Walking down Market St. yesterday and saw this sign. Somehow the cheery lettering and the Giants colors don’t make the sentiment any less dehumanizing.

I just came across this video essay by Kol Marshall, depicting mugshots of women who were arrested for prostitution in the forties. Several of the women have black eyes, all of them look like they have suffered from frequent physical abuse. What really struck me was how easily I could imagine the images of many of the women I work with slipped in to the rotation.

People like to use the fact that many street prostitutes are in abusive situations as a reason for why prostitution should be illegal. The problem is that it is that very illegality that makes their lives so dangerous. How can a woman go to the cops for help if she is afraid she will be arrested? None of the women I know would- they tell me the cops wouldn’t help them anyways. Trust me, the Johns know this.

Apparently, she thinks it’s better to use scare tactics to reduce disease transmission than to provide people with all of the information and let them make well informed decisions. Of course she isn’t remotely alone in this opinion; I remember clearly most of my childhood being filled with the red ribbons of Nancy Reagan’s “Just Say No” campaign. I also remember people wearing those t-shirts in high school while smoking pot.

It is probably (certainly?) true that there is a population of people on whom the assertion that any and all drug use will lead to a life of absolute despair and chaos, will be a convincing deterrent to experimentation, but that leaves out everyone who knows someone that gets high every now and again. I fall into the latter category and remember when I was told about how people are more dangerous when they get high, thinking about adults in my life sitting around laughing and upbeat while passing a joint. As a child I was very sensitive to incongruities, and had a strong radar for bull shit. This led to my throwing the baby out with the bathwater; if they had lied about the risks of marijuana, they were probably lying about everything else too.

As an adult I know that there are risks associated with marijuana use, but they are different to what I was told in 3rd grade. The effects on memory seem more important as I get older and try to cram more and more information in my head; the effects on motivation become apparent as I look at some of my more dedicated stoner friends. However, I am still at a loss at how these are more deleterious to society than say, chronic TV watching, or much more obviously, alcohol.

They say the pot is a gateway drug, and I think this may be true in more than one way. When you are told that something that isn’t very dangerous is very dangerous, you begin to question all assertions of danger. In other words, if they lied about pot, they probably lied about everything else. This is unfortunate because all risks are not created equal, but lumping all illicit drugs together can give the impression that they are.

After experimenting with drugs as a teenager I had found that most risks had been immensely overblown, but was disconcerted to find that there were real risks, and these had been overshadowed by threats of death, derangement, and homicidal tendencies. I began to wish that I had been given more accurate information about the effects and risks of drug use.  Like the subtle effects they can have on your emotional and mental health. Or the very real effects they can have on developing brains. I’m not saying that these facts weren’t shared, they were just lost in the cascade of horrors surrounding drug use that were imparted to me throughout my childhood and adolescence. Luckily, with or without accurate information I survived the recreational drug use of my teenage years to become an upstanding adult. However, I am left with the impression that the Just Say No campaign probably did more to encourage my drug use than to deter it.

But what does this have to do with condoms? Good question. For years, people in the health education community have presented an all or none dichotomy for sexual safety. Recently, as harm reduction has bled over from drug safety into sex safety, we have seen some softening of these lines, but apparently my teacher isn’t up on the cutting edge. The truth is, not all sexual behavior carries the same risk, and by telling people they have to use condoms for vaginal, oral, and anal sex in order to protect themselves from HIV, there will be some people who feel that since they can’t or wont reach perfect condom use, that they may as well not try.

With HIV education condom use has increased, and that is fantastic. I absolutely support condom use, and encourage anyone who wants to obtain the greatest amount of protection to use barriers for all sexual behavior. However, condom use still isn’t even close to a hundred percent, even among very sex-educated people who are incredibly aware of the risks. The thing is, until they invent a barrier that doesn’t interfere with sensation or comfort of sex in any way, that is going to be the case. But all is not lost! There are, in fact, ways to mitigate the risks of disease transmission without using barriers a hundred percent of the time.

It’s hard for me to keep in mind that spreading researched information is a radical act. But I know that any deviation from abstinence, or consistent condom use admonitions, is indeed thought of as reckless, and endangering lives. Understanding that, I am going to slog on, because I believe providing all the information, and asking people to make well thought out decisions, is our best chance at curbing disease progression and unwanted pregnancies.

People are terrified of HIV. It is an easy disease to use as a scare tactic, it’s the boogie man of our generation, but to put some perspective on its lack of virulence consider this: the risk of becoming infected from a needle stick from a used needle that was known to be contaminated from an HIV positive patient is 0.3 percent according to the CDC. Contrast this to the same needle being infected with hepatitis B and your risk rises to 30 percent. When I shared this statistic with a classmate he responded, “Yah, but I’m not going to go around sticking myself with HIV infected needles.” And for anyone reading this, I ask that you take his advice, please do not go around looking for dirty needles to play with. People HAVE been infected from accidental needle sticks, and as someone going into the health care industry Universal Precautions are very important to me. However, I think that it is useful to realize that there are more dangerous risks that we take everyday that people don’t think twice about. In 2007, 52,306 people died of pneumonia, 123,706 people died in accidents, and about 393,600 people die a year because they smoke cigarettes. The CDC estimates about 37,991 people were infected with HIV in 2008. Deaths from AIDS is harder to assess, since people infected with HIV die from a variety of opportunistic infections, but the CDC estimates in 2007, 18,089 people died who had been diagnosed with HIV. Perhaps the most important statistic is this, of the people infected with HIV in 2008, only 13,180 were infected through heterosexual contact, that’s a little more than half of the number of men who got it from having sex with other men. This is an even bigger difference if you consider that the vast majority of sex that is being had in the United States is heterosexual. So what’s going on?

Simply put: your risk of catching HIV during receptive vaginal intercourse is about 0.1%, while the risk during receptive anal intercourse is about 3%, which is about 30 times higher (insertive anal and vaginal sex are about 0.1% as well). Of course these are just averages, there are different factors involved in each sexual event, confection with another STD can increase risk, as can any irritation or tiny tears that may develop. Going back to the very beginning of this rant I mentioned that different geographic areas had strains of HIV that “preferred” different routes of transmission, this is one of the factors of why HIV has spread so much more quickly in some areas of the world. A good explanation of this can be found here. This means that if I was practicing health care in another area, such as Africa, these statistics would be different and risk assessment around condom use would involve much more emphasis on vaginal intercourse.

So, of course I am saying that people should stop using condoms for vaginal intercourse in the US. Somehow I’m guessing that is what many people reading this are going to accuse me of, so let me address right now why I would never say that. First of all, there is still some risk of transmitting HIV, and it’s an avoidable risk, so why not protect yourself? Secondly, there are plenty of other STDs that transmit quite well through vaginal sex, and thirdly condoms are a great way to prevent pregnancy.

What am I saying? That women should know that not all sexual acts carry the same risk for contracting HIV. The risks for oral sex are negligible, the risk for vaginal sex are real, but fairly low, and the risks for anal sex are relatively high.  So for a girl who finds that she is very often not using condoms, even though she has the best of intentions, in addition to helping her find ways to increase condom use I would tell her that it is extra super important to always use a condom during anal sex. And that some condom use is better than no condom use, because every additional exposure increases the risk of transmission.

I read The Fountain Head in high school. I was a huge fan, the characters were awesome, and I was impressionable. There was a moment when I realized that if the story was told from a different point of view, a man whose inflated ego causes him to blow up a public housing project would be considered a selfish jerk. But in high school exotic romances where people make grandiose gestures for their principles seemed really exciting. When I went to college and studied philosophy, Ayn Rand came up again, but this time her philosophy wasn’t shrouded in sexy rape scenes. When you took her philosophy to its extreme it became immoral to save someone who was drowning because it denied their agency. I began affectionately referring to Ms. Rand as the Selfish Bitch. What I didn’t realize at the time was that Ayn Rand was more than a flash in the pan extremist philosopher, she was, and still is, shaping our country and its policies.

Ever wonder why the same people who say they are cutting welfare and other social programs to balance the budget also do things like lower taxes? It seems like a group who wanted to balance the budget would do whatever they could to increase incoming revenue as well as reducing expenses, but that’s not what we see at all. Actually, there are many people who believe that the rich are rich because they deserve to be rich; they are actually better than those who are poor. This is described well in this article in Newsweek. This isn’t new at all, it is, in fact, the same philosophy that reigned through the middle ages and much of humanity’s past. Resources go to those who deserve them. The rich keep getting richer because they are better people. Because they work harder. Because they are smarter. Because they are more clever. Not because the system is set up to keep their money and more flowing back to them. Not because being born into a good family with good schooling and good connections props you up for success. No, that obviously means nothing because a few people have risen out of poverty to become successful. You know, people like Ayn Rand.

I am currently in nursing school at City College of San Francisco. Community colleges are supposed to be one of the ways that poorer people can get a cheap education so they can reach down, grab their bootstraps, and yank themselves into the American dream. I love my program, I have good teachers and I feel that I am receiving an excellent education. But this education is contingent on getting clinical experience within hospitals so that we can become prepared and certified nurses. The problem is that CCSF is always having to fight for clinical spots in hospitals because the hospitals want to give first choice to the more prestigious schools, especially the private schools, who are willing to pay for the spaces. Currently they have not found spots for us next semester for our Psych and OBGYN rotations. We assume they will, because they always do, but it is looking likely that we may have to travel farther to get to the sites. This is particularly hard on students at a community college who are more likely to be working or have kids, and therefore have less time and resources to travel around the Bay Area. Once we graduate, applicants from four year schools will be chosen ahead of us. Our bootstraps keep getting farther away.

I was raised lower middle class, but I’ve had a lot going for me that isn’t readily apparent. Most of my friends’ families had more money so I grew up comfortable around people of means; I learned to speak their language. I was lucky enough to be born white, attractive and smart. I did nothing to earn these things; I didn’t work for them, they were genetic gifts. Yet they made my bootstraps all the more reachable. Still, even with these gifts I have to deal with figuring out how to climb the ladders on my own. I have to deal with discrimination around what school I went to, health problems that I have to tackle without insurance, and paying bills while trying to get enough extracurricular activities to make myself stand out. Everything is stacked against the person who is not born into a privileged class. Yet somehow this isn’t enough. They want more. They are upset that there are programs available to keep people from starving. To help them pay for school. To make sure they don’t die from preventable diseases.

The thing that makes me laugh is that people don’t seem to realize what happens when more and more people get desperate. Do you think they are just going to sit (oops, I mean stand) on the street and starve to death? Some will, but many wont. Crime will increase, people will become radicalized. Things will happen. Things that will make the people on the top very nervous. Social programs are good for everyone. I promise.

If I could just... Pull a little harder...

Yesterday I went out with the folks with the Care Through Touch Institute to wash and massage the feet of people at St. Anthony’s and other homeless outreach centers. One of my clients told me he treated his feet so badly that one day they were going to walk out on him. Yep, I responded, one day you’ll wake up and there will just be a note where your feet used to be. Yeah, he said, a footnote. I almost fell on the floor laughing. Everyone expressed intense gratitude, but some people were confused, just like some of my friends are- why do this, why take care of people’s feet, the place they walk on that end up smelly and rough? There are a lot of answers, on Maundy Thursday it’s to honor Jesus’ example of washing his disciples feet to show we are never above taking care of each other, which I think is rad. But today my answer is- because they need to be rubbed. Symbolism aside, these folks have aching feet, many of them walk miles everyday (thanks to the sit/lie law if they stop to rest they’re asked to move on) in shoes that are often ill fitting and socks that need to be washed. They are more likely to have diabetes, a disease that can cause problems of the peripheral circulation, and can lead to amputated toes or feet.  Foot care becomes even harder for people to do as they get older and can’t reach their feet as well. Furthermore caring touch can reconnect people to each other and allow us to become invested in our shared well being.  This is why I think this organization is so amazing. The people of the Tenderloin know Mary Ann (the directer whom I mentioned in the last post), and many credit her with making a significant impact in their lives.

After the massages we reconvened and talked about our experiences. Mary Ann shared something with us that she had been told by Mother Theresa (yep, she’s such a badass do-gooder that she hung out with Mother Theresa), and that was that she wanted us to allow our clients to “eat us up”. That is, give of ourselves generously, to the point we were pulled out of our comfort zones. This is exactly what every organization, and most people, tell you not to do. She told us to push our boundaries, not to guard too closely against burnout, work when we are tired, spend more than we have, Be Uncomfortable. And have a little faith that we will get enough in return to keep going.

This was something I knew, but had let the self-care ethos make me question. Please don’t get me wrong, having no boundaries will make you a danger to yourself and your coworkers. But opening yourself up to caring deeply about the people you help will turn work into acts of love, and sometimes that sort of connection is more important than the action itself.

Care Through Touch Volunteers

Philosophy is the backbone to my actions. What keeps me going is believing that interpersonal interactions make up a life. So that if my work just involves one on one moments, that’s okay, even if what I do is insignificant in the grand scheme of need, lives are still improved. I have no numbers for the City to ask for grants or prove my worth (though my program does collect those sorts of data), but I know that a woman asks for me by name now when I can’t go out because I bothered to visit her at the hospital once. I know the boyfriends and husbands are happy that there are folks who look out for their women’s needs, like socks and soap. The women show us pictures of their children, they tell us about their illnesses, how long they’ve stayed clean, and how frustrated they are when they can’t.

I don’t know how much growing up Christian has affected what I do. I assume growing up with stories about a God who came to live on earth to hang out with poor people and prostitutes must have been some inspiration to a girl who chooses to do the same. I don’t come with the same message though. I never ask anyone to stop sinning, or become someone new. All I really want from my clients is to make safer decisions: use clean needles, condoms, buddy systems. And I want for them to have the resources available when/if they decide they want to change their lives.

I also want something else for them, and it’s the same thing I want for myself. It goes back to that second question- What makes a life worth living? Little moments of happiness and peace. This is even harder to record in numbers, and I suspect that it’s something that a lot of my clients have stopped thinking about in reference to themselves. Lately I’ve been wondering how that goal can be brought into outreach work. As a volunteer, the longer I work and the more I get to know my clients, the more joy and happiness I get. I hope the women feel the same, I want them to know that we aren’t there because we feel sorry for them, or because we have to be, but that knowing them makes the rest of our lives better.

Tomorrow I’m going to get to connect with some folks in a different way. I’m volunteering with Mary Ann Finch of Care Through Touch to celebrate Maundy Thursday by washing and massaging homeless people’s feet in the Tenderloin. I participated last year and one of my clients was an 82 year old man getting his very first foot massage. It was a really tender experience, and working with Mary Ann is always inspirational. Her goal is to give people love and caring through gentle touch, and she provides free massage every Thursday for the women at The Mission Neighborhood Resource Center for Ladies Night.

I’m looking forward to doing some work where the only purpose is to provide people some pleasure or relief. Basic needs are crucial, but Joy is nice too.

Patriotism and Beer

I am sitting in church and I can see the American flag fluttering over the Anchor Steam brewery through a narrow window. I have been thinking a lot about America lately, and it all seems so symbolic, but then, I guess that’s what church is for. “Out of many- one” keeps waving through my head, and the priest tells us that We are exactly what God wanted; that when God was creating the universe, we were what He had in mind, imperfections and all. There are so many Us, so very many views and plans of action. How on earth can we expect to get along? To get anything done? How can We be exactly what anyone wanted?

I have been trying hard to relate to my fellow Americans, especially my fellow Christian Americans. Most of the time I’m pretty sure there is no overlap between our shared beliefs. Nothing to share at all, really. But I can’t write off so many of my kin; I’m a humanist at heart and I desire to feel a connection, to understand where people are coming from. Why people say abortion is wrong, but seek to defund birth control. Say every life is precious, but vote to defund programs that ensure these children will be born healthy and have food to eat. I wonder, what kinds of lives are considered acceptable as long as every conception pans out?

As a bleeding heart liberal I am told I’m idealistic, but I’m not suggesting we base policy on the assumption that people are going to stop having sex and doing drugs. Am I really the naive one here?

I recently had a long conversation with a friend about The Great Abortion Debate. I was pondering why fetuses are the most well loved of minority groups. How can the same people who support them not support social programs? Why are fetuses more exciting than the people we already know? He told me they were innocent, which I promptly disagreed with, Amorality is not the same as Innocence. He clarified, “They are blameless.” He went on to assert that much of what Conservatives talked about could be related back to the concept of blame. I mulled this over, it seemed fitting, but too simple.

This past week I’ve thought a lot about the concept of blame and how it fits into the Conservative framework, and I’ve found that, correct or not, it explains a lot for me. I’ve renamed The Blame Theory, The Fairness Framework, because I think that gets closer to the heart and doesn’t sound as condescending. One of the things it explains for me is why I find Conservative opinions so utterly baffling; I don’t believe that life is fair, and I don’t believe it’s even something to aim for, so if someone’s philosophy was based on a desire for fairness it would make sense I would find it nonsensical.

I find this incredibly comforting. More than wanting to change people’s minds (which I don’t hold a huge amount of hope for), I want to understand where they are coming from, I want to feel their humanity. When I cannot sense this I feel alienated, and the world seems like a scary and unpredictable place. I understand people wanting things to be fair. I don’t agree with it, and I don’t think it’s possible, but I get the desire, and that understanding is important to me. For me it is a way of healing the huge rift that I sense in our society.

I have a lot more to say on this, but I think that’s a nice place to end for now.

While looking through these handouts I was struck by how little these recommendations were relevant to where my clients are coming from. Most of the women I see rarely leave a two block area, live hand to mouth, and are dealing with daily stressors such as domestic violence and fear of cops. Advice such as picking healthier choices from the grocery store or signing up for a gym membership presupposes resources like money, and recommendations for taking time out to relieve stress by finding a quiet place alone, putting an icepack on your forehead, and listening to soothing music, presupposes resources like personal space, a freezer and a boom box. I imagine my ladies looking at these pamphlets and experiencing an increase in stress just by all the reminders of the things they don’t have.

This is not to say that I think that health education is a lost cause for the women I serve. In fact, I think one of the problems is that we assume that because they have more pressing concerns, that they don’t care about taking care of their health. Most of us have more pressing concerns than preventative health care measures, but many of us still try to alter some of our actions to protect ourselves of dying of heart failure in the future. The truth is that health care education is sorely lacking in these communities because the only time they see health care practitioners is when there is an emergency issue that forces them to the hospital. Those cases aren’t when most practitioners are advising to exercise thirty minutes a day and eat your veggies.

So I printed out the most helpful information and will be endeavoring to create patient education that applies to people engaged in survival living. A lot of harm reduction is based on preventing disease transmission, or devastating infections, but basic stuff like heart disease and diabetes is still a huge risk to these populations and ignoring this is just going to ensure they die of arterial disease instead of hepatitis. You know, like most of us.

However, this is not a task to be done alone, I know there are better minds than mine out there so don’t be too shy to throw in suggestions for this project in the comments. This can be anything from slogans, to issues I should include, or anything really! I’m also going to be looking for someone with art ability to help make goofy health-ed cartoons.

My friend sent me a link to this video today: Thank God for Dead Japanese Atheists. I’m a little reticent to send her more traffic, but why not support good satire? In case it gets removed I’ll tell you the gist: It’s a video about a girl who prayed for God to send Atheists a wake up call and she says that the earthquake in Japan was just this. She has a lot of videos to this effect, and I’m about a hundred percent certain she’s parodizing extremist Christian culture. Whether or not I’m correct however, doesn’t really matter for this post.

Right now she’s getting over a hundred comments a minute from people who find her opinion despicable. I was reading over them, relatively impressed she’s caused such furor, but I noticed a disturbing theme in the violent rhetoric directed towards her. Let’s see if you can find it:

“I lol’ed hard and then decided to punch my balls. This bitch is a fucking RETARD or a whorish troll. In any case I just want to choke her and bend her over and then oil a spiked baseball and rape that cunt over and over again, hell even the ER would facepalm and cut her pussy. SOMEONE KILL THIS BITCH NOW!”

“I want to throw her down and rape her. For fun.
I’m a woman.”

“You can get on your knees and suck my giant cock”

“Get down on your knees and pray to me, woman. I’ll even buy a strap on just so I can watch you choke on my fake dick.”

“Have you considered Weight Watchers? And plastic surgery? Because you’re gonna need it when us 84,000 viewers gonna come and rape you in the ass.”

“You are so ignorant!!!! Many people don’t have to die! For your stupid religion!! I hope a black guy rapes the shit out of you for your ignorance.”

“I hope some big black atheist takes her from behind”

“I hope You will be raped one day by a group of huge-cocked atheist, You psycho bitch ”

“Why don’t you pause the video, get on your knees and suck on a dick you self righteous bitch.”

“take your shirt off, bitch.”

“you damn fucking slut …. i am not even sorry for thinking that someone should please rip you the fuck apart”

“I hope God DIES! Along with you! DROWN in semen bitch!”

“You look cute and dumb, Can i please screw you so hard that you scream out gods name in vanity. …”

“what this bitch need is a good fuck….lol.. then she will be calling my dick god.. lol….”

“I cant contain my load come deep throat my cock and swallow my satanic cum bitch!”

“I’m agnostic and I respect all the religions.. but this went faaaaaaaaaaar away from the acceptable line. I HOPE YOU GET RAPED BY 9.000 PENIS.”

For every overt threat of rape, there are dozens more that just call her a whore or slut and wish her a violent death. This woman (actually, she looks more like a girl, really) describes praying for hateful things, and people respond by describing violent sexual acts they’d like to see performed on her. And I say people because evidently some of these commenters are women. Furthermore, other people are posting her name, phone number, and address and saying they hope she gets what’s coming to her. Wow, way to go mob. What’s worse, an intolerant Christian wishing death on thousands of people or the person who wants to rape her to teach her a lesson? Don’t answer that.

This sort of satire is hard for me, because it brings out and makes fun of the dark side of my religion, but I’m willing to take a bit of ribbing for all the problems that religion has caused. However, I’m not willing to stand by and have violent sexual rhetoric publicly posted about a woman because they don’t like her “beliefs”. We can’t accept this even if we do find what she is saying horrible; doing so only further grants that it is okay to use sexual violence against women to keep them in their place.

Update: In case you think I’m wrong and you think that this lady is totally serious why don’t you teach her a lesson she wont soon forget by Donating to the Red Cross. Or text REDCROSS to 90999 to make a ten dollar donation with your cell phone. It seems more helpful to the Japanese than raping her.