Skip McClatchey on HIV & AIDS – Smart Sex, Smart Love

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This week, Joe’s guest is Skip McClatchey. Skip works for Wayne State University’s Adult HIV/AIDS program and is on the show to discuss how HIV stigma is unwarranted, and helps nobody. Skip began his HIV work as a volunteer with the Wellness project in Ferndale, Michigan, back in the early 90s during the peak rise of incidences.

“It’s not people that are problematic,” says Skip. “It’s the behaviors! HIV is a disease that anybody that has ever had unprotected sex is at risk for.” Skip believes HIV is very treatable, regardless of income or insurance status in Michigan. “Everybody needs to be tested. If infected, get treatment, if unaffected, prevention is available. Too many people equate sexuality with intimacy. I say, ‘safer sex’ not, ‘safe sex!’”

Speaker 1:

Welcome to smart sex, smart love. We’re talking about sex, goes beyond the taboos and talking about love goes beyond the honeymoon. I’m dr Joe Kort. Thanks for tuning in.

Speaker 1:

Hello and welcome to smart sex, smart love. I hope you’ve been enjoying my shows and are following me on Instagram. I really appreciate all my listeners and followers and I thank you for listening and tuning in every week and if you’re new to my show, thank you for joining us this week. My guest is skip McClatchy and we’ll be talking about HIV and AIDS. Skip started his work as a volunteer with the wellness project in Ferndale, Michigan in the early nineties his first job in HIV was with a community based organization called friends Alliance, which was a member based organization. We’re all members were either living with HIV or affected by HIV. Today skip works for Michigan’s Wayne state university, adult HIV AIDS program and believes HIV stigma is unwarranted and helps nobody. Welcome skip.

Speaker 2:

Thank you.

Speaker 1:

I really appreciate you coming on the show and talking about this. You know, even though, um, we have made so much progress, I still as a 57 year old man who went through the whole AIDS crisis in the, uh, 80s and 90s, it’s sends shivers through me. I still, it’s like, it’s yesterday. I remember being a kid or you know, a young man and, uh, waking up every day thinking this can’t be real. Like, you know, it’s like almost a surreal experience. Do you remember the same and I don’t know how old you are.

Speaker 2:

Yup. Yup. I am a 64 and um, yeah, I remember that and how scary it was. And uh, even once they started, uh, or I started working in the field, we were having funerals, two and three funerals a week of members from the organization that I was working at. And it was really, um, right, right around then is when they started the cocktail treatment and they realized that they needed three types of medication to start to control the virus. But for many people it was already too late. And, uh, to be living with that death all the time, it was, it was very depressing.

Speaker 1:

It was very, I remember, so I had, I was in college, right? So I had had hundreds of partners. Um, you know, we have research now that show gay men as I am, have more sex and more sexual hookups than straight when and women and lesbians. And because there’s more opportunity, there’s more availability. And I was a kid in a candy store in college. And so hundreds later I find out about HIV and AIDS and terrorized me. Back then you had to wait two weeks before you got your results. And I told no one, no one, not even the therapist I was seeing until I got my negative response. And I remember making a deal with the universe saying, if I’m negative, I will work at, and I worked at wellness for a while and help these men. And I remember how awful it was, the lesions, the, uh, weight loss, I mean, everything, it was just so awful.

Speaker 2:

Right, right. Yeah. They didn’t really know how to treat it effectively, so they just kept throwing more toxic medicine at the patients. And, uh, there was, um, more it, the side effects were terrible. You know, the AZT would cause wasting and you know, some people look like skeletons walking.

Speaker 1:

I know, I remember that too. And so then they have to get fillers and uh, just so much and that it wasn’t a true too that they had to put it in refrigerator and take it at a certain time. It was very [inaudible].

Speaker 2:

Um, well yeah. What does some of the medications needed to be refrigerated? Um, and when they first started with the cocktail treatments, some people were taking 60, 70 pills a day and for different regiments, some had to be on a, a full stomach, some had to be on an empty stomach. And just the management of the medication was a full time job. Plus the side effects were horrendous. There were some of the um, protease inhibitors when they came out. Some people would have 20 bouts of diarrhea a day until their body got used to that medicine. The medicine was so strong,

Speaker 1:

I didn’t,

Speaker 2:

how do you live a life? How do you go to work? How do you take a bus somewhere if you don’t know when you’re going to have your next bout of diarrhea.

Speaker 1:

I know. And there’s all these men that were, um, all around us, uh, dying. And I didn’t know until most recently that this was primarily, uh, impacting at first African American males, but they never showed that on TV. They only showed white males. Did you know that?

Speaker 2:

Um, yeah, but I think actually the beginning, it was mostly in the white community, a white gay community. Uh, in fact, the before AIDS they called it grid or gay related infectious disease.

Speaker 1:

That’s right. I remember that.

Speaker 2:

Yeah. And um, there was, well there was at one time they called it the four H club. There was homosexual haemophiliacs heroin users and Haitians, the most, uh, infected, uh, populations. And, but you know, the reality and, and everybody likes to say, well, I’m not patient or I’m not this or I don’t use heroin anymore or whatever. But the reality is that all it takes is unprotected sex to put somebody at risk. And I personally don’t know anybody who has not had unprotected sex in their life. So everybody is really at, should be tested. Uh, if they’re infected here in Michigan, we have programs that can make sure everybody gets treated. And if you’re not infected and you continue to have risky behavior, there’s prep a preexposure prophylaxis so that if you were to take this medication, even if the virus got to your bloodstream, you would not be infected because the medicine would keep it from being able to make a copy for 28 days and then the virus would die off.

Speaker 1:

So, wait, let, let me pause there. Cause that’s really important. Most people believe it or not, and maybe you already know this, they don’t know that they, I teach and train therapists all around the country and I tell them about prep and they’re like, I don’t understand. They never heard of it. So what you’re saying, this is a medication that if you take it on a daily basis, prevents HIV transmission and aid transmission. And I think it’s 99%, isn’t that right?

Speaker 2:

Yes. Yes. Absolutely. Yep.

Speaker 1:

So you can remove, um, barrier protection. Uh, obviously you want to be careful cause you can get other STDs like gonorrhea, syphilis, those things, but you’re not going to get HIV

Speaker 2:

correct. Right. As long as you take the medicine correctly, you know, you’ve got to take it before you have the, uh, a risky behavior and then you have to continue to take it for the 28 days afterwards.

Speaker 1:

Okay. And most people just take it every day. Right. Like so that they can be at. Yeah. And then isn’t it true they have to be, um, they have to be tested every three months to make sure the meds are not harming the organs and that it’s working properly.

Speaker 2:

Correct. Um, and they’ve, they’ve come up with a, a second medication. The first medication they knew, uh, could affect the kidneys as well as bone density, but they’ve, they’ve improved that medication and now they’ve done the research to show that it will work as prep as well. And it doesn’t have the same side effects.

Speaker 1:

That’s great. Right. Because, um, and then isn’t it, I’ve also heard or read that there have been some Ciro conversions, in other words going from negative to positive while on prep, but it’s because when they did the blood work, the men weren’t taking the medication properly. It wasn’t the medication.

Speaker 2:

Correct. Yup.

Speaker 1:

And then I know I did a training in Boston and they told me there that uh, they do not allow, like they won’t even refill prescriptions. They require the men to be in the office every three months because of the dangerous to the kidney because that’s where it meant metabolizes. Right.

Speaker 2:

That’s where, I’m sorry, I didn’t hear the question.

Speaker 1:

That prep metabolizes in the kidney, right?

Speaker 2:

Yes.

Speaker 1:

Right. So they’re, you know, wanting to be careful about any organ damage so that if there is, then they can stop the medication and things returned to normal. Can you talk about, is there anything more you want to say about prep?

Speaker 2:

Well, if, if there were a problem, they could switch them to medication and uh, now they do have the one that does that have the same side effects. So I think that most people are starting them off on that and not even using the one with the side effects. They still, they still do the blood work, um, every three months. And you know, they just want to make sure all of this medication is strong medication and everybody’s body’s a little bit different. So they just want to make sure that no, nothing adverse is happening, you know, first do no harm.

Speaker 1:

Can you talk about, so then there’s also pep pep. Can you tell the listeners what that is?

Speaker 2:

Yes. So that’s postexposure prophylaxis and um, it’s two HIV medications that you take and you need to start it within 72 hours of, uh, the risk behavior of, um, so sometimes we use it with sexual assault people who don’t know the status of the person. Uh, but we’ve even done it with people that have just had an anonymous hookup and they didn’t use protection. And then we start them on the postexposure prophylaxis. Uh, the sooner you start, the better chance of it working is, and if it goes beyond 72 hours, if the virus was in the bloodstream, it would have already had that opportunity to replicate. And once it starts replicating, um, uh, the, the post six, the prophylaxis will not work. Um, so the goal is to keep it from being able to make a copy. Um, I don’t know if everybody knows exactly what HIV is. It’s, it’s a retro virus, which means it’s a cell that cannot make copies of itself. So in order to replicate it has to find a host cell and then Jackson’s RNA into that host cell. And then that cell becomes a factory to make other HIV cells. And every HIV cell may, that cell will go find another host cell and, um, create, turn that host cell into another HIV factory. So once that replication process starts, it can snowball very quickly.

Speaker 1:

I so appreciate how your mate, you’re laying this out. So, understandably, you know, cause I don’t think people do understand. But I also want to go back to pep for a minute because I know people get, uh, use alcohol, they use drugs. They may have a rape, a nonconsensual situation, or I’ve been having guys, young guys, millennials in my office say to me, I think the guy last night tried to pause me, I don’t know if you’ve heard this. And I’m, I’m like, at first I said, I thought I knew what it meant, but what do you, what does that mean? He pulled out, he took his condom off, he went back in and ejaculated inside of me, non consensually. And so those are the kind of cases where you want to get on pap within 72 hours in case you might, you know, have transmission.

Speaker 2:

Correct. Yep.

Speaker 1:

You know, so the people don’t think that’s just a gay thing. Other, it’s also called [inaudible] in the heterosexual community where men are pulling out, not telling women taking the condom off and going back in and ejaculates so it’s scary.

Speaker 2:

Yup. Yup. Yup. It’s very scary. Yeah. Um, so, but, but again, we’re lucky in the state of Michigan, we have programs that can cover everybody regardless of their insurance or income level. Um, we, you know, the medications can be very expensive. They can be like three to $5,000 a month. Wow. So we have programs that can cover them, but even if somebody has insurance and their prescription has a 20% copay, you know, a $5,000 medication is a thousand. What is a 20% is like $1,000 copay can. We’ve got programs so we’ll cover them so that they don’t have to pay that copay. We, uh, the Ryan White care act is in place to keep people, uh, from not going broke in getting this tree.

Speaker 1:

I like that. So you’re saying nobody’s left behind in Michigan? Everybody is able to access that?

Speaker 2:

Absolutely.

Speaker 1:

Yup. That’s great. And it’s a different state by state, is that right?

Speaker 2:

Correct. Each state, um, it’s federal money, but each state manages their own program. I, and we’re one of five States where everybody can get covered and we don’t just cover the HIV medication. That’s a, uh, a full formulary because we know that people that are HIV positive have other health issues and um, comorbidities. So we make sure our goal is to keep people as healthy as possible and living the highest quality of life. I work in the largest clinic in the state and we see 2300 patients a year.

Speaker 1:

Wow. So can you talk about the change, cause I think one of the, for me, I do judge this, that I feel like we went from prevention to harm reduction and we should have continued prevention. Uh, w you know, we would have those world AIDS. We have world AIDS days, but we would have big concerts and big pushes in the bars would have all these posters and signs and you just don’t see that anymore. What do you make of all that?

Speaker 2:

Well, um, too many of the public have seen that the treatment is effective. So they don’t think it’s such a big deal, but it is still a very big deal. And a newly infected people are just as stigmatized and stigma is just as high here. And that’s what keeps people from being tested. The stigma keeps them from being tested and, uh, getting treatment. And again, my ideas, anybody who’s ever had unprotected sex is at risk. So you should be tested. If you’re infected, we can get you the treatment without it, you know, breaking your, uh, your bank account. And, um, and now there’s a U equals U, which is if somebody is undetectable, if we get the virus controlled in somebody and they’re undetectable and they continued to take their medicine, they cannot transmit HIV sexually.

Speaker 1:

Right. That’s a really important thing. So you’re saying that in these treatments, prep treatments that, um, it can, uh, create a situation where you, the testing makes it undetectable. It’s still there, but it’s undetectable, right? Right. Yep. And just because it’s there doesn’t mean it’s transmittable because the medication has it, like you said, under control. So if you’re in a monogamous relationship, you can take off your barrier and not even have to be on prep and still be able to have, um, a non barrier sexual contact. Is that right?

Speaker 2:

Correct. Yes. Yup. Yup. So, um, and you know, again that we might be making assumptions, which we shouldn’t, that the person only has one sexual partner. The reality is, you know, too many people just equate sexuality with intimacy and that it really money’s up the water. You know. So here in our clinic we just talk about sexuality and uh, we understand that many people have more than one sexual partner and so we just want everybody to protect themselves,

Speaker 1:

right? And that we don’t say safe sex anymore. We say say first sex anymore. Right. Because I always tell people safe sex is when you masturbate, you’re not going to get any STI or STD through masturbation. That’s safe. But once you’re with a partner, you’re, you’re at bigger risk. Now what about people that say, I don’t think I need to be on prep because yeah, I have a lot of hookups, but I don’t do anal sex. I do everything else. I might even swallow a seaman, but I don’t, I don’t even know sex. What would you say to them?

Speaker 2:

They, they’re putting themselves at risk and it’s up to them how much risk they want to take. You know, somebody could, uh, just bite their cheek while they’re eating a hamburger or something, and that creates a route to the bloodstream. So if somebody ejaculated in their mouth, it can get right into the bloodstream.

Speaker 1:

That makes sense.

Speaker 2:

There’s also HIV can be found in pre-com even before somebody ejaculates. It’s usually not at a high enough, uh, level to, to infect somebody. But again, everybody’s different. You know, somebody’s living with, uh, or somebody might have another STD and they’re at a higher risk of becoming HIV positive because your immune system, it’s funny. The other infection and um, and then they’re at risk. So everybody’s at risk. Um, the reality is that they say that, uh, 20% of the infected people are unaware of their diagnosis and those 20% are responsible for 80% of the new infections each year.

Speaker 1:

Okay. That, that makes sense. Wow. What about the Corona virus and HIV? Have there been a talking a discussion about that? I know it’s pretty new.

Speaker 2:

Yeah, no, no, there’s, there’s, I haven’t heard anything cause you know, they, they don’t, they’re not working together. You know, I, I don’t think there’s enough information for anybody to make a, a correlation.

Speaker 1:

Right. That, that makes sense. What, what, what do you feel about this whole thing in the gay male community? Um, that you’re dirty right now? I know my clients have said when, when they re recognize they have transmitted and now are living with HIV that they feel dirty, but then it was all over the apps don’t be dirty, I’m clean, are you clean? And then there was that whole campaign, which I think was pretty successful to get rid of all that stigmatizing. Um, can you talk about that a little bit?

Speaker 2:

Yeah. It hasn’t been successful, especially here in the Midwest. I think maybe on the East coast and West coast it’s a little bit more successful, but the stigma is still as strong here and the Midwest as it, as it ever was. You know, I, I, we see new, newly infected people weekly and these young people are just as stigmatized as back in the early nineties when I first started working. And, you know, there’s just too much old admiss information, um, to get rid of this stigma.

Speaker 1:

And I think you’re, you’re, I like what you’re saying about the geographic geography because at Michigan is very conservative here. So even the gay men are almost heteronormative, you know, they’re, they don’t believe in open relayer relationships in Michigan. And, and the stigma against HIV is really bad. But then I have clients that land in Denver or, or they go to LA and they’re, and they have on their profile, I’m HIV positive or are you, uh, you know, undetectable and their phones light up on their grinder and Scruffs and there’s just much more acceptance outside of Michigan, like you’re saying, the East and West coast.

Speaker 2:

Yeah. Yeah. And you know, again, people don’t realize that somebody who’s HIV positive and is being treated effectively is probably safer to have unprotected sex with that person than it is to have unprotected sex with somebody who tested negative six months ago.

Speaker 1:

Yeah.

Speaker 2:

You know, because they, their virus is controlled. They’re taking their medication, they cannot transmit it sexually where the person who thinks they’re negative may have had however many, uh, contacts since the last time they tested negative and they don’t really know their status.

Speaker 1:

I’m sad to hear that even amongst the young guys, uh, there’s still stigma. I understand it in my generation because it was so traumatizing and so, you know, it really was like you were living in, I don’t know, a war zone really watching everybody die like that. And so, but the young people you’re saying are like in their twenties are stigmatizing each other.

Speaker 2:

Yeah. Unfortunately, the way the Detroit Wayne County area is one of the, has a highest infection rate, one of the 10 highest infection rates in the United States. Right.

Speaker 1:

Wow.

Speaker 2:

Which is going to bring some more money into the area to do more prevention work. But, um, prevention, you know, is, is funded at less than 10% of what the treatment, uh, is funded. Unfortunately, you know, the, it’s the old adage, pay me now or pay me later. They’re not putting enough money behind prevention.

Speaker 1:

Why do you think it’s so high here?

Speaker 2:

Uh, it’s, unfortunately, it’s a young gay men of color is, is a highest, uh, group that, that are being infected. And, you know, they’re, they’re young people. Um, they think it’s not a big deal to become HIV positive because right now the treatment really is much easier. You might only need to take one pill a day, uh, compared to when I started, people were taking six pills, 60 pills a day. I’m four different, uh, regiments. So, you know, the treatment has gotten much better. The medication is not as harsh. The side effects are not as bad so that people can go on with their life. But the young people take that and they translate it into most amount, a big deal. I don’t have to worry about it. Uh, there, I’ve even heard some people, some young people say, well, it’s a Rite of passage for gay, young gay men that you’re going to become HIV positive. And once you become it, you don’t have to worry about it anymore, which is very sad. You know, it’s, it’s like I’m informed, um, uh, thinking, you know, it’s, it’s just, uh, a policy thinking process, but young people think they’re going to live forever, so they’re not, they’re not so worried about it

Speaker 1:

crazy.

Speaker 2:

You know, once those hormones start raging and they, they learn what makes them happy, it’s like they’re often running, you know, again, the stigma around, um, a gay man, it’s like you, many of them only feel good about themselves when they’re having sex with another man. And, and that’s, that kind of leads to some of, uh, the, uh, the behavior that that puts them in jeopardy.

Speaker 1:

I don’t think we can have this conversation without us addressing at least the bug chasers and gift givers. Uh, I just had a student of mine in her doctorate program do a research paper on this. Um, do you know a lot about it? Do you understand it?

Speaker 2:

Yeah. Um, I haven’t heard of too much recently, but I know for a while, um, again, that Rite of passage, people thought that once I’d become HIV positive, then I don’t have to worry about it. So they would go to parties with known HIV positive people and they would take, uh, you know, whatever their ecstasy or their kind of sexual enhancing, um, uh, drugs and they would have sex with as many people as they can so that they would become HIV positive. So those were the, uh, the bug chasers and they called the people who were positive and having unprotected sex. The gift givers,

Speaker 1:

why would somebody want to be infected that you, what have they told you? What do you know about that?

Speaker 2:

Because then they don’t have to worry about protecting themselves anymore.

Speaker 1:

Okay. So they may have a little obsessive compulsive disorder or anxiety. So if they have it and they just take a pill, then they don’t have to worry about it. Right. I’ve also, yeah, and her research, cause I always thought of it, now this is anecdotal, but my experience was, is it a way of self harm, like unresolved internalized homophobia. So it’s like cutting, like, like putting your body purposely moving it toward death could, could be like a self harm kind of a thing. Have you ever thought of that?

Speaker 2:

Um, I have, I haven’t heard anybody say that. Um, they say that it’s a relief once you get the diagnosis.

Speaker 1:

Yeah. I also know that some men will say, and this was in her paper, they feel disenfranchised from the gay community. So having, uh, the, uh, living with HIV gives them a community. They feel like they have a brotherhood.

Speaker 2:

Yup. Yup. You know what it was even in, uh, some of the homeless population, they realize that HIV services are highly funded. So there were homeless people that wanted to become HIV positive so they could get help with housing and food and clothing and things like this. And, and that, that, there was sad to hear that, but that’s what was going on. When I worked at friends Alliance. Um, there was, um, uh, a soup kitchen in part of the building that we were working in. And um, so we would talk to some of the homeless people and some of the homeless HIV infected people. And that’s, that’s what we were hearing was, uh, the talk, you know, if you become HIV positive, you can get food, you can get clothing, they’ll get you housing. Uh, mm.

Speaker 1:

So, well let me ask you this as we wrap up you, we started the podcast today with you saying HIV stigma is unwarranted and helps nobody. So where do we go from here?

Speaker 2:

Uh, we just, we, I think we need to treat everybody like we would want to be treated. And um, the reality is that it’s not people that are, uh, that are problematic. It’s the behavior. So you know, the stigma about people being dirty if they’re HIV positive or clean, if they think they’re not HIV positive has nothing to do with the reality. It’s the behavior, the sexual behavior. If you’re transmitting fluids, you’re putting yourself at risk. When I test somebody negative, I tell them, just assume that everybody you have sex with is positive and protect yourself. Just do not exchange fluids. It’s the behavior. It’s not the person, because they may not even know that they’re HIV positive, but if you protect yourself, then that’s the best way. And that was even before they had prep. Now we also offer prep right here in our clinic.

Speaker 1:

That’s so good.

Speaker 2:

And actually the, um, city of Detroit STD clinic, um, which is at Woodward and Canfield, they have funding, uh, to provide prep for everybody.

Speaker 1:

That’s so nice. So how can people get ahold of you, skip or get ahold of your organization if they need services?

Speaker 2:

Um, let’s say they, they can, uh, they can start with the, uh, uh, Nope, just, I, I can give out my, uh, work number. It’s, uh, uh, three, one three, uh, I’m drawing a blank. Uh, I’ve got up, let me see. Hi, I’m, I’m looking at the other numbers. So, uh, three one, three, nine, nine, three, eight, seven, zero three, and that will come right to my desk. Uh, and it’s a protected, uh, voicemail. Um, and uh, we can give you a direction for testing or getting treatment, or even if you just want education.

Speaker 1:

Thank you so much, skip. And if you’ve enjoyed this episode, please don’t forget to rate, review and subscribe and follow me on Instagram and Twitter at dr Joe court. That’s J. O E K O R. T till next week. Thanks for tuning in and goodbye. Thanks for listening to this episode of smart sex smart love. I’m dr Joel court and you can find me on Joe kort.com. That’s J O E K O R t.com. See you next time.

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