Friday, February 22, 2008

Wayne Hoffman Guest Blogs on "Staph, Bath and Beyond"

My friend, writer and activist, Wayne Hoffman was able to attend the NYC Community forum on MRSA, HIV and the talk of Bathhouse Closures last night at the LGBT Center. Because I couldn't be there and because he's a pro in this sort of thing I've let him guest blog. Here's what he has to say:
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The Center’s community forum called “Staph, Bath and Beyond” on February 21 left me in a bit of a time warp, since it feels like just yesterday that I was sitting in the center for a community forum on HIV and bathhouse closures. (In reality, that forum was 13 years and about 40 pounds ago.)

The basics: There were about 150 people there, in my rough estimation, mostly (not all) men, mostly (not all) white, mostly (not all) 30s and older.

The trouble with the forum, despite its very catchy name, is that the two subjects it was trying to address are actually mostly separate, and require very different approaches and tones. That was evident last night.

Part I of the forum was about MRSA, the nasty drug-resistant staph infection that’s been making headlines lately – even being (incorrectly) called a new sexually-transmitted epidemic among gay men. Two speakers got up to offer some very useful information about MRSA. Dr. Gary Blick, a physician working in Connecticut, started by asking how many people in the audience had contracted MRSA. Answer: four. He went on to talk about how MRSA is nothing new at all; it’s been around for many years, occasionally showing prevalence in one community or another. About 5 years ago, he noted a surge in MRSA among his (gay male) HIV patients. And indeed, in some places, gay men have had higher prevalence of MRSA than other populations – but we’re not unique in this way. It is also prevalent sometimes among children. Or members of a sports team (the St. Louis Rams, for example). That’s because it’s easily spread by touch – not sex necessarily, but touch. Anyway, some key points:

  • “Drug resistant” doesn’t mean “untreatable.” There are plenty of drugs that can kill MRSA. Bactrim, tetracycline, or some more recent drugs.
  • ”Communicable” does not mean “sexually transmitted.” MRSA is not an STD – you don’t get it from semen, or from any particular sex act. You can get it from a sneeze, casual physical contact, touching a counter-top, sitting on a gym bench, getting a physical exam. So yes, you could get it from a sexual partner while you’re touching, but that’s also true of a cold or strep throat, and that doesn’t make those STDs.
As if to further prove that point, the second speaker was Dr. Melissa Marx [or Marks? Couldn’t find her name on the promotional material], from the Bureau of Communicable Diseases. She presented some early findings from research that the city’s health department has done on MRSA. (This is early info, but still useful.) Looking at MSM (men who have sex with men) who have MRSA and comparing them to a group of MSM who do not have MRSA, the research saw no increase in MRSA based on the number of sex partners the men had, whether they performed certain sex acts, whether they had sex in commercial sex venues, or whether they used drugs – except for crystal. They did find that that the men with MRSA were more likely to have used crystal, to have waited to shower/wash up after sex, and to have attended private sex parties (as opposed to sex clubs or bathhouses). [These last two items seem related to me, since parties taking place in non-permanent spaces are less likely to have showers and a lot of sinks and towels, and are more likely to have surfaces that multiple people share without wiping them down: benches, beds, slings, etc.] Remember, that doesn’t mean that these things cause MRSA, only that they seem to be a common factor among a number of men who have MRSA.

Both docs provided some simple tips for prevention: Wash your hands. Shower/wash up after sex. Don’t share towels or razors. Wipe down equipment – at a gym or a sex club or a bathhouse – after you use it, preferably with an alcohol wipe. And sit on your towel when you’re using that kind of equipment at the gym or a sex club. In short, use good hygiene. Everywhere.

Part I of the forum was quite calm. Good information, no hysteria, good questions, honest answers. Quite useful.

But the next part of the evening was quite different. You might recall the news last month that the NYC Dept. of Health was talking about closing down all bathhouses and sex venues in the city. This move is being considered allegedly because of an uptick in HIV infections among young MSMs in recent years, especially among men of color. (I’m not saying the uptick is only alleged – that uptick seems real and troubling – I’m saying the city’s motivation is only “alleged” to be connected to this situation. More on that below.)

Now, a lot of us in the audience had been through this before, in the 1980s and again in the 1990s. [Shameless plug: I co-edited a 1996 book about the 1990s crackdown on sex spaces, called Policing Public Sex: So we came with a personal history in this discussion, and there was a lot more emotion and energy in this second part of the forum. [Second shameless plug: I also wrote a 2006 novel about AIDS activism and the battles over bathhouse closures in NYC during the 1990s, called Hard.

Dr. Perry Halkitis, from NYU’s Center for Health Identity, began by presenting a series of points about why the city’s proposal to close sex spaces was counterproductive from an HIV-prevention standpoint. Some of his points: Closing sex spaces means we can’t test different types of interventions to effect change in how people have sex. The city’s current approach to sex spaces makes no distinction between safer sex and risky sex. (More on this below.) We need a new paradigm for HIV prevention that takes desire into account when we talk about risk. We need to talk about people, not just viruses, to make new models for prevention. Sex venues have cultural meaning for many gay men. Closures treat gay men as irresponsible vectors of disease, and focus on the risk-takers exclusively. Most of my novel comes out of very similar ideas, so Halkitis and I are very much on the same page here.

Then the fireworks began. Dr. Monica Sweeney, an assistant commissioner from the city’s Dept of Health, got up and announced quite plainly and clearly that she was there (unannounced, meaning she wasn’t on the posters for the event) to put the media rumors to rest: The DOH has no plans to close commercial sex venues, she said. Period.

Unfortunately, her very clear opening statement turned out to be, well, not quite true. Or, to put it another way, total BS. Upon questioning from the audience, the truth eventually emerged: that basically, the media rumors she was there to dispel were, in fact, completely accurate. The internal DOH memo that the media had reported on, laying out four possible policies under consideration at DOH regarding sex venues – including closing them altogether – was, in truth, exactly that: an internal memo laying out four possible policies the DOH is considering – including closures. So when Sweeney opened by saying that the DOH did not have plans to close commercial sex spaces, what she actually meant – as she later, finally, clarified after repeated questions from the audience – is that the DOH is indeed considering closing commercial sex spaces but they haven’t made that decision final yet. So, technically true, they don’t have any plans right now. But the plan is still being considered, and hasn’t been ruled out.

Now, you might think that the audience, having been through similar forums before regarding the DOH and public sex, had some serious questions for Sweeney. And you’re right. Some people thought the tone of some questioners was “hostile,” but as someone who’s been through these things before, I can say it was, for the most part, quite level-headed and civil. Questions were tough and skeptical, but only a few seemed rude or out of line.

One person pointed out that if the city was truly worried about young men in NYC (MSMs under 30 have seen their HIV infection rates climb 33% in the past 5 years – and those 13-19 have seen a 50% increase – while older men’s rates have continued to decline…and the numbers are particularly bad for young men of color), then it didn’t make any sense to target bathhouses, whose (largely older, whiter) patrons overwhelmingly fall into demographic groups whose HIV infection rates are not rising at all. One guy got up and asked how Sweeney could say they weren’t closing sex spaces when in fact they have recently closed the two main sex clubs in Manhattan (The Studio and El Mirage – although bathhouses and transient sex parties still exist). One person talked about a successful HIV testing program taking place at a bathhouse – a program that has even managed to reach younger men who cruise on the Internet, who come to the baths just for a free HIV test – and noted that without sex spaces, we’d have no way to reach these men at all. A promoter of a poz sex party talked about the value of sero-sorting and “breaking the cycle” of AIDS. Catherine Hanssens from the Center for HIV Law and Policy said that the first thing we must do if we care about prevention is revoke the regulation in the state’s sanitary code that prohibits safer sex (fucking with a condom, oral sex) in public venues. I think her point, that revoking this regulation is a non-negotiable first step for any discussion of HIV prevention in New York, is dead on. Until this regulation is removed, I think it’s futile to talk about any kind of realistic or nuanced prevention efforts in public spaces, because those spaces will always be threatened with closure, regardless of what they do or permit in their establishments. Get rid of that statute, and then we can talk about how to make these spaces safer – whether through more relevant DOH regulations, community-based interventions, organization-based informational campaigns, or campaigns for personal responsibility. (Remember, saying you oppose wholesale closure of all sex spaces – from jack-off clubs to baths to fetish parties -- is NOT the same as saying you want zero interventions or regulations or rules of any kind by anyone.) Exactly how to promote HIV prevention in sex spaces is, in itself, a contentious and interesting debate, but we really can’t get to that point until this ridiculous regulation gets the ax.

Anyway, the discussion got fairly heated here. And while Dr. Barbara Warren from the Center tried to keep things moving, there wasn’t enough time (since we’d spent an hour on a very informative, but, as I said, almost entirely separate discussion of MRSA) to finish properly. We heard briefly from Terry Evans from the Positive Health Project, but never got to hear from GMHC’s Sean Cahill, or the party promoters who were supposed to speak. And Catherine Hanssens only got to make her point in about 30 seconds. Plus, Sweeney left after taking a few questions, so she missed the rest of the discussion that she really needed to hear.

In a somewhat surreal moment, Warren started to wrap up by talking about some of the issues that had been discussed that evening, and she said something about how one person that night had gotten up to say that if he wanted to have unprotected anal sex with a hundred people then that was his right and we should keep the laws off his body. Unfortunately, nobody had said anything remotely of the sort. A cute, nerdy bear from the Radical Homosexual Agenda was sitting behind me and he took the words out of my mouth, shouting, “Who said that?! Nobody said that!” Alas, Warren, too, must have been having a flashback to an earlier forum a decade or two ago. (If, in fact, these words were ever uttered in such a stark fashion. I have my doubts. But that’s another story for another day.)

So what did we get out of all this? Well, first, even though the name wouldn’t have been as cute, this forum should have been split in two: One quite informative educational session on MRSA, and the other more of a community discussion, back and forth, about HIV and public sex, with more voices being heard, and the DOH actually sticking around for the whole thing.

And second: Despite Sweeney’s initial insistence that the media rumors about the DOH’s plans to close sex spaces are untrue, they are, in fact, completely accurate. The DOH has not decided to close sex spaces – they are also considering other options, including looking at other cities’ more successful models of prevention in public spaces, which would, again, require getting rid of our rotten sanitary code regulation. But the DOH has also not decided NOT to implement the closure option, despite the fact that such a move would be counterproductive from a prevention standpoint, according to most of the experts who were there last night. (Opposing closure doesn’t mean that you champion and romanticize these spaces and think they’re perfect and have no connection to health issues; we’re talking about HIV prevention here, and what the best approach to sex spaces is from a prevention standpoint. You can find 50 different models in 50 different cities that all have some measure of prevention success, without mandating wholesale closures.)

Crap, now I really do feel like it’s 1995 all over again. I’m going to go put on a Smashing Pumpkins CD and wait for Melrose Place to come on.

6 comments:

Anonymous said...

Eric, thanks for publishing this, it's so well done that we should pay for reading it! Hoffman's prose and style are brilliant, as usual. Anyone who hasn't read HARD by now is missing out on an important piece of NYC sexual political history [plus it's a damn fine read. And very hot.]
In San Francisco, our bath houses were closed decades ago by Diane Feinstein, who became Mayor just after Harvey Milk was assassinated and she was left to deal with the fallout of the Dan White disaster. She is now our State Senator.
The only sexual venue I know of in the city now open is Blow Buddies, a mostly blow-job palace. We have no laws against oral sex in a public space that I know of, though this is actually a private membership club requiring ID and entry fees. The big hangup here seemed to have been fucking. During the 90's it was forbidden under any circumstances and was grounds for immediate removal from the premises. That said, from time to time I saw it discretely carried out anyway. Then, sometime in the past few years, that restriction was removed and fucking was allowed WITH A CONDOM, which I took to be a realistic move on the part of the city and the establishment with messages plastered all over to USE A CONDOM FOR FUCKING. There are no showers there but plenty of sinks, paper towels and free paper cups and mouth-wash. There is also free STD testing on a regular basis, I believe once a week. San Francisco also has a free facility in the Castro called MAGNET, for testing which can tell you within 20 minutes through a saliva test if you are HIV pos or not. They also routinely check all orifices of the body for every conceivable STD, which most doctors don't or can't do. And they provide and reguire counseling for all.
I believe it operates under the auspices of UCSF, though this isn't widely broadcast. I recently gave the clinic a donation and received a letter of thanks from the University.

I'm telling you all this and you all may very well know more about it than I do.
This is a huge issue, public spaces for sex for gay men, and it's not going to go away. While I can see the impetus to close the bath houses at the beginning of the AIDS crisis during the early 80's, I agree with Hoffman that it's NOT the correct thing to do. From personal observation I have seen that these spaces are actually safer in every way than private parties and parks with outdoor sex, fun though it may be. If you don't give gay men a safe place to play, they will find a not-so-safe place to play anyway.

Regarding the MRSA vis-a-vis gay men issue, there are those in our own progressive Bay Area who tried to make this a gay-related Castro-related issue, though the Chronicle allowed enough voices to be heard, mine included, that I think that mistaken notion has been laid to rest. The nightly news presented a city map showing the Castro as a HOTBED of MRSA infection, but said nothing about it not being sexually transmitted nor explaining it thoroughly as Wayne has done here. What he had to say about this in his concise fashion should lay that rumor to
rest once and for all.
The two of you have done a great public service with your message.
John/SF

Positive Health Project said...

For individuals unfamiliar with Positive Health Project, here is some infomation:
Since the summer of 1993 Positive Health Project (PHP) has assisted some of New York City's most challenged residents. PHP's participants include injecting drug users, sex workers, transgender individuals, people who are homeless or precariously housed, residents recently released from New York's correctional system and people addicted to crack/cocaine and other illicit substances. PHP offers its services in the heart of the Chelsea and Clinton communities, steps from Port Authority Bus Terminal, Times Square and Penn Station.
In May 1994, PHP's founder, Jason Farrell, and a small number of recovering and active substance users began offering street outreach, support groups, counseling and a safe haven to any substance user who needed respite from the chaos of street living. A year later, PHP began offering comprehensive harm reduction services, including syringe exchange, from its own offices in the middle of the Chelsea Community. Positive Health Project's service delivery continuum has been built on the 'one-stop shop' concept out of a belief that PHP's distinctive participants require that as many services as possible be offered from a single location. This is the only way to increase the likelihood that participants will return for care, develop trust, access a variety of services, and develop a willingness to engage in less risky behaviors.
PHP has worked aggressively to promote effective and long-standing ties with local businesses including the Fashion Business Improvement District and the members of Community Board 4. Both these organizations have been crucially important in PHP's social service expansion in the heart of the Garment District, including the delivery of onsite medical care. Over time, PHP's management has been successful in cultivating effective relationships with the Police and Criminal Justice System. PHP has become the first NYC agency in the last four years to gain approval as a community service site for the Midtown Community Court (Manhattan's drug court) and to operate onsite support groups for transgender defendants arrested for sex work. PHP's relationship with the Midtown South Police Precinct has led to a number of initiatives including security for PHP's participants to avoid arrest for syringe possession; technical assistance training for the police on current New York State syringe exchange policy and procedures. Midtown Police and the Street Narcotics Unit regularly refer individuals arrested for drugs to access services at PHP.
PHP has also gained significant international recognition for its technical assistance expertise. PHP's senior staff have conducted workshops and trainings at several international and national conferences on HIV/AIDS, harm reduction, hepatitis, and drug policy. Since its modest beginnings as a small syringe exchange serving very disenfranchised New Yorkers, Positive Health Project has grown into a multi-service organization with an international reputation for effective service delivery.
For more infomation on our program, please contact Robert Childs, MPH at rchilds@phpnyc.org

bstewart23 said...

What a terrific, informative, heartfelt post. Thanks, Wayne and Eric, for presenting. Rock on.

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