HIV/AIDS Medical Care For Survivors of Sexual Abuse

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Tim asks if the Smash Street Boys are as tight as we can be. How do you just walk up to someone you cannot bear to be without and say I love you? Maybe Tim can do it but I cannot do it. We were homeless together. It has all been together. If we were broken up we would all fall apart. How close is that? We went up north together. We all go to the same funerals. We act as one another’s medical advocate. You never go to the clinic just for you. You are going for another one of us too. We have stolen food from the same stores. We had to shit in front of one another in an attic toilet. We sold dick on the same streets. We get thrown into the same jails. When we go through withdrawal we puke in the same bucket. We are the Smash Street Boys and we're into together.

Kirk

It is simply horrifying that any adult would choose to punish sexually violated boys by leaving them without appropriate shelter, nutrition, healthcare or legal representation. It is simply horrifying that any adult would then choose to scold such a child (UN classification for any person under the age of 18 years old) for not being enthralled with the idea of find ways to live with acute physical and psychological trauma as a consequence of what was done to him within cultural contexts that do not support male-survivors of sexualized violence.

It is traumatic for a boy who has been sexually violated to be asked to submit his body to highly invasive medical examinations and treatment, even being asked to undress and feeling someone's hand touching his body can be stressful and challenging for a survivor.

Depression comes with the territory. Some of the meds can depress you 2. Suicide attempts among HIV teenagers quickly turns epidemic.

Suicide usually means deliberately trying to end our psychological existence—or at least this particular psychological existence. Young males whose lives are changed forever by sexualized violence are at heightened risk for suicide. Young males who are homeless and living with HIV/AIDS are at heightened risk for suicide.

Adrien is a 15-year-old bipolar sex worker living in Los Angeles who struggles with cyclical, clinical depression. When living on the street, Adrien is unable to maintain his medication. He has assembled for Show Me Your Life — Suicidal. A collage of sound, motion and metaphor exploring the world he endures to survive.

Pascal is a sixteen year old sex worker in Paris suffering from HIV and schizophrenia. He has assembled for Show Me Your Life — à risque: lumière et movement. A collage of sound, motion, dance, and metaphor that explores the perceptions he has of the world around him.

We do not know much about the lives of all the boys who have left the system and are finding ways to survive... 

People Wonder by Damyon

People wonder why I hate my life

I hate my life because I am now

always forced to be around doctors

I hate them and I hate what they do

2 me and i hate nurses most of all

because they humiliate me and I

hate them and I do not want none

of them touching me again

 

"I Don't Want A Catheter. I Don't Want Anyone Touching My Dick"

Scenario One: INT: As seen from Above. An ER where a kid has been admitted who has cracked up his car. People in white coats work feverishly.

Scenario Two: INT: We see the kid waking up from surgery. He lifts a sheet and discovers a catheter.

Scenario Three: A bathroom. We see the kid pulling out the catheter. Horrifying. Maybe to you. Maybe not to him.

The medical team is both offended and confused. Why would anyone do that to themselves.

Why would anyone drive their car into a tree.

You mean, it wasn’t an accident.

I mean, it wasn’t an accident. But let us go back to the “horrifying accident” and rethink all scenarios.

I have seen a lot of blood. I have seen it in Africa. I have seen it in the emergency rooms of Los Angles. I have seen kids shot dead by cops. I have seen HIV blood splattered everywhere. I have seen kids who have carved up themselves like Great Uncle Henry carves a Christmas turkey. When you are exposed to something for thirty years, you see it, and you shrug. I shrug a lot.

Of course, he pulled the catheter out.

Of course, there was blood.

He probably asked (we don’t know because it got edited out of the final cut) to have the catheter removed but his request was at first ignored (playing for time) and then, it was refused.

Consider this: maybe he did what he had to do.

Word that some kid pulled his catheter out (the one upmanship with this is that they know how to do it and you don’t, it’s called power) gets spread around the entire hospital pretty fast. I have seen versions of this a hundred times.

People are just doing their jobs. If this is true, then those same people should be prepared to have the failure that can be inherent to making assumptions — in their face.

You put a catheter in a kid who cannot handle it. Especially when he has failed to kill himself.

Accidents are what kill most adolescent boys.

I would argue that half of the figures here are not accidental.

What to do.

What the system does is adjudicate the boy for 90 days.

Meds. Zombies do not remove catheters. They just piss through them.

Oh, happy, happy health care workers. Who have just been following the rules.

The 90 day hold will end.

Then what.

I am told that one in six boys is abused.

I do not believe it. Anecdotal. I believe it is more like one in three.

We need to build more realistic models as to who such kids really are. Maybe then, we would be more successful at keeping them alive. But this would mean a changing of the status quo. I wish you luck on that.

Int: We see an idiot sitting in a hospital room and we see that said kid is in bed and tied there in a four point restraint the nurses screamed hell about. They would go for a ten point restraint if they could legally get it which they cannot.

Patients have rights.

So do people.

Does he have the right to kill himself.

Yes, he does. Whether we chemically restrain him or not. Whether we alter behavior with laws and rules and religions or not. It is self-evident that all humans who are created have the power to end their lives because their lives belong to them. I would bet the ranch this kid will be dead in three months. His call.

In reality, he has already made his call. Psychoactive drugs or no psychoactive drugs.

“It’s for his own good.”

Sure it is. Usually, it’s for our own good.

If we saw how many of our children actually want to kill themselves, it would be a game-changer. There are just some places culture does not dare to go. Our responsibility is to procreate. That we might be bringing children into a world where human life itself is shit, is not and never will be a sustainable world view. Life is shit and then you die.

INT: We see a wrecking truck hauling a car away. Case closed. Problem solved. We see Shirley Temple in a wheelchair in the Swiss Alps. Such cute curls. Shirley stands up and takes a few halting steps. Look Grandpa, I can walk, I can walk.

Cue orchestra.

Run credits.

Tim Barrus: I have been on a kick to get the HIV+ boys I deal with to quit smoking. When you do this, you seem to bump up against all the other addictions; especially an addiction to a self-image as being cool. It’s not simple. It’s more than just making rules. One success has been teaching photography. You can’t really smoke and deal with the more complex cameras. The kid can find a lot of reinforcement in the photography versus the cigarette. If we go on a photo shoot, the boys are leaving cigarettes behind as a choice by them and not a directive by me. My biggest challenge is in confronting the jaded attitude that “something is going to get me anyway, in fact, it already has.” It’s hard to find activities like making art that have the ability to substitute a social reinforcement from a hit of nicotine with any kind of rush from success when these HIV drugs cost so much, and art materials (and everything else in life) take a back seat to buying ARVs. Even co-pays constitute literal fortunes. I do not see how those of us on the ground can expect to be effective in a confrontation with nicotine when we only have facsimiles of tools to employ in battle with addictive behaviors when the biggest focus in life is to keep the gravy train of ARVs coming. I have observed doctors saying to the boys: “You have to stop smoking.” And I keep wondering: does this doctor really think that simply telling a kid he has to stop smoking means he really will. Compliance is more than a one-way conversation. I can fight many HIV battles with the boys, and I hate seeing a 14-year-old smoke. But I can’t fight HIV and the economic consequences of having very little left over once the monthly meds have been purchased when I am only left with my own one-way conversation about heart disease. At some point the kid just turns you off. These other conflicts like heart disease cannot be addressed when your most basic, fundamental conflict is keeping the child medicated. The high cost of the meds is the problem. Heart disease is an afterthought. It’s one thing to say: it better not be an afterthought. I know that. But I am left with no tools to facilitate the attention of the kid when at the end of every month, we have been drained dry. I am told it is not Big Pharma’s fault. I can understand that. But when I look around at corporate involvement (even a company as removed as Chevron gets involved) in World AIDS Day, I do not see a single corporate entity from Big Pharma at the table. The medical community hates it when I am critical of Big Pharma, and I don’t speak their language. But Big Pharma is entirely indifferent to problems where just throwing pills at kids is such a candidate for failure in the face of nicotine addiction. Economics is a wall you hit on a consistent basis. And now I am supposed to address heart disease. It just doesn’t work that way because the system does not allow it. The boys are right: something is going to get them. How many battles can I fight. The only other weapon I have is peer to peer mentoring. Anectodal: It’s a paradigm that has a history of success but it’s never supported. Kids listen to other kids. I have seen kids quit smoking and take another peer with them. But this is not a paradigm supported by any institution, any funding, and it’s not recognized let alone incorporated into any programmatic context on the ground. I can get boys to take up sports. Then, what you run up against HARD is stigma from the community which we gloss over with the word stigma when, in fact, it’s hate. If I took their blood pressures right now, every last one of them would be on the high end. A few would be alarming. They’re time bombs waiting to go off. Diet. Nutrition. Education. Behavior. Economics. Medication. The list gets longer, and this IS the stuff of heart disease. Trips to the clinic are a hundred miles away because the medical community itself has compartmentalized and marginalized HIV/AIDS to the point that on the way to the clinic we pass dozens of doctor’s offices, hospitals, and a university, all of which treat heart disease as an ordinary treatment modality. But we are left out of that equation, and I would strongly suggest that if any community wants to see us treat heart disease, then that community is going to have to come up with community-based support mechanisms that are real and not limited to telling an addicted kid with HIV that he needs to quit smoking. He knows. But he isn’t and he can’t do it by himself because if he did, half these boys would not have HIV. Maybe all of them. If you were to conduct studies like this with adolescents who do sex work, you are going to find some very, very sick children.

RISK OF HEART DISEASE HIGHER IN KIDS WITH HIV

HIV-infected children and adolescents receiving antiretroviral treatment have more than twice the odds for having a specific marker of heart disease than children without HIV, researchers found.

There was a significant difference in carotid intima-media thickness between children with and without HIV (0.434 versus 0.424 mm, P=0.018), according to Talia Sainz Costa, MD, of University General Hospital Gregorio Maranon in Madrid, and colleagues.

Having HIV was independently associated with a thicker carotid intima-media wall after researchers adjusted for age, sex, body mass index, and smoking (OR 2.68, 95% CI 1.34 to 5.35, P=0.005), Sainz Costa reported at the 2012 EuroEcho and Other Imaging Modalities meeting in Athens, Greece.

Sainz Costa and colleagues noted that antiretroviral treatment does not cure HIV and since the virus remains in the body, the immune system is constantly activated, creating a chronic state of inflammation.

They also noted that research is ongoing into ways to control the inflammation and immune activation with agents such as probiotics, aspirin, and steroids.

Another problem, however, is that antiretroviral drugs often affect cholesterol, specifically by increasing low-density lipoprotein cholesterol and lowering high-density lipoprotein cholesterol, they said.

And since these children and young adults are living longer with the virus, this one-two punch of chronic inflammation and dyslipidemia puts them at greater risk for developing cardiovascular disease much earlier than the general population.

Patients with HIV die 10 years prematurely from non-AIDS diseases, which include cancer and cardiovascular, liver, and renal diseases, researchers noted.

“This is especially important for children because they have been living with HIV since birth or even before,” Sainz Costa said in a statement.

“By the time they are 50 years old, they will have accumulated more toxicity from the treatment and more secondary effects from the infection, and will be at an even greater risk of heart attacks and other complications,” she added.

The investigators concluded that education about healthy lifestyles, as well as aggressive lipid-lowering measures, is needed to prevent early cardiovascular death in children with HIV.

For the study, Sainz Costa and colleagues enlisted 150 HIV-infected children and adolescents and 150 age- and sex-matched healthy controls. The mean age was 14.6 and 63% were female. In the HIV group, 17% were smokers compared with 11% of controls.

Nearly all (96.7%) of the HIV-infected group had an undetectable viral load, and all but four patients were on highly active antiretroviral therapy (HAART).

All participants had their carotid intima-media thickness measured by ultrasound, a measurement often used as a surrogate for the risk of cardiovascular disease. Those with HIV had significantly thicker carotid intima-media.

Sainz Costa commented that this population has “arteries that are more rigid and less elastic, which means that the process of atherosclerosis has begun.”

The investigators also found higher frequencies of activated T CD4+ cells in 34 HIV-infected patients compared with 11 controls (P=0.002), which indicates an activated immune system.

The frequency of activated CD8+ cells was borderline statistically significant in HIV-infected children and adolescents.

“Cardiovascular disease has already put down roots in children and adolescents with HIV, and we need to take preventive measures at this early stage. We should be more aggressive in treating their high cholesterol with medication – this practice is common in adults but rare in children,” Sainz Costa said.

Virulent MRSA Staph Infections in Boys with HIV

I note that when any of the HIV boys I work with are hospitalized for whatever reason, not one of them has ever been allowed to shower or bathe. This is a modern hospital with many surgical specialties.

I note that the use of an intravenous Fentanyl pump seems to close the deal. If you get the pump, you will never shower (in fact, you will never see a bathroom), and not one of these boys has ever been bathed.

Fungal infections are often severe when they get home. The first thing they want to do when they get home is bathe because they feel so filthy.

I also note that when anyone’s white socks touch the floor, the bottoms of the socks turn black. Hospitals are filthy places.

No one wants to do the work of dealing with the intravenous pump so the kid can get into the bathroom.

Typically, they end up with rectal bleeding because the fungal infections just get worse.

Instead of simply throwing antibiotics or something like Miconazole at them, we simply combine those meds with twice daily bathing, and it seems to help even when a kid’s CD4 is quite low.

We try our best to get the kid out of the hospital ASAP.

I know nursing staff is busy. But something like the intravenous Fentanyl pump should not be an obstacle to helping the kid be clean. — tim barrus



























































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