That's the factual part of the 365Gay report.

And as you can see, *part* of the reason for the surge is that more states are now conforming to the CDC's requirements for reporting, and so their new HIV cases are being counted for the first time.

And some of those states are very big -- California and Illinois for example.

At the same time, a number of states with large "men who have sex with men" (MSM) and African American populations -- which is where the epidemic is concentrated in the US -- are still being left out -- including Massachusetts and Maryland.

My guess is that if you factor in those states, the new number of cases in America alone will be about 60,000 per year.

But wait!

There's more!

Because various studies tell us that somewhere between one-quarter and one-third of all those infected don't know they're infected -- so they don't get counted.

Unless and until they're tested.

If you add those folks in, the actual per annum figure for new HIV infections in the US is around 80,000 per year.

Does that matter?

Oh yeah!

A lot.

First of all, and just from a public policy standpoint, all those people are going to have to be treated -- for years and years and years and years and years.

And those treatments are expensive.

One recent study out of Cornell University estimated that it costs $618,900 per person -- that's $2,100 per month -- to keep an infected American alive for 24 years.

And that's not factoring in the various associated diseases, like anal cancer and heart disease and hep C, which so often accompany HIV infection.

So: $2,100 per month -- is the minimum.

$2,100 per month.

Do we -- that is, the Man2Man Alliance -- ever take in $2,100 per month in donations?

No.

Never.

Never even close.

Yet for the cost of keeping just one HIV-infected person alive for one month -- we could reach thousands and then tens of thousands and eventually millions of Men.

Who would learn that there's a way for them to be affectionate, intimate, loving, and sexual with other men -- that's very hot and that doesn't expose them to HIV.

We could reach all those guys -- one of whom might be YOUR guy --

except that we can't because you won't donate.

Oops.

I guess you just lost Prince Charming to analism and HIV.

Prince Charming is caught in the thorny thickets of analism

Without your help --

He'll stay there forever:

But at least your checkbook will still be intact.

I know that's really important to you.

Maybe this summer you can take your checkbook to the beach.

You know, get a little sun together, go swimming, that sort of thing.

Lotsa fun.

Be that as it may -- the cost of keeping alive all those folks whom you can't be bothered to even try to help -- the cost of keeping them alive -- is enormous and will continue to grow.

But hey -- if you're not concerned about cost, here's the other concern:

About half of the newly infected are MSM -- gay-identified males and other men who have sex with men.

What that means for you, dear reader, if you too are a guy who has sex with guys, is that over time, more and more and more of your pool of potential sexual partners is -- INFECTED WITH HIV --

and often other diseases like hep C and syphilis and chlamydia and LGV etc.

So -- you're dealing with -- or, more properly speaking, trolling for sexual partners in -- a community which is, as I often say, riddled with disease.

How are those sexually-transmitted infections -- STIs -- getting into that community?

The answer is easy -- via ANAL PENETRATION.

As we've discussed over and over again, and as you can find neatly summarized here, study after study has shown that the primary and almost only risk behavior among MSM for HIV infection -- is anal penetration.

There's some risk from oral, but it's way low -- somewhere between 10 and 1%.

The rest of the infections -- somewhere between 90 and 99% -- are due to anal.

Not that oral doesn't put you at HUGE risk for other STI like syph and gonorrhea and chlamydia.

But among MSM, HIV is primarily and overwhelmingly transmitted through anal.

And new studies appear regularly confirming that.

Here for example is a PLOS Journal article with the tongue-twisting title of Episodic Sexual Transmission of HIV Revealed by Molecular Phylodynamics

What it's about is how HIV is spreading among MSM in London in clusters or bursts.

I'm not quite sure why that's news, since we've known since 1981 that "AIDS" -- HIV hadn't yet been discovered -- was spreading in tight-knit "party groups."

Nevertheless, researchers need work, and articles do get published, and here's an excerpt from the PLOS article regarding the always-present anal aspect of MSM HIV transmission:

...

New HIV diagnoses among MSM have risen steadily in the United Kingdom for almost 10 years, and are now approaching twice the number recorded annually in the mid to late 1990s [32]. Efforts to characterize the changes in this population that have been responsible, including the National Survey of Sexual Attitudes and Lifestyles (NATSAL; [33]), have provided substantial amounts of information on current risk behaviour of this population. Unprotected anal intercourse with one or more partners in the past year was reported by between 32% and 45% of MSM [34] recruited in different surveys; approximately 18% of respondents in another study reported unprotected anal intercourse with individuals of unknown HIV status [35], and 3.2% of respondents reported unprotected anal intercourse with five or more partners in the previous year [34]. There was also a notable and significant increase in prevalence of risk activities between the 1990 and 2000 NATSAL surveys [36].

So -- the culprit, as it always is in these studies, is "anal intercourse."

Now: you'll notice that the PLOS Journal article refers to "unprotected" anal penetration.

That means anal sans condom = barebacking.

BUT: In 2005, Buchbinder et al found that there was NO significant difference in infection rates between those who used condoms and those who didn't.

Why not?

Because, when we're talking condoms, as we often have here, we're talking breakage + slippage + inconsistent use + incorrect use + disinhibition + THE EFFICIENCY OF ANAL =

Ta Da! -- HIV infection.

So again, when you add it all up, you get the plain truth -- that condoms, as an MSM prevention strategy, are a rank failure.

And that's well-known, and was recently confirmed in a 2007 study which I reported on in the second Ledger message thread:

Goodreau, SM and Golden, MR. Biological and demographic causes of high HIV and sexually transmitted disease prevalence in men who have sex with men. STI 2007; 83: 458-462

In which the study's authors argued that the efficiency of anal is so high, that even were gay-identified men significantly less promiscuous than straight-identified guys, there would still be an MSM HIV epidemic.

Let's repeat that:

Goodreau and Golden concluded that the efficiency of anal penetration in spreading HIV and other STI is so high, that even were gay-identified men to be significantly less promiscuous than straight-identified guys, there would still be an MSM HIV epidemic.

And epidemics of other STI, like syph.

Which is why we're now looking at so many new American HIV infections each and every year.

Remember that the powers-that-be used to think that there were about 40,000 new infections per year, of which about 50%, or 20,000, were among MSM.

Now we know that the actual figure for MSM is closer to 30,000, and may be as high -- I think it is -- as 40,000.

That's DOUBLE the number of MSM getting infected every year.

And as we've discussed many many times, the logic of HIV infection among MSM is such that over time, ALL THOSE WHOSE BEHAVIOR PUTS THEM AT RISK FOR HIV -- get infected.

Now -- what's been the response of the AIDS Prevention aka Promotion Establishment to these new figures?

As reported by 365Gay, and in a word, predictable:

"New CDC data showing a 48% higher incidence of new HIV/AIDS diagnoses in 2006 compared with 2005 are just the latest piece of bad news about the sexual health of the American people," said Marjorie J. Hill, PhD, Chief Executive Officer of Gay Men's Health Crisis (GMHC).

"While there are seven additional states reporting in 2006, this does not account for the 48% jump in new diagnoses. These devastating numbers reinforce what we have known for quite some time: that HIV prevention is under-funded and hamstrung by ideological restrictions that force us to fight this epidemic with one hand tied behind our back."

In recent months, government data have shown increases in HIV infections among young men who have sex with men and young women in New York City, especially young people of color.

Nationally, HIV is up for MSM and dramatically up among Black MSM. Teen pregnancy rates have also increased for the first time since the early 1990s. Earlier this month, the CDC reported that one quarter of teenage females have a sexually transmitted infection, with nearly half of Black teenage females in the study infected.

Michael Weinstein, President of AIDS Healthcare Foundation, called the new statistics a "catastrophe".

"There is no other word to describe these CDC numbers which underscore the wholesale failure of US HIV prevention efforts." Weinstein said.

"We now face $36 billion in costs associated with lifetime care and treatment of all these infected individuals," said Whitney Engeran, III, Director, Public Health Division, and AIDS Healthcare Foundation.

HIV/AIDS groups have fought for increased prevention funding at CDC.

GMHC said that under the Bush-Cheney administration, funding for prevention at CDC has dropped 19 percent in real dollar terms.

So: according to the AIDS establishment, not enough MONEY is being SPENT to PROMOTE -- CONDOMS.

That's why there's been an increase -- they claim.

But as I discussed in dubya dun it, MSM infection rates have risen in other Western countries -- countries with what are, from an American point of view, left-of-center governments which consistently promote condoms and which would never dream of uttering the word "abstinence."

And, fact is, Goodreau and Golden just explained that even with the best condom campaigns in the world, MSM incidence -- that is, the rate of new infections -- which is unacceptably high -- will continue to either hold steady or climb;

which means that MSM HIV prevalence -- the total number of infections -- will go up also.

No way around that.

The AIDS Establishment has its ass in a sling, as it were, because the Bush admin pushed abstinence.

Is abstinence a bad strategy?

Well, if all you have to choose between is abstinence and anal -- abstinence is actually a good strategy and a reasonable choice.

As we discuss in Why Be Faithful, abstinence is a choice often made by guys into Frot who are faced with an implacably analist culture.

A culture which preaches 24/7 that if it ain't anal, it ain't gay, and follows up that heartwarming message with this cheerful advice:

Get on your knees bitch and have some fun!

Fun.

Like I said, faced with the sort of choices analism offers, many guys do quite sensibly choose to opt out aka abstain.

But the fact is that MSM don't have to be abstinent if they want to avoid HIV.

All they really have to do is avoid anal -- because avoiding anal is minimally 90% effective -- far more effective than any potential vaccine.

And if those MSM have the good sense to choose Frot -- they'll be replacing a dangerous, dirty, degrading, effeminized, and heterosexualized act -- anal penetration -- with a truly sexual act which is healthy, ennobling, and super pleasurable because it's directly and mutually genital.

So: MSM don't have to stop having sex -- they just have to stop doing anal.

Because what's driving the MSM HIV epidemic isn't a lack of condom campaigns -- or affordable housing, as one particularly whacked-out group of "AIDS activists" claimed --

nor is what's driving the MSM HIV epidemic an abundance of depression, or drug abuse, or homophobia, or stigma, or any of the other usual suspects.

What's driving the MSM HIV epidemic is anal.

It's the anal.

Among MSM, the risk behavior for HIV infection is anal penetration.

And nothing else matters.

So, the first thing we've learned in this month's AIDS Funnies is that new cases of HIV infection in America have surged by at least 48% -- and they have nowhere to go -- but up.

Up and up and up.

By the way, and speaking of affordable housing, we heard via Cornell that taking care of all those infected will be very expensive -- $618,900 over 24 years.

What happens when we prevent HIV infection?

Cornell:

the treatment expense that can be avoided by preventing each HIV infection is $303,100

Seems to me, of course, that you'd actually save the whole $618,900.

But who, at this moment, cares?

The point is that you could build a lot of new housing with that $303,000 multiplied by 50 or 60,000.

Or prevent a lot of malaria.

Or feed a lot of hungry kids.

Prevention is a no-brainer.

Or is it?

Not, as we'll see, to some very powerful people.

Next in AIDS Funnies:

What can those 53,000+ who are newly infected with HIV expect to experience?

Well, we're often told that HIV infection in the Western world is now a "manageable" condition.

It's managed through the use of "anti-retroviral therapies," and just this week we learned that one of those therapies -- though certainly not the first -- has a nasty side-effect:

It doubles your risk of heart attack:

Study: Widely Used AIDS Drug Increases Heart Attack Risk

by The Associated Press

Posted: April 2, 2008 - 11:00 am ET

(London) A commonly used AIDS drug appears to nearly double the risk of a heart attack, researchers say. In a study published online by the medical journal Lancet, the researchers also said another less frequently used AIDS drug increased the chances of a heart attack by 50 percent. Experts said doctors should be aware of the increased risks, but they did not recommend that patients abandon the two drugs, Ziagen and Videx.

AIDS drugs "are wonderful and lifesaving, but they do have toxicity problems," said Dr. Charlie Gilks, an AIDS treatment expert at the World Health Organization. "It may be that we can continue to use them, but we need to be aware of their long-term problems."

...

How about those long-term problems?

In another article, which I also talked about in the second Ledger thread, the NY Times reported that the outlook for long-term survivors of HIV / AIDS -- isn't good:

AIDS Patients Face Downside of Living Longer

By JANE GROSS

Published: January 6, 2008

CHICAGO - John Holloway received a diagnosis of AIDS nearly two decades ago, when the disease was a speedy death sentence and treatment a distant dream.

Yet at 59 he is alive, thanks to a cocktail of drugs that changed the course of an epidemic. But with longevity has come a host of unexpected medical conditions, which challenge the prevailing view of AIDS as a manageable, chronic disease.

Mr. Holloway, who lives in a housing complex designed for the frail elderly, suffers from complex health problems usually associated with advanced age: chronic obstructive pulmonary disease, diabetes, kidney failure, a bleeding ulcer, severe depression, rectal cancer and the lingering effects of a broken hip.

Those illnesses, more severe than his 84-year-old father's, are not what Mr. Holloway expected when lifesaving antiretroviral drugs became the standard of care in the mid-1990s.

The drugs gave Mr. Holloway back his future.

But at what cost?

That is the question, heretical to some, that is now being voiced by scientists, doctors and patients encountering a constellation of ailments showing up prematurely or in disproportionate numbers among the first wave of AIDS survivors to reach late middle age.

...

"At what cost?"

If you read the article, you'll note the very high incidence of anal cancer among these guys.

That's not surprising, since the Chin-Hong studies of 2004 - 5 told us that 95% of HIV+ gay men were infected with HPV, the pathogen which causes anal cancer, and fully 50% of those men already had the precursors to that cancer.

Oops.

Maybe encouraging buttfuck isn't such a brilliant idea.

Problem: the gay leadership is determined to push buttfuck -- no matter how many gay lives are destroyed by it.

Use a condom, every time, every time, they say -- and that'll fix it.

What's the alternative?

Well, in the view of the AIDS Establishment, the ultimate alternative is -- a vaccine.

Which has often been described as the "holy grail" of HIV / AIDS research.

But, once again, that goal took it on the chin, and hard, just a few weeks back -- which is part three of our AIDS Funnies:

Vaccine Failure Is Setback in AIDS Fight

Test Subjects May Have Been Put at Extra Risk Of Contracting HIV

By David Brown

Washington Post Staff Writer

Friday, March 21, 2008; Page A01

The two-decade search for an AIDS vaccine is in crisis after two field tests of the most promising contender not only did not protect people from the virus but may actually have put them at increased risk of becoming infected.

The results of the trials, which enrolled volunteers on four continents, have spurred intense scientific inquiry and unprecedented soul-searching as researchers try to make sense of what happened and assess whether they should have seen it coming.

Both field tests were halted last September, and seven other trials of similarly designed AIDS vaccines have either been stopped or put off indefinitely. Some may be modified and others canceled outright.

Numerous experts are questioning both the scientific premises and the overall strategy of the nearly $500 million in AIDS vaccine research funded annually by the U.S. government.

"This is on the same level of catastrophe as the Challenger disaster" that destroyed a NASA space shuttle, said Robert Gallo, co-discoverer of the human immunodeficiency virus (HIV), which causes AIDS, and head of the Institute for Human Virology in Baltimore.

...

The working hypothesis for what went wrong is that the vaccine somehow primed the immune system to be more susceptible to HIV infection -- a scenario neither foreseen nor suggested by previous studies.

So:

What we've got is an "AIDS vaccine" -- which makes its victims MORE susceptible to HIV infection.

Oops.

Maybe ignoring behavior change all these years -- wasn't such a good idea.

The New York Times doesn't agree.

In the culminating episode of this month's AIDS Funnies, the Times ran an editorial about the failure of the AIDS vaccine trials, in which it inveighed AGAINST prevention:

Editorial
Grim Outlook for an AIDS Vaccine

Published: March 30, 2008

Back in 1984, federal health officials, flush with excitement over discovery of the virus that causes AIDS, famously predicted that they would have a vaccine ready for market within three years. Now, after almost a quarter-century of toil and struggle, the effort has crashed in failure. No one yet knows whether a vaccine to prevent the disease will ever be possible.

David Baltimore, a Nobel-winning biologist, sounded a note of despair in an address to the American Association for the Advancement of Science in February. He noted that the virus has evolved in a way that makes it virtually impossible to attack by priming the immune system, the usual goal of a vaccine. Repeated efforts have failed, he said, leaving "no hopeful route to success." The best hope, he said, may lie in the biological equivalent of a "Hail Mary" pass - a wholly new approach that would combine gene therapy, stem cells and immunologic therapy to thwart the disease.

At a conference at the National Institutes of Health last Tuesday, AIDS experts assessed how to proceed after the failure of the most promising vaccine candidate in two large clinical trials last year. Early results showed that those who received the vaccine may actually have been more likely to become infected with the virus than those who did not.

At least one organization that treats AIDS patients has called for giving up on a vaccine and shifting the money to testing, treatment and prevention. That is too defeatist.

...

So: The New York Times, the country's leading paper of record, claims that concentrating on "testing, treatment and prevention ... is too defeatist."

Prevention, says the Times, is defeatist.

Can you believe that?

Here's the TRUTH about HIV infection -- and its prevention.

HIV is EASILY avoided.

Unlike airborne diseases like the flu in America, or waterborne diseases like parasites in Africa, it's easy to avoid HIV.

Avoiding it requires only some elementary behavior change.

And when we look HISTORICALLY, what we see is that the behavior change required is, in most instances, change which historically and cross-culturally, the affected populations actually engaged in --

on their own.

Without any prompting from AIDS officials or officious "news" papers like the Times.

Let's start with Africa and heterosex first.

As UNAIDS finally admitted late in 2006, Male Circumcision aka MC is highly protective against HIV -- for the insertive partner.

The level of protection -- at least 60% and probably higher -- is what you could expect to get with a vaccine.

Indeed, a vaccine which conferred 60% protection against HIV would be considered a miracle in AIDS research.

Yet, when it comes to the insertive partner in vaginal or anal, we have that vaccine right now and today.

It's called Male Circumcision, and the FACT is that it was once WIDELY PRACTICED throughout southern Africa, the part of the world most negatively impacted by HIV, in what were known as Manhood Rituals.

These Manhood Rituals, which usually took place in adolescence, involved the circumcision of teenaged boys, and a celebration of male sexuality.

Because nineteenth-century American and European Christian missionaries were opposed both to male sexuality, and to circumcision, which was seen as a "Jewish rite," those missionaries closed those rituals down.

And about a hundred years later, 25 million Africans died of AIDS.

Thank you Christian Missionaries.

Nevertheless, the good news here, which the Times chooses not to mention, is that MC works and that it's part of the historical heritage of the peoples, and specifically MEN, of southern Africa.

What's the other piece to the African puzzle?

Fidelity.

The Ugandans demonstrated years ago that if folks are faithful, HIV incidence and prevalence drops dramatically.

Which is why Uganda has had, for years, the lowest rates of HIV / AIDS in Christian / Animist Africa.

So: a combination of male circumcision -- MC -- with Fidelity would eradicate new HIV infections in Africa -- and in other places in the world where the disease is spread heterosexually.

That's the truth.

But as one prominent MC researcher said to me, It's the truth, but there's NO MONEY in it.

There's a LOT of money in a vaccine.

The Post:

In this fiscal year, the NIH's budget for AIDS vaccine research is $497 million. The STEP and Phambili trials were each expected to cost about $32 million. Pharmaceutical giant Merck & Co. has spent an undisclosed amount developing the vaccine and helping to manage the studies.

Right.

Merck is doing that because it would make MONEY off the vaccine once it was approved.

A lot of money.

MC, by contrast, is cheap and requires NO FURTHER RESEARCH.

While FIDELITY is as FREE as the breeze.

There's no money to be made off of Fidelity.

What about IV drug-users?

In many places today, particulary in the former Soviet bloc, they seem to make up a huge number of the new cases.

Well, needle-exchange programs, which again, are very cheap, work very well.

Even better, of course, are 12-step and other programs which free those folks from their addictions.

Because there are many diseases and other problems associated with drug use.

So needle-exchange works, but better still is freeing people of their addictions.

And again, compared to developing a vaccine, needle exchange and peer-support programs like AA and NA -- are extremely cheap -- and available NOW -- TODAY.

Now, what about our piece of the puzzle, MSM, aka guys who have sex with guys?

Here, the news couldn't be better.

Not only is there a simple behavior change, but guys can keep the S in MSM.

Translation: guys don't have to stop having sex.

They just have to STOP DOING ANAL.

As Goodreau and many others have demonstrated, if they don't stop doing anal -- they'll never stop HIV.

But -- if they stop doing anal -- they stop HIV.

I know -- it's kind of mind-numbingly simple, isn't it?

Which may be why, after eight years of talking about it, my little mind is beginning to feel numb.

Nevertheless, it's the TRUTH.

And that's what my work, and this site, and our Alliance -- is about.

The TRUTH.

So: absent a vaccine, prevention in the case of HIV requires behavior change.

Modest behavior change.

If the behavior change in question were more frequent hand-washing or the boiling of drinking water, the Times would be all for it.

But because the behavior change is sexual, the Times fears it.

It fears that, somehow, the behavior change will interfere with its idea of human freedom.

Truth is, though, that the only freedom the affected populations have today -- is the freedom to die.

Let's be clear:

Even with anti-retroviral drugs, HIV / AIDS is a serious and dangerous condition.

Indeed, the drugs themselves, as we saw, are part of the danger.

HIV -- serious and dangerous.

If we have the means to prevent HIV infection -- we should be using those means.

To do what the Times is doing -- which is, essentially, demanding one sort of vaccine when another will do just as well or even better --

is profoundly immoral.

Let's repeat that:

To do what the Times is doing -- which is, essentially, demanding one sort of vaccine which doesn't exist; when another -- which is with us RIGHT NOW -- will do just as well or even better --

is profoundly immoral.

So though I called this post -- AIDS Funnies --

there's nothing truly funny about what's going on.

People are getting sick and dying -- including here in the US --

of an entirely -- ENTIRELY -- preventable disease.

While cultural warriors -- analists, the Times, the religious right -- get in the way of telling people the simple TRUTHS which would keep them COMPLETELY free of this disease.

On this site and in this Alliance, we offer one set of those TRUTHS --

Truths aimed at "MSM" -- guys who acknowledge, at least on some level, their COMPLETELY NATURAL AND NORMAL male need to love and have sex with other guys.

We offer those guys Truth --

and Freedom.

The Freedom to Live --

and LOVE -- as Men.

In a way, as Frances said, which is natural and organic.

And we speak of Fidelity as well -- which the historical record tells us is the way Men have traditionally Loved other Men.

Faithfully.

What about MC?

MC has been tested and proven in Africa in a "heterosexual" context.

I suspect that in our modern world, in which pathogens can and do travel at jet speed, MC is a good idea for all Men.

And without question for those men who aren't going to be 100% monogamous.

In Africa, all that men are being asked to give up is a little bit of foreskin.

Doing that increases their life expectancy by about 50 years -- half a century.

And it brings them back in line with the historic realities of southern Africa.

It's a shame that the Manhood Rituals themselves can't be revived.

But maybe some enterprising shaman or witch-doctor in Africa will revive them.

Nelson Mandela was circumcised in just such a ritual when he was a boy.

So there must be other Men still alive in Africa who know those rituals.

I said that Frances talked of a way of life which is natural and organic.

Frances also spoke of "something of worth, something of eternal value."

That's what those Manhood Rituals were about.

Teaching boys -- who were about to become Men -- that their sexuality was something of Worth -- something of Eternal Value.

We as Men need to re-capture and re-create the life-giving Warrior rituals -- and Warrior roles -- of our past.

If we do, we'll have a brilliant and happy future.

Living in Worth -- in Warriordom.

And finding Freedom -- and Eternal Value -- in our Warriorhood.

Bill Weintraub

April 9, 2008

© All material Copyright 2008 by Bill Weintraub. All rights reserved.