The Other Pill

truvadaWith last week’s announcement from the CDC there has been a huge uptick in opinion pieces and mixed reactions relating to the prophylactic drug Truvada (or PrEP). In my own life it has become quite the robust conversation topic over social media, dinner parties and happy hour with friends. My broader feelings have been oddly ambiguous, so until now I’ve only commented on smaller, side-issues because I’ve felt so strangely conflicted and underwhelmed by what is surely scientific good news.

As much as I like to think of myself as someone who can just read the medical literature and data (10 years of working for Public Health researchers and epidemiologists has rubbed off on me a little, at least I hope!) I have to confess there are personal, illogical gut-reactions involved too. Either way, this year is establishing itself as the tipping point for the gay community to grapple with several, interlocked issues around this little blue pill.

Way back in distant history–when Bill Clinton was president and web-surfing was something squeezed in at the office–I worked as an administrative temp in downtown Seattle. There was an office manager named Maureen who in so many ways was the prototypical one of that era. Close to retirement and a bit of mother hen to us “kids” (twentysomethings slumming it until we found the proverbial “real job”), she told me a fascinating story that I really hadn’t revisited until lately. She said when she was attending University of Washington, sometime in the early 1960s, she put herself though this peculiar rigmarole to obtain the birth control pill. A Seattle native, she didn’t go to her family doctor who’d treated her since childhood, nor the student health clinic on UW campus. Rather, she made an appointment with yet another, new physician located in Seattle’s Rainier Valley. Not only that, she borrowed a ring from a girlfriend so that she could claim she was engaged at her visit. Fifty years later, Maureen–part of the final slice of the Silent Generation–was laughing with us at birth-control-pills-from-case-eduhow elaborate her performance was. Pretending to be married would have been a more assured way to obtain The Pill with less hassle, but somehow she STILL feared this might get back to her parents via some secret slut-shaming physicians’ network. So Maureen created a back-up plan in case she needed to do later damage control–she could quickly claim she and her boyfriend were secretly engaged (they weren’t and the relationship ended before graduation). Fear of judgement plus some good old-fashioned embarrassment were putting up extra burdens to wise medical prevention. Fear her (male) family doctor would tell her parents she was having sex. Shame that she was having sex and not *really* engaged, much less married. She wasn’t Catholic or against birth control, and probably neither was her family physician, but there was this sense of caution and fear that while The Pill might be a modern science godsend to the *right* sort of girl (married ones who want to responsibly space their children) we must not allow it to be an easy option for the *wrong* sort of girl (unmarried promiscuous ones).

Today Truvada seems to be having some of the same reactions. Some physicians and social commentators are quick to praise it for the *right* sort of gay (HIV discordant monogamous couples) but are very leery of widespread use for the *wrong* sort of gay (unmarried promiscuous ones). In an effective patient/doctor relationship all facts should be on the table, but this is always so much easier said than done. Who doesn’t round-down when even just self-reporting their alcohol consumption, for instance? Talking about Truvada requires being upfront about having condomless sex and taking whatever judgement or awkwardness comes along with that. Because this drug is so new, and is for a narrow niche of the market, it may take a little time–and patients switching physicians–for the awkward cloud to lift. Yet it’s not just the “talking about sex can be uncomfortable” factor that I think is keeping a lot of gay men from embracing this new prevention tool. For the last couple of weeks I’ve been trying to sort out my own feelings. Had the CDC just approved and recommended a vaccine I have no doubt my feelings would have been overwhelmingly positive. Why was I conflicted about a little blue pill that–if taken daily–does the same? My brain has gone through as many justifications and half-truths and second-guesses as Maureen’s did circa 1962: It’s because it won’t protect against OTHER STI’s! Neither would a vaccine, neither does The Pill. It’s because this won’t be affordable for the masses of HIV positive men and women in sub-saharan Africa! Perhaps, but that’s a bigger issue about global health and wealth in general. Sorry, Straw Man. It’s because there could be side-effects we don’t know about yet! Again, that’s true with many drugs. Even if some small portion of people experience side-effects and need to halt usage, surely the greater good (fewer HIV infections, fewer AIDS-related deaths) outweighs that. Those reasons were thin attempts at justifying my lukewarm response to Truvada. I think the real reason the response was so muted in comparison to what a vaccine is something much less

Selfie @ UW's Hansee Hall. Today co-ed, in the 1930s-1970s it was the "girls' dormitory".
@ UW’s Hansee Hall. Today co-ed, during 1930s-1970s it was the “girls’ dormitory”.

admirable. I was underwhelmed by the idea of long-term adherence to a daily drug precisely because that is the reality of healthy, happy people who are HIV positive. A petulant little voice in the back of head was not pleased that the end result was the same: Daily pharmaceutical intake. Awkward conversations with physicians. Potential battles with insurance plans. “So what was the point of trying so hard to be good (caution & condoms) all these years if we are all ending up in the same boat anyway?“was the niggling voice. Somehow I felt because I played by the safer-rules 95% of the time (okay, 85% of the time) I should get some sort of cosmic credit over the cavalier barebacker. This mindset isn’t logical or pretty. But it was there and I’m over it now. Maureen probably went through irrational justifications of why she, an “almost engaged” college girl wasn’t in the same boat as a promiscuous, picking-up-men-in-bars type. People like to rank and categorize. They also like to engage in magical thinking about “what’s fair” on some imaginary cosmic scorecard (ask anyone who has experienced death or divorce about that one).

I still haven’t decided if PrEP is right for me, and I don’t want to shut down–or merely dismiss as alarmist prudes–those who have sincere concerns about what the future could look like for my community post-Truvada. However, I think it’s worth remembering that people take time to sort through their own phobias and embarrassments whenever the topic is sex. Maybe when I am near retirement, having a doughnut in the office, I’ll be able to have a chuckle with a bunch of 21 year olds about my silly justification-gymnastics around a medical breakthrough that ultimately changed the lives of countless people for the better.

Advertisements

Brewer’s backlash to the backlash

A funny thing happened on the way to Equality. Several states rapidly construed modern-day Jim Crow laws cleverly framed in the name of preserving religious freedom, Arizona receiving the most attention. This is an angle I think could have had some legs had the legislators been less rushed, less careless, and less confident that their own bigotry was the majority opinion in their state. Instead they overreached, mistakenly thinking not being a card-carrying GLBT ally inferred sympathy for extreme backlash legislation.

Arizona governor Jan Brewer, hardly known as a liberal and on the record as opposing same-sex marriage, wisely vetoed the law. This led to some of the most hilarious parody pieces ever. These are awesome, but I have also observed a strange need to diminish or explain away the Governor’s rightful use of the power of the veto: “it was because the NFL threatened to leave” “it was because she had a change of heart” “it was because she wants to run for reelection” “it was because she was terrified of tourist boycotts” or, most commonly, “it’s because she realized it’s become bad for business to be a bigot“.

Truthfully, it was probably a combination of all the above. But how much does it matter? What is it with this idea of constantly obsessing over “how heartfelt was it?” on political maneuvers? Haven’t they always been complicated? I can’t help but feel that with each gay political victory Sally Field’s (misquoted) 1984 Oscar acceptance speech “you LIKE BREWERJme you really LIKE me!” is the knee-jerk reaction. Or, more dangerously, a smirk of inevitability. But suddenly the figure of Jan Brewer makes that a bit more complicated. A certain amount of this is expected. If reduced to same-sex marriage you can see the movement is quite literally still in adolescence. In 2000 Netherlands became the first nation to do full-blown marriage equality, Canada in 2005 nationwide, the first US State (MA) only in 2004 (and still not nationwide). A little self-involved adolescent narcissism can be overlooked, maturity mellows feelings. And that’s okay.

Many people might still harbor vague ethnic stereotypes toward Jewish Americans (“they control Hollywood“, “they care too much about Israel and not enough about the USA“) but you’d be hard-pressed to find someone who held those feelings who actually would support a no-Jews-allowed policy at a hotel or restaurant. Of course there will never be a complete absence of gay prejudice or negative preconceptions, but what’s arrived is an overwhelming majority consensus that any sort of legislation that prescribes it is shameful and retrograde. As with all civil rights struggles this has been achieved through legitimate and sincere changing of hearts and minds, some mild social shaming, and a little economic blackmail. And that’s okay.

There will always be a certain segment of the population (for argument let’s say 25%) who feels homosexuality in unequivocally wrong for religious reasons. There is also another section of the population (I’ll guess another 25%) who will range from clumsily practical (“those gays are good for business“), to completely ambivalent, to annoyed and begrudged (“I’m sick of hearing about gay people all the time, where’s my fucking Pride Parade?!”). What the anti-gay Republican legislators misjudged in Arizona is assuming that the latter group would always be in passive agreement with the former group when it came to actual NEW law and not merely preserving tradition. The unlikely figure of Governor Jan Brewer represents that break. And that’s okay.

ImperialLaundry

Partisanship as platform

“I never give them Hell. I just tell the truth and they think it’s Hell”

                                                               — Harry Truman

For the last few months it feels as if everyone is wanting to play Devil’s Advocate about a 2016 presidential run by former Secretary of State Hillary Clinton. Andrew Sullivan asked his reader’s to submit what they viewed as her solid accomplishments to run on. Not the positions held in and of themselves (senator, etc) but actual treaties signed, bills passed, movements prioritized to the top. One reader responded with this:

Her signature issue, what she will run on, is her tenacity and defense of the Democratic principles. She will fight for her agenda, and it will be a classic Democratic agenda, but she will do so with the tenacity and will to win the President has not shown. The President is simply too willing to compromise and his default position is to be bipartisan. Clinton will be clearly and unabashedly partisan. She will be the Democratic’s Democrat. Honestly, if she needs to pull the still beating heart out of Chelsea’s chest on national television to pass a stimulus or extend unemployment insurance, I know she will do it. Essentially, her issue is she will kick Republican butt and not take prisoners.

I too have been hearing this from many people, and it certainly has no basis in her history as Secretary of State, Senator from New York, or tenure as FLOTUS. In fact, this is the person who in 2005 used the terms “sad” and “tragic” in what was widely viewed at the time as a move to the center. This is a person who sat on the Board of Directors of Wal-Mart when she was First Lady of Arkansas, hardly the makings of a progressive firebrand. This is the candidate whose internal campaign materials from the 2008 primary explicitly said not to embrace multiculturalism as a talking point. Where are people getting this impression of HRC as partisan fighter extraordinaire?

The thing is, I do think the partisan fighter as a platform described above is exactly how she will run. A cynical part of me views Hillary as Madonna: constantly reinventing herself as needed in order to stay relevant. What she actually thinks or means long go rendered immaterial. As the Democratic Party has shifted slightly to the Left in how it talks about class, inequality, and poverty so will Clinton.

I think we can definitely expect Clinton to compensate for list-making accomplishments with aggressive Give ‘Em Hell Harry Truman-style fight. This is how she will win over the left-wing of her party who have always been lukewarm on the Clintonian “Third Way” song and dance. The reader above isn’t basing his/her views on anything from Hillary’s resume itself, but rather by the tone he is accurately picking up within the party faithful about President Obama. As the Republican Party has become more obstructionist, Democrats feel their fighting blood boiling. Wise or not, they want the red meat thrown to them.

I was solidly on Team Obama from the beginning but there were two brief flashes that struck me during the 2008 primary debates. At the time I remember thinking if Sen. Harry_S__Truman_posterClinton had kept going down that path (as opposed to the foolish, in my view, path that she was somehow the “experience candidate”) I would have just maybe started a little conversion. I hope I am remembering these moments correctly. At one point Clinton said something along the lines of “the Republicans have been rummaging through my baggage for years” implying she knows how to take them on and Obama was naïve to expect a new leaf turned. Another was when she seemed particularly annoyed at a long Obamanian lecture on the healthcare crisis and its nuances (Romneycare might have come up?). Hillary quickly snapped “single-payer has been a goal of the Democratic Party since Harry Truman proposed it!”. There was a flash of “we’re Democrats, let’s act like it” aggressiveness and impatience. I think if she runs in 2016 we will be seeing significantly more of that Clinton.

Obama’s desire for post-Boomer bipartisanship was what initially appealed to me, but watching the GOP spit in his face at every turn has made me want him to punch back even though he can’t (“angry black man”) or won’t (“professor-in-chief”). Clinton will be a willing vessel to channel all those frustrations.

In 2007-2008 Hillary’s long-but-nonspecific resume was unexpectedly bolstered by tapping the frustrations of Boomer women passed over for the top spot by younger, more dynamic junior (male) employees. In 2016 Hillary’s long-but-nonspecific resume will be bolstered by loyal-but-antsy Obama supporters and a Democratic Party base who are itching for an LBJ style head-cracker.

Hillary-Clinton_0

F. W. de Klerk and respect for the office

Today’s Johannesburg Memorial for Nelson Mandela has been the culmination of the last few days of presidents, prime ministers, former world leaders and the inevitable celebrities providing commentary and reflections on the freedom fighter and former president of South Africa. One of the first commentators I heard from was former president of the nation (and Nobel Peace Prize winner–jointly with Mandela) F.W. de Klerk. His comments about that crucial period when the transition to democracy fell upon Mandela’s shoulders and its difficulties have been mostly what one would expect, but I was surprised to hear from him before Mandela’s immediate successor President Mbeki.

Obama and de Klerk greet Methodist Bishop Ivan Abrahams at Mandela's Memorial today.

Obama and de Klerk greet Methodist Bishop Ivan Abrahams at Mandela’s Memorial today.

However, one thing that really struck me is how virtually every news outlet: CNN, SABC, BBC made no hesitation to refer to him as “former president de Klerk”…occasionally even using the honorary title of “president” when asking him a question. This included interviews in the South African press. Think about it. Certain news outlets and commentators can barely stand to call Obama “President Obama” when he won with a clear, fair majority. Yet who is F. W. de Klerk? A leader duly elected in 1989 in a nation where less than 20% of the population–the white population plus a few others–were allowed the franchise. He didn’t even win that minority by a landslide, either, but with a healthy margin to be sure.  So, at best, around 12% of the adult population of South Africa had cast a ballot for de Klerk and his party. If ever there was a situation where the current media could justify ditching formalities it would be the case of an apartheid-era president of South Africa: a regime/era that has long been internationally discredited.

And yet, they haven’t. There have been the asides from commentators and presenters referring to him as “South Africa’s last white president” or even “South Africa’s last minority-rule president”, yet making a point to respectfully refer to the man as “president de Klerk” or “former president de Klerk”. I am not disagreeing with this, but rather whole-heartedly supporting it. It goes to show the wisdom of Mandela in not completely dismantling the old framework as has happened in other transitions.

Yet the last few years in the USA there have been sitting congressmen who see fit to shout out and interupt a State of the Union address mid-speech. The 2012 picture below of the president with Arizona governor Jan Brewer came to mind in sharp contrast with the respect I’ve seen shown de Klerk the last few days. Can anyone provide me a photo of another incident of an American governor doing the same with his/her president? No matter how much they disagree? I am not saying it hasn’t happened before, I just have yet to see a photograph of Johnson, Nixon or Reagan being lectured this openly or crassly. If one exists I’d be much obliged to see it. ObamaBrewer

The American system has hit a level of crass and open disrespect for the office I would argue we haven’t seen since the middle of the 19th century.  Some of it did begin under President Clinton, and amplified under Bush. President Bush did not win a nation-wide majority vote in 2000. However, he was the rightful president in accordance with system and, as a whole, other politicians and journalists were deferential to the office (if not all folks at the grassroots level).

Another example I would bring up is President Gerald Ford. Remember, upon his swearing-in on August 9th, 1974 not a single American had ever voted for him as president OR vice-president. He was selected by Nixon during his second term as a replacement for VP Spiro Agnew in the light of financial controversies. Yet Ford was given the respect and deference by other political figures, governors, and the media that any majority-elected president would have received. Obama decisively won in 2008 with a larger majority–and a larger % of the white vote–than Clinton did. No sane observer can claim first-term Clinton was treated as an illegitimate usurper in some quarters the same way Obama was in his.

If black South Africans who grew up under the yoke of Apartheid can give former president de Klerk the respect traditionally accorded the office I should think the likes of Justice Alito or Rep. Joe Wilson could handle doing the same in this country.

Image

1918-2013

Nelson-Mandela_54358333264_54028874188_960_639

New Kid on the Block

It’s always seems like when I get hooked on a new passion the universe seems to send me all sorts of information about that topic. Beginning in 2012 a bit of a Teddy Roosevelt obsession began for me when I finally got around to reading the final volume in Edmund Morris’ trilogy on the 26th President. Out of that grew a year fixation on the Spanish-American War and Philippine Occupation. Side note: Did you know we can thank the Phillipe Occupation for introducing the USA to waterboarding and mass circumcision of non-Jewish male babies? Yeah, me either!

Coincidentally Seattle Asian Art Museum (which is situated in Seattle’s Volunteer Park, named for the volunteers who signed up for that “splendid little war”) hosted an excellent talk about the Philippines under the Spanish, then US. Next came the recent publication of Silencing Race: Disentangling Blackness, Colonialism, and National Identities in Puerto Rico by UW History professor Ileana M. Rodriguez-Silva. I can’t recommend this one enough. To cap off about a two-year phase, I figured it was high time for me to visit Puerto Rico.  I’ll be leaving tomorrow for my first ever visit to the island!

I found two really clever political cartoons that relate to my current obsession. Both use offensive imagery, but take opposite views on the same topic of newly found imperial possessions. In this biting critique below Uncle Sam attempts to school his new, scared pupils acquired from Spain on democracy and self-determination (see the chalkboard). The Native American hunched in the Victorian version of a “time-out area” and the African-American child stuck washing the windows makes sly commentary on the USA’s hypocrisy of espousing self-determination. Many newspapers at the time harangued against the idea of the United States aping Europe who in the late 19th century was at its height of carving up Africa, the Middle East, and Asia into exploitive colonies.ColonialPicUncleSam

This 1899 political cartoon below takes the opposite view about the US and its new overseas possessions like Puerto Rico, the Philippines, and others (Ladrones refers to the Mariana Islands, also won from Spain in the war). Here Uncle Sam demonstrates that the USA has finally made it to the A-League of world powers! The audience of Germany, France, and other powers look on as Uncle Sam shows off his new talent of Imperial Rule. To the Americans’ credit there was an active, public debate about the ethics of colonial possessions (see above) not really seen in European nations where colonial possessions were mostly viewed as de rigueur. A decade or so later, in fact, the main reason many Danes publicly opposed selling the Danish West Indies (today the US Virgin Islands) to the United States wasn’t because of their profitability to Denmark but because of the feeling that to be respected as a “real power” colonies were essential.

The snide caption “Why only the other day I thought the man unable to support himself!” is making note that a mere generation ago the US was torn apart in Civil War and threatening to splinter into pieces. Much was made in the press during the conflict with Spain about how sons of Union veterans and Confederate veterans were fighting shoulder-to-shoulder, united. This “splendid, little war” (Secretary of State John Hay coined that one) could serve as the final healing balm between North and South according to the pro-war newspapers.

SanJuan

How I learned to stop worrying and love the aPODment

My neighborhood of nearly a dozen years has recently been subject to much hand-wringing and much national attention for several cities allowing the development of high density housing. While I think the outward appearance of these building could benefit from a little creativity I have to say how amusing I find it that even one of the densest residential areas has trouble embracing an idea that is as American as apple pie.

I have long been a fan of 1930s American popular literature, many of which are out of favor today and probably would get the label of “middlebrow” at best. I heavily mined that same period and genre for my historical thesis of limited scope back in 2002-2004.  A central feature to these novels has always been the boarding house and the urban flat: dwellings for singles, salesmen, kept women, new immigrants, divorcees, spinsters and “confirmed bachelors“, and other colorful characters creating a new dynamic in a busy urban setting. One consequence of the post-war cult of the automobile and flight to the suburbs is, I believe, this concept faded from popular consciousness. When I think of early 20th century US I think of families living in New York apartments with high density, A Tree Grows In Brooklyn, a harried mother getting Mrs So-and-So Upstairs to watch the baby an hour while she runs to the store for something special. This was the era of strict demarcation between urban density and rural life–the American suburban standard that I feel a lot of us still carry with us as the “norm” (yard, garage, basement) hadn’t taken hold.

Seattle aPODments, 2012

Seattle aPODments, 2012

The aPODments may end up being the sort of transient housing the NIMBY activists fear.  Also, I really wish the developers would stop trying to defend themselves by claiming they are some sort of community activists set on creating affordable housing. If you compare a shared-full-kitchen 240ish square foot aPODment with a 490ish square foot studio the price comes out to less bang for your buck, not more. However, I think they have a valuable place in the urban core and Capitol Hill of all places–home of beautiful vintage early 20th century apartments–needs to accept them and fold them in as part of the local landscape. Many of the motel-style apartment homes built for the 1962 Seattle World’s Fair (that event that brought us the Space Needle) seemed just as jarringly out of place mingled among the 1920s terra cotta apartment buildings and brick Tudor-style flats. Yet fifty years later there is an Americana nostalgia to these constructions as well. Part of what appeals to me with city living is observing several layers of time on a 20 minute walk. So long as some historic building of note isn’t being demolished, I have no problem with aPODments filling in the gaps and empty lots in an already dense and vibrant neighborhood.

Fannie Hurst and Edna Ferber are two authors whose heyday would have been from about the First World War to the late 1930s. Their novels of immigrants, working-class girls, fallen women, and confirmed bachelors strongly feature the boarding house:

Fannie Hurst in the late 1950s, after her peak in popularity
Fannie Hurst in the late 1950s, after her peak in popularity

hallways smelling of foods from different cultures. Washing hanging on iron radiators. Milk delivery doors and ice boxes.  All of these things exist at my current home. Granted, the immigrant neighbors down the hall are more likely to be Somalian or Vietnamese than Polish Jews or Italians, and we all use our 1922 ice boxes as cool built-in liquor cabinets now. The scents in the hallway might also be cannabis (it’s legal in Washington State) but the spirit and connectedness is the same.

I live in a 500 square foot studio apartment built when Warren G. Harding was president. It’s by far the smallest place I’ve ever lived, as a child I assumed the older you get and the more you pay the bigger your place will be! I think a lot of people still assume this. This weekend I am feeding the cats of two of my neighbors: a young couple with a toddler upstairs and a 30-yr old single professional down the hall. This week on two separate occasions I had friends over who live less than three blocks away to enjoy dinner and wine–cooking for one is never as fun as cooking for others. Today I helped another neighbor to hang a picture (and learn from my mistake RE: laff paster and making effective use of the oak picture rail). This is not the life I envisioned I would have at 40 (and yes, I made the early 2000s required detour to Real Estate Bubbleland of condos and granite countertops). Yet, part of the reason I think I am embracing it and loving it is because it is precisely the life a part of me always imagined for myself during my teen years. I just could never reconcile it with modernity. Fannie Hurst died in February of 1968, Ferber died less than two months later.  While neither would recognize many aspects of my modern life I am tickled that the urban lifestyle they so often chronicled–albeit with a modern twist–is more alive in Seattle today than when they died.

Relaxing in my 1922 vintage studio apartment, 2013

Relaxing in my apartment, 2013