January 19, 2008
Rethinking spending on AIDS
Posted by: Citizen Crain
The Associated Press has an incredibly one-sided report out quoting public health experts who question whether too much money is being spent on HIV/AIDS globally in proportion with basic health problems like sanitation, malnutrition and clean water that are responsible for more deaths annually:
"We have a system in public health where the loudest voice gets the most money," said Dr. Richard Horton, editor of Lancet. "AIDS has grossly distorted our limited budget."
This is the same old saw we've heard for years, of course, although in the past its proponents were anti-gay conservatives whose compassion is limited to one sexual orientation. Now the doctors and researchers who have benefited from billions (spent far too late in the epidemic) are lobbying for more funds to deal with other health problems. No issue there but it's wrong to take from Peter to give to Paul.
Unlike these other basic health problems, HIV/AIDS is an incurable epidemic already responsible for killing millions and infecting tens of millions more. The nature of the virus and the cost of adequate treatment mean it poses a health threat out of proportion to the number of its victims.
Surely the AP could have found someone to make that case.
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December 28, 2007
Ghost of Clinton past and future
Posted by: Citizen Crain
There's a valuable lesson to be learned in the welcome news today that President Bush signed a bill that allows the District of Columbia to use its own money to fund needle exchange programs in the fight against HIV/AIDS. Besides the obvious -- that it takes Washington about as long as the Vatican to accept inconvenient scientific facts -- there is also a glimpse of what we can expect if Hillary Clinton manages to become the next president.
Ben Smith at Politico.com noted a month ago that Hillary's campaign proposal for HIV/AIDS policy included federal funding for needle exchange, a policy reversal for her and her husband:
The changed position is worth pausing over because needle exchange was the subject of one of the campaign's most illuminating moments, during a New York City event at which an AIDS activist, Charlie King, pressed Clinton on her husband's rejection of recommendations that the federal government back needle exchange programs. I wrote about the exchange, which was caught on video, in July.
"Well, because we knew we couldn't maintain it politically," Clinton said, and went on to discuss the trade-offs in that dispute with Congress. "I wish life and politics were easier," she said.
King then referred back to Clinton's opening remarks. "You made a great comment earlier about how our next president needs to have some spine," he said.
"We’ll have as much spine as we possibly can, under the circumstances," Clinton responded.
That's classic Hillary: "We'll have as much spine as we possibly can, under the circumstances." It's actually classic Clinton, applying to either Bill or Hillary. And it's exactly why her husband was such a dramatic disappointment on gay issues -- and needle exchange -- as president. Bill Clinton had the opportunity in 1998 to approve federal funding for needle exchange, but instead accepted the recommendation against funding from his conservative Drug Czar, Barry Cafferty.
Four years later, attending an AIDS conference as the former president, Bill Clinton said he regretted how he handled needle exchange, but notice how closely the language -- and the thinking -- tracks that of his wife:
Asked about what he had done to fight AIDS as president, Clinton said: "Do I wish I could have done more? Yes, but I do not know that I could have done it."
In particular, he cited his stance on needle-exchange programs, saying, "I think I was wrong about that; I should have tried harder to do that."
He was referring to his administration's refusal in 1998, after a bitter internal debate, to lift a longstanding ban on federal financing for programs to distribute clean needles to drug addicts, even as top government scientists said such programs did not encourage druge abuse and could save lives. At the time, Clinton's advisers said they feared a political disaster for him if he lifted the ban.
Even acknowledging his error, Bill Clinton was saying the same as Hillary did, that he showed "as much spine as he possibly could, under the circumstances." The real issue -- with him then as with her today -- is whether a Clinton president will risk political capital and show leadership on important social issues.
Witness Bill Clinton on gay issues: He caved on "Don't Ask, Don't Tell" and never lifted a finger on the Defense of Marriage Act -- except to sign it into law. The same "under the circumstances" spinelessness caused him to cave on needle exchange, as the late Bob Hattoy, an openly gay and HIV-positive official in Clinton's Interior Department, said back in 1998 in an interview with Southern Voice:
"This is worse than 'Don't Ask, Don't Tell' because instead of just ruining lives, it can actually kill people. The president was either ill-advised or he decided certain Americans with HIV can just die. This is a very sad day for a president who wanted to have any kind of moral authority."
Expect more of the same from Hillary Clinton; she even signals as much. Some five years after her husband acknowledged that he erred in not fighting for needle exchange funding, Hillary was still too cautious and calculating to acknowledge as much.
Now that she's finally come around on needle exchange, no doubt because primary opponents Barack Obama and John Edwards favor federal funding, the whole timeline shows what Ben Smith called her philosophy of governing: "You can call [it] pragmatism and readiness; or too much caution, too little vision. Certainly, Hillary seems to lack Obama's confidence in the ability of a President to shape public opinion, and to lead against it."
On gay rights, that means Hillary would sign the easy stuff -- hate crimes and employment non-discrimination, and maybe even a repeal of "Don't Ask, Don't Tell" -- but don't except anything else from a Clinton II presidency -- whether one or two terms -- unless absolutely no leadership or political risk is required.
*Billary pic courtesy of the clever folks at FreakingNews.com.
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November 30, 2007
Answering HIV's rising gay threat
Posted by: Citizen Crain
I posted earlier this week about a convincing trove of data showing that HIV is again spreading in larger numbers among gay and bisexual men, in the U.S. and abroad. The question remains what we -- the government, HIV/AIDS group and we gay and bi men -- are going to do about it.
Since tomorrow is World AIDS Day, there's no better time to make a few informed suggestions.
One thing is clear: The old ideas of the past, simply handing out condoms and such, are no longer working. It’s time for new ideas and new energy. If anything, the data on rising HIV infections is an indictment of the way most agencies have tackled prevention among gay and bisexual men.
For one thing, it’s long past time to trust gay and bisexual men with real information about the risk of exposure associated with particular sexual behavior. It’s criminal that more than a quarter-century into this epidemic, public health officials still keep secret the data they have on the relative risk associated with giving or receiving oral and anal sex, with and without condoms.
Armed with the better information, people will act more responsibly than they are today under the "use a condom every time" reminder. That's not to say that condoms should be abandoned. Agencies should rediscover effective marketing techniques to remind gay and bi men where they meet -- bars, clubs and online chat rooms -- to wrap it up. The TV ad I posted about a couple of days ago, produced by the government of Brazil, is an example of the kind of frankness that gets noticed.
But it’s not just about condoms. Gay men are already way out ahead of prevention efforts, adopting their own techniques like “sero-sorting” – that is, poz men having sex with only other poz men – to limit if not eliminate their exposure. We need to know what works and what doesn’t.
One thing we know works is getting tested, since men who know they're positive take meds, which makes them less contagious, and are less likely to engage in risky sexual behavior.
The JAMA report also makes one policy argument that is long overdue. The authors called for “legal domestic partnerships as a way to promote stable, longer term [gay male] relationships.” The most effective curb against gay male sexual promiscuity is to encourage committed relationships, and legal recognition is an important way of doing that.
Another is for public and private HIV agencies to help promote the alternative of dating and relationships over promiscuity; not in a preachy way, but by reminding us all how sex with love beats just plain sex any day. The Brazilian TV ad, in which parents counsel their son to take a condom on a date with his boyfriend, is another subtle example of that.
I would go one step further, and develop marketing campaigns that remind us all that good old-fashioned dating, going steady and relationships have a lot to recommend them, especially with rising HIV statistics. Most of the gay men I know who survived the worst of the AIDS slaughter in the 1980s and 90s did so because they were in relationships. There's nothing wrong -- and a lot right even beyond the safe sex context -- to remembering that lesson.
For complete news coverage, click or bookmark: www.gaynewswatch.com/hivaids
November 29, 2007
A refreshing HIV prevention message
Posted by: Citizen Crain
In recognition of World AIDS Day, the Brazilian government has produced a series of safe-sex advertisements that are running on television. There's even one with a refreshingly positive message for young gay men.
Son: I'm heading out...
Dad: Be careful.
Mom: Don't forget to take a condom.
Dad: Son, take it just in case. You never know if your boyfriend is going to have one or not.
Son: Thanks Dad, thanks Mom.
Negra Li: You don't expect all parents to be like this, right? Wearing
a condom should be your attitude, and it is important in the fight
against AIDS.
The spokesperson at the end of the spot is singer Negra Li. If only our government would invest in messages like this, or our TV networks would even air World AIDS Day messages like this in primetime. So much for our leadership role in the global fight against AIDS.
The translation and hat tip go to Made in Brazil.
November 28, 2007
HIV is again on the rise
Posted by: Citizen Crain
Just in time for Dec. 1, World AIDS Day, there is bad news about rising HIV infection rates among gay and bisexual men, in the United States and beyond. Don’t turn the page just yet. This isn’t yet another alert about yet more “alarming” HIV rates or a dire warning about a “second wave” of infections.
They may not have come up with a vaccine to make us immune from HIV, but we’re almost completely immune to these repeated cries of AIDS “wolf.” Too many cogs in the AIDS, Inc. machine – from pharmaceutical companies, HIV organizations and politicians hording government AIDS dollars – have a self-interest in promoting “alarming” data on the epidemic. So we tune them out almost instinctively.
This time, however, is different. It’s not one study; it’s many, and they all show an undeniable increase in HIV infections among men who have sex with men:
- The rate of new infections among gay men under 30 in New York City rose 33 percent from 2001 to 2006.
- As many as 1 in 22 gay and bi men in Florida is infected, with rates reaching 1 in 11 gay white men in Fort Lauderdale, 1 in 13 gay black men in Palm Beach and 1 in 12 gay Latinos in Miami-Dade.
- New infections among gay and bi men in the U.K. are at record levels, with an estimated 1 in 20 infected nationwide and 1 in 10 in London.
- In Australia, HIV infection rates have risen by a third in the last decade, with 88 percent of transmissions occurring through gay sex.
Then came the big one: a report this week in the Journal of the American Medical Association showing that overall, the number of gay and bisexual men in the U.S. with HIV or AIDS has risen 13 percent in just the last four years.
The authors of the JAMA report put a lot of the blame for that increase on the fact that most of us don’t know our HIV status. One study cited in the report found some 77 percent of the gay and bi men infected with HIV were unaware they were positive; 91 percent of black gay and bi men did not know they were infected.
The report also pointed to another cause that anyone who’s sexually active already knows intuitively: Sex without condoms has become more and more common, especially among young gay guys, as rebounding rates of syphilis among gay and bi men also testify.
The reasons are also no mystery. Most sexually active gay and bisexual men weren’t around for the darkest days of the AIDS epidemic, never cared for dying lovers and friends and didn’t attend funeral after funeral for men cut down before they turned 30.
The drug cocktail has transformed AIDS into a treatable, if not curable, disease, and the conservative political climate has diverted too much funding into abstinence at the expense of safe sex prevention efforts.
The rising infection rates will undoubtedly result in calls for additional funding for HIV/AIDS prevention, and no doubt those additional dollars are needed. But the grab for cash ought to be coupled with a hard look at whether we’re throwing good money after bad.
I'll offer a few of my own prevention ideas tomorrow.
For complete news coverage, click or bookmark: www.gaynewswatch.com/hivaids
December 17, 2006
The Obama boomlet goes thud?
Posted by: Citizen Crain
Watching politicians when you feel like your civil rights depend on it can feel like an exercise in courting frustration. Just like the lonely single always expecting happiness from the next date, the would-be courtier almost inevitably disappoints. But since the "prize" is so important, you keep your eyes on it, and the next suitor in waiting. Along the way, you try to walk the line between hopeful skeptic and jaded and bitter.
That's how I felt reading all the positive press about Barack Obama's triumphant appearance in the belly of the beast, winning a standing ovation from the conservative congregation at Saddleback Church in Orange County, Calif., home to anti-gay, pro-life evangelist Rick "Purpose-Driven Life" Warren. "Pastor Rick" cheerfully withshood a mini-rebellion from other conservatives for even inviting pro-gay, pro-choice Obama to speak at a special World AIDS Day service.
Obama delivered with an address that interwove the Illinois senator's religious conviction in a natural way that the John Kerrys and Howard Deans — much less the Hillary Clintons — can only dream of. Liberal pundits cheered and the Obama "boomlet" sounded again. So why did I hear a bit of a thud?
In many ways, Obama's address at Saddleback hit all the right notes, expanding the idea of religious activism beyond legislating conservative theological positions, Taliban-style. His stories about AIDS in Africa were poignant and his call to action effective. But below the surface… we Chandler-Seinfelds of the gay political world saw signs that Obama might be another Bill in Clinton's clothing — the man from a place called Hope, who promised we didn't have a person to waste, whose view of America included us, and who went on to sign the two worst pieces of anti-gay legislation in U.S. history: Don't Ask, Don't Tell and the Defense of Marriage Act.
Many of those signals in Obama's address were in the tone, especially in how every time he referred to sex in relation to AIDS, whether in Africa or in the U.S., he referred to the relationship between "men and women":
- For some, the only way to prevent the disease is for men and women to change their sexual behavior…
- I don't think we can deny that there is a moral and spiritual component to prevention — that in too many places all over the world where AIDS is prevalent — including our own country, by the way - the relationship between men and women, between sexuality and spirituality, has broken down, and needs to be repaired.
- [In Africa], I heard stories of men and women contracting HIV because sex was no longer part of a sacred covenant.
- I also believe that we cannot ignore that abstinence and fidelity may too often be the ideal and not the reality — that we are dealing with flesh and blood men and women and not abstractions.
It wasn't that Obama was off the mark in the substance of what he was saying in any of those snippets, or generally, and he was speaking about AIDS in Africa on World AIDS Day — both of which generally concern a virus transmitted heterosexually. But like a scorned spinster trying to stay hopeful on a date going south, I found myself bracing a bit more each time, waiting for the other shoe to drop. And then, with a thud, it it did:
Like no other illness, AIDS tests our ability to put ourselves in someone else's shoes — to empathize with the plight of our fellow man. While most would agree that the AIDS orphan or the transfusion victim or the wronged wife contracted the disease through no fault of their own, it has too often been easy for some to point to the unfaithful husband or the promiscuous youth or the gay man and say "This is your fault. You have sinned." I don't think that's a satisfactory response. My faith reminds me that we all are sinners.
Ouch. There we are, down there in the muck with the unfaithful husband and the promiscuous youth. And our man Obama is there for us, reminding everyone that they sin as well. Of course, they generally don't organize a civil rights movement asking for legal recognition of their sins, or hold annual festivals to celebrate their pride in being sinners.
Sp what to do with Obama, who has a strong gay rights record, if not one that shows much leadership, though like almost all serious possible Democratic contenders for the White House in '08, he opposes gay marriage? We keep an eye on him, and on the prize, and hope he doesn't follow Dean and other Dems in some quixotic quest to woo the right. For once, we should insist to dance with the ones we help bring.
December 14, 2006
A hetero-only AIDS vaccine?
Posted by: Citizen Crain
Two clinical trials have been halted midstream after it became clear that circumcision reduced by at least half a man's risk of contracting the AIDS virus, at least in heterosexual sex. Officials with the U.S. National Institutes of Health stopped the trials, in Kenya and Uganda, after learning that more than twice the number of uncircumcised men had contracted HIV than in a similar sized circumscribed group. The New York Times reports:
Uncircumcised men are thought to be more susceptible because the underside of the foreskin is rich in Langerhans cells, sentinel cells of the immune system, which attach easily to the human immunodeficiency virus, which causes AIDS. The foreskin also often suffers small tears during intercourse.
The protection offered by circumcision in anal sex is murkier. Anthony Fauci, the famous AIDS researcher and director of the NIH's National Institute of Allergy & Infectious Diseases, told the Times that circumcision "does nothing to prevent spread by anal sex." But a Q&A fact sheet provided by Fauci's agency indicates, "The degree of protection that circumcision may afford for men who have sex with men is unknown." Still, even if circumcision helps protect the active partner (the "top") in homosexual anal sex, the effect will be at the margins, at least in the U.S., where 77 percent of men are already circumcised.
The new NIH study confirms findings from an earlier South African study that concluded circumcised men were 65 percent less likely to contract HIV from vaginal sex than those whose penises are uncut. Francois Venter, a South African AIDS expert at the University of Witwatersrand, made headlines in September 2005 by comparing the effectiveness of circumcision to that of a vaccine.
"We dream of a vaccine which has this efficacy," Venter said then. Indeed, most "AIDS vaccines" that have been approved for any level of clinical trial never even claim to achieve protection in as many as 65 percent of those "vaccinated." Still, Venter's use of the vaccine comparison was roundly criticized for suggesting circumcision provided complete protection. That's a dangerous suggestion, especially considering that it only improves protection odds for men, not women, although women would be indirectly benefited by a decrease in the number of infected men generally.
Played out on a scale of millions, circumcision would no doubt save many lives, especially if the expanded use of microbicides provide anything like the level of protection for women that scientists hope. There are clear scientific reasons why heterosexual, vaginal sex is more easily made safer, since anal sex invariably involves more tissue breakage, both because the anal opening is smaller and the receptive tissue is much more sensitive and thin.
But rest assured that some opportunistic religious leaders will nonetheless leap to moral conclusions about what sex is "natural" or sinful. (Also rest assured, believe it or not, that anti-circumcision groups, often led by gay men, will recklessly try to debunk the new science as encouraging what they call "male genital mutilation.")
It's not difficult to imagine, over the next five to 10 years, that circumcision and microbicides dramatically reduce the risk of HIV infection from heterosexual sex, making anal sex and I.V. drug use again the most prevalent forms of transmission worldwide. We'll see if the AIDS, Inc., industry continues pressing for ways to make homosexual sex just as safe. You can certainly imagine that a grant request with that as a stated goal is much less likely to get government funding.
November 30, 2006
Light up for World AIDS Day
Posted by: Citizen Crain
Tomorrow, December 1, is World AIDS Day, and a good opportunity to remind ourselves that the virus is still out there, still spreading, still incurable and still killing — even here in the U.S. Americans have been inundated in recent years with mostly good news about new HIV treatments, while the bad news about the spreading virus and death tolls are "global AIDS" stories, in faraway places like Africa and Asia.
If the mainstream media — and many gay press outlets — would only pay attention, there are plenty of story threads to cover about HIV/AIDS in the U.S.:
- The stubbornly high rates of infection among African Americans, fueled by homophobia within black culture and the church, that keeps so many gay black men into the closet (call it "the down low" or not), putting at risk themselves and their male sex partners, girlfriends and wives. The media has sensationalized "the D.L." without ever really delving into its roots in the culture and the church — the same types of sources, of course, that keep white gay men in the closet, too.
- The uneven success of HIV meds, which have not cured the disease and, according to recent reserach, only extended the life expectancy — diagnosis to death — from 7 years to 24. And there's no "holiday" from HIV. The first large-scale study on taking "breaks" from HIV meds shows the risk of death doubling, even though the cause of death isn't necessarily AIDS-related. (One caveat: the study, which concludes patients should stay on a daily med regimen their whole lives, was partially funded by pharmaceutical companies.)
- The Bush administration's unconscionable elevation of idelogy over science in pushing "abstinence-only-until-marriage" as a viable HIV prevention strategy. Abstinence has a role to play in prevention, especially among young people who can be encouraged to delay an active sex life. As part of the ABC's— Abstinence, Be Faithful, Condoms — is a proven effective approach. But "abstinence-only-until-marriage" ignores reality and, given opposition to gay marriage, is irrelevant to the lives of young gay men, who remain a very high risk group. It's irresponsibility is second only to the Vatican's morally reprehensible opposition to condom use, even among heterosexual married couples with one spouse who is poz and one who is neg.
- The death of AIDS activism in the U.S. The virus wiped out a generation of gay men and the organizations they started are now largely run by non-profit professionals who no doubt care about the issue but act as if their fiduciary responsibility is to their board of directors and not to those living with the disease or at risk of being infected by it. Only a miniscule percentage of those board members are even HIV-positive. Co-opted by fat checks from the government and a decline in private donations, many HIV/AIDS groups have lost their critical voice like the ones raised above. When is the last time you saw a new, provocative, effective prevention message from an HIV/AIDS group in the U.S.? When was the last time you saw them publicly criticizing the Bush administration's response to the epidemic?
What can you do? We all have a duty to stay informed and make sure our friends, family and those within our zone of influence, stay informed as well. Be careful that your AIDS donations go to groups that still have an effective message and responsible management.
And finally, one small thing you can, is visit LightToUnite.org, an interesting site that allows you to read stories of those impacted by HIV and add your own. And Bristol-Myers, the big pharmaceutical that sponsors the site, will donate $1 for every person who visits. Be sure to add your own story, and make clear if the folks involved are gay. I read three-dozen accounts before coming across the first one that dealt with the issue openly, and it was a woman writing about her boyfriend's "homosexual "brother. Pretty scary in 2006, if that's all the representation we've got, but another of how the virus has mainstreamed.
November 24, 2006
Making family
Posted by: Citizen Crain
I got a few reminders over the holiday yesterday about how we gay men make our own families, whether or not we're in relationships. I spent the day in Washington, thousands of miles from my partner in Brazil. Although Thanksgiving of course has no special meaning for him, he sent me a sweet online card and we talked several times by Internet telephone (we give thanks to Skype!).
During one stretch of afternoon, I drifted off into a daydream, one I've had many times before, of him here with me, maybe smuggled in my suitcase. I know how silly that sounds, but the subconscious takes its own course.
I was reminded of that fantasy later, as I watched the closing scene from "Longtime Companion." I found the film on my TiVo, recorded a year earlier, and had decided to see it (for the first time).
Released in 1990, "Longtime Companion" was one of the first "AIDS movies," and it effectively drew you back to the fear and loss that filled the decade of the 1980s for gay men. At the end, when the original group of seven friends has dwindled to three, they imagine what it would be like if a cure for the virus was discovered, and they could celebrate with all their lost friends. As silly as it sounds, it is a devastating scene. I defy you to watch it without tears.
These men created a family of friends, boyfriends and partners — longtime companions, as the New York Times deigned to refer to them in obituaries — and they stuck by each other as blood families do. Some were still supported by blood relatives, others were turned away, but as the character Willy (Campbell Scott) describes in a memorial service for his friend David (Bruce Davison), their friendship circles were welcoming and unshakeable.
AIDS is still with us, of course, and still kills. I learned this month that Dennis Vercher, the longtime editor of the Dallas Voice, recently passed away from complications from the virus. He was only 53. But even without the trauma of weekly memorial services, there's still evidence of how we make our families. I counted a half-dozen "orphan" dinners for Thanksgiving yesterday, just among the folks I know. These meals are usually hosted by a close set of friends that then widen their net, inviting anyone and everyone unable or not wanting to return home to see family for the holiday.
With so many lost to AIDS and the advent of new drugs, the disease and a united response to it are not so ingrained into the consciousness of those who came out in the last five to 10 years. That's a good thing, of course, because no generation should have to endure such horror, whether from epidemic or war. But these wonderful "orphan meals" on Thanksgiving and Christmas are a welcome reminder of how much we gain from our opening up our circle of friends, our chosen families, to the larger community.
November 17, 2006
HIV's death sentence commuted
Posted by: Citizen Crain
When I came out in 1992, a diagnosis of HIV was a death sentence. In those very dark years, there was no drug "cocktail" and the gay papers will chock full of sometimes dozens of obituaries each week — men in the 30s and 40s, struck down in their prime. At the time, with so many dying and turning positive, I remember imagining that I would probably live another 10 to 15 years before the virus would catch up with me and kill me, too.
Now an American can expect to live on average 24 years from the time he learns he's been infected with HIV, according to new research. That's a dramatic increase from 7-10 years from diagnosis to death in the '90s. The new drugs have a new pricetag, of course, as the average cost of care has skyrocketed to $25,200 per year, or more than $600,000 over a lifetime. That explains why the longer life expectancy is good news limited to First World countries and those with health insurance, public or private.
But despite the upbeat tone from researchers, my reaction was negative shock. We have become so accustomed to thinking of HIV as a manageable, chronic condition that we forget it's still a killer. In fact, the new drugs aren't a cure and can be lethal themselves. Despite all the advances, someone diagnosed with HIV is still likely to die of complications associated with the virus or the meds they're taking to fight it. A 21-year-old who learns he has HIV can expect to die in his mid-40s. That's a message that's not getting out there.
Under George W. Bush, HIV prevention has morphed from a public campaign on safer sex to an emphasis on abstinence and making HIV testing routine and universal. Both policy corrections were needed, although abstinence taught as anything more than a way to delay sex for teens can and does backfire. But universal testing, as nervous as it's made HIV/AIDS groups, is critical to stopping the virus. People who know they're infected are not only more likely to start treatment, but they're more likely to have safe sex, or limit their unsafe sex to other poz people, and that should slow the spread.
Even still, today's "good" news is a reminder that there's still a place for powerful public campaigns that remind people that HIV is out there, and it's still deadly. The Europeans have always done a better job on that.
Thousands quit smoking every year because they're afraid of dying early from lung cancer. Unsafe sex can have the same consequence, with a much shorter fuse and a world of complications along the way. Twenty-four years is great, but it's not a cure.
