HIV/SDD/HCV COUNSELING, TESTING AND REFERRAL TRAINING

Dawn got into the spirit with a shining red ribbon along the horizon under the eastern cloud cover.  Up at 4AM, I was surprised to see how light it had become when I left at 6AM for a workshop called “HIV/SDD/HCV Counseling, Testing and Referral Training.”  Sponsored by the Montana Department of Public Health and Human Services, it was only because of a story in the GF Tribune that I knew about it.  Since it was free and within my driving radius, I went and I’m glad.  I’m grateful that they allowed me to attend just one day of the three days.  In fact, the whole experience was kind of . . . well, unexpectedly endearing.

About twenty people attended, three-fourths women, all evidently in public health-type jobs with backgrounds in nursing or social work.  My impression was that maybe as many as half were relatively new to their jobs, they ALL seemed very young to me, and they were as nonjudgmental and attentive as any group could be.  This outreach effort is very specific:  to identify and contact people at risk, make tests available, and support their use with encouragement and information.  Then to help individuals deal with the consequences, by designing survival strategies, and scrounging for help however possible.  

Harm reduction is part of the plan.  That means stuff like finding safe ways to get rid of used needles.  (Accumulate them in a still half-full bleach bottle, for instance, or dispose of them through a hospital or pharmacy.)   Provide clean needles. (Many authority figures in Montana will resist this on grounds that bad behavior should be punished, though they wouldn’t put it that way.)  Alcohol swabs should be used when shooting up, to help prevent infection.  I take it these folks are not used to working with street people.

A lot of intriguing bits of info floated through.  The Hutterites have made an effort to hold onto their young people by letting them have a formal experimental year or so late in adolescence to go on wanderjahre.  They have learned that some will simply disappear and others will want to return home.  For this latter group, the elders now require for re-entry a doctor’s exam and certification that they are HIV and STD free.  It’s a bit of problem because the diagnostic test for HIV takes three months to wait for the antibodies (which are what the test detects) to build up enough to be measured.  But generally the kid is wanting to come back because of being in some distress and not really able to undertake a wait of months.  An elder will accompany him to the office and demand to see the test results.  State law might not accommodate this.

As with all groups thinking about sex, thoughts wandered and personal experiences came to mind.  The leaders did a pretty good job of keeping the focus.  This was specifically and only about HIV, though other issues like abuse might be hitch-hiking.  I had been told earlier than everyone in this state who needs HIV meds is getting them, but today I heard that the waiting list is eight to ten people long, which is so short compared to other states that people are moving here to get on this list.  The list is not for the meds directly, but for the money to access the meds, which comes from a variety of sources.  The meds are incredibly expensive (thousands per month) and the programs are essentially a pass-through for subsidies for Big Pharma.  There was no railing against Big Pharma.  There was considerable concern for toeing the line, plus quiet wink-wink advice about underground contacts.  No one spoke of sequestration consequences which presumably kick in today

It’s curious that in a state where there are so many ranchers and veterinarians who handle drugs and needles all the time (to say nothing of fist-fucking cows) that these rural people were never mentioned as a source of advice or actual paraphernalia.  Once again, HIV-focused services are almost all located in the major cities, except that it seemed every rez except the Blackfeet was represented.  I asked about Internet access to needles, but no one had experience with that.

Much of the workshop was role-playing with assigned roles.  I was assigned the part of a 45 year old man-who-has-sex-with-men.  We don’t say “gay” men anymore -- we say MSM, because these people don’t consider themselves gay, are usually the “bottom” (meaning the receiver and more at risk, but more likely to rationalize it as passive -- so they aren’t “doing anything”), and are often in sexual relationships with women as well, maybe marriage with kids.  

So I pretended I was a truck driver who was making a mint off the Bakken Formation -- REALLY good money -- but it meant being on the road four or five days a week.  My wife didn’t like it but she realized we would be able to put the kids through college if I could keep it up.  The trouble was that I had to really be sharp, even when I was exhausted by the hours, the weather, and the general tension of making sure maintenance on the truck was done, keeping the deadlines, and so on.  Sometimes I used speed, I smoked a lot, and I had a hard time sleeping on the road in the cab bunk.   I didn’t dare drink or use sleeping pills.  But if some guy gave me the right signals at a truck stop, an encounter was really relaxing.  It really helped.  But I didn’t know whether he used a condom or not.  What did I know about what he was doing back there?  I could smell lube, but . . .   I didn’t really want to know much.  At the same time my wife wondered why I didn’t want sex with her anymore and accused me of not loving her.  I assured her there were no other women. I couldn’t stand it if she left me.

“My” advisor (female) was inexperienced but earnest and expressed sympathy while pressing me to see that I must at least make sure about condoms, and to realize that if I gave my wife HIV, she would REALLY be lost.  The whole family would be affected.  So why not get brave and get tested?  Just as a little step in the right direction.

The keynote speaker and leader was D. Gregory Smith, executive director of AIDS Outreach to Bozeman.  47, gay, poz, handsome, partnered, formerly a priest trained at the Vatican, and now a certified Gestalt practitioner in both Washington and Montana, he sounded too good to be true, but he turned out to be a real Montana boy who had narrowly survived death twice, and returned from Seattle to his home state in gratitude, “giving back” as they say.  He’s big and resourceful now, but as a child he was bullied and trampled in the all-too-familiar way.  He’s kept a calm gentleness that I think did not come easily.

Over the past fifty years (not so much the past ten) I’ve attended so many seminars, panels, workshops, working groups, committees, etc. that I almost get hives walking into these motel rooms with their plaster facades and perpetual coffee urns.  My name (fibertip on construction paper tent) kept falling off the table onto the floor, like some omen.  But in the end, like the Seventies workshop Bill Haw organized for white teachers of Native American Head Start and kindergarten kids, the people themselves were interesting, focused, and open.  The consequences of a half-century of self-inventories, games, role-playing, reframing and redefining by various institutions have been subtle but they were nevertheless effective.  If it hadn’t been for all those years of work in so many places by so many people, we would never today be able to publicly and calmly discuss what people at risk for HIV could do about it, without ever judging them or blaming them for how they came to be at risk.  Just getting on with it.  In the Sixties HIV-AIDS was unknown and the very word “net-working” was new.  Most of the people in the room yesterday had not been born yet.