When he came out as HIV-positive, Americans were forced to recognize that even our heroes can get HIV. Yes, someone out there (perhaps more than one person) transmitted HIV to Johnson, and it’s possible Johnson had non-straight sex. But Gawker isn’t looking to disprove the very real fact that you can get HIV from sex with a woman.
On Wednesday evening, popular blog Gawker.com aired a post offering a cash reward for the identity of the individual who transmitted HIV to Magic Johnson. It was particularly interested in confirming decades-old rumors that Johnson contracted HIV from sex with a man or transgender woman. The post came on the heels of a Frontline report on HIV in the African American community. Gawker editor A.J. Daulerio faulted Frontline for allowing Johnson to reveal only that he contracted HIV from having sex with numerous women. “[I]t seems odd,” Daulerio wrote, “that there’s been no follow-up about which of these women was HIV positive.”
One can imagine a world in which Johnson’s potential sexual activities might be legitimately newsworthy — say he denied that HIV was sexually transmitted or he waged a public campaign against the LGTBQ community. But that’s not the case. What will generate page hits for Gawker in this case is the public naming and shaming of an individual who is HIV positive and the public humiliation of Johnson if he engaged in something other than straight sex. Daulerio’s post coyly capitalizes on the stigma of HIV and the stigma of non-straight sex. In doing so, it plays to the very prejudices that keep people in the closet about their sexual orientation and their HIV status.
The post reflects more serious problems with how we as a society approach HIV. Sexual transmission of HIV provokes a mix of fear, disgust, anger, and fascination. We want information, but mainly information that give us someone to point to and say, “I’m not like that. That couldn’t happen to me.” As a result, even today people living with HIV are subject to discrimination and abuse, ostracized from their communities and families, and — as the Gawker post aptly demonstrates — derided in the press.
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They are even subject to special criminal sanctions. It is currently a felony in several states to have sex with another person without revealing that you are HIV positive. This makes intuitive sense to a lot of people. But more often than not, these statutes reflect outdated information or even myths. For example, almost no statute provides a defense of having taken the precaution of using condoms. Several statutes criminalize sexual activities like receiving oral sex or using a sex toy, which pose risks of transmission so small they are only theoretical.
The punishments for these offenses are far more serious than for statutes that criminalize serious risk in other contexts. In some states, you may get a smaller sentence for playing Russian Roulette (a one in six chance of death) than having protected sex (less than one in 10,000 chance of transmission, depending on the sex act). This is because most states’ maximum sentence for recklessly placing another person at risk of death or serious injury is one year. In contrast, HIV-exposure statutes carry an average maximum sentence of eleven years.
Why is sexual HIV exposure targeted so fiercely compared to the many other ways we expose each other to risk of death and injury? It’s not that it helps deter risky behavior. Studies have demonstrated that these statutes have no deterrent effect. In fact, several public health advocates argue the statutes may increase HIV transmission by discouraging people from being tested (most statutes only apply to individuals who know their HIV-positive status). This is a big problem given that two-thirds of transmission occurs where the transmitting partner doesn’t know she is HIV-positive.
Perhaps we target HIV-positive individuals in the law, in our communities, and—as Gawker demonstrates — in our media — because we want to believe that they are not like us. Maybe states criminalize levels of risk that are perfectly legal in other contexts because it’s not really about the risk. It’s about the perception that individuals infected with HIV are tainted, and sex with a person living with HIV is in itself harmful regardless of the risk of transmission. This perception allows us to ignore the numerous social and economic problems that contribute to HIV transmission in favor of the myth that the real problem is the type of people who get HIV, and we are not those kinds of people.
Magic Johnson shattered that myth for a lot of people. When he came out as HIV-positive, Americans were forced to recognize that even our heroes can get HIV. Yes, someone out there (perhaps more than one person) transmitted HIV to Johnson, and it’s possible Johnson had non-straight sex. But Gawker isn’t looking to disprove the very real fact that you can get HIV from sex with a woman. The story Gawker is looking for is only a story because some people still believe that HIV and non-straight sex are freakish. They aren’t. Let’s move on.
Pregnancy, birth, and breastfeeding are acts often associated with womanhood. We talk about pregnant women and nursing mothers, but this language—which depends on the male-female gender binary—seems inadequate as trans and nonbinary folks are increasingly visible in the parenting sphere.
With his first book, Where’s the Mother?: Stories From A Transgender Dad, Trevor MacDonald hopes to blow the conversation wide open. MacDonald is a Canadian author who has been blogging about his journey as a nursing man on his blog, Milk Junkies, since 2011. He also facilitates a Facebook group for trans folks who nurse, and he initiated and helped design a University of Ottawa study focusing on the experiences of transmasculine individuals with pregnancy, birth, and infant feeding.
MacDonald’s book explores his transition from living as female to living openly as a man, and how that transition ultimately led to his decision to carry and birth a child with his partner.
By sharing his experiences and documenting the many challenges he faced as a man who planned to give birth and nurse his baby, MacDonald asks readers to reconsider everything they think they know about what it means to be a gestational parent. By the end of the book, readers come away understanding that despite a person’s gender, pregnancy and nursing are universal experiences and valid regardless of how they happen. MacDonald’s voice is an important and necessary one in the birthing community, and there are surely many more people out there like him.
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Rewire: You talk a lot about struggling to find literature that you related to because pregnancy, birth, and breastfeeding are typically only associated with women—and motherhood. Can you tell me about the kind of language you’d like to see used to talk about these experiences and why it’s important?
Trevor MacDonald: I think I was a bit naive at first when I was reading those materials. I felt like, “If only the authors knew, I’m sure they would have used different language. They just didn’t know about people like me.” And that’s definitely been the case for some of those authors. Many are starting to change language and using words like “parents” or “pregnant people.” It’s a simple shift, really.
Where I was naive, though, is that there are some people who really don’t want to use inclusive language. Ina May Gaskin is one. I had read her book [Ina May’s Guide to Childbirth] during my first pregnancy and had been so inspired by her writing, and the birth stories are so valuable and needed. I was so hungry for information about what others had experienced. I love that book so dearly, and to realize she really was opposed to including gender-diverse people in her writing was really upsetting. [Gaskin signed this open letter by Woman-Centered Midwifery, a group of “gender-critical” midwives who believe that biological sex determines gender and were concerned about the Midwives Alliance of North America’s use of gender-neutral language to talk about pregnancy and birth.]
It’s also really important to me to point out that no one needs to throw out the words “mother” or “woman”; you just need to include more words. So you could say “women and men and gender-nonconforming people” or “parents.” It’s nice to have more than one word to mix things up a little bit.
Rewire: What was the decision to carry a baby like for you?
TM: It was something I’d never thought I would do until after I transitioned and after getting together with my partner. For me, transitioning in the medical way that I did [through hormone therapy and top surgery involving breast removal] made me comfortable enough with myself to contemplate carrying a baby. Before that, there was so much stress and constant background noise in my thoughts and in my life to do with gender, with bathrooms, and with all the ways I really wasn’t comfortable. When I transitioned and so much of that fell away, I started to consider things I never had before. It helped that I was able to present as male throughout my pregnancies because I had taken testosterone [before pregnancy]. Those things enabled me to express my gender and present myself during pregnancy in ways that were comfortable for me.
Rewire: Did you experience any gender dysphoria—the distress or discomfort that occurs when the gender someone is assigned does not align with their actual gender—during your pregnancy?
TM: For sure, but for me it was more around medical stuff than around everyday living. In my everyday life, I was still presenting as male. But with health-care providers, especially providers who specialize in prenatal care, they’re so used to everything being woman-centered, and it’s really important to some providers to use woman-centered language.
I didn’t have any providers who had worked with an openly trans client before, so people certainly had trouble with the language. One midwife offered a blanket apology that she was going to have trouble remembering to use the right words and that she didn’t mean to be offensive. For me, I think I would have preferred if she had made more of a commitment to trying to change her language—going beyond apologizing, but trying to do something to remember to use my pronouns. I think it must be hard when it’s your first client who has asked you to use new language. It’s a new skill that has to be practiced and learned, like any other.
Another place where I sometimes experienced challenges was when people at work who had previously been using the correct pronouns for me switched to using the word “mom” and female pronouns when they found out I was pregnant.
But for me personally, in my body, I didn’t feel like the experience of being pregnant triggered dysphoria. It was more the way society responded to me that did.
Rewire: Birthing at home was something important to you. Can you talk a bit about why that option felt safest?
TM: I think the difference for me was that care is different. In Canada, we have midwifery care that is part of the health-care system, and it is covered by insurance. We still have a shortage of midwives, so not everyone who wants one can get one. I was fortunate to get midwives for both my births. For me, the continuity of care that they provide and that you get with a home birth is important.
At a hospital birth, there is no way to meet all your providers before you go there and labor, and I felt like there might be a lot of explaining that I might have to do. I did go to a hospital during pregnancy and another time when I had a miscarriage. I had to come out to every provider there, starting with the first nurse and every subsequent person that I saw. Each person needed to hear the same story about how I, a man, was pregnant. One doctor even had a lot of questions about how I could no longer be taking testosterone and still have facial hair. I couldn’t imagine having to explain those things and educate during labor.
Even with midwives, though, it’s not a magical recipe for getting exactly the kind of care that you need. I still had midwives at my first birth that I hadn’t met before.
Rewire: How do you think care providers—whether they’re doctors or midwives, or lactation consultants—can best support families like yours, or people who are not women but may be giving birth or nursing their babies?
TM: I think considering the topic, doing reading and practicing using the language ahead of time, before they ever meet their first trans or gender-nonconforming client is really important. There are more and more resources available now and places to go to read about people’s experiences, and there are a number of different medical associations who have called on their members to do exactly that. This is so they are not asking their individual patients to educate them, particularly when that person needs care and is in a vulnerable position. That’s not the time to be asking questions that they could learn about in other places.
Rewire: Finding donor milk for your son Jacob seemed to be quite a challenge. You mention that you produce about a quarter of the milk your baby needed, and the rest had to come from donors. Can you talk about what some of the challenges to finding donor milk are? Do you think protocols that see milk sharing as “risky” keep babies from being breastfed who might otherwise benefit from receiving breast milk?
TM: I think some of the taboo against milk sharing is really starting to shift in our culture right now. Currently, a lot of regulatory bodies—for example, the Food and Drug Administration and Health Canada—have a position against peer-to-peer milk sharing—like through Facebook groups like Human Milk 4 Human Babies, where we found many of our milk donors.
But La Leche League (LLL) has actually changed their position on it. LLL’s leaders, who facilitate their local support groups, used to not be allowed to discuss peer-to-peer milk sharing in any way, but last year the organization released a statement with a new policy. Leaders are allowed now to share information and can say that these milk sharing websites exist. It would be a great shift if other groups start to take a position more like LLL, where they can provide information. It would be awesome if medical professionals started to tell patients that these networks exist. Karleen Gribble has written papers about the ethics of peer-to-peer milk sharing and the ethical implications of letting patients know about it and how care providers could discuss risks and benefits, not just of peer-to-peer milk sharing, but of using formula.
In pop culture, when people talk about being worried about milk sharing, the fear most often brought up has to do with diseases like HIV. But something we had to consider as well was the medications that people were taking and whether it could be passed through breast milk. Many people who donate milk through peer-to-peer sharing do so because formal milk banks have such strict requirements around who can donate to them. Formal milk banks are not necessarily in competition with peer-to-peer milk sharing, which is important to understand.
Rewire: You talk a lot in the book about milk donation and the community that sprung up around you to help your family achieve your breastfeeding goals. Can you speak about the support you received and how it affected your breastfeeding journey?
TM: We met people that we otherwise never would have met and never would have become friends with. Many of our milk donors are still our friends, and they were such a diverse bunch of people. From a Mormon donor to a military family to a Mennonite family, all these different kinds of families from different backgrounds came together to help us feed our baby. It was amazing to meet these different people and to realize that despite us being a different kind of family in this one particular way, what was most important to all these people was that a baby needed breast milk.
Rewire: It sounds like prior to having your son, you didn’t know any other trans people who had nursed their babies. Has that changed? Are their experiences similar to yours?
TM: Before Jacob, I only knew about the guy, Thomas Beatie, who went on Oprah. I didn’t know anyone in person. I knew a few trans people who had children prior to transition. Through writing my blog, that’s how I first started to connect to a lot of other trans parents and people who were carrying babies while being out as trans. People asked me questions through my blog about how I navigated the medical system and a lot of questions about breastfeeding.
I also got a lot of questions from cisgender women as well, who were grappling with all kinds of different breastfeeding challenges. Many people deal with low milk supply and try to use a supplementer, like I use to nurse my baby (since I only make about a quarter of the milk my baby needs, I use a supplementer to deliver the milk at my chest, which allows me to feed my baby at my chest). So many people can relate to these challenges. A lot of the time, it’s a private struggle that people have, and it’s intense but you don’t necessarily talk about it that much. All kinds of people reached out to me because they could relate to these issues.
Rewire: What do you wish you had known before giving birth to Jacob?
TM: I wish I had trusted my own instincts a little bit more, and given myself more space to just see what my body would want to do in labor. I felt like I was looking to my care providers and my doula for suggestions, and I’m sure a lot of people have that experience when they’re going through something they’ve never been through before.
Rewire: What do you hope people take away from your book?
TM: I really hope that it will open up conversations. I hope it will provide opportunities for people to talk more about gender diversity, not just generally, but in parenthood and related to pregnancy and breastfeeding. If this book contributed to a conversation that way and opened up discussion, that would be amazing. I would be really thrilled.
This interview was conducted by email and by phone. It has been lightly edited for length and clarity.
Thousands of prisoners in Louisiana’s county jails are routinely denied access to HIV testing and treatment, with five of the state’s 104 jails offering regular tests to inmates upon entry, according to a new Human Rights Watch (HRW) report.
The same people who are at the highest risk of HIV—people of color, sex workers, and low-income communities, for instance—face disproportionate incarceration rates in Louisiana, meaning that low-income people of color, and especially Black people, are bearing the lion’s share of the burden of inadequate HIV care in county jails, called “parish” jails in Louisiana.
Louisiana has the nation’s second highest rate of new HIV infections, and the country’s third highest rate of adults and adolescents living with AIDS, according to the report. The state has the highest incarceration rate in the nation, locking up an estimated 847 people per 100,000 residents, compared to the national average of 478 prisoners per 100,000 people. On any given day, there are roughly 30,000 people in Louisiana’s parish jails, contributing to an incarceration rate that is 150 percent of the national average.
Many of those whose treatment has been interrupted while in jail were arrested for minor, non-violent crimes, per HRW.
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Both of these epidemics disproportionately harm Black people, who account for 70 percent of new HIV infections in Louisiana (compared to 24 percent for white people), and 66 percent of the state’s prisoners—even though Black people account for 32 percent of Louisiana’s 4.6 million residents.
“This is not a coincidence,” Megan McLemore, a senior researcher at HRW and author of the report, told Rewire. “The history of the state of Louisiana has been, to say the least, disturbing in relation to African Americans.”
HRW interviewed more than 100 people for the report, from formerly incarcerated people to medical staff in parish jails to HIV service providers. What they found was a pattern of rights violations, including the failure of most parish jails to comply with recommendations by the Centers for Disease Control and Prevention that all inmates be tested for HIV upon entry at a corrections facility.
Jail officials reportedly told HRW that they avoid testing because they can’t afford to treat those who test positive: a course of medication for a single patient can fall in the range of $23,000-$50,000 per year. But the HRW report claims that failing to conduct proper testing, interrupting patients’ treatment plans, and neglecting to provide linkages to treatment centers for people leaving jails could end up costing the state much more in the long run.
Strict adherence to antiretroviral medication regimes has been found to greatly enhance successful management of HIV, the report said, by strengthening a person’s immune system and decreasing the amount of virus in the body, thereby reducing the risk of transmission. By denying inmates access to their medications, Louisiana’s parish jails are contributing to an already grave epidemic: the state is home to more than 20,272 people living with HIV, with half of them diagnosed with AIDS, according to the report.
Jail officials’ behavior heightens the stigma around HIV, advocates said. McLemore told Rewire that Louisiana’s inmate population represents some of the country’s most vulnerable and heavily policed communities.
“These are people who are already stigmatized—add HIV, and the situation becomes almost unbearable. So when jail officials intentionally avoid or neglect testing and treatment, they are not only adding to that stigma, they are actually being discriminatory,” McLemore said, adding that some caseworkers claimed their HIV-positive clients avoided disclosing their status to jail staff because they had no assurance that it would guarantee care.
Darren Stanley, a case manager at the Philadelphia Center in Shreveport, told HRW that half his clients have spent time in jail, and the majority of them are denied their medications on the inside. One of his clients, who spent three weeks in the Caddo Parish Prison in 2013, paid the ultimate price.
“I tried to get in touch with him but he was very sick without his medications,” Stanley told HRW. “He died of AIDS two weeks after he got out.”
A formerly incarcerated woman named Joyce Tosten who spoke to HRW claimed parish jail officers informed her that she would need to have her mother deliver any necessary HIV medications to the jail. But she couldn’t call her mother because she didn’t have phone privileges at the time. Other sources alleged that even when family or friends brought medications to the jail, they were never delivered.
The problem does not stop at incarceration. According to HRW, “release from parish jail is often a haphazard process consisting of whatever is left of their medication package, a list of local HIV clinics, or nothing at all.”
The report includes a series of recommendations such as setting aside adequate funding for HIV testing and care, training jail staff on effective treatment and management options, and strengthening links with local care providers and community-based centers for returning citizens.
Deon Haywood, executive director of Women With A Vision (WWAV), a New Orleans-based grassroots health collective responding to the HIV epidemic in communities of color, told Rewire that HRW’s recommendations were “spot on.”
“They speak to the conditions we have seen in the community for the past 26 years,” she said. “Through my work at WWAV and other New Orleans agencies, I’ve witnessed the failure of incarceration to better the community. We urge Louisiana to invest in education rather than criminalization, and shift the state’s resources and policies towards solutions that address the systematic inequalities that poor communities of color face on a daily basis.”
HRW’s report adds to a list of woes that Louisiana residents confront on a daily basis. The state recently ranked last on a nationwide index measuring social justice issues like poverty and racial disparities.
CORRECTION: This story has been updated to reflect Louisiana’s correct incarceration rate.