Harm Reduction Project News Digest June 19, 2007

News & Opinion This Week 1. Physical Dependence Or Addiction? 2. 23% Of American Adults Say U.S. Lives Worth More Than Others' 3. The Sanguine Sex: Abortion And The Bloodiness Of Being Female (Essay and review) 4. HIV Rates On The Rise In Iran 5. [More on the US'] Surgeon General Nominee's Gay Fascination 6. New Sex-related Infection Passes Gonorrhea 7. NIDA Study Suggests Crystal Methamphetamine Use In Young Adults Higher Than Previously Reported (NIDA News Release) 8. Ukraine: Methadone Scale Up Authorized 9. Of Groceries, Abortions, and Nice, Classic Handbags 10. Russia: More Funding, But HIV/AIDS On The Rise B Upcoming Conferences and Events C Quotes D How To Help E About HRP F Subscription Information -------------------------------------------------------------------------------- I. Physical Dependence Or Addiction? Maia Szalavitz, May 14, 2007 ~ STATS at George Mason University Distinctions are important when it comes to dealing with drug abuse, so why did the Archives of General Psychiatry confuse the press last week by misrepresenting a study in its journal? Last week, the Archives of General Psychiatry published a study finding that at some point during their lifetimes, 10.3% of Americans will suffer from disorders related to drug misuse. Unfortunately, the coverage that resulted was marred by a press release that incorrectly defined addiction, and then spun to suggest that the study shows a great need for expanded addiction treatment, which was not reflected in the actual data. Both errors show that when the media covers drugs, reporters are simply not paying attention. The erroneous addiction definition was picked up without question by Reuters, resulting in flawed reports on MSNBC, CNN and even the website of Scientific American. Defining addiction is not just an academic matter: it has profound implications for when it is legal to use certain medications to treat pain and, as a result, whether the 20-30 million Americans with severe chronic pain have access to appropriate treatment. The press release defined "substance dependence," which is what addiction is called in psychiatry, as "physical dependence on a drug." In fact, physical dependence on a drug is neither necessary nor sufficient to define addiction; people can become addicted to substances like cocaine, which does not produce physical dependence; they can also become physically dependent on blood pressure medications, which do not cause addiction. Unlike the press release, the actual study used the correct DSM definition of addiction, which boils down to compulsive use of substances despite ongoing negative consequences. The study also looked at the more common substance-related disorder, known as "substance abuse" which involves using drugs in potentially dangerous ways, but without being addicted to them. Virtually all pain patients who take opioid medications like morphine or Vicodin for long periods of time will become physically dependent, but only a tiny proportion of those without a history of drug problems will become addicts. Because it is illegal for doctors to "maintain" addicts on opioids (except under special circumstances using methadone or buprenorphine), defining addiction as physical dependence can suggest that treating chronic pain with opioids is illegal. Doctors who equate the two may deny adequate pain care to their patients, and patients can come to believe they are addicts when, in fact, they simply suffer physical dependence. Worse, doctors who try to treat pain aggressively may wind up incarcerated, when prosecutors who believe physical dependence and addiction are synonymous target them. Political reporters have been taking a great deal of flack lately for simply being stenographers; unfortunately, this story shows that the problem is not limited to politics. A spokesperson for the Archives of General Psychiatry (which is published by the American Medical Association) said in an email that the press release was "reviewed and approved by both the JAMA editors and the paper's corresponding author." While conceding that "our definition of dependence could have been more precise," she said that a correction will not be forthcoming because "we don't feel it is strictly inaccurate, in part because we refer to illicit substances - pain patients on prescribed or over-the-counter medications would not fall into this category." Perhaps it is wrong to blame the press when medical authorities like the editors of one of the nation's leading psychiatry journals are themselves unclear. But even the coverage that did not contain the misleading definition spun the story the way the National Institute on Drug Abuse presented it - as showing that most people with drug problems who "need" treatment do not get it. The study did find that only 38% of addicts ever received treatment for their disorder. However, it also showed that only 23% of those who had ever been addicted to drugs were currently addicted. This means that 77% recovered: just over double the amount who reported receiving treatment. More and better drug treatment is undoubtedly a good idea, but the data in the study really can't be used to draw the conclusion that it is needed. The media needs to think carefully when it covers addiction, and not simply parrot the interpretations of research given in press releases. --- 2. 23% - Say U.S. Lives Worth More Than Others' Wed May 23 PEW Research Center Nearly a quarter of American adults (23%) say they mostly (14%) or completely (9%) agree that American lives are worth more than the lives of people in other countries according to the most recent Pew Social Values Survey; those most likely to take this view include white men (30%), persons ages 18-29 (29%) and self-identified conservative Republicans (28%). --- 3. The Sanguine Sex: Abortion And The Bloodiness Of Being Female by Caitlin Flanagan ~ The Atlantic May 2007 The Choices We Made by Angela Bonavoglia Four Walls Eight Windows The Girls Who Went Away: The Hidden History of Women Who Surrendered Children for Adoption in the Decades Before Roe v. Wade by Ann Fessler Penguin In the middle of a hot New York summer 60 years ago, my mother and her two roommates were invited to spend a weekend at Fire Island. The three girls, recent nursing-school graduates, worked together at Bellevue and were sharing the rent on their first apartment. When a fourth young nurse of their acquaintance overheard them talking about the trip, she asked if she and her young man, a resident at the hospital, could borrow the apartment while they were away. In those days, lovers had to seize on those kinds of opportunities to be alone together. The apartment key was given to the friend, no big deal, and my mother and her roommates left for the beach. They returned late Sunday evening, in a commotion of kicked-off shoes and set-down carryalls and switched-on lights. One of them pulled the string on the kitchen bulb, and her cry brought the other two. At first they thought a crime had taken place. Strictly speaking, one had: The boyfriend, a kid with a year or two of medical training under his belt, had performed an abortion on his girlfriend. Literally, a kitchen-table abortion. There was blood on the table and the floor, and there were wadded-up bloody towels in the sink. What happened next, I don't know. Probably two of the girls cleaned up (they were nurses, remember; they would not have been horrified by such a task once they had the nature of the thing sorted out), and probably the third went to the friend's apartment to check on her. All three were accomplices to a crime, and they would have been keenly aware of that. At Bellevue, my mother had twice attended dying young women who were victims of botched abortions, young women-"girls," she called them-who spent their last hours on earth being interviewed by policemen. Terrified, alone, dying, neither would reveal the name of the abortionist; "they were too frightened," my mother said. If I had to put money on which of the roommates bravely went to the girl's apartment, I'd put it on my mother. About 15 years before my mother took her weekend trip to Fire Island, she was a little girl living in Brooklyn in a bad situation. It was the Depression, her father was an unemployed laborer, and her mother-28 years old, a young woman from Coal City, Alabama, very far from home-had a toddler, a 3-year-old, and my mother, age 8. One day, according to the great and fearsome legend that shaped my mother's life and so much of my own emotional life, my grandmother did something very ordinary: She ate a can of tuna fish. The can of tuna fish was tainted with botulism poisoning. She began to have great pain in her abdomen, and-this is a very important part of the story-the doctor wouldn't come. Apparently he sent word that the woman in question had gas, and that she would be better in no time. She was dead in no time. "That's why I became a nurse," my mother said so many times in her life that it would have been a stock phrase, except for the anger and sorrow of the way it ended: "so that they couldn't do to anyone else what they did to my mother." When I was a grown woman, I came across a wooden cigar box filled with old family papers, one of which listed gangrene as my grandmother's cause of death. This surprised me, and I began to wonder about the story I had always been told-beginning with its central element: the can of tuna fish. Mary Parker was a poor housewife with small children and an unemployed husband. By what mechanism of self-indulgence would she have prepared and eaten tuna fish, without giving anyone else in the household so much as a mouthful? How could she have been the only person to have ingested any of the poison? Maybe my grandmother ate bad tuna fish-or, according to an alternate version of the story, bad peaches-and the food killed her. Or maybe she was 28 and living through one of the greatest disasters in American history, with no end in sight, trying to feed and look after three small children, and she found herself pregnant again, and she just couldn't cope. Maybe someone in that Brooklyn neighborhood knew someone who could help her out. Maybe the reason the doctor refused to see her is that he knew what she had done, and he wouldn't go near her. It turns out that badly canned food-with its risks of ptomaine and botulism poisoning-was an ideal culprit on which to blame the sudden death of an otherwise healthy young woman: My family would not be the first to contain such a face-saving legend. In any event, my grandmother died, her husband was overwhelmed with misery, and the children were put on trains and scattered to relatives, and that was the end of that little family. The history of abortion is a history of stories, and the ones that took place before Roe v. Wade are oftentimes so pitiable and heartbreaking that one of the most powerful tools of pro-choice advocates is simply telling them. The Choices We Made is a compendium of such stories, and while you could read it in an afternoon, you should not make the decision to do so lightly: It will trouble you for a long time afterward. In it, women whom we know for the large space they occupy in the world-writers Grace Paley, Linda Ellerbee, and Ursula K. Le Guin, and actresses Polly Bergen and Rita Moreno among them-tell us about a time in their lives when they were reduced to begging for a simple medical procedure that, because of the circumstances in which it was performed, almost killed several of them and left at least one infertile. Abortionists in those days included a handful of merciful and scrupulous doctors willing to risk prison, and more than a few monsters who considered groping or sexually assaulting their patients a droit du seigneur. Who would complain? And who didn't have it coming? In those days, it was not uncommon for a woman to receive a D & C without anesthetic shortly after being lectured about the wages of being a slut. Most of the abortions recounted in the book occurred sometime between the late '30s and the early '60s, a time when so many American young women were ignorant of some of the most basic facts of reproduction, and when an unmarried woman's sexual life was, by definition, a shameful and secret thing. It was also a time in which pregnancy could destroy a young woman's prospects: She could be thrown out of college, fired from her job, removed permanently from the marriage market. Criminal abortions, of course, were dangerous business, and among the women who survived the procedure, many were rendered infertile. The quality of the criminal abortion that a woman received depended largely on where she lived and how wealthy she was. Reports a woman who got pregnant while a student at Barnard in the 1930s: "The actual abortion was comfortable, clean, the absolute tops." On the other hand, here's a description of an abortion the actress Margot Kidder had as an 18-year-old in the mid-1960s. Her boyfriend, John, made the arrangements, "all done with great secrecy and a great sense of evil and sordidness"; the couple were told to check in to a certain hotel room where the abortionist, a woman, would meet them. After gaining their assurance that they would never go to a hospital if something went wrong, she began the procedure. I was told to undress and lie in the bathtub, which I did. John was in the other room. There was no anesthetic, of course. She jammed something through my cervix. It was incredibly painful. I was screaming and crying; I had no idea what was happening to me. Then she used what looked like a douche to shoot some sort of solution up through my cervix. The woman had filled Kidder's uterus with Lysol. T he Girls Who Went Away describes another price women once paid for having sex. It concerns the young girls-usually high-school students-who were part of a phenomenon virtually unheard-of today but once quite common in American cities and suburbs: the sending of underage pregnant girls to maternity homes, where they would bear their babies and surrender them for adoption. Neighbors and friends would be told that the girl had suddenly gone on an extended visit to an aunt or grandmother, and in the fullness of time the girl would return, pale and shaken, to pick up where she had left off, never telling anyone where she had been. In a series of heartbreaking interviews, these women-now in mid- to late life-tell what actually happened to them in those homes, how little they understood of the pregnancies they were experiencing, and how greatly they pined for babies many of them were not allowed to see even once. The brutality of the experience was heightened by the youth of the girls who underwent it, girls who still considered their mothers-not their young boyfriends-to be the chief source of comfort and protection in the world: "It was very hard for me to say good-bye to my mother," writes one woman: I had never been away from home except for an overnight visit to a friend's house. I was devastated to be away from her ... Every night before I went to bed, I would write my mother a love letter. I think she kept them for most of her life. And it kept me in touch with the one person who really loved me. As a younger woman, my heart would have gone out only to the girl in the ward, but in middle age, I imagine just as vividly her mother, receiving those letters and imagining her child so lonely and frightened, and so far from home. Adoption was presented as society's benign alternative to abortion, but the women interviewed for this book feel differently about that. Says another woman who surrendered an infant: It's hard to convince others about the depth of it ... I'd have an abortion any day of the week before I would ever have another adoption-or lose a kid in the woods, which is basically what it is. You know your child is out there somewhere, you just don't know where. I f you are a supporter of legal abortion, reading books like these is chilling and galvanizing, just as their authors intend. But the stories in such books ought to have little role in shaping today's public policy. The women described in their pages are travelers from an antique land, reporting about an America that is at once fairly recent and utterly unfamiliar. Bearing a child out of wedlock is so accepted today that some of the most respected professional-class women I know have done so intentionally. Today, no young woman can be thrown out of college, or fired from her job, or cast out of "society" for becoming pregnant. Nor is adoption the horror that it was a generation ago: No birth mother needs to feel that her child is lost in the woods; she can decide to pursue an open adoption, she can change her mind about relinquishment, days-and in some states, months-after giving up the baby. Furthermore, even illegal abortion would look very different today than it did four decades ago. However bad the toll on women's health would be (and it would be very bad), it would be nothing like the carnage of the past. The age of ignorance is gone, and abortion is a simple procedure. In these days of home pregnancy tests and pharmaceutically induced abortion-and, above all, of sophisticated antibiotics-the mortality rate would be far lower. But that doesn't mean that these stories can't help us understand the complexity of the question of abortion-only that we have been focusing on the wrong part of the narratives. The endings of these stories, with their dangerous abortions and forced adoptions, may have little bearing on the world of today. But their beginnings, with all the emotions and impulses and desires that have always combined to leave some women pregnant when they don't wish to be, are as timeless as anything in human history. They reveal something about the eternal and dangerous nature of being female, and because of this, they merit a great deal of our attention. The way these stories begin tells us as much as we ever need to know about the profound and complex decisions women make when they decide to have sex. Recently, I saw a stand-up comedian joke about the first time he had sex. The only willing girl lived 25 miles from his house, and he didn't own a car. But that didn't stop him: He rode his bicycle to get to her. As the audience laughed at the thought of this desperate, horny journey, he drove his point home: "I mean, the real question is: 'How far wouldn't a man ride a bicycle to have sex?' There's no answer to that. He would just keep riding that bicycle." There was a wave of happy laughter, a response not so much to the particular joke as to the idea it signified, which is the core of a reliable genre of jokes: the gargantuan power of the male sex drive, and men's willingness to endure difficulty and unpleasantness to fulfill it. When I hear jokes like that, I sometimes think of the kitchen sink full of bloody towels in my mother's apartment. Or, now, of the woman in The Choices We Made who returned to her apartment in Hollywood after an illegal abortion and stayed there, alone, for three days until her roommate came home: Blood was on the bed; it was on the floor; it was on the carpet. We had run out of sheets and the mattress was ruined. I guess I did think I was dying ... But you know, I'm sure there was a part of me that thought I was supposed to die. I had done this terrible thing-I had had sex and I'd gotten pregnant. The abortion added to it, but that was not the terrible thing. The real question is not how far a man would ride a bicycle to have sex. It's how much ruin and butchery a woman will risk to have sex-which turns out to be as much ruin and butchery as the world has in it. The heroic and audacious and mystifying part of the stories in these two books isn't how women got through abortions or adoptions; it's how they got the courage to have sex in the first place. To begin with, of course, there is erotic desire. "Despite all of that terror-and I'm talking tooth-gnashing terror," recalls Rita Moreno, I still now and then would give in, succumb, to those pleasurable moments. It's astounding. When you're that scared you usually stay away from the thing that scares you, but not with sexuality. But women have always bound other emotions with their eroticism. To hear these women talk about sleeping with men for reasons that have nothing to do with sexual impulses is to understand something essential about women, and about why they have been so easily exploited by men for sex. "Nobody ever took into consideration feelings," writes Polly Bergen about the harsh lectures she was given about sex when she was a girl: They never took into consideration wanting to be held or wanting to be loved or wanting to be cared for or wanting to not feel alone or frightened ... putting out seems like such a small price to pay for not being lonely. A woman who was made pregnant-as a 17-year-old girl by a 31-year-old man- reports, "It wasn't like I liked sex or didn't like sex; I just wanted to be with him." Women will always have emotional needs that they can fill through sex, and men will always use those needs to their advantage. But men will never bear the brunt of sexuality. The toll of sex-the anguish that it can produce, the consequences of it-falls on women alone. One of the most chilling episodes in The Girls Who Went Away occurs after a girl returns from her ordeal of giving birth and surrendering her baby. She sends the baby's father a note, to which he replies in bewilderment: "You sound so bitter, Lynne. You were never bitter." Jerry Seinfeld used to have a routine about the television commercials for laundry detergents that promise the product will remove bloodstains from clothing. "I think if you've got a T-shirt with bloodstains all over it," Seinfeld would say, "maybe laundry isn't your biggest problem." It's a funny line, and it's one that only a man could think of, because the real reason blood is such a vexing and eternal laundry problem doesn't have to do with gunshot wounds or serial shaving mishaps (in the commercials, a witless husband is forever nicking himself shaving, usually wearing his best white shirt, the male equivalent of showering in your bra and panties). Bloodstains occur and recur in households because women spend a lot of their lives bleeding. If a man or a child woke up in a small pool of blood, the alarm would be genuine and well-founded. But if a woman does so, it's business as usual. The bloodiness of menstrual blood is something that has been steadily de-emphasized in the past century, but blood it surely is. Once I walked into the students' restroom at an all-girls school late in the afternoon on a warm day, and the smell that assailed me was reminiscent of the smell of Buckley's, the butcher shop in Dublin where my mother bought Kerry beef running with blood. Every month, a woman's womb slowly fills with blood in anticipation of an event that she wants to occur only a few times at most, and that up until 70 years ago had a good chance of killing her. This is nature's unkind way with women. The sort of man who knocks a woman up and then disappears is nowhere near as heartless as nature, which allows a fertilized egg to implant in a fallopian tube, or arranges a baby's body in the womb in such a way that it cannot by any natural means escape through the birth canal, or spreads the placenta across the cervix so that it will rupture and cause a hemorrhage almost certain to kill the mother if no medical staff is on hand to stop it. The fact that modern medicine has so radically reduced the incidence of death in childbirth testifies less to the wonder of science than to the crudeness of the dangers at hand. I 've never had an abortion, and at this point in the game, I never will. Nor do I have daughters, so this is not an issue that will affect my own life in any immediate way. But I understand that the reality of women's and girls' lives is that they include as strong an impulse for sex as men's. And maybe because I am a woman, the practical has always had a stronger pull on my emotions than the theoretical. Those old debates about the nature of the human soul have never moved me; surely a soul is no more valuable to God if it exists in this world rather than the next. And a thousand arguments about the beginning of human life will never appeal to me as powerfully as a terrified pregnant girl desperate for a bit of compassion. But my sympathy for the beliefs of people who oppose abortion is enormous, and it grows almost by the day. An ultrasound image taken surprisingly early in pregnancy can stop me in my tracks. In it is much more than I want to know about the tiny creature whose destruction we have legalized: a beating heart, a human face, functioning kidneys, two waving hands that seem not too far away from being able to grasp and shake a rattle. One of the newest types of prenatal imaging, the three-dimensional sonogram-which is so fully realized that happily pregnant women spend a hundred dollars to have their babies' first "photograph" taken-is frankly terrifying when examined in the context of the abortion debate. The demands pro-life advocates make of pregnant women are modest: All they want is a little bit of time. All they are asking, in a societal climate in which out-of-wedlock pregnancy is without stigma, is that pregnant women give the tiny bodies growing inside of them a few months, until the little creatures are large enough to be on their way, to loving homes. These sonogram images lay claim to the most powerful emotion I have ever known: maternal instinct. Mothers are charged with protecting the vulnerable and the weak among us, and most of all, taking care of babies-the tiniest and neediest-first. My very nature as a woman, then, pulls me in two directions. T he Choices We Made ends with a couple of stories about the early days of legal abortion. One is told by Byllye Avery, who founded the first abortion clinic in Gainesville, Florida. The office space she and her three colleagues rented had a terrible tile floor, and the clinic's nurse said they needed to cover it. There was no money left for the shag rug they all wanted to buy, but the nurse said her mother-in-law was going to pay for it: What we didn't know was that, actually, [the nurse] had ordered the rug and charged it to us. When we found out, we were so upset with her, but the carpet is what made the place. We had a beautiful blue shag rug that went through the whole clinic, even the exam rooms. That's what everybody who came there talked about-shag carpets were the rage. It was also that we had the gall to say, "We don't have to have these horrible tile floors just because this is a health-care facility." It helped women to know that abortions didn't have to be bloody and butchery. Certainly, you wouldn't put that kind of rug on the floor if it was going to be ruined. It was a very womanly thing to do-to set your heart on a shag carpet, to trick someone into buying it for you, to rely on the fact that once it was installed, everyone would love it and forgive you. And it was womanly because of the way a simple bit of decoration could send a powerful and audacious message that only other women would be able to interpret. A river of blood runs through The Choices We Made, and it runs throughout the history of womankind. That river stops, more or less, with the installation of that shag carpet. The carpet, and the women who found the money to pay for it, along with all the women and men who made possible a context in which an abortion could be performed legally, safely, and even humanely-together they say: Enough. --- 4. HIV Rates On The Rise In Iran Daily Times, Pakistan ~ June 14, 2007 TEHRAN: HIV infection rates in Iran are increasing rapidly due both to a growing inflow of cheap heroin from Afghanistan and more sexually transmitted cases, according to a senior United Nations official. Christian Salazar, the world body's coordinator on HIV in Iran, praised the country's "progressive and pragmatic" efforts in fighting the virus that causes AIDS, including a programme to hand out clean needles to drug addicts in prisons. But he said the Islamic Republic now faced new challenges to contain a disease that risked becoming more common among other sections of its 70 million population. "Basically all the indicators for a quick advancement of the virus are there," he told Reuters in an interview on Tuesday. "We are worried about the trend." With Iran straddling a key heroin smuggling route from the opium fields of neighbouring Afghanistan to the West, injecting drug users remained the main risk group, but sexual transmission was also on the rise. Salazar, who heads the UN children's fund UNICEF in Iran, said there was a need to raise general awareness among the public at large, even if it can be a sensitive issue in a country which bans sex outside marriage. "We see more and more sexual transmission as a driver of the epidemic," he said. "It creates the problem, so to speak, of how to talk about sex without talking about sex." Aiming to make AIDS "everybody's business," he said UNICEF increasingly sought to approach influential religious leaders. "They are okay with this," he said. "In comparison maybe to other religions, for example condom use or family planning is not a taboo issue." Iran 'a leader': Iran is currently a low-prevalence country in terms of HIV infections, with a rate of about 0.16 pct of the adult population, below levels seen in other parts of the world. For example, it was 0.8 percent in North America in 2006. "But the infection rates are skyrocketing," Salazar said. "In the worst of cases we are moving towards one percent or even 1.8-1.9 percent of the population." reuters --- 5. Surgeon General Nominee's Gay Fascination Richard Kim ~ The Nation Blog ~ June 14, 2007 Bush's nominee for surgeon general, Dr. James Holsinger, has come under fire this week for his anti-gay politics (first documented by Bible Belt Blogger Frank Lockwood). By day Holsinger teaches health sciences at the University of Kentucky where he was chancellor of the Chandler Medical Center. By night, however, the good doctor is a bible-thumping Reverend with a degree in biblical studies from Asbury Theological Seminary and a seeming fascination of antipathy towards homosexuals. Holsinger founded the Hope Springs Community Church, a "recovery ministry" that caters to alcoholics, drug addicts, sex addicts and those seeking to "walk out of that [homosexual] lifestyle," according to its pastor Rev. David Calhoun. When not busy endorsing ex-gay conversion therapy, Holsinger served on the highest court of the United Methodist Church where he voted to remove a lesbian pastor from her position. And today, the Human Rights Campaign released a document Holsinger authored in 1991 as a member of the United Methodist Church's Committee to Study Homosexuality. Titled Pathophysiology of Male Homosexuality, Holsinger's religious tract-cum-scientific paper is a fascinating window into the perverse imagination of homophobia. In essence, Holsinger argues that male-female "reproductive systems are fully complementary" because "anatomically the vagina is designed to receive the penis." The remainder of his paper is a graphic account of the "delicate" rectum which is "incapable" of "protection" if "objects that are large, sharp, or pointed are inserted" into it. From there Holsinger continues to discuss what he imagines are the pains (and pleasures?) of anal sex, from "fist fornication" and "sphincter injuries" to "lacerations," "perforations" and "deaths seen in connection with anal eroticism." Sharp objects! Deaths seen in connection with anal eroticism! Gadzooks! Now, I've been around the block one or ten times, and I don't know any gay men who have put scissors up their ass, much less died from it. Of course, the barely mentioned but palpably anxious context in which Holsinger connects "death" with "anal eroticism" is the AIDS epidemic. And it should come as no surprise that his paper was part of a larger, pseudo-medical, moral discourse in which gay men's mode of sex (and by extension gay men) were blamed for AIDS - the death we deserved, the sexual suicide we courted. The flip side of Dr. Holsinger's lurid speculation is the dangerous presumption that because heterosexual sex is "natural," it is safe -- safe from HIV, other sexually transmitted diseases and the trauma and injury that Holsinger seems so feverishly eager to attribute to gay anal sex. We now know, tragically and beyond any possible doubt, that heterosexual sex is not safe unless one practices it as such. And no amount of wishing and praying by our next Surgeon General on the "complementarity of the human sexes" will make it so. A few years after Dr. Holsinger wrote his little brief against male-male anal sex, then Surgeon General Joycelyn Elders suggested, at a UN Conference on AIDS, that masturbation might be taught to young people as a mode of reducing sexual risk. On this point she was absolutely correct, but for even daring to mention the M-word, she was lampooned by the Christian right and eventually asked to resign by a cowardly Bill Clinton who, in retrospect, might have paid more attention to Dr. Elders and spent less time inserting foreign objects into inappropriate places. But no matter. The doctor who gave sound, clinical medical advice was fired, while the doctor who engaged in wild, graphic and unsubstantiated fantasies about gay sex will most likely assume the helm as "America's chief health educator." And you wonder why we have a health care crisis in this country. --- 6. New Sex-related Infection Passes Gonorrhea By Martha KerrThu Jun 7, 2007 Reuters A relatively new sexually transmitted infection has surpassed Neisseria gonorrhea in prevalence among young adults in the US, according to a new study. Mycoplasma genitalium was first identified in the 1980s. It can cause inflammation of the urethra (the urinary passage from the bladder), in men, and inflammation of the cervix and the lining of the uterus in women, possibly leading to infertility. However, it seems many cases of the infection are symptom-free. In the current study, researchers at the University of Washington, Seattle, tested 1714 women and 1218 men between the ages of 18 and 27 years participating in Wave III of the National Longitudinal Study of Adolescent Health. Results of the study are published in the American Journal of Public Health. The investigators found Mycoplasma genitalium infection in 1.0 percent of the participants. In contrast, the prevalence of gonorrhea was 0.4 percent. The prevalence of chlamydia infection was 4.2 percent. The prevalence of Mycoplasma genitalium infection was 11 times higher among individuals living with a sexual partner, seven times higher among blacks and four times higher among those who use condoms during sex. None of the genitalium-positive individuals had any discharge. "Many M. genitalium infections are asymptomatic, like chlamydial infections," principal investigator Dr. Lisa Manhart told Reuters Health. "However, unlike chlamydia, it is probably too soon to recommend widespread screening for M. genitalium." There are no commercial tests to detect the organism, she explained. Furthermore, she and her colleagues note in their report that it is not clear "whether M. genitalium-infected persons require or benefit from treatment -- and if so, what antimicrobial therapy should be recommended." SOURCE: American Journal of Public Health, June 2007. --- 7. NIDA Study Suggests Crystal Methamphetamine Use In Young Adults Higher Than Previously Reported(NIDA News Release) For Release June 15, 2007 Study Also Connects Use of the Drug to Risky Behaviors Crystal methamphetamine use among young adults in the United States is considerably higher than previous surveys indicate, according to new research funded by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health (NIH). The study, published in the July issue of the journal Addiction, found 2.8 percent of young adults (ages 18-26) reported the use of crystal methamphetamine in the past year during 2001-2002. This is higher than the annual prevalence of crystal methamphetamine use by young adults (ages 19-28) of 1.4 percent reported by NIDA's 2002 Monitoring the Future Survey. Previous national surveys indicate that methamphetamine prevalence is highest among young adults, but until now, few scientific papers have looked at the characteristics and behaviors associated with its use in this age group. Using nationally representative data, and examining the age group most prone to methamphetamine use (ages 18-26), the study found that young adult users are disproportionately white and male and live in the West, and that the odds of use for Native Americans were 4.2 times higher than that for whites. Users also tend to have lower social economic status, use other substances, such as alcohol, marijuana, and cocaine, and the male users are more likely to have had incarcerated fathers. "This new information gives us a clearer picture of use among young adults, and also raises new concerns, said NIH Director Dr. Elias A. Zerhouni. "Use of crystal methamphetamine is associated with multiple health and social risks, including a negative impact on families as well as straining emergency departments and law enforcement resources." "The study showed not only greater use of crystal methamphetamine, it also suggests the drug is associated with risky and antisocial behaviors, including other illicit drug use," said NIDA Director Dr. Nora D. Volkow. "By examining these connections, we hope to identify new avenues for treatment and prevention." The study authors based their findings on data from the National Longitudinal Study of Adolescent Health (Add Health), which asked respondents about their use of crystal methamphetamine in the past year and past 30 days. They examined certain characteristics of crystal methamphetamine users, such as their use of other substances, sociodemographics, and novelty-seeking behavior. They also looked at what was unique about crystal methamphetamine users compared to other drug users, and the associations between past year crystal methamphetamine use and antisocial or risk behaviors, such as crime/violence and risky sexual behavior. To maintain confidentiality, Add Health administered questionnaires via laptop computer using computer-assisted self-interviewing (CASI) technology. The study found that use of crystal methamphetamine and associations with both criminal behavior and risky sex differed between men and women. Associations with both types of behaviors tended to be stronger among women than among men. Among women, the study found crystal methamphetamine use to be significantly associated with drug sales and risky sexual behavior, such as low condom use. However, the authors emphasize that more research is needed to determine whether women who sell drugs are more likely to use crystal methamphetamine or whether use of the drug leads to criminal drug sales among women. Crystal methamphetamine (also referred to as "ice," "crystal," "glass," and "tina") is a common form of methamphetamine, a highly addictive stimulant that affects the central nervous system. As with the powdered form, users of crystal methamphetamine are drawn to its euphoric and stimulant effects, but the drug has higher purity and more potential for abuse. Typically smoked, it produces an immediate, intense sensation and has longer acting physiological effects than powder, which also amplifies its addiction potential and adverse health consequences. Those can include: mood disturbances, cardiovascular problems, heat stroke, convulsions, and psychotic symptoms that can sometimes last for months or years after methamphetamine abuse has ceased. "This study presents a new perspective on crystal methamphetamine users in the United States," said Dr. Denise D. Hallfors, of the Pacific Institute for Research and Evaluation and a co-author on the study. "We hope that this new information will aid in the development of appropriate interventions and help to inform public policy." The National Institute on Drug Abuse is a component of the National Institutes of Health, U.S. Department of Health and Human Services. NIDA supports most of the world's research on the health aspects of drug abuse and addiction. The Institute carries out a large variety of programs to ensure the rapid dissemination of research information and its implementation in policy and practice. Fact sheets on the health effects of drugs of abuse and further information on NIDA research can be found on the NIDA web site at http://www.drugabuse.gov. The National Institutes of Health (NIH) - The Nation's Medical Research Agency - includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary Federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov --- 8. Ukraine: Methadone Scale Up Authorized OSI On June 4, 2007, Minister of Health Yuri Gaydayev signed an order to define procedures for introducing methadone, a medication used to treat opiate addiction, in Ukraine. This order marks the next step in Ukraine's progress toward greater access to substitution treatment for those who inject opiates. The order follows up on the May 15 order, signed by the Deputy Prime Minister for Humanitarian Issues Dmitro Tabachnik, authorizing the Ministry of Health to meet all the requirements of 6th round grant of the Global Fund to Fight AIDS, Tuberculosis, and Malaria, including a scale-up of methadone treatment. These two orders fulfill the decision taken by Ukraine's National Coordination Council on HIV/AIDS in April 2007 to implement the Global Fund conditions. The distribution of methadone will help Ukraine to meet the targets set by the Round 6 Proposal to provide substitution treatment for up to 11,000 IDUs by 2011. Although buprenorphine has been available in Ukraine since 2004, use of the less expensive methadone tablets and solution will allow expanded reach for substitution treatment. Plans call for pilot methadone programs in 41 sites in 8 regions of Ukraine for 2,500 people, with a total of 3,500 patients receiving methadone treatment by the end of 2007. The first methadone is due to arrive in Ukraine by the end of summer, and service providers hope that the medication will reach patients soon thereafter. Ukraine has the highest rate of HIV infection in Europe, and the Ukrainian National AIDS Center has said that IDUs make up 65% of all HIV cases in the country. For more information please contact Konstantin Lezhentsev, [email protected], +38 067 693 4475, or Elizabeth Eagen, [email protected], +36 1 327 3100 x 2484. --- 9.Of Groceries, Abortions, and Nice, Classic Handbags The Nation ~ Blog ~ And Another Thing ~ June 14, 2007 By Katha Pollitt I was planning to start this blog by writing about The New York Times Sunday Magazine's special issue on income inequality -- Larry Summers (him again!), John Edwards, class conflict on Fisher Island and much more. But a practical instance of what true poverty means was waiting for me in my inbox this morning, in the form of an email from Heather Robertson of the Equal Access Fund of Tennessee, which helps poor women pay for their abortions. Heather writes: "I just received a very desperate plea from a local clinic for funding for a patient that I will be unable to help. Our fund has assisted 5 women this month and after giving this woman $200, we have depleted our funds without completely helping her at all. Please read further: "We need $400 more in order to pay the fee $850 fee of a 2nd trimester patient who HAS to be seen tomorrow, or she'll be too far along to be seen in the state of Tennessee. In that case, her fee will increase even more and have to pay the traveling expenses, as well. "She's raised $250 and we have given the clinic $200 on her behalf thus far. "She's a single mom with a 19 month old; co-conceiver skipped town; no child support because that dude skipped town; she is clinically very depressed and extremely desperate. She makes less than $800 a month working fulltime. She makes too much to get any state aid and definitely not covered by TNCare. She becamse pregnant after her birth control failed to prevent her pregnancy. Can you help by sending a paypal donation to [email protected] asap? " "She has an appointment at 7:30 a.m. tomorrow morning. " What a world of hurt is packed into this brief communication! And what a lesson in practical economics. This woman's wages of around $800 a month after taxes put her over the limit for TennCare, the state's medical program-- while leaving her not even close to being able to pay for her abortion herself. (Tenncare doesn't pay for abortion, but it would pay for some of the associated costs included in the fee.) Yet this same $800-- a month's expenses for this woman and her child, or the price of her reproductive freedom -- is less than the amount Gabby, one of the Los Angeles teenagers whose views on money are featured in the Times, thinks is reasonable to spend on a purse ('If you want a really nice, classic bag, it's definitely appropriate to spend, like, four digits, because that's something that's really nice"). $800 is also about what the Equal Access Fund has to give out each month to women in need-- money raised dollar by dollar through donations, eBay garage sales and fundraisers. Fortunately, as I've been writing this, Heather e mailed me to say that the $400 this woman still needs has been raised thanks to donations that came in through her e mail. But what about the next woman and the ones after that? $800 doesn't go very far -- it won't even let Gabby accessorize her outfit. How wonderful it would be if everyone reading this story sent the Fund a donation. Just go to Paypal, and send [email protected] whatever you can spare: the price of a latte or a copy of the Sunday Times or a (big) bag of chips or a beer or a movie ticket (Or, of course, for you lucky loaded few, a handbag!). I should mention that the Fund is an all-volunteer organization, so every dollar you send will go to patient care. And it's affiliated with the National Network of Abortion Funds, so it's tax-deductible and you know it's well-run. You can write Heather Robinson at [email protected]. Check out the fund at its myspace page Find out more at their NNAF member page And while you're there, browse the NNAF site and see if there's a local fund in your area. Chances are, they definitely could use your help. --- 10. Russia: More Funding, But HIV/AIDS On The Rise by Kester Kenn Klomegah MOSCOW, Jun 3 (IPS) - Russia's HIV infection rate continues to rise -- most notably in the heterosexual and non-drug-using populations -- despite steady increases in funds to fight the disease. Experts and medical researchers say dramatic changes in sexual attitudes and behaviour are essential if the trend is to be reversed. "Funds allocated for prevention are not enough and prevention programmes implemented in Russia are very limited in terms of coverage, sustainability and effectiveness. The disease is spreading further into the heterosexual population [beyond] drug users, and especially from men to women. And this trend will continue," Roman Dudnik, regional adviser at AIDS Foundation East-West (AFEW), told IPS. To change behaviour, people need a better understanding of the reasons why they have to use condoms and that condoms are an effective prevention tool, Dudnik explained. "But unfortunately, at the moment, there are different messages that are spread via mass media (safer sex messages and messages that there is not such thing as safe sex) and this creates lots of misunderstanding and confusion in people's heads. And this usually leads to a refusal of any preventive measures," he added. Women comprised 40 percent of the 39,589 news cases of HIV registered in Russia last year. In the first four months of 2007, 15,122 cases were registered, which is seven percent more than in the same period in 2006. Experts say AIDS funds are not reaching the destinations where they are most needed. The human immunodeficiency virus seemingly spreads as the funds increase. Although surprisingly there was a sharp decline in HIV infections through the use of non-sterile equipment by injecting drug users between 2001 and 2005, there is a correspondingly steep increase in the proportions of infections due to unprotected sex, Neill McKee, a communications expert with the Bloomberg School of Public Health at John Hopkins University in the U.S. told IPS. He noted that 40 percent of newly reported infections in 2005 were among women, and that only a minority of those women had contracted the virus through infected syringes or the like. "Russia is a very large territory and is probably experiencing many mini-epidemics rather than one epidemic," he said. For instance, the HIV prevalence amongst sex workers in St. Petersburg is very high -- more than 50 percent -- whereas the prevalence for their peers in Moscow has been measured to be less than five percent. The reason could be that in St. Petersburg sex workers are mainly independent and many inject drugs. In Moscow, however, the crime syndicates that control sex workers also limit drug behaviour. "In other regions the pattern may be different again, and it takes a good deal of research and planning to properly address the epidemic in each region. [There has to be] an in-depth analysis of what investment is needed to defeat HIV/AIDS. And this really will help them to focus on increasing resources for prevention, peer education for young people, counselling and social support for drug users," he added. Condoms, McKee said, are widely available for prevention purposes, but there are many conservative elements in Russian society that would not like to see a highly visible campaign to promote their use. It is also true that condoms don't work well if the people involved are using drugs or alcohol, and that is often the case in risky situations -- so condoms are part of the answer, but not all of it, he said. According to experts, testing and concurrent counselling are only the first step to prevention. To reduce disease transmission requires changes in individual behaviour, social norms, laws, policies, and practices that promote risk. For those who use injected drugs, the primary prevention measures are increased access to clean syringes, effective treatment for addiction, and antiretroviral therapy for those already infected. None of these are being adequately provided in Russia, agree health experts. Russia's health and development ministry said overall funding for fighting AIDS is rising but that just 200 million roubles (7.75 million dollars) would be spent on prevention in 2007 out of a total health budget of 5.3 billion roubles (205.4 million dollars). This would hardly make a dent in the problem, experts believe. "A large portion has to be spent on the problem as it currently is focused -- on drug using populations. But in fact, the opposite seems to be the case," Robert Heimer, a public health researcher at Yale School of Medicine, told IPS. "There is a serious need to reform drug treatment. Detoxification, abstinence-only, and other approaches failed in the vast majority of cases and cannot be considered adequate or ethical treatment. Russia will not be able to manage its addiction problem until it changes its law in this area," he said. While the HIV/AIDS epidemic has created a dire situation in many Russian cities, there are some places that have fared better, and should be touted as examples of successful responses, he said. Two noteworthy examples are Yaroslavl and Kazan: In Yaroslavl, in the province of the same name, just north-east of Moscow, an HIV epidemic among injecting drug users has been averted, thanks in part to early implementation of a peer education programme and expanded syringe access through pharmacies. In Kazan, in the Republic of Tatarstan in Russia's central west, as the epidemic began to take root, the local health ministry committed resources to develop a republic-wide syringe exchange with a three-pronged system to ensure the syringes were distributed. The extent of the expansion of the epidemic beyond injectors to the general population is a matter of great debate. Drug users in Russia tend to be young and sexually active. Therefore, the programmes like syringe exchange, enhanced pharmacy access, and proper drug treatment will need to promote safe sex as well as safe injection. "For this to be successful, there will need to be behaviour change at the individual level and changes in social norms regarding the use of condoms and disclosure of HIV status to sexual partners," McKee said, adding that there also has to be substantial investment in efforts to reduce HIV/AIDS stigma. "On the other hand, HIV treatment and HIV prevention are synergistically linked. Resources have to be expended in both directions simultaneously," he stressed. The World Health Organisation representative in Moscow said prevention activities unfortunately rarely show immediate success or measurable outcomes. "It is also not quite clear how much is 'enough'. Canada spends approximately 10.5 percent of its total public health expenditure on prevention (and public health); and Italy 0.7 percent, France 2.1 percent and Switzerland 2.4 percent. But in the RF (Russian Federation), 7.5 million dollars were allocated for 2007 (through the national priority projects) and spending on prevention only started in 2006," Corinna Reinicke, a coordinator of WHO's HIV/AIDS programme for Russia, told IPS. Citing United Nations Secretary-General Ban Ki-moon, she said that she was encouraged by recent initiatives around the world to improve the care and treatment of people living with HIV, but nevertheless the number of people with the disease has risen in every region, despite progress towards achieving universal access to treatment, prevention, care and support. Combating HIV/AIDS in Russia, like everywhere else, needs sustained and greater investment in tools for prevention and treatment, said Reinicke, and should be targeted to the most vulnerable populations, including fighting gender inequality, stigma and discrimination. "In the RF only about 20 percent of the entire population knows anything about HIV transmission and prevention; mass media could and should play a major role in addressing that issue," she said. More women in Russia, including married women, live with HIV/AIDS than ever before. Based on a recent survey in two regions in Russia among men who have sex with other men, risky behaviour is clearly a concern in the spread of sexually transmitted disease. In a further survey in 2006 in five regions it was demonstrated that a significant proportion of women were engaged in multiple unprotected sexual relations, said Reinicke. The researchers acknowledge that Russian has reiterated a high level of commitment in response to the AIDS epidemic. The State Council held a special meeting on AIDS in which President Vladimir Putin set goals for developing a strategy and improving coordination through a high-level government commission on AIDS, and establishing a unified monitoring and evaluation system. -------------------------------------------------------------------------------- B Upcoming Conferences and Events (send your event listings to [email protected]) The 2007 International Drug Policy Reform Conference December 5-8, 2007 Working Toward a New Bottom Line December 5-8, 2007 ~ Astor Crowne Plaza ~ New Orleans, LA ~ The Drug Policy Alliance's International Drug Policy Reform Conference is the world's principal gathering of people who believe the war on drugs is doing more harm than good. No better opportunity exists to learn about drug policy and to strategize and mobilize for reform. For more information, please click here. --- C Quotes Civil and political rights are critical, but not often the real problem for the destitute sick. My patients in Haiti can now vote but they can't get medical care or clean water. - Paul Farmer In hindsight, maybe it wasn't such a good idea. - Andrew Speaker, a patient with extensively drug-resistant TB (XDR-TB) who went on a wedding trip to Europe and back against the advice of health officials. --- D How To Help The Harm Reduction Project is able to provide services through the support of individuals such as yourself. Please help us make a difference and pledge your support today! PLEASE CLICK HERE TO DONATE or call 801-355-0234 ext 3# for more information. -------------------------------------------------------------------------------- About HRP The Harm Reduction Project works for the enhancement of services available to marginalized populations HARM REDUCTION PROJECT SALT LAKE CITY | DENVER | WASHINGTON DC TEL (801) 355.0234 FAX (801) 355.0291 www.harmredux.org