denominations and, now, a White House regime that is arguing that mistreatment of LGBT individuals in the workplace is perfectly legal. Anyone who thinks that LGBT youth aren't watching and listening to this potentially deadly message is deluding them-self. That supposed "Christians" are in the lead in projecting this message of hatred also directly ties to the growing exodus of the younger generations from religion, a trend that I for one view as positive. A recent piece reviews the linkage between unnecessary suicide deaths and bullying and societal abuse.  Here are highlights: 

Chloe was 12 or 13 years old when she began to question her sexual identity. She felt attracted to girls. She knew she was different from most of her classmates. So she didn’t talk about her feelings at school in the United Kingdom. She didn’t share them with her family, either. She knew they would not approve. “It wasn’t something that would be okay,” she said. A feeling of isolation built up inside her, and Chloe felt more and more like she didn’t fit in. Eventually, she tried to kill herself. Data for 2017 show that 17 percent of all high school students — about one in six — seriously considered killing themselves. That figure was nearly one in every two teens (almost 48 percent) for those who are lesbian, gay or bisexual. And 23 percent of these teens made attempts. Nearly one in three teens (32 percent) who were unsure about their sexuality also thought about ending their lives; 14 percent tried.

Scientists have begun to dig into why suicide risks are higher for LGBTQ+ people, especially teens. . . . The problem, researchers say, seems to stem from how society treats members of these minorities. Changing attitudes toward these teens can help more of them live and thrive. There’s no reason why being a sexual minority means a person must face a higher risk for suicide or other mental-health problems, Mueller says. “What does put kids at risk of suicide is when they feel rejected by families or friends or communities and when they feel ashamed of themselves.” Dealing with all of those stresses, she says, “can be really hard.” Those feelings often emerge when society views those who are different through a lens of stigma. “Stigma is about not valuing people who are different,” explains Ian Rivers. It is about “viewing them as less worthy or less important.” Rivers is a psychologist at the University of Strathclyde in Glasgow, Scotland. When society treats people who are in a minority group as if they have less value, those individuals can feel serious stress. In some cases, stigma leads to bullying. “I was isolated from the boys and they started calling me sissy and things like that,” said Sirus, a study participant. The teasing turned into violence. And, he added, “the teachers did not pick it up.” So they did nothing about it.

In 2015, Mueller and her colleagues found a link between bullying and suicides of lesbian, gay and bisexual youths. As bullying increased, so did the rates for young people’s thoughts of ending their lives, the researchers reported in the American Journal of Public Health. But bullying didn’t fully explain why the rates for LGB youth were so much higher than for other young people. . . . “It’s about a lot of other factors — like rejection from peers or families or shame.”

Young people also can internalize other people’s bad attitudes. In other words, they come to believe what others say. So even though it’s not true, they might come to believe that they’re “not good” simply because they are experiencing a same-sex attraction, Mueller says. To make things harder, society typically assumes “that everyone is heterosexual.” That, she says, “automatically puts everyone who isn’t at a disadvantage.” Burdens created by a hostile social environment “fall hardest on the youngest people” in LGBTQ+ groups, says Geoffrey Ream. He’s a professor of social work at Adelphi University in Garden City, N.Y. Ream recently dug into data from the U.S. National Violent Death Reporting System. . . . LGBT youth were 24 percent of the 49 victims ages 12 to 14. LGBT teens also made up 16 percent of the 15- to 17-year olds. Younger people “don’t have the same level of psychological resources” to cope with challenges that older people do, Ream explains. So children and teens are less ready to deal with the abuse that society may heap on them if they are part of a sexual minority. Youths also have fewer options to get out of the house and find resources to help. Family rejection is a big concern, agrees David Huebner. He’s a psychologist at George Washington University in Washington, D.C. He and others have found that parents’ rejection ups the risk of health problems, including suicide, among young adult LGB people. Name calling, physical violence and being kicked out of home are obvious examples of rejection. But rejection can also be more subtle. For example, parents might criticize a young person’s dress or behavior for not conforming to gender stereotypes.

The Insidiousness of Internalized Homophobia

I've written about the struggle that many of us in the coming out process encounter: overcoming the insidiousness of internalized homophobia.  Letting go of all the religious brainwashing and stigma ingrained in us from the surrounding society that until recently had only a 100% negative message about being gay.  For me, it took years of therapy to undo the Catholic Church had done f*cking up my mind.  And that was just the beginning of the process.  But it isn't just LGBT individuals who have to overcome this internalized homophobia.  One friend who is an amazing LGBT ally and an Equality Virginia "legend," has spoken about how she had to "come out" to be an active and open ally to the LGBT community.  A piece in The Atlantic looks at the realization by a straight actor that he too suffers from internalized homophobia.  Here are some excerpts:

I am not gay. I have no shortage of gay friends. My uncle is gay. I've marched in a gay pride parade. More than half of the roommates I have lived with are gay. I support marriage equality.

So it comes as a shock to me when I realize that, actually, if I am honest with myself, I'm not comfortable with kissing another man on camera. I really don't want to book this part.

I don't want people to think I'm gay. And I'm even more uncomfortable because that isn't a thought that I want to have.

Acting is a curious profession. The Oscars tend to award actors who transfigure themselves. Think of Charlize Theron in Monster or Phillip Seymour Hoffman in Capote. And most actors actively want to stretch outside of themselves. That is, after all, why we tried to make a career out of pretending. But people tend to assume things about you after they have seen you onstage. The character and the person are conflated.

Still, I wouldn't turn down a commercial that required me to pretend to slap a child, or one where I played a Nazi. And—assuming the ad wasn't advocating child abuse or Nazism—I don't think I would feel odd about the audition.

I ask my theatrical agent if there is any industry stigma about doing a gay role. "No," he says, "not since Will and Grace in the '90s."  I call my commercial agent to ask him the same question. "No," he says. "Ikea was doing ads with gay couples in the '90s. Will and Grace really changed things." "But you had to ask me two times if I was comfortable," I protest. "We would do that on any spot where you have to kiss," he tells me.

Gigi Nicolas, the director of on-air promotions at Logo, tells me that at least I was not alone in my discomfort. "We had to do a second round of casting," she says. "Far fewer people auditioned than I expected. Most of my top choices just didn't show up."

There is a long history of discomfort within the industry on gay actors playing straight roles and vice versa. Perhaps more significantly, there is a long history of discomfort within the industry—and across the globe—that gay people exist at all.

The number of straight people playing wildly lauded roles where the character is gay or vice versa seems to corroborate my agents' contention that any stigma these roles may once have had has disappeared. Tom Hanks, Neil Patrick Harris, Phillip Seymour Hoffman, Portia De Rossi, Heath Ledger, Ian McKellen, Michael K. Williams, Cynthia Nixon, Eric McCormack, Ving Rhames, Sean Penn, Michael C. Hall, Wesley Snipes, John Leguizamo, and so on.

While there is no ready tool or survey to measure homophobia or its absence within Hollywood, it seems that I can't blame my own discomfort with the Logo commercial on the prejudices of others. 

If you ever want to feel really wretched about what a big jerk you are, there are worse ways to do it than logging onto Harvard's Project Implicit. Psychologists at Harvard created a series of tests that measure your reaction time when you associate positive and negative concepts with different social groups. The results give you an indication of how racist or sexist or agist or generally prejudiced you are on a subconscious level.

I take some solace in the fact that my preferences are only moderate. But even if it's temperate about it, my subconscious is essentially racist, agist, and homophobic. It is the backwater redneck of my brain. And, apparently, I'm prejudiced against backwater rednecks.

The essential, uncomfortable, flaw with all the progress on gay rights is that even after legislation is passed and everyone's rights are equal on paper—which still sometimes seems a long way off—there is the longer, trickier work of trying to divest each person of the ugly human prejudices we all inherited when we were born.

I, at least, am sorry. You don't have to believe in a Judeo-Christian god to find something redeeming in confession. I am sorry that I balked at the idea of pretending to be gay. I am sorry that my uncle went home alone all those years. I am sorry for the whole ugly human history of slights and hate crimes and exclusion.

In contrast to the author of the article, the Christofascists are not the least bit sorry for the hate they sow and harm they do.  Indeed, the professional Christians and the child rapist protectors in the Catholic Church hierarchy revel in the stigma and bigotry they strive so hard to keep alive.  It's beyond ugly.  Meanwhile, the ruminations of the author may give straight readers of this blog an inkling of what we gays go through and have to face every single day.  It's no wonder many of us have psychological issues to overcome.  The hate merchants have been all too successful in creating a toxic world within which we must live.  The good news is that things are getting better, albeit not quickly enough for some - like the LGBT youth who continue to take their own lives.  As things improve, we can expect the Christofascists and Catholic Church hierarchy to become even more foul in the lies that disseminate against LGBT people. 

2008 Perry Book Compared Gays to Alcoholics

It seems that with each passing day there are more and more reasons to dislike Texas Governor Rick Perry who I will henceforth refer to as the Chimperator II. As Time magazine is reporting, in Perry less than inquisitive, pea sized brain, gays are the likened to alcoholics and advised to simply live their entire lives as asexual celibates. As noted in a post this morning, only in today's Republican Party can one expect to see ignorance and idiocy as positive attributes. Increasingly, Perry makes Chimperator Bush seem like a genius. Here are some highlights from the Time piece:

The origin of homosexuality has become something of a political litmus test for presidential candidates, almost akin to their stance on abortion. Candidates are now expected to explain whether or not they believe homosexuality is a hard-wired predisposition. It’s an important distinction, and how candidates broach the issue can really matter. Just ask Ken Buck, who drew criticism when he compared same-sex attraction to alcoholism on NBC’s Meet the Press in October 2010 during his unsuccessful Senate run in Colorado.

Since leaping into the GOP presidential race, Texas Gov. Rick Perry hasn’t been asked if he thinks gays are born or made. But in a little-noticed passage in his first book, “On My Honor,” a encomium on the Boy Scouts published in 2008, Perry also drew a parallel between homosexuality and alcoholism. “Even if an alcoholic is powerless over alcohol once it enters his body, he still makes a choice to drink,” he wrote. “And, even if someone is attracted to a person of the same sex, he or she still makes a choice to engage in sexual activity with someone of the same gender.”

In “On My Honor,” Perry also punted on the exact origins of homosexuality. He wrote that he is “no expert on the ‘nature versus nurture’ debate,” but that gays should simply choose abstinence. Perry’s campaign did not respond to a request for comment on whether he maintains this view.

If anyone should have remained celibate, it's Perry's parents. Even as Perry prostitutes himself to gay-hating Christianists the Time story notes that a new HRC poll found the following:

A poll released late last month by the Human Rights Campaign, a gay rights advocacy group, found that a majority of Americans now support marriage for same-sex couples, three quarters of men say they could be friends with a gay man and nearly 60% of Americans would not mind if their grand child were gay.

Historic Decision at the United Nations: Gay Rights Are Human Rights

Eighty-five nations have signed on to a resolution of the United Nations Human Rights Council on human rights violations based on sexual orientation and gender identity. The resolution was passed by a vote of 23 in favour, 19 against, and 3 abstentions. The resolution tasks the High Commissioner for Human Rights to prepare a study on violence and discrimination on the basis of sexual orientation and gender identity and calls for a panel discussion to be held at the Human Rights Council. Needless to say, this development will increase pressure on anti-gay nations to cease the persecution of their LGBT citizens. The resolution and signatories can be found here on the Arc International webpage. Here are some highlights:
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Delivered by Colombia to the 16th session of the United Nations Human Rights Council on behalf of the following 85 States:
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Albania, Andorra, Argentina, Armenia, Australia, Austria, Belgium, Bolivia, Bosnia-Herzegovina, Brazil, Bulgaria, Canada, Central African Republic, Chile, Colombia, Costa Rica, Croatia, Cuba, Cyprus, Czech Republic, Denmark, Dominica, Dominican Republic, Ecuador, El Salvador, Estonia, Fiji, Finland, France, Georgia, Germany, Greece, Guatemala, Honduras, Hungary, Iceland, Ireland, Israel, Italy, Japan, Latvia, Liechtenstein, Lithuania, Luxembourg, Malta, Marshall Islands, Mexico, Micronesia, Monaco, Mongolia, Montenegro, Nauru, Nepal, Netherlands, New Zealand, Nicaragua, Norway, Palau, Panama, Paraguay, Poland, Portugal, Romania, Rwanda, Samoa, San Marino, Serbia, Seychelles, Sierra Leone, Slovakia, Slovenia, South Africa, Spain, Sweden, Switzerland, Thailand, Timor-Leste, Tuvalu, Ukraine, United Kingdom of Great Britain and Northern Ireland, United States of America, Uruguay, Vanuatu, Venezuela, and the Former Yugoslav Republic of Macedonia.
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1. We recall the previous joint statement on human rights, sexual orientation and gender identity, presented at the Human Rights Council in 2006;
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2. We express concern at continued evidence in every region of acts of violence and related human rights violations based on sexual orientation and gender identity brought to the Council’s attention by Special Procedures since that time, including killings, rape, torture and criminal sanctions;
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10. We call on States to take steps to end acts of violence, criminal sanctions and related human rights violations committed against individuals because of their sexual orientation or gender identity, encourage Special Procedures, treaty bodies and other stakeholders to continue to integrate these issues within their relevant mandates, and urge the Council to address these important human rights issues.

The Christianist Goal: Sustaining Anti-Gay Stigma

As noted on this blog before, continuing DADT and barring same sex marriage are crucial to the real goal of Christianists, including the leadership of the Roman Catholic Church and the Mormon Church, maintaining anti-gay stigma. If gays are allowed to serve openly in the military, or worse yet to Christianists, marry and heave their relationships recognized, it sends a loud message that (1) LGBT citizens are normal and (2) anti-gay religious based discrimination should be subjected to harsh scrutiny. Yet another reason, of course, is because anti-gay bigotry has been such a successful tool for the professional Christians who make the Pharisees of the Bible seem most virtuous. As a result of these truths, the viciousness of the Christianists and their prostitute like minions will likely increase before society finally turns its back on their vitriol and LGBT Americans achieve full equality. A column at The Dail Beast looks at this reality and the machinations of the far right and Christianists to keep LGBT citizens stigmatized and second class citizens. Here are some highlights:
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Conservatives are normally out there urging people to fight [wars] and to marry. A conservative president launched two wars, and conservatives tried to impeach the adulterous Bill Clinton. When it comes to gays and lesbians wanting to defend their country or provide a stable, loving union, the right wing is suddenly on the other side. Why are they fighting?
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The fight is hot because gays are seeking equal access to the very social institutions, marriage and the military, that confer social approval. In America, and in most of western culture, the soldier and the householder are models of social virtue. If gays can marry and serve their country, well, "Gay is Good" as the old movement button says.
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The fight to keep gays off the standard scale of social value is just the current manifestation of the long history of categorizing them as sinners—which was (and to some extent still is) how people in the Judeo-Christian tradition talk about badness. The right knows it can't make the state punish gays as sinners, for various constitutional reasons, so it is trying to make the state deny them the closest thing it has to consecration: the sacred bonds of warriors and the sanctity of marriage.
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Good people appear in children's books. In the fight over same sex marriage in California two years ago, the antis ran repeated scary images of children learning that gay people could marry. Don't let gay people marry, the message ran. Since marriage is good, children will think gay is good.
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You wouldn't keep interracial couples out of children's books. Is there something wrong with us?"
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Regardless of what they say they're doing, that's the question—not soldiering and marrying—that the Senate Committees and the judicial panel are going to be answering in the coming days.

Justin Bieber Incident Shows No One Is Safe From Homophobic Abuse

I suspect that at times many members of Gay, Inc., who reside in places like Washington, D.C., too often forget what life out in the red states and flyover country is like. The recent flap over an incident involving Justin Bieber in of all places Canada demonstrates that the anti-gay mindset remains pervasive and obviously is still being inculcated into children and teens by homophobic parents. If anyone hasn't heard by now, Bieber was accosted during a laser tag game and called a "faggot" several times. When Bieber pushed past the loud mouthed denigrating him, the aggressor said Biebier hit him. The father of the youth using the anti-gay epitaph now is making threatening noises obviously in the hope of shaking some money loose from Bieber. It's all pretty sickening, but all too typical of life for those of us in states with zero protections who have been thrown under the bus repeatedly by the Liar-in-Chief. Here are highlights from TMZ which first reported the incident:

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We’re told that during the game of laser tag, one kid went out of his way to target Justin repeatedly (a violation of the code of honor of laser tag, if there is such a thing).
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Sources say that Bieber became frustrated when the kid cornered him and wouldn’t stop shooting and when Bieber told him, “That’s enough” … the kid responded, “What are you gonna do about it, faggot?”
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We’re told a shocked Bieber replied, “Excuse me?” Sources say the other kid responded, “You’re a faggot” and then put his hand out toward Bieber and Bieber pushed it away as he left.
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Contrary to several news reports, we’re told Bieber never struck the other boy.
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The real message to be taken away from this episode is that with each passing day that anti-gay laws like DADT remain on the books and "good Christians" fail to loudly challenge their hate-filled fellows, kids like the one who accosted Bieber get the message that homophobia is perfectly OK.

Nearly Half of Gays in Therapy

The Advocate has a story with statistics that I do not find at all surprising given the constant anti-gay message disseminated by so many religious denominations and the fear many of us have on the employment front for lack of employment non-discrimination laws - gays and lesbians get mental health treatment at twice the rate of heterosexuals. Constant dehumanization, being told that one is doomed to go to Hell, and fears of family rejection take a significant toll. In my own case, therapy helped me overcome decades of religious poison. Once I had put that issue behind me, therapy also helped me begin to move on with my life and accept my sexual orientation. For readers who are in the closet and who have not tried therapy, I strongly recommend it regardless of whether you decide to come out. I continue to rely on therapy and medication to help me get through the nastiness of the post divorce wars and push back suicidal thoughts when I find myself subjected to Virginia's anti-gay legal system. Here are highlights from the Advocate story:

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Gays and lesbians get mental health treatment at twice the rate of heterosexuals, a new study concludes. The group least likely to seek treatment? Heterosexual men. . . . . 48% of lesbian, gay, and bisexual men and women have received treatment in the past year, compared to 22% of straight people.

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"The pervasive and historically rooted societal pathologizing of homosexuality may contribute to this propensity for treatment by construing homosexuality and issues associated with it as mental health problems," said Susan Cochran, professor of epidemiology at the UCLA School of Public Health and one of the study's authors.

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Many LGBT individuals do not have diagnosable disorders but seek treatment for psychological distress, the report shows. The study also found that ethnic and racial minorities are less likely to use mental health services. The study was published today in the journal BMC Psychiatry.

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I believe that only when (1) the spiritual murder that so many religious denominations inflict on LGBT individuals truly ends and (2) LGBT citizens secure equality under the civil laws will we see a significant change in the higher rate of therapy among the LGBT community. Being relentlessly stigmatized takes a significant toll.