Re-Centering Science in the Fight Against AIDS

by Sean Cahill, PhD and Perry Halkitis, PhD
May 27, 2011

June 5th marks the 30th anniversary of AIDS. In June 1981, the Centers for Disease Control and Prevention published the first accounts of rare illnesses reported in young gay men in New York and Los Angeles in its Morbidity and Mortality Weekly Report. Within a few years, the disease that we first came to know as GRID (gay related immune deficiency or "the gay plague") and now know as AIDS permeated all segments of our population, and many parts of the world.

Since 1981, medical science has helped us understand the mechanisms of this infectious disease and how to treat it. We have also developed a large body of social science to inform HIV prevention. However, our knowledge about prevention largely has been ignored. New medical treatments have saved or improved millions of lives. But we could save many more if we developed scientifically-directed prevention policies as well.

Much has changed in the last 30 years, due primarily to biomedical advances to treat AIDS. In the mid 1990s, after quarter million deaths in the United States, the maintenance of HIV disease was achieved through the development of effective antiretroviral therapies.

These treatments, while certainly not a cure, have led to a rapid decline in AIDS-related mortality and have transformed HIV disease into a manageable, chronic condition. In 1981, a 20 year-old diagnosed with AIDS could expect to die from AIDS-related complications by age 22; today a newly diagnosed 20-year-old who adheres to treatment can expect to live well into his 50's and likely longer.

More recently, biomedical innovations have also advanced our prevention efforts. In 2009 an HIV vaccine trial in Thailand found that a combination of two vaccines lowered the rate of HIV infection by 31% in heterosexuals. Last year a scientific trial showed that HIV-negative gay men, taking a daily dose HIV medication tenofovir, were 44% less likely to acquire HIV. We've also seen advances in vaginal microbicides, with a South African trial reporting 39% fewer HIV infections among women using tenofovir gel.
But despite these significant biomedical advances, we enter the fourth decade of AIDS with a largely unabated crisis.

About 1.2 million Americans live with HIV/AIDS. Every year, 56,000 more Americans are newly infected. Roughly 50% of new infections are among gay men, and half are among African Americans, whereas by most estimates gay men represent only 2 % of the population, and African Americans constitute 13%.

Globally, 2.7 million people were newly infected in 2008, but for every two HIV-positive people who access treatment globally, another five are newly infected. Most of the 33 million people living with HIV around the world do not have access to treatment.

However, 2011 is also a time of great hope. This is because, after decades of HIV policies informed by fear and ideology, in recent years our national leaders have replaced these policies with ones informed by science. Bans denying HIV-positive people entry to the U.S. and on the use of federal funds for syringe exchange, have been repealed. Abstinence-only-until-marriage education--which numerous government studies found ineffective--has largely been defunded.

Under President Obama we have witnessed a renewed focus on HIV here at home. Last July, President Obama launched a first-ever national HIV/AIDS strategy to reduce new infections, improve treatment outcomes, and reduce disparities affecting black and gay Americans.

Scientific knowledge in the biomedical sphere has empowered us to make great strides in our war on AIDS. But the power of science has not fully been harnessed to reshape HIV prevention. Despite clear evidence that marginalization along lines of economic status, race, sexual orientation, and gender heighten vulnerability to HIV, prevention over the last 30 years has failed to address these systemic issues.

Condom availability and syringe exchange have been shown to reduce HIV risk. So too, interventions targeting the discrimination faced by gay men and African Americans will likely have similar beneficial effects. In fact, the CDC recently stated that our efforts to curtail HIV disparities should not focus solely on changing individual behavior, and must address the social determinants, which exacerbate the epidemic.

Science shows us the way. Research indicates that gay youth who are accepted by their parents are 3.5 times less likely to have unprotected sex than their peers who are not accepted, and that homophobia and victimization within families and in society contribute to heightened vulnerability. Structural interventions within families and communities to combat anti-gay discrimination and enhance the acceptance of gay people would help prevent HIV in this population.

Research also indicates that HIV-related stigma and fear of discrimination deter people from testing and seeking medical care, and that untested HIV-positive individuals compromise their own well-being and the overall public health. We must enact public education programs that destigmatize HIV testing and embed it into the fabric of people's lives. One model program can be found in our nation's capital, where anyone applying for or renewing a driver's license is offered an HIV test.

Social policies shaping HIV prevention largely have ignored the findings of social science. If we are to make advances in the prevention of HIV, our efforts must be directed by science in a manner similar to how biomedical advances have informed HIV health polices. At this pivotal moment and in the hands of an enlightened executive branch, it is critical that science direct the course of HIV prevention, and polices be developed to enact change within our social structures.

Sean Cahill, PhD is Managing Director of Public Policy, Research and Community Health at Gay Men's Health Crisis (GMHC) and a published author. Perry N. Halkitis is Professor of Applied Psychology and Public Health at the Steinhardt School, New York University.

This article was originally published in The Huffington Post on May 27, 2011.
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Lisa Lampanelli Visits GMHC to Bring $50,000 Donation Check

On May 25, 2011, Lisa Lampanelli visited GMHC to bring a check in the amount of $50,000 on behalf of the 48 anti-gay protestors at her concert in Topeka, Kansas on May 20.  Having Lisa at our new offices was a glorious experience!  Our colleague Luna Ortiz interviewed her about the donation.  Click here to watch the interview.  There were close to 75 articles, blog posts and TV/radios interviews, along with hundreds of tweets and Facebook posts. We are immensely thankful for Lisa's courage, tenacity, generosity and comedy. 

Comedian Lisa Lampanelli to Donate $1,000 to GMHC for Each Anti-Gay Protestor at Concert in Topeka, Kansas

On Friday, May 20 at 7:00 pm, Lisa Lampanelli, known as "Comedy's Lovable Queen of Mean," will be performing her comedy showcase at the Topeka Performing Arts Center in Topeka, Kansas.   Members of Topeka's Westboro Baptist Church, headed by Fred Phelps and known for its extreme anti-gay views, are planning to protest Lampanelli's show because of her steadfast support of the lesbian, gay, bisexual and transgender community.  In response to the protest, Ms. Lampanelli intends to donate $1,000 to Gay Men's Health Crisis (GMHC), for each protestor who shows up.

Ms. Lampanelli is a vocal supporter of GMHC.  She attended the 25th annual AIDS Walk New York in 2010, the proceeds of which benefit GMHC and 41 other HIV/AIDS organizations in the tri-state area.

In the 30th year of this epidemic, we know that to end HIV/AIDS, we must also continue to address homophobia and stigma which are lethal drivers of this disease.  We need more people like Lisa Lampanelli to help us by utilizing their creativity, talent, skills and generosity.

We are grateful for Ms. Lampanelli's kindness and courage to fight homophobia.  She is holding up a mirror to bigotry and hatred, and reflecting back love and generosity.
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A City With Two Tales: Hate and Love

by David Mixner

If New York City had two baseball teams playing against each other this past weekend the score would have been "Team Love" 45,000 and "Team Hate" 2500! That is the saga that played out in the Big Apple. In one borough there was a rally against marriage equality that turned out to be a circus of hate with vicious and ugly anti-LGBT rhetoric going far beyond the issue of marriage equality. In another borough there was a love fest of people making a sacrifice of time, money and energy to help those with HIV/AIDS.

Love overwhelmingly won this weekend.

In Manhattan over 45,000 people walked, raised money and sang for people with HIV/AIDS. The Gay's Men's Health Crisis held their annual Walk and raised over six million dollars. People were filled with joy, determination and love. There were no angry or ugly words spoken from the stage. No one attempted to divide the city or degrade any of its citizens. GMHC's HIV/AIDS Walk is how enlightened New Yorkers look at their city.

In the Bronx, Democratic State Senator Ruben Diaz led his second massive march against the passage of marriage equality in New York State. His first drew over 20,000 citizens but this time around the highest estimate of attendance was a pitiful 2,500. The State senator blamed the rain but just so you know, senator, it was also raining in Manhattan on the 45,000! He filled the stage with a coalition of hate and division including one Pastor who advocated death for homosexuals.

For all those politicians in Albany who are afraid of Diaz and his minions, I would suggest they simply look toward New York City this past weekend and that will tell you all you need to know. Check out these photographs from GMHC's AIDS Walk. (photos by Adam Fredericks)

This article originally was published on DavidMixner.com, May 18, 2011.

 http://www.davidmixner.com/2011/05/a-city-with-two-tales-hate-and-love.html

Exultant, GMHC Opens Its New Home

by Paul Schindler, Gay City News

In a celebratory ribbon-cutting ceremony buoyed by praise from elected officials, Gay Men’s Health Crisis formally opened its new home on West 33rd Street –– an inviting, spanking new facility that combines units of the agency that had sprawled over many floors on West 24th Street into two spacious floors, connected by an internal staircase and encompassing 165,000 square feet in total.

For GMHC’s chief executive officer, Dr. Marjorie Hill, the April 29 event was a triumph of sorts, coming just one year after the agency’s plans for moving out of its Chelsea headquarters, located between Sixth and Seventh Avenues, was encountering bitter and highly public resistance –– from some members of its Client Advisory Board, from some longtime supporters, and even from some colleagues in the AIDS world.

The criticisms were broadly diverse –– from concern over the potential for losing the coveted hot-meals program to objections to the severing of a long-standing sub-lease arrangement with a clinic run by the New York Presbyterian-Weill Cornell Medical Center, to the relocation to the far West Side, between Ninth and Tenth Avenues, and even to the configuration of the entrance.

In symbolic response to the distress many clients voiced about the risk that GMHC’s daily hot lunches and its Friday evening dinners would become relics of the past, the ribbon-cutting was held in the agency’s spacious new dining room that boasts not only large windows, bordered with stenciled graphics provided by the Keith Haring Foundation, across its entire north wall, but also an industrial kitchen with brand new equipment fully able to continue the hot-meal tradition.

After making oblique reference to last year’s controversy –– welcoming a crowd of well over 100 to the new space that she said “some people were worried about” –– Hill said the new dining room and its offerings are “state of the art.”

State Senator Tom Duane, the out gay Chelsea Democrat who is Albany’s only openly HIV-positive legislator, affectionately noted the frequency with which GMHC, the world’s oldest AIDS service organization, finds itself in the thick of controversy.

“GMHC is the leader of the fight,” Duane said. “The target of the fight. In the middle of the fight.”

Congressman Jerrold Nadler, another Democrat, whose district encompasses both the agency’s old home and its new facility, recalled teaming up with GMHC in the late 1980s when as a member of the State Assembly he fought to bring down the cost of AZT.

Today, his House staff works with the agency’s Washington policy team every year to fight for increases –– or at least hold off reductions –– in federal spending on the Ryan White AIDS Care Act, on prevention efforts at the Centers for Disease Control and Prevention (CDC), and on the Housing Opportunities for People With AIDS Act (HOPWA).

“GMHC is one of the most important organizations on this planet,” Nadler declared.

In light of the fractious dispute last spring over the proposed move –– the high cost of lease renewal on 24th Street made staying there unfeasible –– a presentation by David Valdez, who headed up the real estate committee of the board of directors over the several-year hunt for a new home, was particularly enlightening.

A real estate professional who now works out of Florida, Valdez stated flatly, “We ended up in the very best possible position.”

Guided by a team led by Cushman and Wakefield, chosen after interviews with the top six real estate companies in Manhattan, and with a pro bono contribution of at least $800,000 from the law firm of Davis, Polk, GMHC, Valdez said, carried out “the smartest, most well-advised, most successful” location search among recent New York City transactions. The outcome, he said, was “spectacular from an economic standpoint” –– and will result in savings of tens of millions of dollars over the eight-year life of the new lease.

After inspecting at least 30 sites and putting in bids on 15, the agency completed a deal that, in a comparison of 150 recent Manhattan leases involving at least 50,000 square feet of space, was the second-least expensive of the lot.

In remarks Hill made during the ceremony, in comments to Gay City News afterward, and in a tour that Janet Weinberg, GMHC’s chief operating officer, conducted for the newspaper, the agency responded to some of last year’s critiques, but also made an affirmative case for why it continues to hold a unique place among organizations delivering AIDS services in New York.

Some critics were sensitive over the fact that the entrance to GMHC, at 446 West 33rd Street, would be separate from the office facilities that house Associated Press next door at 450. Several charged that a form of apartheid was at play, with an HIV-positive population, many of them people of color, being kept away from a white-collar workforce.

Hill stated that the entrance built for the agency speeds clients to their destination –– by freeing them from the neighboring building’s stringent security procedures and offering them an express elevator –– and provides desirable discretion and privacy to those who continue to feel a stigma about their health status.

In fact, the experience of entering the new GMHC headquarters is considerably more relaxed than going into a typical Midtown office building –– or, in fact, into its old location on 24th Street.

Hill pointed to the new express bus lanes on 34th Street in responding to concerns about the new facility’s location an avenue and a half west of the Penn Station’s Eighth Avenue exit. Manny Rivera, who for the past three years has been a client member of the board of directors and explained that he worked hard a year ago to bring together unhappy clients and agency leadership, said the expedited express lane travel time and a bus frequency of every ten minutes mitigate the concern he originally had over the new site.

Dr. Roy M. Gulik, chief of the Division of Infectious Diseases at Weill Cornell Medical College, who has oversight of the HIV clinic Cornell runs in GMHC’s old building, is less persuaded that the agency’s new location does not impose burdens on those it serves.

“I am mostly concerned about some of our clients, some of whom are disabled, walking that far,” Gulik said, explaining that many of the Cornell clinic’s 1,200 clients are among the 8,000 HIV-positive New Yorkers who use services at GMHC. In addition to providing medical care to HIV-positive clients, the Cornell clinic also runs clinical trials, some of them involving uninfected, but at-risk populations.

For Gulik, staying in the heart of Chelsea, which he noted has the highest HIV seroprevalence rate in the city, is critical for Cornell. A year ago, he voiced considerable unhappiness at GMHC’s lack of consultation with his clinic over its planned move, saying it upended Cornell’s build-out costs for its medical facility. The clinic, no longer a sub-lessee of GMHC, will have to move in the next year, but Gulik now foresees no significant problem finding adequate space in its current neighborhood.

“There are no hard feelings,” he said, emphasizing that GHMC offers a range of services tough to find anywhere else.

Weinberg, in walking Gay City News through the new agency home, made that same point over and over. The dining hall, the television room, where movies will be screened following Friday evening dinners, and the Jerry Herman theater desk attend to the clients’ need for nutrition, affordable entertainment, and companionship.

A workplace readiness lab –– stocked with computers provided by SUNY –– responds to the welcome reality of people living longer and healthier with AIDS and the resulting return to the employment world by many. The lab becomes a full-scale high school on evenings, helping clients to complete their GED.

The 33rd Street facility and a prevention and youth outreach satellite due to open on West 29th Street at the end of June will both house branches of MOMS Pharmacy, which specializes in serving HIV-positive populations through treatment adherence counseling as well as oversight of psychotropic drug regimens. Just over one half of GMHC’s HIV-positive clients, Weinberg noted, have also been diagnosed with mental health issues.

A crisis intervention unit, named Team 119, provides immediate care for those who arrive, many for the first time, in a state of distress. Both Weinberg and Hill mentioned a distraught woman who came to the agency the week before, only days after the facility opened, saying she had just moments before received a positive diagnosis. Within minutes, she had a team of professionals and peer counselors working intensively to help her over her emotional hurdle and lay out the first steps toward her care.

With GMHC’s leadership, heading into this Sunday’s annual AIDS Walk, clearly confident that it has surmounted its own hurdles, the question remains how the clients themselves feel.

One leader of the dissident faction, Marcelo Maia, has not reconciled himself to the changes that have taken place. Having resigned from the Client Advisory Board (CAB) at the height of the controversy, he has only been back to the agency a handful of times, and plans to rely on other resources to the extent he is able. Still, in an interview this week, he sounded more disappointed than angry.

“I hope this works out for them,” he said. “I don’t carry a resentment for them. The organization is still vital.”

Joseph Sellman, who fought alongside Maia last spring, remains on the CAB, though he conceded that he has shifted the primary focus of his AIDS activism to the National Action Network in Harlem. Having been to the 33rd Street site only a couple of times in its one-month existence, he said it appeared to be a nice facility, but remained cautious about how things will work out.

“I am thinking there will be more revealed,” he said.

Ed Shaw, a longtime CAB member who assumed its leadership late last year, said the agency’s critics did not reflect the majority of its clients.

“I think I can speak for most clients when I say we are very much elated at the new move,” he said. “The challenges have been put to bed. Everyone I’ve spoken to is very much in favor of what we have at the new facility.”

Shaw said he was particularly impressed by GMHC’s ability to be up and running with all its services so quickly after its move.

Rivera, the board member client who found himself so much at the center of competing factions last year, said he believes the controversies, in the end, proved productive.

“One of the good things that came from the uproar, it brought everyone to the table,” he said.

And then, reflecting the measure by which most clients will probably judge GMHC in the long run, Rivera recalled arriving at the agency 11 years ago with both an HIV and a cancer diagnosis.

“GMHC really saved my life,” he said. “What many of the people there do, you really couldn’t pay for their work.”
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 The article was originally published in Gay City News on May 11.

GMHC Moves to West Side

GMHC officially opens new offices (photo by Winnie McCroy)

by Winnie McCroy, EDGE contributor
May 2, 2011

Elected officials, HIV/AIDS activists and journalists crowded Gay Men’s Health Crisis’ seventh floor dining room on April 29 for the ribbon-cutting ceremony that officially opened their new home on Manhattan’s far West Side.

Doctor Marjorie Hill, chief executive officer of GMHC; state Sen. Tom Duane; city Comptroller John Liu; Congressman Jerrold Nadler; state Assemblymember Dick Gottfried; Councilmember Daniel Garodnick; Miss USA 2010 Rima Fakih and Rabbi Sharon Kleinbaum were among those present.

GMHC’s new headquarters is spread over two floors-administrative offices and public policy staffers are on the sixth floor; and the living and dining rooms, SUNY computer lab, workforce development, mental health counseling, nutrition and wellness and a pharmacy are on the seventh floor. The offices are decorated in bright, engaging works by the Keith Haring Foundation. Services are organized to serve clients a more efficient and effective manner. But Hill stressed the people behind GMHC are more important than just a physical space.

"For 30 years, what made a house a home are the people," she said. "The staff who meet the people, the clients who come here with various challenges, the individuals who insure that we have resources to make things go smooth... While science has made what some of us thought would never happen - HIV for many people is a manageable illness - but in spite of that, science has not created a cure, science has not ended the stigma, poverty, racism, and homophobia that fuel the epidemic, and that’s where GMHC steps in... to challenge where science leaves off."

"Together we can forge a path to the future," Hill noted.

"This new home gives us the potential and promise to meet the increasing needs of HIV in the 20th century," she said. "We want to meet the problems by providing the opportunity for individuals not just to take meds or adhere to their treatment, although that is important, but the opportunity to live more full, more productive, meaningful lives in spite of HIV."

Hill then brought up Duane, an openly gay state senator with HIV who has a long history of working with GMHC. "Quite frankly, I would have thought the stigma would be gone by now, but sadly, far from it," said Duane. "Stigma still exists; here in New York City, in Albany; and GMHC has been a force in fighting back against stigma, and their work goes on. Congratulations to GMHC on your new home; it’s beautiful!"

"Who would have thought 30 years later we would still be fighting HIV/AIDS, but here we are, and GMHC has been a leader in the fight all along," added Duane; who praised GMHC’s wide variety work with every demographic impacted by HIV/AIDS, from serving clients to doing advocacy and policy work.

Hill also reflected upon GMHC’s history. The organization began with $7,000, but its annual budget has grown to $32 million. She acknowledged co-founder Dr. Larry Mass, who was in attendance, as well as others.

"A lot has happened to make this facility happen," added Liu. "A lot of struggles, financial and otherwise, but we are here because the mission of GMHC is even more critical than ever before... but there is still more work to be done. And the stigma Senator Duane talked about still exists. It speaks volumes to the need to have this kind of center. I want people to know that there is a family here at GMHC, clients can come here to get their meals, share in the camaraderie, and know that they have a safe place to come."

Hill was as proud of GMHC’s new headquarters as she was of the fact that the project came in under budget and without tapping into any program funds. She praised Chief Operating Officer Janet Weinberg for keeping her eyes on the prize while leading the organization into their new space.

"GMHC has been a leader in the fight against HIV/AIDS for the past three decades. Through every fight we’ve had, GMHC has been there," said Nadler, who remembered working with the group in the ’80s to get the price of AZT lowered. "We have come a long way. We have changed the diagnoses of AIDS from a short-term death sentence to a chronic, manageable disease. We have changed the attitude in this country in a lot of ways, from needle exchange...to Ryan White and HOPWA funds. It’s taken a lot of work from many organizations, but none more so than GMHC. In addition to all of the direct services they provide - education, treatment, dealing with people on social services - it’s the powerful treatment model that GMHC pioneered that has made the work so effective."

David Valdez, chair of GMHC’s real estate committee, vetted six different real estate firms before choosing Cushman and Wakefield. He toured 30 different buildings to find the right location and negotiating lease agreements. In the end, Valdez said the new building will save GMHC tens of millions of dollars.

"The rent in the first year will be lower than last year’s rent in the old space," he said "And the results are not due to accident or luck. The team that formed in 2008 made this happen."

But at the end of the day, it is about the clients as Hill noted. GMHC receptionist, volunteer, and client Angelo Cavana shared his story about moving from Florida to New York in 2007. GMHC helped him get tested, find housing and fight his substance abuse problem. Cavana became a volunteer before becoming a peer educator last year.

"My journey really started when I walked through the doors of the Geffen Center," said Cavana. "Since then, my life has done nothing but improve."

Kleinbaum, a former GMHC board member, then blessed GMHC’s new home. "May this space be sacred with the blessings each of us brings, how we care for each other, how the staff and clients treat each other, sacred in the way the board meetings are held, in how the building is cleaned, how food is served with love and generosity, sacred in the way we believe in the power of each other to bring healing, hope and love to this world," she said. "Let this building be blessed with the many who will inhabit it, starting only days ago and for many days to come. May this building be full of blessings, and may each of us continue to bring blessings to this space every day."

Hill and Jonathan Tisch, whose mother Joan Tisch is a lifetime trustee on GMHC’s Board of Directors, then cut the bright pink ribbon.

GMHC is now located at 446 W. 33rd St. in Manhattan. Log onto www.gmhc.org for more information.
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Winnie McCroy is a freelance writer based in New York City. She has written for publications including The Village Voice, The Advocate, Curve Magazine, Gay City News, and Chelsea Now.

Winnie's article about GMHC's grand opening and ribbon cutting was originally published in edgeboston.com (see link below). 

http://www.edgeboston.com/index.php?ch=news&sc=&sc2=news&sc3=&id=119171