PositiveLite.com writes: the speech which is reproduced below in slightly edited form was delivered to a plenary session of AIDS 2014 in Melbourne and was also the subject of an aidsmap article titled “Tackling moral judgments about sex and sexuality is vital for HIV prevention” that appeared here.
Originally I was thinking to tell you the story of my HIV diagnosis. About how my diagnosis in 2004 resulted in the threat of deportation due to Singapore’s HIV travel restrictions. I was going to tell you how my HIV status resulted in being stopped at Singapore airport on the Christmas of 2009 and how I was blacklisted from the country thereafter. I had thought I'd share how I fought my way through the blacklist so I could visit Alan, my Singaporean partner of 10 years. But to be honest, there are better things I could be sharing now.
If you want to ﬁnd out about that story, just google the Here I Am campaign from the Global Fund Advocates Network. And while you’re doing that, please show your support for the global fund; we can’t end AIDS in this world without a fully funded Global Fund.
What I'd like to do is share some things that need to be said, share things that often get left unspoken. I will also share with you new ideas that I think could help end HIV among trans people, gay men and other MSM.
I am concerned that our diverse communities live in an atmosphere where people are afraid to speak.! I’m concerned we’re living in an atmosphere where people have to hide. By this I’m talking about fear and hiding on matters of pleasure, sex and sexual health.
You see, science and public health would like reason and logic to be part of every waking moment in our lives. But in reality, when it comes to love, pleasure and desire, our actions are far from rational or logical. That's what makes us human.And there’s nothing more human than sex.
"Humans will continue to struggle or be fascinated with the tension between desire and reason. Tension between risk and pleasure. That’s what life is all about."
Let’s talk about sex for a bit. We know that sex is risky. Not only in the context of STIs, but with sex also comes emotional and physical risk.But we also know that that sex can be pleasurable and fun. That’s why we seek it out. And we also know that whether you agree either statement or not. Humans will continue to struggle or be fascinated with the tension between desire and reason. Tension between risk and pleasure. That’s what life is all about.
So my question is: as community health advocates, how are we navigating between these two statements? If we fail to navigate this well; people become disinterested. Go underground. Become disconnected. And it’s time to reconnect with our diverse communities. Re-engage. Acknowledge our humanity. If we don’t then we risk being branded as out of touch with the reality of life.
One day vaccines and other next prevention tech will be ready. I would hate to think that moral judgement would get in the way. Get in the way of vaccinating our communities against HIV.
Acknowledging this tension may be difﬁcult for some people to swallow. But I believe that there are lessons from 30 years of HIV that can help us out. As health advocates, we can understand the importance of choice for women. So if we can defend the rights of women against moral attack (and we must continue to do so); then it is possible to fathom the same principle of choice in sexual health for trans people, gay men and other MSM.
If we can understand through harm reduction about the importance of maintaining connection with people. If we can learn the beneﬁt of providing health and support consistently, and without judgement. Then we can apply the same principles to trans people, gay men and other MSM.
Our communities are diverse. And if sincere about wanting healthy communities then we have to understand that there’s more than one way to provide health.That said, we know that by acknowledging the principle of pleasure, and providing community-friendly health choices; acknowledging these things will not equate to an instant demand for prevention, care, treatment and support. We know there are other harsh realities that we need to resolve at the same time.
At AIDS 2012 in Washington D.C I spoke at the closing session. If you were there, I have to admit I was a bit nervous. It’s not every day that you have Bill Clinton waiting to speak after you. Some speakers yesterday will know how I felt. Despite the nerves back then, I appealed to health workers around the world. I asked health workers to treat trans people, gay men and other MSM like humans. In essence: to treat people right, and treat them right now.
Since that conference, what have we witnessed in the world? Let me tell you. Since 2012 we have witnessed:
- More homophobic laws passed, in some cases reinstated;
- More violence persecution and threats from the state;
- More exclusion from family, society and denial of livelihood.
-- HIV and STI rates rise persistently among MSM and trans people;
- As well as persistent late-stage diagnosis of HIV.
- And I personally have witnessed more grief-stricken posts on Facebook. People posting about seemingly healthy young men dying inexplicably.
Laurindo Garcia presenting at AIDS 2014. Photo: International AIDS Society/Steve Forrest
All these things we’ve witnessed in the past two years. In an age where HIV is no longer a death sentence. In an age where HIV-positive people like myself can live long healthy lives thanks to antiretroviral therapy. If you're lucky enough to have access. We’re supposed to be living in an age with more options than ever before. We have condoms, lube and rapid HIV testing. Treatment as prevention, PrEP and PEP. All these things that can help save lives.
This morning we've heard of recent research breakthroughs that give us hope. Hope that a vaccine, rectal microbicides and dare I say, even a cure are coming within 20 years. Yet in this 21st Century, in 81 countries around the world, the idea of a health intervention for trans people, gay men and other MSM is to beat us up; or, throw us in jail. To silence us, deny us and force us underground, demean us, devalue us and hate us. Or simply just kill us.
" Our lives are shrouded with so much shame and fear. How can we even think of building healthy lives?"
What good are condoms, lube, PrEP and earlier ARV treatment? What good are these things when we live like there’s a gun held to our heads? Our lives are shrouded with so much shame and fear. How can we even think of building healthy lives? Health for our communities is not limited to what happens between our navels and our knees. We are not simply a population of disease vectors. A population that must to be managed, or worse, to be exterminated.
There is indeed a raging epidemic among trans people, gay men and other MSM; but it’s not just HIV or STIs.What we are ﬁghting here is an epidemic of hate. An epidemic of ignorance. An epidemic fuelled by the ugly side of organised religion and power. An epidemic with hotspots around issues of race and socio-economic class. So much has been invested over the past 30 years. So much knowledge, money, time and energy.And despite all this resource our communities are still getting infected. Despite all this effort our communities are still dying. All that we've done is obviously not enough. We all need to be doing more. Doing more now!
I ask you, what can we do? What can we do to help step up the pace to end HIV among trans people, gay men and other MSM? Well…today I have a solution for us. A new research agenda. This agenda may be of particular interest to the International AIDS Society. I’d like to propose research on: an intolerance vaccine. A vaccine that could help us irradiate a condition that has plagued humanity for generations.
Just imagine if the intolerance vaccine were dispensed to every politician, bureaucrat or religious leader on their ﬁrst day of work. The world would truly be a different place If our decision-makers were more tolerant, I’d bet we see much fairer laws, policies and practices in this world. Imagine if we dispensed this vaccine to the general population at birth. Why, humanity might become nicer to each other. We’d most certainly see a massive improvement in the lives of every minority group on the planet. We might even see peace on the Gaza Strip or in the Ukraine. We really should be sinking our money into research like this. This vaccine could help scale-up HIV interventions like never before.
The next item on new research agenda that I would like to propose to the IAS is: a violence condom. A condom that can protect us from violence. Just imagine people could open up a violence condom; climb into it and walk the streets safer knowing they were safer from the thugs .Imagine how much revenue that violence condom manufactures and licensees could generate. They’d make a killing in places like Nigeria, Russia, Jamaica, Iran, Zimbabwe, Saudi Arabia, The United States and Brunei, just to name a few.Wearing a violence condom would make seeking health services in these places so much easier.I admit, it might be a little awkward and wobbly to walk in. But that’s much better than being beaten up. I’m sure the clinics would be thrilled. Thrilled because more client be able to come out and seek their services without fear.
The third and ﬁnal pillar of my new research agenda for the IAS consideration is the post-hate exposure prophylaxis. A pill you can take after you’ve been exposed to hate or stigma. Young people could self-medicate. Pop a pill to neutralise hateful, homophobic or transphobic language. Hate spewed out by religious fundamentalists, by Fox News, or even by relatives across the dinner table.
This Hate PEP could potentially help save millions of public health dollars. Suicide hotlines, Alcohol and Narcotics Anonymous would be a thing of the past. Personally I think Hate PEP should be marketed as the “Happy morning-after” Pill. We could even do research into pre-exposure prophalaxis, a “Happy morning-before pill” could help every trans person or gay men living with HIV to protect themselves. Protect themselves against being labelled by our own community as “unclean” and “bug-ridden”.Told by our community that we are disqualiﬁed from pleasure, desire and intimacy because of our HIV status. If this pill made us happier there’s a strong possibility that we’d be healthier people.
These three are just excerpts from a research agenda for everyone’s consideration. Call them dreams of absurdity. Or maybe even dangerous ideas.Who’s with me on these proposals? Dr Leuwin? Dr Barre-Sinoussi? Are there any funders in the room? Anyone from amfAR? Let’s talk after this session.
I’ll put these dreams aside for now, and offer a reminder. A reminder that violence, discrimination and stigma is a day-to-day reality. A reality for every trans person and gay man. And It's a reality for the many people who are different from the social norm. But if our societies persist in condoning violence, discrimination and stigma. Treating against people who are the minority as criminals, as dirt, then humanity will never know the meaning of equality, freedom, love and compassion.
We have data that validates our harsh reality. The Global Commission on HIV and the Law tells us that public health investment and strategies are undermined. Undermined by the laws, policies and practices informed by the intolerance of decision-makers. The World Bank has also provided us recent data validating the cost of homophobia. Tax payers need to know that homophobia is expensive business.
The reality for many young men and trans people in the Philippines where I live is that we are on the brink of unraveling 16 years of protecting the rights of people living with HIV. Trans and gay Filipinos could soon face mandatory testing and be criminalised for HIV transmission. All because our department of health is looking for expediency rather than treating people right. The President of the Philippines needs to understand that punitive laws undermine our progress in ending HIV. And I ask that together we call on the President of the Philippines, the country with the fastest growing HIV epidemic in Southeast Asia to take a stand for inclusion and human rights of LGBT Filipinos.
"After being bullied, harassed and excluded from society, you’d feel pretty miserable about yourself too, wouldn’t you?"
We also have data on the harsh reality in which we live from the International Gay and Lesbian Human Rights Commission. ILHGRC tells us that trans people, lesbian and bisexual women in Asia’s LGBT community experience signiﬁcant levels of violence. That combined with violence experienced by MSM means that our communities don’t have a lot to look forward to. Our streets and homes are not safe. If that was your day-to-day reality, how would you feel? After being bullied, harassed and excluded from society, you’d feel pretty miserable about yourself too, wouldn’t you?
Well, to deal with this reality some of us numb ourselves. Numb ourselves with alcohol, drug use, social isolation and suicide. We now have scientiﬁc evidence from MSM Global Forum. Evidence telling us that all these factors contribute to risk of HIV infection among MSM. Living with harsh reality such as this, it takes courage to live through every day. Despite this, we need to muster more courage. More courage to take a stand. Because history tells us that when we do muster courage and take a stand, amazing things are possible.
Do we have the courage to end HIV? I ask you what can we do right here and now? What can we do while we wait for my new research agenda to get off the ground? Any ideas?
Well, today, I have a solution for you. While we wait for violence condom, we can step up the pace to help end HIV if health professions protected people from homophobic and transphobic violence. As health professionals we must continue to provide access to health and treatment. Continue to do our job even if people are branded as criminals. It’s our ethical duty to care for people, no matter what. While we wait for an intolerance vaccine, we can step up the pace to help end HIV if religious leaders, teachers and employers help make our spaces more inclusive. We’re all on this planet together. And we all have a right to be here. If the Church of England combats homophobic bullying in schools. If an imam can welcome marriage equality into his place of workshop. Why can’t other community leaders follow suit to make our communities open for everyone? And while we wait for the research on a “Happy morning-after” pill, we can step-up by the pace to help end HIV by appealing for more empathy. Because our empathy tells us that despite our differences, we all entitled to love, desire and pleasure. And this entitlement is the same regardless of sexual orientation or gender identity. It's the same regardless of whether we are HIV positive or negative.
Many here today are doing outstanding work in the ﬁeld. And for that we thank you. Especially those of us who work in hostile environments. That said, we must continue to challenges ourselves. Continue to push our own personal boundaries. This epidemic of hate doesn’t look like it will end any time soon. So we have to step-up the pace to eradicate hate.
There you have it: four simple things to help end HIV. Protect people from harm and provide access to treatment; Make our spaces more inclusive; And appeal for more empathy. If you can do all these things already. That’s great. Then teach others, and repeat.
I thank the IAS and the AIDS 2014 organising committee. And the traditional owners of this land, past and present. I thank them for welcoming us into this space so that I could talk about my disruptive research agenda.
Please help end HIV among trans people, gay men and other MSM by share this agenda with some who needs to hear it. Thank you for listening.
About the author: Laurindo Garcia is a civil society advocate working in the Asia-Paciﬁc region - based between the Philippines and Singapore who has founded a regional social- enterprise called B-Change. After working in technology, media and communications for over 20 years he is regarded as an expert in harnessing technology for social change with a specialisation in social justice, diversity and health for marginalised groups, especially LGBT (lesbian, gay, bisexual and transgender) people and people living with HIV. He is coordinator for two regional community networks "that promote health for people of diverse sexual orientations and gender identities. He was one of the architects of a multi-country community systems-strengthening initiative for men who have sex with men and transgender people that succeeded in Round 10 of the Global Fund to Fight Aids, Tuberculosis and Malaria. He led his organisation to convene a global gathering of HIV and social justice advocates for the Advocacy[2.0] Summit held in Washington D.C, in partnership with Levi Strauss Foundation. In 2011, Laurindo was a delegate at the high-level AIDS Champions Meeting in Busan, South Korea and was called to be one of the civil society speakers at the opening ceremony of the 10th International Congress on AIDS in Asia and the Paciﬁc making him the ﬁrst gay, Asian man openly living with HIV to address an international plenary in 17 years. He was again called as the community speaker, joining Dr Françoise Barré-Sinoussi and U.S President Bill Clinton in the closing session of the 19th International AIDS Conference in Washington D.C in July 2012.. He is also a regular contributor to the Hufﬁngton Post.He previously worked as HIV Program Manager and correspondent for Fridae.com. Since then he founded a regional social enterprise group called B-Change that published its ﬁve-year strategy for regional community engagement in 2013 called ‘Connecting The Dots’ - a collaboration with the United Nations Development Programme and other global community partners.