“Inconvenient Truths” – Mobilizing MSM and Transgender People towards a More Effective HIV Response: A Look Ahead
Laurindo Garcia, Founder B-Change
AIDS 2014| Closing Plenary | Download the transcript here
Sunday, July 20, 2014 – Setting the Place
I have a story to share with you today. But before I begin I would like to acknowledge the loss that we have experienced. The recent loss of our friends and colleagues on MH17. As well as the many friends and loved ones we have lost since we last met in Washington D.C
As AIDS activists coping with senseless loss is an unfortunate part of our job. This reality doesn’t make it any easier. But as activists I believe we are capable of harnessing the sadness and anger, and transform it into action.
This transformation is important, because we owe it to their memory to continue the fight and hold people accountable. Ultimately make this world a better place for everyone.
The story I’d like to share is about my most challenging and enlightening experience in community engagement. I believe the lessons that I learned are helpful. Helpful as we explore how to set the pace for MSM and trans and truly start to change the course of this epidemic among our communities.
Last year I was invited to speak at an event in Taiwan organised by Taiwanese PLHIV advocates.
The event – called the Happy Life Conference – is supported by the Lourdes Association. The conference was specifically for HIV-positive Taiwanese.
There were 100 participants together for two days in the hills of central Taiwan. The demographic was young and diverse. Mainly gay men. But other communities were present. There were students and white collar professionals; hard-nosed activists and party-boys. There were even a few housewives for good measure. It was the largest gathering of gay men living with HIV in Asia that I had ever attended to date.
I chose to present how I’ve learnt to disclose my status to sexual partners. You see, the story of my diagnosis is widely available on social media, so I thought that sharing my personal attitudes and perspectives on sex and disclosure would be more compelling.
In choosing this topic, I knew that I had commit myself to being open and honest. Cruising and disclosure are topics that we usually keep to ourselves. Topics that are sometimes tied to fear of rejection. So this was a vulnerable moment for me.
In choosing this topic, I had to reveal where and how I cruise. I talked about being openly poz on cruising apps and sites like Grindr, Jackd and PlanetRomeo. I talked about being in a 10-year relationship with a sero-discordant partner. And I talked about the open relationship we have.
I’m sure you can imagine that Q&A session that followed was very lively. Participants asked my views on topics that rarely get spoken about in a room with over one hundred people. They asked my views Sex, using Condoms, Drugs and Alcohol. [They] asked my views on Treatment and the Stigma of Being Poz.
I remember taking a deep breath when the questions started flowing. The only way I could fortify myself was remembering the private commitment to myself to be completely honest. My honesty was rewarded by the honesty of others. People telling of their own struggles.
Unsurprisingly, we found we had a lot in common. Together we found we still have a lot to learn.There were many questions left unanswered.
The organisers and participants approached me after the session. They told me that they appreciated the chance to speak openly. Especially about topics usually taboo in public within the gay community. They said feelings of loneliness and isolation were gone, at least momentarily. They told me they felt better prepared for the challenges that lie ahead.
That session in Taiwan led to me think: what has happened within our communities?
When it comes to matters of pleasure, sex and sexual health: are we living in an atmosphere where people are afraid to speak? Are we living in an atmosphere where people still have to hide?
Science and public health would like reason and logic to be part of every waking moment in our lives.
But in reality, when it comes to love, pleasure and desire, our actions are far from rational or logical.
That’s what makes us human. Humans will often do what makes them feel good.
This is something we have to acknowledge. We have to acknowledge and respond to the diverse realities that our communities face.
For some of our communities, the external realities are terrifying. Violence, stigma and discrimination.
Hate filled prejudice from decision-makers, health providers, bosses, teachers, families; even prejudice from people within our own community. We know these factors create a culture of hiding. We know these stories well.
And I trust we have the knowledge and conviction to do the advocacy needed to make a change in this world. We know what action is required in the coming week at AIDS 2014. And in the months and years to come.
But having protection and equality before the law (or achieving an end of violence); having these things would not automatically spur demand for prevention, care, treatment and support. We know this.
This is no better illustrated than in the Philippines. We had AIDS laws passed in 1998. They are laws that were very good for its time. Laws that protected key populations.
Despite these laws and a relatively improved enabling environment. Despite all this, we now facing a serious crisis among gay and bisexual men in the Philippines.
So while we must continue to advocate for protection and equality before the law. We need to face the realities within our networks and communities. Face the inconvenient truths about sexual health for gay men, MSM and trans. Truths that may also be barriers to health and well-being. We need to learn to acknowledge and discuss these things in a meaningful way.
My theory is that the themes that came up in my Q&A session in Taiwan are observations universal to our diverse communities. And I’d like us to reflect on these now.
Let’s start with sex. We know that sex is risky. Not only in the context of STIs, but with sex also comes emotional and physical risk.
But we also know that that sex can be pleasurable and fun. That’s why we seek it out. That’s why we create apps and websites. Technology to help us find more of it.
So my question is: as community health advocates, how are we navigating the discourse between these two statements?
We know both are true. Yet if focus only on one, we risk losing touch with the people who are motivated by the other statement (any other perspectives in-between).
Another theme is drugs and alcohol. We know that using drugs and alcohol can harm health, impair decision-making and numbs our senses. But we also know that some people find using drugs and alcohol fun and pleasurable.
How well-equipped are we at navigating between these two positions? If we fail to navigate this well; people disengage. Become hidden. Go underground.
How about using condoms? We know that condoms can protect us from infections. But at the same time we also know that people in our communities find condoms to be a barrier. A barrier to pleasure and intimacy. We must still promote condoms and lube. Promote them more than ever be for.
But while we do that, how can we acknowledge the challenges some people face using condoms? Are we going to ignore their problems? Brand them selfish or reckless or “whores”?
Whatever we do, people will continue to pursue pleasure, whether we agree with it or not.
The advent of PreP, PEP and the dream of rectal microbiocides have unearthed a tug of war between public health and pleasure. We need to find a truce in this war. Because one day a vaccine will come. And I would hate to think that after all we’ve fought for over 30 years.After all the pain and death we’ve suffered; I would hate to think moral judgement from within our own community will get in the way of vaccinating people against HIV.
Let’s move onto HIV and STI testing. We know testing should be a regularly and routinely. At the same time people in our community tell us that testing is often associated with shame, and often bogged down with inconvenience. How are we helping people through this? Does one type of testing really fit everyone?
And finally how about the inconvenient truths around being HIV positive? Yes it is “ok” if we are “poz”.
And yes, treatment helps save people’s lives. And I am personally grateful for having access to treatment.
We also know however that living with HIV can suck. Stigma and side effects are real things that people struggle with. Being “poz” means that we’re criminals in some places. And I am sad to say that we may be criminalised soon in the Philippines.
For others, the idea of having sex with a “poz” guy is understandably a scary thing. We have to learn to navigate all of this.
But I see all these are creative tensions. And we know that are community are great at being creative. These issues are all valid and in need of exploration. They need to be talked about. They need to be expressed with sometimes unflinching honesty. All this is important for us to move on.
So what can we do?
We can revisit what we’ve learned from 30 years of the HIV response. Defending the right of women to access sexual and reproductive health has taught us a lot. This principle can be applied equally and consistently to trans people and men.
If we can understand the importance of choice for women. If we can defend rights of women against moral attack. Then it is indeed possible to fathom the same principles for our communities as well.
We can learn from how we have advocated for the health of people who inject drugs. Harm reduction strategies have taught us about the importance of maintaining connection with people. Evidence tells us that zero tolerance is counter productive to health.
We’ve learnt the benefit of providing health and support consistently and without judgement. We should apply the same principles. To those of us in our community who use drugs and alcohol. In fact, I believe this idea can be applied to any pleasure-seeking behaviour.
We can show our commitment to our communities by listening and being prepared to initiate the hard discussions. The ones that unearth all our own fears, insecurities and in some cases shame. Shame around gender roles. Shame around masculinity, femininity and gender variance. Shame around the pursuit of pleasure and love.
Perhaps we need to rediscover sex. Sex is a part of our lives that bares the burden of being stigmatised, criminalised and pathologised over generations. Processing all of this baggage won’t happen overnight.
What I’m suggesting is not merely discussion for discussion’s sake. I’m proposing discussions as a means to re-engaging our communities. Re-engage with our diverse sexual networks. Learn how to work within the sexual networks in this interconnected, digital age.
Engage so that we reconnect with those who are hidden. Learn from their insights so we can chart a better future for us together.
Our job is to build resilient communities, who are well-equipped to deal with uncertainty. And we can achieve this by informing, engaging them with respect and ultimately committing ourselves to promoting and protecting health, no matter what.
Because if we don’t, then people go underground. Hide themselves. And everyone loses.
Please join me in thanking the pre-conference organisers, the Global Forum, our Melbourne colleagues and the traditional owners of this land.
To paraphrase lingo used by Indigenous Australians: we we’ve been provided us space to open up and tackle men’s business and trans’ business. So let’s thank them for this opportunity.
Let’s make sure keep this momentum. And create more spaces in our communities. Spaces to explore these creative tensions with sincerity and heartfelt honesty.
We stand to become better people if do.
Thank you for listening.
-ends-
