From the Sep 3 – Sep 10, 2003 issue

Columns

Letters to the Editor

= LETTER SEES LIGHT
EDITOR: Thanks to The Stranger for raising concerns about the spread of HIV to the highest levels since the beginning of the AIDS epidemic over 20 years ago ["The Immoral Minority," Eli Sanders, June 4]. This rise in HIV lagged behind news of increases in sexually transmitted diseases (syphilis, gonorrhea, and chlamydia) and risk-taking in gay men. We began reporting these increases in 1997. Similar increases are now being reported in nearly every large urban area in the developed world, perhaps an effect of treatment advances making HIV a chronic disease that is manageable, but with often great difficulty. On the heels of our announcement came a lead Stranger article followed by letters and commentary. Some have e-mailed and called us at Public Health, and others have written in these and other media pages, wanting to point fingers of blame. To us, our prevention partner agencies are well meaning, very hard-working, and underfunded. Together with these agencies we are all trying to push a huge boulder up a recently steeper hill.

I write now to clear up some unfair assertions and particularly to question the repeated inferences and statements [suggesting] that previous efforts have failed. HIV prevention interventions that have been funded by Public Health in the last decade have been shown by researchers in many fields of expertise to have significant effects. Who knows what might have happened had they not been applied? But to prevent or cure HIV there is yet no "magic bullet." Instead, we have had to rely on changing the behaviors of a very large and diverse group of humans. These changes can appear drastic in a socially adverse environment (e.g., no socially supported relationships [except now in Canada], and U.S. senators equating gay love with man-dog sex).

Gay City [Health Project], the agency most recently and severely under attack, has been hard at work for HIV prevention. It strives to achieve risk reduction through a community-level intervention approach that supports risk reduction at many levels. Public Health has funded Gay City, Lifelong AIDS Alliance, and many other prevention agencies through a process prescribed by the federal government. Public Health monitors funded agencies and would defund agencies which do not meet specific objectives. Gay City has shown us its comprehensive and exemplary evaluation data.

While Public Health does not believe that prior efforts have failed, we also do not believe they are sufficient at this point to curtail disease spread. We are constantly seeking new and better approaches, as the situation changes. In Eli Sanders' article, we called for more leadership from within the community about responsible sexual behavior to promote individual and community health. We exhort everyone, HIV-positive and HIV-negative, to disclose their HIV and STD status, because partners have a right to informed consent. And we are carefully reexamining the guidance we will soon issue to agencies that will be applying for prevention funds this summer, to see how we can better apply our limited resources.

The work goes on. We welcome more dialogue, but let's keep our focus on the enemy: The enemy is HIV, not the sincere and hard-working folks and groups fighting against disease spread.

Robert W. Wood, MD

Director, HIV/AIDS Control Program, Public Health-Seattle & King County

DAN SAVAGE RESPONDS: In his well-researched, well-reported piece, Eli Sanders examined the problem of rising STD rates among gay men in Seattle by focusing on the ideology of the gay men's health movement and the programming at Lifelong AIDS Alliance (LAA) and Gay City Health Project, the two agencies in Seattle charged with educating gay men about HIV and preventing new infections. What Sanders discovered shocked him: health campaigns devoid of health messages or any useful information at all; a director of education at Lifelong AIDS Alliance, David Richart, who believed HIV infection rates were dropping locally, despite years of warnings from Wood and others that HIV rates were almost certainly rising. Over at Gay City, Sanders found a community-based health organization headed up by a man, Fred Swanson, who believes that "public health approaches using the medical model are not necessarily good for community health." Swanson also couldn't bring himself to say that one gay man knowingly exposing another to HIV was morally wrong.

Sanders also looked at the data behind the rising rates, and in doing so noticed a phenomenon that Public Health, Gay City, and LAA all know about but don't like to discuss publicly: That it's not all gay men who are fueling the current STD and HIV problem--it's really a small core-group of gay men (we called them "The Immoral Minority") who are driving up STD and HIV rates with their reckless, immoral behavior. For example, data and studies of local gay men clearly show considerable numbers of local HIV positive men are having unsafe anal sex without informing their partners that they are positive. No one charged with preventing HIV in Seattle was willing to take on these assholes, or warn people about what they are doing; in fact, the first reaction of most local gay health leaders was to make excuses for them.

In his letter, Wood contests the idea that prevention efforts locally are failing, but rising STD and HIV rates indicate otherwise. If research shows that the kinds of programming being done by Gay City and LAA have "significant effects," those same rising STD and HIV rates would prove either that there's something wrong with the research or there's something wrong with the implementation of these interventions by Gay City and LAA. And as Sanders showed in his piece, the problem isn't that Gay City isn't working hard, the problem is what Gay City is working hard to accomplish--namely, for gay men to never be asked or expected to behave in an ethical fashion.

Sanders called for a new approach to gay men's health, one that embraced concepts of morality, responsibility, and accountability. Sanders also called for more effective and more useful information in education campaigns that targeted gay men. He also called on Gay City and LAA to confront head-on the issue of the core group driving up HIV and STD rates locally. And, Sanders pointed out, while Gay City and LAA may have the best of intentions, their efforts are clearly failing and the leadership at the organizations is clearly part of the problem. The Stranger stands firmly behind Sanders.

Finally, it may seem odd that we're only now running a letter about a feature that appeared in our pages three months ago. Dr. Wood's letter arrived in our office on June 20, but we had reason to believe that it didn't reflect the true feelings of Public Health-Seattle & King County. Which is why The Stranger sent a public-records request to Public Health for all internal health-department e-mails concerning "The Immoral Minority." We wanted to run Wood's letter--The Stranger has always run critical letters--but we wanted to run Wood's letter alongside others that showed what the folks at Public Health-Seattle & King County really thought of "The Immoral Minority," Sanders' reporting, his arguments, and his criticisms of Gay City and LAA.

Let's start with two e-mails sent on the very day "The Immoral Minority" appeared in the paper:

From: Hunter Handsfield [Director, STD Control Program, Public Health-Seattle & King County]

To: [Numerous Public Health Officials]

Sent: June 4, 2003

Bob [Wood] and I have discussed the article ("The Immoral Minority") and agree it is superb, well written and conveying a necessary message both in substance and tone. [It] certainly pulls no punches, but it says almost nothing with which we disagree, and we were happy with the way we were quoted, both in substance and in context. There is only a minor dig at Public Health, for continuing to fund LAA and Gay City despite their failures of leadership, and we don't really disagree with that either.... Bob and I both hope all of us will forthrightly acknowledge, if/when asked, that the article accurately reflects our views, both ours personally and [that of Public Health-Seattle & King County]. And I hope we will use the article as a starting point in negotiating with our community partners about the specificity and assertiveness of their education messages, to begin using "should" and "must," as a requirement for continued funding.... This article might prove to be a watershed that will substantially help enhance our collective prevention efforts.

From: Bob Wood

To: Eli Sanders

Sent: June 4, 2003

This afternoon we all read your excellent article. This week will be a real shake-up for the community partner agencies for sure.

The very same day that Handsfield urged everyone at Public Health to "forthrightly acknowledge... that the article accurately reflects our views," Frank Chaffee, HIV/AIDS program manager at Public Health-Seattle & King County, sent this e-mail to Fred Swanson at Gay City:

From: Frank Chaffee [HIV/AIDS Program Manager, Public Health- Seattle & King County]

To: Fred Swanson

Sent: June 4, 2003

Hi Fred. Please accept my sympathies for the Stranger article. It's got to be enormously discouraging to be set up as the punching bag for someone with a tunnel-visioned agenda....

And two days after Handsfield called on his colleagues to "forthrightly acknowledge" that Sanders' story reflected their views--including Sanders' criticisms of the leadership at Gay City and LAA--it becomes clear that Public Health had no intention of doing so. With Handsfield about to appear on KUOW's Weekday with Fred Swanson to discuss rising HIV rates, Wood warned him not to say anything remotely critical of LAA or Gay City:

From: Bob Wood

To: Hunter Handsfield, James Apa [Communications Manager, Public Health-Seattle & King County], Frank Chaffee

Sent: June 6, 2003

...avoid getting involved in a fight about whether LAA and Gay City are being sufficiently directive, assertive, ethical... if we alienate them by playing into the criticism of their leadership, programs, and use a lot of "should" words, implying that they haven't done this and that, there could be chaos for a long time to come.

On June 9, Chuck Kuehn, the head of LAA, wrote to Bob Wood and Hunter Handsfield asking if they were misquoted or if they "in fact made all those statements, [in which case] we have some issues with being 'hung out to dry' by Public Health." Wood and Handsfield wrote back to Kuehn, telling him that they weren't misquoted. Wood denied hanging LAA out to dry, "but the truth is... that there's been little from and of the gay (not just gay health) leadership saying that these rates, increased risk behaviors, etc., are not acceptable...." Handsfield told Kuehn that he believed there's a need for "articulate, assertive gay leadership." Kuehn wrote back:

From: Chuck Kuehn

To: Bob Wood, Hunter Handsfield

Sent: June 9, 2003

...I would, however, like to challenge yours and Bob's notion that there are specific "gay leaders" who can stand up and make statements of impact in this community. In my seven years here in Seattle I have witnessed a community that [simply] refuses to be led.... I am as frustrated as you are by the trends we are seeing and personally believe we should start approaching the issue of "depression" in the gay community because I believe it is the source of bad personal decisions and judgment (with substance abuse running a close second)....

Twelve days after "The Immoral Minority" was published, Fred Swanson wrote to Frank Chaffee. If everyone at Public Health felt that Sanders' piece was unfair--as Chaffee led Swanson to believe in his e-mail on June 4--Swanson wanted to know why Public Health hadn't yet come to Gay City's defense:

From: Fred Swanson

To: Frank Chaffee

Sent: June 16, 2003

I am disappointed that the Health Department has not made any public statements supporting the groups attacked in the article.... I appreciate your e-mail, but, to be honest, I think we--both Gay City and Lifelong--deserve a little more support when we are being attacked so viciously.... When a reporter [refuses] to print any of the data showing the effectiveness of our work, does not present any positive aspects of our programming, that's a problem. When that same reporter then constructs a false world in which Public Health is disappointed in or not supportive of the programs it funds, that's a problem.... Your public silence only serves to support the notion that you see no value in our work.

What Swanson didn't know, of course, was that there was a good reason for Public Health's public silence: As the record clearly demonstrates, Public Health agreed with Sanders, and Public Health was "disappointed in or not supportive of the programs it funds" at Gay City. Sanders hadn't constructed a false world, but exposed the reality of the situation. Swanson wasn't aware of this, of course, because no one at Public Health would say so publicly.

With both Kuehn and Swanson pressing for a public statement of support, Wood drafted a letter to The Stranger. Wood's letter included arguments lifted from Swanson's e-mails (Sanders ignored data showing the effectiveness of Gay City's programs) and Kuehn's e-mails (gay men exist in a "socially adverse environment"). Shown an early draft of the letter, Handsfield sent this e-mail to Wood:

From: Hunter Handsfield

To: Bob Wood

Sent: June 19, 2003

I am slightly concerned that [the draft of] the letter [to The Stranger] is a bit TOO supportive of Gay City and other agencies....

Public Health shared copies of Wood's letter with Swanson and Kuehn, with the understanding that both men would present the letter to their boards and volunteers to deflect criticism. Providing the letter to Swanson and Kuehn would allow both men to mislead their boards by arguing that Public Health actually supported their programs and had no complaints about their leadership. Since I had seen some of the internal Public Health e-mail praising "The Immoral Minority" after the piece originally came out, and knew for a fact that Public Health agreed with Sanders' criticisms of Gay City and LAA, I blew my stack when Public Health sent Wood's letter to the editor of The Stranger to me, the editor of The Stranger. I proceeded to get into a long, heated e-mail exchange with Wood. (To read our exchange, which is far too long to publish in this space, go to www. thestranger.com/savage-wood.) I forwarded my exchange with Wood to the officials at Public Health who saw Wood's letter to The Stranger. After reading our exchange, Handsfield sent a note to Wood:

From: Hunter Handsfield

To: Bob Wood [and other Public Health officials]

Sent: June 23, 2003

I just read through the e-mail string forwarded by Dan Savage. He may have a point; perhaps we have bent a bit too far in the past two weeks to keep our community partners happy. That's understandable, because we have to work with them, a reality that Dan recognizes.... But he may be right that some of us have been a little more supportive of Eli's article in private than in public. (Bob, are you really so confident in the quality of Gay City's data showing the impact of their interventions?)....

Let's pause here to consider that parenthetical comment: In his letter to The Stranger, Wood praised Gay City's "comprehensive and exemplary evaluation data," which supposedly measured the impact of the group's programming. Handsfield, however, has little confidence in Gay City's data, and he doubts that Wood does either. Does Handsfield know something about Wood's true feelings about Gay City's data? That seems highly likely. Incidentally, when he was reporting "The Immoral Minority," Sanders was told repeatedly by Swanson that Gay City doesn't have hard data showing positive behavior change among the individuals who access its services. Okay, back to Handsfield's e-mail:

...The Stranger article has had exactly the impact we hoped for, to stimulate [more] dialogue and ferment about prevention strategies than we have seen in a decade or more. The other media stories surely had an impact, but Eli's is the one that seems to have stimulated most of the dialogue and virtually all of the controversy.... For that alone, we owe Eli and The Stranger (and, indirectly, Dan Savage) great thanks.

Wow, so many behind-the-scenes compliments! I hope we have room for one more: One of the main thrusts of Sanders' piece was the lack of effective leadership in local AIDS groups. My exchange with Wood prompted discussion at Public Health about leadership in the gay community:

From: Hunter Handsfield

To: Frank Chaffee

Sent: June 23, 2003

...Bob [Wood] and I have long been in agreement in our frustration with the inability and/or unwillingness for highly visible and vocal leadership about the responsibility issues.... What might [these leaders say]? Perhaps a strong ethics-based message: It's just wrong to expose someone to a health risk without his/her knowledge and acquiescence.... And of course any gay leader with such a message would do so at great personal peril, in reputation and acceptance and perhaps even at some physical risk. But that's what leaders do!

From: Frank Chaffee

To: Hunter Handsfield and Bob Wood

Sent: June 23, 2003

It seems to me that Dan Savage and Eli Sanders have both written things that contain messages substantially similar to what you are advocating.... If I'm understanding you correctly, you would like to hear more voices like Dan's and Eli's, particularly from the ranks of the community-based organizations. Fair enough--though I won't hold my breath.

This is astounding. Privately Handsfield and Chaffee were praising Sanders (and The Stranger) for demonstrating the kind of leadership that the AIDS groups hadn't been, and still aren't, providing. Handsfield went on to point out that anyone who does provide this kind of leadership is likely to be attacked ("any gay leader with such a message would do so at great personal peril, in reputation and acceptance"), and at the very moment Handsfield was writing those words, Sanders was indeed being attacked--by Public Health. Even Bob Wood, the man attacking Sanders, had some private praise for Sanders and The Stranger:

From: Bob Wood

To: Frank Chaffee, Hunter Handsfield

Sent: June 23, 2003

Yes; I think Dan and Eli are speaking from within the ranks of MSM [men who have sex with men]. We need more.

At this point, James Apa, Public Health's communications manager, weighed in with a warning:

From: James Apa

To: [Numerous Public Health Officials]

Sent: June 23, 2003

While I do think the letter to the editor was reasonable and doesn't warrant the vitriolic response it's received from The Stranger, I'd also say that, right or wrong, getting into an extended argument with Dan Savage is a loser any way you cut it.... Question: Dan makes reference to at least one e-mail that he has received from our department following the article, praising The Stranger and Eli for running it. What in particular does it say? If Dan's mad enough, he may well use it to do an "inside baseball" story on us, attempting to make his case that we did a 180.

I'm mad enough, James, but I don't need to make the case that Public Health pulled a 180, not when Public Health's own e-mail records make the case so effectively. To recap, here are the facts: Eli Sanders wrote a story that health department officials praised to the skies--in private. When the heads of Gay City and Lifelong AIDS Alliance complained, Bob Wood banged out a letter accusing The Stranger of being unfair. But the Gay City data that Bob Wood publicly praises, Hunter Handsfield privately disses. Oh, and the leadership shown by Eli Sanders and The Stranger is just the kind of leadership Public Health wants to see from Gay City and LAA--but, shhh... let's not tell anybody.

Internal Public Health e-mails that we received through our public records request show that long before Sanders' piece appeared in The Stranger, Public Health officials were worried that Sanders might be critical of them in his upcoming piece. Here's one:

From: Hunter Handsfield

To: Frank Chaffee

Sent: May 16, 2003

...From my rather extensive conversation with [Eli Sanders] Thursday, I don't think he's going to be critical of Public Health.... That said, he will clearly make the ethical argument (with which I am sure we all agree) ... And I'm pretty certain that, à la Dan Savage, he will lament the failure of vocal leadership on this point to emerge from within the community. Personally I agree that is a valid charge, and from numerous conversations I know Bob [Wood] and Frank [Chaffee] agree.

To Public Health's relief, Sanders' criticisms focused instead on Gay City and LAA. It is clear now, however, that Public Health officials should have come in for more of the blame, as their lack of leadership is part of the problem. While Handsfield wants to see gay leaders take stands and lead--even at the risk of personal attacks--Public Health officials won't do the same, for fear of angering people at agencies who rely on Public Health for funding. Why is Public Health-Seattle & King County so cowardly? If a lack of leadership at Gay City and LAA is a part of the problem--a point Public Health and The Stranger both agree on--then a change in the leadership at these agencies is a big part of the solution. Public Health not only has the moral authority to force change at Gay City and LAA, it also has the financial authority--both agencies rely on Public Health for funding.

In his letter, Wood writes that "the enemy is HIV, not the sincere and hard-working folks and groups fighting against disease spread." Yes, yes: The real enemy is HIV. But that doesn't get the leadership at Gay City and Lifelong AIDS Alliance off the hook. However sincere their motives, however hard-working they are, the leadership of our local AIDS organizations are making the STD and HIV problems in Seattle worse--thanks to their lame, misguided prevention efforts, their unwillingness to use "should" and "must" when they talk to gay men, and their inability to address, much less confront, the core group of gay men who are driving up STD and HIV rates in Seattle.

And Public Health can't be let off the hook either: Public Health--Seattle & King County is, without a doubt, making the problem worse through its critical silence and its insincere public approval of the leadership and prevention efforts at Gay City and LAA.

Months after "The Immoral Minority" appeared in The Stranger, why is the criminally misinformed David Richart still the education director at Lifelong AIDS Alliance? Perhaps because Public Health hasn't called on Lifelong AIDS Alliance to fire him. Why is the morally obtuse Fred Swanson still the director of Gay City? Perhaps because Public Health is too busy helping Fred Swanson make excuses to his board, instead of urging his board to start looking for someone who can demonstrate the kind of leadership that Hunter Handsfield is calling for--the kind of leadership, incidentally, that Public Health will only privately praise The Stranger for showing.

Finally, HIV is not the only enemy. Our other enemy is the behavior that spreads HIV. Under their current leadership, Gay City and LAA seem incapable of confronting the kind of core-group behaviors that spread HIV. Indeed, both agencies, by alternately making excuses for core-group behaviors and ignoring the problem, are abetting the spread of HIV and other STDs. And Public Health, by not doing more to change the direction of these agencies, by saying one thing in private and another thing in public, is also in no small measure responsible for rising rates of HIV and other STDs. Shame on all of you.