Setting the Record Straight About Vaginal Contraceptive Film

Question: I am so suprised that nobody is talking or having any comments about VCF which I used all the time. My partner and I are totally confident in that product. Could you touch a word on it?
-Manuel, St Paul,MN

Vaginal contraceptive film (VCF) is a soluble film -- a super thin, wafer-like substance filled with spermicide, usually nonoxynol-9 -- that's inserted into the vagina before intercourse and then "melts," delivering spermicide (chemicals that kill sperm) into the vaginal barrel as a form of contraception. Nonoxynol-9 is also available in jelly, cream, foam, suppository, and tablet forms, and is coated on some lubed condoms; however, these condoms have been found to offer no more protection against pregnancy than those without spermicidal lube.

VCF, when used alone, is far less effective against pregnancy than a condom, which, when used consistently and correctly,[The Condom} offers a 97 percent protection rate. VCF seems to be most effective when used as a back up with another form of birth control. As far as sexually transmitted diseases (STDs) are concerned, although VCF may reduce the risk of getting a bacterial STD, such as gonorrhea and chlamydia, by about 25 percent, it does not protect against them. The only form of birth control effective for STD prevention is a condom.

The following ideas can help increase the contraceptive effectiveness of VCF:

* Using dry, clean fingers, insert one VCF sheet into your vagina, making sure it's placed on or near your cervix.
* Wait at least fifteen minutes after insertion to allow the VCF to dissolve in the vagina before having intercourse.
* Use a new VCF for each sex session as a single application is good for up to only one hour after initial insertion.

New Medicare rules bring trouble for HIV+ people

by Eric Resnick

New federal rules designed to get people off the Medicaid rolls and give senior citizens Medicare prescription drug coverage are causing confusion and may make getting medications more difficult for HIV-positive people.

The new rules, known as Medicare Part D, go into effect January 1. People who need the coverage, and their case managers, are scrambling to choose from HMO-like plans before then. Anyone not enrolled in a program by January 1 will be automatically enrolled in one by Medicare, whether or not that program is right for them.

The changes will hit HIV positive people living on disability with an income between $12,000 and $20,000 per year the hardest, requiring payment of around $4,000 out of their pockets each year to continue getting medications.

Most of the people in this category worked long enough before getting sick to qualify for Social Security Disability Insurance or private disability benefits. Known as dual eligibles, they are also eligible for Medicaid.

According to the advocacy group Treatment Access Expansion Project, there are at least 50,000 people with HIV and AIDS in this group. They are generally poorer and sicker than Medicare-only recipients. Their drugs are currently paid for by Medicaid but will no longer be, under the new plan.

The largest segment of the HIV positive population, people with incomes less than around $12,000 per year who are totally dependent on Medicaid, will not be affected.

Out-of-pocket expenses

Unlike the Medicaid law, which did not allow recipients to be denied medication if they could not pay, patients can now be refused medication for lack of payment.

A Treatment Access Expansion Project booklet says, ?The cost containment measures implemented and contemplated by states will have a significant adverse impact on the health of people living with HIV and AIDS and other disabled Medicaid beneficiaries.?

All Part D enrollees will pay monthly premiums of about $37 per month, a new out-of-pocket cost.

Then they will pay the first $250 of their annual prescription cost, known as the deductible. This is also a new cost.

But the big problem starts after that, as the patients will now pay 25 percent of their costs from $250 to $2,250, then 100 percent of the next $2,850.

Above that point, at $5,100, the recipient pays 5 percent of drug costs for the rest of the year.

The segment from $2,250 to $5,100, where the recipient is effectively uninsured, is called the ?gap period? or the ?hole in the doughnut.?

With drug costs over $2,000 per month, most HIV positive people on the plan will hit that hole in February and March. With their low income, they do not have the money to make those payments.

Non-HIV drugs aren?t on the plan

The other problem is getting the plans to cover other medication, besides anti-retrovirals.

All anti-retrovirals are covered by all the 40 possible plans offered to Ohioans. But people with AIDS take other drugs, often to counter adverse side effects of the anti-retrovirals. Drugs to treat nausea, heart irregularities and diabetes may not be on their plan?s formulary. These ancilliary drugs will have to be paid for totally out-of-pocket.

Some drugs that are in the plans require prior authorization from the insurance company before they will pay.

It is unclear whether or not a person with AIDS can change their plan mid-year if their previous choice becomes unworkable.

Gil Kudrin of Cleveland, 47, who has been positive since 1980, takes five anti-retrovirals and eight ancilliary drugs costing $2,400 per month.

Formerly employed, Kudrin gets combined disability income of $1,466 per month. Currently, Medicaid pays for all of his prescriptions after the state?s drug access plan pays his $700 ?spend down,? or premium.

Kudrin said this leaves him with enough to buy $150 per month worth of vitamins and dietary supplements that make him feel better and improve his quality of life.

After the first of the year, Kudrin worries he won?t be able to afford either the prescriptions or the supplements.

?What do you do when people really don?t care whether you live or die?? said Kudrin.

He criticizes the federal government for making the changes to save money.

?To them it?s money they can spend in Iraq or Iran or wherever is next,? he said.

State says no one will do without

Case managers and social workers say the Ohio Drug Assistance Program has told them that no one will have to do without their medication.

Kate Shumate, who directs the program said, ?I can assure you that people are not going to go without medications as long as it is brought to my attention.?

Shumate said that as long as the patient load remains at the current level, there is enough state money to cover the new costs.

In the Cleveland area, Title I funds are also available to get people through the coverage gap, but those funds are not available outside that service area.

?The state is not going to let people fall through the gaps [on anti-retrovirals]. said Catherine O?Brien of the AIDS Taskforce of Greater Cleveland. ?My biggest concern is the other medications.?

Jason McMinn of Metro Health Medical Center in Cleveland said charity can make up the rest of the cost for some patients.

?The Ohio Department of Health is working with us, case by case, to ensure that the gaps are covered,? said McMinn.

?But where it?s not, people can get rated for charity care.?

McMinn said that people who used to work and thus receive disability insurance, like Kudrin, are ?the most concern.?

He?s also concerned that pharmacies can no longer waive co-payments on drug purchases, as they could under the old Medicaid plan.

At the very least, the situation has caused confusion and fear.

Kevin Sullivan of Ohio AIDS Coalition said his clients are ?concerned and confused.?

Sullivan thinks the new plan may have some benefit for people who can work because it allows them to work more than the old system did.

?However,? Sullivan adds, ?if you were dual-eligible before and now above Medicaid eligibility, this is no little bump in the road.?

Shumate said people need to do things to help themselves and reduce stress, including saving every piece of mail the government sends, carefully picking a drug plan, and communicating issues to case managers and social workers immediately.

With almost half of black gay and bi men HIV+ in some cities, the community works to avoid a repeat of the 1980s

With almost half of black gay and bi men HIV+ in some cities, the community works to avoid a repeat of the 1980s
by L. Michael Gipson

In June, the Centers for Disease Control reported a new national all-time high: One million people in the United States are now HIV positive, and half of those are black.

Before the black community could recover from that startling blow, the CDC also reported that a new five-city study found 46% of all black men who sleep with men are HIV positive.

Just in case you didn?t understand the federal memo, nearly half of all black gay and bisexual men in those five cities have HIV. To give this ominous statistic some perspective, the HIV prevalence rate among black gay and bisexual men in the U.S. is higher than the hardest AIDS-hit sub-Saharan African country, Swaziland, which also has the highest known adult prevalence rate in the world.

The figures for the cities in the study--San Francisco, New York, Los Angeles, Miami and Baltimore--are not necessarily representative of every city in the country, but they show a marked increase from the last study, which said that one-third of black men who have sex with men had HIV. Nearly half means that for every two mistakes, one may have extremely serious consequences.

Despite this gloomy state of affairs, there has been little fanfare in the broader black or gay communities about these announcements. However, in quiet pockets across the U.S., some black gays and lesbians refuse to take the news in stride and are instead fighting back.

In Cleveland, where black gay and bisexual men comprise almost half of all those with HIV, the black gay, lesbian, bisexual and transgender community has been working to save themselves from the high death toll that white gay men in New York and San Francisco faced 20 years ago.

With renewed vigor, social clubs and AIDS service organizations have joined forces and taken on the mantra ?party with a purpose? to describe their efforts to simultaneously meet both the social and disease prevention needs of the black gay community to alter its genocidal course.

Twice a month, a table of black gay men and transgender women convene at the AIDS Taskforce of Greater Cleveland as the Brother 2 Brother Community Advisory Group to hammer out the details of their latest event.

Faithfully, eight to nine concerned citizens and representatives of black gay social groups like the Cleveland Friendship Committee and Da Brothas and Da Sistas try to determine ways to attract and educate Cleveland?s black GLBT community about HIV and AIDS without being preachy or alienating.

Almost monthly, the groups have been developing community building social functions that can route black men into HIV testing and to new HIV educational workshop series like the Afro-centric Many Men, Many Voices offered by the Taskforce?s Brother 2 Brother program. They believe community development is the best antidote to the internalized homophobia feeding black men?s slippery slide to risky sexual and drug-taking behaviors.

Given the disjointed nature of the community the advisory group serves, the body has determined that fun, culturally-centered events should be their primary community development strategy. Besides sweating out the logistical details of each event, the group must also pinpoint ways to market their offerings to a fragmented community lacking the galvanizing spaces of bars, clubs and gay enclaves of the white gay community. There are no black clubs or gay black enclaves for the group to promote their lifesaving ideas and vision for a healthy black GLBT community. With the recent devolution of BlackOut Unlimited, one of Cleveland?s first black GLBT community based organizations, there are no adult spaces that cater daily to the adult black GLBT community.

At each meeting, the group must consider ways to attract black gay and bisexual men who often won?t or don?t identify as gay or bisexual to events that are defiantly gay-identified.

The collaborative agonizes over strategies that effectively infuse HIV education and prevention messages into each event for a community that has demonstrated varying degrees of apathy and fatigue about the barrage of AIDS information targeting them and implicitly demonizes their behavior.

They struggle over how to educate men whose sexual risk-taking behavior is not markedly higher than other male populations, but who, with a background HIV prevalence rate of almost 50%, cannot afford to have any of those other men?s mistakes. Every false move, every misstep a black man takes is weighted with the same probability as a half-filled barrel for Russian roulette.

The black community?s response to the group?s collaborative efforts has been lukewarm. For every outrageously successful Halloween ball there is a mildly attended community-wide forum on HIV and hepatitis C at Cleveland State University, where black sororities, fraternities and student unions were aggressively encouraged by organizers to attend but who all failed to send even one representative.

The group is pinning some of its hopes on the resurrection of a monthly community-forum spun as a black gay talk show, Afro-chats, and the formation of black gay book clubs to provide some consistency in their efforts to regularly mobilize black men. The challenge of their balancing act is clear. Have too many chats focused exclusively on the AIDS crisis or choose too many HIV memoirs and lamentations and the group will end up preaching to the choir or worse?empty seats. Don?t focus enough on the very real possibility of an eradicated black gay male community, fragmented or otherwise, and the group will have mobilized in vain. For glimmers of light and the possibility of success, the group may want to look to the HIV prevention efforts of its young.

Since 2002, the AIDS Taskforce has had a professional development program, the Brother2Brother Peer Leader Training, to cultivate the next generation of young HIV and AIDS prevention leaders in the black gay community.

Since the program?s inception, 23 black gay and bisexual young men ages 17 to 24 have been certified and trained, a third of whom have entered the professional AIDS service field. Throughout the program?s evolution, the Taskforce has hired, contracted, and partnered with teams of black gays and lesbians to implement the program so that empowered members of the black gay community have access to the resources necessary to address the HIV and AIDS issues plaguing their community.

Until the winter of 2003, that collaboration included the former leadership of BlackOut Unlimited, and its youth project, Club 1722. For better or for worse?and everyone has an opinion?dissolution of the BlackOut and AIDS Taskforce partnership in 2004 marked the beginning of the end of BlackOut?s Club 1722 youth group and the beginning of the AIDS Taskforce?s LGBT youth of color satellite center, the Beyond Identities Community Center. Housed at BICC, the B2B Peer Leader Trainee program has been ushering in a new era of local black gay AIDS activism.

The Brother2Brother Peer Leader trainees, the young black men at BICC have been Cleveland?s unsung heroes in the on-going battle against AIDS in the black GLBT community. These young men have led and created five AIDS Awareness social marketing campaigns in three years that have included everything from spoken word CDs to the more recent Destinies Fulfilled DVD film project and poster campaign. The in-your-face sexuality of the Destinies Fulfilled posters have been repeatedly seen by over 50,000 people over two months in 16 street kiosks in the city?s most HIV impacted neighborhoods. The young B2B educators have focused on men in every aspect of the community, from the barbershop to college campus. In 2005, they?ve successfully routed nearly 100 young black men into the black gay-themed Many Men, Many Voices HIV prevention sessions and have argued with thousands of them in front of bars about the merits of consistent condom use.

If the B2B educators have been more successful at reaching their young peers than their elders, it?s partially because of reasons out of the youth and their elders? control. Part of the issue is resources, the amount of federal funding ATGC receives to support BICC and the B2B Peer Leadership Training program is almost three times the amount Cleveland?s Department of Health spends on targeted HIV prevention efforts for all gay and bisexual men?regardless of race?combined. Indeed, despite the fact that the majority of Cleveland?s HIV positive population acquired HIV through same sex behavior, the Northeast Ohio AIDS Regional Advisory Group allocated only 17% of the city?s total prevention budget to support targeted gay and bisexual HIV prevention efforts. State funding cuts and turf wars appear to be more responsible for the lack of state and municipal funding available, rather than apathy or disdain. Still, the outcome leaves gay serving agencies scrambling for supplemental support from individual donors and private foundations.

A much larger issue swinging the pendulum in favor of the B2B youth?s efforts is a matter of sociology and behavioral science. The young B2B educators have BICC to use as a socializing base whose assistance in influencing a more positive self-identity and more sexually health, drug reducing group norms in the youth community is invaluable. The young men use BICC to be able to create a stronger sense of community, while their elders must resort to a string of dates and events to build a community whose older members seem ambivalent about identifying as a separate, sexually-identified community, especially not at the sake of their pre-existing black and faith communities. Which is where the community building activities of the Cleveland Black Gay Pride committee is intended to come in.

In 1997, Cleveland experienced its first Black Gay Pride, joining nearly thirty cities with separate Black Gay Pride events across the US. These events were developed in response to black gay invisibility and alternating black experiences with white gay racism and paternalism. Once known as merely extended sex and drug parties, Black Prides have evolved into HIV testing, education and awareness building machines, with every event liberally including the organizing efforts of HIV educators and activists. 2005 marked the first year that the Cleveland Black Gay Pride Committee expanded its Black Gay and Proud Celebration to a full week of affirmation and solidarity building events. By most standards, the week was an unmitigated success with hundreds of black GLBT people equally attending both the social and educational calendar of events.

However, a curious and alarming thing happened this year, a critical mass of black gay and bisexual men 25 to 40 were notably absent from the party; the very group most likely to become HIV infected. Begging the question, what can the Black Gay Pride Committees and Brother 2 Brother Community Advisory Groups do to get the adult men in their community to not only care enough about themselves to stop engaging in risky behavior, but to actually show up to the services and events that could ultimately assist them in changing their behavior?

The answers for how to save black men are not clear. What is clear is that condom demonstrations and testing campaigns alone will not be enough to address the unrelenting psychological and socio-economic issues that influence the risk-taking behaviors of black men. A paradigm shift of community building that marries the cultural traditions of the black community, the spirituality of the faith community, the sexual progressivism of the gay community and even the economic empowerment focus of conservatives might be a start. What is working in Cleveland?s favor, at least for now, are the small but devoted collection of men, women and adolescents who are willing to roll up their sleeves to meet the Herculean challenge of finding the answers and helping one another avoid that one fatal misstep, lest another aspect of the black male community becomes known as a new endangered species.

L. Michael Gipson is the director of education for the AIDS Taskforce of Greater Cleveland and was one of the co-founders of the Beyond Identities Community Center.