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12 • BAY AREA REPORTER • April 14-20, 2011
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HIV study From page 1
and co-director of prevention at the AIDS Policy Research Center/AIDS Research Institute. Yet the researchers caution that there is still no evidence to confirm that the treatment policy has led to a reduction in HIV infections in San Francisco. “Our clinicians recommended initiating antiretroviral therapy to all of our HIV-positive patients based on our assessment that delaying treatment allows the virus to do damage to major organs systems and would lead to poorer outcomes for patients. It is too early to tell if this shift in treatment strategy last year by our clinic and the Department of Public Health has had any impact in preventing HIV infections,” stated study coauthor, Dr. Diane V. Havlir, chief of the UCSF Division of HIV/AIDS at San Francisco General Hospital. Havlir added that, “Notwithstanding the community benefit from reduced rates of new infections – which we view as an added gain – we strongly believe that the primary reason HIV patients should start antiretroviral therapy
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Teen summit From page 2
still largely ignored as a bias. The question is: ‘How do educators begin to change antiquated attitudes?’” Organizers of the Bay Area summit hope it can provide some answers. The gathering will feature guest speakers and breakout sessions on various topics, from coming out to faith-based concerns. Those expected to address the up to 500 attendees include local gay celebrity pastry chef Yigit Pura; Los Angeles-based drag queen Delta Work from the reality show RuPaul’s Drag Race; Santa Rosa teenager Kayla Kearny, who came out to her classmates at Maria Carrillo High School during a speech honoring Martin Luther King Jr. in January;
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Gay Study From page 1
percent of the adult population). The estimates are part of a report released Thursday, April 7, by the Williams Institute, a well-respected law and public policy think tank within the UCLA School of Law. The institute focuses on issues related to sexual orientation. The report is entitled, “How many people are lesbian, gay, bisexual, and transgender?” and estimates more than 8 million adults in the United States identify as lesbian, gay, or bisexual, and about 700,000 identify as transgender. The report based the percentages on the U.S. adult population (18 and older) as estimated through the 2009 American Community Survey, an annual survey conducted by the Census Bureau. That total was 232 million adults. The report also noted that a slight majority of those adults who selfidentify as lesbian, gay, or bisexual are bisexual, and women are “substantially more likely than men to identify as bisexual.” “[N]o single survey offers a definitive estimate for the size of the LGBT community in the United States,” says the report, authored by Gary Gates, a prominent scholar on LGBT-related demographics. Interestingly, the report’s findings concerning same-sex attraction and behavior are not too far off from the famed Kinsey Institute studies of the 1940s-1960s, and its estimates for self-identifying LGBs is close to that of recent exit polling data collected during national elections.
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upon diagnosis is so that they will experience better health and will have a longer life span than if they had waited.” According to the latest estimates, San Francisco continues to have an HIV endemic, meaning that cases remain flat year after year. The number of new HIV infections have steadily declined over the last decade, dropping from a high of 1,000 per year to as low as 621 per year. The UCSF researchers looked at three different models for HIV testing and treatment among men who sex with men in San Francisco. One tested the impact of following federal guidelines for treating HIV patients with CD4 T-cell counts below 500; a second looked at treatment for all HIV-positive people receiving care; and the third was a combined test and care policy. They based their projections on local HIV surveillance information about HIV prevalence and incidence, testing rates, and treatment outcomes data from the health department and general hospital’s outpatient HIV treatment clinics. The information covered 95 percent of known HIV-positive individuals in the city. The researchers predicted that
with just a treatment for people in care policy, new HIV infections among MSM would drop by 60 percent in five years. When combined with the push to test people so they know their status, the decrease in new infections would be 76 percent. “Our findings show that we can obtain even greater reductions in new HIV infections if we do a better job of encouraging people to get tested, continue to improve our linkages to care and offer treatment to all HIV patients,” stated Havlir. Through the implementation of the “test and treat approach,” the researchers also predict that the number of gay and bisexual men living with HIV in the city would be cut in half over the next 20 years, from about one in four to one in eight. The city estimates that there currently are 15,783 gay and bisexual men living with HIV in San Francisco. “The model does not predict elimination of the HIV epidemic among MSM in San Francisco,” states the study. “However, at 20 years, the test-and-treat strategy predicts reduction in prevalence of HIV infection among MSM in San
Francisco from 26.2 percent to 12.8 percent.” In an editorial commentary accompanying the study, Victor DeGruttola, in the Department of Biostatistics at Harvard School of Public Health, and Dr. Robert T. Schooley, at the UC San Diego Department of Medicine’s division of infectious diseases, write that due to the uncertainty that comes from modeling exercises, more research is needed into “test and treat” interventions before they become universally adopted. The study, they caution, “cannot tell us what will and will not be cost-effective in different regions of the world.” They also warn that modeling exercises “are not based on any genuine attempt to understand the true nature of sexual and transmission networks and, therefore, may not produce reliable results.” Charlebois and his colleagues point out in their study that the results they found are dependent on several components, ranging from patients remaining in care and having access to not just medical treatment but also housing, mental health, and substance use services.
and AIDS and gay rights activist Cleve Jones. Several local politicians are also slated as speakers, including state Senator Leland Yee (D-San Francisco) and out politicians San Francisco Supervisor David Campos and former Supervisor Bevan Dufty. In addition to Aaberg, who is expected to be at the gathering, another advocate for LGBT youth who has gained national attention will be speaking that day: Michigan teenager Graeme Taylor. The 14-year-old publicly came out during a local school board meeting last fall in support of a teacher who was suspended for a day without pay after he conducted a classroom talk about gay symbols. A video of Graeme’s comments went viral, resulting in his being
invited on to the Ellen DeGeneres Show and to the recent White House conference on school bullying. While he himself has not been taunted over his sexual orientation, Graeme said he does have some ideas on how to address the problem. “To be honest, I don’t really know why it is the case. I was fortunate enough that people realize they gain more by supporting me than by tearing me down,” said Graeme in a phone interview this month. “I believe everyone should be concerned about bullying on its own because it can lead to worse things.” His father, Kirk Taylor, will be joining him on the trip out west. A teacher himself, Taylor is currently trying to address the bullying of one his own students, who has
been targeted due to his unique personality. “He is offbeat and gets teased and pushed in the hallways. His parents are working so hard to try to help him. It is so complex and not easy; that is why we are glad so many people right now are coming together collectively to make this a major issue, as it should be,” said Taylor. “To me this has to become almost tiresome, the attack on bullying. It has to become second nature to kids in school and families in schools the fact it is going to be addressed.” Galisatus hopes not just LGBT teens but their straight classmates, teachers, parents and concerned adults will take part in the summit. “It is not only for people who have been bullied but for teens who have seen people bullied and don’t
For more information or to make a donation, visit www.bayareayouthsummit.org.
The sexual behavior studies of Alfred Kinsey found, among other things, that, “Ten percent of males are more or less exclusively homosexual for at least three years between the ages of 16 and 55.” The recent surveys analyzed by the Williams Institute found 8 percent of adults reported having had sex with a same-sex partner at some point in their lives and 11 percent had been attracted to a person of the same sex. Many historians have suggested that the Kinsey studies were the origin of the one-time consensus that gay people comprise about 10 percent of the population. Demographic experts today are much more cautious when trying to estimate the size of the LGBT community, observing that more people are willing to acknowledge a same-sex attraction or behavior than are prepared to self-identify as gay, lesbian, or bisexual. And Gates is quick to urge caution in making comparisons between the Kinsey data and the surveys used by the Williams Institute. For one thing, he noted, Kinsey was not using large, population-based data, but rather interviews with several thousand participants in a study of human sexual behavior. And even the Kinsey reports did not conclude that 10 percent of U.S. adults are gay. The Williams Institute analysis conclusion that about 3.5 percent of the adult population in the United States identifies as LGBT also closely approximates data collected by a major media coalition during recent national elections. The
National Election Pool has found that about 3 percent to 4 percent of people answering exit poll surveys when leaving the voting place have identified themselves as gay, lesbian, or bisexual. The fact that both the surveys analyzed by the Williams Institute and the numbers found by the exit polling are so similar “gives us some real confidence that this [3.5 percent] is a number we can rely on,” said political demographer Patrick Egan. “We now have a number that measures identity that just didn’t exist when I first started doing this work 10 years ago,” said Egan. “The data back then was much more scant, and we had to rely on proxies for different measures.” The Williams Institute analyzed information from several population-based surveys. The estimate for sexual orientation identity was derived by averaging results from five U.S. surveys, including the mammoth General Social Survey of 2008 and the National Survey of Sexual Health and Behavior of 2009. The estimate for adults identifying as transgender came from an average between numbers found on surveys in Massachusetts and California. Estimates concerning same-sex attraction came from the National Survey of Family Growth between 2006 and 2008, sponsored by the U.S. Centers for Disease Control and Prevention. And estimates concerning same-sex behavior came from both the General Social Survey and the Family Growth survey.
Gates said his analysis also examined relevant surveys from four other countries – Canada, Norway, Australia, and the United Kingdom – “mostly to show that LGBT data inclusion is not simply a U.S. issue.” “Some of the international surveys,” he said, “are conducted in ways similar to how the U.S. conducts many of its large surveys. For example, the UK survey is roughly akin to the American Community Survey. It is important for folks to see that surveys like this can successfully include these questions.” The Williams Institute report suggests that the estimates provided by its study are not intended to be the final word on the size of the LGBT community but rather a demonstration of “the viability of sexual orientation and gender identity questions on large-scale national population-based surveys.” “States and municipal governments are often testing grounds for the implementation of new LGBT-related public policies or can be directly affected by nationallevel policies,” concludes the study. “Adding sexual orientation and gender identity questions to national data sources that can provide locallevel estimates and to state and municipal surveys is critical to assessing the potential efficacy and impact of such policies.” Having reliable estimates of the population can help direct government resources and programs to help meet the needs of that population, a point underscored just last week by Kathleen Sebelius, secretary of the U.S. Department of
Health and Human Services. Sebelius issued a lengthy press statement April 1 saying her department would work to increase the “number of federally funded health and demographic surveys that collect and report sexual orientation and gender identity data.” And an Institute of Medicine report, commissioned by the National Institutes of Health and released March 31, recommended that NIH conduct more research to “advance knowledge and understanding of LGBT health” and that HHS surveys collect data “on sexual orientation and gender identity.” Estimates also have a political value, persuading elected officials that a constituency is large enough to make a difference in elections. The 9 million LGBT estimate from the Williams Institute report is equal to the number of people 65 and older who are military veterans; and it’s greater than the number of teachers (7 million) and the estimated number of stay-at-home moms in the U.S. (5 million). The 3.5 percent LGBT population is twice that of the percent of adults who identify as Mormon (1.7 percent). The U.S. Census Bureau estimated there were 565,000 samesex partner households in 2008. They represented 9 percent of the 6.2 million unmarried partner households overall in 2008. Gates noted that data concerning same-sex couples collected during the 2010 U.S. Census will be released in June and will be rolled out on a state-by-state basis over the course of the summer.▼
“Also of concern is the potential for changes in behavior among MSM leading to increased transmission risk, thereby offsetting any potential gains and the specter of drugresistant strains of HIV,” they write, adding that, “these obstacles are not insurmountable” and note there has been little evidence to suggest greater risk behavior among MSM. In addition, they emphasize that contrary to another modeling study that grabbed headlines, “transmitted drug resistant HIV strains have remained stable or even decreased in San Francisco and in similar cities.” The study is titled “The Effect of Expanded Antiretroviral Treatment Strategies on the HIV Epidemic among Men Who Have Sex with Men in San Francisco.” Co-investigators for the study are Moupali Das from DPH and Travis Porco from UCSF. The National Institute of Mental Health provided funding for the study through a grant to the UCSF Center for AIDS Prevention Studies.▼ It can be found at oxfordjournals .org/content/52/8/1046. full?etoc.
know how to address it,” he said. “A lot of people say they hear ‘That is so gay’ on a daily basis but don’t know how to effectively make someone understand why that is offensive.” The summit is estimated to cost $2,000, and so far, the organizers have raised $1,400 plus donated air miles to cover the travel costs of speakers. It will take place from noon to 8 p.m. Saturday, April 23 at Aragon High School, 900 Alameda de las Pulgas in San Mateo. A dinner and a youth-only dance will immediately follow until 10 p.m.▼ The summit and dinner are open to the public; there is a $10 suggested donation to attend.