The Normal Heart, A Generation Later

by Lawrence D. Mass, MD

     

In writing about this play, I am writing from several perspectives:

·    as someone who has known and been entangled with Larry Kramer for 45 years

·    as a composite character in the play, "Mickey Marcus," (named, according to Larry Kramer, after an Israeli general who was the subject of a film, Cast a Giant Shadow).

·    as an AIDS activist and journalist

·    as a co-founder of Gay Men's Health Crisis (GMHC)

·    as a chronicler of the life and work and times of Larry Kramer (I'm the author/editor of the Larry Kramer anthology, We Must Love One Another Or Die: The Life and Legacies of Larry Kramer.)

·    as a gay man, Jew and theater goer

Following the world premiere of The Normal Heart in 1985, I was interviewed by Dinitia Smith for New York Magazine. What was my reaction to the play? Despite having been so unsettled by my initial perception of the play's portrayal of me that I had to step out of the theater for a few moments to regain my composure, I said that I was "honored" --by Larry, by the play, by our struggles. She quoted me on that in a way that made it possible to read my reaction as questionable. "Honored" to have been in this play where you end up on the flight deck at St Vincent's Hospital? 

But I'm proud in retrospect that I got it so right then. I was and remain honored. And in fact, that is exactly what I told Larry Kramer as we sat next to each other at the premiere of Jean Carlomusto's remarkable documentary "Sex in an Epidemic," in which we're both featured, at the GLBT Film Festival in June 2010. "I'm honored to sit next to you, Lar," I told him. And I meant it.

It may still seem questionable that I have such surpassingly positive feelings about Larry after all that has happened. But it's the bigger picture--the forest, not the trees--that I try to keep in view.

The same is true of the play, The Normal Heart. Below, I'm going to list some aspects of the play where there is controversy or where I believe there are distortions. But I have not lost my bigger-picture clarity of the play's truth, power and importance.

·     Felix is a largely fictional creation. During the period of the events and writing of The Normal Heart, so far as I was/am aware, Larry was not having a love affair of such weight with such a figure and there was no "marriage" consecration by Dr. Brookner. 

·     "Dr. Emma Brookner," in real life Dr. Linda Laubenstein, was in many ways the iron-willed, unself-pitying character that is portrayed, except for the high level and pitch of her activism.

As for Dr. Brookner's and Ned Weeks's certainty, or strong instinct, that were dealing with an emergency that required everyone to "just stop" [having sex], to just say no, the best summation of the reality of that moment comes from Rodger McFarlane, GMHC's first executive director, Larry Kramer's closest friend and the AIDS activist Larry has most consistently praised. In Jean Carlomusto's documentary, Sex in an Epidemic, McFarlane says clearly, unequivocally and correctly that prior to 1985, nobody knew with certainty what the cause was, "and don't let anyone tell you otherwise."

Sometimes I wonder how aware Larry is of how much of the dramatic tension of his early scenes with Dr. Brookner comes from our awareness that "Just tell them to stop" was never going to work, not then, not now. I say that I continue to wonder about this in light of Larry's Tony acceptance speech in which he noted that he "couldn't have written this play if so many hadn't needlessly died," echoing his pre-play statement for CNN that this was an epidemic that "could have been prevented."  

I'm not sure exactly what he thinks would have made the difference in that earliest period. If GMHC had uniformly sent around directives saying as boldly and confrontationally as possible--JUST STOP, EVERBODY STOP HAVING SEX IMMEDIATELY!--would that have saved a lot of lives? Beyond questions of how the fragile community would have reacted to that level of panic in the absence of certainty about what was going on and what was causing it and who was giving this advice, and notwithstanding there being no GLBT civil liberties protections of any kind in place, yes, it might have saved some lives.

But from day one, most people wanted to know exactly what they needed to stop doing--holding hands, kissing, having oral sex, having anal sex, etc. That we were not urging condom use clearly and strongly from day one was a mistake we all made (CDC--and me with them--most notably), but it was based on the uncertainty that it was even an infectious agent. Even those who felt most certain that the epidemic was being caused by "promiscuity"--i.e., Dr. Joseph Sonnabend, Michael Callen and Richard Berkowitz--did not believe that a single agent was causative. And even Larry, whose instincts and opinions were/are so legendarily strong and who seems incapable of curbing his urge to cast blame ("Larry Blamer," ACT UP filmmaker Gregg Bordowitz dubbed him), and who seemed to sense earlier and more strongly than anyone else that we might be dealing with some kind of primary infectious agent, never made the mistake of expressing certainty about the exact cause of the epidemic when that cause was still unknown.

·    The reason that Paul Popham ("Bruce") was the leader everybody was willing to follow was not simply that he was "gorgeous" or because he fed the superficial daddy fantasies of gay men by his having been so virile and a former green beret. It's because he had the character to match his looks. He was in many ways the classic "strong silent type" --self-effacing, gentle, generous. For these qualities, Paul was liked.

·    "Mickey Marcus" was and is a physician working in addiction treatment/Methadone maintenance and my patients were as affected by the new epidemic as gay men were. I did not work for the health department and my job was not endangered, as the play suggests. My struggles were more about finding the time and resources to do my independent, unpaid writing on AIDS and about my own personal struggles with addiction than about "not knowing what to tell people." What I was telling people is what I still believe: that we need to remain affirmative and even celebratory about our sexuality, while at the same time recognizing that we are dealing with a public health emergency that requires us to limit, as much as possible and as best we can, risk behaviors. (That AIDS was being caused by a primary viral agent, HIV, was on the verge of being established at the time of the play's premiere.) The best nitty-gritty work of developing safer sex guidelines came from other and subsequent voices--e.g., Michael Callen and Richard Berkowitz, Raymond Jacobs, Michael Shernoff.

·     Mayor Ed Koch does not have a good place in the history of AIDS. Even so, in portraying him as a "mass-murderer," Kramer made him into a scapegoat. The same could be said about President Ronald Reagan (to say nothing of Dr. Anthony Fauci later). Koch and Reagan were serious villains, yes, but in reality, they were more like Pope Pius XII vis-a-vis the Jews of WW II, more leading colluders in their silence and passivity than actual perpetrators of megadeath. They were homophobic, yes, but they were not themselves rabid-dog, frothing-at-the-mouth homophobes actually proposing mass-murder scenarios, like the previous generation's Paul Cameron or the present-day politician-thugs of Central Africa (Uganda) who have been in bed with American Christian zealots. They were not themselves deeply personally invested in homophobia per se the way, say, Michelle Bachmann is.

It's no surprise that Koch really was and remains a closet case. Larry and I had dinner with the man who was said to be and who claimed to be his ex-lover, a patient of homophobic psychiatrist Dr. Charles Socarides (!) who claimed Koch had pressured him to move away from NYC during the period of his re-election. And it's likewise true that Koch very seriously impeded early responses to AIDS, as is portrayed in the play. But over the years of his being Mayor, Koch's record with the gay community was actually quite mixed, with some significant achievements. He marched in the Gay Pride parade when it was still unfashionable for politicians to do so, and probably before Larry did (if he ever did). Koch was instrumental in shepherding NYC's Gay Civil Rights Bill to passage, even though it took 15 years and should have happened a lot earlier. Koch was also key to our getting the GLBT Center here in NYC. No small matter. 

Ed Koch was otherwise typical of a kind of closet case that Larry very appropriately went after tooth and nail. Since Koch, how many conservative Republicans working and voting against us in countless ways have turned out to be closeted gay men? With no exceptions that I can think of, I was on the pro-outing side of the outing debates and controversies. I can't say I regret the verbal tar and feathering Koch (or Reagan) got from Kramer and ACT UP and the play. Not surprisingly, Koch also impeded initiatives to help drug addicts. He opposed the needle exchanges ACT UP worked so hard to promote, which became the most successful of all harm-reduction approaches.

Again, it's hard to defend Ed Koch, but to get the most and best out of people like Koch and others, we had to be able at some level and to some degree to negotiate with them. And therein lies the real conflict between Larry Kramer and the Board of GMHC. GMHC was unfolding as an information and service organization, and, though it's a dirty word, bureaucracy, one that Larry, more than anyone else, with the help of his brother, had put in place, as is detailed in the play. The idea of what GMHC would become was something along the lines of the American Cancer Society, The American Heart Association or the American Diabetes Association. As such, and once up and running, GMHC needed to do a lot of painstaking negotiating and compromising, not the guerrilla warfare confrontational activism Larry increasingly had in mind. 

Of course, what Larry envisioned and wanted us to do--become MUCH more activist--was right, absolutely right. But what was needed was not the reconstitution of GMHC but the creation of another organization much better geared to political confrontation and activism. That organization, ACT UP, is exactly what was needed and Larry Kramer immediately went on to conceptualize, found and lead it in what are certainly among the most glorious chapters in the history of the gay liberation and AIDS movements.

I can't imagine that GMHC would ever have had such impressive early growth without Larry's leadership at every level. But it's also hard to imagine that as a bureaucracy, it would have continued to function optimally with this so much more activist agenda. Did the direction GMHC took after Larry's separation proved that Larry was right?  However much this may smart, the answer is that it proved the opposite. GMHC has done and has continued to do much important and honorable work. And its achievements continue to complement those of ACT UP. Is there really anyone who wants to argue that we would have been better off if Larry had tried to turn GMHC into ACT UP rather than our having both organizations? Larry's founding and leadership of GMHC should always be acknowledged, first and foremost, with the greatest respect. But what happened, inevitably, was to the benefit of us all. No rewriting of history can ever turn the clock back on that.

·    Re: that final letter from the GMHC Board to Larry Kramer. Following my hospitalization, and before that letter was written, I resigned from the Board. According to my memory, and as verified by Larry later, I was not signatory to that letter. I do, however, recall that, however reluctantly, and for the reasons stated in the preceding paragraph, I supported GMHC's move to reconfigure its leadership. I believe that awful, extreme letter was written by GMHC co-founder Nathan Fain. It sure seems very regrettable now, although the move by GMHC to distance itself from Larry still seems to have been the right move in time and place.

...A generation later, after considerable confrontation and protest rallied by Kramer over GMHC's move to a new space (Kramer argued on behalf of a number of GMHC clients that the move was ill-considered and could be bettered, even at the eleventh hour), the ribbon-cutting ceremony for GMHC's new location took place Friday, April 29, 2011. I was there. Larry was not.

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My reaction to the Tony-Award winning revival of The Normal Heart.

There was a paradox to Joe Mantello's Ned. He was probably the plainest, most amiable, least-raging of Neds. And I personally found this a relief. The withering impact of being blasted by Larry/Ned was much less than dreaded. I could relax and pay more attention to the words, although Mantello was at times too soft-spoken (I saw the current revival in preview.). The original Ned, Brad Davis, presented a different kind of challenge. Davis was more effective at conveying the intensity of Ned's inner and outer anger and rage. The paradox with Davis was that he was so "gorgeous"; so the considerable material on Ned's not being as attractive as Bruce and on Ned's love-life issues got convoluted as you watched and were utterly seduced by Davis, who was giving the performances of his life and career (Davis later died from complications of AIDS). The other actors in the Broadway revival were excellent and the production and direction by Joel Grey were tight and crisp.

There was a telling moment as we exited the theater. As has now been reported in the New York Times, a crowd developed outside the stage door to see the cast, especially Ellen Barkin whose star is currently so ascendant. There was palpable excitement as everybody eagerly awaited some sign of activity. On the opposite side in front of the theater, a lone figure appeared to be confronting people with leaflets that said [The AIDS Crisis is Not Over!] People seemed to be picking up their pace to leave the theater area as this in-your-face noodge with a baseball cap dogged them. On closer inspection we could see who the leafleter was. It was Larry Kramer!

The leaflet had summary updates on various characters in the play, though nothing on "Mickey Marcus."

Because of all my entanglements with Larry, the play, and the issues, I can't be truly objective. But I do think The Normal Heart remains one of the most powerful and important plays of our generation. It is a priceless document of gay and AIDS history that will hopefully help inform future generations of who and how we were, and encourage them to be brave, act up and dream big in confronting health and moral crises. It is living testimony to the ACT UP slogan, Silence = Death. The Normal Heart is, like Kramer himself, as far from silent as you can get. Because of Larry Kramer and TNH, the world is a lot less likely to write us out of history, as is already happening (e.g., the otherwise excellent and important 2006 PBS documentary, "The Age of AIDS," which sweeps past the early gay history of AIDS). Because of Larry Kramer and The Normal Heart, the world is a lot more likely to "Never Forget!" 

And because of Larry Kramer, we are far more likely--no, change that to certain--to get both a cure and a preventive vaccine for AIDS, even though both are still believed by many to be impossible dreams. 

                                                                   ______________________

A rougher version of the above commentary was sent around by me to select individuals, including Larry Kramer and his ACT UP list-serve, on the eve of the premiere of the current Broadway run of The Normal Heart. Larry had generously arranged for me to have comps to the previews, one of which is what this commentary is based on. Naively, I thought this was something Larry would appreciate since it is certainly a tribute, whatever its relatively minor qualifiers. Larry says I have this tendency "to say great things about me after dragging me through shit." He was especially incensed at my suggestion that the character of Felix is fictional, or largely fictional, pointing out that I really wasn't around during that period, so "what the fuck do [I] know about it?" I responded that I kept in touch with GMHC people and mutual friends, and edited a book on him (Larry), in the course of which I don't recall any such person being discussed by him or me. And that while I did very vaguely recall a very brief interlude with a Times fashion person, I didn't recall that there was actually a relationship of any continuance and certainly not one that ended in a "marriage" conducted by "Dr. Brookner." I likewise had no recollection of Dr. Linda Laubenstein's having been such a passionate activist.

But in each of these situations, I can see composite, deeper and abiding truth. For example, in Felix, I can see Larry's relationship with the greater community of gay men dying of AIDS. For me, that resonates more powerfully than the actual relationship portrayed in the play and supersedes the question of to what extent Felix may have been fictional. And I remember how touched and inspired Larry was by his friendship with Linda Laubenstein (Dr. Brookner). In real life this truly courageous figure never let something as "insignificant" as being paralyzed and wheelchair-bound keep her from having a major medical career. In addition to her remarkable character, in the play she represents the greater community of physicians struggling to deal with the devastation of AIDS, the lack of treatments and bureaucratic indifference. 

As for the more global issue of my "saying all these great things" about Larry after "dragging [him] through shit," I responded that I'm not his hagiographer and that, yes, I can be critical of him. I might add here that as I see it, the truth about Larry is this complex amalgam of very and truly great, and troubled elements. While he is unquestionably the great hero of the AIDS epidemic, one of the great heroes of gay history and one of the great writers of our time, there is much about Larry Kramer and his work that is served by critical scrutiny, especially his penchant for bullying, character assassination, vilification, scapegoating and the casting of blame, however impressively most such tactics, in his hands and in our time, have yielded activist success.

I don't believe anything in The Normal Heart is really false, when all is said and done. I would even go so far as to say that I believe there to be truth in every utterance of this play. But I do think it's problematic that Larry keeps saying "this is our history." Well, yes, of course it is that to a real degree, and most of its characters and situations emerge, however amalgamated or reconfigured, from actual historical personages and events. But it's not an authoritative history. Rather, it's a dramatization of Larry's version of this history. 

At the simplest if also personal level of example, the character of "Mickey Marcus," which Larry has repeatedly told me was based on me, is not a physician. Clearly, it's an aspect of Larry's compositing of this character that I wasn't behaving like a real physician. Rather, I was more this generic gay activist who wasn't responding with the requisite level of alarm. The real physician for Larry was Dr. Brookner. OK, well, there may be real truth to that perception, and many may agree with it. It's not, however, historically accurate. For starters, I was and remain a physician. In the bigger picture, for whatever reasons, it was not in Larry's interest to credit me more substantively as a gay community physician who was attempting to offer more complex and gay-sensitive observation and input during that earliest period. That would have meant a greater level of affirming the gay community's earliest responses to the AIDS crisis, something Larry didn't seem very inclined to do. The same is true, incidentally, of Randy Shilts “And The Band Played On.” Like Larry, Randy seemed more interested in indicting than affirming the gay community. Why? Well, that is a matter best left to the real historians.

There is a final consideration re The Normal Heart that isn't easy to talk about.  If the AIDS epidemic weren't still so ragingly out of control and incomparably great and serious, what would be our reactions to this play?  Personally, I'm not sure. I know that in my own case, a real part of my great affirmation of TNH is about affirming the importance of AIDS and activism around it. To express one's admiration for the play is, in other words, a way of being politically conscious and politically correct. I've thought long and hard about this issue and I honestly don't know where objectivity and subjectivity merge. For example, in the Age of AIDS, it seems close to criminal to me not to take every opportunity to affirm the seriousness of the epidemic and support for activism of every kind around it. Not to affirm the premiere figure (Kramer) and symbol (TNH) at this point seems so politically incorrect as to be unthinkable. As a writer, I don't want to ever speak untruth, or truth that is not my truth. I don't ever want to say I like or admire something or someone just because it's the right thing to do, if it at some level I harbor real misgivings. All I can say is that I've struggled with this and have done my best to be true to myself, both as a writer and as an AIDS activist. As I have said at several points in this commentary, there is no way I can be truly objective about Larry Kramer and The Normal Heart.

__________________________________________________________________________

Lawrence D. Mass, MD is an American physician and writer. A co-founder of Gay Men's Health Crisis, he wrote the first press reports on the epidemic that later became known as AIDS. He is the author of numerous publications on HIV, hepatitis C, STDs, gay health, psychiatry and sex research, and on music, opera, and culture. He is also the author/editor of four books/collections. In 2009 he was in the first group of physicians to be designated as diplomates of the American Board of Addiction Medicine. Since 1979, he has lived and worked as a physician in New York City, where he resides with his life partner, writer and activist Arnie Kantrowitz. 

Mike Ruiz And Others Donate Time To Gay Men's Health Crisis's (GMHC) 'Kiss & Tell' Campaign (PHOTOS)

By Huff Post Gay Voices

photo by Mike Ruiz

On Saturday, January 21, celebrity photographer, Mike Ruiz donated his time to take photos for Gay Men’s Health Crisis's (GMHC) HIV testing and prevention campaign, “Kiss & Tell.” This campaign encourages black and Latino young men who have sex with men (YMSM) to have open and loving discussions with partners (the people that they are kissing) about their sexual history and HIV status.

The campaign was developed in partnership with young men, ages 13 to 19, who participate in GMHC's new youth leadership-development program, CLUB1319. The program provides HIV prevention education, social networking, skills training, and opportunities to participate in developing social marketing campaigns such as "Kiss & Tell."

The concept originated out of the former and homophobic "don't ask, don't tell" policy which prohibited gay or bisexual people from disclosing their sexual orientation or speaking about same-sex relationships, while serving in the U.S. armed forces. The youth wanted a campaign that spoke the opposite of this policy -- while featuring intimacy and what is possible for young gay couples as they express trust, respect and commitment for one another.

The Centers for Disease Control and Prevention's most recent data show that between 2006 and 2009, the number of new infections that occur each year increased among YMSM -- driven by an alarming 48 percent increase among young, black MSM 13 to 29 years old.

Also joining Mike was Memsor Kamarake, fashion director and stylist, and Merrell Hollis, make-up artist and groomer, who donated their time to style the spokesmodels during the film shoot. Artur Meletin, graphic designer, volunteered to design the promotional materials for this campaign which will be launched on February 14 (Valentine’s Day). The film shoot took place at Sandbox Studio.

To view photos from the shoot, click here.
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This article was originally published in HuffPost Gay Voices, of The Huffington Post, on January 24, 2012 

GMHC Supports H.R. 2704, the JUSTICE Act, and Urges NYC Federal Reps to Cosponsor

In August 2011, Congresswoman Barbara Lee (D-CA), an outstanding leader on HIV/AIDS issues, introduced H.R. 2704, the Justice for the Unprotected against Sexually Transmitted Infections among the Confined and Exposed (JUSTICE) Act. This bill allows prisons to provide condoms to incarcerated individuals. The JUSTICE Act also calls for automatic re-enrollment in Medicaid for former beneficiaries who are HIV-positive.

For HIV-positive prisoners who had either no Medicaid benefits before prison or lost their benefits, this bill would provide automatic enrollment for Medicaid.  This would substantially increase access to HIV treatment upon re-entry and would keep formerly incarcerated people living with HIV, and their communities, much healthier.

This legislation is tremendously important to public health.  On August 4, 2011, Representative Lee released a statement regarding the importance of this legislation as follows:

"As we mark the 30th anniversary of the first discovery of AIDS cases in the U.S., we can no longer afford to ignore the reality that sexually transmitted infections can be spread within our correctional system. I introduced The JUSTICE Act to provide a comprehensive response to the spread of STIs in correctional facilities."

"Among confirmed AIDS cases in prisons, minorities account for the majority, with African-Americans 3.5 times more likely than Whites, and 2.5 times more likely than Hispanics to die from AIDS-related causes. Without uniform prevention, testing, and treatment programs, incarcerated persons living with HIV or other STIs can unknowingly infect others. Often left untreated, incarcerated persons with STIs are frequently in the more advanced stages of their disease, and once released can be even more costly for the public health system to treat."

GMHC calls on all members of Congress representing New York City to cosponsor H.R. 2704, and to voice their strong support of better access to healthcare for all people living with HIV.

Lady Bunny Reflects on Being the "Gayest Thing on Earth" and Practicing Safer Sex

photo by Joan Marcus

Sorry I missed the World AIDS Day memo, but I was very moved by everyone's remembrances of their losses, and touching personal stories which they shared on Dec. 1st.  And I join you in mourning—we all know that the drag community was one of the hardest hit.  World AIDS Day is also about educating in order to help reduce the spread of the disease.  I'd like to share my personal story, hoping it resonates with some of you.

What are the 3 high risk groups? Gays, people of color and IV drug users.  Well, I'm the gayest thing on earth, a bottom who only dates black and Latino guys, and I spent most of my 20s and 30s in NYC's East Village which probably has the highest percentage of junkies in the nation.  So, chances are that I’d have one foot in the grave and the other on a banana peel by now.  I also love to party, and we know how altered states can lead to poor judgment in sexual situations.

I spent the last few decades assuming that I either had HIV or that I’d get it.  I’m a bit of a hypochondriac, so I feverishly imagined that every pimple was a lesion and that every cold was pneumonia.  I could never bring myself to get tested because I was certain that if diagnosed positive, my gloomy disposition would worry me into the grave within months when I might otherwise live for years.  While my doctor repeatedly urged me to get the test, I was too scared.  I assumed that I had HIV, so I never did anything which would transmit it or allow me to get it from someone else on the off chance that I hadn’t contracted it yet.  It didn’t help that if you test positive for the virus in NYC, the results are given to the government.

With religious freaks like Sarah Palin running for the VP with old John McCain who could blow at any time, the government is not the entity with whom you want to share delicate info about your health.  Thinking they were doing God’s bidding, religious freaks like Bachmann or Palin could round up all the infected people and quarantine them if (GOD FORBID) they ever got into office.

However, on a day off in LA and with the moral support of a friend, I steeled myself to go into an anonymous testing center.  The Valium was in hand because the results were quick but not instant, and I just didn’t know how I would cope with even taking the test—much less the results.  Just to add a little edge, some queen who was also there for a test arrived with his pit bull. I thought, “Fab! Watch me avoid a killer disease just in time to get mauled by a killer dog.”

The test came back negative!  No words could describe the joy and relief I felt.  But once that subsided, I realized that I now have a tremendous responsibility to stay negative.  Through all of my drunken sprees and the promiscuity which covered all 3 high risk groups, somehow I had avoided this virus.  It seemed like a miracle to me.

People probably look at flamboyant drag queens and think of them as fearless and not bound by social norms which box others in.  But I wasn’t born a drag queen, and as much as I frown on organized religion, I was raised a Christian in Tennessee.  The predominant message from the backward church folks in that part of the country was that gays are sinful perverts.  I don’t care how strong a person you are, when you’re young these messages sink in until you may start to believe them.  On some level, I believed that I deserved AIDS because of my lifestyle, so my infection was inevitable.  Sometimes this dire outlook can lead, as it did in my case, to wild abandonment with alcohol and drugs and why not, I felt? It was only a matter of time until my trashy ass got the virus.  I know I’m not the only one among us who feels this way.  I can only imagine the struggles that a religious gay endures while trying to reconcile their disapproving church and their lifestyle.

But I’m here to tell you that infection is not inevitable if you protect yourself.  While part of it was luck, I’ve also always practiced safe sex.  Have there been slip-ups? Of course! Human beings make mistakes.  But as much of a slut as I was, I was always vigilant (when not blacked out and blithering) about safe sex.  A safe slut, I call myself—because the more sex you have the more vigilant you have to be.  And let’s face it, many gays are very promiscuous.

What’s going on here? We know how the disease is spread and we ignore it? While I understand the importance of early testing if there’s been an accident.  I don’t understand my friends who get tested every 6 months. That means they obviously aren’t having safe sex—or they would have no need to get tested that often.  I discussed this with a straight friend and he said, “So they are basically just waiting to catch AIDS.” That really stung me, probably because the truth hurts. Many of us aren’t using safe sex. Maybe it’s low-risk behavior like sucking without a condom, but when you’re dealing with your one life should you choose low risk or no risk? Everyone I mention oral sex with a condom says, “I could never do that,” and that it’s low risk.

We all choose which risks we’re prepared to take. I’m fat and far from young, so eating cholesterol-rich foods is risky behavior.  Smoking and driving are risks which many of us take on a daily basis.  And I understand that many can’t warm up to the idea of sucking on latex. Some guys gripe that it reduces their sensitivity. To which I say, “Not as much as being in my grave reduces my sensitivity.” And oral is low-risk ONLY if there are no cuts in the mouth.  Haven’t you ever bled from flossing?  Does that constitute as a cut? Eating pizza or potato chips (I just gave away my diet secret) can abrade the skin on the roof of the mouth.  There’s no blood, but I feel skin flapping sometimes after eating these foods.  Is that a cut? So does that mean that oral sex after flossing, which we’re supposed to do daily, is higher risk? How long after we floss is it safer for us to blow someone?

I just don’t think we’re talking about these things enough. We file these uncomfortable questions away under the file called “Denial” even though they concern our protection.  I see reckless behavior and plenty of new infections, so the information is either not getting out there or we’re choosing to ignore it.  We know how to prevent the spread of this disease.  A friend with AIDS told me that just-infected youth imagined that he’d be sympathetic, but he wasn’t because when he caught HIV, we didn’t yet know how to prevent it.  Now we do. So get on it.

Contrary to what anyone else may have told you, you’re worth it!

_______________________________________________________________________

Lady Bunny is a successful comedienne, emcee, singer, songwriter, actress, DJ, and most famously, the founder, organizer, hostess of Wigstock, the outrageous festival of drag and music that delighted up to 40,000 New Yorkers every Labor Day, for nearly 20 years. For more info, visit her website--ladybunny.net.  Her article was originally published in Odyssey Magazine in Volume 3/Issue 6 (December 21, 2011-January 3, 2012).

Are Our Future Doctors Receiving Enough Training to Care for LGBT People?

by Andrew Silapaswan

After relocating halfway across the country to New York City, finding an LGBT-friendly and culturally competent doctor was not high on my priority list. However, my priorities changed when I required medical services in November. I quickly realized I would have to find a new primary care physician who is both knowledgeable in LGBT health care, and who will treat me with understanding and respect.


My experience is not unique, as many others in the LGBT community face similar challenges. In a 2005 survey 22 percent of lesbian, gay, and bisexual patients reported having experienced some form of discrimination in a health care setting. So why are so many health care providers ill-equipped to handle the health care needs of LGBT people? As a medical school candidate with my sights set on starting medical school in fall 2012, I am cross-comparing prospective M.D. programs and actively examining components of medical school curricula.


A medical school's curriculum must meet rigorous standards established by the Liaison Committee on Medical Education (LCME) to receive accreditation. Nonetheless, recent studies and testimony on behalf of medical school administrations indicate that there are significant gaps in curricular content. More specifically, the quality and breadth of LGBT health-related content is lacking and remarkably uneven across medical schools.


One of the most comprehensive studies examining the incorporation of LGBT content in medical education was recently published in the Journal of the American Medical Association. The report indicated that the median time dedicated to teaching LGBT-related content was five hours (during the entire four years of medical education) in the 132 U.S. and Canadian medical schools that were surveyed. Additionally, nine schools reported zero hours taught during the preclinical years, and 44 schools reported zero hours of clinical training.


In terms of overall assessment of quality, the results are equally discouraging. A majority of medical school administrators revealed that their coverage of LGBT-related content was fair or worse. Thirty-two deans responded that their school's coverage of LGBT health care was "good" or "very good," while 58 reported that it was "fair," and 34 indicated that it was "poor" or "very poor."  The results are especially problematic given the fact that LGBT people have historically faced barriers in accessing competent medical care in addition to having specific health care needs.


Research findings reported by the American Psychological Association indicate that LGBT individuals may be at an increased risk for negative health behaviors and outcomes and experience a number of health disparities compared with their heterosexual peers. For example, gay men and lesbians report higher rates of smoking. Cardiac and cancer risk factors are also more prevalent among lesbians compared with heterosexual women. A large-scale study published in 2000 found that breast cancer rates and several associated risk factors are higher among lesbians and bisexual women.

Furthermore, men who have sex with men (MSM) continue to face disproportionate rates of HIV and are the only demographic in which new infections are rising in the U.S. According to the Centers for Disease Control and Prevention (CDC), MSM represent 2 percent of the general population yet accounted for 61 percent of all new infections in 2009. Clearly, the health care needs of LGBT individuals, which are largely complicated by stigma, homophobia, and other structural factors, underscore the necessity for comprehensive LGBT-related content in medical school curricula.


Medical students' ability to effectively care for LGBT patients has also been measured. Survey results from an online study in 2006 indicated that third- and fourth-year medical students with greater clinical exposure to LGBT patients reported performing more frequent sexual history assessment with their patients. This is a critical component of comprehensive health assessment and management and provides patients an opportunity to indicate their sexual experiences. Furthermore, the students had more positive attitude scores and achieved higher knowledge scores compared to their peers with less clinical exposure to LGBT patients.


At the end of the day, some may question why medical school administrators should care about LGBT health services. The reality is that although many doctors primarily treat patients at the individual level, they also have the social responsibility to act as community-level providers. They have an obligation to deliver unbiased, culturally competent health care, and they also have a role to play in reducing health-related disparities at the population level.


Part of the solution to the problem is rooted in education. With the identified gap in medical school curricula, momentum has been building toward reform.

The Association of American Medical Colleges (AAMC), the Institute of Medicine (IOM) of the National Academy of Sciences, and the U.S. Department of Health and Human Services (HHS) have released their own respective reports on strategies to improve the health and well-being of LGBT communities. In 2007 the AAMC recommended that "medical school curricula ensure that students master the knowledge, skills, and attitudes necessary to provide excellent, comprehensive care for [LGBT] patients." Thereafter, in 2011, the IOM and HHS reports formally acknowledged how the lack of culturally competent provider training and knowledge are structural barriers to care for many LGBT patients. The IOM explicitly stated that "few physicians are knowledgeable about or sensitive to LGBT health risks or needs." Moreover, the IOM recognized that "medical schools teach very little about sexuality in general and little or nothing about the unique aspects of lesbian, gay, and bisexual health, and it is rare for students to receive any training in transgender health."


Although these recent policy recommendations are a promising step forward, the fact remains that many LGBT patients continue to face numerous challenges in accessing health care. Moreover, inadequate coverage of LGBT health-related content in medical school curricula may not meet the LCME's cultural competency requirements as stated in the ED-21 mandate of their accreditation standards. In order to remain in compliance, internal reviews of LGBT curricular content are needed in order to address the reported deficiencies.


Furthermore, the LCME and the American Osteopathic Association (AOA) should initiate a comprehensive review of LGBT health-related content in medical school curricula and expand curricular requirements as part of their accreditation standards in order to ensure that LGBT health care is sufficiently represented in medical school education. Many patients, including me, will benefit from this reform in medical education, and future doctors will receive the necessary training to more effectively care for LGBT patients.

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Andrew Silapaswan is a public policy intern at Gay Men’s Health Crisis (GMHC). His article was originally published in The Huffington Post on January 4, 2012.