Get Used to It: Ep. 154, "HIV/AIDS Today"

(rattling noise) (lively music) - Hi, welcome to Get Used To It. I'm Sheila Kuehl. And as always, I am your greatest hostess taking you through the hour of fascinating show and fascinating guest. And today is no exception. As a matter of fact, I think it's really a highlight because every so often we try to let you know what's going on currently with the issues of HIV and AIDS. And today I have three extraordinary guests to talk about this and bring us all up to date, and I'd like you to meet them. Phill Wilson, who is the president and CEO of the Black AIDS Institute. Welcome Phill. - Thank you. - Michael Weinstein, who is the president of the AIDS Healthcare Foundation. Michael, welcome. - Thank you. And Ruth Slaughter, who is the just retired from being the vice president of prototypes and Ruth will tell us about prototypes as we talk, but Phill, let's start with you. [Phill]- Okay. It's a big subject and there's a lot going on or maybe a lot not going on. What would you say is the most important thing we need to know about sort of what's going on with AIDS and HIV issues, treatment funding, everything today? - Well, it's interesting for the last year I've been talking about the best of times and the worst of times. And I think now it's just the worst of times, we look at particularly on HIV and AIDS among gay men, we see a rising epidemic. At the same time , the Kaiser Family Foundation recently released a study that showed that people are getting less information about HIV. Now, they don't think HIV is as important as it used to be. And they're not as afraid about HIV as they were. We see huge increases going on in people of color communities. And we see around the country due to the economic downturn agencies that are closing, states have budget crisis and here in California, we're basically dismantling HIV prevention, I guess in order not to be just the dooming gloom, there is some good things that are going on. The president signed the Ryan White CARE act now, which is an important initiative. We also lifted the ban on HIV travel in the United States. So those are good things, but by and large I think people who are involved in HIV , there's this interesting sense of optimism that I'm totally confused about. I get that we are excited about the election of Barack Obama as president. And I certainly have consumed that Kool-Aid as well. I'm very excited about it, but when I really look at the landscape, I don't know why I'm so happy because let's every return. There's bad news. - Let's look at the I mean, you, could lecture in a class any day, as far as I'm concerned because you just covered the whole waterfront in about a minute and a half. So let me ask you to embellish a little on each of those, starting with growing infection rate. Is that across communities, are we talking L G B T community more than there had been in black community, other communities of color? - Well, what we see across community now although now last year, the CDC reported that the AIDS epidemic in America is 20% worse than we previously thought it was. So rather than 40 annual new cases, we're looking at more like 56,000, 40,000 annual new cases. We're looking at 56,000 new AIDS cases in this country, which is a significant increase to, - Was that just we weren't counting right? Or some kind of reporting issue? - Well part of it is we weren't counting right. In some reporting things, but just that the epidemic was just worse than we thought. But then when you drill down, we see kind of a leveling at that 56,000. We were never really at that 40,000 number that we were reporting. But at that 56,000, you see a leveling in most population except among gay men And we are seeing increases among gay men and particularly among young gay men and extra particularly among black, young gay men. So we see increasing in cases among those populations, basically the most marginalized and the most vulnerable of us are at increased risk of HIV. - So do you see this as unusually increased so that we, is there discussion about what the reasons might be? Cause you were also your second point had to do with less attention being paid or less seriousness about it, or even less fear about it. [Phill ] - Right. - But how do you attribute the increase? - Well, a few things. I think that clearly there is fatigue among in the L G B T community around HIV. I think that the other thing that's going on is that we've gone through eight years where HIV prevention has been under assault. Now, the Kaiser Family Foundation report, show that people are hearing less about HIV. Now we invested a huge amount of money in these absurd, abstinence only programs, which did nothing to address issues among HIV, among gay men in particular. And we've totally dismantled HIV programs in our schools and in a number of different places. So what we're seeing now is the consequence of that neglect And so I think that speaks to some of the increases that we're seeing in various communities. - And what about the, let's talk a little bit more about where the diminutions have been funding for instance, what do you see specifically either defunded or not? I can't say not sufficiently funded. That would probably be everything. (cross-talk) - Over the last eight years we saw a flat funding of the AIDS budget, but we've seen an increase the domestic AIDS budget, but we've seen an increase in the number of people who are living with HIV now. And so at a time when we should have seen increases, we didn't. And so on a per capita basis, we actually saw a decrease and that's across the board. And so when you look at prevention programs, they are much less resourced today, per capita than they were, let's say, eight years ago. And sadly because of the state of the economy, now the budgets that we see coming out of Washington DC, are no better. Even when we have a Congress, that is leaning to be supportive on HIV issues. And we have a president now who has made a commitment to national AIDS strategy, a president who has made a commitment to healthcare reform, a president who is speaking out on L G B T issues, all of that is not manifesting itself in additional resources on the ground. No. - So let's talk about healthcare reform since you brought it up. Because a lot of times I see a disconnect in the gay community and in communities of color sometimes about, this healthcare plan that they're talking about, people don't see it really connected to their lives. They think maybe they'll be able to get insurance, but just in terms of specifics, not always clear, do you see a connection between the discussions going on about healthcare reform and our concern about HIV and AIDS? - Well. Your question is divided into two parts. I think you're right, that there is a disconnect. I think that that people who are concerned about HIV don't necessarily understand how important healthcare reform is for people living with HIV. Healthcare reform is critically important. Now, how we get there, the devil's always in the details, and if it ends up being merely health insurance, tweaking then that's not gonna benefit people with AIDS as much if we talk about true healthcare reform. But the fact that we have that, if we have a system where we can get now know large numbers of folks who are out of care into care, many of those folks are gonna be those of us who are living with HIV. And that is going to be a good thing. I think that the days of HIV/AIDS exceptionalism are running out and in some ways I never thought that I would say this. And in some ways I think that that's not such a bad thing. I think that we've done a huge amount of work in dealing with stigma, though stigma still a major problem. I think that it is not 1984 any longer. And if we can mainstream HIV care appropriately mainstream HIV care, I think that people with HIV will be better served. but the only way to do that is for us to have real healthcare reform. And so those of us who are interested in HIV, I think have to be involved in the healthcare reform, debate and discussion. And right now I don't see us included in those conversations. And if we're not included in those conversations, if healthcare reform actually happens, and I think there's a good chance that it might, then we have to worry about whether or not our needs are going to be met. So for example, in certain populations, if healthcare reform legislation says that we're gonna include HIV testing, and let's say that the regulations say that you need to be tested once a year. Well, for example, for high risk gay men, once a year is not often enough. So we need to be having those conversations, around those kinds of programs. - So you're saying, because you said there was a difference between health insurance and healthcare reform. And I think even if people in all of our communities are saying, "yeah, I really wanna get involved, wanna be knowledgeable about what I say," how do they understand the difference? And I think what you just said may be one of the things, in other words, the discussion in Washington seems to be primarily around insurance, right? Is everybody going to get it? Well, yes, they're gonna get it, coz we're gonna make them have insurance subsidies. (crosstalk) Because then you have to have a basic required coverage that the insurance companies have to offer. And that, as you said, those are the details that are often problematic because the minimal coverage may not be sufficient. - That's right. - For what you're saying. So it's really a matter of making certain that prevention and testing is included, but there may also, you may also not want to cap on how many times you can be tested. Are there other issues that people wanna look out for in this healthcare debate? - Well, of course in the HIV community, we definitely wanna look out for the drug benefits, and what the definite details of the drug benefits we already experienced. Those challenges and some of the existing systems, the ADAP now there's some challenges around the drug benefits. And so that's a very important detail. Now, preventative medicine is an important detail. Now what's happening with mental health is an important detail. So I think that in our community, we really, I think that, that the most important thing I would say is from where I sit, we are not at the table and we need to get at the table. And we need to make sure that we're involved in the conversation. And the truth of the matter is it just requires us to kind of showing up because there're not really a lot of barriers. They're not folks who are saying, we don't want you at the table. That's may have been true at one point in time, but that is not the case today. If we show up, if we get engaged, we have the power to shape, what's gonna come out of this healthcare reform conversation. - Michael, you've been on the ground with this issue for more years than I think I even remember. And I probably remember all of them. I'm interested in your take on this as well. Even going back to the original question about what are the most pressing issues as you see them at the AIDS Healthcare Foundation and your inclusion in the larger discussions? - Well, I think it's important to look at AIDS on a global basis. AIDS doesn't respect boundaries. It doesn't respect groups. It doesn't respect counties and states and all of that. On a global basis. I think there is the possibility for the first time, a glimmer of hope of global AIDS control. And that's a magnificent thing , it's been reported in the last month that there are 4 million people in the developing world who are getting antiretroviral therapy. That's 10 times more than it was five years ago. And when AIDS Healthcare Foundation first started providing free care in Africa, there were only 50,000 people receiving it. So that's a magnificent achievement. I think that really the biggest issue in HIV as I see it, whether it's in California, US or around the world is the fact that still the majority of people in the world who are HIV positive don't know they're positive. And how do you fight a disease when you don't know who has it, right? HIV is similar to other diseases in the sense that early diagnosis is critical. We know that the majority of new infections are coming from people who don't know they're positive, which is good news, coz people who know they're positive are protecting their partners and there's even better news in the sense that what we've learned is that people who are on antiretroviral therapy are rendered almost non infectious. So actually treatment becomes a form of prevention. I think what's very disturbing to me is I was an early and strong supporter. Personally, of course I represented nonprofit Barack Obama for president, but the things that Barack Obama voted for as a Senator, he is not doing as president. [Sheila ]- Hmm. And there's been a de-emphasis of HIV AIDS on a global basis. And I believe also domestically, we ran ads on CNN in Washington DC talking about how Barack Obama had not mentioned the word AIDS in the first six months that he was in office and there's discussion among high level officials in the administration about de-emphasizing AIDS and putting more focus on mother and child health, which of course is important. But I think that if the United States doesn't keep the commitment that it made on AIDS that it's gonna be a great discredit to us. I think domestically the situation is basically one where, because of treatment success, people aren't dropping life flies that removes a lot of the urgency, both in terms of protection and in terms of community mobilization around these issues, I think in the gay community, among gay men it's a mixed bag. I think first of all, that we've had a culture of self destruction, which we don't really like to talk about A combination of abuse of drugs like Crystal meth and promotion of circuit parties and other types of things which really promote unsafe sex and unhealthy lifestyles. So I think we need to address that leaders of the gay male community have to be more out front and be raising the alarm. And do you think they're dropping the ball on emphasis in terms of the, in the gay community, in terms of emphasis on, on prevention and being aware and. - Well, absolutely. I think it's, you don't see condoms in bars. You don't see safer sex messages in places where people go to hook up on the internet. I mean, I think it's something that people see as kind of a drug and I think that younger generation of people have not seen people get sick and die of AIDS And that is the best AIDS education that anyone has ever had is watching somebody die of aids. Unfortunately. So, but I think that if we have leadership up at all levels, then I think we, and if we identify people in this country who are positive and don't know it and get them into care, then we can bring those rates down. And I think that if you look at rich countries in Europe or poor countries in south America or Africa have done a great job in AIDS is one common theme, political will. But I think another thing that's important is AIDS has revolutionized almost everything it's touched. And in particular it has elevated global public health to a stature that it never had before. It's now like in the Pantheon of important issues, women's rights, poverty environment, democracy. And that's extremely important because we have a shrinking world with jet travel and migration and communications. That's not gonna change. We can't put that genie back in the bottle. And so when& I'm sitting on the tarmac, in a plane in Johannesburg, I'm not thinking about terrorism, I'm thinking about germs. Okay. And so if we ran air traffic control, where we run global public health planes would be colliding in the sky every single day. So we need the equivalent of a World Trade Organization or Kyoto treaty, coz everywhere you go in the world, we're in 21 countries, okay. Every country has different standards for testing for treatment, in some countries, every state. So this is not the right way to be doing this, but I think one of the things that has diminished over the years, that would be very helpful that existed here in other places is that the voice of people with HIV and AIDS is heard more. And I think that that was missing what this year to a large degree, when the AIDS budget of California was eviscerated. And we found it very powerful when we were lobbying on the reauthorization of the global AIDS bill in Washington, we brought people from Africa, we brought people from the other countries and we sat them down and they got to look into the eyes of people and hear their stories. I think it's extremely, vital, but the problem with AIDS overall is that, it intersects all these hot button issues. I mean, if you had a science fiction novel, that talked about a disease that intersected, homosexuality race, drug use, prostitution, all these things. It would seem too fantastic to have believed 30 years ago. But I mean in many of the countries that we operate in, the three main drivers of the epidemic are all illegal. Okay. Homosexuality is illegal in many other countries, sex work and, and IV drug use. And so that makes it far more difficult to achieve the goals that we would like. - Well, In a sense though, isn't that an issue with stigma too? Because I you know, when Phill said that the stigma is less, I think that is true in terms of people thinking if you're HIV affected or if you have AIDS, it's not like, oh, it was your own fault. You deserve to die. That part I think has gone, but still there is, as you've indicated, sort of these connections, especially internationally with these issues, doesn't that make it harder for people to want to know if they have it? - Well, we've been doing what we call mass testing or routine testing in Mexico city subways stations. We did for World Aids Day last year, 1.6 million tests. We did it in truck stops in Africa. We did it at fish landing and literally thousands of people lined up. People do want to know. Yeah, the stigma will always exist. But in public health the whole idea of public health is urgency. - Right. - And containment. Okay. So you can't wait for attitudes to change, but government inaction reinforces the stigma. And I think Phill is correct in saying also that some of the policies that we pursued early on for very good reasons are today are reinforcing some of the stigma, the AIDS exceptionalism in a way is saying, it's so different that we can't do it the way we do public health. And I think that's sometimes a disservice. The reality is today with treatment, with testing and with prevention, we have proven techniques that can control this disease. By control ,I mean that the number of people becoming newly infected is less than the number of people who are dying of disease. The pool of people who are living with the disease is going down. Reality is we have places like Brazil. They have a handle on this disease there. Okay. We have Northern European countries. They have a handle on it . Up until recently and maybe still Thailand. You've Uganda has gone up and down. But I mean saying is we know what to do. Now the question is, are we willing to do it? - Well Ruth, let me ask you about, you spent a good part of your adult life working on issues related to women, families, women, and children. [Ruth]- Yes. - And more recently about women and HIV AIDS. Maybe you could tell us a little bit about prototypes since it doesn't necessarily in the title. Tell us what it does. - Can I just say first, Sheila, that thank you for having me here with Phil and Michael. They were my first teachers because when I started HIV AIDS work and prevention work, I knew very little. And Phill took me under his wing. He became my mentor. He became my teacher and he was so important to the work that we were doing regarding women. Prototypes is probably one of the largest women's organizations in the nation. We provide services in substance abuse, domestic violence, mental health, HIV AIDS prevention, and HIV AIDS care. We have been doing it now for 25 years and it's work that is so important. And prototypes is a model. It was innovative programs to provide HIV AIDS prevention. We were the very first national organization to provide information to women regarding HIV and AIDS We were in Boston, San Diego, Wattles, Mexico, and Los Angeles. We were flown to Washington to do this national program. And we were being trained by gay men and white men about how to work in communities of color. And I think the first day we realized that this wasn't going to work. So we all went back to our cities. And what we had to do was really ask the women, how can we help stop the spread of HIV and AIDS? And the women told us and AIDS for them was not the most important things in their lives. They were concerned about their children. They were concerned about the violence in their communities, mental health, substance abuse. So there was a whole range of issues that they also wanted information about. But because we had this NIDA grant, we incorporated everything around HIV and AIDS and the women did get the message. They did get the information and it was evidence based. It was changing behavior. And so many of the women did change. And so many of programs, I do wanna say so many women across the country and probably the world are changing behavior and they're having safer sex and being very careful. But there's a whole generation now of young women who have no information that they don't understand what's going on. And he, if he looks good and he feels good and smells good, why bother with a condom? And also the other barriers and challenges are women are afraid to maybe tell their partner to use a condom. So there's a lot of barriers stopping women from keeping themself safe. So what we did is also talk a lot about STDs. We talked about unwanted pregnancies, but always tying in HIV and AIDS. This was so important to look at the whole person and not just a part of the person, our women and AIDS care program, women living with HIV and AIDS. Most of them were poor women. Women with very little income. Women may not have insurance and their issues were housing ,transportation because they had children getting the medical care coz the women that we worked with, they did get medical care at HA AIDS Healthcare Foundation, as well as on Tenet, so they had good healthcare, but helping the women to get to their appointments, to being compliant, to having a support group. So they would be able to even tell their families. Disclosure was one of the biggest issues that the women had telling their partners, telling their families and many women were thrown out of their homes once they were found, once the family found out that they were HIV positive, - It took a while before we really started to grasp that there was an epidemic among women. [Ruth]- Yes. - And there was a lot of attention paid. And frankly, we were pretty much on our own in the gay community at first because it was like well, that's your problem. You take care of it as we remember. But then that started to happen. There was a lot of work developed, a lot of models actually developed. And then we started to hear, this is actually a very important issue among women too. But I remember you telling me it was very difficult at first to get that, even that understanding of realization out that this was a growing population. [Ruth]- Yes. With HIV. - Yeah, because we worked with such a high risk, underserved communities. HIV AIDS was not on the radar. It wasn't one of their biggest issues at the time coz it wasn't like the gay community where men were dying. This was the case that you would hear about someone. And then it was hidden. If someone had HIV AIDS in the African American community that was hidden. People didn't wanna talk about it. Didn't wanna deal with it and was still seeing it in our churches everywhere that it was a gay man's dece didn't wanna deal with it at all. So not women were dealing with racism, homophobia as well as sexism. - So what changed because there did become a growing awareness about women i think. - Yeah. I think that the change came when we were starting to get more and more funding and we made it a normal process of education to the community. So we found more and more acceptance. Women more and more wanting to have more in information. We were seen as a resource for all of their needs, not just HIV, but HIV was very important. And one of the things that happened over the years that we were well funded for prevention and HIV care, we were proven that we had good services, that behavior change was happening, but funding became smaller and smaller and smaller Until now it's just about non-existent for prevention programs. And that's very troubling because we have a whole generation of young people who still don't understand HIV AIDS - Well, Michael had indicated that he would love to see more involvement or maybe return to the kind of involvement we used to have of people living with HIV and AIDS, who themselves become advocates for funding, for programs, et cetera. Do you see in the women's community, do you also see a kind of a hanging back and not being aggressive about going after that money or getting the money to in the first place in the budget? - Yeah. Yeah. It almost feels like it's a planned thing to happen and yes i do think the activism and the fighting has to happen again. And that's what we fought for. I mean, at one time we had lost all of our AIDS funding and we brought 40 women down to the AIDS commission office and they all testified until they got so tired of hearing the women that they finally approved it, but that's the type of activism, but I it's almost like it's so passive right now. And with all the other economic crisis, I see this pushed further and further in the background, - Even with the Ryan White CARE act ,the reauthorization, and we're glad that they reauthorized it, but we've now lost the mandate for the HIV planning councils. And so the mandate for community involvement and the decision making process is no longer there. We've lost the mandate for people living with HIV to be involved in the decision making process. So there's an erosion going on on the voices of, on the community level and those are huge losses and they speak to a loss in the sense of urgency. - Well. Let's talk about that because you've all brought up funding. I see that it's not obviously it's not the only issue. [Ruth]- Yeah. - But what do you attribute this to? This is not great grammar, why are we seeing this diminution in funding? Never mind that everybody's saying, oh, well, you know, it's hard times and there's less money. It seems to me that there's as Michael has indicated not, enough attention being paid a little bit of relaxation. - I think there's an irony to the fact that we do better in certain respects during Republican leadership, because we are treated by the Democrats as being like one of the tribes that we have no place to go. And therefore will be satisfied with whatever they give us. I mean to me, it's amazing that AIDS programs are flat funded in the first year of a overwhelming democratic majority in the Congress and a president. And you know, we've given trillions of dollars away to Wall Street and to Detroit and the biggest public health threat we have in this country is being starved. I think also that at the community level, people have such hopes for this new administration that they feel they don't feel the same need to be active, but also i mean, we're a victim of our success is that when people were dropping like flies, when you were spending your weekend going from hospital room to hospital room and the combination of grief and anger and fear was so strong, of course it was easier to get to people to a rally. And now we have medications, one pill once a day, it's all paid for, but I mean the AIDS Drug Assistance Program, which is the lifeline for people living with AIDS and HIV who are poor, that's under severe threat in California. I mean everyone was shocked and disturbed by the cuts last year, but we're facing another year where it could be as bad or worse. And we had demonstrations and we had lobby days, but they were weak, they weren't strong. And so I think that if we wait until it's too late, it's not going to be good, but it's also Americans have short attention spans. I think even within the L G BT community, there's the issue Deja, and I'm not saying they aren't important, but I'm saying that we gotta, we have to begin to look at not just HIV, but sexual health for men and women as a civil rights issue, we have a right to sexual health. Okay. We don't need to be punished for exercising our sexuality. And that is the platform of the Christian, right? 91% of American parents want their children to get sex education in schools. So some fraction of that 9% of crazies have more influence than the 91% of parents who want it. Cause they show up at a school board meeting. I mean, liberals are lazy basically by and large. - Well, it was very difficult to get the sex education stuff through even in California for you had to be able to allow parents to excuse people from sex education. But the interesting thing though, Phill, you were saying they don't do the training in the schools anymore. And yet it's the law in California at least. And I think several other states that there must be something about HIV AIDS in the schools. So are you saying it's kind of like on the books, but you don't see it happening as much? - Well, I think that what's happening is that it's resource driven. And so people are fulfilling the letter of the law, but the kind of robust AIDS education that was going on that was primarily driven by the way, by the AIDS organizations. The way the schools fulfill that obligation is they would invite the organization to do services, but most AIDS organizations no longer have those types of programs, no longer have those types of speaker bureaus programs. Now those are the programs that kind of went by the wayside and the early kind of cuts. Now, we're really cutting against the bone. We're really talking about dismantling programs. And I think for the people who are watching this show, we need to ask ourselves, do we really want to go back to the days when people actually were dying, because that can happen because like as Michael said, when Aids Drug Assistant Programs are in periled and they are in peril around this country, when we're talking about real waiting lists, what happens is that people actually stop seeking treatment And particularly in an environment where have now kind of the critical math of folks that are in treatment, then we have to deal with things like drug resistant virus, because people are not consistent and they're not adhering to their regimens. And then we have a whole new and different epidemic that we've not imagined before now. So Michael's absolutely right. That it will be extremely tragic if we allow ourselves to get to that place where we're facing the kind of crises that we felt in the way that we felt in the early and the mid eighties. - Let me say one thing I'm sorry, is the one group that was protected in California in the AIDS budget was the drug companies. 100%.. - What a surprise. Right. But I don't like to conflate - Let me not interrupt you. [Ruth]- No, go ahead. - I don't like to conflate necessarily who does what. I mean, my experience I'm not in the legislature anymore, but my experience was that often we would have a more robust AIDS prevention and treatment budget. And the current governor was not as supportive. And I think it was a lot of what was lost this year was his, his individual line-item veto, if I'm not mistaken. [Michael]- Yeah. So I think when people are, what my thing always was is if you're gonna advocate, let's have a way of preparing our advocates so that they're advocating to the right people about the right stuff. Cause when people would call and ball me out, for voting for a budget that actually had the funding in it. [Michael]- Right. And we hadn't cut it, it was kind of like I'm stuck, go talk to the other guy. But that's not an excuse nationally or locally. But I think that what it means is we need to do exactly what you're talking about, which is to make certain that people coz people are wanting to volunteer, they are wanting to show up now that they have good information. - Well, yeah, what I was gonna say, i feel like Phill said that HIV AIDS is mainstreamed into medical services, but it's not enough just to have medical services. The women that we see they're at very high risk because of their substance abuse because of their mental health issues. And I'm sure that's true within the gay community. We have to address those issues also because they're not gonna be compliant if they do have these other issues. So it can't be just medical care. And that's where I think the county and probably government is thinking if we mainstream it, we don't have to do these other things. But I think we do. We have to look at the whole person again. - So is when you talk about AIDS exceptionalism, you really meant treated differently from other conditions or diseases. But seems to me what Ruth is talking about is where, where's the integration of the issues of real people's lives, who are living with HIV and AIDS Do you see also a separation programmatic treatment? - Well, i just look at it that we're not talking about healthcare reform, we're talking about sick, the sick industry. We're not talking about the health industry or healthcare. And that we have to tell the truth to people. Okay. They have to take control of their health. They are responsible for the way they eat, exercise, sexual health, getting checkups. And we need healthcare institutions that are structured to promote that, best example is Kaiser. I know people who belong to Kaiser, they harass you if you don't get your colonoscopy or your mammography. [crosstalk] I can attest to that. - Now they've got email Now they send it to your blackberry . [Ruth]- Yeah. I mean. [Phil]- And that's great. - I'm wondering if somebody's not coming knocking at my door head, did you have your mammogram? - But that's a great thing. [Sheila]- It is. Cause you know, we're negligent. Okay. That's how you know and we're in denial, but I mean I testified in Washington at a hearing and I said there are three issues that have to be dealt with if we're going to deal with healthcare. And that is health promotion, end of life, which eats up tremendous amount of resources and every system. [Phil]- So you're the death panel person. - Yes. I am I have all kinds of friends who have me as their durable power of attorney because they know that if they give me an instruction to pull the plug, I will pull it. - Oh, what a great new (inaudible) - But the coz I have seen so many people die, horrible deaths. I saw my father's life extended way beyond reason. But the other thing is that we have this boogaboo about rationing. Well, first of all, we ration care now, but we ration, [Sheila]- No we don't - Irrational [Sheila]- Companies do. - Yeah. Right. But the main thing is that if we're going to cover everybody and we're going to emphasize prevention, then we're gonna have to have a little less emphasis on some of the high tech things. We're gonna have to have some things there's no harm in waiting for. And we have more MRI machines on the west side of Los Angeles than they have in Canada. That's nuts. So, but what I'm saying is what's disappointing to me in this debate is we needed some tough love and we're not getting it. We're really not telling people the truth, which is that they are part of the team. They have to be part of the team. I think in a way that's also the case with HIV AIDS. we have to say to people in the gay community, I have to say to gay men, you have to act responsibly. You have to, if you love yourself, you love your part, you love your community. Then you have to show it by using a condom and you have to talk about these things before you're drunk or high or in the act, I feel like sort of the unwelcome guest at the party a lot or the scold, - I think we used to call it the turd in the punches. - Okay. but it's the truth. - But what's so funny about that is that was the original message. - Sure. - You know. - The original, that. (crosstalk) - And it was, it was a message that one it was the message that actually brought about the change that we wanted to have happened. Now, I remember coz I was at stop base in the very beginning. It was like, we have a responsibility, and you're right. The norm was, and we did all these kinds of things that says that quite frankly know to be in our community, there was a cultural norm and of course there were always outliers, but the core cultural norm was that you were gonna protect yourself. [Michael]- And we could get back there. - That's right. - We ran these ads. I don't know if any of you've seen them in Los Angeles, we're gonna run 'em in other parts of the country, there was a picture of Blair Underwood. And it said, man up and you free HIV test. And that we did focus groups and we had a straight group and we had a gay group, men and women and 100% of them had seen it. And 100% of them responded that, it made 'em think, what are my responsibilities? Just that one little phrase. So I think we can get back there if we make a commitment to it. - But I think what Ruth was saying is it's not always, obviously we don't mean it's only up to the individual because that's a kind of a you don't need our funding. Why don't you just abstain kind of [Michael] - Right. And I know that's not what you mean. [Ruth ]- Yeah. And so it's so different for women, you know, they can't just man up, there are women who are showing a lot of responsibility and who have changed, but there's also a lot of women who there's fear. There's a lot of fear about womening up. Fine. I don't know if that's a word. [Sheila Laughing] - But I think Ruth, the point is that the whole notion now, even in the language of man up and certainly the early messages around HIV prevention were not about individual actions alone they were about community actions. And that's why I talked about it about community norm and the reason why we talk about women being fearful because we've got change the community norm. [Sheila ] Yeah. That fear dissipates when it's a part of the community norm. And that's the change that I think we actually achieve now in the gay community. And quite frankly, as I work in black communities, those are some of the changes that we're starting to see in the black communities now. We are talking about one of the things that I often say when I speak to black audiences is that if we learned nothing from Katrina, we should have learned, they're not gonna send the boats for us. And so should the government do more? Absolutely. It should. Should industry do more. It should. But if it doesn't, we still have a responsibility to survive. And so whether we're talking about women or gay men or black America in general, we all have a responsibility, to survive, you and we should not, we cannot abdicate that responsibility. - Also, I think women have born too much of the burden of responsibility for contraception and other and things like that. And so I think, you know, the message that, and. - We're the ones that needed the condoms in the bars, I guess. Huh? Yeah. It's like here, could you use this place? Well. - I'm gonna say, I think the point really is, I mean, when people say to me that prevention has failed in this country. [Sheila ]- Oh, I don't say. - Okay. When did it start in earnest? where are the commercials on television? We tried to run a condo commercial on family guy. Okay. The raunchiest show on network television. A vanilla commercial. It was refused. So, and the few networks that will run them, run them in the middle of the night. If we spend a fraction of the money promoting sexual health that we do on sugar water, then you can tell me it failed. But we have national leaders telling people to man up. But and I think that we do need to tell men that they have more responsibility than they have exercised. Women inherently wind up holding the bag with unwanted pregnancies and diseases that they get affected from by men. And I think. - And that's worldwide. - Yes, absolutely. - But that's also part of the fear. I think it wasn't just fear of disclosure, fear of being labeled, but also the individual fear when we were working together in the violence against women movement, sometimes you're just not able really to make the sex safe. [Ruth ]- Yeah. And that was an issue for the batter women's movement. That was very difficult because there wasn't seemed to be a great deal of crossover [Ruth ]- Yeah. - From one movement to the other. But that was very good work that prototypes was doing was really showing how those things were connected. - Denial. Also, I don't want to even think that he is having sex with men. I don't want that to come into my household. So I will deny that [Phill ]- That's right. - But it's not just having sex with men. we have to look at, in the context of sexual health, we have an enormous epidemic of sexually transmitted diseases other than HIV. [Sheila ]Yes. You know, we have women getting cervical cancer from it. We, we have lifetime infections with Herpes. 25% of all California teenagers come down with an STD. This is really uncivilized. Other countries, industrialized countries don't have this. - Well, America. I mean, it's, I'm sure it's a cliche, but America has always seemed so sex phobic to me and certainly gay men were the first people to point this out to me, it's kind of like, why do you think they hate us? We're having such a good time. But when just trying to get the sex education bills through and the notion that parents would show up at hearing saying, "I don't want my kids to know that." [Ruth }- Yeah. Not that I want, I wanna be the one that tells them, but I don't want them to know that. And so if you have this whole approach, you're not gonna have condom commercials, but you are gonna have plenty of drug commercials about, you know, depression and I don't what - Erectile Dysfunction. (crosstalk) - This is turning into an X-rated show. It's just great. - Well, we might not wanna talk about sex. we are clearly having a lot of sex and we're having a lot of unprotected sex now because STD rates are up across the board. When, Michael talked about teenagers in general in California, but the national for teenage girls, 25% of teenage girls in America have an STD And for black girls that number's 50% And it's outrageous when I saw that data, when it came across my desk and every black civil rights organization in America was not now out in the streets, reading that am absolutely mortified by it. And so we are having lots of sex, we're just not talking about. - But we think it's the wages of sin, right? That's how we treat it. If you have sex, you deserve to get a disease and that's the price you pay or an unwanted pregnancy. And it goes back to issue of separation church and state, et cetera. But bottom line is that we have a crisis in sexual health and we're hedonistic in our behavior and we're moralistic in our attitudes and that's a deadly combination. - Well, it's always been one of the interesting things to me is when some Democrat is caught in terms of a sexual kind of thing. Well, oh my God, everything big is made out of it. But then if someone from the other party is caught, like killing 14 million people, because it was the wrong kind of drug it's somehow equated like a sexual peccadillo is the same as foreclosing on 20 million people. And in a way we allow that to happen because of the sex phobia in the country. And the fact that we don't, we're gonna make that a real sin. [Michael ]- Yeah . - When from my point of view, the real sin has been why you allow these people to stay poor and sick. - Well, except they're doing both now. (laughing) - Yeah. That's true. That's true. I recently took a vacation in Argentina and everyone. I told them I was going to Argentina. They asked if I was going to find my soulmate. [Phill ]- Exactly. - I thought, oh my gosh, this is. - But the question is, if we don't use the opportunity of having the democratic majority, they just stuffed 50 million back into a bill for absence, only education that had been eliminated. There's no evidence to support that, and it was done is in the dark of night and the Democrats are not standing up for these issues because they're worried that in their constituencies, that someone's going to raise this and scare people with it. So, I mean, it sounds very simple, but we kind of have to grow up. We have to be more mature. And again it applies to, to the gay community too, is that we've been dealing with crisis in sexually transmitted diseases, including HIV. I went to the gay lesbian center when I was 19 years old and half of it was a clap shack, which was a great service, but we know what the problem is, and we know what we can do about it. But so far we haven't had the commitment and course we're all products of a country that doesn't have a separation of church and state. And it puts moralizing above practical solution. - So in, we have a few minutes left and really I think a talk show is more actually for the viewers. we could have done this sort of with a cup of coffee around the dinner table, but let's spend the rest of the time talking about what would you like seriously What would you like to see people do? Which people and what would you like to see them do? I get elected people you'd like to show a little more spine There's no such thing as a Democrat, there's the people who are absolutely with us. And then the people who are scared of their constituents, then the people who are sellouts, that's all my party. [Phill ]- Right. And the other party, I think they have a court of a little more truncated kind of spectrum, but what would you like to see people do? - What I'd like to see happen? There are many churches, Christian churches, as well as Catholic churches and in the African American and Latino communities doing really good work regarding HIV and AIDS, but it's not nearly enough. And I'd love to see more churches involved in educating their community about HIV and AIDS. Is there a particular sort of exemplary program that you've seen - The church in Oakland it's Oakland's [Phill]- Allen temple. - Yes. Allen temple [Phill ]- Allen temple. - Yes. Allen temple So it's a community outreach y'all come whether you go to this church or not. [Ruth ]- Yes. - Yes. - They have huge AIDS ministry. Sadly the AIDS ministry was run by a physician named Dr. Bob Scott, who just died two weeks ago, but they have a used outreach program and for phenomenal work in the middle of Oakland. [Ruth ]- Yes, - Exactly. And in Nashville, Tennessee, there's Metropolitan Community Church, that does remarkable work. There's Riverside in New York , FAME here in Los Angeles, continues to do very good work. So there are a number of churches that are doing work. And I think that for those of us who are interested in HIV and AIDS we need to hold those churches accountable, and we need to push them. And we need to meet folks where they are. We're doing a lot of work with conservative churches and finding people are willing to start. If we're willing to have those conversations. I think the thing that I would want people to do is to show up I think that this administration wants us to hold them accountable. And quite frankly, I think they need us because as the president said on election night, I pledge that it be the president for all of America And if the only part of America is showing up is the right wing. Now then that's the America that sadly he's going to have to serve. And so I think that this administration is helped and they are big boys and girls, and so they can take our critique. And so I think that we should hold them to their feet to the fire. And I think that actually helps them achieve the things that they said they wanted to achieve when they were running for office in the first place. - How about you, Michael? What would you like to see people do? - Well, first of all, I'm getting a little long in the tooth. I just feel like I have a responsibility to the younger generation. It is not a necessary right of passage to become HIV infected. If you're watching this show and you're 22 years old, you do not have to become HIV positive. Your generation does not have to become as infected as our generation is. Secondly, I think we gotta keep our commitment and let people know that people do care. Thousands of people turn out to fundraising events and other activities. And I think they need to let political figures and opinion leaders know that they really do care. If we keep our pedals to the metal, we can conquer AIDS. We're not that far away from that goal. Not necessarily eradicating it, but conquering controlling it. And why give up now, after all that we've suffered. And I think, and I hope in the long run that we make a contribution to issues like sexual health and global public health. - I wanna thank you all three. Thank you. This was a great show. I'm so happy. When I called the three people I wanted to have on the show, they all said, yes, I knew it would be just what was needed. I hope you enjoyed it as much as I did. I hope that you will be involved. I hope that you will be aware. And I hope that in terms of making a difference in the world, you'll get used to it. (music playing)