Tim Barrus: Russian Boys Facing Climbing At-Risk AIDS Numbers


World AIDS Day would like to paint HIV/AIDS with a happy face. Things in Russia are a bit more grim. 

Treating AIDS patients could absorb 82% of the Russian budget by 2020, according to an epidemiological and economic model of the Russian epidemic developed by the Moscow office of the World Bank, the Russian Federal AIDS Centre and the Economics Institute of Charles University in Prague.

Vadim Pokrovsky, Chief of the Russian Federal AIDS Centre and one of the authors of the model, draws a main conclusion: “the government must be more active in prevention — not only to fight HIV, but also because when we fight HIV we are also working for the economy.”

“At the moment HIV/AIDS doesn’t get enough attention from the government; we need to show and explain this model to decision-makers… people from the ministry of the economy, of development — the finance ministries. Of course our objective is to reach the Deputy Prime Minister or Prime Minister Putin himself. That will be the next step.”

With 200 000 people registered as infected with HIV, the federal Russian budget for 2002 was just US$6 million — including treatment and diagnostic programmes. “Of course this is very small” said Pokrovsky. “It means only one rouble per person. It is not enough for prevention. One hundred million roubles (US$3 million) will be spent on treatment, 30 million roubles (US$1 million) on diagnostics, and for prevention not more than 30 million roubles (US$1 million), with another 30 million (US$1 million) for other things.”

“This is, of course, not enough for Russia. There were expert estimates at the beginning of the 1990s that for effective control we’d need to spend about US$140 million a year.”

They are going to have to spend a lot more.

As of August 31, 2007, there were 390,365 officially registered cases of HIV in the Russian Federation.2 In 2006, 0.5 percent of the population between the ages of 15 and 24 was registered as infected; in the 18 to 24 age group, the prevalence rate is over 1 percent. Young people ages 15 to 30 represent about 80 percent of Russia’s cases. HIV first entered the Soviet Union in the mid-1980s, but an epidemic emerged only in 1996–1997, when the virus began to spread among injection drug users (IDUs). Russia in the late 1990s witnessed some of the most explosive increases in HIV incidence ever observed: from under 1,000 registered cases in 1995, to almost 250,000 in 2002. The peak incidence year was 2001, with over 87,000 new cases, declining to about 35,500 in 2005, but then rebounding.

Hints of change appeared in 2003, when President Vladimir Putin first mentioned HIV/AIDS publicly in his annual “state-of-the-nation” address to the Russian parliament. But significant steps forward emerged only in the fall of 2005, with Putin’s announcement of dramatic increases in the federal budget allocation for the fight against the virus. Federal spending on HIV/AIDS programs had risen from about $4 million per year in the early part of the decade to $150 million in 2006 and to an estimated $300 million in 2007. Institutional innovations have followed suit: the State Duma’s health committee held hearings on HIV in February of 2006; the State Council considered a strategy on HIV/AIDS for the first time in April 2006; a month later, the first-ever Eastern Europe and Central Asia AIDS Conference was held in Moscow, with a second scheduled for spring 2008; a high-level, multisectoral Governmental Commission on AIDS was established in October 2006. This commission, consisting of representatives of 11 federal ministries and services (including the Federal Security Service, the State Drug Control Committee, the Ministry of International Affairs, the Ministry of Foreign Affairs, and the Ministries of Finance and Economic Development), members of the legislature, and civil society representatives, is to coordinate federal and regional authorities in the implementation of national policy; organize multisectoral participation in the national response to ensure scale-up of prevention, treatment, and care and support programs; and review legislative regulations related to HIV/AIDS.

The growth of a pleasure-seeking economy afflicted with unemployment, corruption, prostitution and drugs, all have contributed to an HIV epidemic affecting a million people. Russia has the world’s highest growth rate of the virus; up to 12 million Russians could be HIV positive by 2020.

The attitudes of police and politicians, along with Russia’s limited health care and social services, are blamed for this situation. Moscow Mayor Yuri Lushov has banned needle-exchange programs because he believes needles lure people into addiction. Addicts hide needles in public places because they know they’ll be arrested if caught with them. The government refuses anti-retroviral therapy for addicts and some specialists even welcome the HIV epidemic as a biological solution to a social problem.

It’s a tragic, but familiar, story. “If you’re different here, you’re also bad,” says the director of Medecins du Monde, Alexander Tsekhanovitch, who tries to encourage safer drug use among the sexworkers trawling the frosty streets of St Petersburg.

“I think it will take about three to five years to explain to our government that AIDS is a real danger.”

Currently the epidemic is mainly among injecting drug users and in prisons “and this creates another difficulty because people think ‘it’s not my problem”’ Pokrovsky said. “But we are seeing more and more cases of heterosexual transmission. From the year 2000 to 2001 the total number of infected non-drug-using heterosexuals will rise from 2000 to 5000. And the percentage of these people among the total infected increased from 3% to 4%. So there are signs of a generalization of the epidemic into heterosexual transmission.”

Research shows that the risk of HIV infection can be slashed by substituting heroin and other illegal opiates with a safer, legal drug and encouraging addicts to swap dirty needles for sterile ones. 

Twenty-two pilot programmes supported by the Global Fund to Fight AIDS, Tuberculosis and Malaria have prevented 37,000 HIV infections. 

In Russia’s case, the country could cut its HIV rates by up to 55 percent if it implemented these policies. 

At present, Russia prohibits opioid substitution and has only 75 needle-exchange programmes for an estimated two million injecting drug users, around a third of whom are thought to have the human immunodeficiency virus (HIV). 

“Our projections suggest that Russia could substantially reduce the incidence of HIV infection if it permitted the use of opioid substitution treatment,” says the analysis headed by Tim Rhodes, a professor of public health sociology at the London School of Hygiene and Tropical Medicine. 

“The benefits could be even greater than we estimate, as the model does not include changes in offending, or in antiretroviral HIV treatment.”

Read more: Russia’s Strict Drug Laws Blamed for Spread of HIV | Medindia


Another issue is the price Russia is paying for its antiretrovirals – US$ 4200 to US$ 9000 a year, much the same as in the West, compared to some regimens available in Africa at only US$ 850 a year.

“Personally I do try to negotiate with the companies, but some questions need the participation of the government” said Pokrovsky.

Christof Ruehl, Chief Economist at the World Bank Moscow Office and coauthor of the model, says: “The idea has been to put some discipline into the debate” about HIV/ AIDS in Russia. “Up to now anyone could pick whatever idea they liked out of the blue sky. This model ensures that people test their assumptions against facts. Our second goal is for the model to be used as a tool for policy.”

The complete model can be downloaded and run on a PC, and adjustments made to parameters such as transmission rates and costs of ARVs, to see the effects on the economy. It is available from URL The paper on the model is available from

Tim Barrus: Adolescents do not abuse SSRIs


My contribution to MedPage Today. They have a piece in there that claims that adolescents do not abuse SSRIs. I completely agree. The public perception is different, of course. The public perception is always just say no. Stupidity is the norm. The media feeds on ignorance. How can you be abusing a drug you cannot get. Duh.

SSRIs simply do not always work. I deal with adolescent boys with HIV. Many of them are sexual abuse survivors. Who do not always survive. Getting their HIV drugs is one nightmare. Adherence is another. Add some psychotropic medications into the mix , and I wish you luck. If they’re not already crazy, the struggle to obtain their drugs, and stick to them will drive them there. 

Tim Barrus: Keep the Car Running and the Heater Set on High

Don't touch me, I used to think, as people passed me in the street;

don't touch me. I was Echo.

I Am Not the Kind of Kid Who Flies by Rhashan

I never fly. My black ass rides the city bus.

One time I took the bus as far as it would


Then they kicked me off. They have been

kicking me off things my whole life.

I got expelled. I got busted for bringing

my brother’s gun to school. And drugs.

I stole his drugs.

They screamed at me that the gun is

not safe. If it is not safe then why does

he have it in the bed next to me.

I wanted to blow my brains out in front

of the principal in his office. My brains

on his nice white wall.

What if I roll over in bed and that gun

goes off. I ran away.

They can have their school with their white

walls. My black ass has been climbing over

their walls.

All my life.


Rhashan is the only boy whore I’ve ever known who was robbed by a trick.

Among the other boys, this was the lowest of the low. Complete humiliation.

To get ripped off by a trick.

It was unheard of.

So there is a small group of us committed to seeing that Rhashan has at least SOME school success. God help us. Where do we begin.

The kid can dance. But can he spell.

I’m staring at his books.

“It’s all code, Rhashan. All we have to do is figure out the code.”

It’s not that the school even cares that he has HIV because they don’t. That’s not why they want him out. They have washed their hands of him because he has given them no indication; there is no evidence that Rhashan won’t fail and fail and fail.

No one will admit this, but just having HIV and the fact that they KNOW he has HIV (because he has a cocktail he has to tend to) means (in their eyes) that Rhashan has failed.

We’ll begin with English Lit.

Supposedly, I know the secrets there.



“Do you ever have flashes of insight as a writer.”


Tim Barrus: Keep the Car Running and the Heater Set on High

We were swimming. I try to keep them busy. When they’re not busy, hell has this capacity to find us. Grinder has its own GPS satellite. I think Grinder must have spies.

You don’t know what Grinder is. Then, I cannot help you.

You’re not living on the cutting edge. The cars grow darker still.

It was summer. They were swimming. “Do you wanna know how big it was,” Piotr asked, stretching his hands apart in an awesome attempt to impress his audience with the size of his latest trick’s cock. 

It was not about cock size to this particular audience. It was about Piotr’s ability to get fucked by it.

The average age of this particular audience is fifteen.

There are two kinds of whores. Tight-ass whores. This goes to the supposed value of virginity. Some cultural attributes, even ill-fitting ones, never really change all that fundamentally. Or. There are sloppy-cunt whores. Done been used.

Used and abused.

I work with adolescent sexwork boys with HIV. Prostitution anywhere you look. Fish-wives. I think they would be fish-wives. Survival sex in winter is about as low as you can go. Before you crawl into the backseat, you plead with the trick to keep the heater on.

The boys will tell you they have given up The Life. But I have worked many years with many whores. Publishing was fun. Did I believe everything I was told in publishing. But no.

Kid walks by everyone with new shoes.

We know.

Sometimes I laugh at them. Surely wisdom dyes the sky in blood.

The first time I moved to New York, I was a single parent of a young child. Picking up my life and leaving with my kid to live in New York (I wanted to become a writer which I am now mercifully retired from) was edgy enough back then. Economic reality in Manhattan is another universe entirely.

People want to know why I wrote porn instead of literature. Do I look like Jane Austin to you. Porn paid on acceptance not publication.

YOU move to Manhattan with a kid and no job. I double dog dare you to do it. The boys I work with might have HIV, but they know the score. They know that when push comes to shove, I am going to side with them.

Most of them are from the same side of the railroad tracks I am from. The side of the tracks where daylight can go unhinged. Thieves. A place where people live their lives in shifts, and people walked bent in shame. My father did. A lunch bucket of imperfect and quite dry bread.

At no point do any of our kind ever say: now that danger has passed this place.

Yet to die so gone to seed.

And what is the point of going to look at graves. Like any cock, the thing has size or not. Emerson’s grave in Concord is as big as a battleship.

What remains is work and what little scraps you have will be taken away.

Most of us had fathers who stuffed that into us and themselves.

Pain and suffering are ordinary.  In the dark hours I am told they know they deserve to have this disease, and they know something only they know for sure. Half-asleep there and curled. Everything is broken. Incalculable and calculated. It will not be fixed.

World AIDS day or no World AIDS day.

As whores, most of them do not remember a time when there was no Internet. Grinder’s GPS allows them to know who’s down the hall, or around the corner, and what games does he like to play. 

Age and consent.

The old ideas are like my lunch bucket father’s quite dry bread.

The new ideas are not much to do with either age or consent. More like current location and how much.

I blame Facebook. It’s easier.

The new ideas are not unlike the prostitution of writing for the rich or maybe that should be only the rich are writing. Whores are only turning tricks. Art will adapt to whatever the medium of the moment happens to be. 

A fourteen-year-old disappears for three days and returns with an iPhone.

I don’t even own a whip. Having tired of sadomasochism as theatre a long time ago. I can show him how to shoot entire movies with his iPhone. I can show him who William Wordsworth was.

Go ahead. Spit on it. Laugh.

What was Wordsworth. I was a Traveller back then, too. Pain and rage are a pilgrimage. Crawling forth there to sun himself. With his phone, he can take photographs that will advertise his attributes far and wide. Or he can find that there is little time for those of us who want to do other things. What is time to a fourtteen-year-old with HIV. Waiting for coins, what does he really want. I saw the scars beneath his arms perhaps to just be comforted. There is no Grinder for it. Just the grinding like a graph written on the window of a car frozen by the frost. Solitary and common. The cars grow darker still.

I will make this boy a conspiracy of it. We will be co-conspirators. I will make it about us versus them. We will take long walks with secrets out among the fields and spider’s webs. Leaving our phones behind. He will try not to fall for it but then he will. Fourteen is like the poplars and the snapping. It’s winter now. Summer was a while ago with the outstretched arms. My arms will turn him inward it will be nothing. I do it in my sleep.

We will take long walks with dogs through snow. My dogs love snow. And yet to die so gone to seed. All the rags have done that, too. He will forget about the cars and the men and then he will remember them when he’s writing some dark night or he’s shooting a film that has eaten him alive for months.

He will begin to make some sense out of my advice to keep the car’s motor  running and the heater turned on high.


These HIV/AIDS clinics in the US can be a big problem. Like everything else concerning health care in America, the system is completely broken. World AIDS Day is rah-rah-la-te-ta we have made so much progress.

Complete bullshit.

The UN and UNAIDS, specifically, is to blame. The Big Question is: Where has all the money gone. Why are twenty-six million people still infected.

So if we turn the thing into a rah-rah holiday, that becomes the public face of AIDS. No one wants to confront what has become sacred. I guarantee you, because I have seen it, those moving pictures of people dying are still painfully relevant. People die.

The other player, here, is Big Pharma. Big Pharma would like to get as many AIDS clinic pharmacies enrolled to buy the drugs. These clinics buy these drugs in bulk with public money.

Where is the savings.

There is no savings. Big Pharma will not allow “savings.” You buy, you buy at the Big Pharma, Big Girl price.

For most people, this is completely impossible.

Who can afford an additional fifty-thousand dollars a year when your typical clinic patient is not even employed, or if they are employed, they’re making minimum wage. Twelve-thousand dollars a year is not fifty K.

The fifty K is high. I am aware of that. But I am also aware that  no one just buys antiretrovirals alone. Marinol (dronabinol) can make all the difference between life and death. It can be the difference between being able to get out of bed and move around (as in attending to your minimum wage job), or turning your face to the cement wall to die. It treats pain. It treats appetite. It treats debilitating arthritis. It treats drug nausea. The list goes on.

Of course, marijuana does all of this better. Marijuana is illegal. Marijuana is what literally fills the prison system. America’s moral aversion to marijuana simply points to the stupidity of Americans. Americans are a stupid people living in a stupid culture. Always have been. Always will be. Marijuana is illegal. But the medical community, the government, and Big Pharma join forces to make dronabinal, put some jell and some dye in it, and presto-chango, you have synthetic THC. Which, depending on the dosage, can cost you another three grand a month. Minimum wage will pay for that. Minimum wage will not even pay for the insurance that will pay for that. Consuming THC is criminal unless Big Pharma makes it. America’s mentality is one of the superior race, infused with a good chemical dose of sheer greed. Big Pharma greases the political wheels (check out Lilly’s political contribution list for the Republican party), and in return what it gets is an exclusive right to make the drug. This does not protect the American people (the FDA is a joke). It exploits them. This week’s budget proposals have all cut the FDA back more than it was already cut back. Americans are idiots. They vote for whoever advertises the best or the most. No one really knows. The people who think they know sell their knowledge which can be wrong.

Organized crime does this, people go to prison. You cannot conspire to own a monopoly and then to set prices. It doesn’t work like that. Unless you make big payments to the Republican party.

The government is criminal.

It locks African-American men up (nearly a third of them), many of whom contract HIV in prison (prisons farmed out to private companies, always a buck), it treats prisoner HIV only because it has to, and not with the newer drugs, and it returns prisoners to mainstream society without a job or the ability to buy health insurance so they can purchase HIV drugs.

Then people in the medical community scream about adherence. How can you adhere to something you cannot get. Meanwhile, when you run out of drugs, the virus mutates, and we have new genetic strains. Treat that. This is one of the problems with the HIV virus. As soon as we treat it, the thing copes by changing its DNA. We are not winning this battle because no one wants to pay for fucking AIDS. That is the bottom line. Americans would like to make money from it, but loathe paying for it. They would rather not treat your pain (just say no to pain), but maybe there’s a way to make a buck here.

HIV/AIDS is big bucks and a windfall financially for American corporations. If Chevron really wants to help beyond a photo op, it could assemble a group of high-powered attorneys who could start bringing lawsuits to everyone in sight. Chevron will and does opt for the photo opt. It’s great PR. Just say no to AIDS. Meanwhile boys with HIV are getting into cars on Market Street (you know who you are) in front of the Chevron building. Play for pay. Americans are the most hypocritical people to ever infect the planet.

If you are undocumented, and you have HIV, you are probably going to die.

You Americans love your children.

No, you don’t.

You exploit them, you fuck them, you educate them poorly, and then you charge them with paying for higher education to the point of bankruptcy. Why. Because that is how America ALWAYS works. It only works for a chosen few.

You drive let us say one to two hundred miles to any of the few AIDS clinics that have HIV drugs, only to arrive, but they couldn’t get the drugs you need, and they simply don’t have them. This is the norm. These clinics buy these drugs when they can. “Come back to tomorrow.”

But if you do, they still won’t have the drugs. Two hundred miles has now turned into eight hundred round trip. To drive eight hundred miles to buy drugs in America is painfully absurd. Not that Chevron will complain.

Or they might have the HIV drugs but never the marinol. You learn to play catch as catch can. You learn what drugs are the moral drugs. Anything to do with pain.

Is this because Americans like to inflict pain or because they have a moral aversion to addiction. Marinol is not addictive. You don’t have it, you don’t have it. You hold tight to your pain if you can. If you can’t suicide is an option. Pain specialists know this. Ask any of them. Do human beings in pain kill themselves. All the time.

Does any doctor want to treat suicidal patients. Those are a whole other set of drugs. Psychiatrists do not treat pain. You don’t want to be in our wonderful culture. You must be crazy as a loon.

Tribes have their witch doctors. We have them, too.

No doctor wants the headache. Suicide gets messy.

Do AIDS clinics have help for the suicidal.

More pills you cannot get.

How do you define your pride. Get a clue. Put a poster on the wall. Spout rhetoric. Make a happy face. We’ve made progress. The numbers game in AIDS is often simply bogus. The head of UNAIDS jets around the world to do photo ops in places like the favela in Rio.

Smile for the camera.

I would be one of those photographers, and I would attempt to sell my photographs to any NYC-based journalistic media. After all, they will need some images when World AIDS day rolls around. The date is sacred now. It has been set in stone.

There is a black market for HIV drugs. Let us not go there. Let us just be really clear that HIV/AIDS is an economic bankruptcy. It will bleed you dry. Yet one in every twenty adolescents are at risk for HIV infection. Why. Because they do not understand the price they are going to pay. What do you think adolescents is. The culture cannot afford to have the fertile members of the group revaluate their relationship to the culture itself. If people did that, what would the culture do with people who wondered if the price for being a member was worth it.

World AIDS Day is now an institution. What do institutions do. They propagate themselves. Kinda like a virus. You can attempt to change them, but all that changes are the spots.

It’s easier to rah-rah-rah with buzz words, and rhetoric. Hope would be a buzz word. Hope is the central buzz word in any language.






Michele Sidebé. UNAIDS Humanitarian Disaster: Human Trafficking in an HIV pandemic.

Human Immunodeficiency Virus (HIV)

Acquired Immune Deficiency Syndrome (AIDS)

Michele Sidebé. Why are you not speaking about the HIV Humanitarian Disaster involving millions of men, women and children. Human Trafficking & HIV. Millions of people have not tested and have little hope of ever accessing ARVs created to reduce a person's infectiousness and in many cases also raise a person's quality of life and extend a person's life.

WORLD AIDS DAY week end 2012: It is with profound sadness that we come together this week end from across continents and disciplines, generations and cultures to share our collective grief over the death of 30 men and women and children. Together we share the burden of witness as we watched and are still watching those we love dying slow and painful AIDS-related deaths. Knowing there are still 26 million people unable to access treatment (and this number does not include all the undocumented) has prompted many of us to stare in disbelief at the contemporary presentations offered by so many taking a leadership role in shaping the course of the HIV pandemic. Paragraphs, presentations, speeches stuffed full of statistics, currencies and carefully chosen words suggest the epidemic is under-control. We know this is simple not true. How can it be when there are still millions of children at risk for being infected with a virus that attacks their vulnerable immune systems. How can it be when there are still millions of children at risk for being violently infected with HIV in conflict zones, along human trafficking routes, in the shadows of our communities and behind our cultural net curtains in our homes. The cultural and social embarrassment experienced by adults at the thought of acknowledging the extent of sexualized violence directed at children, places hundreds of thousands more girls and boys at risk for being violently infected with HIV and for being left to die slow and painful and premature AIDS-related deaths. Here we must ask ourselves what is more embarrassing. For adults to sacrifice children, or for adults to acknowledge the inter-generational violence experienced by girls and boys. If we do not take urgent action to prevent sexualized violence directed at children in today's HIV/AIDS pandemic and if we continue to fail spectacularly to provide the child-survivors with appropriate and consistent testing and treatment for acutely compromised immune systems, our humanity will surely continue to die slowly of embarrassment.

Thirty years after the HIV/AIDS epidemic began there were a SHOCKING 2.5 million new HIV infections and a STAGGERING 1.7 million AIDS-related deaths in 2011 (WHO estimated figures). 1.7 million deaths also speaks of the enormity of profound grief and stress experienced and borne by millions of people who yearned for those they loved to live as they were dying. Too many people who are infected have not been told they are infected. Too many people have not been tested and do not show in the estimated figures. There are not enough medications for the people who know they are living with compromised immune systems and would like to benefit from the antiretrovirals that have been created to reduce a person's level of infectiousness and in many cases raise a person's quality of life and increase his/her life expectancy. WORLD AIDS DAY 2012 IS A SERIOUS SUMMATION OF HUMAN SUFFERING AND FLAGS THE HUGE AMOUNT OF WORK THAT NEEDS TO BE DONE URGENTLY IF WE WANT TO PREVENT ANOTHER 2 million AIDS-related deaths in 2013.

WORLD AIDS DAY 2012 IS A JOKE (Smash Street Boys/ Show Me Your Life/ Real Stories Gallery Foundation 501c3)

Human Immunodeficiency Virus (HIV)

Acquired Immune Deficiency Syndrome (AIDS)


They say that HIV is like a common cold. It is a big fat lie. Sometimes you can get the meds and sometimes there are no meds for you (Smash Street Boys, USA).

President-elect Barack Obama made a strong statement backing a country's rights to buy affordable generics and promised to “break the stranglehold that a few big drug and insurance companies have on these life-saving drugs.” The pharmaceutical industry prefers to keep prices high. Even in developing countries, health concerns are underrepresented in negotiations. Trade agreements are not negotiated by health ministers, but by trade ministers advised by powerful commercial interests. Their goal is access to foreign markets. They are often quite content to trade away health considerations.

Tim Barrus (USA): I live in a town with a major hospital, hundreds of doctors, labs, a big health care foundation, and a significant university (UNC) affiliation. Not ONE physician will even see a patient with HIV. They sit there and simply shake their heads no. That leaves patients with one and only one option which for some people is over a hundred miles away at a county clinic that is overcrowded, mean-spirited, expensive, harassed, filthy, and the computers are typically crashed. They cannot access your latest labs so what is the point of the long drive. Their pharmacy on a good day can only fill half your meds, and there are waiting lists for antiretrovirals. The health care system is broken. To claim that it’s not disease discrimination is patently absurd. To advocate for repeated, unnecessary visits indicates a fundamental unawareness as to how the system works. It doesn’t work. Waiting lists alone for HIV medications in the United States is unconscionable. It is second-class medical care because HIV patients are seen within such a negative social context. STIGMA is REAL. Hospitalizations are an enormous strain on families who find the transportation issues a challenge. HIV education facilitating compliance is nonexistent. HIV care is better in many African cities. To advise for repeated exposure to a nightmare fails to recognize a system that has collapsed. If it was ever real in the first place. Maybe it looks good on paper, but it is not reality. People are still dying from AIDS even if the media wants to put a gloss on it. Imagine: early morning appointments for people who live far away, and there is no flexibility as to making appointments because they are issued, not negotiated. There is a fundamental ignorance as to how it works on the part of health care professionals. The responsibility to deal with a broken system is put on the patients — how many times can you make these trips even to a pharmacy that tells you to come back next week because they do not have the meds and then when you do, they still do not have the meds and they refuse to deal with patients on the phone because patients are seen as stupid — versus the health care community recognizing that the medical paradigm it functions in is an illusion. The structure represents a public health disaster, and cruel and unusual punishment.

An Humanitarian Disaster: Transmitting messages of hope in an HIV/AIDS pandemic is unkind.

Hope is an emotional state, the opposite of which is despair. Hope promotes the belief in a positive outcome related to events and circumstances in one's life. HIV/AIDS Prevention and Awareness Campaigns have spent millions of dollars informing people throughout the world that Antiretrovirals (ARVs) dramatically reduce a person's infectiousness, thereby lowering the risk of transmission, and if taken appropriately and consistently ARVs will also extend the length and quality of a person's life.

BEING AWARE of this magnificent knowledge whilst simultaneously reaching in vain for ARVs, due to lack of access or a lack of ability to pay for the medications, exacerbates the stress experienced by millions of people who are yearning to live and yearning for those they love to live as they are dying. 

It is cruel to transmit the message of hope to millions of people who could benefit from ARVs, when in reality there is no hope of them ever having access to an appropriate and consistence supply of the medications for themselves or for those they love.

The ideas about hope vary from culture to culture. I do not know what is real to hope for.

Some of the kids at-risk I deal with have hope. But not many.

Ikeena is a very bright young man. If you were looking for hearts and flowers written by happy, smiling, Disney children, do me a favor, and don’t write to me. I’m glad you want to protect your children from the big, bad world. But some children live in it and to assume they’re stupid and backward is both a contempt for them, a paternalism, and it’s just wrong. It is mistaken. Their take on reality is as valid as your take on hope.

I will bring you their poetry when I can. I have little hope we can attract much funding because the subject matter is just to grim for Americans to bear.

Hospitals and Graves: by Ikeena (Nigeria)

(translation provided by Médecins Sans Frontières)


The official language of Nigeria is English

You even own our language

Do Americans speak Hausa


The official language of America is not Chadic or Trade language

The language of English is the language of power.


You in America have everything

You have medicine for AIDS

We have nothing.


You have school

We only have schools here and there.

I had to walk all day to get to school

All day in the sun and dust.


America has shiny cars to drive in

You have food

We have nothing.


A cure does not mean us.


I am tired of God always behind me, where I cannot see him telling ME to have hope.

He has hope

I have nothing.


My father is dead

My mother is dead

My grandmother loaded down with a stone in her grave is sad.

She weeps dead tears

America pretends it cares it cares about America

Do you think we do not know that!


Today the slave ship is not a ship at sea filled with my dead brothers and sisters

Today the slave ship is a continent chained around our legs like the squalid air of harmatta that burns your lungs to breathe.


You have a Government

We have Thieves.


You have Hospitals

We have Graves.


You have Hope

We have AIDS.


Our earth dissolves to dust

Are roads are sand

We have T.B.


We drift in boxes made from corrugated metal and plastic

Our floors are made from dirt

What are your floors made from?


I am supposed to be hopeful because you say so,

You say I must.


We have no running water

You have oceans of it

It comes to you in pipes

Mine comes to me in a bucket I carry from a hole of mud.


You have pills that makes the AIDS go away

My brother was thin like a bird

And crazy.


You have your God and Hope

I have young siblings to feed.


I no longer go to school

You have school sports and computers


You tell me to have hope

I have a shovel to bury the dead

I will be among them.


You have your pills and hope

Your sunlight is not our concern.


All I have are memories wrapped in bandages until they bleed.

Your hope is the sound of an empty language

All I have is hunger in a vacant space.

There is no hope.


Your hope is just another slave ship and we are chained to it in the dark dragging our bones for the hyenas

Who arrive to eat.


Tim Barrus (Creative Director, Show Me Your Life, Real Stories Gallery Foundation 501c3): An estimated 3.4 million children were living with HIV in 2012, 91% of them in sub-Saharan Africa. War and sex trafficking exacerbates the entire tragedy. Many children in Africa send Show Me Your Life a witnessing as to how they live their lives. Children who do so also risk their lives.

Most of these children acquire HIV from their HIV-infected mothers during pregnancy, birth or breastfeeding. With efficacious interventions the risk of mother-to-child HIV transmission can be reduced to 2%. However, such interventions are still not widely accessible or available in most resource-limited countries where the burden of HIV is highest.

Children with AIDS die every day. The number of children receiving ART increased from about 456,000 in 2010 to 562,000 in 2011, but this represents a coverage rate of only 28% among children in need of pediatric ART.

Antiretroviral Drugs (ARVs) Used in the Treatment of HIV Infection

Click on drug brand name for additional information. Multi-class Combination Products

Brand Name

Generic Name

Manufacturer Name

Approval Date

Time to Approval


efavirenz, emtricitabine and tenofovir disoproxil fumarate

Bristol-Myers Squibb and Gilead Sciences


2.5 months

Nucleoside Reverse Transcriptase Inhibitors (NRTIs)

Brand Name

Generic Name

Manufacturer Name

Approval Date

Time to Approval


lamivudine and zidovudine



3.9 months


emtricitabine, FTC

Gilead Sciences


10 months


lamivudine, 3TC



4.4 months


abacavir and lamivudine



10 months


zalcitabine, dideoxycytidine, ddC (no longer marketed)

Hoffmann-La Roche


7.6 months


zidovudine, azidothymidine, AZT, ZDV



3.5 months


abacavir, zidovudine, and lamivudine



10.9 months


tenofovir disoproxil fumarate and emtricitabine

Gilead Sciences, Inc.


5 months

Videx EC

enteric coated didanosine, ddI EC

Bristol Myers-Squibb


9 months


didanosine, dideoxyinosine, ddI

Bristol Myers-Squibb


6 months


tenofovir disoproxil fumarate, TDF



5.9 months


stavudine, d4T

Bristol Myers-Squibb


5.9 months


abacavir sulfate, ABC



5.8 months

Nonnucleoside Reverse Transcriptase Inhibitors (NNRTIs)

Brand Name

Generic Name

Manufacturer Name

Approval Date

Time to Approval



Tibotec Therapeutics


6 months


delavirdine, DLV



8.7 months


efavirenz, EFV

Bristol Myers-Squibb


3.2 months


nevirapine, NVP

Boehringer Ingelheim


3.9 months

Protease Inhibitors (PIs)

Brand Name

Generic Name

Manufacturer Name

Approval Date

Time to Approval


amprenavir, APV



6 months


tipranavir, TPV

Boehringer Ingelheim


6 months


indinavir, IDV,



1.4 months


saquinavir (no longer marketed)

Hoffmann-La Roche


5.9 months


saquinavir mesylate, SQV

Hoffmann-La Roche


3.2 months


lopinavir and ritonavir, LPV/RTV

Abbott Laboratories


3.5 months


Fosamprenavir Calcium, FOS-APV



10 months


ritonavir, RTV

Abbott Laboratories


2.3 months



Tibotec, Inc.


6 months


atazanavir sulfate, ATV

Bristol-Myers Squibb


6 months


nelfinavir mesylate, NFV

Agouron Pharmaceuticals


2.6 months

Fusion Inhibitors

Brand Name

Generic Name

Manufacturer Name

Approval Date

Time to Approval


enfuvirtide, T-20

Hoffmann-La Roche & Trimeris


6 months

Entry Inhibitors - CCR5 co-receptor antagonist

Brand Name

Generic Name

Manufacturer Name

Approval Date

Time to Approval





8 months

HIV integrase strand transfer inhibitors

Brand Name

Generic Name

Manufacturer Name

Approval Date

Time to Approval



Merck & Co., Inc.


6 months

Generic drugs used in the Treatment of HIV Infection

Drugs Used in the Treatment of Pediatric HIV Infection

Approved and Tentatively Approved Antiretrovirals in Association with the President's Emergency Plan (PEPFAR)

Tim Barrus: HIV/AIDS Medical Care of Adolescent Boys Who Are Survivors of Sexual Abuse

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.



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



Damyon, Dude, No one wants to see it. You are supposed to neatly fit into the health care structure the animal has created so it might limp along. You hate it. I believe you. I hate it, too. But i have worked hard to change it around for myself, and for other people so the survivors of sexual trauma do not avoid the health care that every person infected with HIV is subject to. I contend that health care providers have a responsibility to treat us as if the trauma, too, was and is part and parcel of who we are as people, and if the system cannot do this there are going to be people out there acting out and sexually acting out a repertoire of rage and defeat, and we are not exactly recognizing that our own sexual behaviors are not exempt from a process that can eat anyone alive. They started to listen but it took a lot of assertiveness, and it did not happen overnight. And they started to change. Also, I was not alone doing this. People they are obliged to respect were supporting me with their voices. First, the clinic people didn’t want to hear it. Mainly, they’re tired, and exhausted. And this is just one more thing coming at them. I think one of the keys here to getting through to them was in recognizing that they are so obviously exhausted. “What I hear you saying is that handling one more special need is going to make your job harder than it is.” This happens to be the truth, and it is also a simple acknowledgement. I need this, too, from people and rarely get it — a reflection that simply says: what i hear you saying even with your body language is…

I am in no need of being psychoanalyzed by friends. But people validating the experiences of other people is important. We both know that the status quo of the hospital gown and the invasiveness can set us back years and years. They have no idea that we do hate them for humiliating us and it feels as if the violence is happening all over again. I had to remain very firm and they did everything they could do to get me to change my demands, but they lost, and it works for me if i have to go there and I do. That does not make it easy. But here’s my gig with it. They cannot touch me unless I permit it, and i do not. There is no hospital gown. I do not remove anything. They do not like to admit this because they cling to their old, outdated medical paradigms. But the reality is that they can get what they have to know from blood tests. I go. He reads off the blood testing results. I sign off. And he writes me six months of prescriptions. I do it every six months and i never ever complain about anything because i do not want them touching me and i do not want to fly off in a rage. That is why the police are there. People get hurt in these places. People lose it. I myself have punched overly zealous nurses. But there is no need to go there because they recognize my very real need to not be touched. To bring the cops into it is a complete fucking drag.

I would support you in this. Just let me know. Fight back. They will take you on. But the more they lose this battle, the better off we will be. But you have to fight for it because it will never be given willingly. They will have a lot of check lists gone blank. For them, that means federal funding. They do not want to see our reality because it is not their reality. You might have to push. Pushing is okay. It is not monstrous to stand up to the way things have always been. It is only perceived as monstrous. It comes from a fear that what worked in the past might not work in the future. Learning to ignore things is important in this. It is a process, not a single event. You, too, I am sure have people who invade your skin — like at the clinic. Walk in there and hold tight. I am with you all the way. We can and we will inform them that this trauma and these triggers are relevant and valid. Kicking this back to life helps nothing and no one. It is destructive. And if i fuck up with you in any manner that triggers any of the trauma, dude, just yell. Keep pushing.


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