richard kearns, poet activist
[monday, august 18, 2008]

i stand before you this evening as a member of SCHAC, the southern california HIV advocacy coalition. SCHAC’s mission is

• to expand access to quality health care and treatment for all people living with HIV/AIDS;

• to advocate for appropriate funding for HIV/AIDS programs within the state of California; and

• to lobby for legislation and public policies that promote the health, welfare and civil rights of all Californians affected by HIV/AIDS.

it is my joy to unofficially inform you that SCHAC has come out in opposition to prop 8; we have vowed to say no on the same-sex marriage ban, and we urge all HIVers in california and our allies to vow to say no also. i want to share with you tonight some of the board’s thinking behind this action.

our position is intended to focus attention on the significant public health benefits of marriage equality. same-sex marriage saves lives. we wish to point out that, in the gay community, first and hardest hit in the AIDS epidemic,

• marriage provides us greater access to the in-place system of employer-based health insurance benefits, which means more effective access to medicine, therapies and healthcare providers for gay HIVers

• persons who are married are more likely to be monogamous, a protection to themselves and to others from the spread of the virus

• families are primary units of public health infrastructure. wider participation in the institution builds infrastructure and the nation is healthier as a result

• AIDS is a chronic health condition punctuated with repeated, inevitable, acute episodes. it can be overwhelming to manage your own healthcare crises when you are sick, and a spouse’s advocacy can save your life

• love is healing. marriage — the companionship, the partnership, the secure social & cultural standing — must be considered significant parts of the personal infrastructure of healing, addressing issues of loneliness, fear, isolation, abandonment and dimished ability that are themselves life-threatening

as one board member pointed out during out discussion, marriage doesn’t automatically fix things

yes, i replied, but it gives us the possibility to “fix things” that didn’t exist before, and that changes everything.

i suggest to you this evening that the AIDS epidemic is an emotional engine for the same-sex marriage movement, much as it is for medical cannabis movement. and while i do want to eat lunch in this town again, wise counsel is more important than lunch.

vow to say no on 8. for longer, healthier, more livable lives across america and the world

namaste

—richard kearns
http://aids-write.org
rk@aids-write.org

Engagement and Deliverance at the CDC, Part 1

Nedra Weinreich
spare change

. . . Last week at the CDC’s 2nd National Conference on Health Communication, Marketing and Media, . . . So many sessions were scheduled, and nearly every one was spot-on as to the topics I want to learn about, that it was hard to choose which ones to attend. . . .

[here are notes & links from two of the many conference presentations on spare change —rk]

. . . Plenary session

• James Surowiecki, author of The Wisdom of Crowds, talked about how, under the right conditions, a group’s decisions can be smarter than those of the smartest person in the group. He used examples like Google’s pagerank algorithm, racetrack betting and Best Buy’s yearly gift card sales. His point is that if you can devise a way to aggregate individual predictions simultaneously, and to do this within a diverse group of people with different perspectives and ways of approaching problems, the random errors will cancel each other out and you will end up with the closest approximation to the correct answer.

Key lessons: 1) When assembling a team to solve a problem, bring in people with many different viewpoints and skills. 2) Encourage disagreement. 3) Limit the amount of back-and-forth dithering, which leads to worse decisionmaking.

. . . Applying Emerging Theories to Engage the Public

Jennifer Heilbronner, Metropolitan Group - Jennifer spoke about building public will, and how this is a different process from social marketing. She defined it as “a communication approach that builds public support for long-term social change by integrating grassroots outreach methods with traditional mass media tools and connecting an issue to the existing, closely held values of individuals and groups.” While I think she was contrasting this process to the too common mass media-focused, short-term campaign blast many people think is social marketing, her description of public will building is much closer to the more comprehensive marketing mix-driven social marketing process to which many of us in the field adhere. You can download her group’s Public Will Framework to learn more about their process.

August Election Poll: One in Four Americans Continues to Struggle Paying for Health Care
Kaiser Health Tracking Poll: Election 2008 — August 2008

The latest Kaiser Health Tracking Poll: Election 2008 poll finds that one in four (24%) Americans continues to struggle with paying for health care. Health care ranks as a “serious problem” above paying for food (18%), problems with debt (16%), and paying the rent or mortgage (15%) and below paying for gas (37%) or getting a good paying job or raise in pay (26%).

Among the 24 percent that find paying for health care or health insurance a serious problem, those in the poorest health and those with the most need disproportionately report difficulties.

• Half (50%) of the uninsured say paying for health care is a serious problem.

• About four in ten of those with annual household incomes under $30,000 (42%), those living with someone who requires care (42%), those who report their physical health as “fair” or “poor” (40%), and the unemployed (37%) also report struggling with the cost of health care.

• Members of two minority groups, Hispanics (39%) and African Americans (35%), indicate disproportionate problems paying for care.

• Three in ten of those with two or more hospital overnight stays (31%) and two or more emergency room visits (30%) in the past year also report problems paying for care. The August poll, the ninth in a new series designed and analyzed by the Foundation’s public opinion research team, also examines public perception of the major presidential candidates’ positions on health care and reform.

“The economic downturn has heightened the pain of paying for health care for many Americans, but as this latest tracking poll shows, especially for people who are sick, lower income, or uninsured,” said Drew Altman, Kaiser’s president and CEO.

The August poll, the ninth in a new series designed and analyzed by the Foundation’s public opinion research team, also examines public perception of the major presidential candidates’ positions on health care and reform.

Generally, the public’s perception of Democratic nominee Senator Barack Obama and Republican nominee Senator John McCain on health care issues indicates that Obama maintains the traditional advantage of his party on these issues. When asked who better represents their own personal health care views, nearly two times as many registered voters name Obama (42%) as they do McCain (24%). Independent voters are a key factor for Obama’s rating on health care as they are more likely to see him as reflecting their own views on the topic — 37 percent versus 21 percent for McCain.

When voters were asked which candidate “would be more likely to make health care reform a top priority,” roughly three times as many voters mention Obama (58%) as they do McCain (20%). A majority (56%) of independent voters and even three in ten (29%) Republicans say they think Obama would be more likely to make health reform a top priority.

When voters are asked about the candidates’ abilities to address specific aspects of health care, Obama is chosen by a majority to do more to expand coverage for the uninsured (63%) and make health insurance more affordable (54%). Voters appear split on which candidate would do more to lower overall health care spending with McCain garnering 36 percent and Obama 34 percent.

Health care is holding its position among the top voting issues according to the August Election 2008 Tracking Poll, but is not a dominant voting issue. The economy (49%) is far and away the top voting issue with Iraq (25%), gas prices (18%), and health care (16%) rounding out the top four.

The poll involved a national representative random sample of 1,517 adults (including 1,362 adults who say they are registered to vote) interviewed by telephone between July 29 and August 6, 2008. The margin of sampling error for the full sample and for the registered voters is plus or minus 3 percentage points. For results based on subgroups, the sampling error is higher. The poll brief and comprehensive toplines are available online.

Key Findings

Toplines

California doctors can’t refuse treatment to gays on religious grounds, court rules
The state Supreme Court decides that an antidiscrimination law takes precedence over doctors’ right to religious freedom.
By Maura Dolan, Los Angeles Times Staff Writer
August 19, 2008

SAN FRANCISCO — Doctors may not discriminate against gays and lesbians in medical treatment, even if the procedures being sought conflict with physicians’ religious beliefs, the California Supreme Court decided unanimously Monday.

In its second major decision advancing gay rights this year, the state high court ruled that religious physicians must obey a state law that bars businesses from discriminating on the basis of sexual orientation.

“The 1st Amendment’s right to the free exercise of religion does not exempt defendant physicians here from conforming their conduct to the . . . antidiscrimination requirements,” Justice Joyce L. Kennard wrote for the court.

The decision stemmed from a lawsuit filed by Guadalupe T. Benitez, an Oceanside lesbian who lives with her partner and wanted to become pregnant with donated sperm.

Benitez filed a suit after Dr. Christine Brody, an obstetrician and gynecologist at the North Coast Women’s Care Medical Group in Vista, said she would not perform an intrauterine insemination. In her lawsuit, Benitez alleged that Brody said her religious views prevented her from providing the procedure to a lesbian.
Another physician at the clinic, Dr. Douglas Fenton, later told Benitez that the staff was uncomfortable helping her conceive a child and advised her to find another doctor outside the medical group, Benitez said.

The doctors denied the allegations. Brody said she would not perform the procedure on any unmarried woman, heterosexual or homosexual.

The state high court said the doctors’ constitutional rights to freedom of religion did not trump the state antidiscrimination law because the state has a compelling interest in ensuring full and equal access to medical care.

But the doctors “remain free to voice their objections, religious or otherwise, to the [law’s] prohibition against sexual orientation discrimination,” Kennard wrote.

The court also said the doctors could testify at a trial that their religious beliefs barred them from doing the procedure for reasons other than the patient’s sexual orientation.

Robert Tyler, general counsel for Advocates for Faith and Freedom, predicted that the ruling would spur voters “to recognize the radical agenda of our opposition” and support a November ballot initiative that would amend the state Constitution to ban same-sex marriage in California. A state Supreme Court ruling in May made gay marriage legal.

Kenneth R. Pedroza, who represented the doctors, said the ruling would probably cause many physicians to refuse to perform inseminations at all. Pedroza said Brody did not violate the law because it did not bar discrimination on the basis of marital status when Benitez sought insemination in 1999. The state law has since been amended.

Asked whether Brody would perform the procedure on a married lesbian, Pedroza said: “I don’t know.”

But Jennifer C. Pizer, senior counsel for Lambda Legal, said Benitez’s experience was “sadly common” for lesbians seeking reproductive healthcare.

“We get calls routinely about it,” she said.

Benitez, 36, who is now the mother of three, said she has been pursuing her case for 10 years.

“This isn’t just a win for me personally and for other lesbian women,” Benitez said. “It’s a win for everyone because everyone could be the next target if doctors choose their patients based on religious views about other groups of people.”

Justice Marvin R. Baxter, the court’s most conservative justice, said in a separate concurring opinion that doctors could protect against liability by referring patients to other doctors in their practice who did not share their religious objections.

But he conceded that sole practitioners might have little choice and hinted that he might vote in a future case to spare them from the requirement.

“I am not so certain this balance of competing interests would produce the same result in the case of a sole practitioner,” Baxter wrote. The court did not specifically address that question.

A spokesman for the California Medical Assn. said it opposes “invidious discrimination” and believes it is “not protected by a claim of a religious belief.” The spokesman said he did not know what practical effect the decision would have on doctors and stressed that the group has no position on what the outcome of the lawsuit should be.

A trial court ruled for Benitez, but an appeals court overturned that decision in favor of the doctors. After the case landed in the state high court, civil libertarian groups sided with Benitez, and religious groups, including Jewish and Islamic clergy, argued that doctors were entitled to disavow treatments that conflicted with their beliefs.

Monday’s ruling clears the way for Benitez’s case to go to trial.

maura.dolan@latimes.com

chers—

there are two historical models of plague whose records we can study to try and understand effects and course of the AIDS plague — first, the 14th century bubonic plague, and second, the 1918 influenza epidemic.

so these findings offer clues about ending AIDS. this seems to be a pretty good resource article.

namasté

—rk

Bacteria played a role in 1918 pandemic flu deaths, scientists say

The virus triggered a violent immune response that injured the lungs, making them a target for bacterial infection, two studies say. The findings may guide preparations for future outbreaks.

By Mary Engel, Los Angeles Times Staff Writer
August 18, 2008

Most deaths in the 1918 influenza pandemic were due not to the virus alone but to common bacterial infections that took advantage of victims’ weakened immune systems, according to two new studies that could change the nation’s strategy against the next pandemic.

“We have to realize that it isn’t just antivirals that we need,” said Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases and coauthor of one study. “We need to make sure that we’re prepared to treat people with antibiotics,” said Fauci, whose study will be released online this month by the Journal of Infectious Diseases.

In both studies, scientists analyzed a trove of historical documents from around the world, examining firsthand accounts, medical records and autopsy reports.

Writing about the 1918 influenza outbreak in the August issue of the journal of Emerging Infectious Diseases, researchers reported that few deaths were swift, which is what scientists believed characterized a viral pandemic. Instead, they found most deaths occurred a week to two weeks later — indicating the deaths were the result of opportunistic bacterial infections.

Most of the bacteria recovered from patients, dead or alive, are common colonizers of the noses and throats of healthy people, according to coauthors Dr. John F. Brundage, a medical epidemiologist at the Armed Forces Health Surveillance Center in Silver Spring, Md., and Dr. G. Dennis Shanks, director of the Australian Army Malaria Institute in Queensland.

Both groups of researchers were trying to understand why the 1918 virus — a novel strain of influenza for which few people had natural immunity — was so lethal. The virus swept the globe, killing an estimated 50 million people, striking down young, healthy adults even though influenza usually kills the very young, the elderly and the chronically ill.

It has long been recognized that most flu deaths are due to pneumonia caused by secondary bacterial infections.

But to explain the 1918 pandemic’s unusual virulence, many scientists had come to believe the virus killed by provoking an overzealous, destroy - the - village - to - save - it immune response, especially in young adults with robust immune systems.

In a previous experiment, scientists reconstructed the 1918 virus — using a genetic blueprint pieced together in 2005 from scraps of frozen DNA — and injected it in mice and monkeys. The animals’ immune systems responded violently, inflaming and flooding their lungs with blood and fluids, essentially drowning them.

A similar overkill response has been seen in deaths from the ongoing avian flu outbreak that began in Asia. Capable of jumping the species barrier, the H5N1 virus has infected 385 people, killing 243 of them, and scientists fear that it could mutate easily from human to human instead of bird to human.

The two new studies suggest the 1918 virus did induce severe immune reactions, particularly among young adults. But what made the reaction so deadly was that it destroyed the lining of the respiratory system, making it easier for bacteria to infect the lungs.

In most infected populations, Brundage and Shanks found less than 5% of flu deaths occurred within three days of the illness’ onset. The median time from the onset of symptoms until death was 7 to 10 days. A significant number died two weeks after their initial symptoms, which is typical of bacterial pneumonia.

Michael Katze, a University of Washington virologist who was a lead scientist in the mice and monkey experiments, said the animals’ violent and rapid immune response made it “almost unreasonable” to expect victims of the 1918 virus to live long enough to develop secondary infections.

But he acknowledged the flu pandemic deaths could have been the result of a polymicrobial infection — a co-infection by multiple microbes.

“Certainly the idea that resident bacteria flora already present could play a role in developing pneumonia is relatively reasonable,” he said. “If the 1918 flu had any impact that compromised [immune] function, it could render a normal resident bacteria pathological.”

So far, public health officials around the world have focused on stockpiling vast quantities of vaccines and antiviral drugs to combat future pandemic flu strains.

Fauci said scientists also needed to develop new antibiotics as well as vaccines against bacteria, especially against a virulent strain of Staphylococcus aureus that has been linked to seasonal flu deaths and is resistant to many antibiotics.

mary.engel@latimes.com

Court asked to order state to pay $8 billion for inmate health care
By Andy Furillo - afurillo@sacbee.com
Published 10:14 am PDT Wednesday, August 13, 2008

California prison medical care receiver J. Clark Kelso filed a legal motion today to force the state to come up with $8 billion over the next five years to fund his plan to build seven long-term care facilities and provide other improvements for inmate patients.

The action filed in U.S. District Court in San Francisco also seeks contempt of court citations against Gov. Arnold Schwarzenegger and state Controller John Chiang.

Kelso said he is still talking with the governor’s and controller’s offices and other officials to resolve the dispute over funding of his medical plan but that he will ask that both Schwarzenegger and Chiang be present at a scheduled Sept. 22 hearing in San Francisco if the issue is not resolved.

“We have fully explored and exhausted every avenue for securing this funding in a manner that least affects California’s budget and immediate cash needs,” Kelso said at a press conference at his downtown Sacramento headquarters. “But the state’s leaders have failed to act. Therefore, it is with great reluctance and yet a sense of firm conviction that today I seek the federal court’s intervention to secure this funding.”

Kelso said he wants $3.1 billion in the 2008-09 fiscal year. The request would increase the projected $15.2 billion spending shortfall for the year by another 20 percent.

He said Schwarzenegger and Chiang “have repeatedly refused to provide timely construction funding to the receiver,” which Kelso said “stands in stark contrast to their recent public assertions of extraordinary powers to control state spending regarding state employee salaries and other obligations.”

Amid the budget crunch, the governor has sought to cut salaries on tens of thousands of state workers to the federal minimum wage. The controller has said he will refuse to cut the workers’ pay and that he will continue to cut them checks at their regular wages.

Schwarzenegger spokesman Aaron McLear issued a statement today that the administration “will continue to work cooperatively with the receiver and the Legislature to move forward in a fiscally responsible way to provide the necessary funding for the Receiver’s efforts.”

Chiang, in a prepared statement, said he needs legislative approval or a court order to compel him to make any payments. He said the state will have to pay for the receiver’s medical plan “one way or another” and that lease revenue bonds would be the most “fiscally appropriate.”

Kelso blasted the Legislature for failing so far in its current session to provide bond funding for his project. He singled out the state Senate’s Republican caucus for holding up the bonds because of its concern that last year’s prison construction bond plan hasn’t taken hold.

A spokeswoman for Senate GOP leader Dave Cogdill of Modesto did not have an immediate comment on the receiver’s motion.

Kelso flashed anger in answering a question on why he is taking his legal action now, with the Legislature wrangling with an overdue budget and in the final weeks of the 2007-08 legislative session.

“I indicated to the Legislature that I did not want to be drawn into the budget vortex where late-night deals are made, without public consideration, and without time for thoughtful consideration,” he said. “I don’t want to be drawn into that. They’ve had plenty of time since (the failure of the bond bill) to act on this. I’ve waited really as long as I can wait. I do have a serious cash flow issue I need to get resolved.”

He said he needs an immediate $360 million to keep the construction planning process moving forward.

Kelso’s medical plan for the prisons includes upgrades to health care facilities at all 33 state prisons as well as the seven new facilities he hopes to build in Folsom, Stockton, Ventura, Chino, Solano County, Whittier and San Diego. He also has since been charged by the courts to oversee judicially-mandated improvements to dental and mental health facilities in the prison system.

The receiver is operating under a federal court order, never challenged by the Schwarzenegger administration, that gives him power over state prison medical operations that now cost $2 billion a year, not counting the capital construction programs.

His office was created after U.S. District Court Judge Thelton Henderson in San Francisco found that an inmate a week was dying due to medical neglect and ruled that prison medical care in California violated constitutional protections against cruel and unusual punishment.

A DANGEROUS SHIFT
The wrong way to fight AIDS

By Laurie Garrett
Published: July 30, 2008
international herald tribune

In a few days [published just prior to the opening of the mexico city conference —rk] some 20,000 people who work in various capacities on the AIDS pandemic will gather in Mexico City for the International AIDS Conference. I will not be there: This will mark the first AIDS Conference I have deliberately missed since 1985, when a cluster of scientists convened the first such gathering in Atlanta.

Many of the leading lights in the battle against AIDS from all over the world are similarly disinclined to attend, saying they are not able to join in celebrating the creation of a vast, multibillion dollar AIDS treatment industry, employing hundreds of thousands of individuals worldwide that serve as a vested lobby on behalf of a prolonged medical approach to a virus that ought to be eliminated entirely from the pantheon of threats to Humanity.

Do not misunderstand - there is genuine joy among us every day that millions of people are kept alive because of the 1996 invention of combination drug treatment for HIV. All HIV-positive people the world over should be able to share in the benefits of those treatments, and the U.S. Congress is to be congratulated for recently passing a $48 billion reauthorization of the President’s Emergency Plan for AIDS Relief, or Pepfar.

But it is troubling that formerly militant activists, United Nations agency leaders, government health officials, the American foreign policy establishment, religious leaders, scientists and physicians fail to see AIDS treatment for what it is: A stop-gap measure to tide humanity over until we can collectively reach what ought to be our real goal - stopping HIV’s spread, entirely. On an individual basis living with AIDS is a proper goal; on a population basis it is catastrophic.

The slogan of the first 15 years of the pandemic was, “Until there is a cure!” Today it seems the global health leadership of the world is satisfied with, “Until there is lifelong drug therapy for everybody, and no prevention strategy!” A dangerous sentiment is sweeping over the AIDS establishment, calling for elimination of all funding for HIV vaccine research and prevention programs, shifting those dollars, euros and yen to expanding HIV treatment.

It is inconceivable that children coming of age in 2021 - 40 years after the recognized start of this epidemic - will feel gratitude toward today’s leaders for saddling them with a still widely circulating virus. If today’s HIV-treatment model is viewed as an interim step - keeping people alive until a cure and vaccine are discovered - its funding and expansion make sense not only morally, but also as a practical matter of economics and foreign policy - but only if a massive commitment to funding searches for both a vaccine and cure for HIV are sustained for years to come. (Even the cancer lobby recognizes the needs for both oncology treatment access and ongoing curative research.)

Yes, recent news from the HIV-research front is demoralizing. The best-funded HIV vaccine trials have all failed over recent months, or been halted due to serious safety concerns. The vaginal microbicide trials have fared even worse, with the compounds actually increasing the likelihood of women becoming infected.

As for “cures” - no leading figure in HIV research has publicly uttered the word cure since the early 1990s. Most of the multibillion dollar HIV research enterprise focuses on improving the treatment model that is already in place, finding new, consistently more expensive drugs to add to the existing cocktails. The global price of this giant treatment exercise will inexorably increase.

The economist Mead Over of the Center for Global Development warns that with Pepfar, “the United States has unwittingly created a new global “entitlement” to U.S.-funded AIDS treatment that currently costs about $2 billion a year and could grow to as much as $12 billion a year by 2016- more than half of what the United States spent on total overseas development assistance in 2006. And the AIDS treatment entitlement would continue to grow, squeezing out spending on HIV prevention measures or on other critical development needs, all of which would be considered “discretionary” by comparison.”

By 2016, meanwhile, Americans may find themselves fed up with generosity. If we cannot find a way to reform the U.S. health care system, we will likely by then have some 80 million citizens without health insurance, including HIV-positive people, and medical costs will devour $1 out of every $4 of America’s GDP. We will be servicing a national debt in the trillions of dollars while struggling with everything from global climate change to catastrophic disparities in access to food, energy and water. Our dreams require a dose of realism.

At the Bill & Melinda Gates Foundation there is much talk of “aspirational goals” in health, such as dreaming of eradicating malaria. What is the aspirational goal for AIDS?

Shout it loud in Mexico City: “Until there is a cure!”

Laurie Garrett is a senior fellow for global health at the Council on Foreign Relations.

I remember when Russell came home the first time. A Sunday afternoon.

The occasion was a homecoming for me too—one more of a zillion homecoming - from - the - hospital parties. Pardon me — brunches and openhouses.

This time my hospital stay had been necessitated by an eye infection that went berserk. Every half hour, for six days and seven nights, ceaseless nurses put two different super-potent antibiotic drops in my left eye. It was perfect medical management: the mild madness of sleep depravation kept me from realizing how brutal a hit the rest of my body was taking from the toxicity of the antibiotics. Before I could object, my eye was saved.

Sixteen weeks until I was up and around again. Not what I would call being in the loop.

Back to Russell.

I love every homecoming party I have ever been to. I never counted to find out how many. I have liked them all, first for the obvious reason: my ability to attend. Second: I like the rite of passage the homecomings have become.

I love the flowers everyone brings.

In the weeks following any return from the hospital, my place will be afloat in flowers. Brilliant yellows, hot reds, lavenders, rose whites and leafy greens. Perfume in the air. It’s like Spring is a houseguest.

I love the flowers. I contemplate them, and stay with them as they wilt, and droop, and turn brown, and gather bits of mold. They never really die. Someone else always throws them out and cleans the vases. I can’t bear to.

Back to Russell and the homecoming.

The crisis had passed. The watch was over.

Come to me, all my Watchers, you who were at your posts these six days, seven nights and more, come to me. I felt your vigilance, I felt your readiness to live or die as I did, I felt your prayers like smoke, your restless nights by my bed or in your own. Come to me. Come close. Stand next to me a moment, and together let us observe life slithering along toward better. The watch is ended; the peril past; return to your own ways with my gratitude, which burns like my tears.

Russell was one of the watchers this time.

So was Sam.

So was Ruth.

So was Saint Lillian.

So was Emmie Lou.

Russell was late, of course. He appeared to be in danger of missing the party.

We were the last ones, winding it down, waiting for him. They’d never met him.

Sam. Blonde, tall, skinny, Hamptons chic, with a deep, rich, expressive voice honed from a lifetime of theater. Sam and I lived together for five years. I haven’t gotten over him.

Before I came home, Sam and Saint Lillian stopped by my apartment to clean. Sam did my laundry. Sam is the best folder of clean clothes in the known universe. Even underpants. Even Speedos. Even teeny, silky, sexy, zippered and strapped stuff, the folding challenges.

Folded to perfection. Corners sharp as thorn, like the poet says.

Ruth. Ruth is the Rita Hayworth of Southwestern Unreformed Episcopal University. Drove an Audi Turbo TT at the time. My ex-wife. Chair of the English Department, and therefore my boss. A soul of adamantine brilliance, diamond durable. My shelter and refuge. Long, chestnut red hair this day. Clear lucite spiked heels that cheered me up tremendously.

Emily. Emmie Lou. Emmie. Interchangeable names. Emily was my healer, my acupuncturist. Her mentoring was part of my healing. She was dressed in an amazing floor-length tailored tunic that looked like it had been designed by Calvin Klein. Grey outside. White underneath. “Can’t genius be fascinated by madness without chasing after it?” she asked me when I first talked with her about Russell. Here she was, to be supportive, to see for herself. And she’d never met Saint Lillian before.

Saint Lillian. One of the original LA boon companions. Saw me with Ed back at the 1979 writer’s workshop. Saw me move to LA. Saw my marriage to Ruth. Saw me with Jeff. Saw me leave Ruth and move in with Sam. Saw me break up with Sam. Liked Emily. Now, she was waiting to meet Russell. I confessed to her: I was as close to being in love with him as you can get without actually saying it out loud.

Saint Lillian came to me in the hospital. She hated hospitals. As a kid, she’d watched her family die in hospitals. She warned me, often, that she didn’t visit hospitals anymore. Ever. She came to me despite.

Russell came to me in the hospital also. I don’t know how he made himself do it, he was terrified of all things medical. Russell had AIDS with me, but refused to go to doctors, have blood tests, Take Steps. His cure and his refuge were in crystal meth. The only time Russell needed me to take him to the hospital, he went into hiding, and it was three days before I could bring him in. He wouldn’t get his own meds, but would take anything of mine that I would let him. Or beg him to take.

Anyway.

His timing was perfect.

We’d started to pack the party up, speculating about why he’d failed to show. “He’ll be here sooner than you think,” Emmie said, without revealing her sources.

There came a crash of garden pottery from the patio. He was here. He’d probably been sitting out there for the last fifteen minutes listening to us. Russell could never resist making an informed entrance.

We all turned toward the open porch door, expectant. It was involuntary.

A pause: one beat, then two. Where was he? What was he doing?

Russell swept into the room, arms raised up like a diva taking in adulation, and he wore the Great White Smile.

Russell was an incredible hunk when I met him ten years ago. Six foot one-eighty. Nice chest. Tanned. Dark brown hair. Startling blue eyes. Sky blue, the way it ought to be. Master of charm. Master of the incandescent smile.

He was on the threshold of his thirties then. He was on the threshold of his forties now, and fighting it.

He remained six foot one-eighty, but it hung on him differently. He had a spare tire. The baby fat was gone from his face. Dressing was a serious and protracted matter of inner debate and much soaking in the tub for him. It is why he was always late. But he still looked great naked, which was where it counted, so he was content with that and minimized anything other. Always a charmer. Always a smile.

He stood there in my blooming living-room-slash-office, arms extended, wearing my favorite silk print shirt. Ruth had given it to me six years ago at Christmas. I lived with Sam at the time. Creamy white with huge black inky brushstrokes and smaller dabs of red. Raised eyebrows, both Ruth and Sam. Emmie Lou giggled and covered her mouth with her hand.

It was the shirt I had intended to wear myself for the homecoming. I was sporting a black eyepatch from the hospital that would have been perfect with it, but when I couldn’t find the shirt in my closet, I figured it was at the cleaners or something, and would surface later.

Russell looked fabulous. (I would have looked better, but I had the eyepatch, so it wasn’t really a competition, even if he filled it out more. “That shirt needs meat in it,” he told me later. “You didn’t need it. You looked way better in what you wore.” I’d worn jeans and a Nino Cerruti double-breasted dark grey pinstriped blazer with no shirt underneath. Eyepatch added, and I was a heartbreaker again.)

Saint Lillian, who was clueless but puzzled, was the first one to speak and break the ice. “Hey, Russell, great shirt. I’m Saint Lillian—Captain’s told me a lot about you, I’m glad to finally meet you.” She held out her hand for a hearty shake. “Doesn’t the Captain have a shirt that looks like that?”

It was an unusual life moment.

Introductions all around. Jokes about making entrances. Russell ducked out to the porch to retrieve his backpack. He hadn’t brought any flowers, nor had I expected he would. Russell was always broke. For that matter, I was always broke.

He’d brought something, though. He clutched the shadowy green and black backpack to his chest and made his way purposefully to the kitchen, where he opened the tool drawer, pulled out a screwdriver, and then ran into the bathroom, shutting the door quickly behind him.

Well.

There are only so many times you can make a first impression.

He stayed in the bathroom for quite a while. We cleaned up. Ruth washed dishes and packed trash to be taken out. Saint Lillian wrapped leftovers in aluminum foil and put them in the fridge. Sam 409-ed every surface he could find. Emily burnt a little sage at my personal alters for Raven and Gwan Yin, restocked my supplies with fresh smudge sticks and a bag of votaries from her purse, She threw out the empty teacandle shells. I watched. Everyone lingered, waiting to find out what Russell was doing in the bathroom.

We heard him move to the hallway and start rousting around in the linen cabinets, opening the doors and slamming them shut.

Conversation ceased. We sat down and waited.

Silence in the hall.

The sound of one linen cabinet door shutting. Then another.

More silence.

Russell reappeared in the hallway entrance. There was a sheen of sweat on his face, and several curls of hair were slick and flat on his forehead. Superman in brown tones, but my judgment is colored.

He smiled at the group.

His blue gaze found me, and he turned the wattage way up on his smile.

He took three big steps through the dining room into the living room, grabbed my hand, pulled me out of my chair and led me to the bathroom, where I saw what he did.

Russ had replaced every one of my drab, old, wooden, paint-stuck cabinet handles with the most beautiful cabinet knobs I had ever seen.

They were pewter spheres, burnished so that every shade of grey you might ever imagine, light to black, was reflected on their surfaces. They had corners—or, more correctly, each sphere had one corner in its lower left or lower right quadrant (depending on which way the cabinet door opened). But the corners made the spheres subtly, irresistibly, somehow magically art deco in style. You could feel the weight and sway of them in your fingers by just swinging the doors on their hinges, and you could tell they weren’t merely cabinet knobs, they were butlers and major domos and house sergeants, the close-mouthed custodians of vast troves of treasure.

That was the moment. That was when I knew—right then. I was certain. He was home. I kissed him hard. Russell kissed me back harder.

We returned to the living room a little dazed. Russell hadn’t wanted to depart the bathroom, and while I liked that notion in principle, I couldn’t go to the floor while my best friends sat waiting down the hall. We wouldn’t have been quiet, either.

We showed off the new pewter in the bathroom and on the linen cabinets. The others seemed puzzled, but impressed nonetheless. Emily tapped one of the globes with a finger as if she were testing to see if it was hot. Her finger rested on the sphere, and she looked at me and pursed her lips.

They departed. Finally.

“I thought you liked that shirt,” Ruth said to me on the way out. “What did you give it to him for?”

“He’s borrowing it,” I said. “Like sisters.”

“Oh,” said Ruth, frowning. Then a smile, and a kiss on the cheek, a furtive glance over my shoulder to make sure Russell wasn’t close by, and she was gone.

We had no trouble picking up where we had left off, and the dishes were already washed, the garbage already taken out. We lit the candles everywhere, and turned out the lights. “Lighting a candle is invoking the presence of god,” Russell used to say. I glanced around expectant every time he said it.

In the night, before the morning, after we had finished our kissing and were lying together in wonder, night’s candles still burning, I began sobbing uncontrollably.

It’s a thing that happens every first or second night home from the hospital. Fear, horror, rage, desperation, panic, misery and pain, the monsters I suppress in order to function as the head of my own medical enterprise—they all come rushing home too, there on the shore of sleep, stealing along the passages of dream, and I am undone, and must wash away their tracings with tears.

Also, I’m very emotional about sex. It’s not like it’s the first time I’ve ever burst into tears in bed.

Russell held me, and rocked me, and it was enough. I didn’t know if he understood my weeping, but I know he wept with me, and I know it was because he never wanted to lose me. I was his pearl. I was his Captain. In zen terms, his fear of losing me had finally overcome his fear of losing me.

Maybe not zen.

Book editors protest cuts at the Times

Four past book editors of the Los Angeles Times — Sonja Bolle, Digby Diehl, Jack Miles and Steve Wasserman — released a letter protesting the planned termination of the Sunday Book Review, which apparently will be replaced by a smaller number of pages appended to the Calendar section.

LOS ANGELES, Calif.–As former editors of the Los Angeles Times Book Review (1975 through 2005), we are dismayed and troubled at the decision by Sam Zell and his managers to cease publishing the paper’s Sunday Book Review.

This step signals the end of an era begun 33 years ago when Otis Chandler, then the paper’s publisher and owner, announced the debut of the weekly section. Since then, the growth of the Los Angeles metropolitan region and the avidity of its numerous readers and writers has been palpable. For example, every year since its founding in 1996, the Los Angeles Times Festival of Books has attracted upwards of 140,000 people to the UCLA campus from all walks of life throughout Southern California. Four hundred writers from all over America typically participate. The written word is celebrated. It is the most significant civic event undertaken by the Los Angeles Times to deepen literacy and to strengthen the bond between its news coverage and its far-flung community of readers. But without the Book Review itself, the book festival will be a hollow joke.

The dismantling of the Sunday Book Review section and the migration of a few surviving reviews to the Sunday Calendar section represents a historic retreat from the large ambitions which accompanied the birth of the section.

To be sure, no section of any newspaper can remain hostage to past ways of covering the news of the day. We are convinced, however, that the way forward is to increase coverage of our literary culture — a culture that every day is more vibrant and diverse in the thriving megalopolis of Los Angeles.

Angelenos in growing number are already choosing to cancel their subscriptions to the Sunday Times. The elimination of the Book Review, a philistine blunder that insults the cultural ambition of the city and the region, will only accelerate this process and further wound the long-term fiscal health of the newspaper.

We urge readers and writers alike to join with us as we protest this sad and backward step.

Sonja Bolle
Digby Diehl
Jack Miles
Steve Wasserman

Added: Publishers Weekly reports that two book editors are being laid off at the Times, and blogger Sarah Weinman (Confessions of an Idiosyncratic Mind) notes the Tribune’s Hartford Courant just laid off its books editor.

Medical Marijuana Patients and Supporters March at DNC
Protesters Call on Obama to Stand Up for Medical Marijuana

On Thursday, August 28, 2008, medical marijuana patients and supporters will march in front of the Democratic National Convention in Denver, CO, calling on Barak Obama to change federal laws that prohibit medical cannabis in the twelve states where voters approved its use. “This will be the first national medical cannabis protest since patients and activists gathered in Washington, DC, in April 2000,” said parade organizer Richard Eastman, who has been using medical cannabis to treat the symptoms of AIDS since 1994.

“Patients are angry that the federal government continues to harass and prosecute medical cannabis patients and providers, while blocking research into the drug’s medicinal benefits. We are tired of seeing friends arrested and harassed for using the medicine that helps hundreds of thousands of patients stay alive,” said Eastman.

“It is time for the federal government to change its policy, and the new president needs to recognize how important this issue is,” said Mr. Eastman, who is a former HIV/AIDS Commissioner for Los Angeles County and a long time advocate for medical cannabis patients’ rights.

The federal government does not recognize the validity of the state medical cannabis laws, which allow patients in California, Washington, Oregon, New Mexico, Colorado, Arizona, Rhode Island, Maine, Nevada, Vermont, Maryland, and Alaska to use the drug, in spite of federal law. Patients and providers in California and other states have come under increasing federal pressure since January 2007, when the Drug Enforcement Administration (DEA) escalated enforcement of federal laws in states where it is legal. The escalation has generated opposition from the California State Legislature, which will vote on a resolution calling for and end to DEA raids this year (SJR 20), and in Congress, where US House Judiciary Committee Chairman John Conyers has criticized DEA tactics and called for an investigation.

The coalition of medical marijuana patients and supporters is organized under the name “Democrats for Safe Access,” and will march at 1:15 PM on Thursday, August 28, beginning at the parade staging area at Bannock Street between 14th Ave. and Colfax Ave., adjacent to Civic Center Park. Organizers caution attendees that parking will be scarce and encourage marchers to take public transportation.

Eastman will announce speakers and additional event information soon. For additional information about Democrats for Safe Access or the medical cannabis march, call Richard Eastman at (323) 474-4602 or visit www.AmericansForSafeAccess.org/DNC2008