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HARD TO REACH CHILD SEXWORKERS WITH HIV

SmashStreetBoys, this is a far cry from the old days when you were issued secret codes and had to wait two weeks for test results. The only thing I wonder about — and it’s not just a question relating to this clinic — is setting up health care on the spot, and how that works with the criminally expensive HIV meds.

Putting people through public health assistance is not done overnight. It takes time.

Even at places like UNC’s Infectious Disease Clinic, there is a three month waiting period to just get in the door.

Another question is: how does this work with undocumented people. I have asked these question to HIV/AIDS agencies, NGOs, many, many times. Usually, they ignore me, or they send me a few poster slogans about how we are all in this together.

No, we are not. People who do not have HIV cannot ride in that very crowded boat, and why should they.

Or they send me pithy little statements about how they include everyone without hesitation immediately. I do not believe this. If major Infectious Disease clinics at university teaching hospitals have waiting lists, so do they.

They feel like I am annoying them and that is NOT my intent. I simply question ANY financial ability, and this would include health department clinics, that would give the newly diagnosed access to this kind of health care in a timely way.

Boys at SmashStreet Safe House struggle hard to get these drugs that no one can afford.

My intent is to imply that HIV/AIDS NGOs are not immune from the financial plague that comes with the disease.

They often imply that people can walk into their clinics, and walk out with the drugs. Like it’s nothing. 

I get the same response whenever I discuss how SmashStreet deals with a very hard to reach population of sex work boys that slogans and rhetoric and program websites from the CDC simply do not reach. They seem mystified as to how we do this.

One option that they never want to explore is the one where we confront big Pharma right in the eye. This is street creds for kids. I am not convinced that getting into any of it with any of the NGOs would be productive. They would simply have to set many of their values aside like drug use.

My position is that just because a sex work boy walks in the front door, it is not realistic to expect him to give up what gets him through the night in one fell swoop.

It’s a process.

There is a webinar that deals with this stuff next week (the day after I am having eye surgery so I am not sure how much of it I will be able to see) http://ythlive.org/2013-program/ and I would encourage any of you to sign into Google to see it.

I do not mean to target Whitman-Walker. What I am attempting to understand is the reluctance of any of these agencies to talk straight to such boys as the ones we deal with as to the money angle.

I have never met one who has health insurance.

I know there is public assistance (the assistance the drug companies themselves offer is so small, it’s ridiculous) but there are also waiting lists and by the time an infectious clinic diagnostic is made, and the assistance approved, I have seen it be a six month wait.

What if you have no documents. What if you are a runaway. What if you are running away from violence.

Six months is not a reality. It is a lifetime.

But no one wants to address this.

The CDC itself increased testing programs but did not increase subsequent funding to those tested and positive. So you end up with more people and less resources.

A kid feels overwhelmed with all of this. And they are made to feel like it’s as painless as getting your finger pricked. It is a lot more than that.

The NGOs want to know why boys like yourselves are so hard to reach. I would suggest they cop to some of the way things really are even during a time when we want to cling precariously to the idea that great progress has been made.

Tim Barrus: le Suits

I do not normally spend my day with suits. I have not done so in a long, long time. Today, I participated in a Twitter Live Feed/ Dialogue with about at least a hundred public policy people at the CDC and various health department heads from around the country.

Every time I leave my cave, I stand amazed.

These people really, seriously have no clue about what it means to live with HIV. Not one molecule of empathy. It was stunning.

A lot of the conversation was about public health policy and social media.

The men move immediately to take over the conversation. The women smile, act nice, and hide.

I was the only person there who was not a suit.

When I used the term — the suits — in explaining why there are so many subcultural groups that continue to have rising HIV infection rates, I was, indeed, implying that this failure in outreach is due to the behavior of the very suits who were at this meeting of the minds.

And there’s the thing: no minds meet. They fence. It is a competition for resources. Animals do it. Bacteria does it. Retroviruses do not do it. They’ve already won. The simplicity of the genetic code is its power, and its ironic purity in design.

The hostility toward my presence at this meeting of the minds was so thick, it amazes even me.

They sincerely wish we would go away.

I am exhausted. The level of meanness is stunning. There was one guy who ran an AIDS program for a high-risk population who was in the wrong job. This guy sucked the energy from the room.

It will never happen again because I will never attend another one of these.

Newsflash: Smash Street Boys: the suits do not like you AT ALL.

The indifference is there, but so is a subtle, barely boiling under the surface rage.

It’s not about HIV. It’s about power. And the men go for it. The women sit back.

This is not my world.

I am back in the cave of my universe. I have a pounding headache. Can you possibly imagine sitting in an office all day and working with these kinds of men.

But no. I would go mad.

I will avoid the temptation to think we can make a difference at that level by participating. It is a waste of time.

But the hostility is outright draining. Daunting. It was an experiment for me. I wanted to get a lay of that land, and I got it. OMFG. And people wonder why public policy fails.

It fails because the people who run it hate the people they are invested to serve. In fact, they want to BE served.

Another day of it, and clinical depression would come at me like the green snakes have escaped from inside the walls.

Tim Barrus/ It’s WAY past time to think outside the box. The box has got to go.

Antiretroviral cocktails have been around for over fifteen years. Why that amounts to a rahrah is beyond my ability to comprehend. Cheerleading and warm fuzzes is not a vaccine against HIV. The cocktails are not enough. It’s time to get off our institutional big fat butts and do something, and I do not mean another AIDS walk.

Too many activists have essentially collapsed into the bed of addiction and suicide and numbness and too many of them have let institutions do the heavy lifting. Get out of bed. Rahrah some other time. Thirty years is too much. Fifteen years is settling for the status quo. I am sorry you are tired. But get the fuck out of bed. To that end, Real Stories Gallery, Show Me Your Life, Cinematheque Films, and Smash Street Safe House have been making a real effort to draw YOUNG people with new ideas into a decidedly old fight.

Old people will just have to look out of the way. We need new eyes with new visions. We need new ways to approach what too many oldsters who are whining about what they see as intractable problems comes the silent sound of overt indifference. We need young people who can stand up to stigma because the old people tremble in their nightgowns and their oatmeal that something bad will happen because they raised their voice. There was a point when we were chaining ourselves to the front door of drug companies. They were moved and so was the federal government.

We’ve been bought off, and cheaply. We are nothing more than a bunch of cheap tricks.

Today, we get to sit in on a lot of meetings so we can all compete for the same crumbs and where has that got us. I will tell you.

Nofuckingwhere.

Anyone can rahrah and pretend we have made progress. Anyone can put a suit on. It means nothing. It is irrelevant. We need young people who are not burdened with all the old stigmatized assumptions that this is how the world turns so beware.

Eat me.

I have a friend who tells me that women are underestimated and that they are loaded for bear and they’re dangerous, and just because they are not particiating in the dialogue outside the context of institutional hierarchy doesn’t mean they aren’t going to come roaring into this with vital energy to behold.

It’s bullshit. The preaching never ends. Anyone who preaches at me that stuff is going to happen that obviously is not going to happen beyond finger waiving, gets to see my butt walk away. I do not have time to wait around for women to find the power of their collective voice.

Women have had every opportunity to do it. It’s not getting DONE. It’s WAY past time to think outside the box. The box has got to go.

Why. Because the women are the suits.

Don’t hold your breath for women to do much more than be cogs in the great machine.

I want young people who are going to develop an app for AIDS, and I want them to make it free to everyone no exceptions.

That is what I want. Join us.

And get the fuck out of bed.

tim barrus

Tim Barrus: There is Always Hope is Patently Absurd

People cling to their little rafts. Don’t rile the water. People might drown.

Newsflash: People have been drowning for a very long time. There is little evidence that the change and the hope that has received professional spin is real. Step back. Take a look around you. Do you really need some evil court jester like me to say to you. Look here. Look under this rock. Look over here.

In the drowning, people cling to their little rafts because they have to. I get it. This is just a more or less stupid, and inarticulate, frequently outraged voice saying: look here.

This is significant.

A scientific study was released yesterday, and it’s an important one. Let me put it here. This from MedPub today. Headlined:

Treating HIV in the first weeks and months of infection is associated with slower disease progression and better recovery of the immune system, according to two studies in the Jan. 17 issue of the New England Journal of Medicine.

In the so-called SPARTAC trial, researchers found that 48 weeks of antiretroviral therapy started within 6 months of infection significantly slowed HIV progression compared with no treatment.

In a second study, investigators found that starting therapy during a transient immune system rebound, usually seen about 4 months after infection, was associated with a more robust recovery of the immune system than delayed treatment.

Taken together, the studies add “more fuel to the fire” of increased interest in early treatment, commented Michael Saag, MD, the director of the division of infectious diseases at the University of Alabama at Birmingham.

The bottom line, he told MedPage Today in a video interview, is that “these studies underscore that by starting (treatment) early, especially in the setting of acute or recent infection, you can get a lot of clinical benefit.”

The question of when to start therapy has long vexed HIV clinicians and patients, especially in the early years of highly active antiretroviral therapy (HAART), when drug treatment was often associated with serious adverse events.

But in recent years, drugs have improved and the tendency has been to recommend therapy earlier in the disease course, especially with mounting evidence of both better health for individuals and a beneficial effect on HIV transmission rates.

The most recent recommendations of the International Antiviral Society–USA, issued last July, urge that anyone with HIV get treatment, regardless of the state of his or her immune system.

In that context, the SPARTAC trial showed that early treatment of HIV had a clear impact on two important markers of HIV, according to Jonathan Weber, FRCP, of Imperial College in London, and colleagues.

They were looking at the possible long-term effects of a short burst of anti-HIV therapy soon after infection – the trial’s acronym stands for Short Pulse Antiretroviral Therapy at Seroconversion.

The 366 participants, whose median count of CD4-positive T cells was 599 per cubic millimeter of blood, were randomly assigned to 12 or 48 weeks of triple-drug treatment or to no therapy, which was the standard of care.

The primary endpoint of the trial was a composite of reaching a CD4 count of 350 or having to begin anti-HIV therapy if it had been stopped or never started.

Weber and colleagues found that, after an average follow-up of 4.2 years, half of those who got 48 weeks of treatment had reached the primary endpoint, compared with 61% in each of the other two groups.

That yielded a hazard ratio for the primary endpoint with 48-week treatment of 0.63 compared with standard care (95% CI 0.45 to 0.90, P=0.01). The hazard ratio with 12-week treatment compared with standard care was not significant.

The median time for those on 48-week treatment to reach the primary endpoint was longer by 65 weeks than with standard care, Weber and colleagues reported.

They also found a benefit in terms of the level of HIV – 36 weeks after stopping therapy, plasma viral loads in the 48-week group were lower by 0.44 log10 copies/mL than were viral loads in the standard care group 36 weeks after they were randomized.

The other study, by Sunil Ahuja, MD, of the South Texas Veterans Health Care System in San Antonio, and colleagues, looked at the “trajectory” of CD4 cell counts over a 48-week period in 468 patients with acute or early HIV infection.

The primary endpoint of the study was the likelihood of reaching a plasma CD4 cell count of 900 cells per cubic millimeter within 48 months of starting HAART.

In the absence of therapy, they found a transient increase in the CD4 count from the level at study entry at about 4 months after infection – from a median of 495 cells per cubic millimeter to a median peak of 763 cells before resuming a decline.

When patients started triple-drug therapy during that period, Ahuja and colleagues reported, their CD4 counts rebounded to a much higher point than if treatment were delayed.

Specifically, 64% of those treated within 4 months after infection reached 900 or more CD4 cells per cubic millimeter within 48 months, compared with 34% of those whose initial treatment was delayed beyond 4 months.

Taken together, both studies offer evidence of a greater CD4 cell recovery associated with earlier initiation of therapy, according to Bruce Walker, MD, and Martin Hirsch, MD, both of Massachusetts General Hospital in Boston.

However, they noted in an accompanying editorial, “both fall short of defining a clear clinical benefit for such early treatment.”

The studies support current recommendations for immediate treatment but do not “provide ironclad proof” that such treatment offers health benefits for patients, they wrote.

Saag, for his part, told MedPage Today that evidence of clinical benefit is unlikely to be observed in such short-term studies. “For that benefit to be seen,” he said, “you’re going to have to follow patients for 10, 15, 20 years.”

The study by Le et al. had support from Veterans Affairs Center for AIDS and HIV Infection, the VA Center for Personalized Medicine of the South Texas Veterans Health Care System, the NIH, the International AIDS Vaccine Initiative, the California HIV/AIDS Research Program, the National Health and Medical Research Council of Australia, the Doris Duke Distinguished Clinical Scientist Awards, the Elizabeth Glaser Pediatric AIDS Foundation, Burroughs Welcome, and the Max and Minnie Tomerlin Voelcker Fund.

Ahuja did not report any financial links with industry.

The SPARTAC study had support from the Wellcome Trust.

Weber made no financial disclosures but several other authors reported financial links with several pharmaceutical companies.

Editorial author Walker reported financial links with Boehringer Ingelheim and BMS.

Now, allow me to publish my response.
Look here.
Thirty years.

I work with/teach young boys who do sex work who have HIV. These are street kids. Although that is disingenuous. They can come from anywhere. They’re hard to reach. I have always assumed that they were expendable. Society hates these children. Mainly because they put sex and sexuality for sale in everyone’s face. I have lost all of my friends. Every last one of them. The deaths I have attended in the past thirty years have been horrific. The culture never cared about them much, either, although they tended to be professionals; some of them lived a double life because they had to. And this study is coming out now? It’s thirty years too late. MILLIONS are dead. People who could have and were making contributions to this planet. You are telling me what I already know, and I already know it on a very intense anecdotal basis. This will not go unnoticed. NOT what the study concludes. But that it took THIRTY YEARS and millions dead before the medical community could announce: you should really take your pills. Do you THINK!

“Oh, he’s being emotional.” You bet I am. I am a member of ACT UP, and we were right all along. Indifference equals hate, and indifference equals death. I used to blame a virus. The medical community was only responding to a crisis. But this one, this study, is a game changer, and it’s the dates that count. We already know to take the medication. People can fight that reality and do fight it, and in the end, they usually lose. That, too, does not go unnoticed. WHY did it take thirty years to conclude this.

Internal dialogue: Look here: At the institutions who participated in this study, and who were funded to do exactly that. Thirty years, and what the suits are saying is take your pills. Why are you an AIDS activist. Because the institutions do not really CARE. The operant word they use of the street is care. They don’t care about us and they never will.

External dialogue: We did everything we could. Enormous money was spent.

Internal dialogue: Be calm. Don’t let them see you cry. They didn’t care ENOUGH.

Thirty years.

Internal dialogue: Why am I doing this. You are doing this because they even deny these boys exist. That is indifference. That is how it works. That it takes institutions thirty years to address a problem only after tens of millions of people are dead? What people. You know what people.

Hey, the pills work.

Once again in HIV/AIDS, I am stunned. I am tired. Every day I question whether I can keep doing this. The boys will say, and they do say: They do not care. Not enough. NOW you’re telling me we can put a bandaid on a virus that has outclassed us at every turn. There are few, few, few people I trust in this battle with this virus. I look for anecdotal signs. I am a student of human behavior because I have to be. Watch the nonverbals. Watch what people really say. Anthony Fauci is very even-keeled. I’m not. But he is. The NIH plods along. He uses the word hopeful a lot. “We are hopeful, but don’t get your hopes up too high.” The message is a contradiction in terms. Be hopeful but don’t be hopeful. What is he really saying. This is where I study the face. This is where the eyes go grim. This is where Fauci’s professional jaw clenches. He’s not giving you PR spin. AIDS is a disease virtually filled with PR spin. To get through it, you have to take a very hard look at what people are saying. Fauci is really saying: When you get angry, and you chain yourselves to our doors, it makes our work more difficult, please be patient. Please be patient.

How much more patient can I be.

The undocumented boys I work with can’t even get the medication. First, they’re incarcerated in detention centers where they are allowed to walk around a basketball court for one hour. There is virtually no testing because we don’t want to pay Big Pharma for it. Enormous greed even outweighs indifference. People are RICH from AIDS. Then, after weeks or months of this, the boys are put on the bus. Why are you putting children with HIV on a bus and telling the ones who appear to be sick that there’s a hospice in Tijuana. A hospice that has nothing and can’t even get food.

These medication that you’re telling us are so necessary aren’t for everyone. For all the progress rahrahs, the reality is that considering the totality of the numbers we can’t even visualize, it’s a drop in the bucket. If I had to stand there in a uniform and tell sick children that there’s a hospice they can hitch-hike to that can’t even feed them, well, there is just so much indifference I can stomach.

We run a program called Show Me Your Life. It’s in eighteen countries. In the past year, ten children are now dead. But they’ve left a record of their lives, and it’s on video because we give them video cameras. Some of those lives are very difficult to look at. The Russian kids tell us that there are social scientists (yes, they are scientists, too) who are saying: “It’s for the better that Russian AIDS is skyrocketing because it will clean out the gene pool.”

Clean out the gene pool. The operant word is skyrocketing.

The operant word on the street is care. Indifference equals death. We’re expendable.

Thirty years.

***

It was almost surreal that the second I typed the last period of the previous inarticulate rant that I received a message from the IT GETS BETTER campaign to take the pledge. What pledge. A pledge where we look children in the eye and we lie to them and we say:  It gets better.

Dear It Gets Better,

Tell it to the trafficked kids I teach. Tell it to the kid who is surviving on the street doing survival sex that it gets better. Go ahead, look him in the eye and tell him. Do not expect the trafficked kids to look you in the eye because mainly what they look at is the floor. None of us believe it gets better. It can get far, far worse. If we are already twisting in the wind, how does that make it any better if we go from twisting in the wind to twisting in the wind a little faster.

I wish I could take your pledge, but there is only so much hurt I can inflict on kids. They are not a theory. They are not an issue. They are human, and frequently, they are lost.

It gets better is rhetoric. It’s a slogan. It has pissed off the kids I work with because they know differently. Boys doing survival sex on the street are n-o-t stupid enough or unsuspicious enough to not comprehend a slogan when they see one. It is an easy out. Adults with easy outs is what they know. Adults who lie to them is what they expect.

It can get worse.

Maybe it can get better for very privileged people. Bust most of us are out here just trying to survive, and we know that everything kids might have; your confidence, your ability to  take your HIV medication when you are living on the street, your integrity as an individual fucking and sucking married men in the backseat of cars, your health, your sanity, your addictions, and your self-image, can all fall into a very real tailspin, and the issue is survival, and we know this: It’s not a day-to-day proposition. It’s a moment to moment reality.

Being that intensely alert on a moment-to-moment basis that you are at imminent risk of dying, and not dying well, takes a toll on any human body. It can all fall apart in the next breath.

We’re not talking about kids who have the kind of support system where they can defer reinforcement for twenty-five years, and they can finally leave school (the kids I work with have usually left school a long time ago), and enter the job market.

I do not know any kid like that. Not one.

The kids I know and work with tell me often that they wish they were dead. Suicide ideation is very real. I cannot sit there in my comfortable office and say: It gets better. It might not, and they are very aware of that reality. I would be laughed into the street they live on.

External dialogue. But what can we tell them so they do not kill themselves.

Internal dialogue: We can start respecting them enough to tell them the truth. It will be a truth they already know. But their battered internal dialogues will say: they’re being honest with us; maybe they care.

But that dialogue of mine is internal.

Because if I go against the politically correct grain, they will flay my guts out in every publication from Los Angeles to New York, and the work I do with these kids will be held up to ridicule, and so will with the kids themselves be held up to ridicule, and shame.

Your campaign now exists at the level of an institution. Maybe it’s not run by suits. Maybe it is; I would not know. It’s irrelevant. What I do know is that when I get a computerized message that says — take the It Just Gets Better pledge — I am joining an institutional effort that let’s adults off the hook. I’m with my kids. When you start building a culture that doesn’t throw kids into the street, when you develop a culture that gets people the medications they need to survive, when you do not bankrupt people,  when you treat an undocumented kid the same way as you treat me — let us know. Maybe we could join you then. But those things are not happening, and when kids kill themselves, it’s for a reason. Those reasons cannot be and must not be obfuscated by the reality that many kids out there lead lives filled with doubt, terror, and the very real issues of clinical depression.

External dialogue: You, young people, who do not believe it gets better. You do not listen. To us. We are the adults. You fail. We will marginalize you. You are a threat to our core values.

We already know that, too.

We are not the ones who have failed you. You have failed us.

It’s not worth being here.

I am tired of hearing that litany wherever it comes from day after day after day after day. It gets better. Not necessarily. Look here. Look under this rock. Terror can come in many forms.

RIDING THE SHARK: THE SEARCH FOR A CURE FOR HIV/AIDS

RIDING THE SHARK will be a documentary film that explores not just the search for a cure. The cure will come. But we need to also explore who will get the cure, and how. Let the discussion and the story-telling begin.

Eight Thousand people still die from HIV/AIDS every day. Profits must not stand in the way of a cure. Through the art of story-telling, we explore what our options are. How do we transcend this status quo. RIDING THE SHARK will explore the search for a cure. We can do this. And when we do, the issue will not be medical. The issue will be who gets this cure, and how will they get it.

 

How do we include Big Pharma in this picture. By throwing their weight around the developing world, with Chapel-Hill-based Glaxco calling India a country of thieves and pirates, with Big Pharma filing lawsuit after lawsuit as a form of intimidation, with Big Pharma’s campaign of corporate hate, they have made a medical cure for HIV/AIDS a very difficult road to traverse.

We have to remain unintimidated.

Silence=death. Ride the shark. 

Breaking Barriers: We must not accept the status quo. Too many people, most of whom have no voice, and no chair at the table, are dying every day. The war with AIDS is N-O-T over. It will not be over until the fat lady sings.

 

Riding Sharks is dangerous.

If anyone is cognizant of indifference in AIDS funding, it’s me. But what exactly do I have to lose. Nothing.

In recent budget negotiating, the Obama administration put the Ryan White Act — funding to assist people living with HIV/AIDS in their access to HIV medications — on the chopping block. The only unknown in this equation is whether there will be tens of millions cut or hundreds of millions cut. They haven’t worked that one out yet, but they will.

There were those of us who saw this coming a long time ago.

I do not see one iota of difference between what Romney wanted to do, and what Obama is doing.

The same old same old same old same old.

Prediction: Lots of people are going to die. Duh.

People are numb. I do not even see the point in taking on the issue.

It’s a done deal, locked solid.

I know people whose drug bill is over 50K a year.

I know other people whose drug bill is as low as 20K a year.

But I do not know anyone whose drug bill is any lower than that. You can’t just count the HIV drugs. You also have to count the drugs that make taking the HIV drugs possible.

I read on the le Internet that some people have drug bills as low as 3-6K a year.

I do not believe it. The reason I do not believe it is because I have never seen it. And I know a LOT of people who struggle to pay Big Pharma what Big Pharma demands.

CIPLA took them on in India. If you read through my blog, you will get to a video where CIPLA is making HIV drugs for twenty-five cents a pill. Kolkata is the Indian epicenter for HIV. Hundreds of thousands of people have died there. CIPLA is supplying more and more people with the necessary HIV drugs.

The United States has sued.

Big Pharma wants Indians to pay what Americans pay. Greed has absolutely no boundaries whatsofuckingever.

Big Pharma grows rich off the backs of countries like the United States. Our trade delegations to the WTO support this.

Americans don’t know too much about it mainly because they don’t give a fuck. In American eyes, people with HIV deserve what they get.

Silence equals death. Greed equals death. Indifference equals death.

I was going to do a talking head clip tonight but I do not have the energy for it.

I know I will never get the funding to make RIDE THE SHARK: THE SEARCH FOR A CURE. I am not a stupid person. I am however a person who wants to be a burr up Big Pharma’s rich, fat, overfed ass.

So I will continue to plug away at it. But I do know the score.

Within the context of that documentary, I want to connect the stories of four entities who continue to do what they do valiantly every day. Tristan’s Moon, Umthombo, Kolkata Children’s Art Collective, Smash Street Safehouse, and Show me Your Life all have voices that could add immeasurably to other voices such as Desmund Tutu’s, Anthony Fauci’s, and Dr. Yusuf Hamied’s.

Such a documentary would be a historical witness as to where things stand today. But the biggest voice would be the voice of art. That would come from Kolkata, South Africa, Russia, and places like Mexico where there is a bare bones hospice so bare bones, they do not have so much as food. I want to get all the kids in SMYL to contribute. They would jump at the opportunity. We have discussed it.

But I have not pulled that trigger quite yet. Do I really want to disappoint them again. Since beginning Show me Your Life, five children have been killed in wars, and ten have died from AIDS.

Working with them on the construction of their videos has been very intense.

All these places where people are still dying.

That would include America, too. A hundred people a day die from HIV/AIDS complications in the US. It hasn’t gone away. Party all you like. It’s still here.

CIPLA has saved a lot of lives. A quarter a pill. I do not think that story has been told in the way it needs to be told. It’s actually a corporation that has helped. In the United States, that would be a contradiction in terms.

When you get down into the deep and dirty of the statistics, you discover things such as how little the Clinton Foundation has really done. You find the Big Donors (Gates) defending their turf. You find that twenty-five cents a pill goes a long, long way. It’s not abstract. It’s not a hopeful idea. It’s not wishful thinking. It saves lives. There are stories to be found there.

I had occasion today to communicate with Michael Moore. He is not going to help. Apple won’t help. The two Bills, Gates and Clinton, wish the small fry like myself (we annoy them) would go away, and we will do exactly that.

How can it matter how many headlines you can grab when the real issue is that we do not really have the will to institute any real change that would equate to getting more drugs to more people.

2013 will see less spent in real dollars on AIDS than 1990. We are going back. No one wants to hear it. It’s not rahrah look how much progress we have made.

I fault UNAIDS on that.

Politics at the UN comes down to seven words: No one wants to pay for it.

I have articulated the idea that if there ever is a cure, the struggle over who gets it will be intense.

This is disingenuous on my part.

There will not be a cure. Bill Gates knows. So does Anthony Fauci. They loathe saying it in any public way. But I have heard both of them say: Probably never.

They do not want to rain on your parade.

But the rain is coming.

2013 is going to be a banner year for American corporations that manufacture pharmaceuticals.

They have that dog and pony show locked up, locked down, and locked away.

Riding Sharks is dangerous.

Tim Barrus/ TURNING TRICKS

I think that when people hear the word SEXWORK (also spelled sex work, both work for me), they think SEX. Ummm, it’s obvious, right. I do not know what is and isn’t obvious anymore. I do know that, for me, the idea of sex was so far removed from SEXWORK that the two terms might have lived on different planets. Today, I’m just another ordinary washed-up, old whore. Once a whore always a whore. But the kids with HIV I work with are out there doing SEXWORK — turning tricks — and it’s a story as tired as time itself.

It’s illegal. Both SEXWORK. And having HIV while turning tricks.

One more time. It’s about survival. People have to eat and I mean food, not hole, not pussy, not shit.

I have given up nagging at them like some morality play crone witch wagging her finger you naughty boys are going to fucking hell. I don’t care about the SEXWORK anymore. It’s as dangerous as it always was. Getting into cars with people you do know is dangerous, and there is no way I can be convinced otherwise. The whores I know, and I separate the adolescent whore from the adult whores, and I know a lot of whores, are mostly women. Every last one of them hate men with a passion amazing to behold. To hear us talk, I don’t think straights would understand a word of it. The whole conversation is code. The boys I know turning tricks do not exactly hold the straight men who fuck them — that is not a contradiction in terms — in high regard either. In fact, most of them have to get high to do it. I did. All of us designing paradigms to get paid without getting busted. I know a lot of whores who’ve been busted.

I am an anomaly. I have never had so much as a parking ticket. I think most of it is simply luck and not being in the wrong place at the wrong time. Most of the men I turned tricks with were cops. Cop always pay. They understand quid pro quo. And they didn’t fuck around so to speak. Some just wanted someone to listen to them because the nature of their work had caused their lives to become so much wreckage. They were different. I liked them. I liked them because they didn’t want to know me, and they very definitely did not want to be in charge or run the scene. Lots of them were into bondage. This is about giving up power because all day you had to wield it. And cope never tried to take advantage. I was going to run the scene and that is what they wanted. Your normal run of the mill, ordinary trick isn’t there for sex. He’s there to try and run the scene. His sense of what power is and how it works is more fucked up than you can possibly imagine. He doesn’t really want to fuck you. He wants to hurt you or he wants to exert some kind of power over you if he can.

Like any other whore, I hated these men, too. But like any other whore in the real world with a real job, money is money, and money talks.

It is politically incorrect to talk or write about SEXWORK without going into the whole dog and pony show about how we have the right to do it. There is a lot of truth to that.

But I can’t reconcile it with adolescence. Maybe the women can convince me someday it’s okay for adolescent boys to interact with adult men in the way they do combined with how whoring works. The adolescent boys I know are still making up their minds. About who they are. For them, everything is unfinished. SEXWORK should be about choices. Not about being abused.

SEXWORK was the only occupation I could do, and still be able to write. Having all sorts of stupid fantasies about becoming a real writer. Not that I had any kind of real notion as to what whoring that would be (I would learn that later). Turning tricks is easier. I wasn’t exactly trained to be a plumber, and like a LOT of whores, I also had a kid to feed, and clothe, and pay for school. Montessori was as expensive if not more so than the rent. I had no relationships. I did try. It never worked. The women I knew and the gay men I knew wanted a trophyboy, not a human being. They were ALL looking for someone with money. What I wanted was to parent, pay the rent, go to the grocery store, Cala Foods on Nob Hill, and write. Turning tricks was just the avenue to get there.

I never worked the streets. You had to figure out how to get my phone number to get to me and you needed a credit card. Street sex or survival sex is a cash only economic imperative.

So like a lot of whores, I became an editor, and ended up running a magazine.

Where I had a lot of contact with the University of Indiana. Because that is where the Kinsey Institute was. Kinsey liked me and I liked them. Their information as to human sexuality was superb.

I have no idea where they are today. Do NOT tell me because I want to draw my OWN conclusions. Masybe they disintegrated. It happens. I never did get the Indiana connection.

I have avoided them. They would be incredulous to know I live in a conservative, hateful, racist, southern, perfectly disgusting small town populated by minds smaller than the town. How did that happen. I moved here because it’s cheap.

But doing what I do did not turn out to be cheap.

I am going to contact Kinsey again. I just feel the need to do that. I am not sure why. They’re probably still up there in Indiana.

How bizarre is that.

Curiouser and curiouser. I am just feeling the need for more information. I can’t get it from the Internet. The academics just piss me off. They’re into their timid little girl smarmypants (they’re kinda like the good little girl every classroom has who knows every answer and waves her frantic hand a lot and tattles on everyone else and you want to kick her) academic heads because they’re fearful. Of real life. It might bite them. Information for the sake of boxes of it doesn’t work for me. It has to come armed with real life or it’s worthless.

Real life is a junkyard dog.

If cops can be trained so can dogs.

I still know NOTHING about mainstream, straight life. It was never anything I could write about. My writing was more out there on the edge.

But it is my impression from observing it (mostly with sheer horror) that the thing has an advanced case of rabies.

Behind My War Paint haïtienne par Anton

Ma photographie et Poetry Project

Je ne suis pas simplement invisible. Je suis gravement invisible.

Régulièrement là où il appartient entre les baraques en tôle.

Rêves invisibles de mes sœurs. La boue.

Un pied fracassant dans le noir. la

nuit qui tourne au chien que les roches

aveugle. Il n’y a pas de nourriture et le sommeil gonflé

rues sont vides. Le virus est le sang

de la mort.

Mi moto ha quemado el Mundo por José

La frontera me mantuvo fuera. Me estaba muriendo de hambre.

¿Cómo alimentar a los niños. Embers.

Y el dolor. Bailar en el humo.

Sex Work by Wilson

His cock tasted like burnt chocolate.

His tongue was acid.

Eating through me.

His finger in my hole suspended like my pills.

The big blue ones calling Mama.

My head like hot syrup.

Aunt Jemima drowning.

In the backseat of a car.

Bugs in my Hair by DeMarian

They said I had bugs crawling in my hair.

Daddy shaved my head that time.

Then he poured kerosene on me.

Stinging my candle eyes.

With burn.

Then when I got the virus.

He could not make it better.

Or cut the thing out of me.

And he kicked me out and I could feel the cold wind around my head.



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